I got a question on my members’ Facebook page a couple of weeks ago regarding water retention. There is nothing worse than a bloated tummy – it can not only make you feel physically uncomfortable, but can also wreak havoc on your psychological state (as many people equate the bloating to ‘feeling fat’, despite there being no relationship between the two). Further, a bloated stomach impacts on your ability to move properly. We can’t engage our core muscles, so aren’t able to move, lift, push or pull in a way that is functionally optimal. This has important implications for our core strength and injury prevention. Of course water rentention affects more than just our stomach – a long haul flight to somewhere warm can turn anyone’s lean calves into kankles due to changes in the pressure in the capillaries, causing fluid to leak out into the body tissues. There can be many reasons for this, so I thought I would investigate the most common causes and possible solutions.
Minimize your sodium intake. Although sodium (aka salt) is an essential mineral because it’s used to regulate the fluid levels in body tissues, bringing water into the cells. Excess intake of sodium may cause excessive fluid retention in the body tissues. While the evidence behind this recommendation suggests it isn’t something that affects everyone, this may help some people, particularly those who are salt sensitive or hypertensive. Do note, though, that if you follow the types of principles that I suggest, your diet is probably quite low in salt anyway, as most salt comes from processed foods (around 70%). However, there are whole foods that are high in sodium, such as cheese, miso, cured meats and biltong, so you could reduce these, and avoid adding salt to your food to see if this makes a difference.
I probably don’t need to tell you to avoid eating too many refined carbohydrates – these tend to spike insulin, which causes sodium (often found in these foods) to be re-absorbed back into the kidneys, thus increasing water retention. Your best bet for carbohydrate foods are those whole-food, minimally refined varieties that have negligible sodium for a start, and that you eat in a mixed meal with good fats and proteins to help slow down the release of carbohydrate into your bloodstream, minimising insulin response.
Any form of dehydration can cause your body to hold onto water. Therefore, ensure that if you drink alcohol, do extended exercise training sessions, or are in a hotter environment that you remain well hydrated to offset any potential for dehydration. The fluid you lose during exercise should be replaced in the three hours after training, and at 1.5 times the amount lost – you can work out how much this is by weighing yourself before and after an exercise session. The amount of weight lost roughly equates to the amount of fluid lost. Prior to drinking alcohol, have a couple of glasses of water (this will also help slow down your drinking). And be an adult about how you drink: is it necessary to drink more than a few in any one sitting?
Take adequate amounts of vitamin B6 combined with magnesium. For women, prior to your period you can feel a little bloated and that you are retaining water. Interestingly, however, some research investigating the timing of this around the menstrual cycle has found bloating occurs more in the onset of your cycle (day 1) after which is rapidly declines, despite the perception of puffiness or bloating in the week prior to menstruation. This puffiness, however, could well be related to food choices in that week, as the intake of higher sugar choices can increase for some.
If you have water retention before your period, you may, however, benefit from taking both a magnesium supplement (at 250mg per day) combined with a vitamin B6 supplement (40mg) daily – a study found this combination the most effective for decreasing premenstrual symptoms when administered for two months by balancing your hormone levels.
Potassium works in conjunction with sodium, pumping fluid out of the body cells. Therefore, if you aren’t consuming enough then it could cause problems with water retention. The reality is, though, that you are following the meal plan and including plenty of vegetables, your potassium intake is likely fine. However, if you don’t have a good intake of vegetables (at least 7 serves per day) then increasing these is a good idea. This will also bump up your fibre intake, which can further help reduce fluid retention.
Take natural diuretics. Dandelion root has long been used to help flush water out of the body – therefore investing in a good tea such as this Golden Fields one is not only delicious (often used as a substitute to coffee), it will also be beneficial. In addition, this kidney cleanse tea from Artemis has other natural diuretics to help flush water out.
Exercise regularly. Exercise can help reduce water retention, not just by increasing sweating, but by moving water from the intercellular compartments to the muscles.
Increase your caloric intake, if only for a day. I know – this one sounds weird, but a ground-breaking study in the 1950s called the Minnesota Experiment found something interesting mid-way through their study. The study followed men on a 1500 Calorie diet for 6 months, and subjected to hours of hard labour per day. Half way through the trial the men were allowed a celebration meal, effectively increasing their caloric intake to 2300 Calories. Following a night of getting up to go to the bathroom several times, the men were a few pounds lighter the following morning. Obviously, the weight lost was water weight – but why would this be the case? Potentially the long-term calorie deficit caused an increase in cortisol levels, and this increases water retention in the body. By increasing caloric load, the body reduced cortisol levels and this reduced water retention.
Reduce overall stress load. As we have just discovered, higher cortisol levels will increase water retention, therefore anything you can do to reduce stress is going to impact favourably on water loss. Let’s not forget the impact that high stress levels have on blood sugar levels, inflammation and fat gain (to name just three areas it impacts). While stress is a perception of a situation, and changing your mind-set is one of the best things you can do to lower stress levels, ensure you are getting adequate sleep, time in nature, time with loved ones and taking time just for yourself. These are going to help lower your cortisol levels and combat any stress-related water retention.
So… not a definitive list, but hopefully a few pointers to help you get to the bottom of your fluid retention issues and make some improvements. For more individual advice, don’t hesitate to contact me for a consultation or for online nutrition coaching. Further, if you’re in the Bay of Plenty, Queenstown, Nelson or Wellington regions, then I’m headed your way for an evening of ‘real food’ talk – click here to find out more information and to book tickets!
Are you back into the swing of things but your taste buds aren’t? It happens! Especially around this time of year where intake of sugar, alcohol and processed carbohydrates tends to be higher for most people, and while going cold turkey can be the best move, it’s sometimes easier said than done. The good news is that by reducing these foods, you’ll begin to lose the taste for them, and they’ll no longer hold the appeal that they had. For some though, completely removing them is a better idea – even small amounts can continue to drive the appetite for them. Regardless of which camp you fall into, here are some proven, some anecdotal, and some interesting ways to combat those cravings.
The basics: build your plate based around protein and fibre, with fat for satiety. Protein is well known to be the most satisfying nutrient, and along with fibre (also key for adding bulk and feeling full) will keep most people satisfied longer than either carbohydrate or fat. Any starchy or carbohydrate-based foods are best if they are minimally processed (such as potatoes, kumara, legumes, fruit) as these will provide more nutrient bang for your buck). How much of each? Protein-type foods (meat, fish, eggs, poultry) aim for 1-2 palm-sized portions. Starchy carbs (if included) at around a fist-sized amount. Fat? 1-2 thumb-sized amounts, depending on the type of protein portion you’re eating: a fattier cut might be satisfying enough, however a lean chicken breast will likely require some added fat to help satisfy you. And vegetables? Go for gold – other than the starchier varieties (mentioned above) you could fill your boots with these. For some people, having a full plate is essential to feeling satisfied and if you can do that by adding more volume, it is going to have a positive effect on the satiety from a meal (that’s definitely me). For some ideas, check out my recipe e-book or my online coaching service.
Get rid of anything that is ‘your poison’- if you are the person that hears the icecream calling you from the freezer, it is much better off out of the house. Out of sight, out of mind.
Put all the ‘treat’ type food in one place in your house, preferably above eye level. This will save you seeing the Christmas cake when you are grabbing the eggs, and the chocolate almonds when you are searching for the bottle of olive oil. Constant reminders of all the things you are trying not to eat will NOT help your cause.
Chew your food properly at each meal. Aim for 30 times per mouthful. That way you’ll digest your nutrients effectively, feel more nourished and less likely to be hungry an hour after eating because you wolfed that meal down.
Do not substitute those refined sugars for ‘natural’ sugars. That dried fruit is pretty much just sugar – and (a few nutrients and fibre aside) no better than sugar and will continue to drive your sugar cravings. You shouldn’t rely on dried fruit (or any sweet food that is marketed as ‘refined sugar free’) as a substantial nutrient source . Any additional fibre or nutrients they provide in the diet is negligible compared to the whack of goodness you’ll get when you follow #1 above. When health bloggers or food producers market something based on the healthfulness of the ‘natural’ sugar, it is pure embellishment. 6 meedjol dates and a banana does not make a smoothie sugar free.
Coconut oil – this is a favourite of Sarah Wilson’s: a teaspoon of extra virgin coconut oil can kill a craving in its tracks. If we head to the literature to find any peer reviewed papers on the topic (for what it’s worth, there is a LOT of research published by the Coconut Research Center), there isn’t a lot to definitively tell us that it will cut cravings. That said, there is someresearch has found that people who include more coconut oil in their diet (compared to other types of fat) have reduced food intake overall, particularly in the subsequent meals. Like most things, you have nothing to lose by trying it.
Cocoa – chocolate is long associated with cravings, though right now, consumption of chocolate may well increase the cravings rather than stamp them out. It’s also not exactly useful if you’re trying to focus on reducing your intake of junk food! That said, chocolate is known for its cognitive and mood enhancing benefits. So how about some unsweetened cocoa (or cacao) in hot water with some milk to deliver the chocolate taste you are after. Add a touch of stevia if you wish. You could also do this cold with almond milk and ice – and add 1 tablespoon of psyllium husk or gelatin in there for some additional fibre or protein. If chocolate is what you’re after – go for the darkest that you can stand. Many people find they stop at 1-2 pieces of 90% chocolate instead of the 1-2 rows consumed of the 70%.
Anything that lowers your blood sugar response to a meal is going to positively impact your cravings. The steep rise and fall of your blood sugar in response to a meal causes alarm bells to start going off in your brain. The body runs a tight ship and prefers when all systems are in homeostasis. Low blood sugar causes a release in stress hormones which tell your liver to dump glucose into the bloodstream, and create cravings so you can re-establish blood sugar to within a normal range. Including cinnamon can reduces glucose response after a meal (in amounts of 6g) and affects insulin response. Stabilising blood sugar is going to help reduce cravings. Sprinkle this gold dust on your breakfast, with your teaspoon of coconut oil, in your cocoa drink etc.
Glutamine – can enhance secretion of GLP-1, a hormone which promotes insulin release that helps increase satiety and dampen appetite – this is only seen in some people however, suggesting there is individual variation of its effects. The flipside of this is that the insulin-releasing effects may override any satiety benefits, increasing hunger (and subsequent meal size) at the next meal. However, in practice this is a tool that many clinicians (myself included) have found useful for some (but not all) clients. The presence of glutamine in the bloodstream is associated with improved insulin sensitivity in healthy people. In addition to this, glutamine has been found to be beneficial for improving intestinal permeability and tight junction protein expression in the gut, being one of the most abundant amino acids in the body. If your cravings are related to gut dysbiosis then it could be useful from this perspective. In addition, it functions as part of neurotransmitter production. Taking L Glutamine by putting it under the tongue as a craving hits (1-3,000mg) may just work for you.
Magnesium is a nutrient that is involved in over 250 processes in our body, and particularly when we are under stress, it is put under the pump. Sugar (or specifically) chocolate craving is often linked to a deficiency to magnesium, but that isn’t conclusive. At any rate, magnesium is perfectly safe to take, and as our food supply is relatively low in magnesium, looking for a supplement that is a magnesium glycinate, citrate or chelated with amino acids may be useful, at amounts of around 300-400mg elemental magnesium.
Chromium is another supplement that some people have found useful for stopping cravings – research has found a reduction in carbohydrate cravings, food intake and an increase in satiety when supplementing with chromium…however this is in the laboratory using mice. There’s nothing definitive in the research to support using it for people who already have adequate amounts of this mineral. That said (as with anything), it’s individual – I know many clients who swear by using Chromium supplements when a craving hits. The only way to know if it works for you is to try it, by taking 1000mg chromium in two doses in meals that contain carbohydrate (due to its suggested benefits at reducing blood sugar response to carbohydrate meals)..
Branched chain amino acids (BCAAs) are three amino acids that act as nutrient signallers which may help reduce food intake . Leucine (one of the BCAAs) activates mammalian target of rapamycin (mTOR) which is required for our brain to respond to leptin (a hormone that tells our body when we have had enough food). BCAAs are involved with hormone release in both the gastrointestinal tract and in fat deposits. BCAAs and dietary protein enhanced glucagon like peptide-1 (GLP-1) release and reduced the expression of genes required for synthesis and adsorption of fatty acids in a human intestinal cell line (NCI-H716), suggesting an intestinal mechanism for the beneficial effect of BCAAs. Those that have successfully used BCAAs suggest 5g in the AM and every few hours while you’re adjusting your diet back to baseline awesomeness.
5htp: 300-500mg taken with a meal to increase satiety of the meal – studies have found a reduced food intake (particularly carbohydrate). Studies conducted have focused on people who have reduced availability of tryptophan in the brain (a precursor to 5htp). Increasing 5htp increases tryptophan and therefore serotonin production, reducing cravings and overall food intake. (Don’t use if you are currently on antidepressants without clearance from your doctor.)
Exercise. A no brainer, really, but research has found this to be super effective for reducing cravings. In fact, any activity done while in the midst of a craving will take your mind off it. So when a craving hits, doing something active for 10-15 minutes can reduce your desire for something sweet. Go for a powerwalk, shoot some hoops, do some hill sprints…
Make sure you’re getting enough sleep! It’s hard this time of year with longer days and opportunities to take advantage of summer (when it shows up…) Sleep restriction enhances activity in brain regions involved in reward in response to energy dense, nutrient-void food (think: lollies, chips, chocolate), suggesting heightened sensitivity to rewarding properties of food. This can lead to increased cravings. If you are burning the candle at both ends and not yet back to your regular 7-8 hours sleep per night, then nailing this will go a long way to helping curb that sugar demon.
Meditation: decentring – viewing your thoughts as separate from yourself – has been found to help reduce food cravings and want for unhealthy food items. Mindfulness practice is also useful for not only reduced cravings, but for reduced emotional eating, body image concerns. It doesn’t require a 90 minute class three times a week (though there’s nothing wrong with that!) Headspace, Calm or Buddhify are three smart phone applications which may help you get going and provide guided sessions of between 2-20 minutes long. It’s consistency and frequency that makes a difference (like any habit).
Clay modelling to reduce cravings: yep. Researchers found that visual imagery plays a key role in reducing craving. Participants who worked for 10 minutes constructing shapes from plastacine had reduced cravings for chocolate compared to people who were left to their own thoughts or who were given a written task.
Your gut bacteria can influence your cravings. There is indirect evidence for a connection between cravings and the type of bacteria lurking in your gut. For example, people who enjoy and crave chocolate have different microbial metabolites (i.e. bacteria by-products) in their urine than “chocolate indifferent” individuals, despite eating identical diets. In addition, gut bacteria can influence the production of our ‘feel good’ and motivation hormones (serotonin and dopamine), thereby influence food decision-making based on our mood. Finally treating mice with a probiotic reduced hunger-inducing hormones and food intake. Action points here? Yes, you could start with a probiotic, particularly when you’re in the thick of it all, as this will help ensure there are beneficial bacterial strains present in your gut. However, for ongoing gut health, the regular addition of probiotic and prebiotics through food will help you maintain a healthy gut microbiome. Therefore:
Include fermented vegetables into 1-2 meals daily, working up to 1-2 tablespoons at a time.
The addition of unsweetened yoghurt (dairy or coconut) as part of your everyday diet (as it contains beneficial bacteria).
Kombucha, at around 100-150ml per day (check the back of the label to ensure a lower sugar variety).
Water, milk or coconut kefir, start with around 100ml per day.
Raw apple cider vinegar in water – start with 1 tsp in a small amount of water, working up to 1 tablespoon. This will help stimulate stomach acid when taken prior to meals, helping you digest your food properly, and delaying gastric emptying, so your glucose response to the meal will be slower too.
Vegetables, in abundance, to include fibres that feed your gut bacteria.
(As a side note, any change to your gut environment can result in unintended (and unwanted) changes to your digestive tract! If you’re new to the fermented foods and/or probiotics, then start small and work your way up. If you end up spending way more time in the bathroom than you wanted, reduce back further. Consider yourself warned.)
You won’t need to do all of these – but I think #1-5, #14, #15, #16 and #18 would completely diminish that sugar demon so you can get back to feeling awesome.
Grab that cupcake and bin it immediately. Underneath something that will stop you from retrieving it later on. (PC: SamadiMD.com)
Want to minimise collateral damage when it comes to fat gain over the Christmas period? It happens! While I agree with sentiments around being relaxed and not stressing too much, sometimes people benefit from having structure around how to be more relaxed … as paradoxical as that might seem. Being relaxed means you’re less likely to view a disruption to your plan as a major catastrophe to your health goals – and we all know this makes you more likely to be successful in the long run. Further, sticking to a rigid diet can increase feelings of deprivation and increase dependence – these are not attributes that turn your nutrition plan into a lifestyle.
Despite this, many clients are not happy with advice to go with the flow and ‘do what you can’ – they are after guidelines to help them… have their (Christmas) cake and eat it too (so to speak). Is this possible? Well it could be. Here are some practical things you can put into place in the lead up to and days following an event like Christmas day to minimise fat gain and help you continue to progress. I’m not suggesting these will help you lose body fat, but more give you some strategies so you feel in control of your food intake, and not the other way around.
Treat the Christmas and New Year period as an opportunity to put into practice all of your healthy habits that you’ve developed, rather than an insurmountable challenge to healthy eating which can only be dealt with by pushing “pause” until January 2nd.
View Christmas day as a metabolic boost. Following a lower calorie diet can downregulate your metabolism – lower calories over a longer period can reduce active thyroid hormones, increase cortisol levels and increase ghrelin levels – all of which can shift the body into energy conservation and fat storage. Therefore, it stands to reason that periodic overfeeding may help reverse this, favourably influencing hormones (such as thyroid hormones and the appetite hormone leptin) and increased energy expenditure, sending signals to the brain that it doesn’t need to downregulate metabolism and stall fat loss.
Studies conducted to test the effects of exercising before or after a big meal show that exercising after a meal burned more energy, and more so than exercising beforehand. Low intensity exercise will also have an effect (compared to no exercise at all). Therefore, regardless of whether you go for a gentle walk on the beach or on Christmas day or a more vigorous game of backyard cricket, it is all beneficial. That said….
…if it’s not possible to do that, then any activity is better than none! Exercising prior to the meal to deplete muscle glycogen stores and activate proteins that help deliver glucose to the muscles will result in hormonal changes favourable for fat loss. The upshot of this? More calories used to restock and less hanging around to be stored as fat. Resistance training focusing on movements that recruit both big and small muscle groups (think squats, deadlifts, shoulder press and chin ups) or high intensity interval training are your best bet: time is money this time of year and you’re going to get more bang for your buck. Of course, if you’re an endurance athlete, then doing your long run or cycle will also suffice!
Take advantage of the ‘second meal effect’: the hormonal response to your Christmas dinner will be improved if the meal before was based around an abundance of non-starchy vegetables (fibre), good sources of protein and a lower overall glycaemic load. You know, the kind of meal you might normally eat. It’s easy to do this around this time of year: think barbeque meats and salads, an omelette filled with feta cheese, pumpkin and asparagus, or a quick chicken stirfry.
Psyllium husk. Research has found that around 20g psyllium husk (in water) 3 hours and immediately prior to a meal can have a gastric emptying and appetite reducing effect for the next 3-6 hours. While it’s tempting to think that this could be useful for long term caloric control and subsequent fat loss, there is no good evidence to support an effect on either of these. However if the additional fibre can make you feel less hungry and you’ll be less likely to eat as much then you’ve got nothing to lose by trying it, right? (And popping this into your breakfast meal or smoothie is an easy way to boost fibre intake and enhance that ‘second meal effect’).
Fill your Christmas dinner plate with protein, fat and vegetables first, then think about your starchy sweet options – again, super easy if your table is filled with lamb, turkey, ham, vegetables – and aim to finish these before contemplating the dessert table. Minimally processed foods are more filling and will produce a lower blood sugar response, and let’s face it: it’s a lot harder to overeat on the pavlova if you’ve filled your plate with foods that boost satiety. Added bonus: you’ll be less likely to fall into a food coma and more likely to have more energy for some after meal activity (see #2).
Chew your food properly. This is something you should do regardless, obviously, but it’s always good to be reminded of the basics. Not only will this help you digest the nutrients more effectively (minimising the amount of discomfort you might experience after a meal), a meta-analysis of studies looking at mastication (the scientific name for chewing. I know) found chewing your mouthful of food 40 times leads to changes in your gut hormones that favour an increased feeling of fullness and subsequent decrease in food intake later in the day. In addition, chewing is related to reduced stress hormones and increased alertness. These hormonal changes will change your hormonal and potentially your emotional response to food, and the increased cognitive functioning may help you make better decisions. Overall, this may help you feel relaxed about what you eat and less likely to overeat.
Have 3-5 bites of the delicious foods you have on the Christmas table. While you might think that you want to finish the Christmas pudding and the pavlova, chances are, if you’ve followed some of what I’ve suggested above, you’re not going to be that hungry anyway. Does this mean you should miss out? Of course not – however practically speaking, the level of satisfaction derived from higher fat and higher sugar foods is transient – the last bite is never as delicious as the first. I could also add here to choose between the Christmas pudding or the pavlova (as research shows an increased variety of food increases overall intake at a single meal) but I’m not convinced this is a good strategy at Christmas for some people! This could potentially lead you to feeling deprived – deprivation does no one any good at all. Instead, savour every bite of the food you want to be eating, and really enjoy it.
The day after Christmas? Get up and move around. Low level activity (and structured activity) is going to make you feel physically and psychologically better. And what of the food? My best advice for anyone looking for mitigate fat gain around Christmas is to not let Christmas day turn into Christmas week. So, clearly, I’d recommend NOT finishing the trifle off (sorry to be a Christmas leftover Grinch!) You are much better off having leftover cold meat, salads, perhaps some cold jersey benny potatoes (there are health benefits of these you know!) However, if you decide you want leftover trifle want to, then own it and don’t beat yourself up for it! Nutrition goals are not gained or lost in one meal or even four meals. Consistency is key, and it’s what you achieve over the course of the year that is most important, not what you don’t do over a few days.
Jump back into your usual routine ASAP – if you need help with this, head over to my website for the perfect solution to get you back on track.
Don’t weigh yourself if you’re tied to the number on the scales. Overeating will increase your carbohydrate stores and water stores, so you may naturally weigh more the next day and it can take a few days to return to baseline levels. For some, it might take a few days to Intellectually you know this, but it doesn’t change how you might feel about it. If the scales are your choice of measure, then wait at least four days before jumping back on them. That said…
Aim to maintain, not lose, over the next two or so weeks. This doesn’t counteract what I’ve suggested above, however if fat loss (and weight loss) is your goal, I honestly think that it’s easier on you to decide not to focus on that right now and remember it’s normal for there to be peaks and troughs. Feeling comfortable about this means you’re at a place where your attitude towards food is less about rapid weight loss (you may have been there, done that) and more about health. You can still have an overall goal of losing body fat with this mindset – and will likely be far more successful in the long run with it.
Obligatory Christmas-related body composition picture
I know what you’re thinking. She’s too young to be writing about perimenopause, right?! Actually, no. I might feel 24 years old, but it only takes being around younger age groups to remember I’m not! Despite the ‘M’ word being almost a taboo, unwanted phase of life that some women fear (and men too!) it is a natural part of our lifecycle. What isn’t natural are the symptoms associated with menopause. Like premenstrual symptoms, the discomfort experienced through perimenopause may be common, but it’s not normal. This was reaffirmed in my mind when I listened to a fabulous interview with Lara Briden (naturopath who works with women with hormone imbalances, based in Sydney and Christchurch). A wealth of information who had some great information around why we can experience symptoms and (importantly) what we can do about them.
Defined as 10 years before going through menopause, practitioners often view this as highly variable, with women from 35 years to 55 years in this perimenopausal state. The average time spent here is around 4 years. Though, as with any ‘average’ this might not reflect your experience!
All hormone levels change during perimenopause. There is first a decrease in progesterone, which changes the balance of progesterone to oestrogen (some describe this as ‘oestrogen dominance’, though not all practitioners like using this term). Testosterone also declines, and this is an important hormone for sex drive. Finally oestrogen drops – and while we will continue to produce oestrogen (as this occurs not only by the ovaries but by the liver, breasts, adrenal glands and by fat tissue, it is at amounts of around 30-60% lower.
Oestrogen is a major regulator of a number of processes in the body, and the sex hormones and our glucocorticoid hormones (the most ‘known’ one, cortisol) are controlled by the hypothalamus -the part of our brain who is also the controller of our sex hormone regulation – therefore it makes sense that a change in one will result in a change in all of them.
Decreased sense of wellbeing (research shows that extended periods of low oestrogen, fluctuating levels of oestrogen and sudden withdrawal of oestrogen – via surgery or stopping oral contraceptive pill – is affected with lower mood)
Some women are ABSOLUTELY FINE and sail through perimenopause. Generally, though, those that have been on the oral contraceptive pill are more likely to experience symptoms than those that haven’t. This may be due to the difference in the hormonal balance once the pill is removed. The pill provides large amounts of synthetic hormones, and it is a huge adjustment to go back to the normal (lower) levels of hormones. Approximately 147,000 women in New Zealand take the oral contraceptive pill, of which 80% of them are on a combined pill, delivering oestrogen and progesterone.
During perimenopause, women can have fluctuating oestrogen levels due to variable concentrations of FSH (released by our pituitary gland in response to a low oestrogen environment – it isn’t necessarily all low oestrogen. This could also be a result of an inability to detoxify and clear out oestrogen metabolites.
A well-functioning liver is required to remove oestrogen from our body and prevent build up and associated symptoms. Our liver packages up oestrogen metabolites and removes it through our detoxification pathways. We need our inbuilt antioxidants to be firing, along with certain nutrients (selenium, B vitamins and glycine (not present in large amounts in the standard diet) to do this.
Many women going into perimenopause are insulin resistant (oestrogen has an insulin-sensitising role in the body and influences glucose uptake) – this partially explains the increase in body fat (particularly around the middle) that many women experience as they progress through. This makes it harder for their body to metabolise and use carbohydrate effectively
Many women going into perimenopause have a low thyroid function due to age-related changes in thyroid physiology. These include a reduction of thyroid iodine uptake, synthesis of free thyroxine (FT4) and free triiodothyronine (FT3) and the conversion of FT4 to reverse triiodothyronine (rT3). TSH levels may be slightly elevated. Luteal-phase spotting, or lumpy breasts may indicate this.
Your gut? SUPER IMPORTANT!!! The oestrogen might get detoxified (packaged up ready for removal) via pathways in your liver only to be unpackaged (deconjugated) again by nasty gut bacteria which pushes it back out into the blood stream as more toxic forms of oestrogen.
These 11 points may or may not have been news to you – certainly probably not to those experiencing some of the symptoms, or who have dug a bit deeper to determine the cause of the symptoms. This wasn’t a post for you to sigh in resignation and decide there is nothing you can do. Yes these symptoms and health outcomes are common – but (as stated earlier) they are not normal. Like many things, we normalise a lot of health issues because so many people experience them. We just think they are an inevitable process in ageing and moving into a different phase of life. Certainly (I gotta say), some health professionals don’t suggest otherwise so it’s no surprise many are led to believe this.
Some awesome tips from Lara as to how to start the process of mitigating symptoms – some are great DIY ones that you can put into action immediately; others will likely require the help of a practitioner who has a solid understanding of how our hormones interact – this may be your open-minded doctor, which is excellent – or naturopath, nutritionist or dietitian.
Limit alcohol consumption – it impairs oestrogen clearance rates from the liver and may be one of the influencing factors in the relationship between alcohol and breast cancer risk
Limit or omit dairy –dairy can increase oestrogen in the body, increase insulin release and the A1 caesin in dairy is pro-inflammatory and increases gastrointestinal inflammation (which could then push inflammation out to rest of your body).
Reduce intake of carbohydrate if following a higher carbohydrate approach, and get rid of processed, refined foods and sugar.
Eat your brassicas: broccoli, Brussel sprouts, cauliflower, cabbage – all provide di-indolylmethane (DIM) which targets certain proteins in our body that help reduce inflammation and balance hormones (particularly detoxifying oestrogen). Supplementing with this is also really helpful, but only once you establish that oestrogen clearance is an issue for you – super unhelpful otherwise (a practitioner can help you find this out – and there is a test I’ve started using with clients called the D.U.T.C.H test which is able to measure each hormone and it’s metabolites in much more comprehensive detail than a blood test alone.
Ensure a healthy gut: bloating, excessive gas, cramps and diarrhoea or constipation are not the normal consequence of eating (though they are extremely common). Keep a food diary to establish what might be causing your digestive upset by connecting your symptoms to your food intake. Work with a health practitioner experienced in the ‘real food’ digestive health to help not only heal your gut, but seal it too.
Iodine: low dose supplementation can be extremely helpful in supporting the pathways associated with thyroid hormone production which in turn affects the sex hormone production pathways. Again, talking to a practitioner is a good idea to establish your own requirement. However, 150 micrograms per day (and having 2-3 brazil nuts to balance this with selenium) is a safe amount.
SLEEP. Hands down, the most often overlooked yet important restorative, nourishing thing you can do to support your hormone health.
Meditation. Journalling. Yoga. Diaphragmatic and full belly breathing. Slowing down. Yep – stress reduction.
Regardless of if you are pre, peri or post menopausal, I think there is some excellent information here that will be helpful for hormones in general actually, and if you are experiencing some of the unwanted (and unnecessary in most cases) symptoms of hormone balance, this may give you some pointers as to how to combat them. Definitely check out Lara’s site for accessible and informative hormone related content.
Gout is an auto-inflammatory disease caused by a disorder in purine metabolism and the resulted chronic elevation of blood (serum) uric acid (i.e., hyperuricemia)
Men have a higher risk of gout at a lower given blood level of uric acid, and at a lower age than women – generally 10 years earlier.
Women who go through early menopause, or have estrogen deficiency are at higher risk than women who progress through menopause at a normal age, due to oestrogen’s role in increasing uric acid excretion.
Insulin resistance increases risk of gout, as insulin reduces uric acid secretion. The relationship between insulin resistance and gout is more pronounced in women than in men.
There is a bi-directional relationship between high blood pressure and gout: ie if you have high blood pressure, your risk of gout goes up (independent of diuretic medication that is taken), and if you have gout, your risk of developing high blood pressure also increases. High blood pressure can result in damage to kidney and a reduction in uric acid excretion, and the inflammation associated with gout can stiffen and damage arterial walls, and reduces production of nitric oxide – which helps widen arteries.
Genetics play a role in determining risk associated with gout – and people with a particular genetic profile (such as those of European descent with the SNP sequence SLC2A9 as an example) have an increased risk, as do those with ABCG2 rs2231142. However, as with any genetic risk factor, lifestyle determines if these genes are switched on or off, so while this information could be useful (and more people are starting to find out their genetic profile and determine what it means for their health), it is your lifestyle habits predominately regulate overall risk
Triglycerides increase in the bloodstream when people overeat refined carbohydrate foods, and recent research suggests a reduction in serum uric acid occurs when triglycerides decrease.
Alcohol intake is associated with an increased risk of gout – beer more so than wine.
Overall fructose load in the diet is the only type of carbohydrate that is known to increase uric acid levels, potentially because when metabolised, it depletes phosphate and therefore doesn’t help produce ATP (energy) in the body and instead increases uric acid production. Fructose from processed food (and particularly sugary sweetened beverages) can elevate insulin levels and increase risk of insulin resistance. There may be a genetic element to this also, with people who have polymorphisms in SLCA9 and ABCG2 genes responding unfavourably to a load of fructose.
A large cross sectional survey found that people following a vegan diet had the highest serum uric acid concentrations compared to fish eaters, meat eaters and vegetarians, independent of smoking status or alcohol intake.
While seafood is often cautioned against for people who experience gout due to its purine content, a number of studies have failed to find a relationship between seafood intake and serum uric acid levels. Those that have found a relationship may not have adjusted for body mass index (BMI), which can confound the relationship as it did in this study. Indeed, those populations who are at greater risk today (such as Maori and Pacific among New Zealand population) enjoyed a traditional diet of predominantly seafood, vegetation, tubers and gout was non-existent.
What to do?
Look after your gut. Bacteroides caccae and Bacteroides xylanisolvens are increased, and Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted in the gut of people who experience gout, suggesting a strong correlation with the presence of gout. F prausnitzii is one of the most abundant bacterium in the gut of a healthy individual, helping produce short chain fatty acids butyrate, which is fuel for our gut bacteria, and the provision of B pseudocatenulatum improves markers of gut wall integrity. So these are pretty important! While this doesn’t necessarily mean that the provision of certain bacteria through probiotics will reduce gout attacks, it does suggest that inflammatory processes of the gut play a role in the presentation of gout and provides further evidence of the importance of a diverse population of bacteria in the gut for overall health.
Supplementing with 1500mg vitamin C reduces serum uric acid and its antioxidant functions may also help kidney function by reducing inflammation.
Like your coffee? You don’t have to go without if you have gout and in fact, 4-5 cups per day have found to decrease serum uric acid that isn’t seen with green or black tea, or total caffeine intake. Decaffeinated coffee has afforded similar benefits, leading investigators to suggest the phenol content (phytochemicals) might increase insulin sensitivity and decrease serum insulin, as discussed above insulin levels have a positive correlation with uric acid due to decreased renal excretion. Furthermore, xanthines, either in caffeine or in coffee itself, could inhibit xanthine oxidase – an enzyme that increases reactive oxygen species (and inflammation).
Magnesium intake is associated with a decreased serum uric acid level in males, and marginal intakes is associated with higher levels of markers in the body indicative of inflammation. Magnesium is low in soil which makes dietary sources of the micronutrient not as high as they once were, therefore supplementing with magnesium of 300-600mg/day (depending on bowel tolerance) is likely a good idea. (To be honest, I’m a big fan of magnesium supplementation for pretty much anyone male or female, given it’s a co-factor in over 300 processes in the body).
Tart cherry extract – not just useful for sleep – is found to reduce the prevalence of gout flare ups in cross sectional studies, potentially due to the presence of polyphenols including anthocyanins, and vitamin C found in the fruit, which have anti-inflammatory and antioxidant affects.
Anecdotally (as in, I didn’t find any study on pubmed to support this), baking soda is used to increase pH level of the blood (¼ teaspoon in water), thus making uric acid in the blood able to be excreted. If you know of any studies around this that I’ve missed, let me know!)
While a low purine diet is often recommended as a dietary prescription for people with gout, many purine-containing foods (such as seafood and vegetables) do not contribute to hyperuricemia or gout and may in fact be protective. The effects of red meat consumption on serum acid levels are arguably hard to disentangle from other elements of the modern dietary pattern, and are often in conjunction with higher alcohol intake, lower fruit and vegetable consumption and higher fast-food intake – all contributors to inflammation in the body. In addition, the agricultural practices of the cattle industry in countries such as the US where many of the epidemiological studies that associate red meat with poor health (including higher serum uric acid levels) include the use of antibiotics, poor farming practices and animals that are grain and not grass fed, altering the fatty acid profile of the meat to be higher in omega 6, pro-inflammatory fats. Furthermore, processed and fresh meat is often grouped together – thus a steak is viewed the same as a hamburger from a fast-food outlet – the latter often being in the company of a bun, fries, mayonnaise made with industrial seed oils and a sugar sweetened beverage – the adverse effects which many, myself included, argue cannot be adjusted away by a statistician when determining risk.
*I don’t think you need to start consuming low fat dairy if right now you’re enjoying the benefits of full-fat dairy in the context of an awesome diet. I think this could well be indicative of overall lifestyle patterns. I’d be surprised if there were studies showing that risk of gout is increased in a diet that is whole food, minimally processed, an abundance of vegetables that also incorporated full-fat dairy products.