Preventing post-natal nutrient depletion

Many women struggle with the after effects of childbirth and the overwhelm of having a little human who relies on them 24/7. The term ‘post-natal depletion’ (I first heard from my clinical psychologist friend Karen) accurately describes the nutrient state of a new mum, and whilst some women may experience depressive symptoms because of this, others feel general weariness and fatigue that is an expected part of being a mum. I recently listened to a podcast with the amazing Lily Nichols (well known for her work on gestational diabetes and diet) and her thoughts on the role of nutrients and if there is anything that can be done to mitigate these symptoms or help the recovery process, pre and post birth.

From a fitness perspective, if we consider the evolutionary picture, there is a definite mismatch between the activities of adults then compared to now. In activities of daily living there was a lot more squatting, lifting, lunging and pulling as part of gathering food and providing shelter. This made for a much stronger pelvic floor and core muscles than we have now. The strength and muscular fitness of the mother during pregnancy can really influence their recovery period post-birth. In addition, one of the main roles of the elders at the time of late pregnancy and childbirth is believed to have been to gather the additional calories required by the childbearing women, as it is difficult to obtain that amount of dietary energy. There was an enforced rest period post birth to help with recovery and bonding of child and mother, and this isn’t a focus in modern day life, where there seems to be real pressure to get back up on your feet after a few days and get going. From a food standpoint, the overwhelming and all-encompassing burden of being a mother to a new-born (first or third time around) makes it challenging to prioritise the nutritious meals required.

Childbirth is extremely energy demanding, whether you have a physiological (vaginal) birth or whether you have a caesarean section (c-section). For some, the double whammy of the intention to have a natural birth but, after 40 hours of labour, be whipped into surgery for a c-section likely even more so. The emotional and physical trauma relating to all of the above scenarios should not be understated, however while guidelines exist during pregnancy for nutrition, there are no real guidelines in place for postpartum recovery. The nutrient requirements of growing another human, plus the demands of labour leaves a woman in a very real depleted state, from a caloric perspective and from a nutrient perspective. It is therefore no wonder that women experience exhaustion and a depressive mood post childbirth. Furthermore, upregulation of protein turnover occurs post birth (both via c-section and vaginal) to help repair and heal tissue, and as a result of increased inflammation. This will certainly increase the requirements for protein and the amino acids responsible for musculoskeletal health.

And what about carbohydrate calories? It appears to be individual as to the requirement for most women. If someone develops gestational diabetes during pregnancy and has been limiting their carbohydrate intake, Lily suggests it is prudent to continue this lower carbohydrate approach post pregnancy for 6-12 weeks and ideally self-monitor their blood glucose responses to meals with a glucometer to assess if their levels has reduced to normal range.  There is no optimal intake amount for carbohydrate (as it isn’t an essential nutrient, the body can make it well enough), however a key indicator of individual requirement would be milk supply for the breastfeeding mother, and mood, energy and stress response may also be good indicators. Carbohydrate helps produce serotonin in the body and quality sources such as potato or kumara can be great for helping with mood and calming anxiety. There’s no right or wrong way here, but I wouldn’t recommend a ketogenic diet for most healthy women post-birth, instead aiming for a good intake of vegetable fibre and adding a couple of serves of fruit and/or kumara or potato into the day. This may take the carbohydrate content to around 80-120g per day which is still a low-moderate amount. Quality is key here.

It is well recognised that breastfeeding increases the caloric requirements of women by around 600 per day compared to pre-pregnancy,  however there are no guidelines for an increased caloric intake post-birth for women who don’t breastfeed, which may lead to some women feeling they should immediately return to pre-pregnancy food intake for fear of not being able to lose the ‘baby weight’. It is reasonable to consider that, breast feeding or not, the healing that needs to take place to recover from childbirth will require additional calories and expectations of dropping weight quickly would ideally be put on the backburner until the body is healthy enough.

From a micronutrient standpoint, there is an increased risk of anaemia with childbirth and more so with multiple c-sections. The estimated blood losses during a c-section is thought to be up to 1000ml, so it is no wonder that someone may come out depleted. And, worth mentioning, there is a clinical link between anaemia and postpartum depression, which highlights the important role of iron in the brain. In addition, the sudden drop of progesterone post-birth may create an imbalance until normal levels resume with the menstrual cycle. Coupled with fluctuating oestrogen levels, this is thought to be one of the major influences of mood and can have negative impacts. Finally, it can take time for the thyroid (which enlarges during pregnancy) to come back to normal size, and the problems this can create for thyroid function, triggering hypothyroidism or hyperthyroidism in the short term, leading to a low mood state. Therefore, along with iron, iodine, selenium, zinc and other cofactors in thyroid metabolism need to be considered.

Practically speaking, what steps should be taken to avoid post-natal depletion and adjust to the new additions to the family? Some tips from Lily Nichols:

Ideally, if possible, get strong and fit in a safe way, enlisting the help of a qualified fitness professional before and during pregnancy

While pregnant, once a week, for several weeks, purposely cook a meal to freeze for post-birth, and make sure it’s something you are going to want to eat. Casseroles, slow cooker, mince-meals, pre-cooked chicken breasts, frittatas are all things that can be frozen but if you don’t like the idea of thawing and eating these, then it’s not going to be worth making them. You may want to do this in the second trimester-beginning of third trimester, so you are sorted prior to the last few weeks when fatigue more rapidly sets in. This might require more freezer space, but this will help emulate the traditional ‘village’ feel of not having to do everything yourself post-birth. In addition, baking low sugar muffins, loaves and breads (if you’re a baker) and slicing and freezing will give something quick to consume when necessary, without you having to rely on processed refined foods. If budget allows, consider Plate Me Up, Jess’ Underground Kitchen or another company that creates prepared whole food meals to take the pressure off having to cook (and the temptation to buy take aways).

Post-birth: continue taking pre-natal supplements and look to get your nutrient blood markers taken perhaps 10-12 weeks post-birth, when inflammation and hormones that are disrupted during the pregnancy and birth have had time to settle down. This will give you a more accurate reflection of any nutrients that you may be running low in. Work with a health professional such as a nutritionist, naturopath or dietitian to provide you with good advice around quality supplements, as price of supplements don’t necessarily reflect quality.

Ensure adequate protein and fats at each meal, with a moderate amount of carbohydrate. If possible, avoid meals that are too skewed towards carbohydrate as these are going to cause blood sugar swings that will impact on energy levels and mood state. This is obviously problematic when also sleep deprived!

Don’t ignore your hunger signals. Remember you need more calories currently, breast feeding or not. Eat until satisfied and trust your body and the signals it is giving you. Now is not the time for Isagenix or fasting. That said, aim to eat your meals within a 12h window, avoiding snacking if you get up to feed during the night if possible. This is reasonable given what we know about circadian rhythm and the potential deleterious effect of food intake later in the evening.

Liver, eggs, salmon, sardines and red meat that is close to the bone all contain essential amino acids and fatty acids that are important not only for baby’s growth and development, but for mum’s brain and blood sugar. Regular inclusion of these should be a priority for optimal nutrient intake.

Keep well hydrated and electrolytes up – a major source of fatigue is when plasma volume drops due to dehydration, therefore making the blood more viscous and increasing the work the heart has to do to pump it around the body.

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PC: home-startcentralbeds.org.uk

LCHF and IF for the female endurance athlete (IMHO).

Following on from the couple of blogs I wrote about Dan’s LCHF athlete lifestyle, I got a lot of messages from women regarding my opinion of it for the female endurance athlete. Great question, especially as – if you look at social media – there are nutritionists who warn against the danger of LCHF (and intermittent fasting) for women, to the point that the blanket statement is that it is harmful and not to be undertaken. Whilst it is hard to be objective in the nutrition space – all of us influenced to some degree by our own experiences – the low carbohydrate and fasting space seems to bring with it its own special degree of hysteria. The prevailing message is that both low carbohydrate diets and fasting is too stressful on the endocrine system of females (which regulates hormones) and causes a reduction in metabolism and reproductive potential. Thus, it is to be avoided at all costs. This point of view may be drawn from clinical experience of the practitioner and be dependent on the type of client they see. If their target audience are women who have struggled with maintaining a healthy weight and have problems with eating enough, then the opinion of the practitioner could well be influenced by this (and is entirely sensible!) Likewise, I see many women who’s hormones benefit from periods of intermittent fasting while utilising a LCHF protocol. What we see in clinic will dictate our points of view, regardless of how objective we try to be.

I have in the past written about the negative impact of fasting and calorie restriction on the expression of genes that regulate kisspeptin in the body, a hormone involved in our reproductive cycle. However I will point out that the effects seen in studies conducted in rodents may be more dramatic than if they were carried out as clinical trials in humans. Rodents have a much faster metabolism, thus a 24h fast for a mouse is equivalent to a 3 day fast in humans. Likewise, chronic caloric restriction over a week, where the mice lose close to a quarter of their body weight (and which is thought to be responsible for the downregulation of the kisspeptin receptors that result in negative effects) may be equivalent to 12 or more weeks. Rodent models in science are great for illustrating potential mechanisms, but can never be viewed as hard data as it pertains to humans.

Alongside any scientific data that exists, I think it’s important to step back and consider perspective here. What we should all be aware of is that there is no one right dietary approach for everyone, and often there is no one dietary approach to suit someone for the rest of their lives. As things change, so do our nutritional requirements. Low carbohydrate diet and intermittent fasting is not exempt from this – therefore to say that it is not suitable for any woman is, quite frankly, erroneous and misrepresents what we see in the literature and what we see clinically. While certainly a vast majority of the studies investigating lower carbohydrate diets have been conducted in males, there are studies showing a positive impact for overweight women with infertility. Further, it is accepted best practice to include periods of low glycogen availability in the training schedules of athletes. Even in the researchers who err on the side of pro-carbohydrate diets recommend cycling carbohydrate intake to be sometimes low, and sometimes high, to upregulate fat oxidation pathways that allow the athlete to become more efficient at burning fat. To state that no female athlete should start an exercise session in a fasted state goes against current best practice for endurance performance.

Possibly the negative impacts of fasting and low carbohdyrate diets are not about the fasting period or the carbohydrate content – it’s much more likely to represent chronic underfuelling – i.e. a lack of calories over an extended period of time, with no thought given to cycling of both energy intake and/or macronutrients. It’s just low, full stop. That’s why it is important to work with an experienced sports nutrition practitioner (like me, Kaytee Boyd, Caryn Zinn as some top picks) to ensure these training tactics are used to the advantage of the athlete in a training cycle, not to the detriment of them.

Don’t misread this as a recommendation to do all sessions in a fasted state, to undergo an intermittent fasting protocol that involves skipping breakfast every day of the week, or that everyone should adhere to a very low carbohydrate approach. If you’ve read any of my information (or followed anything I’ve suggested) then you’ll know this isn’t the case. The point of this blog is to remember that there is no one right dietary approach for everyone, and that if you’re successfully adhering to a lower carbohydrate diet with periods of intermittent fasting and feel it’s working well for you (ie no sleep, hormone, training or recovery problems), don’t be concerned with the rhetoric that exists regarding the harmful nature of this. You are your own best investigator when it comes to your nutrition, and your experience is the most important data when it comes to you.

Intermittent fasting

Post on IF, cue picture of empty plate with clock. #standard (PC http://www.stack.com)

Hungry?

One of the things that clients fear most is being hungry. When I talk to some of them about removing snacks and eating just three times a day (or 1-2 times, depending on their individual plan), there is a look of fear that comes into their eyes. For others, though, they almost relish the opportunity to feel hungry because it has been forever since they’ve felt the grumbling in their stomach that tells them they are ready for food. This doesn’t, however, mean that they never eat! But it does affect their enjoyment of food – and, let’s face it, food is not only fuel, but it is one of life’s pleasures. One that, for many, they’ve denied themselves the opportunity to experience.

Which camp do you fall into, why do you feel that way, and how do you change your mindset around hunger (if you need to?)

Why do you fear being hungry?

In my clinical experience there are two main reasons why people are scared to be hungry. Firstly, hunger is not actually just felt in your stomach, your entire being experiences it. If your hunger comes on suddenly and without warning (you go from feeling fine to being ravenous), if it changes your physical state (ie you start feeling light headed, lacking in energy, maybe even start sweating) and your emotional state (you feel irrationally angry, sad or conversely, on something of a high before a big energy crash), then our emotion around being hungry can be one of fear. No-one likes being shunted from one emotional state to another, particularly if it comes completely without warning, which is often the case in this type of scenario. The fear of over-eating in response to this physiological and emotional state is the second reason for being scared to be hungry. When they do finally get to eat, they don’t trust they will make good decisions around food, and thus starts a (sometimes perpetual) cycle of fear, eating, self-punishment, eating….

What gives? This kind of hunger isn’t hunger at all – it’s blood sugar. Whenever we eat too little, or too little of nutrients that regulate our appetite hormones (nutrients such as protein, fibre and fat) at a meal, it is going to cause our blood sugar to drop and – in some instances – drop too rapidly. This response from our blood sugar sends an alarm signal to our brain that we are in danger (or potential danger) of having no fuel on board. In evolutionary times, this could have meant almost certain death: we wouldn’t have fuel to either fight for our life or run for our life. There may be no sabre-tooth tigers lurking around in everyday life now, but our body’s genetic blueprint hasn’t changed in that regard. Those ringing alarm bells drive us to search for food and do it fast – hence the rapid change in our physical and emotional state. The type of food our brain tells us to seek out is that which is going to deliver quick energy – sweet or starchy food. That is what will bring our blood sugar back to within normal range and get us out of the state of emergency our brain was experiencing. The problem is, though, is that the type of food we go for is the same as what got us into the blood sugar position in the first place.

No wonder you are scared to be hungry, and you feel you can’t trust yourself around food. While one option is to eat frequently (thus, almost to prevent being hungry), this isn’t the best approach. Every time you eat, you send signals to your body that you’ve taken on board fuel, therefore causing changes in your blood sugar levels and creating a hormonal environment that is more favourable to fat gain. In addition, it’s likely the types of food you are snacking on are those which created this blood sugar problem in the first instance (this is not your fault! We’ll blame the 80s-early 2000s for that, and the message to eat ‘six small meals a day’*). They may not be high in free sugar (ie ‘junk’ foods), but they could well be low in fat, fibre or protein, all potent regulators of our blood sugar. Cue the creation of the same problem as if you had just eaten a high sugar snack. Your body doesn’t know the difference without a good amount of the aforementioned nutrients to go alongside it.

If not ‘eat more often’, then what? Eat more but eat less often. The main driver of this is fluctuating blood sugar levels, therefore to combat this we need to fill up more at our meal times (be it 1, 2 or 3 times per day) to avoid a dramatic drop in them. The approach to eating I advise takes care of that for you. As I said, this physiological response is because you’ve eaten too little (or too little of the right** foods) in the first place. Your blood sugars won’t rise to the same extent, will be buffered by the additional protein, fibre and fat, so will decrease at a far slower rate, thus there will be no alarm bells ringing, and no stress response. Hunger will come on gradually (perhaps 4 hours after a meal) and, if you were called into a meeting, you would be able to concentrate on the situation at hand, rather than be distracted, irritated or hangry.

And what if you fall into the other camp, when you are never hungry? The main reason for this is often due to the first scenario – you are pre-emptively eating, thus never allowing yourself the opportunity to digest food and wait for your body to send signals to your brain that you are hungry. More often than not, this is because you are scared to be hungry (so, back to the first reason then). However, there is also another factor I see that impacts on appetite – and it is stress. If you are in an elevated state of ‘doing’, and are constantly on the move, stress hormones can suppress your appetite – therefore eating is somewhat of a chore, something that you feel you should do and therefore you don’t enjoy it. Conversely, you don’t eat which leads you to overeating later in the day when you are finally able to relax. Interestingly, a lot of clients report that, in both scenarios I have described, they continue to eat after having a normal (or larger) size meal because they are not satisfied.  This is usually despite the fact that physically they feel full, but emotionally they are somewhat empty. If you don’t take the time to enjoy your food (and it’s something you derive pleasure from) then no amount of additional food at this time is going to make you feel better. In fact, most people report feeling worse. Taking the time to sit down and enjoy your food helps you to listen to your body and eat when you are truly hungry.

*like anyone knew what six small meals a day were – most examples were enough to feed a 110 kg body builder, not a person trying to maintain a size they felt comfortable at.

**foods higher in protein, fibre, with added fat for satiety.

 

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This caterpillar was, in fact, very hungry. (PC: scholastic.com)

Jan’s story: a real food success story

When I met Jan, she had already lost 10kg through Jenny Craig but was super unhappy and hungry, experiencing bouts of hypoglycaemia (and used dates to help lift her blood sugars again, which would exacerbate the problem), had knee pain, was experiencing patterns of low mood and overall didn’t feel very good. Further, her HbA1c, measure of long-term blood sugar control, placed her in the pre-diabetic range (above 41 mmol/L). To my mind, this cut-off seems a little arbitrary. There really is nothing different between 40 and 42 mmol/L where one is ‘fine’ and healthy, and the other is ‘pre-diabetic’. Many GPs I talk to feel the same, but I digress.

We talked through her diet, which was a little like this:

  • Pre-breakfast: Cup of tea plus piece of fruit (off to do some work on the farm)
  • Breakfast: 2 eggs on toast with butter
  • Snacks: scroggin mix, fruit, rice crackers
  • Lunch: salad with greens with grated cheese and tomatoes
  • Dinner: standard kiwi dinner food, with some adjustments made thanks to Jenny Craig programme.

It certainly wasn’t a junk-food diet the way we understand ‘junk food’ to be, however it was low in protein with the balance of macronutrients geared towards higher carbohydrate choices: fruit, toast, dried fruit, rice crackers etc.

We talked through dietary changes and lifestyle changes, and I made several recommendations based on the information she provided and subsequent blood tests that she had conducted. The main shifts in her diet were to:

  • Anchor meals around protein, fibre and fat to stabilise blood sugar
  • Avoid snacking where possible
  • Removal of most carbohydrate (including fruit) to help lower her overall blood sugar level
  • Including raw apple cider vinegar around meals (to help with glycemic control)
  • Remove dairy (clinically I see many women in their late 40s and above benefit from removing dairy from their diet)
  • Supplementing with magnesium and chromium for blood sugar control, and supplements to help support her liver function
  • Slow cook meat wherever possible (to reduce the formation of advanced glycated end-products which are toxic, especially for someone with poor blood sugar control).

Over the course of the next 14 weeks, Jan has experienced the following:

  • Sleep has improved
  • Knees no longer sore when moving
  • Blood sugars have stabilised, no signs of hypoglycaemia
  • Mood has infinitely improved
  • Skin and hair are better
  • No cravings
  • Appetite is good, feels satisfied with food
  • Body composition changes: she has dropped 15 kg
  • HbA1c had dropped to 37 mmol/L (out of the ‘danger’ zone).

Importantly, her overall wellbeing is SO much better than it was. She sounds so much brighter on the phone, she feels so much better about herself and she has achieved so much. When we caught up two months ago at our previous appointment her weight had stabilised around 5 kg heavier than it is now, though she continued to notice body composition changes – her shape was changing but on the scales, it was the same. I see that frequently, and nothing is linear, of course. It can be weeks of plateauing on the scales before they shift. Is this a metabolic adaptation? Not sure. Usually it’s compliance to diet, though Jan had been consistent with her approach. Of course, there are things you can do to help move the needle a little bit if necessary, but sometimes it can just be a matter of waiting it out before the trend down continues. The key is to not be demotivated by this. Scales can be a good indicator of progress, but remember not to rely on them as the sole indicator. Luckily for Jan, she was experiencing the benefits of eating well every day, so even though the number on the scale hadn’t changed, she still felt good about her lifestyle change. Her husband has also benefited from her lifestyle change, dropping excess body fat by virtue of eating from the same food supply.

A typical day’s food intake for Jan now would be:

  • Breakfast: 2 eggs plus bacon and mushrooms
  • Lunch: salad, chicken, a boiled egg
  • Dinner: salmon, roast pumpkin and carrot and salad

OR

  • Breakfast: 3 scrambled eggs, tomatoes, spinach
  • Lunch: sushi (no rice), cabbage slaw
  • Dinner: butter chicken with cauliflower rice

If she feels like a sweet treat, she makes something like this Pete Evans nut bar, or mixes up some coconut yoghurt and frozen berries to make a sorbet-type dessert, and is completely satisfied. She was initially worried about my reaction to the nut bar, given it’s got some dried fruit in it, however she reiterated that she cut it into 30 pieces, froze it, and brings it out “not every day” to have with a coffee. Honestly, though, had she told me she ate it every day and got these physical and psychological benefits, then it is working for her regardless of what I think (in the context of an already stellar food intake). One food doesn’t make or break a diet.

She finds it is super easy for her to follow this way of eating and eating out or with other people is not an issue. She asks for dressings for salads, and sauces for steaks on the side to control how much of these she has, and to help avoid hidden added sugar or industrial seed oils that are commonly found in these foods. She is ‘busy’ but not overly active, and we are working on getting her resistance training up to help protect her bones AND increase muscle mass. These two things will help her overall health and prevent sarcopenia in later years. We are starting with home based activities for this. While she could have started this earlier, it’s sometimes easier to focus on one health behaviour and bring the others in – everyone is different though; so this needs to be considered on a case-by-case basis.

One thing she does find interesting is other people’s reaction to her weight loss, with some people asking when she will stop doing what she’s doing (as if it is a ‘diet’, which Jan isn’t on), or saying that she is getting ‘too thin.’ This regularly happens when someone loses weight and gains health; people are used to seeing a different version of them. To deviate from this can be unsettling. For others, they subconsciously take the actions of someone like Jan personally, like she (who is adopting the improved health behaviour) is doing it to highlight some failing of their own. While that might seem ego-centric of them, I don’t think it’s on purpose for most people! These people are often good friends and want to see you succeed. The important thing for Jan in this instance is to not take on board what others say and stay confident and strong in her approach.

So that’s Jan. Awesome, huh? She’s booked a holiday too – something she said she wouldn’t have contemplated previously. This has less to do with her weight (though certainly she can move around much more freely) but more about the increase in overall wellbeing that has occurred through adopting these changes. It makes me feel so privileged to work with people like Jan and share in their success. While I gave Jan the tools to guide her, the hard work was up to her. If you’re in a position to do the same, click here to set up an appointment, or check out my online nutrition coaching options here.

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Delicious food! (PC: runningcompetitor.com)

10 tips to help reduce your water-bloat

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.

  1. 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.
  2. 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.
  3. 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?
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Exercise regularly. Exercise can help reduce water retention, not just by increasing sweating, but by moving water from the intercellular compartments to the muscles.
  9. 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.
  10. 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!

 

Does your doctor value nutrition? These 3 questions might help you find out.

How much does your doctor value nutrition? This has been a rather hot topic of late, with the recent gagging of Gary Fetke in Australia, an orthopaedic surgeon who co-owns a nutrition clinic that employees dietitians to help clients. He has recently been ‘gagged’ by the Australian Health Practitioner Regulation Agency (AHPRA) and is not able to talk about the role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

That’s troubling to say the least. Nutrition and talking about nutrition is certainly a contested field, and perhaps there is some protection of the patch when it comes to nutrition advice. I’m not going to lie to you – I can get a little scratchy myself when I read prescriptive advice from people who aren’t qualified in nutrition that push the boundaries in terms of scope of practice. Mainly because of the potential fall out if they aren’t equipped with the knowledge to either resolve an issue or refer it on. But to prevent a doctor talking about nutrition is just madness.  Doctors SHOULD be talking about nutrition – especially given that some of the most common reasons people go to their general practitioner (GP) can be improved (if not resolved) by diet. Thank goodness similar shenanigans have not been taking place this side of the ditch.

To what degree GPs should have the authority to discuss nutrition with their patients is a bit of a ridiculous question if you ask me. I know many brilliant GPs that use a holistic approach to their practice, who know a LOT about nutrition, give guidelines when that is all that is required and also who refer their patients on to more in-depth nutrition help if necessary. More important is asking your GP to what degree do they value nutrition. If you feel nutrition is an important part of your overall health, I think that having a GP who feels the same is rather important, and these three questions I heard on a podcast could be a good start to give you confidence that your needs will be met by their services.

  1. What affect does nutrition have on my health?

This may seem like a weird question to be asking your GP. I mean, surely everyone knows that diet and health are intricately linked, and doctors – well, it’s their job to know this stuff, right? Given the number of clients I have who leave their doctor’s clinic rooms feeling stupid for even mentioning diet, I don’t think we can take it for granted that your GP is going to be open to the idea of diet being a reasonable therapy (or adjunct therapy) to any condition. Sure, the diet-health connection isn’t foreign to them – there is the lipid hypothesis after all. And if you’ve ever stepped on the scales and been told your body mass index (BMI) is too high, so you need to eat less and exercise more to lose a little weight and reduce your overall health risk, then clearly your GP didn’t sleep through their three nutrition lectures provided in the medical school curriculum. However I wouldn’t be surprised if you know more about diet being able to prevent or manage conditions such as auto-immune disease (including type 1 diabetes), mood disorders, inflammatory bowel disease or irritable bowel syndrome, metabolic conditions (such as type 2 diabetes), asthma and allergies and the like. Now I’m not saying your GP is an idiot – at all! But time is a resource many health professionals don’t have, and while your GP might be open to exploring alternative or adjunct nutrition therapy, they may not have had the time to research this avenue. That (in my opinion) isn’t so much of an issue. It’s not as important (in my mind) that your GP may not know as much as you; being open to you exploring it speaks volumes, though. If your GP isn’t interested, then that is a problem. Given some of the reactions that clients have reported when mentioning to their GPs they use diet as a way to manage their health condition, there are clearly GPs who choose to remain ignorant. If you are dismissed, laughed at, or told in no uncertain terms that diet will not help, alarm bells should ring in your head. My advice would be to look for another GP.

  1. What do you think about the difference between normal lab ranges and optimal ranges for nutrient status?

There’s a difference? There appears to be, or at least, some doctors argue that there is. Vitamin D is a great example of this. In New Zealand, the adequate vitamin D level starts from 50nmol/L but a published review determined that looking at endpoints on a broader scale than just bone health (including  bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer) determined it best to have serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L.

Low to low normal levels of serum folate are related to increased risk of depression and increased severity of depressions and affective disorders. Our ‘normal’ starts at above 7 nmol/L and research has shown that people with chronic mood disorders have lower morbidity when their nutrient status is above 18nmol/L, and symptoms began to alleviate when supplementation brought the levels up to above 13nmol/L. Low folate is also associated with higher homocysteine levels in the blood which is an independent risk factor for atherosclerosis.

While B12 levels in the blood are actually a poor indicator of B12 activity (as only 5-20% of the is bound to transports and able to be metabolically active), research has found a relationship between levels of B12 of 258pmol/L and lower in the bloodstream and depression. The ‘normal’ range starts at 170pmol/L, with borderline low from 110-169pmol/L. I know GPs who look for levels of 400pmol/L as being optimal for cognitive functioning and health. A sports doctor I am aware of uses higher cut-offs when it comes to haemoglobin and ferritin (both markers of iron deficiency) for athletes and will supplement to determine if a boost in iron intake helps address fatigue-related complaints or not, even if the athlete is within ‘normal’ range (see here).

Thyroid stimulating hormone, a commonly measured marker of thyroid function has a reference range between 0.5-4.0mIU/L. However, TSH is considered to be a poor indicator of thyroid function and the ‘normal range’ included people that had underactive thyroid or thyroid disease. The recommendation from the American Association of Clinical Endocrinologists association was to lower the range to 3, with a view of it lowering further to 2.5mIU/L because data from the National Academy of Clinical Biochemistry found more than 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L. Though this was recommended in 2003, it was contested by other governing bodies, potentially as it meant that the number of people in the US with subclinical thyroid function increased from 3 to 20% of the population, thus (as concluded in this paper) many more would require thyroxine medication as treatment.

These are just a few examples where you may fall into the ‘normal’ range, but may not be optimal according to the opinion of some doctors. At the very least, it may explain why you may be experiencing physical symptoms but these aren’t recognised by your lab test results.

  1. What will you do if my test results don’t marry up with what I’m telling you my symptoms are?

Important question, don’t you think? Let’s hope that your GP doesn’t respond with ‘perhaps you need to see a psychologist’ – as one of my clients reported. To be honest, I actually think there is a degree of psychosomatic issues that occur when someone is struggling with a health problem – most of us are familiar with the gut-brain axis and relationship between stress and digestive problems. This is partly driven by the return of seemingly ‘normal’ test results that don’t explain their ongoing concerns. However, to dismiss your symptoms as being unimportant because the results don’t reflect what you are reporting should (to me) set off alarm bells.

I think one problem could lie in the funding for lab tests. My GP is brilliant and will order me any test I want, but at my cost. I don’t blame her for this as there is pushback with GPs ordering tests. However I know that not all GPs are like this, and not all people can afford testing to get to the bottom of the issues. I think if more GPs appreciated the role nutrition can play in preventing, managing or reversing many of the chronic conditions people are dealing with today, then, then there would be more referrals to nutritionists or dietitians on the basis of reported symptoms or test results that may fit into the ‘normal’ range, but aren’t what is considered optimal.  From here, nutritionists, naturopaths and dietitians can order tests that delve further into hormonal issues, gut problems and even cholesterol levels if required. But this might not be necessary as they may pick up from your initial test results that certain nutritional strategies can help you optimise your nutrient levels without the need for further testing.

At the end of the day, you should feel confident that your GP values nutrition as much as you do.These questions may help you determine that and, if you suspect they do not, perhaps it’s time to find another GP.

Nutritionist

Obligatory doctor and fruit shot. I couldn’t find one with a steak.(PC: http://www.healthtrap.com)

 

11 things you may not know about perimenopause (and 10 things you can do about those symptoms).

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.

  1. 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!
  2. 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.
  3. 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.
  4. Some of the main symptoms of perimenopause are
    1. Heavy periods
    2. Hot flashes
    3. Breast tenderness
    4. Worsening of premenstrual symptoms
    5. Lower sex drive
    6. Headaches or migraines (due to sudden removal/reduction of oestrogen)
    7. Fatigue
    8. 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)
    9. Irregular periods
    10. Brain fog and memory – oestrogen helps consolidate both episodic and spatial memory in the brain, and protects against cognitive decline as we age.
    11. Vaginal dryness; discomfort during sex
    12. Urine leakagewhen coughing or sneezing and an urgent need to urinate more frequently – due to oestrogen’s role in maintaining the vascular mucosa folds in the vagina, acting as a watertight seal.
    13. Mood swings (via fluctuating levels of hormones)
    14. Trouble sleeping
  5. 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.
  6. The types of hormones in the pill are synthetic and are not ‘bioidentical’ – meaning that the amounts are higher than what the body would produce AND they are in a form that the body can’t use. The pill doesn’t regulate hormones, it shuts them off.
  7. 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.
  8. 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.
  9. 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
  10. 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.
  11. 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.

  1. 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
  2. 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).
  3. Ensure adequate vitamin D status – optimal is around 100-150nmol/L which is required for the production of all hormones, and related to other hormonal issues such as endometriosis
  4. Reduce intake of carbohydrate if following a higher carbohydrate approach, and get rid of processed, refined foods and sugar.
  5. 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.
  6. 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.
  7. Turmeric in therapeutic doses (more than you can get from food) helps reduce oestrogen related oxidative stress, reduce prostaglandins (inflammatory biomarkers) – opt for one that is also combined with bioperine (to make it more bioavailable) such as this Good Health 15800 Turmeric complex. The alternative is one that says it is formulated to have smaller, more bioavailable particles, and the Meriva formulated varieties have this.
  8. 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.
  9. SLEEP. Hands down, the most often overlooked yet important restorative, nourishing thing you can do to support your hormone health.
  10. 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.

PC www.gazetteinterviews.com

Let this not be you. Or your mum. Or your wife. PC http://www.gazetteinterviews.com.

 

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