The Gout: what you need to know and 7 things you can do about it.

  1. 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)
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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
  7. 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.
  8. Alcohol intake is associated with an increased risk of gout – beer more so than wine.
  9. 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.
  10. 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.
  11. 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?

  1. 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.
  2. Supplementing with 1500mg vitamin C reduces serum uric acid and its antioxidant functions may also help kidney function by reducing inflammation.
  3. 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).
  4. 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).
  5. 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.
  6. The consumption of low fat dairy products is linked to a lower risk of gout in larger population studies.*
  7. 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!)

The take-home?

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.

 

14 reasons to ditch the toast and jam (and 7 key tips to help you do this).

After feeling like I’d taken a trip back to 2003 with some of the sports nutrition posts and articles I’d been reading lately, I got tagged in a cool picture from a listener of our Fitter Radio podcast  – a triathlete who has switched from the traditional higher carb, lower fat diet approach to eating lower carb, higher fat, real food whilst training and commented she ‘didn’t know her 41 year old body could be the best body I have ever had’ (Woot! high fives all around!!) This coincided with finishing Mark Sisson’s Primal Endurance book.

Mark outlines 115 reasons why athletes should train and eat the Primal Endurance way. I concurred with pretty much all of them. I have added my own 2c worth, added some literature below (and cut it down to 21 for brevity’s sake). While geared towards athletes, hands down this is applicable to everyone. Everyone.

So if you’re currently eating toast and jam pre OR post training (or in general), I’ve outlined the 14 reasons why you need to ditch that junk and become a fat burning beast, and 7 key tips to help you get there.

  1. Western diet is based on excess grains and sugars (and low fibre) which stimulates excess insulin production, leading to lifelong insidious weight gain, chronic inflammation and elevated disease risk factors.
  2. A high carb, grain-based diet can leave endurance athletes nutrient deficient (due to phytic acid effects on minerals), inflamed and more susceptible to the oxidative damage of the stress of training, general life and poor nutrition.
  3. The way that most people consume modern grains (cereals, breads, pasta) ends up being a cheap source of calories which are immediately turned into glucose upon ingestion and offer minimal nutritional value. There are no good reasons to consume these types of grains and many good reasons not to, especially for those who are sensitive to gluten and other anti-nutrients found in wheat.
  4. Everyone is sensitive to the health compromising effects of grains at some level, especially the pro-inflammatory effects of gluten and the propensity for the lectins in grains to cause leaky gut syndrome.
  5. Even lean people suffer from the consequences of carbohydrate dependency, such as chronic inflammation, oxidative damage, and accelerated ageing and disease risk factors.
  6. Carrying excess body fat despite careful attention to diet and a high training load is largely due to carbohydrate dependency caused by a grain-based diet and chronic training patterns.
  7. Carbohydrate dependency cycle looks like this: consume a high carbohydrate meal – elevate bloods sugar – stimulate an insulin response – shut off fat metabolism and promote fat storage – experience fatigue and sugar cravings – low blood sugar elicits stress response and we consume more carbohydrates – stimulate the fight or flight response to regulate blood sugar – dysregulate and exhaust assorted hormonal processes, and end up in burnout and weight gain (potentially lifelong)
  8. Weight loss through portion control, low fat foods and calorie burning is ineffective long term. And while we think calories burned through exercise stimulate a corresponding increase in appetite – research might not back this up. I tend to think that people are more likely to eat more because they ‘reward’ themselves OR the long slow training allows increased opportunity to eat sports ‘junk food’ and the amount of calories burnt through training is far less than you think – and overestimated more so in females in certain instances. At any rate, the secret to weight loss is hormone optimisation, primarily through moderating excess insulin production.
  9. Endurance athletes can begin to dial in to their optimal carbohydrate intake by asking themselves the question ‘do I carry excess body fat?’ Any excess body fat calls for a reduction in dietary carbohydrate intake to accelerate fat burning.
  10. Endurance athletes who already have an optimal body composition but are looking to optimise training and recovery should choose high nutrient value carbohydrates. These include a high volume of vegetables, a moderate fruit intake, kumara/potatoes and other starchy tubers, dairy for those that tolerate, wild rice, quinoa and small amounts of dark chocolate.
  11. Endurance athletes with high calorie needs who also have an optimal body composition can enjoy occasional treats, but the habit of unbridled intake of nutrient-deficient carbohydrates should be eliminated in the interest of health and performance.
  12. Primal style eating (or eating minimally processed foods) is fractal and intuitive, and when escaping carbohydrate dependency and becoming fat adapted, you don’t have to rely on ingested carbs for energy. Eating patterns can be driven by hunger, pleasure and maximal nutritional benefit.
  13. Escaping sugar dependency and becoming fat adapted gives you a cleaner burning engine, since glucose burning promotes inflammation and increased oxidative stress
  14. Ketones are an internally generated, energy rich by-product of fat metabolism in the liver when blood glucose and insulin levels are low due to carbohydrate restriction in the diet. Ketones are burned efficiently by the brain, heart and skeletal tissue in the same manner as glucose. You do not need to be on a ketogenic diet to upregulate your ability to produce ketones – you can do this via a lower carbohydrate approach.

HOW TO DO THIS: 7 KEY TIPS

  1. Step one: omit sugars, grains, industrial seed oils for 21 days. Step two: emphasis highly nutritious foods such as meat, poultry, vegetables, eggs, nuts, fish, fruits, some full fat dairy, seeds, and kumara/potato.
  2. 100g or less of carbohydrate promotes fat loss, 150g is around maintenance level and over this could promote lifelong weight gain and over 300g could promote disease patterns.
  3. While transitioning to primal there are some struggles initially due to lifelong carbohydrate dependency and the addictive (for some) properties of sugar and excess grains and wheat. Headaches, dehydration, lower blood pressure and ‘dead legs’ are all initial side effects when removing processed food. Trust me – this too will pass.
  4. To minimise side effects, start the transition in a base-training phase of your training where training occurs at an easy pace. The transition phase can take anywhere from 2-12 weeks initially.
  5. Consume salt. Don’t underestimate the importance of this! Lower circulating insulin affects your body’s ability to retain sodium (and other electrolytes) – so we need more, particularly as processed food (of which you are no longer basing your diet around) is where you got around 70% of your sodium from.
  6. You can accelerate the process of fat adaptation by instigating some of the tactics used by athletes who opt to ‘train low’ – i.e. in a low glycogen training state. Some of these are naturally undertaken if you train without eating in the morning, or work out after dinner in the evening and don’t consume anything post-workout. If you’re new to this, have a read through to establish which might suit you best, and start instigating 1-2 x per week. Don’t undertake all of them as this aggressive approach could cause too much additional stress, derailing your plans to become a fat-burning beast.
  7. The FASTER study and Peter Attia, Sami Inkinen suggests any endurance athlete can become fat adapted and deliver performances that may be superior to carb-fuelled efforts all of the way up to anaerobic intensity. This is a new and growing research space, one AUT is testing, among other Universities around the globe.
Strong, lean and awesome at 41y.

Strong, lean and awesome at 41y.

 

PS What the Fat Sports Performance – currently an ebook, about to be published is one I can’t WAIT to read as well – sure to be a goody.

10 ways to naturally reduce your cholesterol-related risk and save yourself $8.00

I was at the supermarket yesterday and just happened to be taking a picture of an iced coffee drink when someone came beside me to grab a couple for themselves and put them in their trolley alongside a pottle of Flora ProActiv margarine.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

There’s a disconnect right there.

These margarines are not only ridiculously expensive and taste terrible (I suppose that’s the nature of margarine anyway), but consuming this spread in an effort to reduce cholesterol levels is totally misguided. Don’t get me wrong. They work. In fact, a good friend of mine did her Master’s project at the same time as I did to show their effect at lowering LDL cholesterol in a clinical trial. There have been more than a handful of randomised controlled trials that show plant sterols can inhibit cholesterol absorption and reduce LDL cholesterol.

The end goal, however, shouldn’t be about reducing your LDL cholesterol levels. You’re probably down with that anyway given you’re reading my blog. The end goal is about reducing your overall health risk, and these margarines have not been shown to do this, despite the Heart Foundation tick and the Health Star Rating. In fact, for a substantial proportion of the population, a lower cholesterol level increases the risk of heart disease (for more information, read this excellent blog post by Zoe Harcombe)

Interestingly, even the American Heart Association released a statement saying the use of sterol and stanol esters should be reserved for adults requiring LDL cholesterol lowering because of hypercholesterolemia, or as secondary prevention after an atherosclerotic event – and these have yet to be updated.

If you want the real benefits of cholesterol lowering foods, eat your plant sterols in the form that nature intended (i.e. plants), not a pharmaceutical company

Anyways.

Here are 10 ways to naturally reduce your risk related to cholesterol and save yourself $8.00

  1. Eat more vegetable fibre. Fibre is the ‘f’ word that is super important but doesn’t receive nearly as much press as the other ‘f’ word (fat). Current recommendations are 28g for females, and 34g for males and we are currently consuming an average of 20g per day. Fibre comes in a few different forms and while soluble fibre has been found to lower cholesterol absorption – this is not the most important aspect to my mind. A few people (who may have a genetic defect that makes them hyperabsorb fibre, or have a defect on their LDL cholesterol recpetors which limits their cholesterol uptake and removal) would benefit from this in particular. Moreso, eating more plant based fibre shifts us back to an eating pattern that, as Eaton & Cordain point out, we consumed for over 99% of human evolution. And while estimations of fibre intake of Hunter Gatherers vary (as pointed out by Steve in this excellent blog post), the point is: we don’t eat enough of these plant-based foods and we need to eat more AND more from the sources of foods which are as close to their natural form as they can be. You’ve heard of the 5 a day campaign? I say we should aim for 9 – and mostly vegetables. This is particularly true if you do have underlying inflammation that is driving up your cholesterol level. There different types of fibre and soluble fibre is known to absorb cholesterol and remove it from food you eat and your bloodstream. This level of detail is certainly useful if you have a genetic predisposition towards a high cholesterol level which places you at risk (i.e. familial hypercholesterolemia). However, to keep it brief: if you’re currently barely managing three serves of vegetables a day – work on increasing vegetables in general. Natural sources of fibre from plants will deliver soluble and insoluble fibre, along with resistant starch. This is a good place to start.
  2. Ditch processed food. Sounds dramatic I know – and it’s not realistic to ‘never eat anything in a packet’. However if most of your daily calories come with a nutrient information panel and an ingredient list, then you seriously need to reconsider what you are putting into your body. Processed food is devoid of nutrients in the forms your body requires, contains additives and preservatives, some of which have a dubious health profile and takes very little energy to digest. This leads to peaks and troughs in your blood sugar levels, poor appetite control and the potential to overeat.
  3. Ditch sugar. No surprises here. Sugar not only increases your risk of metabolic syndrome that can result in type 2 diabetes and increased cardiovascular disease risk, it drives almost all inflammatory pathways in the body. Thankfully though, if you try hard to stick to #2 above, you’ll do this by default. Do note though, minimising sugar includes all forms of sugar – including the ‘natural’ forms. If you’re unsure of what a sugar is, print out this PDF which tells you the 56 different names to burn into your brain for your supermarket shop.
  4. Lose weight. Or, more specifically, lose body fat. Being obese is an independent risk factor for cardiovascular disease, type 2 diabetes, neurological conditions and some cancers. Yes there are certainly limitations with how we define ‘overweight’ or ‘obese’, but you don’t have to rely on tools to establish whether or not you need to lose some additional fat around the middle. You know this yourself.
  5. Increase your intake of omega 3 fatty acid rich foods (think salmon, mackerel, herring and sardines) and consider an omega 3 supplement if you don’t eat fish. I know – you’re thinking ‘what about plant-based sources’? truth is, these don’t contain the type of long chain fatty acids that are most beneficial for reducing risk of chronic disease, and their conversion rate into those forms is quite poor. Eicosapentanoic acid (EPA) is the omega 3 that is involved in reducing inflammation, and if you do have high cholesterol and inflammation, then a supplement such as this Nordic Naturals could be worthwhile taking. While a very recent clinical trial failed to show improvements in total cholesterol with the addition of an omega 3 supplementation, it did show a reduction in fasting blood sugar, triglyceride levels and c-reactive protein (a marker of inflammation in the body). And as I said, your cholesterol level might not be the most important metabolic marker to focus on anyway. Vegetarians especially would benefit from supplementation, and an algae supplement would provide a similar benefit.
  6. Get out in the sun…. and get your vitamin D levels checked. There is an association between low vitamin D and poor metabolic health – studies have shown a link between high sunlight hours and lower cholesterol levels at a population levels. This is due to the exposure of skin to the UVB rays that uses cholesterol to create vitamin D. However, a large percentage of New Zealander’s are below adequate levels. For best and safe practice, sun exposure, minus the burning, for 10-15 minutes where parts of your skin not often seen by the sun (for maximum absorption) are exposed (think: armpits, abdomen – unless you’re young and gorgeous) is best. The thing is, though, the sun doesn’t hit the earth at the right latitude to get any of those rays to produce vitamin D in winter, so we can be lagging even more coming into spring. So supplementation could well be required. In addition to the mechanism above, studies (like this one) have shown that higher dose vitamin D supplementation can lower cholesterol and inflammatory markers in women. If supplementing, choose a supplement that also includes vitamin K2 to help vitamin D’s absorption such as this Clinicians one.
  7. Alpha-lipoic acid (along with other antioxidants vitamin C or E) can provide antioxidant support to help reduce your overall health risk associated with cholesterol levels (i.e. reduce inflammation and oxidative species) by increasing the activity of your body’s antioxidant defences. If you’re wanting to spend your money on actively lowering your cholesterol, these relatively safe supplement options are a better idea than margarine.
  8. Your thyroid, your gut, your genetic profile can all influence your cholesterol profile. If your cholesterol is more than a bit elevated, consider investigating other reasons for this. FYI it’s now easier to get your LDL cholesterol tested, rather than calculated, including those which are more atherogenic, such as VLDL, oxidised LDL if you do have concerns. You can work with a practitioner to do this.
  9. Exercise. Free and long known to improve metabolic health. The arguments for or against the benefit of exercise for losing weight are irrelevant. Mood, lean muscle mass, cardiovascular fitness and general all around awesomeness will increase. It doesn’t mean you have to slog it out in the gym. Body weight exercises and some short, sharp, intense exercise a couple of times a week – combined with walking and general movement as much as you can – is most effective for health and wellbeing. If you like to track your details then get a Fitbit or a Garmin or similar. If you obsess over numbers then don’t.
  10. Stress less. Sleep more. And if you are losing weight, and doing all of the above, wait for your weight to stabilise before worrying too much about your cholesterol levels, which can be elevated during this time.

 

Body weight exercises from the 7min workout - not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

Body weight exercises from the 7min workout – not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

An endurance athlete’s ‘real food’ success story: making it work for you.

I got this email this week from a client that I have worked with since just before mid-year. She is an endurance athlete that came to me as her overall energy levels were low and she was carrying a few extra kilograms that she wasn’t used to.

We chatted through not only nutrition but lifestyle-related changes that she could make to help support her busy lifestyle. This included changes to her diet, additional supplemental support, working on sleep-related behaviours and finding the middle ground between ensuring adequate energy levels and losing body fat to a level that was sustainable and achievable. You can appreciate this is a delicate balance! I discussed with her that when we sorted her energy levels, the body fat loss would take care of itself – she was aware of this and that her energy levels were the priority.

As an endurance athlete she often trained at both ends of the day and came home late, stayed up a little later than she thought she should, and relied quite a bit on carbohydrate-based choices such as bread and cereal to boost her energy levels during the day. While she didn’t recognise it, I immediately flagged this as one of the reasons she was feeling exhausted. She was also hungry a lot, eating at multiple times during the day. This was another indicator that her food choices were not geared towards an optimal balance of good quality carbohydrate, protein and fat. A detailed discussion on her diet proved this to be true.

This client was very motivated to feel better, and took the suggestions that I made and found a way to work them into her lifestyle. We had four sessions together, the last being just before a race that she was doing – the first one for her in a while.

I asked if she minded if I shared her email – she was happy for me to do so.

“Thanks for the item on Thyroid on Fitter Radio this week – it was really helpful. Good to know low thyroid is not something you are necessarily stuck with for life.

Following our catch-up at the end of September I just thought I’d update you with how things have gone since then, and where I have found a really comfortable place with training and nutrition.

Update:

So in summary, I performed well at my last race and was very happy with my placing in my age group. I really noticed that getting extra sleep made a big difference to how I felt, two nights before the race I had 9 hours and felt amazing the next day.

My weight has stabilized at around 53kg so I think this is possibly the happy place for my body, and it’s the same as it was a couple of years ago when I was running at my best.  I feel good at this level and I’ve figured out how to keep it there – for me it’s:

  • at least 7.5 hours sleep;
  • not eating late; and
  • doing some kind of activity in the evening, even if that’s just a walk.

Food wise, what seems to be working and manageable is:

Prep: (crucial to ensuring that I’ve got options available during the week):

  • Bulk making a week’s smoothies at the weekend, then freezing and using during the week
  • Ordering Primal Kitchen for weekday lunches and weekend main meals
  • Making a few wraps at the weekend for weekdays when I do something straight after work. For example, Farrah chia wrap* with Vital Vegetables Slaw, lemon juice, a flavour (Thai spice mix, peanut butter or salsa) + a protein such as smoked salmon or chicken

*yes I know it’s has wheat in it and is a carb but it seems to give me enough energy/and is practical – if I eat fewer carbs than I am I don’t seem to have enough energy.  I have tried other things instead of a wrap like cabbage leaves/sushi sheets/… but they just don’t work as well, they fall apart. The thing that does work is the Vietnamese rice paper wraps but they are very fiddly so I would tend to buy the Farrah wraps instead – very good place in central Wellington to get them! 

Breakfast – usually 5:30-6:30 depending on day

  • Smoothie and a hot drink + a spoon of peanut butter – I usually make the smoothie quite thick and eat it out of a bowl with a spoon!
  • If I’m doing something hard-ish like a swim squad or a run/bike then I have something else too. This tends to be either a sachet of plain oat porridge with the smoothie on top, or 2 hard-boiled eggs with some salt (or on a race day 1-2 x banana depending on length or race).

Mid morning – usually have a coffee with rice milk but don’t need to snack much now. If I do it’s 1-2 Brazil nuts

Weekday lunch – usually eaten around 11am-noon

  • Primal kitchen – 1/2 a warrior size shared with partner + handful baby spinach
  • 2 squares of dark chocolate and maybe a couple of strawberries.
  • Raspberry white tea

Mid afternoon – usually have a Redbush tea with rice milk but don’t need to snack now. If I do it’s a carrot and maybe a few almonds.

Weekday dinner – on days when I do something around 5 or 6pm in the evening, I just eat this around 4pm which seems early but it gives me fuel for the activity then I don’t need to eat a meal later. This way I get a semi-fasted thing happening (as per train-low principles) without it feeling hard. And it means I don’t eat a bunch of rubbish in the afternoon. So it works!

  • Wrap
  • 2 squares of dark chocolate
  • Redbush or green tea

Evening – Usually have a hot drink (not caffeinated), and maybe a swig of wine or my partners beer, but I don’t need to snack as much now – if I do it’s because I’ve just been for a hard-ish training session or MTB ride, and, something like a gold kiwi and few nuts does the trick.

Weekends, similar but we have Primal Kitchen in the evening but I try make sure we eat early, like by 6. For lunch something like sardines on toast if at home with salad, or eggs on toast if we are at a cafe.

Overall

It’s working well and although probably to you getting Primal Kitchen for most of our main meals will probably seem like a bit of a cop out!! But actually takes the stress out of everything – otherwise I would end up doing all of the thinking ahead/planning for both of us on food and basically end up spending more of my free time on it which to me wouldn’t feel fair! (My partner is wonderful but he just isn’t as organised as me and has lean genes and the fastest metabolism on earth so can eat anything. To him, super healthy food isn’t so much of a priority). I think it also works out the same cost or cheaper, definitely frees up some time and makes logistics easier. I’m sure at some point in my life I’ll enjoy doing more food prep and cooking more but this works right now and keeps the balance of effort fair!**

I am planning on giving up triathlon after this summer and just focus on running, mostly trail running and doing other stuff I enjoy for fun.

So, that’s it! Thanks for everything and your podcast, the whole experience of getting nutrition consultation has been a really positive one and the result for me has been to shift a good couple of kilograms and change my mental attitude in a very positive way.  🙂 ”

You can see from the discussion of her food choices, her diet isn’t low carbohydrate per se – though it is definitely LOWER in carbohydrates than it was. There is a lot more protein here than what she was having, and overall the nutrient density has improved.

Overall I think this is such a good ‘real food’ success story and that’s why I asked if I could share it. Does she eat ONLY non-processed food? No – however it’s all about context and finding the middle ground with what can be achieved in the context of the individual’s lifestyle.  That, to me, is success. 🙂

Merry Xmas.

 

**to be clear, I don’t think that getting meals from a place like Primal Kitchen (or ordering through My Food Bag etc) is a cop-out at ALL. I think it’s a smart strategy to help people meet their nutrition goals and not fall back into bad habits that could contribute to poor overall health status. It’s really interesting here that it works out MORE cost effective too. It saves on buying food that they would have to throw out as they haven’t found the time to cook it. It also saves the temptation of just having toast or cereal in the evening, or a sandwich that doesn’t provide enough protein and important nutrients. Primal Kitchen is a great choice.

 

Navigating the school lunchbox: Ella’s first week.

My friend Helen and I were chatting about her daughter’s first week at school, an event I knew had been causing some apprehension. Over the last few years Helen has been changing the food supply in the family, and while it was much easier for her than she anticipated, getting the kids on board has been a very gradual process. When the children are at home for meals, it’s much easier to eat a minimally processed diet and parents have a much better idea about what their children are eating.  Possibly more of an issue though is that at home kids aren’t surrounded by other children and their brightly coloured, sparkly packaged food which might make their homemade lunches both different and a little mundane. I know a lot of parents have this concern – starting school is both exciting and scary for parents and children alike; the last thing either want is to increase this by appearing different from the masses. I asked Helen to write about how that first week went as I was sure she could offer tips to help other parents navigate the lunchbox.

I have been dreading this week. My little girl has started school and neither of us was entirely ready for it. On top of that, the thought of preparing enjoyable and nutritious lunches every day has been freaking me out! How would I cope? Would every day be a battle? Would I have to accept defeat and make sandwiches?

One week down and I realise lunches were the least of my worries! It’s been an emotional roller coaster but one thing that has actually gone OK is the lunch box so I thought I’d share my experience. The first thing to consider was the lunch box. We let her choose her own and the Sistema ‘Quaddie’ is working well. The fact that other children in the class have it is a big plus too.

Day 1

Lunch was prepared the night before and this has now become the routine. We had slow cooked lamb and veggies for Sunday dinner and thankfully she enjoyed it so much she asked if she could have it in her lunchbox the next day. I couldn’t believe my luck! So on her first day of school, off she went with lamb, kumara mash, roast beetroot and feta. The previous week I’d been complaining how she would never have dinner-type meals for lunch and there she was asking for it.  Selecting non-chewy pieces of meat was the key (slow cooking helped massively here) and using smaller plastic containers within the bigger box to stop things getting messy.

Lunch isn’t until 1pm so the children take a small brain snack as well as morning tea. The brain snack we were told should be a piece of fruit – a bit of a problem when your daughter doesn’t like fruit. We don’t have an issue with that, given her love of a variety of vegetables. She said she would have a small piece of banana but this was the one thing that came home uneaten on Day 1. Nuts, yoghurt with ‘special sprinkle’ (based on this Sarah Wilson granola), cheese, a few rice crackers and a homemade dark chop chip muffin based on this I Quit Sugar recipe were all eaten and (I think) enjoyed. Ella told me there was too much food but nerves were probably affecting her appetite.

Day 2

Lunch was chicken goujons – made the previous week with a Pete Evans crumb recipe (such as this one) and then frozen – more veggies (buttered), a hard-boiled egg, cheese, nuts, yoghurt. Same result as Day 1 – all eaten, partly due to the teachers encouraging the children to eat everything in their box. This actually upset Ella a bit – she eats when she’s hungry and doesn’t want or need to be forced to eat. I deliberately put in more than I thought she would need so that a) she would have choice and b) there would definitely be enough. I said I’d have a word with the teacher if it became an issue but thankfully it doesn’t seem to have.

Day 3

Lunch was going to be meatloaf but due to a mini meltdown about being scared of school and not liking meatloaf, it was removed and alternatives were offered. I’ll try not to let this happen too often but I was desperate for her to be happy during what was becoming an upsetting week. When she turned down one of her favourites – a tuna mayo sandwich on seed bread – I realised this was more about not wanting anything at all than about not wanting meatloaf. I think if I’d offered her ice cream that day she would have said no! We took her brother to daycare, came home, had a game of Monopoly and tried again! I let her look in the freezer and choose anything she liked….she chose a piece of salmon, leftover from one of our dinners the previous week. We usually buy a bigger piece of salmon than we need and pop the leftovers in the freezer in bite sized chunks so they can be defrosted for lunches.

The night before I’d made some seed crackers so these went in too, along with some cheese and other bits and pieces and the verdict that night…..I want exactly the same tomorrow!

I won’t be doing this every week but it was so good to see her happy, off I went to the supermarket to buy some salmon! And we did it in reverse…I cut off a couple of inches for her, cooked it for 2 minutes in the microwave and we had the rest the next day.

Day 4

This was the same as Day 3, with the addition of some buttered green beans. Meanwhile her little brother Tom had the uneaten meatloaf from the previous day (another Pete Evan’s creation) and loved it! I told Ella this and to my surprise she said she would like it in her box the next day. So Day 5 was sorted. Fortunately she is happy with eating food at room temperature due to us not having facilities to heat her baby food when she was younger and we were travelling. More green beans, carrot and dip, some almonds and peanuts, yoghurt and ‘no grainola’, and seed crackers and cheese finished off the box. Oh and a small beetroot that she pulled from the ground herself earlier that day. So we have a system and so far so good. She’s even eating a little bit of fruit each day – a one inch slice of banana with skin removed and no trace of any stringy bits!

Reflecting on our first week…

The food is fresh and real but I’m not slaving over it every morning or night. I realise now it’s just filling a box with whatever’s on hand, having shopped for the basics at the start of the week.
I’m no longer stressing over creating real food versions of typical lunch box items, or worrying that she needs a completely different box every day. When the box has the variety of nutrients in it that hers does, and she likes it, much of it can stay the same each day.

I’ll make a batch of ‘no grainola’ and seed crackers every Sunday and hopefully a different homemade dip each week (I’ll use rice cruskits sometimes if I run out of seed crackers or for a change). And perhaps once a month a loaf of grain free bread to sandwich some tuna mayo in one day. I’ll make and freeze meatballs, goujons, muffins and mini egg frittatas that can be pulled out and defrosted overnight. When we BBQ I’ll put on extra meat and in the morning when I make myself an omelette to take to work, I might make it bigger and put a slice in her box.  I’ll hard boil a pan of eggs and when I cook veggies I’ll always do extra. When the weather heats up I’ll freeze yoghurt or a smoothie before it goes in the box.

I see now that I’d built the whole lunchbox thing in to a bigger deal than it is and I’ve gone from being daunted by the prospect to quite excited by what good food I can pack her off with each day. Our kids have had a couple of years of living a balanced real food lifestyle – by which I mean that most meals and snacks are unprocessed and nutrient dense, but ice cream, pizza and cake are enjoyed occasionally. They are the much enjoyed treats that they were when we were kids. She knows these aren’t everyday foods and really enjoys a wide variety of vegetables (especially when tossed in butter) and other whole foods. It’s just the norm for her and I hope it can stay that way.

She’s active, with a healthy metabolism so it’s not about her lunch box being low carb, it’s about it being as nutrient dense as possible. It’s about it containing foods that will give her energy and help her body and brain develop. I love that she will grow up thinking a real food lifestyle is the norm, where you make things rather than buy things and even grow them yourself where possible. I hope this becomes the norm for more kids her age.

My husband and I are in total agreement about what we are doing and although I am doing most of the preparation, it is a shared responsibility that he will happily take on when needed. We start the day with an awesome breakfast and finish it with a wholesome dinner, so even if the box I make doesn’t get touched, or it isn’t perfect every day, it won’t be the end of the world.

I know she loves good food and will eat if she’s hungry. Where possible I’ll get her involved in making and choosing things but at the end of the day, she’ll get what she’s given, just like I did and I turned out alright! It will not be a hassle but it will get as much thought as our meals do…it should shouldn’t it?

Post-script: Ella now enjoys sushi every Friday, just a few pieces. She loves it and it makes for an easy lunch day for us.

 

A few quick thoughts on the Ministry of Health Eating and Activity Guidelines for Healthy Adults

After over a year since the Ministry of Health asked for submissions to the draft food guidelines, they have finally announced an update. Undoubtedly they were waiting for the lead taken by the US who are in the process of updating theirs and, looking at ours, it’s a shame that New Zealand didn’t man up and take the lead from Brazil last year, who focused not only on food but non-food related factors related to eating behaviour, such as the eating environment, the social environment and food advertising. Anyway.

As in the first draft, there has been little more than just wordsmithing of the existing guidelines that were last updated in 2003 in this new document, the Eating and Activity Guidelines. While there is a paragraph on the end that recommends choosing ‘whole food’, (which is great, I do really like this), for the most part the guidelines remain largely unchanged from the existing ones and therefore aren’t in line with that recommendation.

While there has been an extended period of time between the original draft and now, and the guidelines say they are based on best available evidence, to my mind this actually is NOT evidence in some areas. As part of the Human Potential Centre we wrote a submission to the Ministry of Health and provided them some of this best available evidence. This hasn’t appeared in the final update. While unsurprising, it is still a bit disappointing.

The full guidelines are here and I just thought I’d give a quick summary of where I feel the Ministry could have improved the guidelines for the health of the population.*

Enjoy a variety of nutritious foods every day including:

  • Grain foods, mostly whole grain and those naturally high in fibre

Pasta and noodles and couscous and cereals aren’t whole grains. They may have been whole grain once (as they are grain products!) But they are FAR from whole grain despite what it says on the packet. Sorry. Regardless of whether they say ‘whole grains’ or not, there are few whole grains in the diet. Barley might be one. As Prof Mann from Otago has said ‘most wholegrains in the food supply aren’t intact and are equivalent to a bag of glucose (read this here for a dietitian’s view on the post – and then check out who his clients are or have been….cough cough).

With this in mind, and with two thirds of New Zealander’s categorised as overweight or obese, a growing number of people being diagnosed with pre-diabetes and type 2 diabetes (and many more estimated undiagnosed) it is perplexing that there is a focus on foods which are as nutrient devoid as the packaging they come in (i.e. pasta). Not all carbohydrate sources are created equal, and your naturally occurring carbohydrate sources such as potato, kumara, yams and fruit are far more nutritious sources of carbohydrates for people who can tolerate them. It’s not about ‘no carb’ – it’s about quality carbohydrate. The recommendation to include pasta, cous cous, bread and cereals –processed, refined carbohydrate foods – is in contradiction to the awesome recommendation to choose whole foods.

  • Some milk and milk products, mostly low and reduced fat

This is NOT the most up to date research. Many many epidemiological studies support the use of full fat dairy being beneficial for weight management, heart health, gut health in all age groups. Ministry of Health is scared to say ‘blue milk’ as it contains saturated fat (in context of whole food diet in normal amounts, this isn’t an issue.’ MOH should read my blog post on why full fat dairy has important health benefits that can’t be gleaned from low fat. And…. Full fat dairy is far more satiating than low fat. We feel fuller and are able to better manage blood sugar levels and with it mood, concentration and overall energy. We’ve been buying into the low fat message for far too long and it’s about time we kicked that to the curb.

  • Some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red meat with the fat removed (Eat less than 500 grams of cooked red meat a week.)

A large proportion of New Zealanders are both iron and zinc deficient and red meat is the richest source of these nutrients, along with fat soluble vitamins and antioxidants such as Co-Q10 which play important roles in the health of our cardiovascular, digestive and musculoskeletal systems. Most dietary iron comes from breads and cereals which contain nutrients which bind iron and prevent absorption. There has been the recent IARC report suggesting that red meat is a carcinogen, and while it’s important that red meat intake is moderated to a palm size portion as part of a meal, it’s good to be aware of the critiques around the red meat issue (such as this and this). I do wonder, though, if there are differing health effects in populations eating red meat in places such as New Zealand, where our beef and cattle industry (predominantly grass fed, no antibiotics or hormones) is quite different from the hormone, grain-fed, antibiotic administered environment of that in the US.

In addition – as you know, it’s the processed meat that we need to be more mindful of. Luncheon and saveloys and chargrilled (burnt to a crisp) sausages on the BBQ should be avoided.

  • Choose and/or prepare foods and drinks with unsaturated fats instead of saturated fats (SAFA).

We’ve been over this a LOT I know – check this out and this out. Abnormal amounts of anything is going to tip the balance in the wrong direction health wise, especially in the context of a diet that is also high in refined carbohydrate. It can also be problematic for people consuming large amounts in the context of a real food, low carbohydrate diet actually. So it is individual. However there is a difference between consuming ridiculously large amounts (i.e. a bulletproof coffee for breakfast alongside bacon and eggs fried in butter) and encouraging people to choose butter (a minimally processed food) instead of margarine or other industrial seed oil spreads (highly processed) to sauté their green beans in.

In addition, while the guidelines say that it’s beneficial for heart health to replace saturated fat with polyunsaturated (PUFA) fat, I’ve asked some smart people about this and replacing SAFA (or any fat) in the diet with PUFA may only beneficial when the diet is deficient in nutrients such as antioxidants provided by the seed oil, or if the diet is deficient in PUFA (never really seen in New Zealand. Further, the real benefit comes from long chain omega 3 fatty acids (from fish for example) rather than seed oils, which are certainly beneficial for health, including heart, brain and vascular health.

So… while it’s great there is the inclusion of the paragraph that encourages the consumption of real food that is minimally processed (and on that most people are in agreeance), the continual promotion of grain-based foods, low fat dairy and plant-based polyunsaturated fats such as seed oils goes against this recommendation. I don’t know if this paragraph is merely a nod to the growing awareness the consumer is having with regards to their food (rather than a genuine recommendation) or a lack of understanding of what ‘minimally processed’ means. It feels like they have their feet in both camps, but it could only serve to confuse people who are navigating an already confused food environment.

*someone else much smarter and more articulate with more time could probably do a more indepth review.

What this nutritionist ate on Wednesday.

So after the Business Insider profiled the typical diet of a nutritionist this week, I got a number of people asking to see what I ate in a day. Happy to talk you through the photo essay that represented what I ate on the following day, a Wednesday. It’s a fairly typical ‘non-typical’ day for me. I have busy client days on Tuesday and Wednesday and if I’m not that prepared then it can end up a bit all over the place (as with most people). However I wanted to be genuine with it and not stage the perfect day. Because I don’t eat a perfect diet! Yes I follow the dietary principles that I advocate, but am pretty….normal?! If you follow me on Instagram then you’ve seen all of this before. What follows is going to be of no interest to anyone who isn’t interested in food or my general musings/setting the scene.

A bit of diet preamble: I would describe my diet as low carb,  healthy fat (LCHF). Not low carb high fat – the hangover from being an overweight teen/young adult and from preaching the low fat guidelines up until around four years ago. What does this mean? It means that if you come to my house for dinner then I’m unlikely to serve all of the vegetable dishes swimming in butter, cream, cheese or olive oil.  In fact, that kind of grosses me out to be honest. You might get one vegetable side dish like this. I will also typically drink my coffee black unless I feel a bit on edge for whatever reason, and I will have it with cream – I’ve tried to find some literature to support the idea that cream dampens down the cortisol response of coffee (which makes sense to me, as caffeine and other constituents of coffee stimulates insulin and cortisol) but have yet to do so. It also means that I no longer freak out if someone serves me a meal that DOES have the vegetables swimming in butter or coconut oil (and I will probably like it).  It means that I cook curry-type meals with coconut cream and not yoghurt, that I am no longer afraid to use more than a teaspoon of coconut or olive oil when I cook, that I add fat to my salads by way of mayonnaise or pesto. That I snack on cheese and that I add nuts and seeds to salad. That I don’t purposely buy food that has had the fat removed.

This may not be your LCHF diet, but for me it’s the healthy addition of fat in normal amounts (on my plate at least). If I was keto (as I have been before) then clearly this would be different.  It’s funny, there’s always backlash when I post a food that is (naturally) low in fat from the hard-out LCHF’ers. I use my ‘I know better than you’ nutritionist stance to remind them LCHF is a dietary pattern, not a food category. It doesn’t mean that every food you eat should be low carb, high fat. I prefer fresh and crisp, light and colourful, and I probably eat more of a ‘Zone’ type diet actually (if I was going to ‘label’ it in regards to macronutrient content). I haven’t put my food intake into an food database analysis to check this – but in my job you pretty much know things like calories, fat, protein, carb content of what you eat. Just like a personal trainer knows what muscles they are working when they do a set of mountain climbers. You don’t need a database to tell you the basics.

Anyway: this is what I ate on Wednesday:

  1. A tribute picture...forgot to take one at time so I staged this. You get the drift.

    A tribute picture…forgot to take one at time so I staged this. You get the drift.

    Up at 4.40am (yes, early! I channelled my inner elite athlete or morning radio host here) to do a longer run before an early client. I had a coffee (instant – Moccona. I have a Nespresso that sits on my bench that gets little use) and some coconut butter. I don’t always eat before a run, I base it on how I feel more than a schedule as such. Sometimes I eat before an easy run, sometimes I go fasted before a long run. I have coffee before a long run or a harder effort, and sometimes I have a teaspoon of coconut oil with the coffee. Alongside it, not in it. Not tablespoons of it blended with butter and labelled ‘bulletproof’, just a small amount. Perhaps more psychological than anything else. FYI this run isn’t a ‘long run’ in runners terms, but as I’m building up from Gold Coast many months ago, it was longer than normal.

  2. Sometimes I put psyllium husk in it. Not today.

    Sometimes I put psyllium husk in it. Not today.

    Two glasses of water, one of them with vital greens in it. The bonus of writing down what I’m eating is that I’m thinking about my water intake! (Women particularly shouldn’t just rely on the thirst mechanism to encourage drinking – while drink to thirst might be approrpriate for men, hormonal differences mean it may not be true for women. Anyway. Water FTW*

  3. It's v cool to ensure your feet are in pictures too right now.

    It’s v cool to ensure your feet are in pictures too right now.

    This is coffee – my travel plunger from Kathmandu that I’ve had for years AND LOVE IT. Yes it probably contains enough caffeine for 4 shots in here (!) but it is actually just for me. Sometimes I finish it, sometimes I drink just half of it. My question is: if it was meant for more than just one person, why put a sipper lid on it?! This coffee experience has ruined others for me though, as I demand a strong coffee, and like a lot of volume. Alongside this is a grapefruit custard thing that I’m testing as part of recipe development for my online nutrition coaching members. ½ grapefruit, an egg, ½ cup coconut milk, 2 tsp Great Lakes gelatin, 1 tsp psyllium husk. I also had a hardboiled egg alongside it. And (not shown) ½ a Canterbury bierstick (sorry I ate that before I photographed it). FYI The Canterbury brand has no nasties and, while sugar is in the ingredients, it is minimal – maybe 1.3g per 100g.

  4. Love this straw.

    Love this straw.

    Off to the Go Healthy Superfood launch. Get handed a smoothie tester made by one of my food heros Kelly Redmond (bonnie delicious blog). We have bonded via Instagram over a shared love of nutrition and health podcasts and she is as much of a geek as I am. The snoothie had cacao powder, date, almond milk, coconut water (I think?) and possibly another superfood super powder. I have about half of this. I’m not that enamoured by coconut water actually, so just put it to one side. I also have a couple of glasses of sparkling water.

  5. We've got zoodles, vegetable dips, raw cookie, a cacao brownie and some chocolate mousse.

    We’ve got zoodles, vegetable dips, raw cookie, a cacao brownie and some chocolate mousse.

    The recipes that we made as part of the launch. A tasting plate and there is no size distortion in this picture. It’s a small plate. FYI recipes developed by Kelly and Mon from The Snack Pack – she’s the creator of Amazeballs and has made a lower sugar Amazeball (a woman after my own heart). I’m not a big fan of raw treats that are heavy on honey, dates and the like – obviously from the ‘health halo’ perspective of ‘no added sugar’ but I’m mentioning it here not from a zealous nutritional stance, but just a taste preference actually. Another cup of water.

  6. IMG_1190Back up to the clinic in Ponsonby to have a quick snack before clients. Have a small cucumber with a couple of eggs. I also have a glass of water here. Normally I would have a salad actually, but I wasn’t sure if the launch was going to be lunch, or if it was going to be smoothies, or completely sans food, so I prepped some additional food just in case. Yes, those counting would see this is four eggs in one day. I don’t always eat four of them (as I try to vary my protein), however I do love them and they are super easy to just eat like this, so it’s not a major. This isn’t ‘lunch’ per se as it’s not big enough to be a meal – more like (along with the tasting plate and below) one of a series of snacks.
  7. The zucchini in a smoothie is an idea from Sarah Wilson. Makes it smooth and thick and adds vegetables. #winning

    The zucchini in a smoothie is an idea from Sarah Wilson. Makes it smooth and thick and adds vegetables. #winning

    Home to have a smoothie as the random eating pattern has made me hungry today. Usually I wouldn’t normally snack this often, and more often than not I don’t snack  – but if I’m hungry then I will eat. I’m also thirsty so this is perfect. It has cacao powder, zucchini, a cup of almond milk, a tablespoon of protein powder, some psyllium husk. I also have ½ a boerwors stick (found this Mrs Grills no nasties one at my local fruit and vegetable shop. Really hot though!!)

  8. IMG_1196I meet friends for a quick drink before dinner. I generally have 1-3 glasses of wine across the week. Not normally on a Wednesday.
  9. The usual.

    The usual.

    This is pretty standard and I love eating like this. Leftover chicken with assortment of vegetables (brussels, carrot, pumpkin, tomato, zucchini, red cabbage, avocado, almonds, carrot dip and babaganoush (both homemade), homemade mayonnaise and Be Nourished Ruby Raw Kraut. If not chicken (and rarely chicken breast) then it will be beef (mince, burgers), salmon (smoked, fresh), pork (belly, mince), lamb (roast, mince), liver (chicken or beef). I very rarely have vegetarian meals (unless doing some recipe development) and my days at Weight Watchers has put me off The Stirfry for life. It would be a rare event where (at home) I wouldn’t have a salad of some description. Weirdly I wouldn’t have canned salmon, tuna, eggs or sardines for dinner. Nothing wrong with that though – it’s almost like they aren’t on my radar past lunch. Of course if you serve them to me as part of a meal then I’m sure I will enjoy it immensely. I don’t often have steak as I have little confidence around cooking it. I’m no chef – more a food hack.

  10. IMG_1201After dinner treats. 99% of the time I eat a sweet treat after dinner because I enjoy doing it. This is a couple of squares of chocolate and some leftover genuine sugar free treat I made which is seriously delicious. I would often have some peanut butter and coconut after dinner if not chocolate. Yes that is a Starbucks cup. A different one from the one at the start of the day. I love these as they are big and hold a good volume. And cute too. I have a San Fran, a New York and a Los Angeles one.

So there you have it. Nothing was staged, this was my food for this day.  Unlikely to be interesting enough to go viral or to be picked up by a digital magazine (:-) – I mean these pictures are pretty dire even by MY standards). It reflects an ‘atypical’ day but gives you an idea of the choices I make on a day to day basis. I don’t avoid dairy but there’s none in my food intake for this day. I would definitely have a bigger lunch on a ‘typical’ day. I don’t avoid fruit either but I would probably eat more fruit during the summer months. I can’t think of any other disclaimers to add other than, like all posts such as these, it’s not up here for you to emulate (like I said, it’s not perfect! Not that I expect you to be perfect) as we are individual as to our nutrient, energy, meal, allergy requirements. General tips would be:

  • Include protein in all meals and snacks
  • Add fat for satiety and/or include fattier sources of protein
  • Your better sources of carbohydrate are always the starchy (potato, kumara, peas, corn) and fruit as opposed to pasta, bread, crackers etc. Your requirements for this are on a sliding scale from ‘none’ to ‘fist- 2 fist size’ depending on activity, metabolic flexibility (ability to burn fat as a fuel source), metabolic health, energy, mood….
  • Include vegetables where possible and I know you’re thinking Try for 5 or 5+ a day. Back yourself. Why not 8?! Your meal ideally would be based on an abundance of vegetables. As those over on Instagram like to boast #morevegetablesthanavegetarian

* FTW = for the win

Do you need some Headspace?

Do you sometimes feel like you just need more room in your head? Like there’s little space in your brain to concentrate on important things because you’ve got a lot of other tasks, thoughts and emotions which are taking up room? I did. On the encouragement of my mate Bevan I decided to give Headspace a crack. Headspace is described as a gym membership for the mind. A course of guided meditation, delivered via an app or online, that you can undertake sessions in length from 5-20 minutes per day. Apparently 80% of business leaders and entrepreneurs engage in some meditative practice daily, and while obviously not the sole reason these people are successful, some swear by it as the making of them. And this is daily meditation – not yoga for 90 minutes, 1-2 times per week, but small amounts of time to sit down and just ‘be.’ If you’re reading this then you’ll know I’m about more than just food; anyone who has come to see me in the clinic knows that I spend around two-thirds of the time talking about seemingly ‘non-food’ related lifestyle information. However most of you also realise that these elements of health can’t be changed in a silo – they all affect each other and help uncover whether your dietary habits are working for you or against you.

I’d resisted Headspace (and any kind of meditative practice) as I thought that you had to be quite ‘Zen’ to even do it. Which, when I think about it, is kind of ridiculous given that the whole purpose is to help you sit with your own thoughts, not try to get rid of them or shut them down. I also thought that I had to do it for at least 20 minutes every day in order to experience benefits (and who has 20 minutes?!) Again, this is also incorrect. In fact, these misconceptions were really the first of many I’ve discovered after doing Headspace consistently over the last 100 days, some I’m sharing today.

I am a person prone to anxiety. These things run in my family. My nana wasn’t a particularly happy person until she went on medication for her anxiety – quite frankly, this didn’t dramatically change her personality but it certainly made a change to her disposition. Others in my family are also more likely to feel depressed or worried and anxious, so I would use the label when describing to people (or even when I thought of myself) as the type of person I am.

But, actually, I’m not.

This isn’t just about engaging in meditation – my brain definitely calmed down when I ditched processed food actually, however I still identified with being an anxious person. After around a month of Headspace it dawned on me that the physical and emotional signs of being anxious weren’t actually present. It wasn’t until, during the anxiety sessions of Headspace when we were asked to try to disengage with the thought patterns associated with anxiety that I realised they weren’t actually there (this thought was actually quite distracting!)

I have thought a lot about this over the last couple of months. I don’t think Headspace enabled me to view the world so differently that I don’t respond with an anxious head and heart – I think what it has done is enable me to view myself differently. I had set up this belief in my head that I was a person with anxious tendencies, and with this firmly planted in my head it dictated how I described myself to others and, more importantly, how I responded to the world around me. Do you know how liberating it feels to be free of this? I actually can’t describe it, but it has noticeably changed my thought patterns and subsequently my actions. The thing is, beliefs do that – they create this lens with which how you interact with other people and the environment without really realising it. People who have started and stopped diets multiple times in their lives almost unconsciously label themselves as a failure when it comes to eating well. Is this you? Do you embark on a ‘diet’ or ‘way of eating you already ‘know’ that you will fail? Changing these belief structures are key to changing whatever emotional or physical road blocks that might exist when trying to change your diet.

Headspace has also made me realise that I needed to get rid of a lot of things that were either in my emotional space or in my physical space. I’m not a minimalist (though not a fan of trinkets), it’s more of a ‘get rid of things that don’t matter’ declutter. Books I don’t need yet I have hung on to. Clothes I don’t wear yet can’t get rid of.  I’ve deleted over 400 people from my personal Facebook page. And if you’re one of them, it’s not you it’s me (genuinely).  I have tried a few times over the last two years to do this but I could never make the start as I would scroll through the list of friends, hand hovering over the ‘unfriend’ button, and come up with reasons as to why I couldn’t delete that person. This time I went into the exercise with a different set of questions. As basic as it sounds (and perhaps you can concur), the first question I asked was ‘do I actually know you?’ I used to love Facebook as a way to connect with friends, old and new and this is just a way of bringing it back to the reason why I signed up in the first place. And, the reality is, the people that have ‘unfriended’ probably just never got around to doing it first and likely won’t even realise I’ve done it. Again, this may not just be about Headspace, but I think it made me more aware of ‘stuff’ that takes up unwanted space in my physical and emotional surrounds and this helped me make a start and declutter. What about you? Do you feel burdened by ‘stuff’ to a point where you feel you’re wading through quick sand but not getting anywhere? Do you need to declutter your physical space, your emotional space, maybe even people around you to create room for behaviours, habits, feelings and people that will serve to help move you forward rather than hold you back? If you don’t really know, then meditation can help you step back and evaluate the ‘stuff’ that is important and positive and the stuff that is not.

When I bring the idea of meditation up with people in my clinic I get a mixed response. People are so willing to change their food, their exercise and even their sleep habits actually before trying to change their thought patterns. In fact, without the latter most people are not going to see any sustainable, positive changes in the former. I get it. In today’s fast paced, stressed-to-the-max world where there are demands on your time from every corner, it’s difficult to imagine where you are going to find more time to do one more thing. However, you really can create more time by doing some form of meditation. It’s just difficult to believe until you try it.  And, hey, maybe you don’t need it. However, if the idea of taking 10 minutes out of your day to sit down and just ‘be’ sets you in a panic because you are just far too busy, then perhaps you do need Headspace*.

Buddhify is another popular app. Or even Youtube some meditation practices if you’re unsure of how to start. There are so many of them out there that if one doesn’t grab you, I’m sure you’ll find another that does.

Image from hinesight.blog.com

Image from hinesight.blog.com

 

Could your gut health be responsible for your high cholesterol?

You are probably aware if you have been reading my blog for a while and following likeminded people that it’s not as black or white as whether or not your high cholesterol level is a problem. Much as I get a bit on edge when I see plates of food without any colourful vegetables (I’m not going to lie to you!), I get a little bit twitchy when I see it professed everywhere that it’s no longer a problem to have a high cholesterol level. Not true. Now cholesterol is essential to life. Without it, we wouldn’t be able to make hormones, repair cell membranes and do 68 other things that require cholesterol. Your body makes 85% of the cholesterol circulating in your bloodstream even, meaning that, for most people, the cholesterol eaten by way of animal products (animal protein, eggs, cream, butter, cheese) will have very little impact on their overall cholesterol level in the body.

One of the main factors that can cause high cholesterol levels is not the cholesterol that you eat (and you’ll be aware that in New Zealand we’ve not had a recommendation around reducing cholesterol containing foods for a while – though the rumour of the egg just will not die). It’s also not just about the fat that you eat. While scientists were busy trying to prove the diet-heart-hypothesis correct over the last 50 years (you know, the one that has pretty much governed our public health nutrition messages and is still today being pushed by nutrition authorities, despite the failure of aforementioned scientists to do so), the powerhouses of the food industry were busy manufacturing and marketing those low fat, processed, refined carbohydrate-based foods that contribute to an inflammatory state which underpins all chronic disease – including heart disease and high cholesterol levels. That is something I have understood well. However after listening to that brainiac Robb Wolf discuss cholesterol with Dr Rhonda Patrick on a recent podcast about cell metabolism the role that the gut plays in both the inflammatory state and our cholesterol levels which could determine whether or not we should be concerned was touched on. One of these was through increasing insulin resistance (IR; and inflammation) at the local level of the gut, and the other was the inflammation that occurs through gastrointestinal or gut issues which may include this IR, but also any challenge which stimulates an immune response.

We know that IR is caused by high circulating blood sugar levels requiring a constant response from our pancreas to produce the hormone insulin to ferret that glucose to where it’s required (working muscle tissue, our carbohydrate stores, red blood cells and retina, brain and excess converted to triglycerides in the liver). Constant and chronic high blood sugar levels and subsequent insulin release causes the pancreas to work overtime which, over time and in some situations, our body is unable to read appropriately or respond effectively – our cells become immune to the insulin trying to deliver glucose and glucose and insulin hang around our blood system causing glycation of proteins, cell damage, oxidation and inflammation. The IR causes systemic inflammation which further drives insulin resistance, higher blood triglycerides, lower HDL cholesterol and weight gain, specifically central weight gain which creates even more inflammation. A bit of a cascade which, if not managed, leads to type 2 diabetes (one of the major ‘end points’ of insulin resistance, if you like). Further, those with type 2 diabetes tend to have higher cholesterol levels. Well, what if this also starts in the gut?

Dr Rhonda Patrick spoke of a paper she read in Nature* that reported on research that showed chronic over consumption of processed refined carbohydrates can cause epithelial cells of the gut to become insulin resistant and unable to take up the sugar. We get IR in the local level of the digestive tract and this is pushed out to the rest of the tissues because of the inherent systemic features of the inflammation. Meanwhile, the bacterial cells that are present in our gut are getting all of the glucose that they want and thriving*. Because the IR means our gut cells aren’t able to take the glucose up, the goblet cells in our gut (the ones responsible for secreting mucus to protect our gut wall) aren’t getting the substrate required for them to make energy and produce the mucus to protect our gut intestinal lining. Over time, with no energy, the gut barrier will begin to break down.

Now – this is where the quality of the carbohydrate matters. Dense carbohydrates such as potatoes, sweet potatoes and minimally processed grains tend not to be metabolised in the upper portion of the small intestine and tend to provide more fermentable substrate that feeds our gut and supports our gut health (for an excellent paper by Dr Ian Spreadbury – incidentally one of the speakers at the upcoming Ancestral Health Society conference in Queenstown in October, click here). This means that these types of carbohydrate are not going to create the inflammation in the way that those refined grains do – the ones that we base our public health recommendations on (cereal, wholegrain bread, pasta and the like).

So, that inflammatory state that is started locally at the gut level is another mechanism that explains how the state of our gut can determine whether your high cholesterol level could be a problem.

The other one more directly affects the LDL cholesterol circulating the body.

FACT: the gut is the nexus to health – it has the largest concentration of immune cells as it is exposed to the external environment (food). Those immune cells are there to fight off things which are pathogenic.  The gut also it has the highest concentration of bacterial cells, and immune cells and bacteria together are NOT a good thing, particularly when they come into contact – that’s why we have that epithelial barrier that protects the immune cells.  As soon as that barrier breaks down, the immune cells come into contact with the bacteria cells and it’s all on, they start firing off these pro-inflammatory cytokines to kill off the bacteria. This results in the bacteria releasing off endotoxin – which is where some of the problem relating to LDL cholesterol can originate.

Bacteria in the gut have a cell wall called lipopolysaccharide which holds endotoxins –it gets released into the circulation when the bacteria are dying (which is why anyone who is undergoing diet or supplemental changes to change the bacteria in the gut might experience initial discomfort as the bad bacteria die off). This increases production of very low density lipoprotein (and LDL eventually) because these bind endotoxins – they soak it up like a sponge. However, instead of being delivered back to the liver to be recycled it remains in circulation as the endotoxin binds to the LDL receptor on this particle and prevents it from being taken back up by the liver. This will increase the likelihood of the LDL particle being oxidised – a major risk factor for cardiovascular disease. You know it’s not about LDL cholesterol or total cholesterol, it is to do (in part) to particle size –the small dense particles have been associated with heart disease.

Now the problem with these LDL particles that have an endotoxin attached is that they are the smaller, denser LDL particles. These particles, already a risk factor for heart disease now have a bacterial signal floating around the blood stream. This causes your immune cells to suddenly be on high alert. The macrophages that come to kill off the bacteria are attacking the LDL and endotoxin and the subsequent action of the immune system starts a cascade of events which over time will lead to the stiffening and narrowing of the artery as it gets stuck there.

Is your head spinning? Tell me about it. And I’m not a brainiac and suspect this could have been explained far more simply by someone far more intelligent than I. However, the main take home from this is that if you are someone that leads a lifestyle which promotes inflammation (high intake of processed carbohydrates and vegetable oils, little to no vegetable fibre, no exercise, lack of sleep, too much exercise, smoking, high consumption of alcohol…) then your high cholesterol reading could be a problem. That, for most people, should by now be a no-brainer.

However, if you are someone who has these factors dialled in and still has a high cholesterol reading, perhaps it wouldn’t hurt to consider the health of your gut.

*try as I might, I couldn’t find this paper. Let me know if you can as I’m interested to read it. Thanks George.

(Not me, though I'm as cute as this dude IMO) - and thanks to http://mrmenoc.wikia.com/wiki/Mr._Brainiac for image.

(Not me, though I’m as cute as this dude IMO) – and thanks to http://mrmenoc.wikia.com/wiki/Mr._Brainiac for image.

Should you be taking a supplement?

Probably*.

I know. I am not even going to write ‘it depends.’ I never used to think like this. In fact, I think you could describe me as being adamantly opposed to supplementation. I would look quite suspiciously on nutritionists who would recommend a raft of additional pills and potions for their clients (from their supplement range). I was a big believer in the idea that you could get everything you needed from food and supplements were for the ‘worried well’, the term used to describe our biggest users of supplements in New Zealand: young, middle-class, female.

That’s changed. While I think you SHOULD be able to get everything we need from food, I no longer think that you CAN get everything from food. A few examples:

For many years now it is well known that micronutrients essential for antioxidant, neurotransmitter and musculoskeletal processes in the body are depleted in our food supply. Iodine is the obvious one. Essential for metabolism and the production of thyroid hormones, the removal of iodophers as cleaning agents from our dairy industry in the 1950s (which was our main source of iodine) and the naturally low level of iodine in our soil has resulted in mild iodine deficiency. Associate Professor Skeaff at Otago (one of my favourite lecturers) completed her PhD in this area and her research suggests that this deficiency, whilst not resulting in goitre, could lead to cognitive problems in children due to low iodine status in mothers during pregnancy. The foetus relies on the mothers thyroid hormones for normal growth and neural development and hypothyroxinaemia (i.e., low maternal fT4) results in damage to the developing brain, which is further aggravated by hypothyroidism in the foetus. This problem has (in recent decades) been further exacerbated by the removal of our main source of iodine (table salt) due to the public health messages around salt and hypertension. Now I’m not suggesting that we need to supplement with iodine in this instance, actually, as the inclusion of kelp, nori wakame and other sea vegetables (and some seafood), nor do we need to go back to pouring anti-caking agent on our food. However, this is a good example of a nutrient that is not readily available ‘in a balanced diet’ for most people.

Another obvious nutrient is vitamin D. While the majority of vitamin D is produced through exposure to the sun, it’s well accepted that this is nigh on impossible for anyone in New Zealand in winter (for the sun doesn’t hit the earth at the right angle for the production of UVB rays). Further, the ‘slip slop slap’ message has led many people to completely avoid the sunlight when it is available for the necessary production. Vitamin D3 is added to a lot of foods by way of fortification in New Zealand, however most foods it is added to are not nutrient dense, whole foods that I would recommend my clients consume (cereal bars, dairy desserts, food drinks, meal replacements, margarines, skim and modified milks, soy milks and yoghurt). Further, while the recommended amount of vitamin D is 5ug/day through the diet, this is based on the role that vitamin D plays in bone metabolism, and is not accounting for the myriad of other roles it has in neurotransmitter production, brain, gut and heart health and overall wellbeing. In New Zealand we have over 30% of adults who have levels below 50 mmol/L as measured in the blood. That’s a significant portion of the population who are considered ‘sub optimal’ yet not deficient. If you have sub-optimal vitamin D status, and are a person who is grappling with a low mood, weight gain and the normal stressors of everyday life, then boosting your vitamin D could be a really good option for you. Vitamin D forms the backbone of our corticosteroid hormones, and when your body is under times of stress (and this is dietary, physical, emotional or environmental stress), the production of our stress hormones increases at the expense of our thyroid or our sex hormones. Call it our evolutionary response to modern life. Why would your body be interested in reproduction (for example) if the immediate problem is one of survival? Further (to all of this), if you are taking a supplement for vitamin D, it’s a good idea to balance it with vitamin K2. This is a vitamin low in our modern food supply (for most of the year – though you can find it in full fat dairy products, egg yolks, fermented foods and in grass fed cows). While 50% of vitamin K2 is produced by our gut bacteria, however the modern diet, the increased exposure to medications, antibiotics and environmental toxins, combined with an overall reduced diversity of bacteria in our gut has undoubtedly reduced our endogenous production of this vitamin (along with impacting on our overall health as we now understand the essential role of our gut in determining overall health.

I could go on with 18 other examples, however your attention may wander, so I’ll move on.

Outside of the food supply, even if someone truly were getting the optimal levels of nutrients as determined by the recommended daily intakes (RDIs), how accurate are these are determining optimal levels of health?? As suggested earlier, some people advocate much higher dietary levels of vitamin D, well above the RDI. The RDIs are determined from clinical trials whereby the micronutrient in question is removed until deficiency symptoms occur, then added back into the intake until the symptoms are corrected and nutrition status is restored. And this is exactly how you want to do it. But this (for a lot of micronutrients) was determined decades ago. Do the same recommendations support the demands of everyday life today? I (along with others) do not think so. Modern life brings with it stressors that can deplete us of nutrients in ways that were probably not even dreamed of when the RDIs were set. Our exposure to  heavy metals, pesticides and other environmental pollutants can impact on our ability to absorb and digest nutrients and may also increase our requirements as a consequence of such exposure. Further, the rate of depletion of the B vitamins, magnesium, zinc and vitamin C are greater due to their role in immune function pathways, which are upregulated when there is this additional burden placed on us through the modern day environment.

Another example of this is an epidemic of zinc deficiency worldwide – and in fact a quarter of New Zealand males are zinc deficient. Zinc – found in pumpkin seeds, seafood, lean meat, eggs, has an important role in our sex and thyroid hormone production, insulin production, immunity, growth, our senses (taste, vision, and smell) and blood clotting (to name a few). Not only is the zinc content of our soil low, chronic stress over time has been shown to deplete plasma zinc and increase plasma levels of copper; an imbalance that contributes to inflammation and with it the health issues that come with that. So, while we may be consuming enough zinc according to the RDIs, there is more to consider than just dietary intake alone.  I really don’t think that it was possible to imagine what life would be like for a lot of people these days, much less account for these in the recommended dietary intakes, even though these were updated close to 10 years ago.

Now, you might not agree that supplementing is necessary, and if someone is in optimal health, with no problems indicative of malabsorption and stressors at a minimum, then I would agree. However, the number of people I see falling into this category are few and far between. Yes, perhaps I may be seeing a skewed portion of the population – after all, they are seeking my help with their energy, digestive, hormonal and weight challenges. Further, they have the necessary resources to invest in my help. However, again, I don’t think this is a valid argument. While my target market as a nutritionist could once be considered the ‘worried well’, this description doesn’t accurately depict my clientele. Worried? Yes. Well? Not so much. Average life span in the general population may be increasing, this is not a reflection of the health of the nation, with the prevalence of allergies, asthma, overweight, cancers, cardiovascular and neurological diseases increasing. All of which require nutrients that aren’t easily obtained through a ‘balanced’ diet (whatever that is).

So…should you be supplementing then? Well, NOT in the absence of an awesome real food, varied diet that also incorporates fermented food, obviously. And… (sorry) it’s NOT as simple as popping a multivitamin, unfortunately. It’s not even that ‘you get what you pay for’ when it comes to supplements – as a hefty price tag doesn’t always reflect biological usefulness in the body which may even lead to a build-up of some nutrients leading to major health problems (as mentioned with zinc and copper). Nutrients that are derived from food sources will always trump a supplement as they are designed by nature to contain these in amounts that work synergistically (together), not antagonistically. There is a lot to consider with supplementation. A standard multi might not be an issue. But it can be.

* My advice is to work with a health practitioner to determine YOUR nutrient needs, as it’s far more complicated than taking a pack of pills in the morning and another at night, and crossing your fingers you’ve covered your bases. While you can take some without the worry of toxicity there are certainly toxicity issues with others. They can then look at the whole picture and not just the food you are or aren’t consuming. That said, most people could probably do with increasing magnesium via a supplement. 

PS If you have even a passing interest in the effects of modern life on our health, check out the Ancestral Health Society of New Zealand – we have a symposium coming up in October in Queenstown!

bottle from somewhere on the interweb. Thank you, random site I've now forgotten.

bottle from somewhere on the interweb. Thank you, random site I’ve now forgotten.