Time restricted eating: when you eat matters

Intermittent fasting is an increasingly popular phenomenon among people wishing to improve their body composition and their overall health – almost as much as consuming the latest superfood.

Intermittent fasting (or time restricted eating, as it is known in the scientific literature) is when we restrict our eating during the day to a window of from around 8 hours to 12 hours, and has been popularised by the fitness industry in recent years. There are different ways to approach it, though from a health perspective, eating earlier in the day to allow for the feeding to align with our body’s circadian rhythm may optimise the health benefits for overall longevity. Fasting has been a practice undertaken for centuries in some cultures, and research reports favourable effects on many markers of metabolic health, including blood lipid profile, blood glucose metabolism and hypertension when these populations have been studied. More recently, researchers have investigated different time restricted feeding protocols in relation to risk of cardiovascular disease, neurological disorders, diabetes and some cancers using rodent and human trials. The longer time spent fasting may have pronounced health benefits, though recently a more conservative method (of even an 11 hour fast) has emerged as being beneficial for certain populations. Indeed, time restricted eating is being thought of as an easy to implement, effective lifestyle intervention that could help improve appetite control, markers of overweight, inflammation, blood glucose metabolism and hypertension, all reducing risk of cardiovascular disease, diabetes and some cancers. This recent small study found that late night (or prolonged eating periods) increased fasting glucose, blood triglycerides, insulin and weight gain.

When healthy adults eat meals that are identical in terms of macronutrients (ie carbohydrates, proteins and fats) and caloric load at breakfast, lunch and dinner, the postprandial (ie. after eating) glucose response to the meal is lowest after breakfast and highest after dinner, even though the meal is identical. This is one example which suggests that our metabolism, and response to food, changes across the course of the day (see here). We are diurnal creatures – we do most of our activities during the day (including eating, working, exercising) and we rest at night. This is controlled by our internal clock in the brain, the superchiasmatic nucleus (or SCN) which in turn influences smaller internal clocks (or oscillators) in the peripheral tissues of our body. These clocks control thousands of genes within our body, including those that regulate our metabolic processes, which accounts for around 10% of our entire genome. While light is the major cue for the SCN in our brain, timing of food intake influences the circadian rhythm in the other tissues, including the liver, which has implications for metabolism. This tells us that our basic metabolic physiology is supposed to behave differently according to the time of day – this is everything from making neurotransmitters, to making insulin, to glucose transport inside of cells, to fatty acid oxidation and repairing cellular damage. It makes sense then that when we eat has just as important implications for our health as what we eat. Research investigating the health effects of fasting has found that anything that breaks the fast will break the fasting period, including no calorie options such as black coffee and even herbal teas. This is because there are compounds within these fluids that require breaking down by the liver. That is not to say that people don’t experience benefits from fasting if they consume a hot beverage earlier in the day (as is often recommended to help get through the morning hours and comply with a 16:8 protocol) or limited calories (for example, 50 calories), however longevity benefits may well lie within the strictest definition of fasting.

With the advent of artificial light, and the changing structure of work schedules (combined with the increasing busy-ness of everyday life), this has elongated the period of time that people eat, which has negative health consequences. While you may have heard in media reports of scientific studies that eating late at night makes no difference to overall weight loss, the focus on weight ignores the more important, underlying metabolic and chronic disease risk that eating late into the evening can have on health outcomes. It may be easier to regulate appetite too, as  research suggests that appetite hormones respond more favourably to eating earlier (8am to 7pm) than later (noon – 11pm), and the level of satiety achieved with this could prevent overeating. This is relevant with time restricted feeding as research has shown that more frequent eating patterns can be detrimental to metabolic health if consumed close together. One study found that participants who ate excess calories consuming their food over three meals and three snacks had increased visceral (stomach) fat deposition, liver triglycerides and lower liver insulin sensitivity compared to those consuming the same number of calories over three meals. The snacks were consumed later in the day, and after each meal, so elongated the overall eating period.

Animals limited to 9-12 hours feeding period, but not limited in the number of calories they eat have experienced benefits including decreased fat mass, increased lean muscle mass, improved glucose tolerance and blood lipid profile, reduced inflammation, higher volume of mitochondria (the energy powerhouse of our body), protection from fatty liver and obesity, and a more favourable gene expression. In humans, research studies suggest that eating within a time restricted window of 11 hours (say, 7am to 6pm) is associated with a reduction in breast cancer risk and occurrence by as much as 36%. Earlier eating time has resulted in more effective weight loss in overfat people, and every 3 hour increase in fasting duration was linked with 20% reduced odds of having an elevated glycated haemoglobin (HbA1c), a marker of long term blood sugar control. For every 10% increase in calories consumed after 5pm there was a 3% increase in c-reactive protein, a biomarker used to measure inflammation (the underlying process that, when elevated long term, can influence risk of diabetes, cardiovascular disease and some cancers). Finally, when meal times were constructed earlier in the day this resulted in a 10% decrease in c-reactive protein. Eating within a 12-hour window improved sleep and weight loss within an otherwise healthy population. You can see then, the myriad of potential benefits to eating within a time restricted eating – could it be worth trying to fit into your lifestyle? And if so, how to do it?

There are many different time restricted eating protocols to choose from – and the type of fast you choose to do really comes down to what works for you. The 16:8 protocol that seems to be most popular is a little aggressive for anyone new to fasting, and this may ultimately leave you feeling hungry, cranky, and vulnerable to overeating later in the day – undoing any potential health benefit that has been shown in the research. Indeed, many people I see that try this as their first experience report that they can successfully get to 11am or lunchtime without eating, but once they are home from work, no amount of food will keep them full, eating right up until bedtime.  My advice is to start a little more conservatively. Given that (in an ideal world), we sleep for 8 hours a night, not eating in the 3 hours leading up to bed time should be a good place to start for most people, thus it gives that 11 hours where some of the health benefits begin to be realised. From there, once adapted, you could try to push it out by an hour. While the most potent benefits occur with the strictest definition of fasting, the blood glucose and lipid improvements, along with fat loss can still occur in those whose definition of fasting refers to calories, not coffee and tea as mentioned above. That the benefits occur in the absence of caloric restriction is important to reiterate, however by restricting the eating period, many people also reduce overall caloric intake, which can further improve overall metabolic health and body composition. Fasting doesn’t appear to be something you must do every day to see the health benefits either, and even 3-4 days a week could be beneficial for metabolic health.

That said, this reduction in calories and extended time NOT eating may not be good for all, especially if your notice increased anxiety, sleeplessness or disruptions in hormone balance, so it is always best to proceed with caution. It would also be prudent for any individual with a health condition to discuss with their health professional before embarking on time restricted eating, especially the more aggressive protocols.

(PS I’ve got dates booked for Nelson, Wellington, Dunedin and Christchurch for my talk! Click here to find out more details, would love to see you 🙂 ).

clock

As with many things, it could be all about timing…

Susan’s ketogenic experiment

Now for something different: Susan came to me this week wanting some support as she embarked on a ketogenic diet. As a woman who is both an avid consumer of information and investigative, she’s done a lot of reading about it but hadn’t come across a much information on the effects of a ketogenic diet on a woman of her age.  So she’s undertaking an n=1, and wanted to document it. She will undoubtedly start her own blog but right now, she’s starting the journey here.

I’m Susan, a 50 year old woman and 1.53m tall, originally from the US, married to an awesome man (but sadly childless), an ‘enthusiastic participant’ of most all things outdoors and lifting weights. I was really lucky to have been raised in a very loving family, working class, suburban, incredibly ‘normal’. My mum certainly did her best where food was concerned, or at least to the understanding she had at the time – iceberg lettuce salad with dressing to start, things like meatloaf or pork chops, spaghetti and meat sauce, tinned veg, and ice cream for dessert. We normally had fast food as a treat maybe once a week – McDonalds, KFC, Fish & Chips. We were normal suburban kids, out on our bikes or in the cul-de-sac until dark, running around, walking to school, and I reckon I was normal weight until…the microwave oven!!!!!!

Both my parents worked, and when the microwave arrived, so did the easy, processed, and addictive after school treats. Hot Dogs! Burritos! Pizza! Hot Pockets! Basically, we’d get home from school and have another complete meal. Still, until I was 16, my weight was pretty much fine. I was never an athlete, but I loved my tramping and my outdoor pursuits, and was an avid girl guide. I lived my last year of high school on Grape Nuts Cereal and Diet Coke. And Snickers. And voila, the spiral into something I never imagined, not just for myself, but never imagined existed. A metabolic nightmare that ensued for the next ten years. By the time I was 19, I had gone from a regular menstrual cycle to having maybe 3 or 4 per year. I went looking for help, and what was the doctor’s solution? You got it, birth control.

When I was 21 I met the man who was to be my first husband, I remember that preparing for the wedding, when I was 23, I went on a crash diet which involved 2 shakes per day and not a lot else, and I managed to get down to about 53kg, which was the lowest I’d been since I was 15 years old. Slowly the weight crept back up, but by then I felt like I had all of the tools to understand what it took to keep me in a relatively small state (mainly, don’t eat!). I also went off birth control, as we wanted to have a child. I did manage to fall pregnant quite quickly, only to miscarry at 12 weeks. Following that, once again my periods pretty much stopped, and eventually I went to another doctor to try to figure out why. I had massively polycystic ovaries (PCOS). The doctor was emphatic that the only solution was a ‘wedgectomy’ and massive doses of clomiphene to force ovulation. I declined.

Fast forward 5 or 6 years, I’m out of my first marriage and in bliss with my current partner and living in the UK. I was still having irregular periods and turned to IVF – which involved three unsuccessful attempts, and difficult recoveries from each. About this time I started having some major anxiety issues. Looking back on it, this was really the turning point for me and my health. It was suggested that acupuncture might help, and thanks to an amazing 5-element practitioner, I was brought back to some semblance of physical and emotional balance. This experience led me to start reading and exploring alternative approaches to health and well being. Some worked for me, the acupuncture and cranio-sacral therapy, and some didn’t and felt like a waste of money, like reflexology and kinesiology. I was  OK with that – I felt that it was OK to try things even if there is a chance that they won’t work .

My weight was not good. My lovely man is (was) a vegetarian when we met, and naturally I joined him. Lots of pasta, rice, soy, bread. You can guess what happened. Then we went on the macrobiotic diet, and that made things worse, especially for me with mood swings and ‘hanger’… By the millennium, I weighed 68kg. Technically obese for my frame. But why? Wasn’t I doing all the right things? Eating purely? Being aware? Clearly not, but then, another voila moment.

My cousin’s daughter had been diagnosed with PCOS, and prescribed a drug called Metformin. My ears pricked up – there is another treatment besides a wedgectomy??? I went straight to the doctor, who kindly but firmly explained that in the UK he couldn’t possibly prescribe Metformin for anything other than Type II Diabetes. However, the universe (and science) had turned. Literally a few weeks after that I read in the Sunday Times about a doctor in Harley Street, London, who had been successfully treating women with PCOS. I make a booking immediately.

When I walked out of his clinic an hour after I’d walked in, my life had changed forever. Dr. Carey knew about the connection of insulin to PCOS, the condition of hyperinsulinanemia, and was fairly confident that changing my diet to exclude wheat and processed sugar, and 1/2 hour of light walking in the morning would work wonders. I can still see the little graph he showed me about what happened to my blood sugar when I ate carbs, how my metabolism had become broken so that regardless of the amount of insulin I secreted it wasn’t effective at clearing the glucose, and that my PCOS was a manifestation of those elevated levels of insulin.

I got my period the next month. And I have had one EVERY MONTH SINCE. And the weight started to melt off. I accelerated this through buying Dr. Robert Atkins book, and adopting the low carb principles. Throughout the week I would eat low-carb bars, nuts and protein.   On the weekend I would eat ice cream and drink red wine. I spent my last few years in the UK quite happily hovering at between 60-62kg. Not lean, but certainly nowhere near obese. We emigrated to Aotearoa in 2003. Joined the gym, took up snowboarding in the winter, kitesurfing in the summer and tramping regularly; we’d found our ‘place’ for sure.

At the start of 2007, I had started getting serious about my weight lifting and potentially body building.  I decided to find a trainer who ‘got me’ and I wound up working under the tutelage of a Sydney based body building enthusiast (female) for the next 4 years. Over those years, I broke innumerate personal records for lifting heavy things, for testing myself beyond my wildest imagination. That was the good part. The not so good part was the dieting! For those 4 years and beyond, I weighed and measured every morsel that went into my mouth. Within 15 months I went from 60kg and 27% body fat to 52kg and 13% body fat (tested in hydrostatic tank) I looked amazing, but my wonderful husband nearly left me! There is a very, very thin line between commitment and obsession.

Without knowing it, those 4 years set me up for another, even worse metabolic nightmare, but again, one that no one could have predicted or imagined. I was fit, lean (a little bit miserable) and seemingly unstoppable.

Then the earth moved.

I was in Southern Cross Hospital on Bealey Avenue at 12:51 on 22nd February. I was getting ready to be prepped for my procedure, when I was thrown out of my chair and watched the building twist and shift. As anybody who was there knows, that was just the beginning.

Everyone had a different emotional and physical reaction to the earthquakes – some left, some got ill straight away, some got depressed. I just went harder. Action, movement, gotta keep going, gotta help, can’t stop. By July I noticed that I was losing whole chunks of time – it was like I’d suddenly ‘snap back’ to reality, having no idea where I was, what I was doing. This was particularly scary when it happened whilst driving! Then one fateful day I was going hard in Bottle Lake Forest on my mountain bike, and my legs stopped working. I wish I could adequately describe the sensation – it wasn’t cardiovascular in nature, but literally, I could not push my legs around on those pedals. I have no idea how I got home.

I had been avoiding going to the doctor for the other symptoms quite simply because I didn’t have a doctor, as mine was tragically killed in the CTV Building. But I now knew I had to do something, so I contacted a wonderful doctor at the Helios Integrative Medical Centre. Thanks to her, I managed to bring myself back to health over the next 18 months through supplementation (including whole thyroid), relaxed, intuitive eating, and much, much less exercise. My physical journey back to health was celebrated by completing the Oxfam 100km in April 2012.

Post Traumatic Stress is a very real thing, whether or not you label it adrenal collapse. I think that through my experience I had instinctively begun to recognise the power of food as medicine, or at least much more powerful than we give it credit for. It sounds obvious now, but I hadn’t really thought of food as anything but pleasure or fuel. What about as true, deep nourishment?

My real food journey included finding the work of Weston A. Price, and the wonderfulness of Raw Milk. We joined a herd share and started our own fermentation bench – whole milk kefir and yogurt – yum! Having been wheat and gluten free (also corn, which is actually the worst for me) since 2000, I made the further step to becoming grain free in November 2012. I will have sushi as a treat, or the occasional slice of gluten free bread with eggs bennie for brunch out, but overall eliminating grains have been super easy for me.

For the past 18-months or so, my focus has been on real food. I made another discovery – I love lambs liver! I’d never had liver of any description, but now we eat it once a week. I buy organic meat or from the butcher whenever possible, and have so enjoyed the nourishment that meat brings to our bodies. I also make bone broth, kombucha and sauerkraut.

I feel great, healthy, balanced, calm, focused, and as an avid consumer of information I have come across the ketogenic diet but cannot find a lot of information out there for the peri-menopausal woman. Hence, I’m enlisting Mikki’s help for my own great Ketogenic experiment. Given where my health is at now (i.e. not a metabolic mess) it is a good time to try it. (Ketogenic: 80% calories coming from fat; 10-15% protein, 5-10% carbohydrate).

I have just received  a Ketonix electronic breath ketone-measuring device from Sweden to measure ketones (a sign that you are burning fat as your prefential fuel, and not glucose), and my overall goals are:

  • To be in ketosis for these 30 days, as measured by my Ketonix, noting anything and everything about the state and its effect on mood, sleep, energy, etc.
  • To be confident enough at the end of these 30 days to STOP weighing/measuring (the most difficult part of this experiment has been getting my head round going back to that practice)
  • To not lose strength in the gym
  • To become metabolically flexible enough to complete a 4-5 hour endurance training session for a multsport race I’m doing, with no carbs and no ill effects (this is the long term goal; and it isn’t ‘no fuel’ it is ‘no carbs’ – this is a long term goal)

I have not weighed myself at the beginning of this month, but I do have a ‘number’ in mind that I would like to see at the end of it, and I’m really interested to see what happens to my blood cholesterol levels (which were tested in June and will be retested in 8 weeks’ time).

Thanks for reading, and I’d love it if you would follow me on this journey. Mikki will be posting updates regularly on my progress.

Raise your glass: a toast to Dry July.

Well, we’ve made it. It’s 2/3 of the way through calendar winter and, for Auckland at least, the climate starts to feel a lot more like spring (despite the deluge of rain this morning). Along with that, we can all raise a glass to those who participated in Dry July. A month without a drop of alcohol is, for some, a big deal. Earlier in the month there was an opinion piece in the Herald regarding Dry July, questioning the utility of it – asking what the point of going one month alcohol free when actually people should look to having a few alcohol free nights per week instead. For those who follow my Facebook page, you’d have seen my initial comments about it. There’s no dispute that choosing to drink moderately throughout the week and including alcohol free nights per week is important; certainly the toxic effects of excess alcohol consumption on inflammation and our organs that contribute to chronic disease are well established. But to my mind, the editorial missed the point. Yes, Dry July is an exercise in abstinence that isn’t a long term approach to alcohol consumption for most. However some people who undertake the challenge, sponsored or not, choose to do it because they are curious as to the impact that not drinking will have on their wellbeing. And these aren’t people who you might consider would ‘need’ it.

A client of mine is just that person. She wasn’t close to the maximum of two standard drinks per day, 14 in total across a week. She enjoyed just one on most nights throughout the week, perhaps two at the most on the weekend. The last time she drank what she would consider ‘too much’ was back in 2008 on a girls night out. And it wasn’t that one drink made her feel drunk – or feel anything other than relaxed – however there was a nagging thought in the back of her mind that the attachment to the glass of wine wasn’t a good thing. She didn’t hang out for the wine from 8am in the morning but it was a little oasis of relaxation in an otherwise busy day that started before 5am with an ironman training session, to move swiftly into her role in a busy insurance firm to another training session to finally arrive home for dinner at around 8pm. It was the only thing that helped her wind down and there was nothing she enjoyed more than that glass of wine as she prepared dinner. We had a discussion about this. While she enjoyed the glass of wine with her partner, she would also take pleasure in drinking it by herself. Her main fear centred less around the physical damage of her drinking but the psychological pull. Her parents are heavy drinkers and have been for years, so alcoholism is something that runs in her family. For her, going alcohol free was as big a deal as the person who has a drink or three after work and then one with dinner four or five nights a week.

What she noticed across the course of the month was interesting. As she reflected back to me this week, she said that the first week was eye opening. She realised that she had been waking up feeling slightly groggy and dehydrated for years without realising it. It wasn’t until she decided to go cold turkey that she discovered it wasn’t a natural state for her to be in. Even the seemingly small amount that she drunk had that effect on her. While the first week was a little strange – as the habit of a glass of wine after work has been ingrained for years – it became easier across the course of the month to go without. In fact, by the end of week four, with just a few days remaining, she realised the main issue for her giving up the wine was the question as to whether or not she would go back to drinking it. The exercise in abstinence proved that she could go without – however to reintroduce it suddenly put her in a conundrum. Would that attachment still be there? Yes, likely – it’s only been a month. The question of whether or not she should drink alone also came up. For some, this type of drinking is a red flag for a more serious drinking problem. However, this isn’t the case for everyone, and I didn’t see it as an issue with this client particularly. The association of guilt here is a lot like guilt around food – I think that in itself can be problematic. If you feel guilty for the drink that you have, you are more likely to drink quickly (almost like it didn’t happen) and not enjoy it. For some, this could also increase the amount being consumed as ‘this is the last time I’ll have a drink by myself.’

The thoughts going around her head were largely related to her family history – which is why she decided to do Dry July in the first place. The one thing she was most concerned about was the possibility that the first drink could open the flood gates and she would be on a slippery slope from one drink a night to two bottles of wine. You’d probably agree this seemed extremely unlikely. She’d been drinking this way for at least 10 years and it hadn’t cascaded into more problematic behaviour. We bandied about ideas that could help her enjoy her wine without the associated (and unnecessary) guilt – but this put rules on it which also didn’t make her feel comfortable. In the end we decided that, if she felt like a glass of wine, she would first have a sparkling water to satiate her thirst, then pour a glass if she felt like it. This solution may mean the end result wouldn’t look any different from what she was doing before Dry July, but it might at least offset the dehydration she felt. Also, for anyone who drinks, this is a good way to slow down how quickly you consume alcohol, especially those who neck the first drink due to thirst. I also always recommend to clients they back up every alcoholic drink with a non-alcoholic, sugar free option. That way they would drink only half as much as they would normally. I’d say I have about a 30% hit rate with that little gem. Those who do it though report feeling a lot better the next day, heavy drinkers or not.

So, raise your glass (of your drink of choice – alcoholic or not) to Dry July, as it creates an awareness around drinking behaviour – for heavy and light drinkers alike. Cheers.