Six things I think you should know about LDL cholesterol

Does bacon deserve the health halo it now seems to have in light of what is becoming common knowledge about saturated fat? Mm. Good question, and it probably comes down to context. If we were to position bacon against Flora Proactive, then that changes the question somewhat: which is better for your health? I mean, one is designed specifically to lower low density lipoprotein (LDL), aka ‘bad’ cholesterol (something we’ve been told for years to strive for) and is ridiculously expensive; the other is … well, bacon. Due to its saturated fat content (or perceived saturated fat, it contains less than 50% of its fat from saturated sources), it is always the second food which people think of when it comes to elevating cholesterol levels and causing heart disease – the first being butter.

Many clients come into my clinic with a total cholesterol above 5 mmol/L and are told by their GP that they should bring their cholesterol level down by way of eating low saturated fat, low total fat and reducing animal protein in their diet. OR (worse) go on cholesterol lowering medication (why is medication worse? Check out here and here). There are many things contributing to a higher cholesterol level, and the risk this poses to you is based on many factors. I’ve covered some of these (and what you can do about it) previously.

Here are 6 things I found useful to know about LDL cholesterol. I’m not talking about particle size, particle number, patterning of particles or Apo A or B, reverse transport cholesterol etc. Keeping it kind of simple. If you know more than your average Joe about cholesterol this will likely be a bit elementary. Otherwise:

  1. Most studies and media reports that report a reduction of risk of heart disease when taking cholesterol lowering medication focus on the relative risk. Relative risk – takes a small effect and it amplifies it. This makes the medication look far more effective than it actually is. Let’s explore what this means:

If you have a clinical trial whereby 100 people are given a placebo drug* and 100 people are given the experimental drug, you might find that 2 people in the placebo group go on to have a heart attack (2%), 98 have no adverse events. In the drug-treated group, 1 person has a heart attack (1%), and 99 people have no adverse events. The difference is 1%, however the relative risk reduction is 50% and a much more impressive number, don’t you think? Those reporting in the media certainly do.

  1. We need cholesterol to synthesise naturally occurring steroids in our system. It is necessary for life. It is the substrate for every sex steroid, for vitamin D, to make new neurons and new synapses to consolidate memories. Many people think cholesterol is in our body solely to clog arteries, and the lower the better. This is not the case. For example, in some populations a low total and LDL cholesterol are linked to higher incidence of depressive symptoms. A low cholesterol level may also result in less synthesising of vitamin D in the body, lower hormone production and an impaired immune system.
  2. LDL is an innate part of the immune system. When there is damage to the artery, you have susceptibility to infection, and there is evidence of pathogens present in plaques. When there is damage to the artery and artery wall, resulting in atrophy, there is an infusion of white blood cells as well as LDL cholesterol which work together to promote inflammation (for healing purposes). Blaming LDL for creating damage is like blaming the fireman for creating a fire.
  3. There is NO level of LDL that is unhealthy. There is an assumption that LDL cholesterol is inherently atherogenic and that above a defined level it is dangerous – there is something about the LDL packaging of cholesterol that causes heart disease. That’s not the case, and some experts in the field believe there is no level of LDL that should be treated with a statin. Researchers reviewing the literature have found people with high LDL with no heart disease. The cut-off of 4mmol/L or 5mmol/L depending on your reference point is an artificial distinction that has been created to suggest LDL is inherently toxic to the heart and cardiovascular system. Now there are people who have a genetic predisposition to storing cholesterol, so they have an increased risk? Actually research looking at the lifespan of people with familial hypercholesterolemia (FH, a mutation in the LDL receptor whereby the end result is elevated LDL cholesterol) have found that, aside from a subsection of the population, there is normal lifespan, with just a small number of these people going on to develop heart disease. There are people who have other genetic variants which do result in build up of LDL cholesterol, and we don’t know enough to say that a very high LDL level is NOT dangerous – however the likelihood of harm will be increased with the presence of other risk factors for cardiovascular disease, such as high blood pressure or smoking.
  4. It is not LDL that is causing heart disease. Blood cholesterol (including LDL) is high in people consuming a higher fat diet. However, research shows that other biomarkers are not only fine, but can be improved when transitioning to a higher fat diet from the standard western diet. A recent paper found that people 60 years and older who have the highest LDL live as long or even longer than those with low LDL. They have lower rates of cancer and lower rates of infectious disease.
  5. If it’s not LDL cholesterol, then what is causing a heart attack? A critical trigger factor is coagulation. We rely on the coagulation factors in our bloodstream to create a clot when we become wounded and begin to bleed. However, our blood can clot without there being a wound. High stress, tobacco smoke, high blood sugar all trigger clotting mechanisms. It looks like this:
    1. In our artery wall, there are tiny arteries which feed to the inside of the artery (called vasovasorum).
    2. Vasovasorum are easily blocked or clogged by clots.
    3. If these can’t feed our artery wall, the wall essentially becomes hypoxic and the tissue dies.
    4. When the tissue dies, the LDL cholesterol comes in to repair it, and this happens repeatedly, causing the artery wall to become thicker and thicker until it chokes the artery.
    5. When you combine this thickening of the artery wall with something that might trigger clotting of the blood (such as high blood sugar, smoking or a stressful or emotional event etc), a clot will pass through the narrowed artery,
    6. The clot will eventually block the artery entirely and the result is a heart attack.
    7. None of this is caused by LDL cholesterol.

What really matters is keeping your clotting factors inactive until they are needed. Most people (unless they are haemorrhaging) don’t need their clotting factors on high alert all the time.

So, which is better for your health? IMO – while bacon may not be a health food, I’d choose it over the Flora (preferably free range, minimal added preservatives, along with an abundance of vegetables). Flora doesn’t have a lot going for it, TBH, and while it may lower your cholesterol level, how important is that really? If your cholesterol levels are high and you’re not sure of your risk, get in contact with someone like me who can work with you to address the lifestyle factors that might be driving up your cholesterol levels and contributing to health risk.

IMG_3158

This bacon isn’t preservative free, however it’s the only one I could see that had less preservatives and was free-farmed, so using it as an illustration. Henderson’s is free of preservatives but only select supermarkets carry their free-farmed variety FYI

 

Do you need to snack? Here’s 31 ideas just in case (and because you’re awesome).

Sometimes you just want some new ideas. Or it’s a day where you just feel like mooching around and making a few things in the kitchen.

Snacking. As I said earlier this week on Facebook, I’m not a fan of snacking for most people as it often means they haven’t eaten properly in the previous meal, thus their need for a snack is due to roller coasting blood sugar levels which affects their stress hormones, energy and mood.

However, sometimes you just need to snack. And if you’ve eaten what you normally KNOW is a balanced meal with plenty of vegetables, a good hit of protein and some fat, but still feel hungry – then you should probably eat. And if you’re not sure what a balanced meal looks like, then check out Jamie’s blog discussing the Heart Foundation’s take on paleo – he outlines what his meals look like. Pretty simple. (And do read the whole post – it’s GREAT).

Ignoring your hunger cues is not good in the long term – yes, even if your goal right now is to lean up, if you’re eating well and exercising appropriately, then it’s likely your muscle mass is increasing and you need to feed it! Don’t use the scales as a guide to your progress – this is gravitational pull – nothing more. In the last 6 months I’ve gained 10 kg to help restore hormonal equilibrium to my over-stressed body – and while on paper it might look like a lot, visually it’s not what you would imagine it to be, as I’ve kept up weight training and gotten a lot stronger. Of course I’ve got more body fat, but I’m a lot healthier too because I’ve got more muscle; it’s had the opportunity to grow as it hasn’t been broken down to use as fuel (which can happen when you’re over-stressed). The scales tell you nothing about the composition of your body. To under fuel (even when trying to lean up) would put your body in a catabolic state, stripping muscle and potentially bone too if you go too low in calories (protein is the major component of bone, you know).

The more you listen to your body and NOT eat to a schedule, set calorie number or macro nutrient goal, the better you will be at at figuring out what your body needs. For most people, we lose this ability at a very early age, because we are told to ‘eat everything on our plates because there are starving children in Africa.’ I feel sorry for parents actually, as almost everyone I know blames their parents for a certain lack of intuition around their eating. It’s not their fault. They were told the same thing.  The good news is, though, is that it’s not irreversible. We just have to start being more aware of what we eat (processed food which is quickly digested, low in fat or protein and not satisfying), how we eat (fast, slow), where we eat (at the table? in front of the TV?) and how much attention we are actually paying to what we eat (device use, TV etc). Here’s some quick tips about mindful eating. You can retrain yourself to listen to your body. It just takes time and effort, but it will be worth it. I’ve just ordered this book too – I’ve heard great things about it and think it will be a really valuable resource.

So back to snacks. Muesli bars, low fat fruit yoghurt and snack packs of Snax crackers are going to leave you hungrier than before you ate them. They are developed to provide the sensory pleasure to your brain that makes you want to eat more (called a Bliss point). They are also high in processed carbohydrate or sugar (especially that fruit yoghurt, these new yoghurt pouches have 4 teaspoons of sugar, around 3 of them from added sugar) which are just best avoided.

Here’s 31 other ideas in case you need some more inspo.

  1. A couple of hardboiled eggs (boil a dozen at the start of the week and make your way through them. They’ll last a good 5 days unpeeled).
  2. A couple of cooked chicken drumsticks (meat that is closer to the bone is far tastier and there are far more nutrients than just pure muscle meat).
  3. Half an avocado, seasoned with salt and pepper.
  4. Around 40g cheese (not Edam. Unless you really enjoy it! Full fat dairy has many important health benefits which for some reason got overlooked with the updated food guidelines. Didn’t they read my blog?
  5. Meatballs – make these and freeze in single serve packs to have an easy go-to snack. Try my sesame miso meatballs.
  6. Almost 4 ingredient chocolate chai brownie. No sugar added at all (I promise).
  7. Raspberry coconut berry bites.
  8. Lemon coconut lunchbox treat. Again, no sugar was harmed in the making of this deliciousness.
  9. A scoop of protein powder with minimal added crap (such as Clean Lean Protein, Vital Health, Balance Natural Whey powder) + ½ cup of full fat Greek yogurt topped with berries. There are many better quality protein powders now available on the market. And while protein powders aren’t my go-to for every day eating, those people who are more active and require protein to support their lifestyle, OR for people who for some reason can’t or don’t eat animal source protein, they can be a good addition to the diet. However there are many CRAP products out there, with a lot of additional fillers, preservatives, additives for flavour, thickeners etc. Check the ingredient lists.
  10. Half an avocado with 1/2 can salmon mixed in, lemon juice, salt and pepper.
  11. Steam some greens (broccoli, brussel sprouts, beans) + drizzle with 1-2 tablespoons of olive oil or butter, add salt and pepper.
  12. Vegetable chips (bit of prep) but thin sliced beetroot, carrot, parsnip, tossed in bag with 2 Tbsp olive or coconut oil + spice of choice OR salt/pepper – baked in preheated oven of 170 deg (350 deg far) for 10-12 min.
  13. Tamari almonds from Alison’s Pantry. These are dry roasted, unlike many that you find that are roasted in vegetable oils.
  14. A handful of Pure Delish cereal (look for 10g/100g or less sugar per 100g) – I love this cereal but to be honest, as a breakfast I’m not going to recommend it as a go-to. I think the brand itself is great, and perfect for tramping/camping as an easy breakfast option. But if you want to ensure you’re not going to go hungry, start your day with a bit more protein. This would fill you up but it is easy to over eat in order to feel satisfied.
  15. The only plant that would survive a nuclear holocaust chips, like these Ceres Organics ones. Hello. Delicious, but wow – expensive! Obviously super easy to make these yourself (many delicious ways to do this).
  16. Kelp leaves flash fried in coconut oil with salt (a great source of iodine, a mineral important for our thyroid function which isn’t easily available in the food supply for people who don’t enjoy seafood). This kiwi (and local to me!) product is seriously tasty.
  17. Dried meat snacks (Biltong, bier sticks) – such as Canterbury I love Epic bars in the States but while some are made with quality NZ meat, they aren’t available here. It’s hard to come by a brand which is minimally processed, so definitely read the ingredients list. Jack Links (despite the great radio adverts which I think are awesome – is NOT a great product. When you try Canterbury V Jack Links, you can taste the difference too – alongside the addition of preservatives other than spices and salt, it is a sweeter product, with 20g of sugar per 100g product, compared to between 1-3g per 100g for Canterbury.
  18. Crackers free of grains, such as Little Bird or Flackers – or make your own. Super simple and a lot cheaper too. There are a lot of variations to these, here’s mine.
  19. Apple slices layered with a tablespoon of peanut butter + 1 tsp chia seeds mixed through
  20. Meedjol date sliced lengthways, with salted pistachio nuts stuffed inside. This is small and not at all lower carb. Delicious though.
  21. Large tomato, scoop out middle, crack an egg in, grate some parmesan cheese, bake in a 180 degree oven till egg is cooked.
  22. The Vegery snack wraps: hello delicious! These would be a great lunch on the go or for a snack. Try the apple and coffee one with some peanut butter and grated carrot. Delicious.
  23. ½ cup cottage cheese + ½ small sliced banana + a handful of walnut halves.
  24. Rice paper (which has been dunked in warm water to soften, then patted dry, wrapped around sliced avocado, a slice smoke salmon, cucumber, grated carrot, snow peas.
  25. Lightly toast a handful of sunflower seeds in a pan, then pop some into a pitted avocado half, salt + pepper. Delicious change of texture.
  26. Cheese + sliced red pepper sliced wrapped in ham that has been sliced thinly off the bone.
  27. ¼ cup hummus (ideally home-made, like Jamie’s one, he is awesome) + teaspoon of pesto in bottom of jar, carrot/cucumber sticks standing up in them. Try to choose a pesto that has an olive oil base, such as this Genose one – not one that is made on a canola oil base.
  28. Apple slices cooked in coconut oil and topped with haloumi, a’la Sarah Wilson style.
  29. A leftover sausage, split into half lengthways, with some cheese grated into it and mustard, heated in microwave.
  30. A slice of my tahini chia loaf with avocado. Yum.
  31. 2 squares of 90% Lindt with a teaspoon of almond or peanut butter. Decadent. You’re worth it.

And I’ve plenty of other ideas where these come from. If you would like more individualised help, check out my services page or sign up to my online nutrition coaching system – it’s free for 28 days for you to try!

snack

PC: www. revive.ca

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.

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.

 

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.

Got a headache?

Ever get a headache?  I would say that most people I talk to have experienced a headache in the last couple of weeks. Indeed, a 2014 telephone survey found that headaches were one of the top five symptoms reported on a weekly basis, with over one-third of those questioned experiencing an episode. Increasingly, it is more than an infrequent occurrence that can be put down to an occasional late night (lack of sleep), being dehydrated or too much alcohol the night before. In fact, I think that headaches have come to the point where we’ve normalised them so much we barely see any reason to pay them much credence. Everyone gets a headache – what’s the point in worrying about it? Nothing ibuprofen can’t fix.

In my opinion, this normalisation of pain is how we’ve addressed (or not) the chronic stress, tiredness, bloating, inability to wake up properly or the slight malaise we might feel on a day to day basis. For a lot of people what I’ve described is just ‘life’. There’s no point complaining because this is what everyone is experiencing so we may as well buck up and get on with it. Like all of the conditions I’ve mentioned above, frequent and recurring headaches impact massively on quality of life. While obviously migraines are a type of pain that would cause more disruption to everyday life, a headache shouldn’t just be dismissed either. It’s a sign that something is out of balance in your life that you should probably address. That said, a closer look at your diet might reveal elements which could be changed or optimised to reduce the likelihood ot these occurring, Specifically, there are nutrients which have been found (in addition to an awesome diet) to be useful for reducing severity and frequency of headaches or migraines occurring. While the jury is out on both omega 3 fatty acids, and vitamin D (with some research suggesting that too much vitamin D may have the opposite effect), there is fairly good evidence to suggest that these may be useful:

Magnesium: in powder form, along with a citric acid or as an amino chelate – up to 600mg per day over three months (this might equate to 2.5g – 5g of powder from a brand such as Bioceuticals Ultraeaze). Studies have shown that many experience a reduction of attacks by up to 41%. Now that is significant.

CoQ 10: not just as part of face cream, in doses of up to 300mg/day (which is fairly substantial) has been found to reduce frequency of attacks and also symptoms of nausea associated with headaches.

Riboflavin: this amino acid in doses of 400mg/day over four months have also been found to reduce severity and frequency of attacks – people of European background are more likely to respond than others due to genetic differences.

A well balanced whole food/paleo diet contain substantial amounts of these nutrients. Magnesium is abundant in vegetables, animal products and fruit; CoQ 10 present in salmon, sardines, red meat, nuts such as almonds, and seeds such as sesame   seeds; and riboflavin is found in substantial amounts in cheese, beef, pork, eggs and oily fish. However if you are consuming such a diet and not experiencing relief, it might be worth considering supplementing in addition to this.

Now people who experience migraines are likely to know which foods trigger an attack. A well studied group of amino acids have been found to trigger headaches and migraines in susceptible people: tyramines, histidines and arginine.

  1. Tyramines: are found in fermented foods (such as sauerkraut, kimchi), blue cheese, broad beans, beer and sulphate-containing wine, dried fruit, grapes, cured meat and fish (not a complete list). Some people lack the enzymes to inactivate these and it can lead to a build up in the blood, causing temporary nausea, increase in blood pressure, sweating and migraine headaches. Tyramines are found in fermented foods (sauerkraut, kimchi, yoghurts), blue cheese, broad beans, in beer, wine that contains sulphates, other sulphur-based dried fruits, grapes, cured meat and fish.
  2. Histamines: are a result of the conversion of an amino acid histidine by two enzymes diamine oxidase and histamine N-methltransferase. People who have low levels of these enzymes have a build up of histamine in the body as they are unable to metabolise it. Histamines, like Tyramines are found in fermented based foods, along with all alcohol and vinegars. Other sources are fruits such as strawberries, avocado, and bananas, vegetables (tomatoes, spinach, eggplant) and nuts including walnuts, peanuts and cashews.
  3. Arginine: is an amino acid that causes vasodilation of the blood vessels by increasing the amount of nitric oxide in the blood. Great if you’re an athlete wanting to go at higher intensities, not so great if it causes pain through vasodilation and expansion of the cranial blood vessels. Avoiding these foods can minimise this, and nuts and chocolate have the highest amount of arginine in them. (As a side note, people who might experience break outs in the herpes virus have been recommended minimising these foods in their diet).

Not all of these groups of food are going to affect everyone, and not all foods within the different groups are going to trigger a migraine or tension headache, but it’s a process of figuring out which ones do by eliminating them from the diet for one to three months to see if there is respite from frequent migraine headaches, then reintroducing them (as you would any food).

There are many things which affect frequency and severity of headaches and migraines. Like other stressors, the effects of these (or anything) that might trigger an attack can be made worse depending on overall stress load. If you are lacking in sleep, relying on sugar or coffee for energy, have a lot on your plate at work, drinking too much alcohol (etc) then you may well experience more of an effect compared to other times where you feel a little more on top of things. So while you can remove certain foods from your diet and optimise others to minimise attacks in the short term, looking at the root cause of what is causing the headaches is clearly the best option long term.

How would you tackle this problem?

Do you have someone close to you who challenges your food decisions? For some it is like water off a ducks back. For others, particularly after years of the own battles they’ve had with food, to have someone else question something which they finally (finally!) believe is making them feel better can bring up the insecurities that were beginning to be put to rest. If it’s just to do you and what you eat, then perhaps it’s a matter of riding it out and letting the results speak for themselves. What happens, though, when the challenge comes from your partner and extends to differences in what you want to feed your children? Readers: we need your help.

A lovely client of mine is in exactly this predicament now. She is constantly battling with her husband with how they feed their energetic three year old daughter. He travels quite a bit for work, therefore leaving Jane largely responsible for Annie’s food intake. For the last year Jane has been following a whole food paleo style diet and feeling fantastic. Like most people she’s found it relatively easy to maintain. Unlike other diets she has followed in the past, she no longer feels the light yet slightly gnawing hunger across the course of the morning, or the drop in blood sugar around mid afternoon that is often experienced by people who are “good*” during the day. She feels much calmer than she has in the past and feels the food she’s eating is optimising her nutrient intake. Most importantly, after a long history of battling with her weight, body image and self esteem, she finally feels like she’s on her way to conquering the negative thoughts in her head that have told her for years that unless she is a perfect size 10, she is not worthy. Those thoughts that tell her she’s already a failure before she has even started on (yet another) calorie restricted plan are no longer lingering. It’s a sense of empowerment that finally she is able to control her food intake and that it doesn’t control her.

Naturally, given she is the major caregiver for their daughter, she has done a lot of reading around the best foods to feed Annie. Gone are the cocoa pops and Weetbix. These have been replaced by scrambled eggs and potato hash, fruit smoothies that include coconut milk and spinach, and pancakes made from banana, eggs and almond butter. Crustless sandwiches and roll ups have been replaced with kumara wedges and roast chicken drumsticks for lunch. Needless to say Annie loves it. Some slight resistance initially upon trying different foods, but after the ‘food lag’ she is happy to try lots of different foods and now even talks about preferring fruit and nut butter to single lunch box packets of potato chips… and therein lies the problem. Instead of being happy that their daughter is being nourished through whole food choices to optimise her growth and development, Jane’s husband is taking a stand against whole food and this ‘fad paleo diet.’ When he is home, he is frequently challenging her on the food choices available in the pantry and the seemingly deprivation approach to meals that Jane is serving up at home. When they eat out, the evening typically starts with an argument over where to eat. Not because Jane is any more particular over restaurant choice than her husband (as they both enjoy good food), but because he refuses to choose a restaurant as he doesn’t know what she’s “allowed to eat.” The already tense undertones of the evening are further exacerbated by the inevitable “is there anything you can eat on here?” and his insistence on choosing Annie menu options that resemble the standard western junk food diet.

Jane finds that they are constantly arguing over what they feed Annie. He views paleo through the lens of the media. Cutting major food groups, overly restrictive, the higher saturated fat content leading to adverse health in later years are three such criticisms that come up when he googles ‘paleo is dangerous.’ Just as important, he believes Jane is setting up Annie for a future of dietary restriction and problems with food. Not unlike, he points out, what Jane has been battling since her teens. Not only is Jane influencing Annie’s future physical health, but she is intentionally damaging her psychological health by being overly obsessive about removing processed food.

Ouch

While you might think that Jane just needs to discuss with him the premise of a whole food philosophy to clear up a few misundersatndings, unfortunately there appears to be little that can be done to change his mind. Any source of information that she provides him to back up her decision to include full fat dairy products or remove bread is countered by dietary guideline recommendations to build a diet on healthy wholegrains. Any evidence she presents him is discredited because it doesn’t come from health authorities and nothing she has said can convince him otherwise.

Tricky.

What’s a person to do in this situation? There are two immediate issues here. The first one is the lack of belief from Jane’s husband that she has turned a corner with her own self esteem issues. Her enthusiasm for the paleo diet is being read by her husband as a continuation of her obsession with food and body image. While she genuinely feels that she is getting on top of this, his accusations are bringing back feelings of doubt and insecurities. Obviously those aren’t the words he is using, but because she is being accused of being obsessive around food, that is what she is hearing. Potentially a bigger problem is his accusations around how she is feeding their daughter. What strikes at the core of Jane’s being is the inherent distrust he appears to have in her ability to be a responsible caregiver for Annie. That’s not what he is saying, but there is no doubt in her mind that that is what he is thinking.

So I’m writing this post as a shout out to others who may have been in this situation to offer some words of wisdom. Jane’s husband won’t listen to her. Or me. The information has to come from someone he trusts and respects, and looks up to. Theres no one in their immediate circle that fits that bill at this stage. And while Jane could ‘just relax’ when her husband is at home, that’s not ideal either. So, short of that, how does Jane tackle this?

*you know what I mean by good eh? That 300 calorie per meal diet that just gets you through to lunch but makes you want to chew off your arm by 4pm. blame their mid-afternoon crash on lunch. For a lot of people it’s under eating at both meals even if they feel somewhat satisfied after breakfast.

Shift work and health: the Cliff notes.

I’ve worked in a wide variety of jobs in my life. Like many people, I spent the latter part of my high school and university years cleaning toilets, clearing tables, washing dishes, delivering pizza and making sandwiches when there was only one sandwich maker in town. Subway, George St. Aaah….the memories. Somehow I was always put on the graveyard shifts of Thursday night 8pm-4am and Saturday 10pm-6am. Though it totally went against my natural tendency to be early to bed, early to rise, they were the most fun shifts to work. As one of the few places open 24 hours over the weekend, we got queues out the door of students either rolling in from the Cook or stumbling home from KCs, with the busiest period being from 2.30am to around 4am. I still remember the excitement at serving both a glazed eyed Marc Ellis and Rachel’s brother Jonathan from Shortland Street – before seeing Shorty stars was as ho-hum as …. seeing Shorty stars. Anyway. I’d get home either 4.30 or 6.30 and sleep 5ish hours before getting up and try to get back into a daytime routine. I always felt rubbish through lack of sleep and so thankful that I wasn’t pursuing a career that required me to do shift work.

Now, though, amongst the industries that have always needed to be available 24/7, the global society we live in now necessitates other occupations to put in hours that extend beyond the 9-5. The prevalence of employees working shifts in the media, healthcare industry, on the front line and in the corporate world is estimated to be around 20% and the available data in New Zealand is in line with this. This is a large subsection of the working population, and why it’s of note is that there are well established links between shift work and poorer health outcomes – both short and long term. The constant sleep deprivation that results from shift work is a major underlying issue.

The most important things we can do to help mitigate the effects of chronic sleep deprivation that occurs due to shift work (aside from actually sleeping!) are the very things that go out the window. A regular exercise routine is more difficult to maintain, due to tiredness from lack of sleep or the inability to structure if you are on a shift cycle that changes from day to night. Eating healthily is more difficult as having motivation to plan and prepare is more challenging, and often the pull to higher sugar, poorer nutrient foods is governed by cravings and accessibility. In addition, perhaps overlooked, maintaining relationships can be more difficult as the non-sociable hours of shift work impact on our availability to spend time with friends and family. Hanging out with John on the 5th floor is not the same.

It’s also well established that the affects on circadian rhythm put shift workers at a higher risk of many chronic diseases. Up until 150 years ago we were constrained by the natural sunrise and sunset and life on earth had evolved according to this. When artificial light was invented there were suddenly more hours in the day that could be spent being awake, and the shift in our wake and sleep cycle impacts on metabolism, hormones, digestion, cardiovascular system; in fact all of our cells in our body is affected by this. Sleep deprivation in the short term increases insulin resistance – it takes just a single nights’ sleep for this to occur. There is an increase in the risk of injuries on the job, and a link between both acute and chronic gastrointestinal problemsMood disorders are also associated with circadian rhythm disruption, and both observational and experimental data point to an increased risk of obesity in shift workers due to these circadian rhythm changes.  Over the long term, there is an increased prevalence of risk factors associated with the metabolic syndrome, type 2 diabetes, cardiovascular disease and cancer are all seen in shift workers compared to those who keep a more normal work schedule.

While you might think people who are early risers would be more negatively affected by shift work, this hasn’t been found to be the case.  Research shows that those who are late risers have lower levels of melatonin (a hormone that mediates the sleep-wake cycle); the suppression of which is one proposed mechanism for the increased health risks associated with working hours that disrupt circadian rhythm.

So what to do? Obviously, being able to opt out of shift work is not realistic for the 20% of the population who live and work in this 24 hour society. This report details the interventions in the research setting that have been found to be most beneficial. These include scheduling shifts to be ‘forward’ shifts rather than backward shifts (i.e. moving from a morning, to an afternoon, to an evening shift), avoiding stimulants such as coffee (in excess) and wearing light blocking eyeglasses on the way home from night shift. Sleeping in a dark room and wearing an eye mask will also help.

Along with the above, ensuring good sleep hygiene practices through both diet and exercise are essential. Though it might be the last thing you feel like doing if you’re just getting into exercise, a routine that you stick to will go a long way to helping you mitigate these effects. Exercise is so important for everyday health and well being, that to ignore it would only further exacerbate some of the health issues mentioned above. Further, in the face of sleep deprivation and acute insulin resistance, strength training helps improve insulin sensitivity and may minimise the blood sugar disruptions experienced. As mentioned, coffee is likely one of the first things you go to when you feel like you need an energy hit, but instead of this, why not try green tea – it has L-threanine in it which helps keep you alert without the caffeine hit. Perhaps save coffee for your days off (and limit to just one); dare I say it – try a decaffeinated brand otherwise. Some companies like to supply food for their employees, and this tends to be cheap plain biscuits, white bread and jam, and other types of food to provide a quick hit of energy when time is of the essence and there is no time to stop for a real meal. These options, along with the vending machine, are the last foods you want to be eating. On your off days make it a habit to prepare two or three ‘dinner’ like meals that you can freeze and eat throughout the week. Trying to structure your whole food, minimally processed meals so they are ‘dinner’ like at dinner time (before you head into a night shift, perhaps), lunch like in the middle of your shift, and then a lighter meal before you hit the sack in the morning will maintain the regularity of meals regardless of whether you’re working or not. Being prepared with your good food options means you can avoid those that are available at work. In addition, a magnesium supplement (with an amino acid or citric acid chelate) before bed can help promote good sleep. Finally, if you are constantly waking up, practicing some deep breathing in bed can help calm you down and send you back to sleep. Diaphragmatic breathing will decrease your sympathetic nervous response – ‘fight or flight’ and the levels of stress hormones entering the bloodstream which are released because of this which could prevent you falling easily back to sleep.

Shift work is a necessity for many people, and some fare better than others. If you are a shift worker who fares fairly well despite the disruption in sleep and subsequent poor lifestyle habits you may not feel that these tips would apply to you. However maintaining your health is as important now to offset the long term effects of shift work.

Snapshot of the brain 2 (and a bit of a related, but slightly off topic vent).

Now… where was I? Oh yes. The brain. As I said in my brain post three weeks ago, it’s not just calories and energy required to fuel it – in fact, if that’s all that you relied on, your cognitive function would diminish, brain fog would ensue and overall brain mass would reduce. Seriously. The importance of a nutrient-rich diet cannot be overstated when it comes to a healthy body and mind, at which the brain is at the centre of. The myriad of reactions and interactions of nutrients in the brain is too involved for me to adequate write up here, and as you know, scientific scribe is not how I roll, so this is a very brief overview, combined with a bit of a vent (my favourite).

In order to convert the calories provided (either by glucose, fat or lactate) into ATP for the mitochondria to use (energy to be produced), riboflavin and niacinamide (B vitamins), Co-enzyme Q10 (not just good as part of a skin cream) and magnesium are required to enable reactions at various stages of the process. Antioxidants are also required to scavenge free radicals so they do not damage cellular tissue through oxidation. The B vitamins and amino acids are important as neurotransmitters to send messages from the brain to various parts of the body. Magnesium is like a super mineral – involved in over 300 processes in the body – it has a really important role in the brain, acting as a ‘guard at the gate’ if you like, blocking excess calcium and glutamate from entering the cells. Both of these can increase cellular damage due to their excitatory effects in the brain. Magnesium also exerts control over the hippocampus, preventing it from stimulating the release of adrenocorticotropic hormone, or ACTH. ATCH instructs our adrenal glands to pump out both cortisol and adrenaline in times of stress, and magnesium inhibits these hormones from entering the brain and causing additional cellular damage. Thank you, magnesium, you’re not just good for relieving constipation and regulating insulin sensitivity.

Vitamin D has a neuroprotective role, promoting their survival and reducing damage – hence its association with the preservation of cognitive function in the brain. It helps reduce inflammatory factors related to neurological disorders such as multiple sclerosis and there is an association between vit D levels and depression – with receptors for the active form of Vitamin D found in the hippocampus.

Vitamins C and E are antioxidants, and clinical trials have shown that adults who supplement these two vitamins improve their cognitive function when compared to a placebo group. Iodine has been found to be particularly important in the development of the brain, and if a pregnant women has an insufficient intake of iodine, their baby may be born with a low birth weight, cognitive impairment and their physical development impaired. Sulfur is another component that contributes to antioxidant activity and acts as a neuroprotector in the brain.

Docohexanoic acid (DHA) is a long chain fatty acid that is found pre-formed in fatty fish such as salmon, sardines and mackerel. It may be the most studied nutrient with regards to the brain and is the most abundant omega 3 fat found in the cell membranes of the brain. Our body is not good at synthesising it and the conversion of it from plant-based sources such as alpha-linoleic acid is poor. It’s important for ensuring membrane fluidity, protects membrane integrity and is involved in the development of synapses. Indeed, archaelogists suggest one of the pertinent factors in humans having an encephalisation quotient as big as we do is largely due to early populations living close to the shore line and having access to marine life. Associations have been drawn between fish consumption and neurological function. In addition, in health older adults, more essential fats , vitamins and minerals present in bloodstream is associated with bigger brain, better cognitive test. Higher intake trans fats and processed food – smaller brains, lower cognitive function.

So when you do hear ‘a calorie is just a calorie’ as is often touted, particularly in the weight loss arena where the argument of a calorie restricted diet versus the nutrient-focused diet is often played out, you can see that this just isn’t true. A calorie restricted diet is often too restrictive, not only making fuel availability questionable at certain times, but not focusing on the right macronutrient calories – given that carbohydrate is much less calorie dense than fat. In addition, the focus on calories shifts attention away from the all important micronutrients I’ve listed above (among others) which are essential for brain functioning and (importantly) overall mood and wellbeing. No wonder those on a 1200 Calorie diet counted by adding up the numbers on the back of their cereal boxes, muesli bar wrappers and diet yoghurt containers don’t get the same feeling of calm and nourishment that comes when following a real food approach. The addition of nutrients to cereals by way of fortification doesn’t help – particularly if the delivery vehicle is a cereal that has additional gluten added to bump up the protein content (i.e. Special K; a topic deserving a blog post all on it’s own). Unfortunately when we consider all of the elements that promote and preserve brain health in light of what people are actually buying, then it doesn’t make for a pretty picture. Take this for example – the top 10 foods sold by volume in supermarkets in 2009. Bar the bananas, all foods on the list are nutrient devoid.

ANCESTRAL HEALTH 19 Jun]

Thanks, Jamie for this info.

In NZ currently, we have children who are over-represented in both the low academic achievement rates and the lower socioeconomic sections – these are interlinked obviously. Further, these children tend to have a poorer diet – with less fibre, less calcium, less fruit, cheese and milk than their school-aged peers. As these foods are important contributors to the aforementioned nutrients above, is it any wonder that those most disruptive in class, less likely to achieve academically are less likely to finish high school? There are clear links between diet and hyperactivity, concentration, and even cognitive development – the available nutrients include those delivered from the mother prenatally. How are these children supposed to further themselves if they don’t have the right start in life.

Yes, in NZ we have the Fonterra breakfast in schools programme (Kickstart) – now funded and widely available to those less privileged in decile 1 schools. Is it better than nothing at all – yes? Are weetbix and milk the best we can do? I don’t think so. What about government funded school based gardens/kitchens? What about attention in the curriculum to teach children the fundamentals of good nutrition, perhaps through an integrated curriculum? Teach them the importance of it in an environment that supports it – not in one where all attention is pushed towards ‘energy out’ physical activity model. School Food and Beverage guidelines? Bring it. Much better than the voluntary system that is in place now in schools. All of these take time, resources, investment – the government has a $40 million healthy lifestyles initiative which looks at supporting communities to make healthier choices, which – if included the above – could be promising. However the first sentence on the website doesn’t fill me with much hope: “Encouraging families to live healthy lives – by making good food choices, being physically active, sustaining a healthy weight, not smoking and drinking alcohol only in moderation – is part of the Government’s approach to promoting good health.” Not because I don’t think the government should be doing this – but this is no different from what they’ve always said. People need more than encouragement – they need infrastructure to make it easier. Anyway, let’s see.