Holiday weight gain? Read this.

Easter and Anzac has meant that, for many, it’s enough for more than just a mini-break. And who doesn’t love a holiday? A break away from early alarm clocks, work and household chores. When out of your own space you’re forced to leave behind the normal routines that are well established in everyday life, which is obviously why we come back feeling refreshed and ready to get back into it. The problem, though, is that many people panic about getting out of routine with their food and exercise – what if that 10 days in Fiji goes and undoes the last three months of hard work and they end up gaining weight?

Well, it won’t. Why?

1. You are a LOT more active on holiday compared to real life: driving to work and sitting in an office does not afford the same opportunity to be as active as sight-seeing does. I clocked up almost double the number of steps as I normally would when I was away. Even on days we didn’t run, relying on both public transport and my feet to see a city racked up enough steps so I was regularly doing 23,000 or more each day. However, if you’re a lounge-around-the-pool kind of vacationer, if you had a hit out in the hotel gym, you can avoid weight gain for a short term holiday in the face of a calorie excess.

2. You sleep more: lack of sleep will drive up insulin and cortisol levels and create a hormonal environment that is unfavourable for fat loss. Even if you have the perfect diet (if there is such a thing), no amount of calorie counting, carb watching, or protein eating will make up for the string of 5-6 hours a night you manage during the week when work, exercise and home duties take up so much time, you stay up later than you know you should just to enjoy a little time out.

3. You’re generally more relaxed. The everyday stress created by school pick-ups, work deadlines and weekend sport might be ‘normal’ life, but don’t underestimate the effect this can have on your ability to lose weight. While we may not know the underlying mechanisms, like the effects of sleep deprivation, a chronic overload of stress will increase hormones responsible for fat gain regardless of what you eat or how much exercise you do. In fact, for some, their normal stress relief of going for a run or doing an F45 class will only add to the stress bucket, further exacerbating a weight loss stall. And, when stressed, we often reach for food that is high in calories, low in nutrients.

What if it does?

If you were maintaining or losing weight prior to going away on holiday, then that tells me you’ve got the tools necessary to help you refocus on an eating style and exercise routine that will easily shed any fat gain that is the result of too many cocktails by the pool.

Actual fat gain will be quite minimal, and pretty easy to shift – potentially easier than what you were finding before your holiday. The additional calories eaten on holiday aren’t all stored as fat (at all!) We restock depleted glycogen, and for some, short term overfeeding  increases resting metabolic rate in response to increased food (as many of the overfeeding studies conducted under laboratory conditions have found). Even if you have a predisposition for weight gain, the amount of weight you can is usually far less than the excess calories eaten would predict.

However, for those panicking about the additional fat gain (if any):

1. Up the protein intake. This will help reduce any carb-related cravings from too many pancakes/baked goods/fat chips. Aim for foods that will provide 30g of protein per meal (as an example, a 150g beef steak has about 37g of protein, 3 large eggs around 24g of protein). This will help fill you up and regulate blood sugar, preventing any dip in energy that might be exacerbated by lack of sleep or jetlag. Combined with strategies listed below, it’s a recipe for fat loss.

2. Lay off the alcohol. I tend to drink a bit more wine and beer when on holiday. Despite that I don’t drink any more than 1-2 glasses, it is more than what I’d normally drink in ‘real life’. If you’re like me, then take a break for a week or two  – not a long time, but enough to help get over my post-holiday blues (alcohol is a depressant after all) and to ‘break the habit’ as it were.

3. Drop back the fat intake – if you’ve gained excess body fat, then we want your body to tap into this (potentially) accessible fuel source – this obviously requires a calorie deficit. There is no need to seek out ‘low fat’ foods or avoid foods that naturally contain fat (i.e. egg yolks), however reducing down the amount of added fat to meals (via sauces, dressings, cooking oils, nut butters etc) will help reduce the calorie content of your diet with minimal effort.

4. Drop back the carbohydrate intake – some people benefit from doing a 21 day low (er than normal) carbohydrate diet. I know what you’re thinking – if I drop the fat AND the carbs, what do I eat? I’m talking short-term here – you base your meals around protein and titrate fat and carbohydrate according to that. If you know you feel better with a bit of carbohydrate in your diet, that’s no issue – just make it good quality (i.e. kumara, potato) and make it a moderate serving. However, ample amounts of even low sugar carbohydrate (like rice, pasta, bread etc) will make it more difficult to shift.

5. Include plenty of vegetables – base your meals around these. The prebiotic fibre can help improve the gut environment after a week or more of too much fried foods (though that cheese hoagie was delicious) and too much alcohol. Splashing raw apple cider vinegar (ACV) on steamed vegetables ups the taste factor and helps reduce post-prandial (post-meal) blood sugar, making you less likely to search for something sweet. In addition, you can go for gold on most non-starchy vegetables, so fill your plate to help fill you up.

6. Lift weights. Heavy ones. If you don’t have access to a gym then even body weight exercises (such as press-ups, squats, lunges) if not doing them, will create stress to help you build muscle. I’m not suggesting you avoid lacing up for your long run – I’m a long-distance runner after all! –  resistance training, though, is metabolically demanding in the short term, and in the long term will preserve your resting metabolic rate to allow you to burn fat in everyday life. Plus, you’ll improve strength. Bonus.

7. Consider fasting. Be it the 5:2 protocol that I utilise in my fat-loss plans, a 16:8 protocol that is popular (i.e. fast from 8pm to 12pm the next day, or Super-fasting as per the Schofield/Zinn protocol outlined in What the Fast, it’s consistently found to improve metabolic health markers and can reduce calorie intake to elicit a fat-loss response. Note: I’m not talking about some excessive ‘not going to eat till Friday’ type fast. But shorten that eating window.

8. Get plenty of sleep – try to get back into a 7-8h per night habit with this one and be disciplined about it, for reasons I outlined above.

And, finally (and most importantly), does it matter? I mean, does it truly matter that you come back from an awesome time away with a couple of additional kilograms? Part of the beauty of a holiday is leaving behind all of the routines of your day to day life, including exercise and your normal foods for breakfast, lunch and dinner. Many of us need a mental break almost as much as a physical one, and this includes a break from your usual diet and exercise regime. You will come back feeling refreshed and ready to embrace these with renewed energy (or being in a mindset of change for the better, if that is more appropriate).

egggs

LCHF and the athlete: The Plews approach

Sfuels, a ketogenic fuel for endurance athletes recently had Dan Plews host a Facebook live event regarding his LCHF training and daily diet. Now those of you have listened to our Fitter Radio podcast will know Dan from the Plews and Prof segment. He’s an exercise physiologist who last year was the overall age group winner at Kona World Championships in a record time of 8:24. He’s been working in exercise physiology for the last 15 years and has a number of research papers both related to this, and in the ketogenic diet space (for athletes), one of which I posted about last year. Because I love Dan’s work (and this area in general) I wanted to outline for you what he spoke about in the Facebook live for those people, athlete or otherwise, that are interested. This week, due to length, I’ll cover the normal diet, and next week I’ll outline his pre-race and race-day strategy.

As a bit of background, Dan has been doing triathlon forever, however came into LCHF when he was at the Olympics as an exercise physiologist and came across work by Tim Noakes (who has heralded the latest Banting movement in South Africa). From 2012 he made a decision to give it a crack. Even now, though, six years after embarking on LCHF training and nutrition, Dan notes that adaptations are still occurring, and puts his incremental improvements in performance in the Ironman distance finishing times (in hours:minutes) being: 9:22, 9:11, 9:12, 8:54, 8:35 and 8.24 Kona 2018) down to not only the consistency of training , but the consistency of the dietary approach.

What is important in LCHF and endurance training? The end goal for performance is to conserve as much energy as possible – fuel availability is the limiting factor over such a long distance. We can’t store too much carbohydrate – around 2000 Calories compared to 40000 Calories of fat that is stored in even the leanest individuals. The problem, though, is that people can’t access their fat stores to exercise at a high intensity. Or even, for many endurance athletes, at a lower intensity (where we should be able to burn fat). The type of diet we eat influences our fuel preference when we exercise, and the modern diet (where carbohydrate is the predominant available nutrient) makes athletes much more reliant on carbohydrate which – like kindling on a fire – is likely to run out quickly.  We want to be metabolically flexible, that is, to burn more fat as a fuel source and only use carbohydrate when we really need it. Dan has tested his fuel utilisation in a laboratory and can burn fat at 1.3g/minute (the FASTER study reported around 1.6g/minute) – most people are around 0.6g/minute or thereabouts. However research such as that done by Volek and colleagues have shown it is possible to shift that if you go LCHF. From the testing that Dan has done, he knows that at his race intensity on the bike, an average 260 watts, his fuel utilisation is around 66% from fat stores. This allows him to preserve a lot of carbohydrate when working at this race pace intensity.

Ideally, that preservation of carbohydrate stores to use at the back end of a race when energy availability is limited should be the aim of the endurance athlete (and is extremely challenging if they are burning predominantly carbohydrate from the start). In addition, the lower LCHF diet means having lower blood glucose levels on a day-to-day basis,  important for overall health and body composition goals too. Higher sugars equals higher insulin, which is a nutrient delivery hormone – therefore there is more opportunity for fatty acids in the blood stream being stored in our fat tissue. Don’t go thinking we want rock bottom insulin levels all of the time, as insulin itself is critical for life! However ideally our levels would be low outside of the time period around meals, as elevated insulin is linked to a number of metabolic disease processes. In addition, when following a LCHF approach, we have lower stores of carbohydrate, which makes us more sensitive to the signalling for fat adaptation and upregulating of fat oxidation pathways.

So… the details?

Dan’s diet on a day-to-day basis:

  • Coffee with cream, collagen and MCT (medium chain triglyceride, our body can’t store this and is an easily used energy source)
  • SFuel bar (low carb snack)
  • Training – doesn’t eat during training, but if he does it may be a SFuel drink (MCT/branched chain amino acid (BCAA) drink mixed with some other compounds, but it is a higher fat option)
  • Breakfast is eggs, avocado, some vegetables
  • Lunch is tuna salad or similar. During heavier training load, he may add a bit of paleo bread (around 20g carbohydrate, similar to normal bread but this is made of better quality ingredients)
  • Dinner is salad with a steak
  • Snacks may be macadamias, almonds and pickles.
  • Fruit may come into it from time to time, particularly as the training load and intensity ramps up.

While not ketogenic in way that he eats, he will still likely be in ketosis during the day – by virtue of training and his normal diet is low carbohydrate – it’s around 80g – 100g carbs per day, thus naturally depleting his stored carbohydrate (glycogen). Ketogenesis is a is a physiological state, not a diet, thus it’s less important to stick rigidly to foods labelled as ketogenic and to think more globally about it. My athlete plan  is based around these dietary principles, and there are likely some nuances for the female athlete, but this general approach works well for most people I work with. It could be important for a carbohydrate refeed 1-2x per fortnight if following a very low carbohydrate diet, and that’s something I recommend to my athletes on the basis that hormonal responses will be favourable. This isn’t something I’ve seen a lot in the literature, but based more on clinical experience (and may be more important for the leaner athlete).

As I mentioned, I’ll cover off the race day side of things next week. However, if you’re keen to know more about what Dan recommends, then definitely check out his new site – he’s developing an online course that details specifics for coach and athlete alike, and is releasing it soon!

plewsOAP

Kona 2018. (PC: oxygenaddict.com)

Food rules.

I’m all for flexibility when it comes to what people eat. Labels like ‘vegan’, ‘paleo’, ‘keto’ for a lot of people aren’t particularly useful (even when self-imposed) if that means the structure of their food intake is tied up into the ‘rules’ of that particular diet. People panic when they are out of their own food environment and unable to eat according to the rules of their dietary ethos. While there are those who intuitively know they don’t need to rigidly eat the same foods or meals to be able to progress towards their health goals, this isn’t a widely appreciated concept. For some, diet ‘rules’ can create a certain degree of neuroticism around food; people argue it is a form of orthorexia at its worse – I’m not sure I agree with that, given the complexities associated with diagnosed eating disorders. Regardless, if the anxiety around food exists, it can lead the person to turn down invitations where their dietary rules will not be able to be adhered to, thus becoming socially isolated from their normal circle of friends. Or they may still attend with the intention not to eat, only to ‘cave in’; one small snack becomes a bit of a binge-fest because they have ‘blown it all.’ Both of these situations can make a person feel pretty terrible, and do nothing for their self-esteem.  You can see why, then, there are people who are adamantly against ‘rules’ around food.

However, I don’t agree that there shouldn’t be any structure around what, how, and when a person eats.  I think you’ll know I’m not suggesting this structure should equate specifically to a dogmatic dietary regime, such as only eating ‘paleo’ or ‘raw vegan’. I’m talking about rules that take the decision making out of some pretty common every day food experiences. Let’s face it, most people have a lot going on in their lives – we make 35,000 decisions per day (apparently!), 200 of them are food-related, though we are conscious of about 12-15 of them. Many people don’t have the bandwidth to be directly  making decisions about what to eat day-in, day-out (hence food plans like mine are awesome, btw). That’s what makes it so easy to ‘succumb’ to takeaways at the end of the day (I say ‘succumb’ as I know many people think it’s lack of willpower. Well, no, it’s more decision fatigue than anything else). Dogma around diet is, after all, the appeal of following it – someone else has deemed what you can eat and what you can’t. This takes the thinking out of it and works perfectly fine… until it doesn’t. And it doesn’t take long for it to start causing more headaches than not. The type of rules, then, that I’m thinking about are those which are akin to brushing your teeth. You just do them, they are non-negotiable. Once you get into the habit of them, you don’t even have the think about it.

The types of rules I’m thinking about include:

  1. Never eat standing up (therefore omitting mindless snacking).
  2. Brush your teeth after dinner (to avoid snacking later in the evening).
  3. Have at least one serve of vegetables at breakfast, and 2-3 at lunch and dinner.*
  4. Put all junk food in the house in an opaque container and keep high up in the pantry, so they aren’t having to see it every time they open the cupboard to prepare meals (out of sight, out of mind).
  5. Choose a protein choice (meat, eggs, fish) and vegetables first when eating a meal out, and then (if still hungry), choose something else. This will fill you up, so there is less room for other foods that are easy to overeat.
  6. Order dressings and sauces on the side (so you can control how much you use).

Instead of feeling anxious about having to decide what to eat, then constantly second-guessing what to do, simple guidelines like these can help you make better decisions in any context. They take the thinking out of it, therefore less energy is wasted and they aren’t constantly ruminating about what to eat. This creates less anxiety and neuroticism, and people can feel empowered and confident in their food decisions.  It’s less about the availability of specific food choices and more about way food is eaten, the environment it is eaten in, and the type of food. You don’t need to be perfect to be awesome, you just need to be consistent, and consistently approaching food in the same way (not deciding that you’ve ‘blown it all, so you’ll binge’ whenever you make a choice not deemed ‘suitable’ as part of your dietary regime).

From clinical experience, I find most people respond well to strategies such as those mentioned above.

One Simple Health Rule copy

If only it were this simple. (PC: theironyou.com)

Does HIIT take a hit on a ketogenic diet?

Much of the research points to the utility of a keto diet for increasing fat oxidation for longer, slower training. After a period of adaptation, athletes are then able to tap into an alternative fuel source which affords them an extensive supply of fuel at a steady rate, unlike carbohydrate (glycogen) stores which are limited and easily depleted in a moderate-long training session. Thus, it stands to reason athletes are able to go for longer than if they are straight carb-burning athletes in an endurance event – something that Maunder and colleagues discuss in this most recent paper outlining the practical application of a low carbohydrate diet for athletes of varying abilities. However many of the recent randomized trials (such as this one here) have found that performance, particularly at the top-end of the spectrum, is compromised when athletes switch to a lower carbohydrate approach. Further, the relative effort at a given heart rate is increased. You go slower, but it feels harder. Ouch. This understandably makes an athlete’s coache a little nervous to recommend their athletes go on a lower carbohydrate diet.

Interesting though, this is not the experience of many people I work with who transition to a lower carb diet. If anything, performance improves for the athlete (something I’ve written a lot about over the last few years, including this blog here). Given enough time, any reduction in power that occurs early in the transition phase appears to be reversed and the athlete comes out leaner, stronger and fitter in their endurance training. Reducing reliance on carbohydrate as a training fuel reduces the oxidative damage that occurs during training, thus inflammation is reduced. They aren’t placing their body under as much oxidative stress and therefore the athlete can train more consistently during the season with less risk of stress-related injury and illness. This may also be due to a higher presence of beta hydroxybutyrate in the bloodstream, which act as signalling molecules and increase the transcription of enzymes that encode antioxidant genes superoxide dismutase, catalase 2 and glutathione peroxidase. This helps scavenge free radicals created through training and protects the athlete from tissue damage. This may be one of the reasons why they are seeing better results with their key races.

Two of my mates felt similarly, and experienced similar benefits of adhering to a low carbohydrate diet, experiencing no detriment to high intensity training, despite what the research deemed. So they decided to test the hypothesis.

They took 18 male endurance athletes who were habitually eating a standard western diet, and randomised them to consume either their normal diet (control group), or a very low carbohydrate ketogenic diet, consisting of no more than 50g carbs per day for four weeks, and performed graded exercise tests before and after the experiment, and a HIIT session (5x3min, work/rest 2:1, passive recovery, total time 34min) before, and after 2 and 4 weeks.

The researchers found that (as expected) fat oxidation levels increased in the experimental group throughout the tests, and total time to exhaustion, performance in the HIIT session and rate of perceived exertion was no different between the groups. Ergo, the ketogenic diet did not impact the athlete’s ability to undergo high intensity training (nor make it seem harder for them). Interestingly, the level of protein in the diet was around 29%, higher than the 17% used in other studies – this could account for the level of ketones present in the blood stream that were lower at the end of the study (0.4 mmol/L), just out of the ‘nutritional ketosis’ range. The difference this may have made to the athletes’ performance, however, we don’t really know.

Many of the studies conducted that have found performance is reduced are likely too short to allow the athletes to adapt to a ketogenic diet, which is thought to take several weeks to months. Hopefully this new research makes you think twice about taking the results of a study like such as the one here, as a reason to dismiss the low carbohydrate diet for athletes.

To recap, then, of what we know is possible for athletes following a lower carbohydrate approach:

As a side note, lots of peeps look at the elite athlete who chows down on carbohydrate in racing and during everyday life and thinks to themselves that, if they can perform to that standard eating a higher carb approach, then why can’t I? A couple of points to note:

  • The elite athlete may train from 20-30 hours per week – by default they spend a lot of time in a depleted state, meaning they are likely training low glycogen as it is impossible to replenish carbohydrate at the rate they are burning it. This is going to afford them the same capacity to train in the lower carb state that provides enhanced training adaptations. The average age grouper may have time to train 12-18h a week maximum, and don’t have the volume available to get into the low glycogen state.
  • They are elite for a reason. They are able to go harder and faster than most people –psychologically they are able to hurt more and potentially go longer before they bonk – we age-groupers have more of a preservation mindset. They may also be able to train harder when in an inflamed state for this reason. I’m not saying this is ideal (far from it). I’m just putting it out there as a reason why there are professionals who are able to see results where others don’t.
  • Even at the top of the field the elite athlete can suffer, and far more than an age-grouper. Years of a nutrient-poor, carbohydrate rich diet and overreaching to the point of overtraining will leave an athlete burnt out and unable to continue on at the level they previously enjoyed. It might appear that elite athletes are bullet proof but I’m sure as you’re reading this you’re thinking of someone who falls into this category. Things aren’t always as they appear, and the golden glow of success can be pretty fleeting.
  • Of course, there are others who are just awesome and continue to turn up and take it out year after year, regardless of diet, training methods, lifestyle etc. Like the people who drink every day, smoke like a chimney and don’t eat vegetables, yet live to 102 years.
  • Re: racing high carbohydrate – that Maunder paper again – worth a read.

hiit-for-cyclists01c52

Hungry?

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

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

Why do you fear being hungry?

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

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

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

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

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

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

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

 

very-hungry-caterpillar-teaching-plan-lesson-plan-16-9

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

Overcoming stumbling blocks on a ketogenic diet: a case study

I had a client contact me for an email consultation this week. She was frustrated as, despite following a ketogenic diet (where carbs are restricted to 30g or below, over 70% of calories should come from fat, and protein is moderated), she was unable to get into ketosis.

I had a look at her food diary and could quite quickly see where I thought she could change things to help enhance her ketogenic approach. With her blessing, she’s allowed me to share this with a wider audience. Like many things, if one person is having challenges finding the right balance in their diet, there are likely many more people doing very similar things and potentially experiencing the same frustrations.  I focused on some of the main issues I saw.

You’ll notice there are foods that don’t align with ketogenic diets OR would be included in any diet for someone wanting to shed fat. We (the client and I) spoke on that in general, as clearly she knows this (i.e. cheesecake). The points I focused on were those that can trip people up that she might not be aware of. I’ve screenshot her food diary, and then my comments are below.

Her diet:

​​​​​​

Major points – unable to get into ketosis despite sticking to under 30g carbohydrate per day. This is measured by a blood ketone meter, and she wondered if she needed to add more fat to do this. Her overall goal is weight loss.

The thing with weight loss and the ketogenic diet, if you follow the advice from Phinney and Volek, pioneers of the ketogenic diet space, part of the energy your body needs to consume should come from your own fat stores, and not be provided for by diet. It’s a common misconception, as I see many people embark on a ketogenic diet for fat loss purposes but the opposite occurs – they gain weight. A common strategy at this point is to further reduce carbohydrate intake and bump up the fat. However, this will often further exacerbate weight gain (and frustration around the approach). Worst case scenario here is when the frustration leads to ‘to hell with it’ and that low carb diet is supplemented with all manner of processed refined carb junk food because ‘what’s the point? I can’t do this anyway, I’m useless and it’s not working for me.’ Clearly the end result of this self-punishment is further fat gain, some horrible carb cravings and a bad psychological state. Needless to say, I don’t think adding in more fat is the answer in this instance (and for this client), however I do think that tweaking what she is already doing is going to help.

It’s also good to remember that blood ketones aren’t the be all and end all – these indicate ketones in your bloodstream but sometimes, when these are low, this just means we are using them for energy – which is what you want! This is more likely to be the case in an athlete rather than anyone who is generally just active. In this case example,  I think the diet is the main reason for her not being in ketosis, rather than that the client is using ketones efficiently. However,  it is worth remembering that if you are following a ketogenic diet and are not seeing the expected results on the blood ketone meter.

Finally (and something I mentioned to the client) you don’t need a ketogenic diet to successfully lose weight, and sometimes focusing instead on the pointers I give at the end, regardless of ketosis, will give the same end result. Something like my online menu planner and individualised nutrition coaching. However, I would recommend in that instance to up the protein (double the recommendation I give you) and drop back the fat intake, as people often find that far more satisfying and easier to adhere to – which ultimately is THE most important thing with any dietary approach.

Key issues I picked up:

  • Too much protein in one sitting/in general
  • Processed foods
  • Dairy
  • Unintentional free sugar

1.Milk –  both the sugar in a cup of milk and the protein (whey) will raise insulin levels, thus put you out of ketosis. This is true of skim and standard milk.

2. Protein cookies: the type of sweetener/fibre used to make it a lower carb item can also spike insulin. For some people it is definitely a dose response thing going on – they can eat ½ cookie no problem, but a whole one will kick them out of ketosis. For any items like these, and if you do have blood glucose or blood ketone meters, it can be good to get a reading after a certain dose to see what effect they have for you. At any rate, highly processed goods can still negatively impact on blood sugar and appetite regulation in the absence of them being carb-based.

3. Coconut water – contains 3g sugar per 100ml or thereabouts. Any amount of free sugar in the diet is going to impact pretty quickly on your blood sugar levels if you haven’t just finished exercising, and kick you out of ketosis. The types of carbs you want to be having in your diet are specifically non-starchy carbohydrates -the majority of any carb sources coming from green leafy vegetables, other colour vegetables, perhaps some pumpkin/carrot depending on their effects on your blood sugar.

4. Grapes: any fruit is going to impact on your blood sugar levels, and particularly grapes – even if you stick within your limit of carbohydrate, the sugar from these are going to hit your bloodstream pretty quickly and cause an insulin response, thereby lowering ketones, especially if eaten outside of a meal that contains fat and/or protein (both of which slow down the glucose from hitting the blood stream). Fruit is typically best avoided on a ketogenic diet, aside from lemons, grapefruit, some berries.

5. Protein content of meals: for most, these need to be lower unless an individual is athletic. If struggling with getting into ketosis, it can be good to lower protein consistently to 1g/kg ideal body weight. For this particular client, this is 65g per day. Many days are consistently above this. In addition, the amount of protein in any one meal makes a difference – ideally, not more than 30g protein in any one sitting and, for you, likely 20g in a meal. This is obviously going to differ from person to person – as mentioned, athletes who have a greater energy output can generally get away with more protein (and more carbohdyrate) compared to a person who is sedentary or just lightly active.

6. Timing of food: eating within a restricted window (and not eating later in the evening) can help a ketogenic diet – our liver’s ability to metabolise carbohydrate is dictated in part by a ciracadian rhythm;  we are naturally more carbohydrate sensitive in the AM, less so in the PM, so carbs are likely to spike insulin more in the evening. In addition, fasting naturally upregulates ketone production and can help accelerated ketosis. Further, snacking can (for some) keep them from being out of ketosis, so 3 meals, or 2 meals plus a snack is recommended.

Key recommendations:

1. Drop protein down in each of the meals so you are averaging approximately 20-25g at meals.

2. Time any foods that have a greater amount of carbohydrate in them for after exercise (ie lower sugar fruit, or nuts that have a higher carb count such as cashews). The body doesn’t need to rely on just the action of insulin to deliver carbohydrates to cells in this instance, as we have receptors called GLUT-4 receptors in our muscles and in adipose tissue that can take up carbohydate and are activated post-exercise. Remember, an increase in insulin suppresses the production of free fatty acids, the precursors to ketone bodies.

3. Engage in exercise to help upregulate ketone production – aerobic/weight training.

4. Fasting for 14h at a time to help body produce ketones. Now for women, fasting can be a great tool, but can also backfire (read more about that here). Generally speaking, the fasting approach can be something that is incorporated 1-2 x per week if fat loss is a goal, and on other days, opt for a 12h window between dinner one night and breakfast the next day. The most important thing, though, is to be aware of negative changes to energy, how you feel, mood and sleep patterns – all underlying signs of a stress response that you might not be able to cope with.

5. Focus on diet quality – so the carbs, protein, fats are coming from whole foods and not processed or snack foods – ie protein cookies, fat bombs etc

6. Remove drinks / foods that contain easily digested carbs even if they fall within the carb count for the day. You’ll feel far more satisfied (and it is far more nutritious) to get your carbohydrates from green leafy vegetables which also contains a good amount of fibre.

7. Dairy – stick to hard cheeses and forgo the softer cheese/milk.

These are just some pointers from this client’s diet; another practitioner may pick up others. I will reiterate my point, however, in that a ketogenic diet, when done purely for weight loss, isn’t always the best approach and, for alot of people, unsustainable and too much like hard work. If you’re struggling to get the balance right and not seeing the results, then there are definitely other alternatives out there – one which will fit your lifestyle, eating behaviour, budget and allow you to lose weight with far less effort. It’s adherence that is key. Let me help you with that.

Selection of healthy fat sources

Delicious, nutritious food regardless of your dietary approach.

My diet approach: less rigidity and more ‘real life’

A couple of comments on my Facebook page, a comment from a client that she wasn’t  ‘my perfect client’, and a post from one of my good nutritionist friends inspired me to have a bit of a think about how I approach nutrition, or the expectations that others have of my nutrition approach.

Whenever I put something out on social media, people will read from it what they will – I want them to comment and engage (why else would I put a post up?)  One of these was a comment I got after posting a recipe up on my page. Someone commented that she was very concerned that I say I follow a minimally processed diet approach, yet used a protein powder in my pancake recipe, clearly a highly processed ingredient*. She’s not wrong – protein powder is highly processed for sure, even the brands that I use and recommend others do: those that don’t have a lot of added ingredients bar the protein powder, some flavouring and stevia-based (or thaumine) sweetener . It got me thinking though. This person was annoyed that I was straying from their perception of what I advocate. If I could include protein powder in my recipes, clearly I’m not an advocate of the real food approach. How could people trust anything I say if I suggest that protein powder is okay? I wasn’t living up to her expectations of me, and she was disappointed.

It’s a tough balance: when I changed my philosophy around food I think I was a lot like other people – went too far in the extreme of finding the perfect real-food approach in an effort to ditch processed food. Legumes and all grains were off the menu (regardless of dietary tolerances, as this was the ‘perfect paleo’ way). All bread was to be avoided at all costs. Only drink red wine (less sugar) … It was 95% of what you’d call a ‘primal’ approach.

Like most people, though, I have settled in an approach to eating that is more practical to real life and, frankly, less exhausting. I have my diet non-negotiables –for me, I don’t touch diet soft drinks and chewing gum. In fact, I had a dream a few months ago that someone offered me a piece of gum and I took it. I woke up in a panicked state. This is because around 6 years ago I couldn’t go a day without having Wrigley’s Extra gum, and now I am scared that if I have it again that it would be a quick slide back into a daily habit that I couldn’t stop (even though when I gave it up it was literally like a switch had gone off in my brain and I couldn’t imagine having it again). I don’t have food allergies, so unlike other people, there isn’t anything that I must avoid or I’d be seriously compromising my health. That said, if I was eating the way I did during my Master’s degree at Otago, I couldn’t last during the day – I’d regularly have to nap in the afternoon under my desk after a diet coke and a massive ciabatta bun from Il Panificio bakery for lunch, which was backing up a large milky trim cappuccino and a dark rye sesame bun for breakfast. A carb overload and no fat or protein will do that to me (and a lot of people) – and don’t get me wrong – I LOVED it (and still would!) Just not how it makes me feel and, unfortunately, now I know too much about the long-term implications of eating such a nutrient-void diet). Huh. And I was doing a Master’s in nutrition at the time…

For everything else, though it is more about dietary principles rather than strict rigidity. Less religion and more realness. I try to avoid vegetable seed oils and artificial sweeteners that impact on blood sugar levels. However, if there is a dip that someone has brought along to a dinner party that has canola or sunflower oil as the second ingredient, I would likely have some if I thought it sounded nice, even if I wouldn’t buy it myself.  I avoid eating soy – especially products that use it as a cheap protein filler as you’ll find it in many packaged goods, though by now living in a vegetarian/vegan household, I eat organic tofu around once a week – and really enjoy it. I consume gluten when I have (for example) a date scone, or I really feel like toast. This might be once a fortnight. I drink wine. I have 3-4 alcohol free nights per week, but enjoy red wine (and coming into summer, white wine too – even though it has a higher residual sugar count). Not a lot – 1-2 glasses, and what they serve at the local bar is probably a more generous pour than we have at home. I like chocolate. I eat Quest protein bars (the varieties that don’t have sucralose as a sweetener in them – some do, some don’t) and use these as a bit of a stop gap as when training intensity ramps up (as it has over the last couple of months). I’m just hungrier in general and am not always organised. Despite their ‘organic’ label, these are about as far away from real food as you can get.

We buy white bread – the stock standard cheap loaves – as this is one of the only things that never comes home in the school lunch box during the week. If you’re wondering, I don’t think there is too much difference between white and multi-grain bread, really – it is all rubbish. I don’t eat it myself (any toast I have would be out at a cafe, a more delicious type of sourdough or ciabatta, probably), and can justify it till the cows come home but truth be told, getting any food in some kids can be difficult, so if they will eat a white bread egg or cheese sandwich that is going to at least fill them up, then so be it. A friend of mine commented on how she laughs when I post about lunchbox options for kids – and how (for her at least) it’s just a little unpractical and/or even if the kids show interest one day, the next they won’t have a bar of it. Now I get it. I really think I didn’t have a true appreciation for this and if I can somehow crack the nut that is ‘school lunches’ then I’d probably be a gazillionaire. One day. Maybe. (And if you have any bright ideas that I might not have thought of, pass them on!)

So, yeah. I still call my dietary principles ‘minimal processed food’ relative to the food environment and where I was at 7 years ago. Sorry to disappoint or concern anyone. Or perhaps this just makes you feel a little relieved that, despite best intentions, it doesn’t read like a perfect food environment or a perfect food diary, even for someone with my nutrition qualifications and practical experience. But that’s real life, and we do what we can. Some days are awesome, some weeks are awesome, and some, well, some just aren’t. That’s life, right? And when the dust settles, I’m pretty happy with it actually.  If you do what you can and have the best intentions going into it – then you’re always going to do better than if you didn’t try at all.

So please don’t think you have to be perfect – I’m not and nor should you stress about striving to be so. If you want some guidance at reaching your ‘happy spot’ click here to book a consultation or check out my online nutrition coaching services.

Jan’s story: a real food success story

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

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

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

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

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

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

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

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

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

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

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

OR

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

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

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

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

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

paleo-table

Delicious food! (PC: runningcompetitor.com)

Trouble shifting body fat? Two solutions (which are free! And simple).

Lots of good things happen when you eat well (and by well, I mean forgoing the advice of the dietary guidelines and following a less processed, more whole food kind of approach). Your sleep can improve, your skin clears up, your eyes sparkle with an increase in vitality and that brain fog you were struggling with for years (it’s just age!) has cleared. Your concentration levels are second to none.

But your weight isn’t budging. And you’re frustrated as hell. I get it. I talk to many clients and online coaching members about this. If all other aspects of your health improve with the change in diet and lifestyle, then by default, excess body fat should begin to shift. But, unsurprisingly, not for everyone*.

What,then, are two diet ‘hacks’ that could help you push through the weight loss stall?  Well it could be pretty simple, actually. You could either eat more, or eat less.

Eat more

If you are consistently trying to eat fewer calories, this can backfire on you – over an extended period of time this will break down muscle tissue and reduce overall metabolic rate, sending signals to your hypothalamus to shut down all unnecessary metabolic processes as energy needs to be preserved. In this context, the last thing your body wants to do is shift body fat. This is something that the physique athletes (such as bodybuilders) have known for years and often use a ‘refeeding’ period (of more calories or carbohydrates in one or more meals per week) that sends a message to the hypothalamus assuring it that there is enough calories coming in that it doesn’t need to slow anything down, or shut any processes off. While this is used a lot anecdotally, in research we see an increase in the hormone leptin with an increase of carbohydrate calories during periodic overfeeding, though the metabolic changes are modest at best. Despite lack of scientific verification, I’ve seen many weight loss stalls broken through once calorie cycling is introduced (and overfeeding, something I term a metabolic reset meal – I should really ™ that one).

Some options could be to:

  1. Include a meal based around kumara or potato, and make it a large one (for example, jacket potato with taco mince for dinner.
  2. Have dessert – it doesn’t have to be processed, refined carbohydrate if you don’t want it to be (though it can be! 90/10 and all that…) How about a fruit crumble or real banana icecream made with frozen banana and coconut cream?
  3. Eat whatever you want, one meal a week – this isn’t a license to binge, but rather a recognition that it’s what you do typically that makes the overall difference – one meal is neither here nor there, really. Have McDonalds if you really want to (not judging or anything, though I can’t imagine why you’d want to.)

Your body responds well to changes in energy flux – consuming a higher number of calories on days where you expend more energy (ie a high energy flux) will encourage hormone signalling in your body that allows for more lean tissue to be laid down, and is great for bone health.

Eat less

Conversely, if you’re eating too many calories on every day of the week, then you’re…eating too much. I know, can it really be that simple? Think about it: you’ve changed the types of foods you’re eating, and this has equated to better appetite regulation so you’re no longer eating because of insulin surges and blood sugar crashes. However you may still be in the habit of eating a certain amount of food which could be preventing you from dropping body fat. If you’re following a low carbohydrate, higher fat approach as a means to lose weight, a common mistake is that people eat too much fat. Don’t forget that you want to utilise some of those calories stored on your body, and part of the ‘HF’ of LCHF should come from this reserve rather than be provided by the diet. You don’t need to count calories to do this, either. It might be as simple as:

  1. Dropping out one or more snacks (if you’re in the habit of snacking) –those nuts mid-morning, the bier stick mid afternoon or the 70% cocoa chocolate at night. What is the worst that can happen? You’ll feel hungry, likely. This doesn’t mean you need the calories, it’s more likely your body’s used to eating at that time, therefore it’s anticipating a feeding period and releasing ghrelin (our ‘hungry’ hormone) because of this. It will pass. Have a drink of sparkling water and brush your teeth instead.
  2. Dropping the fat content on days you aren’t as active – this is an easy way to drop calories (thus cycling calories) – but without the feeling that you’re depriving yourself. I’m not suggesting you use products that have had their fat removed (ie trim milk), but don’t use as much added fat as you normally might on the days where energy expenditure is lower. Forgo the almond butter on your cottage cheese and berries for breakfast, omit the nuts that you’d normally add to your lunchtime salad, or serve salmon with the skin on at dinner with steamed vegetables rather than creamed or roasted ones. If you are hungrier, then up the amount of protein you consume on these days by about a third per meal (as we know that this will likely benefit body composition). This won’t make up for the number of calories you’ve saved by making these small changes.
  3. Experiment with fasting. You’ve got nothing to lose with this one and, if you do it in a way that is sustainable for your lifestyle, then you’ll naturally drop body fat with little effort. I know many people are afraid to fast for the additional stress it might place on their body. To be honest, I think there’s almost been a disservice to our stress response – we hear so often of how everyone is ‘too stressed’ and while this is true, I speak to many people who are now too afraid to exercise due to the metabolic damage they could incur due to their already stressed state. Stress is really healthy for the body – it adapts and becomes more resilient. Fasting is a type of stressor (and I’ve written about it in more detail here) and it might be the thing you need to kick your fat loss into gear. You may have more to gain from a 5:2 protocol, where your normal food intake is cut by a third on two (non-consecutive) days of the week. You may wish for this to be one meal or two smaller meals. Go easy on the activity on these days (and time your workouts to be before your larger meal), and when you do eat, make them protein and vegetable based – the caloric restriction doesn’t allow for a large fat intake, and protein will be more satiating anyway. I suggest not doing back to back calorie-restricted days- you may eat slightly more food the day after the fast (or not, it’s quite individual) and if you fast for a second day after a refeed meal, this could put you in a bit of a hungry/hangry spin.

So, these are just a couple of things you could try. Of course, there may be more going on that is preventing you from shifting fat, and that’s where talking to a professional can help. But if you’ve not tried either of the above, then give it a whirl. For a good 4-6 weeks I think. Your body needs time to adjust to a change in environment.

* Now I don’t use scales in my clinic, nor make it a blanket recommendation for people to do so as their measure of fat loss. How your clothes fit, your waist measurement, what you see in the mirror –these are far more accurate ways of assessing changes in body composition. In saying that though, some are motivated by what the scales say and if they can remove their perception of self-worth from the number on the scales, then it’s not a problem. In addition, some find them a very useful monitoring tool and can keep on target if they use scales daily – research does support the daily use of scales for helping people reach their body composition goals.

East_More_Food

PC: eatTV.com

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