Will that high protein diet kill you?

After last Tuesday’s television show ‘how not to get cancer’ I got a number of concerned emails and Facebook messages from people questioning their protein intake. Specifically,  information that a high protein diet increases health risk and mortality. As a nutritionist who advocates a higher protein load, here’s what I’ve read about the role of protein and disease, as written by people much smarter than I am:

Information regarding health risks associated with a high protein intake has been critically reviewed by experts in the field, specifically the way the population dietary data from the National Health and Nutrition Examination Studies (NHANES) was analysed to determine that higher levels of protein increase overall health risk. The major criticisms were:

  • They eliminated half of the data points with no explanation;
  • Their definition of low protein (below 10%) should in fact be labelled as ‘inadequate protein’ as defined by the Institute of Medicine (IOM) protein ranges (10-35% of dietary energy), and in New Zealand adequate protein is 15-25% of energy in diet. The arbitrary cut-off used by the authors meant less than 450 people fell into the ‘low protein’ group;
  • The population data gathered dietary information via a single 24-hour diet recall once in an 18-year period; and
  • Body weight or body mass index (BMI) was not reported – given the clear association between excess body fat and chronic disease such as cancer, cardiovascular disease etc, this was a massive oversight.

While the paper outlined in the review also looked at laboratory trials, these were based on rodent studies and not clinical trials in humans. Differences in metabolic rate, the way we utilise nutrients and digestive tracts (the rodents more able to handle fibrous foods than ours) means that, despite interesting findings, we cannot conflate the findings here to humans, as they are not directly transferable.

Other points to note regarding research suggesting that a lower protein diet is good for longevity:

  • Many of the studies are based on rodent studies (not humans) and, in addition to what I posted above, the type of protein studied is typically casein – a dairy protein that has more potential to be inflammatory and one rodents are not naturally adapted to consume;
  • High amounts of dairy protein have been found to increase insulin, triglycerides and result in excess body fat compared to other sources of protein provided to the rodents;
  • Much of the research also show that it could be an effect of a high methionine intake which – when not balanced with other amino acids such as gelatin) for some people, can build up the amount of homocysteine (another amino acid) that increases risk of cardiovascular disease;
  • As we age, we are at greater risk of sarcopenia, dyopenia and poor health due to falls if we don’t have a decent amount of muscle mass, which requires protein to help lay down this muscle;
  • The majority of studies point to a higher protein intake being protective for quality of life as we age, not detrimental; and
  • We become more anabolic resistant as we age, meaning we are unable to lay down muscle the way we are when we are younger to the same extent. This could be as a result of both inactivity and lower levels of oestrogen and testosterone, meaning the a higher protein intake is required (in addition to resistance training).

And here is what I know regarding a low protein diet in the real-world setting:

  1. People are hungry. Women, especially, struggle to eat an appropriate amount of food when they restrict protein. This restriction (intentional or otherwise) leads to poor blood sugar control, poor appetite control and mood problems (either low mood or increased anxiety).
  2. People can only restrict for so long until it backfires. A lower protein intake might be totally fine on a Monday, things are okay on a Tuesday, but by Wednesday people are climbing the walls looking for something to eat. Or, for some, this process happens across the course of a day. This means that despite having a decent amount of food at dinner, the undereating of protein across the day leaves you standing in the kitchen at 8pm looking for something to eat and wondering why you are not hungry, but just ‘not satisfied’.
  3. Practically speaking, when you restrict protein, what is there left to eat? Carbohydrate. We eat until our minimum requirement for protein is filled and, in the absence of quality protein sources we will overeat on calories (specifically carbohydrate calories) until this requirement is met. For many, this results in poor nutrient status, poor blood sugar control and excess body fat. It’s these three things which have consistently been found to result in increased risk of metabolic disease and cancer, not the protein load.
  4. People (generally speaking) fare best when we base their meals around protein and then toggle the fat and carbohydrate around that, based on their body composition and their activity levels. For many, this is more than a palm sized serve at each meal, and across the course of the day, for most people, this is at least 100g of protein from foods that are quality protein foods. In New Zealand, we get most of our protein (according to the most recent nutrition survey – which is 10 years old, actually) from bread. Bread! Wheat derived protein is one of the lower quality sources we can eat, with the amino acids not being as easy to digest and assimilate as those from animal-based sources.

So, clinically I am not at all concerned about advocating a moderate-high protein load for most people, and the television show last Tuesday did nothing to change my view on it. A longevity diet approach which is low in protein looks promising for a week a few times a year to confer benefits of fasting related to lifespan, but in terms of a day-to-day diet it will likely leave you frail, hungry and irritable. There is not enough human data to show that this approach will lead to a longer life, but I gotta say, it doesn’t sound like an enjoyable way to live beyond 100 years. Most evidence points to muscle mass being extremely important as we age to maintain quality of life and health span. This requires adequate protein and resistance training. In the words of Robb Wolf (as said on a recent podcast), we need to “eat and move in a way that lays down as much muscle as we can now, and then fight like the devil to keep it”.

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A good source of protein, and pretty delicious (PC: healthline.com)

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).

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

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

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

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

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

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

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

The Plews on racing LCHF

Last week I detailed Kona Ironman age-group champion Dan Plews’ daily and training nutrition using a LCHF approach. How does this change in the lead up to an event, and what does he do on race day?

Like conventional sports nutrition principles, there is somewhat of a carbohydrate loading phase pre-race. This isn’t the 500-600g of carbohydrate that is recommended for most athletes in the three days before (which generally leaves an athlete feeling lethargic and bloated), however it is more than he would generally eat. Don’t forget that tapering for a race is, in effect, carbo loading, as the muscle glycogen stores are not depleted during training and it allows them the chance to be replenished and not in the deficit they normally are. Based on Rowlands paper which showed that a higher fat diet with a preload of carbohydrates, he’s dialled in his approach that Dan now feels works really well for him. He lifts his carbohydrate intake from the 80-100g he typically eats in the days prior. On the Wednesday (for a Saturday race), he will include additional potato or sweet potato in his evening meal, taking him to ~125g carbs per day. This increases to ~175g per day on Thursday and Friday (the two days before the race) – including fruit alongside the potato or sweet potato. In addition, he makes sure snacks etc on hand are low carbohydrate so  not to be caught out during the lead up period with having to rely on the petrol station or four square options. If you do have to rely on these, and are looking for lower carbohydrate, then biltong, cheese snacks, even lower carbohydrate protein bars can be good stop gaps. On race morning before Dan’s Kona race he opted for was porridge: oats with a bit of Super Starch added, which is a slow release carbohydrate to not inhibit fat burning, and is a higher molecular weight carbohydrate, so it is easier to digest.

During the race:

Despite research studies in this area using a ‘train low glycogen, race low glycogen’ model to determine the efficacy of a LCHF approach for sports performance, in practice Dan follows what practitioners advocate: a ‘train low, race high’ model. Ideally, the train low approach has enabled you to increase your efficiency to burn fat as a fuel source in addition to using carbohydrate that you have stored or take on board, thus maximising the amount of fuel you have available. Dan takes in around 50g carbohydrate per hour;  because he is very efficient at burning fat, he doesn’t need as much carbohydrate as he would otherwise. A real benefit of this is that it minimises the likelihood of gut issues many endurance athletes experience during a long event – the more carbohydrate fuel you have to take on board, the more opportunity there is to get the dose wrong. Importantly though, the more fatigued you become, the more your body will divert blood supply away from the gut to the muscles, and thus impacting on your ability to digest the fuel.  During Kona Dan used energy blocks with gels on the bike, and a couple of gels with some swigs of sports drink or coke during the run. His paper Different Horses on the Same Courses outlines how to take this individualistic approach to fuelling, as will his online course that you can sign up to by clicking here.

Finally, post-race, Dan gets back on board the LCHF approach fairly swiftly, as he has seen the impact that a higher carbohydrate fuelling day has on his blood glucose level across the course of the following week. It certainly doesn’t reduce down to normal levels the day after, and it’s likely that inflammation and muscle damage impacts on this too. Your best bet is to (as soon as possible) get back to your LCHF diet and help your recovery process.

LCHF for the top end:

Whilst LCHF is increasingly more accepted in the endurance space as part of the approach, what about at that top end – does it limit performance there? There is very little quality research on this, however Dan’s research group found that there was no detriment to perform high intensity intervals (as I blogged about here), but the jury is definitely out on this point and I wonder if, like many things, it is individual. A person’s ability to metabolise fat as a fuel source and use it at a higher intensity is trainable for sure (that’s what fat adaptation is all about), but there could be individuals who are less able to produce ketones to be used for energy – this is speculation though on my part. Yes, there is a down regulation in pyruvate dehydrogenase which helps turn stored carbohydrate into glucose for energy, however the importance of this is questionable given the increased availability of fat for fuel, and there may be other enzymes upregulated to counteract this change in the fuel use. A potential way around this issue (and to ensure glucose metabolism is continued on your LCHF approach) is to do higher intensity efforts in training that force liver to convert glycogen to glucose – thus keeping glucose oxidation pathways high. I’m also beginning to recommend that people take on a small amount of glucose pre-high intensity sessions if they are beginning the fat adaptation phase during a training cycle that incorporates higher intensity efforts. Ideally your fat adaptation phase will occur during base training when we can keep intensity low. But that isn’t always possible. Fifteen-20g glucose prior to training for these high intensity sessions can keep output high but is unlikely to be enough to “ruin” your adaptation process. Again, there is no research behind these numbers, but from a practice perspective I’ve seen this work well.

Finally, you know I’m an advocate of ketones to help support training whilst lower carbohydrate, and it certainly has helped me and many of my clients. We don’t at this point know enough about ketone utilisation in the body and whether taking exogenous ketones downregulates the body’s ability to produce them. This is an emerging field we are looking at with interest with regards to dosage, timing, type of ketone supplement etc. There has been decades of research into carbohydrate as a performance enhancer, and we can probably expect that it will take a few years of research for these questions to be answered in the science research space. Trying them yourself is likely the best approach to see how they impact your own performance (and I can help you with that).

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Plews at Kona (PC http://www.trizone.com.au)

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!

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Kona 2018. (PC: oxygenaddict.com)

Exercise for longevity – is there a best approach?

The older I get, the more I am interested in the effects of ageing on our overall health span. Ageing is unavoidable, it happens to the best of us. Listed below are some of the physiological and biological changes that can occur the older we become:

  1. Insulin resistance – this is in healthy weight older adults also, with research showing there is more peripheral insulin resistance compared to a younger population (an inability to dispose of glucose into the tissue).
  2. Decreased availability of anabolic hormones, and increased frailty with lower levels of hormones
  3. Increased anabolic resistance, so not only is there a decrease in the hormones that signal tissue growth, the muscle tissue is less responsive to the stimulus of amino acids (protein) and exercise, and there is less muscle protein synthesis in comparison to breakdown.
  4. Greater protein requirements for the same relative gains in muscle, strength and function compared to a younger population
  5. Decreased motor neuron function, therefore less neural signalling to muscle tissues and reduced motor function.
  6. Increased intracellular oxidative stress, causing inflammation and reduced cell functioning
  7. Reduction in satellite (stem) cells numbers and regenerative capacity – these cells are essential for the maintenance and repair tissues in normal physiological processes or in response to muscle damage/trauma.
  8. Elevated myostatin signalling, a protein that blocks our ability to build muscle
  9. Increased chronic inflammation (also known as inflamm-aging)
  10. Changes in autophagy, where ageing reduces our ability to clear out damaged DNA
  11. Mitochondrial functioning abnormalities, where we can’t utilise energy metabolites as effectively to fuel mitochondria
  12. Reduced ability to be physically active (due to many of the reasons listed above)

Clearly, these are not all inevitable. However, it is a long, daunting, and rather depressing list of what can occur as we age – and we are an ageing population. There is no doubt that if we don’t look after this body we have got, then we really are staring down the barrel of a loaded gun.

The list above describes many of the mechanisms to explain the loss of muscle mass and function. It’s not about being ripped or having gainz, it’s about having proper functioning of the muscle so it can work effectively in our older years – this is what is shown to have the most positive impact on our cardiovascular, neurological and musculoskeletal systems.

Inactivity is the broader environmental issue that contributes substantially to the physiological issues I have mentioned above. We need to be active – in everyday life, and with some structured activity too. Hanging out washing and housework isn’t going to cut it, I’m afraid. I see a lot of people who have this idea that you don’t need to exercise in order to lose weight, and you can do it solely on diet alone. This is true, of course, but when you embark on any weight loss plan that restricts calories (i.e. any weight loss plan that is out there), then you will lose both fat weight and muscle mass – lowering your overall metabolic rate along with it. This is one of the reasons why weight regain is so prevalent. However the powerful combination of diet plus exercise helps sustainable weight loss. And exercise isn’t just moving around the house, doing chores – this should just be part of everyday living. Data looking at the effects of exercise show that resistance training confers benefits over and above what we would see if we were just doing 30 minutes of cardio-based exercise per day, something that many of us maintain, but it doesn’t offer the same benefits.

The right type and duration of exercise:

The challenge is to get people exercising. And this is especially so for those who read what I have said above, and think that – on top of 30 minutes of aerobic training they don’t have time to do, they need to then put some resistance (or weight) training in.

This is not a call to encourage you to find an additional 3 hours in your week, though. In fact, a study that is about to be published (I heard about it on STEM talk) suggests that just 72 minutes a week in total is enough to help many of the conditions associated with ageing and poor health that I’ve mentioned above. Egan and colleagues found a combination of both resistance and cardiovascular exercise in a circuit-type setting for adults over 65 years just three times a week for 24 minutes increased walking speed, leg strength and reduced trunk fat. These measures speak to better muscular function, obviously increased strength, and will help reduce metabolic health risk. The improvements were more potent in this combined group than either resistance training or aerobic training for the same duration. It wasn’t olymic lifting from the sounds of it,  but it also wasn’t lifting pink dumbbells, either.

So this was a very long preamble to the main message: if you are currently NOT exercising, then please start. While there are modalities that are better than others, seriously, anything will be better than nothing. The study I talked about is in older adults, you likely don’t need me to tell you that any age you start is obviously better than not starting at all. AND the earlier you start, the better the overall health outcomes.

There is often an argument as to which is best; exercise or diet for improving health. That’s a weird argument to my mind. Both are important and should be prioritised if you want more life in the years you’ve got left.

stronger-effect-of-resistance-training-when-combined-with-protein-supplementation

One of the only pics I could find that didn’t involve pink dumbbells. (PC: https://www.frieslandcampinainstitute.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)

Coffee: your friend or foe?

Coffee. It’s like the world’s favourite elixir. Mine included. For an athlete, there are many studies supporting its use as an ergogenic aid for athletes – helping reduce rates of perceived pain and effort, improving muscle fibre recruitment and enhancing glycogen repletion post-workout. These benefits are individual, however, and while research suggests that genetic differences in our ability to detoxify caffeine could account for this, it is not a universal finding. This is something true for athletes and non-athletes alike.

Other features of coffee are also salient for all individuals. Caffeine is ketogenic; not only can it help mobilise fatty acids to be used for energy, it increases the presence of ketones in the bloodstream – hence it is a good pre-workout fuel to help elicit fatty acid oxidation pathways and provide fuel for the workout in the absence of glucose. This doesn’t necessarily translate in additional body fat loss (more important lifestyle strategies are required for that, such as a caloric deficit, resistance training, reduction in stress etc), but can encourage these energy pathways to be upregulated, helping in the process of becoming adapted to a lower carb dietary approach.

Coffee improves insulin sensitivity and glucose tolerance (potentially related to the polyphenols present, though the mechanism is currently unclear), therefore enhancing the effects of both a lower carb approach, or a plan that includes fasting (either intermittent fasting, super-fasting, or a 5:2 approach such as the one in my fat-loss plans). Further, anyone doing my accelerated fat loss plans who have that 16h intermittent fast on the ‘fasting mimicking’ days could experience a more potent effect from the fast by including black coffee alongside water as their beverages of choice.

Autophagy, where our body starts to clear out damaged cells from the liver, heart and muscle tissue, is one of the benefits of fasting as you know. In mice models it might take just 16 hours for this to occur, in humans it is likely to take a lot longer given the differences in our metabolic rate (a mouse has a faster metabolism). Consuming caffeine on an empty stomach (or as part of a fast) promotes autophagy, which theoretically would shorten the time that is required to fast to stimulate this process. It also triggers AMPK, an enzyme that inhibits fat storage, promotes fat burning and activates antioxidant networks. These properties are thought to underpin much of the purported health benefits of drinking coffee.

It IS a balance though – if you’re following a fasting protocol, working out, and reading this at 3.30am in the morning, it’s a good sign that your brain is wired – raising cortisol to the extent that it’s (quite obviously) disrupting sleep. When we fast, like exercise, it places a stress on the body – this is where many benefits come from, as your body responds and adapts, becoming more resilient. However, too much of anything is too much! If coffee on top of your fasting regime or exercise program (or, life in general) is causing this stress response, then it is worth dialling it back a bit (or go 1/2 and 1/2 with decaf) to see if this changes your stress response.

Caffeine (or coffee), though, may not be good for anyone with gut issues. As it can stimulate the stomach cells to release more gastric juices, aiding in digestion, we often hear that too much coffee promotes a highly acidic environment and as such, could increase the risk of damage to the cells and subsequent gut issues. The literature, though, reports that caffeine does not negatively impact gastric or duodenal ulcers, and in fact when administered in vitro, could help repair cells damaged by inflammatory bowel conditions such as ulcerative colitis, and is also protective for the mucosal layer of the gut. Research suggests this is because caffeine increases blood flow to the gastrointestinal tract. Conversely, caffeine can lower the tone of the oesophageal sphincter – the valve that controls the release of stomach acid into the oesophagus, thus may promote heartburn and reflux.

With all research studies, it’s important to remember you are your own best investigator when it comes to how coffee affects you. I’ve said this before, but a good point to reiterate. The best advice, then, is to pay attention to how you feel when you drink coffee. Does drinking coffee make you more wired, especially when you fast, indicating it stimulates your stress (or cortisol) response? Does it give you reflux or heartburn? Does it upset your digestive tract more than settle it? Everyone has a different tolerance level to coffee, and further, our ability to detoxify it may also be different. If you feel great when you have coffee, and you don’t have any gut-related issues, then it is likely absolutely fine for you. If you notice an irritated gut, or you feel a bit wired, then it isn’t worth persevering with coffee for the purported health benefits – in your case, it might be making things worse.

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Ahhh… coffee 🙂

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.

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Hungry?

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

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

Why do you fear being hungry?

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

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

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

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

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

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

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

 

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