Does your doctor value nutrition? These 3 questions might help you find out.

How much does your doctor value nutrition? This has been a rather hot topic of late, with the recent gagging of Gary Fetke in Australia, an orthopaedic surgeon who co-owns a nutrition clinic that employees dietitians to help clients. He has recently been ‘gagged’ by the Australian Health Practitioner Regulation Agency (AHPRA) and is not able to talk about the role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

That’s troubling to say the least. Nutrition and talking about nutrition is certainly a contested field, and perhaps there is some protection of the patch when it comes to nutrition advice. I’m not going to lie to you – I can get a little scratchy myself when I read prescriptive advice from people who aren’t qualified in nutrition that push the boundaries in terms of scope of practice. Mainly because of the potential fall out if they aren’t equipped with the knowledge to either resolve and issue or refer it on. But to prevent a doctor talking about nutrition is just madness.  Doctors SHOULD be talking about nutrition – especially given that some of the most common reasons people go to their general practitioner (GP) can be improved (if not resolved) by diet. Thank goodness similar shenanigans have not been taking place this side of the ditch.

To what degree GPs should have the authority to discuss nutrition with their patients is a bit of a ridiculous question if you ask me. I know many brilliant GPs that use a holistic approach to their practice, who know a LOT about nutrition, give guidelines when that is all that is required and also who refer their patients on to more in-depth nutrition help if necessary. More important is asking your GP to what degree do they value nutrition. If you feel nutrition is an important part of your overall health, I think that having a GP who feels the same is rather important, and these three questions I heard on a podcast could be a good start to give you confidence that your needs will be met by their services.

  1. What affect does nutrition have on my health?

This may seem like a weird question to be asking your GP. I mean, surely everyone knows that diet and health are intricately linked, and doctors – well, it’s their job to know this stuff, right? Given the number of clients I have who leave their doctor’s clinic rooms feeling stupid for even mentioning diet, I don’t think we can take it for granted that your GP is going to be open to the idea of diet being a reasonable therapy (or adjunct therapy) to any condition. Sure, the diet-health connection isn’t foreign to them – there is the lipid hypothesis after all. And if you’ve ever stepped on the scales and been told your body mass index (BMI) is too high, so you need to eat less and exercise more to lose a little weight and reduce your overall health risk, then clearly your GP didn’t sleep through their three nutrition lectures provided in the medical school curriculum. However I wouldn’t be surprised if you know more about diet being able to prevent or manage conditions such as auto-immune disease (including type 1 diabetes), mood disorders, inflammatory bowel disease or irritable bowel syndrome, metabolic conditions (such as type 2 diabetes), asthma and allergies and the like. Now I’m not saying your GP is an idiot – at all! But time is a resource many health professionals don’t have, and while your GP might be open to exploring alternative or adjunct nutrition therapy, they may not have had the time to research this avenue. That (in my opinion) isn’t so much of an issue. It’s not as important (in my mind) that your GP may not know as much as you; being open to you exploring it speaks volumes, though. If your GP isn’t interested, then that is a problem. Given some of the reactions that clients have reported when mentioning to their GPs they use diet as a way to manage their health condition, there are clearly GPs who choose to remain ignorant. If you are dismissed, laughed at, or told in no uncertain terms that diet will not help, alarm bells should ring in your head. My advice would be to look for another GP.

  1. What do you think about the difference between normal lab ranges and optimal ranges for nutrient status?

There’s a difference? There appears to be, or at least, some doctors argue that there is. Vitamin D is a great example of this. In New Zealand, the adequate vitamin D level starts from 50nmol/L but a published review determined that looking at endpoints on a broader scale than just bone health (including  bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer) determined it best to have serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L.

Low to low normal levels of serum folate are related to increased risk of depression and increased severity of depressions and affective disorders. Our ‘normal’ starts at above 7 nmol/L and research has shown that people with chronic mood disorders have lower morbidity when their nutrient status is above 18nmol/L, and symptoms began to alleviate when supplementation brought the levels up to above 13nmol/L. Low folate is also associated with higher homocysteine levels in the blood which is an independent risk factor for atherosclerosis.

While B12 levels in the blood are actually a poor indicator of B12 activity (as only 5-20% of the is bound to transports and able to be metabolically active), research has found a relationship between levels of B12 of 258pmol/L and lower in the bloodstream and depression. The ‘normal’ range starts at 170pmol/L, with borderline low from 110-169pmol/L. I know GPs who look for levels of 400pmol/L as being optimal for cognitive functioning and health. A sports doctor I am aware of uses higher cut-offs when it comes to haemoglobin and ferritin (both markers of iron deficiency) for athletes and will supplement to determine if a boost in iron intake helps address fatigue-related complaints or not, even if the athlete is within ‘normal’ range (see here).

Thyroid stimulating hormone, a commonly measured marker of thyroid function has a reference range between 0.5-4.0mIU/L. However, TSH is considered to be a poor indicator of thyroid function and the ‘normal range’ included people that had underactive thyroid or thyroid disease. The recommendation from the American Association of Clinical Endocrinologists association was to lower the range to 3, with a view of it lowering further to 2.5mIU/L because data from the National Academy of Clinical Biochemistry found more than 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L. Though this was recommended in 2003, it was contested by other governing bodies, potentially as it meant that the number of people in the US with subclinical thyroid function increased from 3 to 20% of the population, thus (as concluded in this paper) many more would require thyroxine medication as treatment.

These are just a few examples where you may fall into the ‘normal’ range, but may not be optimal according to the opinion of some doctors. At the very least, it may explain why you may be experiencing physical symptoms but these aren’t recognised by your lab test results.

  1. What will you do if my test results don’t marry up with what I’m telling you my symptoms are?

Important question, don’t you think? Let’s hope that your GP doesn’t respond with ‘perhaps you need to see a psychologist’ – as one of my clients reported. To be honest, I actually think there is a degree of psychosomatic issues that occur when someone is struggling with a health problem – most of us are familiar with the gut-brain axis and relationship between stress and digestive problems. This is partly driven by the return of seemingly ‘normal’ test results that don’t explain their ongoing concerns. However, to dismiss your symptoms as being unimportant because the results don’t reflect what you are reporting should (to me) set off alarm bells.

I think one problem could lie in the funding for lab tests. My GP is brilliant and will order me any test I want, but at my cost. I don’t blame her for this as there is pushback with GPs ordering tests. However I know that not all GPs are like this, and not all people can afford testing to get to the bottom of the issues. I think if more GPs appreciated the role nutrition can play in preventing, managing or reversing many of the chronic conditions people are dealing with today, then, then there would be more referrals to nutritionists or dietitians on the basis of reported symptoms or test results that may fit into the ‘normal’ range, but aren’t what is considered optimal.  From here, nutritionists, naturopaths and dietitians can order tests that delve further into hormonal issues, gut problems and even cholesterol levels if required. But this might not be necessary as they may pick up from your initial test results that certain nutritional strategies can help you optimise your nutrient levels without the need for further testing.

At the end of the day, you should feel confident that your GP values nutrition as much as you do.These questions may help you determine that and, if you suspect they do not, perhaps it’s time to find another GP.

Nutritionist

Obligatory doctor and fruit shot. I couldn’t find one with a steak.(PC: http://www.healthtrap.com)

 

Struggling to lose weight on a low carbohydrate, high fat diet?

“I’m a 5’10” guy who weighted 180 lbs. I run about once a week and honestly don’t do much else. I cut out beer and all refined sugars (which included a few servings/day of bread and pasta) and lost 15 pounds in 7 weeks.

I feel like a million bucks. It’s crazy how my legs and arms where there was seemingly no fat all became more defined and skinnier.

The best part – I make a full packet of bacon every Sunday and eat it over the course of the week and I absolutely stuff myself with the good stuff you’re supposed to eat – salted cashews, sweet potato fries, fruits and vegetables etc…”

– Taken from some random comments section from a blog (can’t remember where, sorry)

Not your experience? You’re not alone. Though I know those struggling to lose weight on a low carbohydrate high fat (LCHF) diet do feel they’re the only one not stripping off fat faster than they can pour the cream into their coffee. Unfortunately the mantra ‘fat doesn’t make you fat’ probably requires an asterisk, and an explanation. Along with ‘calories don’t count.’ These are related. A good friend of mine was struggling with unwanted weight gain on LCHF. She had listened to what people were doing with the diet and had swapped breakfast for a couple of coffees with cream, wasn’t eating lunch but perhaps grazing on some nuts or cheese during the day and having a big dinner at night that was eaten quite quickly because she hadn’t really had the pleasure of eating all day. Her one concession on LCHF was white wine and not that she drank often, but the couple of nights a week she did drink, it was definitely more than your standard two glasses. Lacking in energy, motivation, and frustrated with the betrayal of both her body and the diet, she asked for my advice. How come everyone else was losing weight but she wasn’t?

It’s too easy to think that the LCHF diet is the panacea for weight loss and weight maintenance – and absolutely, if you read my post a few weeks’ ago around LCHF diets for health and performance then you’ll know it’s at least as effective as your usual low fat regime. Certainly, too, for people I work with it’s an easier lifestyle approach to eating. If I had to put a number on it, about 75% of people I work with take the general guidelines of a LCHF diet, run with it and see considerable success. This includes people who have a history of weight loss, weight gain, and yo-yo dieting. However for some, the switch to a LCHF diet isn’t the magic bullet that it’s purported to be. After an initial drop in body weight (by perhaps 1-3 kg, largely attributable to fluid loss), the body seems to settle into a new ‘normal’ at that point and those last 5kg continue to remain elusive.

Is it the plan itself? No. Any plan that someone can adhere to is going to be successful. But there’s more to it than that. Even people who abide 100% to a LCHF approach can have weight loss stalls and, worse, begin to gain weight. Is it lack of sleep? Thyroid function? Work stress? Not enough exercise*? Too much exercise? Could be. But for some, it actually is the plan. Not in principle though, it’s how they execute the plan. And by all accounts, my good friend had also fallen into this trap.

Where once fat was vilified, it’s now carbohydrate that has been positioned as That Which Must Be Avoided. Problematic because actually there is no good or bad nutrient as a whole. Yes, there are certainly better choices within each obviously (i.e. butter is a much better choice than margarine, and potato or kumara will trump bread every time), but this blanket approach that demonizes an entire class of nutrients can set the scene for an unhelpful (and, at times unhealthy) approach to meals, snacks and eating behaviour. Carrots, pumpkin and beetroot – off the menu. Tomatoes are viewed with suspicion, onions don’t get a look in, and the rainbow of colour in a salad has now been limited to different shades of green and yellow. But it’s not from capsicum (too many carbs!) it’s from half a block of cheese. Now – I know that for some, this actually isn’t an issue and in fact, it’s the best thing they can do for their metabolic health. A LCHF diet makes perfect sense if someone is struggling with blood sugar and insulin control. In fact, for people with diabetes (type 1 and 2), having a very low carbohydrate diet is the best thing for them (why add fuel to an already out-of-control fire?) People either forget (or don’t realise that LCHF is generally 25% of so calories from carbohydrate which can still equate to a good amount of carbohydrate-containing foods. This all or nothing approach to carbohydrate (or… just nothing) is unnecessarily extreme for most people in my opinion. Like Weight Watcher’s ‘fat and fibre’ plan of the 90s, which saw meringue back on the menu for hundreds and thousands of delighted dieters worldwide (and unhelpful for most of those people), it is almost that the ‘no holds barred’ has been shifted from vegetables to foods high in fat. Cream in coffee, nuts in abundance, lashings of butter with everything – because ‘fat doesn’t make you fat’ and ‘calories don’t count.’ For those that can’t effortlessly lose weight with this approach and you have accounted for the lifestyle factors that I mentioned above (as my friend had), then actually you are eating more than you need. If that’s the case, then fat can make you fat and those calories do count.

So what now?

For my friend, and others who come to see me, what actually worked was taking another approach. Still LCHF. But not as LC. And not as HF. It also included a lot more protein. It is an­­ approach to eating that is sustainable in the long term. Remember that the premise of LCHF is a nutrient-dense, real food diet. For my friend:

  • I got her to drop dairy – not because it is inherently bad, but because her sources of dairy were only high fat and in larger amounts than I think she was aware of. It was easier to omit entirely in this instance.
  • I got her to start eating breakfast again and to include starchy carbohydrates. Not in large amounts! But enough to help her feel satisfied between her meals and also happy with a standard pour of wine from the bar and not a large. For some, restricting carbohydrate can lead to increased desire to drink more alcohol (or gave them licence to do so). This also helps people recognise that carbohydrates shouldn’t be vilified the way we did fats.
  • I also got her to sit down when she ate and told her to eat slowly, enjoying her meals and to never eat standing up. That way she knew what (and how much) she was eating.
  • I suggested that she cut nuts and seeds unless part of a salad meal and that she aimed for three meals a day and no snacks.
  • If she was hungry in between meals, then I asked her to increase the protein portions of her food, as this would keep her satisfied. For my friend, it wouldn’t have been helpful to focus on increasing the fat as it didn’t work for her previously.
  • The protein foods she ate weren’t necessarily lean, nor did she seek out the fattiest cuts she could find. She ate a broad spectrum of quality protein foods.
  • She ate non-starchy vegetables in abundance.

While initially suspicious of this approach, she very quickly saw success. In fact, over the course of four weeks, she had dropped 5.5kg. Her meals were still lower in carbohydrate, and higher in fat – but also included good amounts of protein and a lot more nutrients overall. For my friend, this ‘back to basics’ approach to diet was just what she needed. It was both the food choices and the behaviour around food that we needed to change. Though weight was her initial measure, she told me the change in how she felt about herself and about the food was far more important.

If you are struggling to lose body fat with a LCHF diet, then remember the devil could be in the details. In my opinion it really is the panacea for optimising your body composition goals, but it might be that the way you execute it needs adjusting.

*fat doesn’t make you fat: unfortunately, eating too much fat could make you fat – because too much of anything can lead to an excess in energy that your body can’t burn and therefore it has to go somewhere – deposited into your fat tissue is the likely scenario.

*calories don’t count: calories do count. But the finer details relate to how your body burns those calories and available energy.

The Best and Worst Diets of 2015? DASH v Paleo

Chloe from the Paper Trail contacted me earlier this week to ask for my opinion on the US news Best Diets of 2015 article that was published earlier in January. To be honest, I’d not done more than take a cursory glance at the article as I didn’t expect to see anything earth shattering in terms of conclusions. So this was a good chance for me to have a look at the diets, the criteria, the experts and give my two cents worth. With Chloe’s blessing, I have re-posted here what I thought of the review.

Another year, another bashing of any diet that doesn’t conform to the dietary guidelines… the US News article outlining their Best Diets of 2015 held no surprises. Twenty-two experts weighed in on the review, with many top professors and clinicians from some of the world’s most prestigious institutions included. No one can argue their expertise and knowledge when it comes to critiquing the 35 contenders. But like anything, it’s not necessarily which diet comes out on top that’s important to consider, it’s more relevant to consider what the criteria is they are ranking the diets on. When you’re using the standard dietary guidelines as a framework, it comes as no surprise then that the DASH diet comes up as #1, whereas the Paleo diet shares the dubious last place position along with the Dukan Diet – for the second year in a row. As someone who uses a paleo template approach to diet, it could ruffle my feathers somewhat to see this. Does this mean you need to ditch your paleo diet for the more conventional healthy eating approach? Perhaps not.

Let’s look at what was reviewed. The criteria used included how easy the diet was to follow, its ability to produce short-term and long-term weight loss, its nutritional completeness, its safety and its potential for preventing and managing diabetes and heart disease. Panelists were also asked for their opinions on 35 different diets. I thought it would be useful to evaluate their ratings of both the top (DASH) and bottom (PALEO) and give my two cents worth.

The Dietary Approaches to Stopping Hypertension (DASH) diet is one of the few to cross over from the laboratory to population-based recommendations. The diet focuses on a high vegetable and fruit intake (9+), a high intake of low fat dairy products, a low overall fat and sodium intake. Along with the recommendation to reduce sodium (targeted in many public health campaigns for reducing blood pressure), these diet recommendations help increase other electrolytes (calcium, magnesium and potassium) responsible for blood pressure regulation.

The research has consistently shown the DASH diet is successful at reducing blood pressure. Those who are prescribed the DASH diet are coming from a standard Western diet and any improvement in food choice is going to improve health status. The increase in fruit and vegetables to such high (and awesome!) amounts will help crowd out the dinner plate and reduce the consumption of processed refined foods. This naturally reduces sodium intake (abundant in such foods) and sugar intake – also associated with increased blood pressure. While the glycemic load of the diet is particularly high – bran, orange juice, whole-wheat bread, bread roll, potato – potentially the inflammatory effects of a high GL diet which contribute to health risk are offset by the anti-inflammatory effects of both a low fat dairy intake, and the antioxidant effects of a higher vegetable intake. And, again – moving from a standard western diet to an eating plan like this will reduce inflammation regardless, thus reduce health risk.

It meets the recommendations for the macronutrients and ticks the box on the nutrients of concern: fibre, potassium, sodium and calcium – while falls short on the vitamin D. The expert panel has deemed it to be favourable for weight loss and reducing diabetes, and not too difficult to follow due to its protein and fibre content which increases satiety. All in all the DASH diet outplays all other dietary patterns.

So what is it about the paleo diet then that makes it rate so low compared to the DASH diet? It appears that the opinion trumps evidence in this “best diet” review, with a fairly dismissive overview of a dietary approach that focuses on vegetables, fruits, animal protein, nuts and seeds, while removing dairy, grains, legumes and refined fats and oils. This is evident just by looking at the section that illustrates how to apply the diet (the ‘dos and don’ts’ section). The reasoning of why to avoid dairy and grains ignores the evidence that exists illustrating the adverse relationship between western diet patterns and chronic disease and instead relies on the ‘because our ancestors didn’t do it, we should too.’ Few paleo advocates would use this as their main justification. More than anything, that is just a bit of lazy journalism. Further, the views around paleo have shifted since Cordain wrote his book on the paleo diet (from which the meal plan provided is based around). While certainly there are still people who steadfastly eschew dairy and legumes based on historical evidence, this is certainly not the case for most paleo advocates now who include them for people who can tolerate them.

The experts were particularly critical of the nutritional completeness of the diet – one saying that the risk of deficiency is “very real and one would need to take a multivitamin supplement.” Notwithstanding that a multivitamin was welcomed on the highly ranked low calorie Weight Watchers diet (and was not seen as a problem for the experts), that they equate the removal of food groups with the exclusion of nutrients is at best, ignorant. There is nothing in grains that can’t be provided for in a well-balanced paleo diet. If we compare the nutrients in the DASH diet with those provided by paleo, the main differences stem from the macronutrient contribution to energy. Had the experts been provided with Paul Jaminet’s or Chris Kresser’s paleo approach to diet, this would look quite different. While most paleo advocates recognise that low carbohydrate and paleo are not one and the same, popular media and those in ivory towers have yet to catch up. Earlier renditions certainly kept starch and fruit low but for those who are metabolically healthy and active, potatoes, kumara, seasonal fruit can all be included in a paleo diet. Further, if we compare these types of carbohydrates to grain-based varieties, it Further, evidence suggests these are more beneficial than grain-based carbohydrate making up the bulk of calories in other diets.

A closer inspection of fibre and micronutrients found a higher fibre, potassium, B12 and lower sodium content than pretty much any other diet. The experts point out that vitamin D is still likely to be low, yet intake is likely to be highest in a paleo diet with foods such as fatty fish, offal and eggs are some of the foods that are naturally highest in vitamin D in our food supply. Certainly the calcium content of the diet presented is lower than the recommendations. However, while calcium as a nutrient is certainly important for bone health –magnesium, potassium and vitamins A, D and K2 are all necessary for bone cell turnover, and all available in a paleo diet. There are plenty of cultures who don’t consume dairy products, yet have healthy bones. While the recommendation for calcium in New Zealand between 1000-1300mg, some suggest that 600-800mg is enough for bone health. Further, the bioavailability of calcium may be less than what is found in dairy products, it is better in people with optimal serum levels of vitamin D. As pointed out above, these levels are more likely to be found on a paleo diet. Finally, aside from my point above regarding the inclusion of dairy products in a paleo approach to eating, not all traditional paleo diets are as low in calcium as the one presented here. Dairy is indeed an excellent source of calcium, but not the ONLY source, with , foods such as sesame seeds, green vegetables, sardines and salmon (with bones in) containing considerable amounts of calcium.

The expert panel scored the paleo diet low with regards to weight loss and an individual’s ability to follow despite its high protein and high fibre content. Not only are these both known to improve satiety and weight loss outcomes, these were the reasons provided by the experts as to why the DASH was rated highly, yet ignored here for the paleo diet. Perplexing. There are few populations these days who are not yet westernised, though the data that does exist illustrate populations relatively free from the modern diseases of cancer, cardiovascular disease and diabetes that are so prevalent in the Western World. Studies do exist though (for example, see here and here), yet were largely ignored by the panel. Finally, if the panel embraced the paleo approach advocated by most people who promote it and include full fat dairy products for people who tolerate it, they would have more reason to rate it highly given the unique health benefits provided by dairy fat, including the provision of conjugated linoleic acid (shown to reduce cardiovascular risk) and butyric acid (shown to feed good gut bacteria).

This is the 5th edition of US News Best Diets, and until the paradigm under which these diets are evaluated changes, the results will not change. So back to my original question: does this mean you need to pop your Practical Paleo cookbook on Trade Me and pick up the latest version of the DASH diet? No. It means you need to stop taking the time to read these ridiculous New Year articles.

Nigel’s diet… why so much meat?

Thanks to Nigel there was an explosion of interest in my blog post last week – and with it, a lot of questions around including certain foods in my recommendations. One I’d specifically like to address is the inclusion of animal protein (or red meat) in (what some viewed as) large amounts. Now for those who have been reading my blog for a while, this will be covering old ground as I know I’ve talked about elements of this previously. However Nigel’s documentary series has sparked much more interest in what to eat and, as the questions I got suggest, a lot of this information is new ground for many – so I’m happy to delve further into some of these issues and explain why I encourage the inclusion of red meat in the diet.

The first point to make here is that a whole-food/paleo diet (as I recommended Nigel eat) is not a meat heavy diet – it’s good to dispel that myth immediately. Sure, some doing ‘paleo’, include large amounts of meat at every meal at the expense of vegetables; however that is not what most people I know do. In fact, I eat more vegetables than some vegetarians I know. The inclusion of small amounts of meat or animal protein at each meal helps stabilise blood sugars and prevents overeating due to energy crashes. In addition, these foods contain complete proteins that are essential for the repair and rebuild of musculoskeletal tissue, they provide (amongst others) iron, zinc, iodine (fish) which are important for over 200 metabolic processes in the body important in brain, gut, liver and thyroid health, and deliver important antioxidants such as co-enzyme q 10 for heart health (and great skin!) Alongside these are the fat soluble vitamins (A, D, K) and essential fats (omega 3 fatty acids, monounsaturated fats and saturated fats) and cholesterol that form the backbone of many hormones and messenger enzymes that are responsible for delivering instructions throughout the body.

I’ve taken a broad-brush approach to the many benefits of including animal protein in the diet, but one thing I want to point out is that it’s not the eye fillet steak and the boneless, skinless, (tasteless) chicken breast that I’m talking about – the meat that is closest to the bone is the most healthy meat. Yes it’s fattier – but that’s a good thing (see above re: essential fats). There is beginning to be a trend of nose-to-tail eating now, making many of the offcuts of meat that were often binned now available to be purchased and used at the fraction of the price of an eye fillet steak (if people are willing to try them!). In New Zealand we have predominantly grass fed meat, which means we are largely protected from meat that has been grain fed. Grain fed cattle produces meat with a higher fat content but its fatty acid profile is not ideal – higher in omega 6 fats and higher intramuscular triglycerides (pro-inflammatory). The grain affects the health of the cattle, with more risk of infection and harmful bacteria which have downstream consequences to the quality of the meat we find in our food supply. While in NZ cattle are ‘finished off’ with grain, after a Twitter conversation I had the other week I believe the health consequences of this for us are negligible – though am happy to stand corrected!

And then there’s the issue of meat and cancer. And meat and heart disease. And meat and [insert health condition here that suggests you are a medium-rare steak away from certain death]. The problem with the media snippets most people are exposed to is that the finer (read: important) details are overlooked in amongst the rush to print that meat is as bad for you as smoking. Well (gasp) it’s not. Firstly, any research that suggests meat is adversely linked to any of the aforementioned conditions is association, not causational. These research studies cannot determine cause and effect and are not designed to do so. Secondly, many of the large trials asked participants to report their retrospective meat intake over a 6-10 year period once, in a questionnaire format (many people I know struggle to tell me what they ate last week). Thirdly, the distinction between actual meat and that which is found in a hamburger (for example) or even a meat sandwich in some cases is not made. There is a vast difference in quality between a rump steak and a sizzler (not to mention the latter is only around 45 percent meat and isn’t legally allowed to be called a sausage). People seldom eat a hamburger without a bun (this was before the advent of an ‘oxygen’ burger from Burger Fuel) and lumping a person who eats burgers five times per week (and upsizing with the fries and Coke) in the same category as someone who dines on eye fillet at a Pete Evan’s paleo restaurant five nights a week is problematic. Of course, I’m speculating here as to the overall diet quality of participants – but that’s all I can do as these important details pertaining to other nutrients known to affect health (i.e. processed refined carbohydrates, industrial seed oils) aren’t known. Many other lifestyle factors that contribute to poor health (such as a low level of physical activity, smoking, higher alcohol intake) are also seen in those with the highest intake of red meat and in some instances there wasn’t a linear relationship between meat intake and health (or death….) with the death rate falling in between those with the lowest intake and those with the highest intake (when split into groups according to overall consumption patterns.) These details mean little however when it comes to health reporting in the media. Nothing sells like sensationalism, and if we can draw parallels between red meat consumption and smoking then you don’t even need consumers to read the article to guarantee you’d have made an impact. Again, this is my Women’s Weekly overview; for a far more eloquent and in-depth critique of this, go to Zoe Harcombe’s review or Jamie Scott’s blog post discussing this issue.

Another big pushback against the inclusion of meat is from an ethical and sustainability perspective. Now I’m not at all suggesting that people who choose not to consume animal products based on their moral standpoint should reconsider. This is a judgement call I have no business in commenting on. However for others, thankfully the availability of free range meat now accessible at relatively cheaper cost is increasing. Demand also affects supply, and the more we ask for free range meat and eggs, the more the price will be driven down (especially considering its not essential to be choosing eye fillet for every meal). Another argument against encouraging meat consumption is that it’s not sustainable for the environment, with more demand for meat increasing the fossil fuel used to produce it, the water usage required and an increase in the methane emissions (and the carbon footprint). If we put it into perspective, most of what we do has a carbon footprint. Grain-feeding cattle may (or may not) be more resource intensive (and have a larger footprint) given what is necessary to grow the grains to be fed to the cattle as opposed to raising cows on a grass field. And promoting a vegetarian diet based on this argument is flawed given the resources required to feed the world on vegetables.

emissions

Turn your heating off a put on a jersey instead.

So that’s my stance on including animal protein (and red meat) in the diet. There are many reasons why people choose not to include red meat in their diet – but if they are based on optimising nutrient intake, protection from later chronic illness, or from a sustainability perspective, then perhaps reconsidering it wouldn’t go amiss.

 

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

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

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

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

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

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

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

ANCESTRAL HEALTH 19 Jun]

Thanks, Jamie for this info.

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

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