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 an 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)

 

11 things you may not know about perimenopause (and 10 things you can do about those symptoms).

I know what you’re thinking. She’s too young to be writing about perimenopause, right?! Actually, no. I might feel 24 years old, but it only takes being around younger age groups to remember I’m not! Despite the ‘M’ word being almost a taboo, unwanted phase of life that some women fear (and men too!) it is a natural part of our lifecycle. What isn’t natural are the symptoms associated with menopause. Like premenstrual symptoms, the discomfort experienced through perimenopause may be common, but it’s not normal. This was reaffirmed in my mind when I listened to a fabulous interview with Lara Briden (naturopath who works with women with hormone imbalances, based in Sydney and Christchurch). A wealth of information who had some great information around why we can experience symptoms and (importantly) what we can do about them.

  1. Defined as 10 years before going through menopause, practitioners often view this as highly variable, with women from 35 years to 55 years in this perimenopausal state. The average time spent here is around 4 years. Though, as with any ‘average’ this might not reflect your experience!
  2. All hormone levels change during perimenopause. There is first a decrease in progesterone, which changes the balance of progesterone to oestrogen (some describe this as ‘oestrogen dominance’, though not all practitioners like using this term). Testosterone also declines, and this is an important hormone for sex drive. Finally oestrogen drops – and while we will continue to produce oestrogen (as this occurs not only by the ovaries but by the liver, breasts, adrenal glands and by fat tissue, it is at amounts of around 30-60% lower.
  3. Oestrogen is a major regulator of a number of processes in the body, and the sex hormones and our glucocorticoid hormones (the most ‘known’ one, cortisol) are controlled by the hypothalamus -the part of our brain who is also the controller of our sex hormone regulation – therefore it makes sense that a change in one will result in a change in all of them.
  4. Some of the main symptoms of perimenopause are
    1. Heavy periods
    2. Hot flashes
    3. Breast tenderness
    4. Worsening of premenstrual symptoms
    5. Lower sex drive
    6. Headaches or migraines (due to sudden removal/reduction of oestrogen)
    7. Fatigue
    8. Decreased sense of wellbeing (research shows that extended periods of low oestrogen, fluctuating levels of oestrogen and sudden withdrawal of oestrogen – via surgery or stopping oral contraceptive pill – is affected with lower mood)
    9. Irregular periods
    10. Brain fog and memory – oestrogen helps consolidate both episodic and spatial memory in the brain, and protects against cognitive decline as we age.
    11. Vaginal dryness; discomfort during sex
    12. Urine leakagewhen coughing or sneezing and an urgent need to urinate more frequently – due to oestrogen’s role in maintaining the vascular mucosa folds in the vagina, acting as a watertight seal.
    13. Mood swings (via fluctuating levels of hormones)
    14. Trouble sleeping
  5. Some women are ABSOLUTELY FINE and sail through perimenopause. Generally, though, those that have been on the oral contraceptive pill are more likely to experience symptoms than those that haven’t. This may be due to the difference in the hormonal balance once the pill is removed. The pill provides large amounts of synthetic hormones, and it is a huge adjustment to go back to the normal (lower) levels of hormones. Approximately 147,000 women in New Zealand take the oral contraceptive pill, of which 80% of them are on a combined pill, delivering oestrogen and progesterone.
  6. The types of hormones in the pill are synthetic and are not ‘bioidentical’ – meaning that the amounts are higher than what the body would produce AND they are in a form that the body can’t use. The pill doesn’t regulate hormones, it shuts them off.
  7. During perimenopause, women can have fluctuating oestrogen levels due to variable concentrations of FSH (released by our pituitary gland in response to a low oestrogen environment – it isn’t necessarily all low oestrogen. This could also be a result of an inability to detoxify and clear out oestrogen metabolites.
  8. A well-functioning liver is required to remove oestrogen from our body and prevent build up and associated symptoms. Our liver packages up oestrogen metabolites and removes it through our detoxification pathways. We need our inbuilt antioxidants to be firing, along with certain nutrients (selenium, B vitamins and glycine (not present in large amounts in the standard diet) to do this.
  9. Many women going into perimenopause are insulin resistant (oestrogen has an insulin-sensitising role in the body and influences glucose uptake) – this partially explains the increase in body fat (particularly around the middle) that many women experience as they progress through. This makes it harder for their body to metabolise and use carbohydrate effectively
  10. Many women going into perimenopause have a low thyroid function due to age-related changes in thyroid physiology. These include a reduction of thyroid iodine uptake, synthesis of free thyroxine (FT4) and free triiodothyronine (FT3) and the conversion of FT4 to reverse triiodothyronine (rT3). TSH levels may be slightly elevated. Luteal-phase spotting, or lumpy breasts may indicate this.
  11. Your gut? SUPER IMPORTANT!!! The oestrogen might get detoxified (packaged up ready for removal) via pathways in your liver only to be unpackaged (deconjugated) again by nasty gut bacteria which pushes it back out into the blood stream as more toxic forms of oestrogen.

These 11 points may or may not have been news to you – certainly probably not to those experiencing some of the symptoms, or who have dug a bit deeper to determine the cause of the symptoms. This wasn’t a post for you to sigh in resignation and decide there is nothing you can do. Yes these symptoms and health outcomes are common – but (as stated earlier) they are not normal. Like many things, we normalise a lot of health issues because so many people experience them. We just think they are an inevitable process in ageing and moving into a different phase of life. Certainly (I gotta say), some health professionals don’t suggest otherwise so it’s no surprise many are led to believe this.

Some awesome tips from Lara as to how to start the process of mitigating symptoms – some are great DIY ones that you can put into action immediately; others will likely require the help of a practitioner who has a solid understanding of how our hormones interact – this may be your open-minded doctor, which is excellent – or naturopath, nutritionist or dietitian.

  1. Limit alcohol consumption – it impairs oestrogen clearance rates from the liver and may be one of the influencing factors in the relationship between alcohol and breast cancer risk
  2. Limit or omit dairy –dairy can increase oestrogen in the body, increase insulin release and the A1 caesin in dairy is pro-inflammatory and increases gastrointestinal inflammation (which could then push inflammation out to rest of your body).
  3. Ensure adequate vitamin D status – optimal is around 100-150nmol/L which is required for the production of all hormones, and related to other hormonal issues such as endometriosis
  4. Reduce intake of carbohydrate if following a higher carbohydrate approach, and get rid of processed, refined foods and sugar.
  5. Eat your brassicas: broccoli, Brussel sprouts, cauliflower, cabbage – all provide di-indolylmethane (DIM) which targets certain proteins in our body that help reduce inflammation and balance hormones (particularly detoxifying oestrogen). Supplementing with this is also really helpful, but only once you establish that oestrogen clearance is an issue for you – super unhelpful otherwise (a practitioner can help you find this out – and there is a test I’ve started using with clients called the D.U.T.C.H test which is able to measure each hormone and it’s metabolites in much more comprehensive detail than a blood test alone.
  6. Ensure a healthy gut: bloating, excessive gas, cramps and diarrhoea or constipation are not the normal consequence of eating (though they are extremely common). Keep a food diary to establish what might be causing your digestive upset by connecting your symptoms to your food intake. Work with a health practitioner experienced in the ‘real food’ digestive health to help not only heal your gut, but seal it too.
  7. Turmeric in therapeutic doses (more than you can get from food) helps reduce oestrogen related oxidative stress, reduce prostaglandins (inflammatory biomarkers) – opt for one that is also combined with bioperine (to make it more bioavailable) such as this Good Health 15800 Turmeric complex. The alternative is one that says it is formulated to have smaller, more bioavailable particles, and the Meriva formulated varieties have this.
  8. Iodine: low dose supplementation can be extremely helpful in supporting the pathways associated with thyroid hormone production which in turn affects the sex hormone production pathways. Again, talking to a practitioner is a good idea to establish your own requirement. However, 150 micrograms per day (and having 2-3 brazil nuts to balance this with selenium) is a safe amount.
  9. SLEEP. Hands down, the most often overlooked yet important restorative, nourishing thing you can do to support your hormone health.
  10. Meditation. Journalling. Yoga. Diaphragmatic and full belly breathing. Slowing down. Yep – stress reduction.

Regardless of if you are pre, peri or post menopausal, I think there is some excellent information here that will be helpful for hormones in general actually, and if you are experiencing some of the unwanted (and unnecessary in most cases) symptoms of hormone balance, this may give you some pointers as to how to combat them. Definitely check out Lara’s site for accessible and informative hormone related content.

PC www.gazetteinterviews.com

Let this not be you. Or your mum. Or your wife. PC http://www.gazetteinterviews.com.

 

Like what you read? For more, check out mikkiwilliden.com for individualised nutrition plans, or sign up now for online nutrition coaching and meal plans.

The Gout: what you need to know and 7 things you can do about it.

  1. Gout is an auto-inflammatory disease caused by a disorder in purine metabolism and the resulted chronic elevation of blood (serum) uric acid (i.e., hyperuricemia)
  2. Men have a higher risk of gout at a lower given blood level of uric acid, and at a lower age than women – generally 10 years earlier.
  3. Women who go through early menopause, or have estrogen deficiency are at higher risk than women who progress through menopause at a normal age, due to oestrogen’s role in increasing uric acid excretion.
  4. Insulin resistance increases risk of gout, as insulin reduces uric acid secretion. The relationship between insulin resistance and gout is more pronounced in women than in men.
  5. There is a bi-directional relationship between high blood pressure and gout: ie if you have high blood pressure, your risk of gout goes up (independent of diuretic medication that is taken), and if you have gout, your risk of developing high blood pressure also increases. High blood pressure can result in damage to kidney and a reduction in uric acid excretion, and the inflammation associated with gout can stiffen and damage arterial walls, and reduces production of nitric oxide – which helps widen arteries.
  6. Genetics play a role in determining risk associated with gout – and people with a particular genetic profile (such as those of European descent with the SNP sequence SLC2A9 as an example) have an increased risk, as do those with ABCG2 rs2231142. However, as with any genetic risk factor, lifestyle determines if these genes are switched on or off, so while this information could be useful (and more people are starting to find out their genetic profile and determine what it means for their health), it is your lifestyle habits predominately regulate overall risk
  7. Triglycerides increase in the bloodstream when people overeat refined carbohydrate foods, and recent research suggests a reduction in serum uric acid occurs when triglycerides decrease.
  8. Alcohol intake is associated with an increased risk of gout – beer more so than wine.
  9. Overall fructose load in the diet is the only type of carbohydrate that is known to increase uric acid levels, potentially because when metabolised, it depletes phosphate and therefore doesn’t help produce ATP (energy) in the body and instead increases uric acid production. Fructose from processed food (and particularly sugary sweetened beverages) can elevate insulin levels and increase risk of insulin resistance. There may be a genetic element to this also, with people who have polymorphisms in SLCA9 and ABCG2 genes responding unfavourably to a load of fructose.
  10. A large cross sectional survey found that people following a vegan diet had the highest serum uric acid concentrations compared to fish eaters, meat eaters and vegetarians, independent of smoking status or alcohol intake.
  11. While seafood is often cautioned against for people who experience gout due to its purine content, a number of studies have failed to find a relationship between seafood intake and serum uric acid levels. Those that have found a relationship may not have adjusted for body mass index (BMI), which can confound the relationship as it did in this study. Indeed, those populations who are at greater risk today (such as Maori and Pacific among New Zealand population) enjoyed a traditional diet of predominantly seafood, vegetation, tubers and gout was non-existent.

What to do?

  1. Look after your gut. Bacteroides caccae and Bacteroides xylanisolvens are increased, and Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted in the gut of people who experience gout, suggesting a strong correlation with the presence of gout. F prausnitzii is one of the most abundant bacterium in the gut of a healthy individual, helping produce short chain fatty acids butyrate, which is fuel for our gut bacteria, and the provision of B pseudocatenulatum improves markers of gut wall integrity. So these are pretty important! While this doesn’t necessarily mean that the provision of certain bacteria through probiotics will reduce gout attacks, it does suggest that inflammatory processes of the gut play a role in the presentation of gout and provides further evidence of the importance of a diverse population of bacteria in the gut for overall health.
  2. Supplementing with 1500mg vitamin C reduces serum uric acid and its antioxidant functions may also help kidney function by reducing inflammation.
  3. Like your coffee? You don’t have to go without if you have gout and in fact, 4-5 cups per day have found to decrease serum uric acid that isn’t seen with green or black tea, or total caffeine intake. Decaffeinated coffee has afforded similar benefits, leading investigators to suggest the phenol content (phytochemicals) might increase insulin sensitivity and decrease serum insulin, as discussed above insulin levels have a positive correlation with uric acid due to decreased renal excretion. Furthermore, xanthines, either in caffeine or in coffee itself, could inhibit xanthine oxidase – an enzyme that increases reactive oxygen species (and inflammation).
  4. Magnesium intake is associated with a decreased serum uric acid level in males, and marginal intakes is associated with higher levels of markers in the body indicative of inflammation. Magnesium is low in soil which makes dietary sources of the micronutrient not as high as they once were, therefore supplementing with magnesium of 300-600mg/day (depending on bowel tolerance) is likely a good idea. (To be honest, I’m a big fan of magnesium supplementation for pretty much anyone male or female, given it’s a co-factor in over 300 processes in the body).
  5. Tart cherry extract – not just useful for sleep – is found to reduce the prevalence of gout flare ups in cross sectional studies, potentially due to the presence of polyphenols including anthocyanins, and vitamin C found in the fruit, which have anti-inflammatory and antioxidant affects.
  6. The consumption of low fat dairy products is linked to a lower risk of gout in larger population studies.*
  7. Anecdotally (as in, I didn’t find any study on pubmed to support this), baking soda is used to increase pH level of the blood (¼ teaspoon in water), thus making uric acid in the blood able to be excreted. If you know of any studies around this that I’ve missed, let me know!)

The take-home?

While a low purine diet is often recommended as a dietary prescription for people with gout, many purine-containing foods (such as seafood and vegetables) do not contribute to hyperuricemia or gout and may in fact be protective. The effects of red meat consumption on serum acid levels are arguably hard to disentangle from other elements of the modern dietary pattern, and are often in conjunction with higher alcohol intake, lower fruit and vegetable consumption and higher fast-food intake – all contributors to inflammation in the body. In addition, the agricultural practices of the cattle industry in countries such as the US where many of the epidemiological studies that associate red meat with poor health (including higher serum uric acid levels) include the use of antibiotics, poor farming practices and animals that are grain and not grass fed, altering the fatty acid profile of the meat to be higher in omega 6, pro-inflammatory fats. Furthermore, processed and fresh meat is often grouped together – thus a steak is viewed the same as a hamburger from a fast-food outlet – the latter often being in the company of a bun, fries, mayonnaise made with industrial seed oils and a sugar sweetened beverage – the adverse effects which many, myself included, argue cannot be adjusted away by a statistician when determining risk.

*I don’t think you need to start consuming low fat dairy if right now you’re enjoying the benefits of full-fat dairy in the context of an awesome diet. I think this could well be indicative of overall lifestyle patterns. I’d be surprised if there were studies showing that risk of gout is increased in a diet that is whole food, minimally processed, an abundance of vegetables that also incorporated full-fat dairy products.

 

10 ways to naturally reduce your cholesterol-related risk and save yourself $8.00

I was at the supermarket yesterday and just happened to be taking a picture of an iced coffee drink when someone came beside me to grab a couple for themselves and put them in their trolley alongside a pottle of Flora ProActiv margarine.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

Heinous drink containing 75g sugar on the left, and overpriced margarine on the right. JICYWW.

There’s a disconnect right there.

These margarines are not only ridiculously expensive and taste terrible (I suppose that’s the nature of margarine anyway), but consuming this spread in an effort to reduce cholesterol levels is totally misguided. Don’t get me wrong. They work. In fact, a good friend of mine did her Master’s project at the same time as I did to show their effect at lowering LDL cholesterol in a clinical trial. There have been more than a handful of randomised controlled trials that show plant sterols can inhibit cholesterol absorption and reduce LDL cholesterol.

The end goal, however, shouldn’t be about reducing your LDL cholesterol levels. You’re probably down with that anyway given you’re reading my blog. The end goal is about reducing your overall health risk, and these margarines have not been shown to do this, despite the Heart Foundation tick and the Health Star Rating. In fact, for a substantial proportion of the population, a lower cholesterol level increases the risk of heart disease (for more information, read this excellent blog post by Zoe Harcombe)

Interestingly, even the American Heart Association released a statement saying the use of sterol and stanol esters should be reserved for adults requiring LDL cholesterol lowering because of hypercholesterolemia, or as secondary prevention after an atherosclerotic event – and these have yet to be updated.

If you want the real benefits of cholesterol lowering foods, eat your plant sterols in the form that nature intended (i.e. plants), not a pharmaceutical company

Anyways.

Here are 10 ways to naturally reduce your risk related to cholesterol and save yourself $8.00

  1. Eat more vegetable fibre. Fibre is the ‘f’ word that is super important but doesn’t receive nearly as much press as the other ‘f’ word (fat). Current recommendations are 28g for females, and 34g for males and we are currently consuming an average of 20g per day. Fibre comes in a few different forms and while soluble fibre has been found to lower cholesterol absorption – this is not the most important aspect to my mind. A few people (who may have a genetic defect that makes them hyperabsorb fibre, or have a defect on their LDL cholesterol recpetors which limits their cholesterol uptake and removal) would benefit from this in particular. Moreso, eating more plant based fibre shifts us back to an eating pattern that, as Eaton & Cordain point out, we consumed for over 99% of human evolution. And while estimations of fibre intake of Hunter Gatherers vary (as pointed out by Steve in this excellent blog post), the point is: we don’t eat enough of these plant-based foods and we need to eat more AND more from the sources of foods which are as close to their natural form as they can be. You’ve heard of the 5 a day campaign? I say we should aim for 9 – and mostly vegetables. This is particularly true if you do have underlying inflammation that is driving up your cholesterol level. There different types of fibre and soluble fibre is known to absorb cholesterol and remove it from food you eat and your bloodstream. This level of detail is certainly useful if you have a genetic predisposition towards a high cholesterol level which places you at risk (i.e. familial hypercholesterolemia). However, to keep it brief: if you’re currently barely managing three serves of vegetables a day – work on increasing vegetables in general. Natural sources of fibre from plants will deliver soluble and insoluble fibre, along with resistant starch. This is a good place to start.
  2. Ditch processed food. Sounds dramatic I know – and it’s not realistic to ‘never eat anything in a packet’. However if most of your daily calories come with a nutrient information panel and an ingredient list, then you seriously need to reconsider what you are putting into your body. Processed food is devoid of nutrients in the forms your body requires, contains additives and preservatives, some of which have a dubious health profile and takes very little energy to digest. This leads to peaks and troughs in your blood sugar levels, poor appetite control and the potential to overeat.
  3. Ditch sugar. No surprises here. Sugar not only increases your risk of metabolic syndrome that can result in type 2 diabetes and increased cardiovascular disease risk, it drives almost all inflammatory pathways in the body. Thankfully though, if you try hard to stick to #2 above, you’ll do this by default. Do note though, minimising sugar includes all forms of sugar – including the ‘natural’ forms. If you’re unsure of what a sugar is, print out this PDF which tells you the 56 different names to burn into your brain for your supermarket shop.
  4. Lose weight. Or, more specifically, lose body fat. Being obese is an independent risk factor for cardiovascular disease, type 2 diabetes, neurological conditions and some cancers. Yes there are certainly limitations with how we define ‘overweight’ or ‘obese’, but you don’t have to rely on tools to establish whether or not you need to lose some additional fat around the middle. You know this yourself.
  5. Increase your intake of omega 3 fatty acid rich foods (think salmon, mackerel, herring and sardines) and consider an omega 3 supplement if you don’t eat fish. I know – you’re thinking ‘what about plant-based sources’? truth is, these don’t contain the type of long chain fatty acids that are most beneficial for reducing risk of chronic disease, and their conversion rate into those forms is quite poor. Eicosapentanoic acid (EPA) is the omega 3 that is involved in reducing inflammation, and if you do have high cholesterol and inflammation, then a supplement such as this Nordic Naturals could be worthwhile taking. While a very recent clinical trial failed to show improvements in total cholesterol with the addition of an omega 3 supplementation, it did show a reduction in fasting blood sugar, triglyceride levels and c-reactive protein (a marker of inflammation in the body). And as I said, your cholesterol level might not be the most important metabolic marker to focus on anyway. Vegetarians especially would benefit from supplementation, and an algae supplement would provide a similar benefit.
  6. Get out in the sun…. and get your vitamin D levels checked. There is an association between low vitamin D and poor metabolic health – studies have shown a link between high sunlight hours and lower cholesterol levels at a population levels. This is due to the exposure of skin to the UVB rays that uses cholesterol to create vitamin D. However, a large percentage of New Zealander’s are below adequate levels. For best and safe practice, sun exposure, minus the burning, for 10-15 minutes where parts of your skin not often seen by the sun (for maximum absorption) are exposed (think: armpits, abdomen – unless you’re young and gorgeous) is best. The thing is, though, the sun doesn’t hit the earth at the right latitude to get any of those rays to produce vitamin D in winter, so we can be lagging even more coming into spring. So supplementation could well be required. In addition to the mechanism above, studies (like this one) have shown that higher dose vitamin D supplementation can lower cholesterol and inflammatory markers in women. If supplementing, choose a supplement that also includes vitamin K2 to help vitamin D’s absorption such as this Clinicians one.
  7. Alpha-lipoic acid (along with other antioxidants vitamin C or E) can provide antioxidant support to help reduce your overall health risk associated with cholesterol levels (i.e. reduce inflammation and oxidative species) by increasing the activity of your body’s antioxidant defences. If you’re wanting to spend your money on actively lowering your cholesterol, these relatively safe supplement options are a better idea than margarine.
  8. Your thyroid, your gut, your genetic profile can all influence your cholesterol profile. If your cholesterol is more than a bit elevated, consider investigating other reasons for this. FYI it’s now easier to get your LDL cholesterol tested, rather than calculated, including those which are more atherogenic, such as VLDL, oxidised LDL if you do have concerns. You can work with a practitioner to do this.
  9. Exercise. Free and long known to improve metabolic health. The arguments for or against the benefit of exercise for losing weight are irrelevant. Mood, lean muscle mass, cardiovascular fitness and general all around awesomeness will increase. It doesn’t mean you have to slog it out in the gym. Body weight exercises and some short, sharp, intense exercise a couple of times a week – combined with walking and general movement as much as you can – is most effective for health and wellbeing. If you like to track your details then get a Fitbit or a Garmin or similar. If you obsess over numbers then don’t.
  10. Stress less. Sleep more. And if you are losing weight, and doing all of the above, wait for your weight to stabilise before worrying too much about your cholesterol levels, which can be elevated during this time.

 

Body weight exercises from the 7min workout - not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

Body weight exercises from the 7min workout – not a bad place to start. (http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/)

A real food success story.

I love a good Real Food success story – and Julie has a great one. She has happily let me post it here. Over to you, Julie.

My name is Julie, I’m a 50 year old nurse, and Neale and I are coming up to our thirtieth wedding anniversary this year. I have four children and three grandchildren. While not being excessively overweight in my teens, I lived in a dieting environment with a mother always going on a diet “on Monday”. Food was always on my mind, the more I ate the more I seemed to want to eat. Four children and seesaw weight loss and gain followed. In 2002 I was heaviest I had been and a friend introduced me to the high protein low carb eating style and the rationale behind it.

The realisation that I had a high insulin response to carbs was liberating. I had always been constantly puzzled about the fact that no matter how much cereal and fruit and trim milk I ate for breakfast, by mid-morning I was ravenous, foggy headed and wanting to have a sleep. No one else seemed to feel like that and I concluded I was an undisciplined pig. If I was trying to lose weight and went to bed starving, that was a triumph. But the weight went back on – that old familiar story. So I read “The Protein Power Plan” and tried that for about a week and went through carb withdrawal complete with the headaches, moodiness and brain fog. I took that book back and she gave me “Enter the Zone” and this is when the light switch really went on and the liberation of knowing my response to carbs was not my fault allowed me to gain some control.

I counted blocks to the gram, lost weight, felt amazing and thought I could do this forever. And I did always continue to try and follow the very sound principles of eating in a balance of fats, carbs and protein to manage my hunger. But I was still eating grains (limited – low carb 2 slices a day with grilled cheese on top) and making choices for my blocks that were still processed and simply started eating too much always thinking “I’ll start again tomorrow” and lo and behold, there I was at the start of 2014 the heaviest I had ever been – again. A friend came to visit on January 2nd 2014. He is an amazing weight lifter and heavily muscled but wanted to lose some weight and he had read about paleo and was following the principles fairly strictly and lost weight fairly quickly. I had heard the paleo term round and about and admit I am guilty of dismissing things I don’t know enough about until it is thrust in my face, so had thought it was just a fad. I thought I had the tools with “the Zone”, I just needed to get my head back around it.

Neale was keen to lose weight as well so the next day we went to the butcher and vegetable shop and stocked up. I wasn’t prepared to give up dairy (again, I thought I knew better and I actually do tolerate dairy just fine, and don’t have as much as I thought I would want) but never ate bread again from that day – I knew it wasn’t my friend, I couldn’t afford to let it in. Do I want it now? Not a bit. Freedom. And I read. I read everything I could; Robb Wolf, Chris Kresser (I find his book is realistic and possible), Melissa and Dallas Hartwig’s “It Starts with Food” and others. I follow Facebook pages and blogs, and found Mikki in the “North and South” magazine at about that time and started following her as well. Mikki keeps it real too which made me realise this is doable. Forever. I still read and search for anything new, because knowing why I am making these changes makes it easier. But I must stress, it just hasn’t been that hard. The weight loss of 30 kilos is a bonus, but was certainly my main motivation in the beginning was because I wanted to audition for “Mamma Mia!”, the stage show. While I was never going to look amazing in lycra, I wanted to look as good as I could!

What do I eat? When I started I ate all the things “allowed” and quite a lot of it so after the initial loss of 7 kg, I stalled. I continued to read and found intermittent fasting. I would skip breakfast – just coffee with a bit of cream – and have around a 16 hour fast overnight. I was surprised at how well I functioned on two meals and consequently eating less (but never starving), the weight started to drop. Meals with adequate protein (palm of my hand) and lots of vege, never skimping on fat (butter, coconut oil, olive oil, avocado) kept me going in peak form. Two or three days a week I would add breakfast. My crockpot is my best friend, I make tons of bone broth which we drink or turn into soup in the crockpot again – kale or other greens, carrot, some kumara or pumpkin, swede (Southland swede rocks!), leeks, celery, whatever is available. Make enough for the week and lunches are never an issue. I have Melissa Joulwan’s “Well Fed” books and prepare as much for the week in one go as I can. I go to the farmers market and prepare vege, chopped, stir fried or mashed. I brown mince in a pan and use that to add protein to my soup. I keep boiled eggs in the fridge. Being prepared is the key and food is simple, often a one pan wonder, but always tasty because you cook in fat and add salt because there is no added salt in unprocessed food. When I cook, I cook plenty so there is always leftovers. I pin on Pinterest. I have a lot of recipes for treats, but in reality I hardly ever make them, because I just don’t yearn for them. But ideas are good. I do make treats for my grandchildren, and feed them a very clean diet. They love my home-made chicken nuggets from The Ancestral Table, and my 18 month grandson loves porridge made with banana, coconut milk, eggs and ground flaxseed. I make coconut flour waffles for waffle toast which gives them extra protein with eggs and added cottage cheese, and coconut flour mini donuts. I buy cheap apples at the market to make apple sauce for sweetening. It’s great to see Nadia Lim’s recipes guiding us to this way of eating as well.

Healing my gut has been important, I make water kefir and of course the bone broth helps. I sleep like a log, I take a magnesium supplement every night, my blood pressure is plum normal and I’m off meds – whilst it was never normal even on meds. I have stopped taking anti depressants, I feel calm and even in my mood. I guess my diet is fairly low carb because it’s hard to eat too many carbs when your main source is vegetables. I eat 1-2 pieces of fruit daily and some starchy vege like kumara. When I first started the Zone, I understood that it worked for me but I was constantly annoyed ( to say the least) that other people could eat bread and a “normal” diet without being starving all the time and not putting on weight. I just don’t feel like that now. I don’t feel cheated, or that I am missing out on anything. Exercise is something I haven’t done with much regularity and that’s just a mental block of mine which I will conquer next.

People ask me what I’ve done. I say I eat clean, I don’t love the paleo label, but at the end of the day if they want to make changes they will listen, and they will want to learn for themselves. A year may seem a long time but the time goes by anyway, so make it count now, not next year. If you want to see obstacles, you will. If you want to make a change to how you feel and ultimately look, you can. And the obstacles become challenges and then you rise to those challenges and you are there, and you will want to learn as much as you can. I eat what I feel like eating now and I only feel like whole, natural, unprocessed food, and continue to lose about a kilo a month. I have a pair of jeans I want to fit…..but the journey is as rewarding as the goal.

julie

Julie’s transformation

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.

Low carbohydrate diets for health and performance

AUT University’s Human Potential Centre has been commissioned by New Zealand’s Register of Exercise Professionals (REPs) to write research reviews around current exercise and health-related topics that are relevant to the fitness industry. I recently wrote this review of the efficacy of low carbohydrate diets for health and performance. It is definitely longer than my usual posts, so grab a sparkling water and settle in ;). It is appropriate for personal trainers to give guidelines that optimise diet to aid the client’s body composition, health, and performance goals, and then refer clients to a nutritionist or dietitian for a more individualised plan. So, an understanding of the current evidence base on the efficacy of low carbohydrate diets for fat loss and metabolic health outcomes is important hence this review provides a brief summary of current research and some practical tips. In research, a low carbohydrate diet is defined as one that contributes less than 26% of dietary energy (kilojoules) from carbohydrate foods. There is a wide variation in the absolute grams of carbohydrate per day between individuals that would fall into this category. A person who eats 2000 Calories per day would consume less than approximately 120g of carbohydrate, whereas for someone with an intake closer to 2800 Calories per day, less than 170g of carbohydrate would be considered the threshold for ‘low carbohydrate’. As a general rule though, when using absolute amounts, less than 150g of carbohydrate per day is generally considered a low carbohydrate diet – this is compared to the mean intakes of approximately 207g (females) and 278g (males) per day currently consumed in New Zealand. Clearly, low carbohydrate diets are nothing new, with the Letter of Corpulence published in 1863 that instructed readers on the dietary approach that successfully shed weight. The restriction of bread, butter, milk, sugar, beer and potatoes were hallmark features of this plan and provided the foundation for subsequent carbohydrate restricted approaches. In the 1970s the low carbohydrate diet approach was popularised by Dr Robert Atkins and the Atkins Diet Revolution. While at the time this was criticised due to the lack of research around its long term safety (and it was directly opposed to the dietary guidelines at the time), it was the start of the modern era of low carbohydrate diets that included the Scarsdale Diet, Protein Power, South Beach along with updated versions of the Atkins Diet, the latest (A New Atkins for a New You) being released in 2012. A lack of understanding of these diets has led many health professionals to dismiss them as quackery due to a perceived lack of fibre, vitamins and minerals, despite the relative success that some people experience when following a well formulated low carbohydrate diet. The percentage calories coming from fat in a low carbohydrate, high fat (LCHF) diet  is generally around 50-60% depending on individual variation. This naturally increases the amount of fat coming from both animal and plant sources. A major argument used by opponents to the LCHF dietary approach is that it promotes unnaturally high levels of saturated fat in the diet and, as saturated fat increases cholesterol in the body, this will clog arteries and lead to cardiovascular disease. There are a number of issues that need to be addressed here. Firstly, dietary fats don’t exist in nature in isolation, therefore any food that has a high percentage of calories coming from fat will supply the diet with a range of fatty acids and not one type of fat exclusively. For example, an avocado is predominantly monounsaturated fat but contains not insignificant amounts of both polyunsaturated fat and saturated fat. A well formulated LCHF diet will certainly increase levels of saturated fat in the diet, but will also increase levels of all types of fat. A major premise of the LCHF plan is not to eat unnaturally large amounts of fat from any one source. Instead it is to include more of the fat naturally occurring in minimally processed foods (such as some dairy products, plants and animal protein). It is certainly true that an increase in saturated fat leads to an increase in total cholesterol for some people depending on dietary context; however the majority of people see an improvement in their overall lipid profile with the appropriate reduction in carbohydrate as mentioned above. The role of saturated fat in the development of cardiovascular disease is widely disputed in the scientific literature, and while an increase in saturated fat levels in the blood can lead to an increase in atherosclerosis, these levels are increased with a higher intake of refined carbohydrate and not a diet that is high in saturated fats. Further, while the original hypothesis that saturated fat increased cholesterol levels which increases heart disease has been what public health nutrition guidelines have been built around, this has simply not borne out in any randomised controlled trials designed to test this hypothesis. In fact, when comparing the disease outcomes associated with different nutrients, the risk of cardiovascular disease mortality in the US associated with the highest sugar intakes in the USA is 2.75, and in high GI refined carbohydrates it is 1.98, meaning that women with a high consumption of these foods have almost double the risk of dying from cardiovascular disease. The association between the highest saturated fat intakes and heart disease incidence was 1.00, or no association at all. Further, dairy fat – the most saturated of all fats – confers health benefits over and above low fat dairy products due to the type of fatty acids present. Research shows a protective effect with regards to diabetes, cancer and cardiovascular disease, and contribution to obesity. The premise of a low carbohydrate diet for weight loss is built not on the ‘energy in, energy out’ model of weight loss, but the metabolic fate of carbohydrates in the body. While gram for gram, carbohydrate has less than half the number of calories as fat, it triggers hormonal effects which can lead to fat storage. When carbohydrates are ingested, they are digested and broken down into glucose and delivered into the bloodstream, resulting in the release of insulin from the pancreas. Insulin is responsible for disposal of glucose into the cells thus returning the blood stream back to its homeostatic level of glucose (of between 4 mmol/L to 8 mmol/L). Insulin also stimulates the production of glycogen in the liver, and when the liver is saturated with glycogen, the glucose is synthesised into fatty acids to travel in lipoproteins into the bloodstream. The glucose that is transported into the fat cells is synthesised into glycerol and used to create triglycerides. For these reasons, insulin is considered to be a major player in fat storage, and carbohydrate is the macronutrient which has a profound effect on insulin secretion. Protein on the other hand, has a minimal effect on insulin secretion (with the exception of whey protein) and fat does not stimulate insulin release. (For more information, go here). In terms of food, our ability to burn fat if we consume a can of soft drink is compromised compared to consuming two eggs (predominantly fat and protein). This is not to suggest that calories don’t matter, as a calorie deficit still needs to occur for fat loss to be achieved. However, our ability to burn calories stored as fat is far greater when carbohydrate intake is low (as addressed below). The research clearly shows that a greater reduction in weight is achieved when following a LCHF diet compared to conventional dietary advice promoting a low fat, calorie-restricted approach. Researchers have studied LCHF diets in both calorie-restricted and ad-libitum conditions (where participants could eat as much food as they like), and weight loss was greater in the LCHF group. When it came to dietary adherence, as measured by trial completion, low carbohydrate diets achieved better adherence than low fat (i.e., 79.5% vs. 77.7%, respectively). While the difference is marginal, it still indicates from these studies that LCHF diets are at the very least not harder to stick to than other diets. A possible reason for this might be that these diets appear to reduce hunger and participants are permitted to eat until satiated. While people argue that diets high in both fat OR sugar will result in increased energy intake and weight gain, the results of the above studies illustrate the opposite. A low carbohydrate diet may normalise energy intake due to the higher satiety of fat, and this isn’t typically seen in a higher carbohydrate, lower fat approach. In relation to health outcomes, the LCHF diets outperform standard practice guidelines when it comes to lipids, HDL cholesterol and triglycerides, and have similar beneficial outcomes with glycaemic control and blood pressure. There appear to be no serious adverse effects arising from either of the dietary protocols, thereby assuring safety from both. Importantly, in the studies where abdominal fat was measured (which is an independent risk factor for cardiovascular disease), LCHF groups have a clear advantage over low fat diets. A LCHF diet has its benefits for athletes, and utilising fat as a fuel source is advantageous from an endurance sport perspective where performance can be limited by the amount of carbohydrate able to be ingested throughout events greater than 2+ hours. The goal of becoming efficient at burning fat as a fuel source is to enable the athlete to become metabolically flexible (i.e. to be able to burn either fat or carbohydrate) during both training and racing as the intensity of the effort requires it. An athlete who has a high carbohydrate diet is less able to tap into fat stores if their body hasn’t had a chance to adapt to a lower carbohydrate diet, and upregulating the fatty acid pathways in the body helps delay the use of stored glycogen which is beneficial for endurance events. Further, the ability to utilise fat as a fuel source allows for improvements in body composition as less exogenous fuel sources need to be ingested. This also helps reduce the incidence of gastrointestinal issues experienced by many endurance athletes in both training and racing who cannot take in enough carbohydrate to fuel the demands. While it is argued that a low carbohydrate approach to diet is detrimental to an athlete’s performance, when timing carbohydrate intake to meet recovery needs, and when given adequate time for the energy system to change from burning predominantly carbohydrate to burning predominantly fat, most athletes benefit from a LCHF diet. The length of time to adapt is individual, however, and anecdotal reports suggest it can take anywhere from 4-12 weeks in the first instance. Therefore changes to a diet should take place during off season or when an athlete is building base endurance for their event, and not in a period of high intensity training. While the application of an LCHF diet is obvious for an endurance athlete, a lower carbohydrate, higher fat diet may be beneficial for other athletes participating in shorter events of higher intensity or team sport athletes. The timing of carbohydrate intake to fuel glycolytic activity and maximise recovery needs to be addressed, and working with a sports nutritionist or dietitian is required for more specialised advice. One of the main criticisms of a low carbohydrate approach is that carbohydrate is an essential nutrient and cutting this out leads to a reduction in optimal functioning. A nutrient is defined as essential when we can’t produce it in our body and therefore it must be supplied by our diet. As we have a limited storage capacity for carbohydrate (approximately 400-500g depending on muscle mass), this has led to the misconception that we require daily replenishment. Unlike fat and protein, however, our body is very adept at producing glucose through a process known as gluconeogenesis; the production of glucose from both fats and amino acids. We produce roughly 120-140g of glucose per day independent of food intake. A second criticism of a LCHF diet is that the exclusion of food groups (specifically whole grain cereals) leads to a deficit in nutrients. However, a well formulated low carbohydrate diet can be far more efficacious at supplying all nutrients when compared to conventional weight loss dietary advice which is based on providing a low fat diet that is rich in whole grains. In actual fact, very little food sources contain the whole grains that confer actual health benefits and in New Zealand true wholegrains such as pearl barley, brown rice, and pumpernickel bread are not common items of our dietary intake. Most wholegrain breads are made with white flour and other refined additives (they are in fact highly processed foods). The grinding of wholegrains to make flour produces a high-GI carbohydrate. The consumers most convenient guide to what is wholegrain and what is not comes from packaging claims which are more or less misleading. Furthermore, attempts to comply with this recommendation in institutional kitchens often results in the addition of bran to refined grains. A recent meta-analysis has concluded that the health benefits of a diet high in wholegrains could be overstated, and the suggested benefits observed in epidemiological studies are not supported by the clinical trials. In addition, there is increasing prevalence of maladaptive immune responses to proteins of various grains and legumes in a significant proportion of the population. The rate of coeliac disease, while acknowledged as a small population prevalence, is highest in the cultures that eat the largest proportion of diet as wheat. The increasing recognition of sub-optimal health related to non-coeliac gluten sensitivity – including allergies, headaches, gastro-intestinal problems and fatigue – suggest that reducing wheat-based carbohydrate in the diet for many could be beneficial. Phytic acid, which is found in high levels in unrefined grains, binds to minerals, rendering them insoluble, and is linked to deficiencies of iron, zinc, magnesium and calcium. The third major criticism of a LCHF diet is that it leads to ketosis which is a dangerous metabolic state to be in. We are able to burn both glucose and ketones as a fuel source, however given the modern diet, most people preferentially burn glucose. Nutritional ketosis is a state whereby the body burns ketones as opposed to glucose as a fuel source. Ketones are produced from the breakdown of fatty acids and amino acids, of which there are three types: acetone, acetate and betahydroxybutyrate (BOHB). This survival mechanism likely provided humans with a metabolic advantage in prehistoric times when food was scarce and we went for a period of time without fuel. The limited storage capacity for carbohydrate requires an alternative fuel source for the brain (first and foremost) and the ketone bodies produced through ketosis provides these. Nutritional ketosis is when ketone (BOHB) production measured through the blood is around above 0.5mmol/L, with the ideal spot (to confer mental acuity benefits) said to be between 1-3 mmol/L. This state of nutritional ketosis is confused with diabetic ketoacidosis, a serious health condition due to uncontrolled ketone build up in the blood. This comes from the inability to take glucose into the cells in people who aren’t able to produce insulin (typically people with type 1 diabetes). The body recognises this as a fasting state and effectively starts to produce ketones for an alternative fuel source, however there is no ability to clear either ketones or glucose without the provision of insulin and instead the rapid rise in ketones (to levels above 10 mmol/L) can lead to serious metabolic conditions. This is as a result of a low pH level of the blood that can result in nausea, vomiting and unconsciousness. This state is, however, impossible for anyone who can produce insulin as the body has a feedback loop which enables the clearance of glucose and ketones from the bloodstream. Importantly, the level of carbohydrate in the diet required to achieve ketosis is less than 50g per day and, for many, closer to 30g per day. Protein levels also have to be closely monitored due to gluconeogenesis. So, while a low carbohydrate diet can lead to ketosis, this isn’t an inevitable part of embarking on a low carbohydrate diet, and nor is it a requirement for being able to use fat as a primary fuel source. There are many pathways in the body that allow us to use fat as an energy substrate. This includes upregulating lipolysis (the breakdown of fat stores into fatty acids and triglycerides to be used by the muscle as energy); the upregulation of beta oxidation which increases the conversation of fatty acids to acetyl coA (the precursor for the Krebs cycles to produce ATP) and the increase in gluconeogenesis (the conversion of protein and fat to glucose) are all pathways that can aid in fat burning that don’t require a ketogenic diet and instead can be enhanced through following a well formulated LCHF diet. Finally, people mistakenly assume that a low carbohydrate diet must be high in protein and that this is both expensive and unsafe. As mentioned above, a well formulated LCHF diet contains a moderate amount of protein, with the remaining calories coming from fat. In the literature the percentage energy coming from protein is typically in line with standard recommendations for protein intake (between 15-25%). It is also worth mentioning that a higher protein intake is not associated with adverse health outcomes in people who are healthy; those with impairments to their kidneys do need to monitor protein consumption as the kidneys are the organ responsible for processing protein load in the body. For most people this is not a concern. In summary, while there certainly isn’t one diet to suit every individual, a well formulated LCHF dietary approach is beneficial for metabolic, health and sports related outcomes. When designed to optimise nutrient quality, the similarities between this and a ‘paleo’, ‘whole food’ or ‘clean eating’ approach far outweigh the differences. Practical tips:

  • A low carbohydrate, high fat diet (LCHF) is one which the calories from carbohydrate are approximately 25% or less in the dietary intake, and typically below 150g per day in absolute amounts.
  • The premise of a well formulated LCHF diet is one which is based around food quality and consuming food as close to its natural form as possible.
  • Build meals around an abundance of non-starchy vegetables of all colours.
  • The carbohydrate foods consumed on a well-formulated LCHF diet come a small amount of starchy vegetables and legumes, low sugar fruit and full fat dairy products.
  • Incorporate moderate amounts of animal protein, fish and eggs for quality protein sources in a meal.
  • Fats such as butter, coconut oil, lard and olive oil are best to cook with, and other nut oils can be used as dressing for salads. Include avocado, raw nuts and seeds as high fat options in meals and snacks.
  • Processed or highly refined foods, oils and margarines or spreads are best avoided.
  • Incorporating fat and protein in every meal or snack will help minimise blood sugar swings and improve glycaemic control across the day.

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.

Take a B vitamin supplement? Read this.

A lot of clients I see take a general multivitamin tablet, kind of as an ‘insurance’ to optimise their nutrient intake (or as a bandaid for a less-than-ideal diet). Some also specifically eat fortified foods to make up for the lack of nutrients in their food choices later in the day. Fortification is the addition of nutrients into a food product by manufacturers that are not originally present. Why eat real food when you can get all the nutrients you need in a box of cereal, right? Special K is high in protein (thanks to the addition of wheat gluten) and contains 18 essential vitamins and minerals. Despite not having research studies specifically telling me so, I’ve been mildly suspicious for years that our absorption of these would be different if they are added to a food product. A good example of this is iron – Nestles’ Milo contains 5.3mg of iron per serve (to add to our recommended 8mg – 18mg per day we should obtain from diet)  – but that certainly doesn’t come naturally from a…. milo bean. Whenever anyone asked my thoughts on how useful it is to incorporate Milo in their diet due to the addition of iron, I was more inclined to direct them to mussels and beef as a better source*.

I tend to think my suspicion could be more intuition as I delved more into the availability of other nutrients from the foods we eat. Take our B vitamins folate (B9) and cobalamin (B12) for example. These are found in the diet in leafy green vegetables (folate) and animal protein sources (B12), with beef and chicken liver being a great source of both. These are also a favourite addition to the raft of supplements provided by breakfast cereal and the B vitamins as a group are often a supplement listed by clients filling out a health information sheet prior to a consultation, often as part of a stress complex (or de-stress) or prenatal formula. There are a number of different formulations for vitamins, and those  most widely available in supplements and in fortified foods are folic acid (as opposed to folate) and cynacobalamin. Does this matter? It could. Folic acid added to flour in many countries has been effective at lowering the rate of neural tube defects (NTDs) but if choosing to supplement rather than rely on fortified foods, it might not be the best form of folate to seek out.

I should back the truck up a little bit here. Firstly, folic acid is often used interchangeably with folate but they aren’t the same thing – and therein lies a (potential) problem. Folate is more of an umbrella term that encompasses a group of compounds from the biologically active form that the body uses to the synthetic folic acid produced in a laboratory to be shelf stable to be able to be added to food products or as part of a supplement. In between we’ve got a host of different forms of folate (folic acid, methylfolate, tetrahydrofolate as examples) and if you looked at the chemical structure of these they would look very similar – however there are differences which can determine their usefulness in the body. The most bioactive form of folate has a methyl group attached, and folic acid does not. This means that folic acid has to go through a bunch of different steps in the body to be converted into methylfolate.

Folate is not just beneficial for women of childbearing age to protect the foetus from NTDs – its functions are wide and varied. Our skin is regenerating itself on a daily basis, as are the cells related to our gut, our brain…. In fact, everywhere in our body. This is only made possible by our body’s ability to produce DNA. Folate plays an important role in methylation  – which is a whole series of posts within itself, and I’m not smart enough to write those. It is a fascinating area and one which I learned a whole lot more about at the Ancestral Health Society Symposium earlier this year from Dr Tim Gerstmar (who will be presenting at our AHSNZ conference in Queenstown, October 2015). Basically it’s responsible for turning on and off genes in our body (some we want to have on, others we want to have off), making certain genes, is vital for controlling inflammatory pathways, for detoxification…. Co-factors responsible for processes in the body (such as creatinine, Co-Q 10, phosphatylcholine to name a few) requires methylation, as does neurotransmitter production – melatonin and serotonin production. And methylation requires folate. Folate is also necessary for red blood cells, white blood cells and platelets – clearly, it’s critical! Without the necessary levels in your body, you can see that these everyday reactions could well be compromised.

When folic acid from supplements and fortified foods goes through the conversion process to the more bioactive forms, it is a slow process. This can lead to an accumulation of unmetabolised folic acid (UMFA). There’s uncertainty around the implications of this particularly with our immune system – as UMFA appears to inhibit the action of natural killer cells, an innate part of our immune system responsible for rejecting foreign bodies. . Further, high levels of folic acid can mask B12 deficiency.

What about B12? Same deal. It works alongside folate (and the other b vitamins) and is also required for methylation. While you might take a supplement (and your serum level of B12 when tested reflects a good intake) it doesn’t mean that you have good levels of active B12. Measuring methylmalonic acid (MMA) – which accumulates in the absence of adequate vitamin B12 can be tested alongside serum B12 to get an idea of functional B12, but I don’t know how standard it is to do so. If you suspect you are low (or your health professional does) then testing this could be a good idea.

So…  while I think that getting what we need from food should be a given, I’m not actually against supplements. Truth be told, more and more people I see tend to benefit from adding in supplements such as a B complex to help support energy metabolism (among other things) in addition to an awesome diet. So if you do supplement it makes sense to me to get the most bang for your buck and supplement with the most active forms, such as a methylated folate and cobalamin. I’ve come across the Biobalance brand as one such form (and, no, I’m not affiliated with this, but it’s good to share when you find something useful).

* Related, when I was investigating the cost of the average family’s food intake I was surprised to see that Milo was included as a staple from the ‘basic’ trolley to the more ‘liberal’. Milo had apparently become a staple food for all New Zealanders. After reading that the New Zealand Food Cost Survey aimed to meet current dietary recommendations for nutrients…it made more sense to me. After all, Milo also contains B vitamins, vitamin C and vitamin A… and when teamed with trim milk it’s low GI. Wow, a superfood that could bump up the nutrient intake of all people, regardless of food budget. Who knew?!

Spice it up

One of the benefits of eating real food is that it minimises the amount of processed refined foods that drive the inflammation pathways in the body which, as you know, is the underlying cause of modern chronic disease. From a general health perspective, this is awesome. From an athlete perspective it is even more so – given that the training derived oxidative stress causes cell damage and breakdown, increasing recovery time from sessions. Anything that impedes recovery is not going to allow you to make the fitness gains you are looking for. Of course, it’s more than just diet you have to consider.  I’m three weeks post-marathon and am up to running around 50 minutes every 2-3 days, with calf and foot niggles making me more cautious that what I’ve needed to be in the past. It’s frustrating for me to tell you the truth; yes I enjoy gym work and swimming, but there is nothing I love more than running and when the weather is blossoming into summer and the choice is between a Smith squat machine or Auckland Domain, I’d know where I’d rather be. Worse is that I really only have myself to blame. I’ve pretty much got my diet dialled in (as to be expected – though, no, it’s not perfect as I am human 😉 ) and I honestly have been taking the return to running seriously and listening to both Coach and osteo advice to ease into it. But it’s slower than what I would have imagined. Where I fall down is the recovery out of training – you know, the wind down time, getting enough sleep – that kind of thing. Hence I’ve been making a real effort this week to get to bed early, to practice diaphragmatic breathing whilst driving and to invert my legs up onto the wall at the end of the day and just ‘be’. So it got me thinking about additional ways to support the body outside of the diet, exercise and lifestyle. What other dietary factors can help support the anti-inflammatory pathways in the body outside of a reduction of processed food and the free-radical scavenging properties of fruits, vegetables, animal protein and eggs?

A lot of athletes are heading into heavier schedules with the Christmas holidays allowing for some block training to occur. This is (for some) combined with the increased indulgences of additional alcohol at end-of year drinks and caffeine to get through the day. In combination with late nights and early starts, it’s no wonder that we hang out for December 23 as this time of year can wreak havoc on the body. It’s too easy to think you can pop a Voltaren or Neurofen tablet before going out and training (or at the end of a hard session) to mitigate the niggles and strains you feel that come from a lack of recovery. This might not seem like a big deal at the time but it really does more damage than what you think. I know – I used to be blasé about these things too – I had a ‘stomach of steel’ that was Impenetrable to even the most harshest of substances (there’s few things harder on the stomach than a mixing bowls worth of green gooseberries that I’ve successfully put this away with no ill effect in my younger years). But the older I’ve become, the more digestive issues I’ve struggled with around training, the more aware I’ve become of the impact that anti-inflammatory pharmaceuticals can have on the gut and subsequent health. Training in itself has been found to increase gut permeability. The decreased blood flow to the gut through even moderate steady-state exercise has resulted in intestinal injury and elevated liver enzyme parameters – and that’s an acute effect of just 60 minutes training. You can imagine what your normal high intensity effort or Sunday bunch ride does in relation to tearing up your insides?*  This increased gut permeability is a big deal. The once tight junctures that should not allow foreign matter to travel through are now not-so-tight. When we have foreign bodies allowed into our system this sparks an auto-immune response. Inflammation is one of the body’s first line of defence against injury, and over time this acute inflammatory response can become chronic which leads to deleterious health effects moreso than just impaired recovery. So the training in itself loosens the guts main defence against foreign proteins, which can increase inflammation – and when you throw ibuprofen on top of that, the effects on the gut and inflammation over time are even worse. It’s an easy thing to do, certainly, and a lot of people do it – however over time this can cause sensitivities to foods that you once had no problem digesting. Think grains, milk, certain types of carbohydrates in the FODMAP spectrum. Our gut has just one cell thickness protecting it from the outside environment. It doesn’t take a lot to upset the balance.

Of course, I’m speaking mechanistically here and everyone is different – some people will go through their athletic career and not have an issue at all despite a regular habit of popping vitamin V; others though, will notice that their tolerance to certain foods is now lower, the time taken to recover from training sessions is greater, and they are not able to get as fit as fast as they used to be able to. Is it an age thing? Sure. You’re not as bulletproof as you were in your 20s. But it could be more than that.

So I thought I’d mention some spices that can help support the anti-inflammatory pathways in the body. This isn’t going to dive into the ins and outs of that information – this post is already verging on being too long.

Tumeric (active ingredient curcumin): (particularly in the presence of fat to help absorption) – my friend Chris loves eggs with a heaped teaspoon or two of turmeric, and avocado and butter in the morning.

Ginger (I love ginger tea, just grating it fresh into hot water) and in green smoothies with lemon.

Cinammon: known for helping blood sugar control and also for its anti-inflammatory properties – I always like to include this in my breakfast meals, as a sweetener for baked rhubarb (no sugar required), in a slow cooked meat recipe or mince.

Garlic a member of the sulfur family, a well known anti-inflammatory compound.(okay, not a spice, but worth a mention)

Cayenne and chilli (active compound capsaicin) – chilli flakes and cayenne pepper are great on eggs, in salad and have you tried chilli chocolate? it is Christmas after all.

The beauty of these spices is that they are cheap, readily available and complement perfectly your real food lifestyle. This post is not prescribing anything more than the liberal inclusion of them in your everyday food. Every real food pantry should regularly utilise these in cooking, baking and barbequing. They are not a panacea to burning the candle at both ends – but it is worth your while to spice things up a little bit in the kitchen if you’re not already doing so.