Six things I think you should know about LDL cholesterol

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

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

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

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

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

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

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

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

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

 

No willpower when it comes to food? Read this.

‘ The chocolate bar calls my name. No, really – I can’t NOT eat it if it’s in the house.’

Many people I talk to lament that they can’t control themselves when it comes to sugar or junk food – that they don’t have the willpower to say ‘no’ despite their best efforts. This implies that they have all the control. Now I’m not saying there isn’t an element of discipline that may initially be required when changing the way you eat, especially for people who have lost touch with their appetite and satiety signals which can happen when the food eaten drives unfavourable hormone responses in the body; a phenomenon which is common in the current food environment. However, there are other more powerful forces at play here. Your No physiology has far more say in your food decisions than you think, and I’m going to cover one of the main ones I see (and one of the easiest ones to correct) that will help people control their food intake, rather than let their food control them: the blood sugar rollercoaster

This is one of the biggest drivers of cravings in my experience. The type of diet that many people follow is either carbohydrate heavy or devoid of protein and fat. Both situations are going to set your blood sugar up for rise and fall of (what can be) epic proportions. When carbohydrate is broken down into the bloodstream into glucose, this takes our blood glucose level out of homeostasis (normal). One thing our body likes is homeostasis – a blood sugar level too high or too low will send signals to the brain that this needs to be corrected. The greater the fluctuation, the louder this signal is. Insulin is the hormone responsible for removing glucose from the bloodstream to be used immediately for energy or to store it for later use (in our muscles and liver) and return the blood glucose level to homeostasis (normal). However, a meal that has a large amount of carbohydrate (a high carbohydrate load) will accelerate this process, as will a meal that has minimal protein or fat (even with a lower carbohydrate load, as the proportion of carbohydrate will still be greater). This is because insulin responds first and foremost to carbohydrate, with a minimal response to protein containing foods, and (for most people) a negligible response to foods predominantly containing fat. When this process is accelerated, insulin moves too much glucose into cells and our blood glucose level rapidly drops to below normal (an over-correction). The signal to our brain therefore becomes a panic signal: blood sugar has dipped below normal and needs to be rapidly restored – enter sweet food cravings as our brain recognises these foods are going to return our blood glucose levels back to within that normal range much quicker than, say, a salad. Along with the cravings, we may experience ravenous hunger (where 15 minutes earlier you felt fine), irritability (‘hangry’) and (in particularly bad cases) dizziness, light-headedness, sweating and vision loss.

The quicker the carbohydrates are digested (especially in the absence of fat and /or protein), the higher the rise and fall in blood sugar, and the greater the effects on energy and subsequent cravings for food (and ‘lack of willpower’). You may be fine for the morning and rapidly cave in post 3pm. Or it might be that Monday and Tuesday you are sweet, but by Wednesday you are raiding the kids ‘treat’ box in the pantry.

This isn’t just an issue with regards to blood sugar management and fat loss goals, but more importantly it can make you feel pretty rubbish. So many people start a tirade of negative talk that they weren’t able to say ‘no’ to a paleo muffin or chocolate biscuit, that they have ‘failed again’ and they ‘may as well finish the entire packet as it’s the last time they’ll eat X food again.’ Or their inability to resist a sweet treat clearly indicates they aren’t worthy of whatever health goal or life goal they’ve set themselves, and will eat junk food as a form of punishment (or undereat to try to get it under control), and so starts the rollercoaster ride of the blood sugar crash.

While I’d like to say it’s really easy to figure out which foods are most likely to cause this process, recent research tells us that there is wide individual variation. You are your own best investigator when trying to figure this out. It is useful, of course, to know where carbohydrate comes form in the diet and starting to explore how these foods affect you specifically. You can use an app like Easy Diet Diary, My Net Diary, Fat Secret to help you determine where the carbohydrate is in your usual diet if all of this is new to you. That said, an energy dense, carbohydrate source is more likely to trigger a blood sugar response. These include (but are not limited to):

  • Dates
  • Other dried fruit
  • Honey
  • Rice malt syrup
  • Bread
  • Pasta
  • Rice
  • Cereal (including Nutrigrain, Cheerios, most cereals with a Health Star Rating)
  • Honey
  • Coconut sugar
  • Kumara
  • Potato
  • Grapes
  • Fruit juice
  • Vegetable juice with a fruit juice base
  • Vegetable juice with beetroot/carrot base

This doesn’t mean that all of the above choices are bad! At all, however, in the wrong amounts, and when eaten in isolation of other food choices, these are more likely to spike your insulin levels than other foods. Artificial sweeteners do not get a free pass either, unfortunately, with some showing the same physiological effects as sweet foods, eliciting a glucose/insulin response.

So… it’s not willpower, people – it’s physiology.

The easiest and *best* way that helps mitigate this is NOT a supplement. While these can be useful in certain situations or medical conditions, for most people it comes down to food timing and balancing. Protein and fat don’t have the same insulin effect, so they are not going to cause the same blood glucose rollercoaster that carbohydrate does. Incorporating these as the majority of your energy source is going to slow down the digestion of the carbohydrate you eat and the subsequent rise in blood glucose. Without reaching the same ‘highs’, your blood glucose doesn’t have the same drops – and cravings, hunger and crashing energy levels are FAR less likely. Fibre from non-starchy vegetables are another way to have this effect and help maintain a homeostatic state.

Despite what I say, what other experts tell you or what the literature or dietary guidelines tell us, you are your own best investigator when it comes to figuring out what works for you. One of the easiest ways to measure how food affects your blood sugar control is to assess the qualitative signs after eating: do you feel like falling asleep after a carb-based meal? Do you get moody, irritable, ‘hangry’ a couple of hours after eating? Are you fine, fine, fine, STARVING a few hours after eating? These are all good indicators that your blood sugar is in control of your actions (rather than you). From a quantitative perspective, getting a glucometer (finger-prick blood glucose reader) from the pharmacy and testing your blood sugar two hours after eating a particular food or meal is another good way to see how this affects your blood sugar levels. If it lurks above the 7 mmol/L mark at this point, then potentially the carbohdyrate type (or the context with which you ate it) isn’t ideal for you. Remember, this isn’t just about the food you’re eating at that time, it has implications for your food decisions later in the day. This is potentially more important if you find you have ‘no willpower.’ If you need help figuring out what to do from here, contact me for a consultation, we can sort it out.

Finally, pro-tip: when eating a meal, eat the protein and vegetables before tucking into the carbohydrate component. This will lower the post-prandial glucose response and the overall effect on your energy levels, levelling them out as opposed to leading to a crash.

Time restricted eating: when you eat matters

Intermittent fasting is an increasingly popular phenomenon among people wishing to improve their body composition and their overall health – almost as much as consuming the latest superfood.

Intermittent fasting (or time restricted eating, as it is known in the scientific literature) is when we restrict our eating during the day to a window of from around 8 hours to 12 hours, and has been popularised by the fitness industry in recent years. There are different ways to approach it, though from a health perspective, eating earlier in the day to allow for the feeding to align with our body’s circadian rhythm may optimise the health benefits for overall longevity. Fasting has been a practice undertaken for centuries in some cultures, and research reports favourable effects on many markers of metabolic health, including blood lipid profile, blood glucose metabolism and hypertension when these populations have been studied. More recently, researchers have investigated different time restricted feeding protocols in relation to risk of cardiovascular disease, neurological disorders, diabetes and some cancers using rodent and human trials. The longer time spent fasting may have pronounced health benefits, though recently a more conservative method (of even an 11 hour fast) has emerged as being beneficial for certain populations. Indeed, time restricted eating is being thought of as an easy to implement, effective lifestyle intervention that could help improve appetite control, markers of overweight, inflammation, blood glucose metabolism and hypertension, all reducing risk of cardiovascular disease, diabetes and some cancers. This recent small study found that late night (or prolonged eating periods) increased fasting glucose, blood triglycerides, insulin and weight gain.

When healthy adults eat meals that are identical in terms of macronutrients (ie carbohydrates, proteins and fats) and caloric load at breakfast, lunch and dinner, the postprandial (ie. after eating) glucose response to the meal is lowest after breakfast and highest after dinner, even though the meal is identical. This is one example which suggests that our metabolism, and response to food, changes across the course of the day (see here). We are diurnal creatures – we do most of our activities during the day (including eating, working, exercising) and we rest at night. This is controlled by our internal clock in the brain, the superchiasmatic nucleus (or SCN) which in turn influences smaller internal clocks (or oscillators) in the peripheral tissues of our body. These clocks control thousands of genes within our body, including those that regulate our metabolic processes, which accounts for around 10% of our entire genome. While light is the major cue for the SCN in our brain, timing of food intake influences the circadian rhythm in the other tissues, including the liver, which has implications for metabolism. This tells us that our basic metabolic physiology is supposed to behave differently according to the time of day – this is everything from making neurotransmitters, to making insulin, to glucose transport inside of cells, to fatty acid oxidation and repairing cellular damage. It makes sense then that when we eat has just as important implications for our health as what we eat. Research investigating the health effects of fasting has found that anything that breaks the fast will break the fasting period, including no calorie options such as black coffee and even herbal teas. This is because there are compounds within these fluids that require breaking down by the liver. That is not to say that people don’t experience benefits from fasting if they consume a hot beverage earlier in the day (as is often recommended to help get through the morning hours and comply with a 16:8 protocol) or limited calories (for example, 50 calories), however longevity benefits may well lie within the strictest definition of fasting.

With the advent of artificial light, and the changing structure of work schedules (combined with the increasing busy-ness of everyday life), this has elongated the period of time that people eat, which has negative health consequences. While you may have heard in media reports of scientific studies that eating late at night makes no difference to overall weight loss, the focus on weight ignores the more important, underlying metabolic and chronic disease risk that eating late into the evening can have on health outcomes. It may be easier to regulate appetite too, as  research suggests that appetite hormones respond more favourably to eating earlier (8am to 7pm) than later (noon – 11pm), and the level of satiety achieved with this could prevent overeating. This is relevant with time restricted feeding as research has shown that more frequent eating patterns can be detrimental to metabolic health if consumed close together. One study found that participants who ate excess calories consuming their food over three meals and three snacks had increased visceral (stomach) fat deposition, liver triglycerides and lower liver insulin sensitivity compared to those consuming the same number of calories over three meals. The snacks were consumed later in the day, and after each meal, so elongated the overall eating period.

Animals limited to 9-12 hours feeding period, but not limited in the number of calories they eat have experienced benefits including decreased fat mass, increased lean muscle mass, improved glucose tolerance and blood lipid profile, reduced inflammation, higher volume of mitochondria (the energy powerhouse of our body), protection from fatty liver and obesity, and a more favourable gene expression. In humans, research studies suggest that eating within a time restricted window of 11 hours (say, 7am to 6pm) is associated with a reduction in breast cancer risk and occurrence by as much as 36%. Earlier eating time has resulted in more effective weight loss in overfat people, and every 3 hour increase in fasting duration was linked with 20% reduced odds of having an elevated glycated haemoglobin (HbA1c), a marker of long term blood sugar control. For every 10% increase in calories consumed after 5pm there was a 3% increase in c-reactive protein, a biomarker used to measure inflammation (the underlying process that, when elevated long term, can influence risk of diabetes, cardiovascular disease and some cancers). Finally, when meal times were constructed earlier in the day this resulted in a 10% decrease in c-reactive protein. Eating within a 12-hour window improved sleep and weight loss within an otherwise healthy population. You can see then, the myriad of potential benefits to eating within a time restricted eating – could it be worth trying to fit into your lifestyle? And if so, how to do it?

There are many different time restricted eating protocols to choose from – and the type of fast you choose to do really comes down to what works for you. The 16:8 protocol that seems to be most popular is a little aggressive for anyone new to fasting, and this may ultimately leave you feeling hungry, cranky, and vulnerable to overeating later in the day – undoing any potential health benefit that has been shown in the research. Indeed, many people I see that try this as their first experience report that they can successfully get to 11am or lunchtime without eating, but once they are home from work, no amount of food will keep them full, eating right up until bedtime.  My advice is to start a little more conservatively. Given that (in an ideal world), we sleep for 8 hours a night, not eating in the 3 hours leading up to bed time should be a good place to start for most people, thus it gives that 11 hours where some of the health benefits begin to be realised. From there, once adapted, you could try to push it out by an hour. While the most potent benefits occur with the strictest definition of fasting, the blood glucose and lipid improvements, along with fat loss can still occur in those whose definition of fasting refers to calories, not coffee and tea as mentioned above. That the benefits occur in the absence of caloric restriction is important to reiterate, however by restricting the eating period, many people also reduce overall caloric intake, which can further improve overall metabolic health and body composition. Fasting doesn’t appear to be something you must do every day to see the health benefits either, and even 3-4 days a week could be beneficial for metabolic health.

That said, this reduction in calories and extended time NOT eating may not be good for all, especially if your notice increased anxiety, sleeplessness or disruptions in hormone balance, so it is always best to proceed with caution. It would also be prudent for any individual with a health condition to discuss with their health professional before embarking on time restricted eating, especially the more aggressive protocols.

(PS I’ve got dates booked for Nelson, Wellington, Dunedin and Christchurch for my talk! Click here to find out more details, would love to see you 🙂 ).

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As with many things, it could be all about timing…

10 tips to help reduce your water-bloat

I got a question on my members’ Facebook page a couple of weeks ago regarding water retention. There is nothing worse than a bloated tummy – it can not only make you feel physically uncomfortable, but can also wreak havoc on your psychological state (as many people equate the bloating to ‘feeling fat’, despite there being no relationship between the two). Further, a bloated stomach impacts on your ability to move properly. We can’t engage our core muscles, so aren’t able to move, lift, push or pull in a way that is functionally optimal. This has important implications for our core strength and injury prevention. Of course water rentention affects more than just our stomach – a long haul flight to somewhere warm can turn anyone’s lean calves into kankles due to changes in the pressure in the capillaries, causing fluid to leak out into the body tissues. There can be many reasons for this, so I thought I would investigate the most common causes and possible solutions.

  1. Minimize your sodium intake. Although sodium (aka salt) is an essential mineral because it’s used to regulate the fluid levels in body tissues, bringing water into the cells. Excess intake of sodium may cause excessive fluid retention in the body tissues. While the evidence behind this recommendation suggests it isn’t something that affects everyone, this may help some people, particularly those who are salt sensitive or hypertensive. Do note, though, that if you follow the types of principles that I suggest, your diet is probably quite low in salt anyway, as most salt comes from processed foods (around 70%). However, there are whole foods that are high in sodium, such as cheese, miso, cured meats and biltong, so you could reduce these, and avoid adding salt to your food to see if this makes a difference.
  2. I probably don’t need to tell you to avoid eating too many refined carbohydrates – these tend to spike insulin, which causes sodium (often found in these foods) to be re-absorbed back into the kidneys, thus increasing water retention. Your best bet for carbohydrate foods are those whole-food, minimally refined varieties that have negligible sodium for a start, and that you eat in a mixed meal with good fats and proteins to help slow down the release of carbohydrate into your bloodstream, minimising insulin response.
  3. Any form of dehydration can cause your body to hold onto water. Therefore, ensure that if you drink alcohol, do extended exercise training sessions, or are in a hotter environment that you remain well hydrated to offset any potential for dehydration. The fluid you lose during exercise should be replaced in the three hours after training, and at 1.5 times the amount lost – you can work out how much this is by weighing yourself before and after an exercise session. The amount of weight lost roughly equates to the amount of fluid lost. Prior to drinking alcohol, have a couple of glasses of water (this will also help slow down your drinking). And be an adult about how you drink: is it necessary to drink more than a few in any one sitting?
  4. Take adequate amounts of vitamin B6 combined with magnesium. For women, prior to your period you can feel a little bloated and that you are retaining water. Interestingly, however, some research investigating the timing of this around the menstrual cycle has found bloating occurs more in the onset of your cycle (day 1) after which is rapidly declines, despite the perception of puffiness or bloating in the week prior to menstruation. This puffiness, however, could well be related to food choices in that week, as the intake of higher sugar choices can increase for some.
  5. If you have water retention before your period, you may, however, benefit from taking both a magnesium supplement (at 250mg per day) combined with a vitamin B6 supplement (40mg) daily – a study found this combination the most effective for decreasing premenstrual symptoms when administered for two months by balancing your hormone levels.
  6. Potassium works in conjunction with sodium, pumping fluid out of the body cells. Therefore, if you aren’t consuming enough then it could cause problems with water retention. The reality is, though, that you are following the meal plan and including plenty of vegetables, your potassium intake is likely fine. However, if you don’t have a good intake of vegetables (at least 7 serves per day) then increasing these is a good idea. This will also bump up your fibre intake, which can further help reduce fluid retention.
  7. Take natural diuretics. Dandelion root has long been used to help flush water out of the body – therefore investing in a good tea such as this Golden Fields one is not only delicious (often used as a substitute to coffee), it will also be beneficial. In addition, this kidney cleanse tea from Artemis has other natural diuretics to help flush water out.
  8. Exercise regularly. Exercise can help reduce water retention, not just by increasing sweating, but by moving water from the intercellular compartments to the muscles.
  9. Increase your caloric intake, if only for a day. I know – this one sounds weird, but a ground-breaking study in the 1950s called the Minnesota Experiment found something interesting mid-way through their study. The study followed men on a 1500 Calorie diet for 6 months, and subjected to hours of hard labour per day. Half way through the trial the men were allowed a celebration meal, effectively increasing their caloric intake to 2300 Calories. Following a night of getting up to go to the bathroom several times, the men were a few pounds lighter the following morning. Obviously, the weight lost was water weight – but why would this be the case? Potentially the long-term calorie deficit caused an increase in cortisol levels, and this increases water retention in the body. By increasing caloric load, the body reduced cortisol levels and this reduced water retention.
  10. Reduce overall stress load. As we have just discovered, higher cortisol levels will increase water retention, therefore anything you can do to reduce stress is going to impact favourably on water loss. Let’s not forget the impact that high stress levels have on blood sugar levels, inflammation and fat gain (to name just three areas it impacts). While stress is a perception of a situation, and changing your mind-set is one of the best things you can do to lower stress levels, ensure you are getting adequate sleep, time in nature, time with loved ones and taking time just for yourself. These are going to help lower your cortisol levels and combat any stress-related water retention.

So… not a definitive list, but hopefully a few pointers to help you get to the bottom of your fluid retention issues and make some improvements. For more individual advice, don’t hesitate to contact me for a consultation or for online nutrition coaching. Further, if you’re in the Bay of Plenty, Queenstown, Nelson or Wellington regions, then I’m headed your way for an evening of ‘real food’ talk – click here to find out more information and to book tickets!

 

LCHF…why isn’t it working for me? (Part 2)

Last week I posted three reasons why many people undertaking a LCHF diet stall with their success or never get it off the ground to begin with. The following delve a little deeper into the less obvious reasons why people struggle with their diet, and offer some options to help troubleshoot.

  1. Fat doesn’t fill you up. For some people, they don’t feel satisfied when swapping out their carbohydrate for more fat. If it takes a few handfuls of nuts or half a block of cheese to feel satisfied, then there can be some serious increase in calories that isn’t compensated for by an appropriate increase in satiety from the meal. Yes, cheese and nuts contain protein, but to be honest I treat them more as sources of fat than I do protein. If this is you, then.
    1. Increase the portion of protein you are consuming with your meals. I know many people are scared to consume more protein because protein can be broken down into glucose in the absence of carbohydrate, therefore pushing up their blood sugar levels. For people on a ketogenic diet (where 80% of their calories should come from fat), or those metabolically damaged (whereby there is a dramatic change in blood glucose response from a protein-rich meal), this may be a problem. For most people though? upping protein by 1/3 of a serve is no biggie. Still hungry? Up the protein some more.
    2. Drop out some fat –make room for the added protein by dropping out some of the fat – you could start with ½ – 1 serve and see how satisfied you feel when you do that. A serve of fat is typically 1 tablespoon of oil or butter, or ¼ avocado.
  2. You’re eating too much in one meal. A lot of people move from three meals a day, to two a day, to a ‘minimal food during the day’ approach, to sit down to a large meal at night, especially if they’ve been in the LCHF way of eating for a while and are further tweaking it. This may be awesome for some people, but not all. Eating most of your calories in one meal can, though, wreak havoc on your metabolic blood markers (such as blood glucose levels and insulin), increase fat gain, inflammation and reduce your day-to-day energy if this eating pattern doesn’t suit you. You’ll know if this is you, and if it is then:
    1. Spread your food intake out across 2-3 meals to lighten the caloric load and see if this makes a difference to your energy or other more objective markers mentioned above.
    2. Remember you’re still a rockstar even if you have to eat more often.
  3. You’ve got a high intake of dairy or nuts. Some, especially women, are not suited to high amounts of dairy or nuts, and when the begin to include more of these foods – ones they’ve avoided for years due to their fat content – they have a weight loss stall they can’t move past or, worse, they begin to store fat around their middle. While some suggest cheese is a food akin to crack, research investigating the addictive properties of the protein in cheese have not found this to be the case. Of course, if you personally can’t stop at one slice and find you’re eating the block, then perhaps it is for you. Nuts can also be trigger foods for some people, and they find it difficult to stop once they’ve started eating them. Ditto with a jar of peanut butter. What to do?
    1. Omit dairy for 30 days – sometimes it’s not the dairy per se, it’s the amounts that you’re eating it in that need to change. Removing it entirely will allow you to change your habits and then reintroduce it.
    2. Omit nuts and/or nut butter as per above in #6a.
    3. Swap snacks to those that are predominantly protein-based rather than fat based – despite the satiating effects of fat, for some, it’s just not like having protein. A hardboiled egg or some leftover chicken wrapped in lettuce or nori sheets (my current obsession) may satisfy you more.
  4. Genetically this isn’t the diet for you. If metabolic markers such as cholesterol, blood sugar or inflammatory factors go skewiff then it could be the LCHF approach doesn’t suit you. Genetic variation in the ApoE gene (ApoE4) is associated with LDL cholesterol not being recycled very well, and therefore it’s more likely to hang around the bloodstream and increase the chances of it becoming either oxidised or being transformed into smaller LDL particles, both highly atherogenic. Variants in the gene FTO can increase risk of obesity in the context of a high saturated fat and low polyunsaturated fat intake and may increase risk of high blood sugar and diabetes in individuals already overfat. The PPAR genes plays a role in ketogenesis (the oxidation of fat for energy) and storage of fat by activating genes associated with fatty acid transport and metabolism. Variants of this gene (particularly PPARa and PPARg ) are associated with increased risk of high triglycerides, total small dense LDL cholesterol and type 2 diabetes in the context of high saturated fat to polyunsaturated fat intake. Further, individual glycemic (blood sugar responses) vary considerably for the same amount of carbohydrate in food, suggesting there are a lot of factors to consider when determining the best diet for you (such as genetics, gut microbiome, activity level, stress etc), not just its macronutrient content. How to figure out if LCHF is not the diet for you? A few things to consider:
    1. Are you losing weight? If so, then wait until your weight stabilises and then retest your numbers – your body recycles triglycerides that are released from adipose (fat) tissue, therefore your triglyceride levels can appear high, but it is transient.
    2. Don’t get your cholesterol levels measured if injured, if you haven’t slept properly or you’ve been under significant stress. Cholesterol levels can change easily based on environmental triggers.
    3. Some people notice their cholesterol increases specifically in response to dairy fat, others to coconut fat – experiment for 6-12 weeks by dropping these out of your diet and get your cholesterol levels retested to see if this brings a drop in your numbers. Replace it with foods that have a more balanced fatty acid profile (such as lard or beef tallow) and foods high in monounsaturated fat or omega 3 fats, such as avocadoes, olive oil, nuts, seeds, salmon, mackerel, sardines.
    4. Here’s one I prepared earlier (and by ‘one’, I mean, ‘post on reducing your cholesterol naturally’. And by ‘naturally’ I mean ‘without Flora Pro Activ’).
    5. Get more in-depth testing of your cardiovascular disease risk profile – cholesterol is one measure and possibly not the most important one. CRP, fibrinogen, LDL particle size, number, oxidation and patterning can all give you more information than the run-of-the-mill lab test can. Contact me as I can help you arrange this testing which, for the most part, your doc might not even be aware of.
    6. Consider getting tested to find out your genetic predisposition (either through your doctor, or I can assist via Fitgenes gene testing).
    7. Consider dropping your fat intake, upping your protein intake and perhaps your carbohydrate intake too – ala the Zone diet approach. Despite its gimmicky name, it’s proven itself to be very effective for blood sugar stabilisation and blood cholesterol management. Some people just aren’t meant to eat a higher fat diet.
  5. You’ve got an intolerance you didn’t realise you had. Going LCHF means, for many, significantly increasing fat content in the diet from the obvious choices: cheese, nuts, seeds, avocados and coconut products. However, while these are awesome in terms of the nutrients they deliver, they can cause digestive issues in a number of people. Avocado, coconut, nuts and seeds are moderate-high in FODMAPs – a type of carbohydrate that can cause bloating, abdominal pain and other irritable bowel symptoms in many people. Further, the inclusion of larger amounts of cream, cheese or full fat yoghurt can be problematic due to an intolerance to the dairy protein or fat which can result in similar IBS in susceptible people. If you’ve been following a low-fat diet for many years, enzymes that help digest the fat and protein may be downregulated, so your body might not cope with the additional amounts. Sometimes it is a matter of backing down and building up, and sometimes it is that these foods just don’t agree with you. What to do? One of these tips may help:
    1. Follow a lower FODMAP approach to see if removing these foods settles down your discomfort. Doing this for at least 21 days and reintroducing a different food one at a time can pinpoint which one in particular might not agree with you.
    2. Introduce fermented foods as per #3e above to re-establish healthy bacteria in your gut.
    3. Replace dairy fat for alternative fat choices: nuts, seeds, avocado, coconut oil, beef tallow, lard.
    4. Ensure you chew your food properly at each meal to break it down, include lemon juice in water in the morning, and apple cider vinegar with meals to stimulate your digestive system, and consider ox bile supplement or a digestive enzyme that has lipase and/or pepsin enzymes to help you break down the fats and proteins.
  6. You’ve upped your alcohol intake because red wine and white spirits are “allowed” on LCHF. This might not even be intentional, but dropping your carbohydrate intake can lead to increased alcohol cravings, especially if your fat intake is too low, or your food intake is too low, or your stress levels are chronically too high. Or perhaps, you enjoy a moderate amount of alcohol but are continuing to gain weight on the LCHF diet.
    1. Be honest about how much you are drinking. Regularly consuming a ‘large’ as opposed to a ‘standard’ pour at the pub? Cracking open a bottle one night and then drinking to finish it off? Your plan to be alcohol free during the week has reduced to being alcohol free Monday – Wednesday? Evaluate if this is a problem for you … or not!
    2. Go alcohol free 5 nights a week, and enjoy a glass of whatever you fancy on the other nights. Ideally not those lolly water vodka mixes, but if you don’t like red wine, then choose something else. It’s not a deal breaker.
    3. Eat enough during the day so you’re not craving alcohol in the evening. This may mean including some additional starchy carbohydrate in your lunch meal – it doesn’t mean you’re not ‘low carb’ – as that in itself is a spectrum. This can really offset your cravings. Try it for 14 days to see if there is an effect.
    4. Lighten the load by choosing to have a low-fat meal if you drink. Old Skool 90s ‘dieting’ approach – those fat calories will only be missed by your adipose tissue, which is where they will be directed to when consumed with alcohol (which is processed first and foremost).
    5. Drink to ensure you are hydrated before you have your first alcoholic drink. This is like 101 really – we always drink more when we are thirsty, and then when we drink more, we become uninhibited and then all hell can break loose, right?
  7. Food timing: If you’re beginning your day with breakfast at 7am and winding down with a cup of tea and some dark chocolate at 10pm, you may be doing yourself a disservice. Eating over a time period of more than 12 hours can be deleterious to health. Recent research has found that restricting the eating period to 12 hours or less can improve insulin resistance and glucose tolerance, and reduce breast cancer risk even when the calories remain the same. Anything you consume that requires processing of any sort by the liver – including black coffee or herbal teas – will begin the metabolic process. When we eat is also important as our appetite hormones are on a circadian rhythm (food being an important signalling molecule for hormones), and eating late at night – even if overall eating window is short – can be problematic for your liver. The benefits derived from intermittent fasting (such as these) can still be realised if your version of fasting includes coffee in the morning, however it appears actual fasting (nothing but water) for at least 12 hours is most beneficial for metabolic health.
    1. Try to keep within a 12 hour window for consuming anything other than water. If you struggle with remembering to do this, there are apps that can help. It’s not as hard as it might seem – if you have breakfast at 7.30am and are done eating by 7.30pm then you’ve nailed it.
  8. You’ve focused entirely on diet without giving pause to consider other aspects of your lifestyle that contribute to your wellbeing. Lack of sleep, chronically elevated stress levels, over or under activity can all contribute to some of the common complaints people attribute to diet which have nothing to do with the food.
    1. Evaluate your sleep – are you getting to bed at a reasonable hour? Able to sleep through the night with ease? Feel refreshed waking up?
    2. Evaluate your physical activity – are you doing enough? Are you doing too much?
    3. Evaluate your stress levels – are you trying to do too much? Feeling overwhelmed? Or conversely is there not enough stress to keep you stimulated and motivated?

Of course these factors contribute to how your body responds to the food, but it isn’t the food per se. As I said last week, this isn’t a definitive list, however if any of these resonate with you then try some of the ideas I’ve listed, or enlist the help of someone like me to guide you to the best approach for you.

PS: I have organised a few talks over the next couple of months to talk about making a real food (aka LCHF) approach work for you. At the moment I have:

  • Takapuna 23 March @ Streetwise Organics, Byron Ave
  • Hawkes Bay 6 April – location TBC
  • Queenstown 25 May – location TBC

…with others to come, so watch this space 🙂

pres2

Yes, I created this pic myself 🙂

 

LCHF…why isn’t it working for me? (Part 1)

It’s about this time of year that I start seeing people come through my doors needing some minor (or major) tweaks to their LCHF eating approach. There are usually one of two scenarios.

Scenario #1: When they embarked on LCHF they saw ALL of the benefits they heard about, effortlessly shedding body fat, boundless energy (in training and afterwards), improvement in skin tone, hair condition, sleep and digestive problems. But lately the opposite is true. Despite seemingly nailing this LCHF lifestyle, they’ve noticed they are lacking energy, gaining weight (especially around the middle), latest blood tests have seen their cholesterol levels have shot up (and perhaps triglycerides), they are unable to sleep… … yet if anything, they’ve instigated (and nailed) the hacks they’ve read to optimise their LCHF eating approach. What gives??

Scenario #2: They’ve given it a good go on their own for the last 5 weeks, following it to the letter and despite this, it’s ‘not working for them.’ Worse, their husband/workmate/training partner has taken to it with ease.

Frustrating, much?

While we are all individual as to what is going to work for us, the LCHF approach is a really good one for most people, most of the time. Despite that, there are small things that can derail your best efforts to improve your diet, so I want to cover off the basic (and more nuanced) reasons people don’t fare well on a LCHF approach, and some tips on how to overcome them. I’ve ended up splitting this post into two parts as it was so long!

  1. Too low carb. The internet is a wonderful and terrible thing – information is everywhere, everyone is an expert and the version of paleo/LCHF/JERF that you’ve adopted based on what others are doing may well be too low carb for you. LCHF is a spectrum, and what is low carb for one person may well be higher carb for someone else – generally speaking, anything up to 200g of carbohydrate/day could be low carb. It all depends on context. I see a lot of people who are trying to stay strictly below 25g of carbohydrate a day – too strict (and unnecessary) for most people. Even Prof Tim Noakes, staunch advocate of a LCHF approach to eating (“banting”) has loosened up on this. The people who really benefit from a diet this low would be those embarking on it for therapeutic reasons: diabetes (both types), epilepsy, cognitive health (Alzheimer’s, for example). That’s not to say that others out there can’t make this level of carbohydrate work for them. But if you’ve noticed fat gain (especially around the middle), irritability, hormone imbalances (such as a missed menstrual period), lack of energy (past the initial phases of the LCHF approach), irregularity of bowel motions, sleeplessness – to name a few symptoms, then you may have gone too low. What to do?
    1. Track your diet for 4-5 days to get an average of the grams of carbohydrate you eat per day. If it’s on the very low end of the scale (less than 50g*, for example), then try adding back in some good quality starch to see if any of your symptoms improve. Don’t be pedantic about vegetables. Really. That includes carrots and tomatoes. To be honest, you don’t have to track your carbs if you’re not a numbers person – but it can be a good way to assess if this really is the problem. Use My Fitness Pal, Cron-o-meter, My Net Diary or Easy Diet Diary as nutritional tracking tools. (If you’re embarking on a lower carb diet, this is a good first step regardless, so you don’t make the jump from 400g a day to 60g a day).
    2. If your carbohydrate intake is in the realm of 80-100g carbohydrate, you may not be too low, it might be more of a timing problem – ensuring you have carbohydrate in the meal after a high intensity (i.e. CrossFit or F45) or long duration exercise session can help improve recovery and alleviate a lot of fatigue/irritability. If you’re struggling with insomnia, then adding in some kumara or potato into your evening meal increases production of precursors to melatonin.
    3. Is it more protein you need? Protein can help keep you fuller for longer, stabilise blood sugars (therefore has implications for focus/energy/concentration), promote recovery and help with sleep. Many people fear protein because of the potential for it to be converted to glucose in the body (via gluconeogenesis). For someone following a LCHF diet this isn’t an issue. Try upping your protein portions by 1/3 – ½ at each meal.
    4. If it’s in the initial phases, then up your intake of sodium – to levels more than you think you need. When we drop the carbohydrate content of the diet, we drop a lot of water stores too (hence a rapid loss on the scales) – this is because for every gram of carbohydrates stored, we store an additional 3g of water. Add salt to your meals, a pinch in your water bottle, make a miso drink or drink bone broth.
  2. Not low carb enough. I see this a lot. People equate carbohydrate to bread, pasta, rice and cereal and don’t think about other foods that are predominantly carbohydrate –fruit, dried fruit, ‘green smoothies’ with a fruit base, bliss balls, natural fruit and nut bars… In addition, many products are promoted as ‘sugar free’ when they contain dried fruit, maple sugar, rice malt syrup or some other type of natural sweetener. This may seem elementary to you, but I know many people are confused by this point. Regardless of what you hear, sugar IS just sugar – that one sugar is lower in fructose doesn’t mean it’s not going to influence your blood sugar levels, it’s likely to affect them more. This has to be my biggest bugbear of the ‘real food’ movement; not that these products contain sugar – but that they are marketed as not. This is no better than being told that Nutrigrain is healthy. We all know that’s not true.
    1. Again, track your numbers (as per above) via a tracking tool. A lower carbohydrate approach is not a fixed number, it’s a spectrum. But if you’re still consuming over 200g a day and not engaging in regular physical activity, then something might need to be tweaked (especially if you’re not seeing the results you’re after).
    2. Get rid of the bliss balls, the dried fruit, the paleo muffin or the smoothie from your favourite juice bar that you thought tasted suspiciously sweet for something ‘green’.
    3. Read the ingredient lists on the packages you buy. Sugar has over 56 different names. You probably don’t need to know them all, but it would be good to have an idea, right?
  3. Too many processed foods or snacks. Even if you’ve found a sweet spot with your macronutrient intake, having too many processed ‘low carb’ snacks can continue to drive your appetite hormones in a way that favours eating more than you need. Leptin is a hormone produced by fat cells that tells the body when we’ve had enough to eat, and is involved in the regulation of calories we burn and body fat that we store. A consequence of being over-fat is high circulating leptin levels in the bloodstream, and the brain stops reading signals sent by leptin that we’ve consumed enough food. Instead, it incorrectly believes that we are starving, thus we feel hungrier. Excess body fat increases Inflammation in the body, and is one of the drivers of leptin resistance, and processed food can drive inflammatory pathways in the body – even low carb processed food. And if you’re not over-fat? Well, vegetable oils and certain additives and preservatives found in these foods can drive inflammatory pathways in the body. In addition, an overabundance of processed flours may cause disruptions to our gut microbiome as they are easily digested, perhaps not even making it to the gut bacteria in our lower digestive tract. This can mean we are starving our good bacteria and instead feeding bacteria that release endotoxins, causing increasing inflammation. This can have a secondary effect of increasing your cholesterol level (see this post here). These foods are created in such a way to send signals to your brain’s pleasure centre and drive your appetite for more food that you just don’t need. One of the benefits of a real food approach (which naturally lowers your carbohydrate intake) is that inflammation reduces, insulin drops, gut bacteria can rebalance and the signalling pathways in the brain that regulate your appetite hormones can begin to normalise.
    1. Get rid of most foods or snacks that come in a package with ingredients you don’t recognise.
    2. Eat real food. Base your snacks around hardboiled eggs, cheese (for the dairy tolerant), vegetables, leftover meat, macadamia nuts, egg muffins.
    3. Drop the nut flours. Just because they’re low carb does not mean it’s a free for all with these processed flours.
    4. Increase foods that help balance out your fatty acid profile: more fatty fish (such as salmon, mackerel, sardines) and (grass fed) meat for omega 3 fats. Consider taking a fish oil or algae omega for those who don’t eat fish – and be picky about the supplement!
    5. Take care of your gut: consider a probiotic for 30-60 days (such as Lifestream Advanced, Inner Health Plus, Syntol or Prescript Assist) to help populate the gut with the good guys, but also keep them fed with fermented foods such as sauerkraut, raw apple cider vinegar, water kefir and an abundance of vegetable fibres.

I’ve got more – quite a bit more actually! – but will post that in Part 2 so as not to risk losing your attention ;-). These are three of the basics that people can get wrong (particularly in the initial phases), and the next post will cover some of the more nuanced reasons, and what you can do to correct them. If you’re not sure whether your LCHF diet is working for you, why not jump on and book a consultation with me? An expert eye can help take the thinking out of it for you and save a lot of stress long term.

*50g still pretty low actually! Again, it’s all context 😉

low-carb-zone

Are you in the zone? (PC: http://www.tripfitness.com)

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

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

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

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

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

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

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

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

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

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

snack

PC: www. revive.ca

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.

 

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Should you be taking a supplement?

Probably*.

I know. I am not even going to write ‘it depends.’ I never used to think like this. In fact, I think you could describe me as being adamantly opposed to supplementation. I would look quite suspiciously on nutritionists who would recommend a raft of additional pills and potions for their clients (from their supplement range). I was a big believer in the idea that you could get everything you needed from food and supplements were for the ‘worried well’, the term used to describe our biggest users of supplements in New Zealand: young, middle-class, female.

That’s changed. While I think you SHOULD be able to get everything we need from food, I no longer think that you CAN get everything from food. A few examples:

For many years now it is well known that micronutrients essential for antioxidant, neurotransmitter and musculoskeletal processes in the body are depleted in our food supply. Iodine is the obvious one. Essential for metabolism and the production of thyroid hormones, the removal of iodophers as cleaning agents from our dairy industry in the 1950s (which was our main source of iodine) and the naturally low level of iodine in our soil has resulted in mild iodine deficiency. Associate Professor Skeaff at Otago (one of my favourite lecturers) completed her PhD in this area and her research suggests that this deficiency, whilst not resulting in goitre, could lead to cognitive problems in children due to low iodine status in mothers during pregnancy. The foetus relies on the mothers thyroid hormones for normal growth and neural development and hypothyroxinaemia (i.e., low maternal fT4) results in damage to the developing brain, which is further aggravated by hypothyroidism in the foetus. This problem has (in recent decades) been further exacerbated by the removal of our main source of iodine (table salt) due to the public health messages around salt and hypertension. Now I’m not suggesting that we need to supplement with iodine in this instance, actually, as the inclusion of kelp, nori wakame and other sea vegetables (and some seafood), nor do we need to go back to pouring anti-caking agent on our food. However, this is a good example of a nutrient that is not readily available ‘in a balanced diet’ for most people.

Another obvious nutrient is vitamin D. While the majority of vitamin D is produced through exposure to the sun, it’s well accepted that this is nigh on impossible for anyone in New Zealand in winter (for the sun doesn’t hit the earth at the right angle for the production of UVB rays). Further, the ‘slip slop slap’ message has led many people to completely avoid the sunlight when it is available for the necessary production. Vitamin D3 is added to a lot of foods by way of fortification in New Zealand, however most foods it is added to are not nutrient dense, whole foods that I would recommend my clients consume (cereal bars, dairy desserts, food drinks, meal replacements, margarines, skim and modified milks, soy milks and yoghurt). Further, while the recommended amount of vitamin D is 5ug/day through the diet, this is based on the role that vitamin D plays in bone metabolism, and is not accounting for the myriad of other roles it has in neurotransmitter production, brain, gut and heart health and overall wellbeing. In New Zealand we have over 30% of adults who have levels below 50 mmol/L as measured in the blood. That’s a significant portion of the population who are considered ‘sub optimal’ yet not deficient. If you have sub-optimal vitamin D status, and are a person who is grappling with a low mood, weight gain and the normal stressors of everyday life, then boosting your vitamin D could be a really good option for you. Vitamin D forms the backbone of our corticosteroid hormones, and when your body is under times of stress (and this is dietary, physical, emotional or environmental stress), the production of our stress hormones increases at the expense of our thyroid or our sex hormones. Call it our evolutionary response to modern life. Why would your body be interested in reproduction (for example) if the immediate problem is one of survival? Further (to all of this), if you are taking a supplement for vitamin D, it’s a good idea to balance it with vitamin K2. This is a vitamin low in our modern food supply (for most of the year – though you can find it in full fat dairy products, egg yolks, fermented foods and in grass fed cows). While 50% of vitamin K2 is produced by our gut bacteria, however the modern diet, the increased exposure to medications, antibiotics and environmental toxins, combined with an overall reduced diversity of bacteria in our gut has undoubtedly reduced our endogenous production of this vitamin (along with impacting on our overall health as we now understand the essential role of our gut in determining overall health.

I could go on with 18 other examples, however your attention may wander, so I’ll move on.

Outside of the food supply, even if someone truly were getting the optimal levels of nutrients as determined by the recommended daily intakes (RDIs), how accurate are these are determining optimal levels of health?? As suggested earlier, some people advocate much higher dietary levels of vitamin D, well above the RDI. The RDIs are determined from clinical trials whereby the micronutrient in question is removed until deficiency symptoms occur, then added back into the intake until the symptoms are corrected and nutrition status is restored. And this is exactly how you want to do it. But this (for a lot of micronutrients) was determined decades ago. Do the same recommendations support the demands of everyday life today? I (along with others) do not think so. Modern life brings with it stressors that can deplete us of nutrients in ways that were probably not even dreamed of when the RDIs were set. Our exposure to  heavy metals, pesticides and other environmental pollutants can impact on our ability to absorb and digest nutrients and may also increase our requirements as a consequence of such exposure. Further, the rate of depletion of the B vitamins, magnesium, zinc and vitamin C are greater due to their role in immune function pathways, which are upregulated when there is this additional burden placed on us through the modern day environment.

Another example of this is an epidemic of zinc deficiency worldwide – and in fact a quarter of New Zealand males are zinc deficient. Zinc – found in pumpkin seeds, seafood, lean meat, eggs, has an important role in our sex and thyroid hormone production, insulin production, immunity, growth, our senses (taste, vision, and smell) and blood clotting (to name a few). Not only is the zinc content of our soil low, chronic stress over time has been shown to deplete plasma zinc and increase plasma levels of copper; an imbalance that contributes to inflammation and with it the health issues that come with that. So, while we may be consuming enough zinc according to the RDIs, there is more to consider than just dietary intake alone.  I really don’t think that it was possible to imagine what life would be like for a lot of people these days, much less account for these in the recommended dietary intakes, even though these were updated close to 10 years ago.

Now, you might not agree that supplementing is necessary, and if someone is in optimal health, with no problems indicative of malabsorption and stressors at a minimum, then I would agree. However, the number of people I see falling into this category are few and far between. Yes, perhaps I may be seeing a skewed portion of the population – after all, they are seeking my help with their energy, digestive, hormonal and weight challenges. Further, they have the necessary resources to invest in my help. However, again, I don’t think this is a valid argument. While my target market as a nutritionist could once be considered the ‘worried well’, this description doesn’t accurately depict my clientele. Worried? Yes. Well? Not so much. Average life span in the general population may be increasing, this is not a reflection of the health of the nation, with the prevalence of allergies, asthma, overweight, cancers, cardiovascular and neurological diseases increasing. All of which require nutrients that aren’t easily obtained through a ‘balanced’ diet (whatever that is).

So…should you be supplementing then? Well, NOT in the absence of an awesome real food, varied diet that also incorporates fermented food, obviously. And… (sorry) it’s NOT as simple as popping a multivitamin, unfortunately. It’s not even that ‘you get what you pay for’ when it comes to supplements – as a hefty price tag doesn’t always reflect biological usefulness in the body which may even lead to a build-up of some nutrients leading to major health problems (as mentioned with zinc and copper). Nutrients that are derived from food sources will always trump a supplement as they are designed by nature to contain these in amounts that work synergistically (together), not antagonistically. There is a lot to consider with supplementation. A standard multi might not be an issue. But it can be.

* My advice is to work with a health practitioner to determine YOUR nutrient needs, as it’s far more complicated than taking a pack of pills in the morning and another at night, and crossing your fingers you’ve covered your bases. While you can take some without the worry of toxicity there are certainly toxicity issues with others. They can then look at the whole picture and not just the food you are or aren’t consuming. That said, most people could probably do with increasing magnesium via a supplement. 

PS If you have even a passing interest in the effects of modern life on our health, check out the Ancestral Health Society of New Zealand – we have a symposium coming up in October in Queenstown!

bottle from somewhere on the interweb. Thank you, random site I've now forgotten.

bottle from somewhere on the interweb. Thank you, random site I’ve now forgotten.

Got a headache?

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

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

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

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

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

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

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

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

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

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