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.

Constant cravings? Here’s 18 evidence-backed (or anecdotal) tips that will curb them.

Are you back into the swing of things but your taste buds aren’t?  It happens! Especially around this time of year where intake of sugar, alcohol and processed carbohydrates tends to be higher for most people, and while going cold turkey can be the best move, it’s sometimes easier said than done. The good news is that by reducing these foods, you’ll begin to lose the taste for them, and they’ll no longer hold the appeal that they had. For some though, completely removing them is a better idea – even small amounts can continue to drive the appetite for them. Regardless of which camp you fall into, here are some proven, some anecdotal, and some interesting ways to combat those cravings.

  1. The basics: build your plate based around protein and fibre, with fat for satiety. Protein is well known to be the most satisfying nutrient, and along with fibre (also key for adding bulk and feeling full) will keep most people satisfied longer than either carbohydrate or fat. Any starchy or carbohydrate-based foods are best if they are minimally processed (such as potatoes, kumara, legumes, fruit) as these will provide more nutrient bang for your buck). How much of each? Protein-type foods (meat, fish, eggs, poultry) aim for 1-2 palm-sized portions. Starchy carbs (if included) at around a fist-sized amount.  Fat? 1-2 thumb-sized amounts, depending on the type of protein portion you’re eating: a fattier cut might be satisfying enough, however a lean chicken breast will likely require some added fat to help satisfy you. And vegetables? Go for gold – other than the starchier varieties (mentioned above) you could fill your boots with these. For some people, having a full plate is essential to feeling satisfied and if you can do that by adding more volume, it is going to have a positive effect on the satiety from a meal (that’s definitely me). For some ideas, check out my recipe e-book or my online coaching service.
  2. Get rid of anything that is ‘your poison’- if you are the person that hears the icecream calling you from the freezer, it is much better off out of the house. Out of sight, out of mind.
  3. Put all the ‘treat’ type food in one place in your house, preferably above eye level. This will save you seeing the Christmas cake when you are grabbing the eggs, and the chocolate almonds when you are searching for the bottle of olive oil. Constant reminders of all the things you are trying not to eat will NOT help your cause.
  4. Chew your food properly at each meal. Aim for 30 times per mouthful. That way you’ll digest your nutrients effectively, feel more nourished and less likely to be hungry an hour after eating because you wolfed that meal down.
  5. Do not substitute those refined sugars for ‘natural’ sugars. That dried fruit is pretty much just sugar – and (a few nutrients and fibre aside) no better than sugar and will continue to drive your sugar cravings. You shouldn’t rely on dried fruit (or any sweet food that is marketed as ‘refined sugar free’) as a substantial nutrient source . Any additional fibre or nutrients they provide in the diet is negligible compared to the whack of goodness you’ll get when you follow #1 above. When health bloggers or food producers market something based on the healthfulness of the ‘natural’ sugar, it is pure embellishment. 6 meedjol dates and a banana does not make a smoothie sugar free.
  6. Coconut oil – this is a favourite of Sarah Wilson’s: a teaspoon of extra virgin coconut oil can kill a craving in its tracks. If we head to the literature to find any peer reviewed papers on the topic (for what it’s worth, there is a LOT of research published by the Coconut Research Center), there isn’t a lot to definitively tell us that it will cut cravings. That said, there is some research has found that people who include more coconut oil in their diet (compared to other types of fat) have reduced food intake overall, particularly in the subsequent meals. Like most things, you have nothing to lose by trying it.
  7. Cocoa – chocolate is long associated with cravings, though right now, consumption of chocolate may well increase the cravings rather than stamp them out. It’s also not exactly useful if you’re trying to focus on reducing your intake of junk food! That said, chocolate is known for its cognitive and mood enhancing benefits. So how about some unsweetened cocoa (or cacao) in hot water with some milk to deliver the chocolate taste you are after. Add a touch of stevia if you wish. You could also do this cold with almond milk and ice – and add 1 tablespoon of psyllium husk or gelatin in there for some additional fibre or protein. If chocolate is what you’re after – go for the darkest that you can stand. Many people find they stop at 1-2 pieces of 90% chocolate instead of the 1-2 rows consumed of the 70%.
  8. Anything that lowers your blood sugar response to a meal is going to positively impact your cravings. The steep rise and fall of your blood sugar in response to a meal causes alarm bells to start going off in your brain. The body runs a tight ship and prefers when all systems are in homeostasis. Low blood sugar causes a release in stress hormones which tell your liver to dump glucose into the bloodstream, and create cravings so you can re-establish blood sugar to within a normal range. Including cinnamon can reduces glucose response after a meal (in amounts of 6g) and affects insulin response. Stabilising blood sugar is going to help reduce cravings. Sprinkle this gold dust on your breakfast, with your teaspoon of coconut oil, in your cocoa drink etc.
  9. Glutamine – can enhance secretion of GLP-1, a hormone which promotes insulin release that helps increase satiety and dampen appetite – this is only seen in some people however, suggesting there is individual variation of its effects. The flipside of this is that the insulin-releasing effects may override any satiety benefits, increasing hunger (and subsequent meal size) at the next meal. However, in practice this is a tool that many clinicians (myself included) have found useful for some (but not all) clients. The presence of glutamine in the bloodstream is associated with improved insulin sensitivity in healthy people. In addition to this, glutamine has been found to be beneficial for improving intestinal permeability and tight junction protein expression in the gut, being one of the most abundant amino acids in the body. If your cravings are related to gut dysbiosis then it could be useful from this perspective. In addition, it functions as part of neurotransmitter production. Taking L Glutamine by putting it under the tongue as a craving hits (1-3,000mg) may just work for you.
  10. Magnesium is a nutrient that is involved in over 250 processes in our body, and particularly when we are under stress, it is put under the pump. Sugar (or specifically) chocolate craving is often linked to a deficiency to magnesium, but that isn’t conclusive. At any rate, magnesium is perfectly safe to take, and as our food supply is relatively low in magnesium, looking for a supplement that is a magnesium glycinate, citrate or chelated with amino acids may be useful, at amounts of around 300-400mg elemental magnesium.
  11. Chromium is another supplement that some people have found useful for stopping cravings – research has found a reduction in carbohydrate cravings, food intake and an increase in satiety when supplementing with chromium…however this is in the laboratory using mice. There’s nothing definitive in the research to support using it for people who already have adequate amounts of this mineral. That said (as with anything), it’s individual – I know many clients who swear by using Chromium supplements when a craving hits. The only way to know if it works for you is to try it, by taking 1000mg chromium in two doses in meals that contain carbohydrate (due to its suggested benefits at reducing blood sugar response to carbohydrate meals)..
  12. Branched chain amino acids (BCAAs) are three amino acids that act as nutrient signallers which may help reduce food intake . Leucine (one of the BCAAs) activates mammalian target of rapamycin (mTOR) which is required for our brain to respond to leptin (a hormone that tells our body when we have had enough food). BCAAs are involved with hormone release in both the gastrointestinal tract and in fat deposits. BCAAs and dietary protein enhanced glucagon like peptide-1 (GLP-1) release and reduced the expression of genes required for synthesis and adsorption of fatty acids in a human intestinal cell line (NCI-H716), suggesting an intestinal mechanism for the beneficial effect of BCAAs. Those that have successfully used BCAAs suggest 5g in the AM and every few hours while you’re adjusting your diet back to baseline awesomeness.
  13. 5htp: 300-500mg taken with a meal to increase satiety of the meal – studies have found a reduced food intake (particularly carbohydrate). Studies conducted have focused on people who have reduced availability of tryptophan in the brain (a precursor to 5htp). Increasing 5htp increases tryptophan and therefore serotonin production, reducing cravings and overall food intake. (Don’t use if you are currently on antidepressants without clearance from your doctor.)
  14. Exercise. A no brainer, really, but research has found this to be super effective for reducing cravings. In fact, any activity done while in the midst of a craving will take your mind off it. So when a craving hits, doing something active for 10-15 minutes can reduce your desire for something sweet. Go for a powerwalk, shoot some hoops, do some hill sprints…
  15. Make sure you’re getting enough sleep! It’s hard this time of year with longer days and opportunities to take advantage of summer (when it shows up…) Sleep restriction enhances activity in brain regions involved in reward in response to energy dense, nutrient-void food (think: lollies, chips, chocolate), suggesting heightened sensitivity to rewarding properties of food. This can lead to increased cravings. If you are burning the candle at both ends and not yet back to your regular 7-8 hours sleep per night, then nailing this will go a long way to helping curb that sugar demon.
  16. Meditation: decentring – viewing your thoughts as separate from yourself – has been found to help reduce food cravings and want for unhealthy food items. Mindfulness practice is also useful for not only reduced cravings, but for reduced emotional eating, body image concerns. It doesn’t require a 90 minute class three times a week (though there’s nothing wrong with that!) Headspace, Calm or Buddhify are three smart phone applications which may help you get going and provide guided sessions of between 2-20 minutes long. It’s consistency and frequency that makes a difference (like any habit).
  17. Clay modelling to reduce cravings: yep. Researchers found that visual imagery plays a key role in reducing craving. Participants who worked for 10 minutes constructing shapes from plastacine had reduced cravings for chocolate compared to people who were left to their own thoughts or who were given a written task.
  18. Your gut bacteria can influence your cravings. There is indirect evidence for a connection between cravings and the type of bacteria lurking in your gut. For example, people who enjoy and crave chocolate have different microbial metabolites (i.e. bacteria by-products) in their urine than “chocolate indifferent” individuals, despite eating identical diets. In addition, gut bacteria can influence the production of our ‘feel good’ and motivation hormones (serotonin and dopamine), thereby influence food decision-making based on our mood. Finally treating mice with a probiotic reduced hunger-inducing hormones and food intake. Action points here? Yes, you could start with a probiotic, particularly when you’re in the thick of it all, as this will help ensure there are beneficial bacterial strains present in your gut. However, for ongoing gut health, the regular addition of probiotic and prebiotics through food will help you maintain a healthy gut microbiome. Therefore:
  • Include fermented vegetables into 1-2 meals daily, working up to 1-2 tablespoons at a time.
  • The addition of unsweetened yoghurt (dairy or coconut) as part of your everyday diet (as it contains beneficial bacteria).
  • Kombucha, at around 100-150ml per day (check the back of the label to ensure a lower sugar variety).
  • Water, milk or coconut kefir, start with around 100ml per day.
  • Raw apple cider vinegar in water – start with 1 tsp in a small amount of water, working up to 1 tablespoon. This will help stimulate stomach acid when taken prior to meals, helping you digest your food properly, and delaying gastric emptying, so your glucose response to the meal will be slower too.
  • Vegetables, in abundance, to include fibres that feed your gut bacteria.

(As a side note, any change to your gut environment can result in unintended (and unwanted) changes to your digestive tract! If you’re new to the fermented foods and/or probiotics, then start small and work your way up. If you end up spending way more time in the bathroom than you wanted, reduce back further. Consider yourself warned.)

You won’t need to do all of these – but I think #1-5, #14, #15, #16 and #18 would completely diminish that sugar demon so you can get back to feeling awesome.

cravings

Grab that cupcake and bin it immediately. Underneath something that will stop you from retrieving it later on. (PC: SamadiMD.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/)

Is sugar the only sweet poison?

Have you heard sugar being referred to as ‘sweet poison‘? Probably. You’ve likely also heard rumours that the sugar alternatives (such as Equal and Splenda) could potentially be worse for our health in the long term, yet (like I did), brushed off the propaganda-type campaigns that suggested our insides would rot and we’d grow a second head. There was a time not so long ago (err… 18 months prior) where I used to use a LOT of artificial sweetener. To the point that it could have been considered a food group all on its own. For a good 22 years. So I wasn’t sure how to react when my friend Helen forwarded me an email from The Lancet Journal of Oncology this week that reported the International Agency for Research into Cancer (IARC) have made investigating the carcinogenic effects of Aspartame and Sucralose a priority over the next couple of years.

Aspartame is a methyl ester comprised of phenylalanine and aspartic acid, two amino acids found naturally in foods such as meat and dairy, and certain fruit. It’s used as a replacement for sugar in products such as diet soft drinks, sugar free gum and other artificially sweetened foods. A quick google search brought up this list of foods in New Zealand containing Aspartame and while many of these have changed to using Splenda, the active sweetener in Splenda is Sucralose – the other sweetener under the spotlight (which I’m not talking about in this post). You will notice that many of the products on the list are pharmaceutical and in fact that was how these products originally entered the food supply – as a way to make medicine more palatable. Stevia – a non sugar sweetener which I’ve actually been using of late due to the ketogenic diet (usually I would use rice malt syrup or another sugar alternative if making anything sweet) – has been used for 1000s of years. More recently sweeteners were developed to make pharmaceuticals more palatable and the first to be manufactured was saccharin in the 1890s. Aspartame specifically has been in the food supply since its creation in the 1960s, with the Food and Drug Administration (FDA) approval for wide-spread use since 1996 in all food types.

If Aspartame has been approved by the FDA as safe (and it’s touted that the level in the average diet is approximately 1/50th that considered to be the acceptable daily intake (ADI) limit – 50 mg/kg body weight (BW) in the US, 40 mg/kg BW in Europe), why now is the IRAC announcing that the safety of it (and Sucralose) is being called into question? I did a bit of digging around the literature and found a review paper based on the current evidence that was released earlier this year. This isn’t going to be an indepth review of all literature pertaining to aspartame – that would take me more time than I have on a Sunday to write the blog and, let’s face it, I’m no brainiac. I did, though, want to share the take-home messages I got from this review, in an effort to understand the sudden interest of the IARC into aspartame. Interestingly, this review paper was written in light of another organisation’s interest in the safety of aspartame, the European Food Safety Authority (EFSA). Along with a re-examination of the trials conducted using animal models, more recent trials showing a dose-response relationship between aspartame and cancer lesions in rats, their investigation also evaluated evidence from two large scale population-based studies.

The first of these evaluated dietary data from the National Institute of Health—American Association of Retired Persons surveillance, and included 473,984 individuals aged 50–71 who were surveyed in 1995, and followed until 2000 for signs of gliomas (a malignant tumor found in the nervous system) (315 cases) and hematopoietic tumors (tumours in the blood, 1,888 cases). The authors reported that for a daily intake of aspartame  greater than 900 mg/day (equivalent to 1.5 L a coke – yes, a lot!) no significant increase in risk of hematopoietic neoplasms (RR 0.98, 95% CI 0.76–1.27) or of gliomas (RR 0.73, 95% CI 0.46–1.10) was observed.

However, despite the large number of people followed, this conclusion has been criticised due to the limited duration of exposure and  follow-up, and the low exposure levels that reduced the statistical power to detect an effect. Because of the overly simple evaluation of the exposure (measured as the consumption of products containing aspartame during the 1 year immediately prior to the start of the 5 years follow-up), there were concerns about the validity of the results.

The second study examined data from the Nurses’ Health Study and the Health Professional’s Study – two large scale population-based studies where the intake of diet soft drink was observed across a 22y time period (1984-2006) every four years. In total, consumption levels were evaluated in over 77,000 women and close to 48,000 men. The researchers concluded there was a statistically increased risk of both multiple myeloma and non-Hodgkin’s lymphoma in men who consumed more than 1 serving diet soda per day. No clear effect was seen in women, which the authors speculated may be due to the increased activity of the alcohol dehydrogenase type 1 (ADH1) enzyme in men that is responsible for converting methanol (a constituent of aspartame) to formaldehyde. Remember, these are correlational studies and cannot establish cause and effect. However, it is from this foundation that we form questions in order to test in a more rigorous setting. In nutritional research, this would be by conducting a randomised controlled experiment where participants consume either a predetermined amount of a beverage containing aspartame or a placebo daily for 20 years, whilst observing the incidence of newly formed cancer. Hmm. There-in lies the problem. Studies like that are clearly unethical (and not mention hideously expensive!!) Much like the research related to the increased risk of lung cancer with tobacco smoking, many people argue that there is enough research now to recommend lowering our overall exposure to aspartame in the food supply.

Despite what might appear to be worrying reports based on quite a small dose of aspartame, the EFSA‘s review concluded that the base of the evidence was not strong enough to recommend a lower dose of aspartame and future animal model studies should be set up to determine the effect of aspartame with regards to reproduction and development (not cancer lesions). They also recommended the evidence base that would warrant a change in position stance should come from animal models and not epidemiological research. If they had decided that carcinogenic tumours were the endpoint of interest, would they have decided differently?

Now, then, the IARC are set to review the evidence for and against the use of aspartame in our diet. In light of what I learned through reading the review paper I’m both relieved that I no longer have it a regular part of my everyday diet, and slightly concerned of the effect that my long term consumption of foods containing it could have on my overall health. But  I’m not going to dwell on that as it’s completely beyond my control. My other thought is around the focus we’ve had on sugar in the diet of late. Many soft drink manufacturers have jumped on board the ‘no sugar’ bandwagon and have started heavily promoting their ‘no sugar wares’, Of course, the alternative could, down the line, be far worse for the health of the consumer. The best option? Choose real food and beverage options. If you like to cook and would normally use a sweetener, why not cut back the amount you use and choose a natural product over Splenda? Better yet, begin to reduce the amount of sweet foods in your diet (artificial or otherwise) so you can begin to retrain your palate and adapt to a diet that is high in nutrients, and lower in all types of the sweet poison.