Does HIIT take a hit on a ketogenic diet?

Much of the research points to the utility of a keto diet for increasing fat oxidation for longer, slower training. After a period of adaptation, athletes are then able to tap into an alternative fuel source which affords them an extensive supply of fuel at a steady rate, unlike carbohydrate (glycogen) stores which are limited and easily depleted in a moderate-long training session. Thus, it stands to reason athletes are able to go for longer than if they are straight carb-burning athletes in an endurance event – something that Maunder and colleagues discuss in this most recent paper outlining the practical application of a low carbohydrate diet for athletes of varying abilities. However many of the recent randomized trials (such as this one here) have found that performance, particularly at the top-end of the spectrum, is compromised when athletes switch to a lower carbohydrate approach. Further, the relative effort at a given heart rate is increased. You go slower, but it feels harder. Ouch. This understandably makes an athlete’s coache a little nervous to recommend their athletes go on a lower carbohydrate diet.

Interesting though, this is not the experience of many people I work with who transition to a lower carb diet. If anything, performance improves for the athlete (something I’ve written a lot about over the last few years, including this blog here). Given enough time, any reduction in power that occurs early in the transition phase appears to be reversed and the athlete comes out leaner, stronger and fitter in their endurance training. Reducing reliance on carbohydrate as a training fuel reduces the oxidative damage that occurs during training, thus inflammation is reduced. They aren’t placing their body under as much oxidative stress and therefore the athlete can train more consistently during the season with less risk of stress-related injury and illness. This may also be due to a higher presence of beta hydroxybutyrate in the bloodstream, which act as signalling molecules and increase the transcription of enzymes that encode antioxidant genes superoxide dismutase, catalase 2 and glutathione peroxidase. This helps scavenge free radicals created through training and protects the athlete from tissue damage. This may be one of the reasons why they are seeing better results with their key races.

Two of my mates felt similarly, and experienced similar benefits of adhering to a low carbohydrate diet, experiencing no detriment to high intensity training, despite what the research deemed. So they decided to test the hypothesis.

They took 18 male endurance athletes who were habitually eating a standard western diet, and randomised them to consume either their normal diet (control group), or a very low carbohydrate ketogenic diet, consisting of no more than 50g carbs per day for four weeks, and performed graded exercise tests before and after the experiment, and a HIIT session (5x3min, work/rest 2:1, passive recovery, total time 34min) before, and after 2 and 4 weeks.

The researchers found that (as expected) fat oxidation levels increased in the experimental group throughout the tests, and total time to exhaustion, performance in the HIIT session and rate of perceived exertion was no different between the groups. Ergo, the ketogenic diet did not impact the athlete’s ability to undergo high intensity training (nor make it seem harder for them). Interestingly, the level of protein in the diet was around 29%, higher than the 17% used in other studies – this could account for the level of ketones present in the blood stream that were lower at the end of the study (0.4 mmol/L), just out of the ‘nutritional ketosis’ range. The difference this may have made to the athletes’ performance, however, we don’t really know.

Many of the studies conducted that have found performance is reduced are likely too short to allow the athletes to adapt to a ketogenic diet, which is thought to take several weeks to months. Hopefully this new research makes you think twice about taking the results of a study like such as the one here, as a reason to dismiss the low carbohydrate diet for athletes.

To recap, then, of what we know is possible for athletes following a lower carbohydrate approach:

As a side note, lots of peeps look at the elite athlete who chows down on carbohydrate in racing and during everyday life and thinks to themselves that, if they can perform to that standard eating a higher carb approach, then why can’t I? A couple of points to note:

  • The elite athlete may train from 20-30 hours per week – by default they spend a lot of time in a depleted state, meaning they are likely training low glycogen as it is impossible to replenish carbohydrate at the rate they are burning it. This is going to afford them the same capacity to train in the lower carb state that provides enhanced training adaptations. The average age grouper may have time to train 12-18h a week maximum, and don’t have the volume available to get into the low glycogen state.
  • They are elite for a reason. They are able to go harder and faster than most people –psychologically they are able to hurt more and potentially go longer before they bonk – we age-groupers have more of a preservation mindset. They may also be able to train harder when in an inflamed state for this reason. I’m not saying this is ideal (far from it). I’m just putting it out there as a reason why there are professionals who are able to see results where others don’t.
  • Even at the top of the field the elite athlete can suffer, and far more than an age-grouper. Years of a nutrient-poor, carbohydrate rich diet and overreaching to the point of overtraining will leave an athlete burnt out and unable to continue on at the level they previously enjoyed. It might appear that elite athletes are bullet proof but I’m sure as you’re reading this you’re thinking of someone who falls into this category. Things aren’t always as they appear, and the golden glow of success can be pretty fleeting.
  • Of course, there are others who are just awesome and continue to turn up and take it out year after year, regardless of diet, training methods, lifestyle etc. Like the people who drink every day, smoke like a chimney and don’t eat vegetables, yet live to 102 years.
  • Re: racing high carbohydrate – that Maunder paper again – worth a read.

hiit-for-cyclists01c52

14 reasons to ditch the toast and jam (and 7 key tips to help you do this).

After feeling like I’d taken a trip back to 2003 with some of the sports nutrition posts and articles I’d been reading lately, I got tagged in a cool picture from a listener of our Fitter Radio podcast  – a triathlete who has switched from the traditional higher carb, lower fat diet approach to eating lower carb, higher fat, real food whilst training and commented she ‘didn’t know her 41 year old body could be the best body I have ever had’ (Woot! high fives all around!!) This coincided with finishing Mark Sisson’s Primal Endurance book.

Mark outlines 115 reasons why athletes should train and eat the Primal Endurance way. I concurred with pretty much all of them. I have added my own 2c worth, added some literature below (and cut it down to 21 for brevity’s sake). While geared towards athletes, hands down this is applicable to everyone. Everyone.

So if you’re currently eating toast and jam pre OR post training (or in general), I’ve outlined the 14 reasons why you need to ditch that junk and become a fat burning beast, and 7 key tips to help you get there.

  1. Western diet is based on excess grains and sugars (and low fibre) which stimulates excess insulin production, leading to lifelong insidious weight gain, chronic inflammation and elevated disease risk factors.
  2. A high carb, grain-based diet can leave endurance athletes nutrient deficient (due to phytic acid effects on minerals), inflamed and more susceptible to the oxidative damage of the stress of training, general life and poor nutrition.
  3. The way that most people consume modern grains (cereals, breads, pasta) ends up being a cheap source of calories which are immediately turned into glucose upon ingestion and offer minimal nutritional value. There are no good reasons to consume these types of grains and many good reasons not to, especially for those who are sensitive to gluten and other anti-nutrients found in wheat.
  4. Everyone is sensitive to the health compromising effects of grains at some level, especially the pro-inflammatory effects of gluten and the propensity for the lectins in grains to cause leaky gut syndrome.
  5. Even lean people suffer from the consequences of carbohydrate dependency, such as chronic inflammation, oxidative damage, and accelerated ageing and disease risk factors.
  6. Carrying excess body fat despite careful attention to diet and a high training load is largely due to carbohydrate dependency caused by a grain-based diet and chronic training patterns.
  7. Carbohydrate dependency cycle looks like this: consume a high carbohydrate meal – elevate bloods sugar – stimulate an insulin response – shut off fat metabolism and promote fat storage – experience fatigue and sugar cravings – low blood sugar elicits stress response and we consume more carbohydrates – stimulate the fight or flight response to regulate blood sugar – dysregulate and exhaust assorted hormonal processes, and end up in burnout and weight gain (potentially lifelong)
  8. Weight loss through portion control, low fat foods and calorie burning is ineffective long term. And while we think calories burned through exercise stimulate a corresponding increase in appetite – research might not back this up. I tend to think that people are more likely to eat more because they ‘reward’ themselves OR the long slow training allows increased opportunity to eat sports ‘junk food’ and the amount of calories burnt through training is far less than you think – and overestimated more so in females in certain instances. At any rate, the secret to weight loss is hormone optimisation, primarily through moderating excess insulin production.
  9. Endurance athletes can begin to dial in to their optimal carbohydrate intake by asking themselves the question ‘do I carry excess body fat?’ Any excess body fat calls for a reduction in dietary carbohydrate intake to accelerate fat burning.
  10. Endurance athletes who already have an optimal body composition but are looking to optimise training and recovery should choose high nutrient value carbohydrates. These include a high volume of vegetables, a moderate fruit intake, kumara/potatoes and other starchy tubers, dairy for those that tolerate, wild rice, quinoa and small amounts of dark chocolate.
  11. Endurance athletes with high calorie needs who also have an optimal body composition can enjoy occasional treats, but the habit of unbridled intake of nutrient-deficient carbohydrates should be eliminated in the interest of health and performance.
  12. Primal style eating (or eating minimally processed foods) is fractal and intuitive, and when escaping carbohydrate dependency and becoming fat adapted, you don’t have to rely on ingested carbs for energy. Eating patterns can be driven by hunger, pleasure and maximal nutritional benefit.
  13. Escaping sugar dependency and becoming fat adapted gives you a cleaner burning engine, since glucose burning promotes inflammation and increased oxidative stress
  14. Ketones are an internally generated, energy rich by-product of fat metabolism in the liver when blood glucose and insulin levels are low due to carbohydrate restriction in the diet. Ketones are burned efficiently by the brain, heart and skeletal tissue in the same manner as glucose. You do not need to be on a ketogenic diet to upregulate your ability to produce ketones – you can do this via a lower carbohydrate approach.

HOW TO DO THIS: 7 KEY TIPS

  1. Step one: omit sugars, grains, industrial seed oils for 21 days. Step two: emphasis highly nutritious foods such as meat, poultry, vegetables, eggs, nuts, fish, fruits, some full fat dairy, seeds, and kumara/potato.
  2. 100g or less of carbohydrate promotes fat loss, 150g is around maintenance level and over this could promote lifelong weight gain and over 300g could promote disease patterns.
  3. While transitioning to primal there are some struggles initially due to lifelong carbohydrate dependency and the addictive (for some) properties of sugar and excess grains and wheat. Headaches, dehydration, lower blood pressure and ‘dead legs’ are all initial side effects when removing processed food. Trust me – this too will pass.
  4. To minimise side effects, start the transition in a base-training phase of your training where training occurs at an easy pace. The transition phase can take anywhere from 2-12 weeks initially.
  5. Consume salt. Don’t underestimate the importance of this! Lower circulating insulin affects your body’s ability to retain sodium (and other electrolytes) – so we need more, particularly as processed food (of which you are no longer basing your diet around) is where you got around 70% of your sodium from.
  6. You can accelerate the process of fat adaptation by instigating some of the tactics used by athletes who opt to ‘train low’ – i.e. in a low glycogen training state. Some of these are naturally undertaken if you train without eating in the morning, or work out after dinner in the evening and don’t consume anything post-workout. If you’re new to this, have a read through to establish which might suit you best, and start instigating 1-2 x per week. Don’t undertake all of them as this aggressive approach could cause too much additional stress, derailing your plans to become a fat-burning beast.
  7. The FASTER study and Peter Attia, Sami Inkinen suggests any endurance athlete can become fat adapted and deliver performances that may be superior to carb-fuelled efforts all of the way up to anaerobic intensity. This is a new and growing research space, one AUT is testing, among other Universities around the globe.
Strong, lean and awesome at 41y.

Strong, lean and awesome at 41y.

 

PS What the Fat Sports Performance – currently an ebook, about to be published is one I can’t WAIT to read as well – sure to be a goody.

An endurance athlete’s ‘real food’ success story: making it work for you.

I got this email this week from a client that I have worked with since just before mid-year. She is an endurance athlete that came to me as her overall energy levels were low and she was carrying a few extra kilograms that she wasn’t used to.

We chatted through not only nutrition but lifestyle-related changes that she could make to help support her busy lifestyle. This included changes to her diet, additional supplemental support, working on sleep-related behaviours and finding the middle ground between ensuring adequate energy levels and losing body fat to a level that was sustainable and achievable. You can appreciate this is a delicate balance! I discussed with her that when we sorted her energy levels, the body fat loss would take care of itself – she was aware of this and that her energy levels were the priority.

As an endurance athlete she often trained at both ends of the day and came home late, stayed up a little later than she thought she should, and relied quite a bit on carbohydrate-based choices such as bread and cereal to boost her energy levels during the day. While she didn’t recognise it, I immediately flagged this as one of the reasons she was feeling exhausted. She was also hungry a lot, eating at multiple times during the day. This was another indicator that her food choices were not geared towards an optimal balance of good quality carbohydrate, protein and fat. A detailed discussion on her diet proved this to be true.

This client was very motivated to feel better, and took the suggestions that I made and found a way to work them into her lifestyle. We had four sessions together, the last being just before a race that she was doing – the first one for her in a while.

I asked if she minded if I shared her email – she was happy for me to do so.

“Thanks for the item on Thyroid on Fitter Radio this week – it was really helpful. Good to know low thyroid is not something you are necessarily stuck with for life.

Following our catch-up at the end of September I just thought I’d update you with how things have gone since then, and where I have found a really comfortable place with training and nutrition.

Update:

So in summary, I performed well at my last race and was very happy with my placing in my age group. I really noticed that getting extra sleep made a big difference to how I felt, two nights before the race I had 9 hours and felt amazing the next day.

My weight has stabilized at around 53kg so I think this is possibly the happy place for my body, and it’s the same as it was a couple of years ago when I was running at my best.  I feel good at this level and I’ve figured out how to keep it there – for me it’s:

  • at least 7.5 hours sleep;
  • not eating late; and
  • doing some kind of activity in the evening, even if that’s just a walk.

Food wise, what seems to be working and manageable is:

Prep: (crucial to ensuring that I’ve got options available during the week):

  • Bulk making a week’s smoothies at the weekend, then freezing and using during the week
  • Ordering Primal Kitchen for weekday lunches and weekend main meals
  • Making a few wraps at the weekend for weekdays when I do something straight after work. For example, Farrah chia wrap* with Vital Vegetables Slaw, lemon juice, a flavour (Thai spice mix, peanut butter or salsa) + a protein such as smoked salmon or chicken

*yes I know it’s has wheat in it and is a carb but it seems to give me enough energy/and is practical – if I eat fewer carbs than I am I don’t seem to have enough energy.  I have tried other things instead of a wrap like cabbage leaves/sushi sheets/… but they just don’t work as well, they fall apart. The thing that does work is the Vietnamese rice paper wraps but they are very fiddly so I would tend to buy the Farrah wraps instead – very good place in central Wellington to get them! 

Breakfast – usually 5:30-6:30 depending on day

  • Smoothie and a hot drink + a spoon of peanut butter – I usually make the smoothie quite thick and eat it out of a bowl with a spoon!
  • If I’m doing something hard-ish like a swim squad or a run/bike then I have something else too. This tends to be either a sachet of plain oat porridge with the smoothie on top, or 2 hard-boiled eggs with some salt (or on a race day 1-2 x banana depending on length or race).

Mid morning – usually have a coffee with rice milk but don’t need to snack much now. If I do it’s 1-2 Brazil nuts

Weekday lunch – usually eaten around 11am-noon

  • Primal kitchen – 1/2 a warrior size shared with partner + handful baby spinach
  • 2 squares of dark chocolate and maybe a couple of strawberries.
  • Raspberry white tea

Mid afternoon – usually have a Redbush tea with rice milk but don’t need to snack now. If I do it’s a carrot and maybe a few almonds.

Weekday dinner – on days when I do something around 5 or 6pm in the evening, I just eat this around 4pm which seems early but it gives me fuel for the activity then I don’t need to eat a meal later. This way I get a semi-fasted thing happening (as per train-low principles) without it feeling hard. And it means I don’t eat a bunch of rubbish in the afternoon. So it works!

  • Wrap
  • 2 squares of dark chocolate
  • Redbush or green tea

Evening – Usually have a hot drink (not caffeinated), and maybe a swig of wine or my partners beer, but I don’t need to snack as much now – if I do it’s because I’ve just been for a hard-ish training session or MTB ride, and, something like a gold kiwi and few nuts does the trick.

Weekends, similar but we have Primal Kitchen in the evening but I try make sure we eat early, like by 6. For lunch something like sardines on toast if at home with salad, or eggs on toast if we are at a cafe.

Overall

It’s working well and although probably to you getting Primal Kitchen for most of our main meals will probably seem like a bit of a cop out!! But actually takes the stress out of everything – otherwise I would end up doing all of the thinking ahead/planning for both of us on food and basically end up spending more of my free time on it which to me wouldn’t feel fair! (My partner is wonderful but he just isn’t as organised as me and has lean genes and the fastest metabolism on earth so can eat anything. To him, super healthy food isn’t so much of a priority). I think it also works out the same cost or cheaper, definitely frees up some time and makes logistics easier. I’m sure at some point in my life I’ll enjoy doing more food prep and cooking more but this works right now and keeps the balance of effort fair!**

I am planning on giving up triathlon after this summer and just focus on running, mostly trail running and doing other stuff I enjoy for fun.

So, that’s it! Thanks for everything and your podcast, the whole experience of getting nutrition consultation has been a really positive one and the result for me has been to shift a good couple of kilograms and change my mental attitude in a very positive way.  🙂 ”

You can see from the discussion of her food choices, her diet isn’t low carbohydrate per se – though it is definitely LOWER in carbohydrates than it was. There is a lot more protein here than what she was having, and overall the nutrient density has improved.

Overall I think this is such a good ‘real food’ success story and that’s why I asked if I could share it. Does she eat ONLY non-processed food? No – however it’s all about context and finding the middle ground with what can be achieved in the context of the individual’s lifestyle.  That, to me, is success. 🙂

Merry Xmas.

 

**to be clear, I don’t think that getting meals from a place like Primal Kitchen (or ordering through My Food Bag etc) is a cop-out at ALL. I think it’s a smart strategy to help people meet their nutrition goals and not fall back into bad habits that could contribute to poor overall health status. It’s really interesting here that it works out MORE cost effective too. It saves on buying food that they would have to throw out as they haven’t found the time to cook it. It also saves the temptation of just having toast or cereal in the evening, or a sandwich that doesn’t provide enough protein and important nutrients. Primal Kitchen is a great choice.

 

Type 1 diabetes, endurance sport and the LCHF approach: Lewis’ story.

I first met Lewis about a year ago when he came in to see me for a consultation. He will explain his story below, but the crux of it was that he wanted to ensure he was on the right track with his food intake as he started on a low carbohydrate, high fat (LCHF) diet to help his blood sugar control and his endurance sport. In reality, I merely confirmed what Lewis was already doing. Lewis had some trouble finding a lot of information for people with type 1 diabetes who undertake endurance sport, so felt the more he could share his experience, the better it will be for others looking to transition to a low carbohydrate, high fat diet for their blood sugar control. Despite what you may believe, it is not dangerous to follow an LCHF approach to diet if you have diabetes (type 1 or type 2). In fact, it’s quite the opposite. Thanks, Lewis, and over to you.

I was diagnosed with Type 1 diabetes 30 years ago, aged 9 years. I have always been a well-controlled diabetic, (according to the ‘diabetes guidelines’). About 3 years ago, I started training daily. It started out being just gym, then moved on to training for triathlons. Doing exercise is a vital part of a control plan for someone with type 1 diabetes, but it isn’t always easy to balance the amount of sugar, exercise and insulin. It is this balance between the amount of sugar, exercise and insulin that they call the ‘three legs of a stool’. They all are vital, and without any one of them, the chair will fall over. I try and keep my sugar levels above 4 and below 8 mmol/L, what is considered ‘normal’ and is typically controlled by the body’s natural hormonal processes in a person without diabetes.

What I found as I was training was that I was having to supplement large amounts of glucose whilst exercising to stop my sugar dropping. Then, after the exercise, my sugar levels would sky rocket to 15 mmol/L or higher. I would have to take extra insulin to counter the extra high blood sugar, and that would drive my sugar right down low again. It is this extreme roller-coaster of sugar levels that I interpreted as being necessary if one wanted to participate in endurance training. I would typically require a Gu gel every 20 – 30 minutes to stop my sugar dropping. On a four hour bike ride, that would be a massive (and expensive) 8 Gu gels, taking in approximately 160g of carbs. My sugars would be ok during the ride but then would skyrocket afterward.

Also, I had no confidence what my sugar level at any one time would be. If it was in the “good” range, was it only temporary? Was it on its way up, or on its way down? After having diabetes for 25 years, I still had no idea at all. I was thin, muscular, getting fitter and fitter. But my sugar levels were extremely erratic. I was pre-occupied with food, and was always hungry.

Then, a number of things happened all in the same month, October 2013:

  1. I heard Grant Schofield speak about LCHF diets
  2. I watched a Youtube clip of Dr Troy Stapleton, an Australian doctor who developed diabetes and eats LCHF. He said his inspiration was Dr Richard Bernstein’s Diabetes Solution.
  3. I read that book, and it pretty much changed my life. Dr Bernstein is an engineer who was diagnosed with Diabetes in the 1950s. He was the first person to do “home glucose monitoring” and turned the industry on its head, saying patients needn’t go to hospital to check their blood sugar. He later became a doctor (in his 40’s) to specialise in diabetes, and further the cause for good blood control.

He was, and remains, and engineer at heart. His basis for blood sugar control is one only an engineer could come up with. In a nutshell, you can’t predict what your sugar level will do. You can’t get the balance right between sugar and insulin. You will always be wrong. If you happen to be right, it is only by accident. He was describing me, and my rollercoaster sugar control. He explains that if you don’t eat carbs, then you don’t need as much insulin. If you don’t take as much insulin, then you don’t need as much carbs. I switched to LCHF in October 2013, and did my first Half Ironman in Jan 2014. I had submitted a detailed race report to Grant about this race.  Fast forward a year later and I have never looked back.

In terms of the food, eating becomes easier and easier. I do the cooking at home, which is quite useful!

My typical breakfasts now comprise an omelette with 3 eggs, chopped mushroom and chopped tomato. Alternatively, I soft boil 3 eggs, and have them with an avo and tomato salad.

My typical lunch would comprise a green salad with left-overs from the night before. I take care to make enough supper to leave something for lunch the next day.

Typical suppers in our house are below; it is all organic, whole food and high in fat.

  • Spaghetti bolognaise with low carb mung bean pasta (less than 5g net carbs for a big bowl of pasta). covered with olive oil and cheese.
  • Pizza on pizza base made from 1 cup almond flour, 1 egg, 1tbs olive oil, 1 tsp salt. (makes enough for 2 pizzas. very filling)
  • Hamburger on a bread roll made from 1/3 cup almond flour, 1/3 cup ground linseed, 1tsp baking powder, 1 egg, 1tbsp olive oil, 1tbsp cream, 1/2tsp salt. Baked in a mini-round tin, comes out like perfect soft bread roll.
  • Creamed mushroom soup (lots of mushrooms, cream, soup stock) served with Almond bread toasted slices. I make a large almond and linseed loaf once a week, slice it and freeze the slices for ready toast.
  • Bangers and mash (using cauliflower mash)
  • Fried chicken thighs (fatty and juicy) served with a green salad laden with olives and cheese
  • Fish fingers and “chips”. The fish finger batter is coconut flour and seasoning. Fried in Coconut oil. The chips are the same recipe as the pizza base but rolled thinner. Baked until brown and crispy. Add salt and the kids love it.
  • Butter chicken and rice (using cauliflower rice)
  • Taco night where it’s all the Mexican trimmings on either cauliflower tortillas, or large fresh crisp iceberg lettuce pieces as tortillas.

I try keep the level of protein at every single meal the same. Approximately the size of a deck of cards.

With regard to my sugar control and insulin levels during the year…

There is a test called HbA1c, which measures the average blood sugar over the last 3 months. The traditional diabetes practitioners (such as where I go at North Shore Hospital) have this range up, and the red oval shows where the practitioners try to have you aim your sugar levels.

hba1c

A non-diabetic is supposed to be 5%. The reason the practitioners want us diabetics to be at an average of 8-10. (which is too high, as the non-diabetic body wants to be at 5%, is that (as a diabetic) when you eat regular carbs, you blood sugar will always rise after a meal. It can rise to 10 or 12, and then come back down again. This is “normal”. So, if your sugars are always rising to 10-12 after a meal, and your average is sitting at 5, it can only mean one thing. You have many many dangerous low blood sugar hypos.

I take 2 different insulin types. I take a long acting insulin called Lantis, which processes the natural sugars the body creates. (nothing to do with food). I also take a short-acting insulin (purpose made to handle carbs in food) each time I eat. My long acting Lantis dose has not really changed since going LCHF.

Now, when I was eating my traditionally healthy high carb low fat diet, I was taking between 10 and 12 units of short-acting Humalog each meal. My sugar would absolutely rise after the meal, then I would more likely than not correct it, then it would fall too low. Hence the terrible roller coaster. I assumed, as does the Diabetes Clinic, that to achieve non-diabetic levels of blood sugar control, it required a lot of low blood sugar hypos. I would have had to correct my low blood sugars hypos 3 – 4 times a day.

Nowadays, eating LCHF, I would typically take 1-2 units per meal. This is only for the hidden carbs in vegetables etc. If I was stricter in my eating, I could reduce that dose even further. I have since had to buy a “paediatric” insulin pen, which allows me to dose in half units. Which is quite something. My sugar never rises after a meal. Then, because I am taking very small insulin doses, it doesn’t drop down low either.

My last HbA1c reading was 5.6 and then 3 months later 5.3. A cause for celebration really, as this is approaching non-diabetic levels. The Diabetes Clinic sister on duty was extremely unhappy, and had to call a supervisor. They were not happy letting me drive home. They could only deduce that for my levels to be so low, I must have been having many many dangerous hypos.

I took it upon myself to explain diabetes to them. “If I take no carbs, then my sugar won’t go up. If take no insulin then my sugar won’t come down”. I can manage my sugar in a very accurate range. I have very few hypos, and when I do, their intensity to slight (ie, not powerful caused by large over-doses of insulin). And that by following their protocols, I would have many more.

lewis

Lewis completing the Auckland Marathon last weekend (November 2nd, 2014). Note the glucose monitor on his left arm.

Not tonight, honey. I’m exhausted.

Have you heard the term ‘ironman widow’? Where someone’s husband (or wife) is basically invisible for the better part of 12 weeks as they prepare for an upcoming race. This not only relates to being physically present (which is diminished when the training time is upwards of 15-20h a week) but also ‘present’ when at home. Often exhaustion sets in, particularly nearer the end of the week or after a heavy training day, where the mere thought of moving from the couch is akin to another 6h ride. Sex? Don’t even go there. It’s a fairly common (yet usually unspoken) phenomenon that rolling around in the sack is off the agenda in the lead up to the event. And I’m not talking about the day before an event; it’s more like as a general rule because they are too damn tired. Does this sound familiar? Yes, being tired is a natural (and expected) part of the training cycle – however, much as we talk about adrenal fatigue and hormonal imbalance in women – this is not an uncommon occurrence in men. It’s just not often talked about.

When we talk hormones, I know that I’m guilty of just addressing women. You know – the stress hormones, thyroid hormones and sex hormones. However men are not exempt from the debilitating effects of overdoing it. Just as a ‘rushed’ lifestyle can affect the thyroid and sex hormones in women (including testosterone), men who undertake endurance sport are at risk of poor testosterone status.

Testosterone: a sex hormone (also present in women too) is a chemical messenger. It declines as we age, and some studies have found a that testosterone levels for a male in their late 30s are down by as much as 50 % on the levels that were present in their 20s. Just as oestrogen is controlled by the hypothalamus, it is the same for testosterone; when the hypothalamus detects a deficiency of testosterone in the blood, it secretes a hormone called gonadotrophin-releasing hormone (GRH). This is detected by the pituitary gland that in response starts producing follicle stimulating hormone (FSH) and luteinizing hormone (LH). These travel to the testes where testosterone is produced from cholesterol by the leydig cells with just a small amount produced by the adrenal glands. It’s then sent back into the blood stream and either attaches to sex hormone binding protein (SHBG) and becomes biologically inert, or remains free in the bloodstream.  Normal levels are between 300 ng/dl – 1200 ng/dl (10.41)-41.64 ng/dL. The three types of testosterone you might see reported are:

  • Total testosterone- As the name implies, it’s how much testosterone available and is the sum of free and bound testosterone.
  • Free testosterone is the most biologically active form of testosterone. Free but low biologically active test and therefore still have signs/symptoms of overall low testosterone.
  • Bound testosterone-This is the testosterone bound to the protein Sex Hormone Binding Protein (or Globulin) (SHBP/SHBG). A high amount of SHBG will usually indicate a low free testosterone.

Testosterone is not just important for reproduction and sex drive – it has a number of other roles including supporting bone mass, regulating fat distribution, muscle size and strength and red blood cell production. If you are a typical endurance athlete who tends to push themselves and have had stress fractures that can’t be put down to a lack of calcium, it could well be that low testosterone is a contributing factor. As we know, testosterone increases during training and contributes to overall energy levels; a low production of testosterone contributes to the fatigue that can be felt under a heavy training load, making someone feel worse than they should. It’s difficult though, to know what is a normal byproduct of a heavy training load (because, let’s face it, endurance sport requires longer and harder training than, say, golf). Below are some common signs and symptoms of low testosterone.

  • Decreased/absent early morning erection
  • Reduced sex drive
  • Erectile dysfunction
  • Loss of facial or pubic hair
  • Testicular atrophy
  • Low bone mineral density/fractures
  • Night sweats

Phew! That’s not you? Well, you may not be out of the woods just yet. Less specific (or earlier signs) include:

  • Decreased energy or motivation
  • Poor concentration and memory
  • Disrupted sleeping patterns
  • Moody
  • Reduce muscle/increased fat mass
  • Reduced performance

You can see that the early signs of a reduced testosterone level could be summed up by being a bit ‘tired’ and are fairly non-specific. The best way to know what is going on with your testosterone is to get it tested through your doctor (noting that the free testosterone is the important measure).

Thankfully there is plenty you can do with your diet to ensure you’re optimising your ability to produce testosterone without getting a prescription for the pharmaceutical type. Unsurprisingly, these come down to pretty much what I write about on a weekly basis:

  • Ensure adequate vitamin D – this is involved in the production of the corticosteroid hormones and it’s important we have enough available to support the production of our thyroid, stress and sex hormones. Food sources are full fat dairy products, a small amount in butter, liver, animal protein and fatty fish such as salmon, sardines and mackerel. Taking a supplement (that also contains vitamin K2) is warranted for a large part of the year in New Zealand, but particularly as we come out of winter and into spring, where the UVB rays are diminished and we’ve been spending the vast majority of time inside on the windtrainer to dodge the weather.
  • Ensure adequate zinc intake (through oysters and animal protein, and brazil nuts too) – a note here is that iron can reduce our overall ability to absorb zinc, and this may need to be looked at if you’re taking an iron supplement.
  • Ensure adequate selenium intake (seafood, Brazil nuts) and vitamin A (full fat dairy products, liver, eggs, animal protein)
  • Saturated and monounsaturated fat: Again, most of the foods mentioned above are good sources of saturated fat in the diet, and monounsaturated fat is found predominantly in olive oil, eggs, avocado and raw nuts. The reality is, all fats contain the range of fatty acids we need, and are labelled ‘saturated’ or ‘monounsaturated’ fats due largely to the amount they contain. Coconut oil (which has had some bad press of late, despite a lack of evidence of a relationship to heart disease) is particularly rich in saturated fat.
  • Cholesterol: another important co-factor in the creation of the sex hormones, and forms the backbone of these. Foods of animal origin help supply dietary cholesterol for this role. If you’re someone who has followed a low fat diet or vegetarian diet and has a low cholesterol level, then potentially your testosterone could be lower than ideal.
  • Ensure adequate B vitamins and magnesium also (present in the foods mentioned above and in abundance in vegetables).

Finally – on the life side of things: sleep more, ensure adequate recovery from training and have more sex. That will increase your testosterone.