Zymology and the gut: fighting the good fight

AppId is over the quota
AppId is over the quota

Heard of zymology? Me either, until I started doing a bit of digging around on the benefits of including fermented foods regularly in the diet. Fermented foods are the result of zymology (or fermentation); the process of converting carbohydrates to alcohols and carbon dioxide or another organic acid, using bacteria, yeasts or a combination of the two. Fermented foods are a great source of prebiotics - organisms that promote the growth of good bacteria in the gut; and probiotics - live microorganisms that can colonise the gut and increase the numbers of good bacteria in the gut. Our gut bacteria are present in their trillions (!) and are the gatekeepers of our immune system and overall health. Most people are aware of probiotics present in yoghurt and while we are familiar with the terms acidophilus bifidus, some are a little less clear of other food sources of these organisms which play such an important role in our health. This is a very brief overview of the what, why, how and when of fermented foods and gut bacteria.

Gut health is important for overall health full stop, as 70% of body’s immune response originates from here. It’s not just about digestion, our gut is like our body’s armour shield against the environment, and the integrity of the gut lining is important in terms of protecting our system from proteins, toxins or foreign bodies that could trigger an immune response and cause inflammation. Children get their first exposure to immune boosting bacteria when they are born vaginally; in fact research shows that children who are born via caesarean have lower levels of good gut bacteria and are at higher risk of obesity, allergies and the development of chronic conditions later in life as their immune system doesn’t have the right bacteria to evoke an appropriate immune reaction.

Gut bacteria are responsible for breaking down compounds in food that could be harmful (carcinogens), synthesising b-vitamins (biotin, folate) and vitamin K, and help absorb minerals such as calcium, magnesium and iron. They also convert non-digestible carbohydrate (CHO) to short chain fatty acids (SCFA) acetate, propionate and butyrate, which provides energy and are beneficial to lining of the gut by stimulating the growth of cells that form the inner lining of the colon. In addition, butyrate has anti-inflammatory effects that can increase insulin sensitivity and may be useful in treating digestive-related conditions such as irritable bowel syndrome (IBS) and Crohns disease.

The inflammation that results from an imbalance of bacteria in the gut may contribute to development of many chronic conditions – both physical and mental health. Often people think that problems in the gut are evident only with digestive issues. Not so. When this imbalance leads to the intestinal tract becoming permeable, substances leak into our bloodstream and trigger an immune reaction – this contributes to the development of a range of conditions from autoimmune disease, to depression, obesity, skin disease. Leaky gut isn’t always obvious in terms of gut symptoms – but can be skin rashes (eczema, psoriasis) , anxiety, fatigue, joint pain, acne and fibromyalgia.

Lifestyle factors contributing to an imbalance of gut bacteria include the use of antiobiotics and other medications such as ibuprofen, a poor diet that is high in processed refined carbohydrate and industrial seed oils and low in nutrients; chronic stress (physical, mental and environmental), chronic infections and small intestinal bacteria overgrowth (SIBO). This is an overgrowth of bacteria in small intestine (instead of colon, where it belongs) – causing malabsorption of proteins, fats, fat soluble vitamins, b-vitamins and other micronutrients important for immune health.

So why fermented products? Research has shown their usefulness in  improving intestinal tract health, enhancing the immune system, synthesizing and enhancing the bioavailability of nutrients and decreasing the prevalence of allergy in susceptible individuals due to the availability of prebiotics and probiotics. Some common food sources are listed below. This isn’t an exhaustive list, but some found in the health food store or (in some instances) your supermarket include:

Water kefirDairy kefirSauerkraut (raw, in refrigerated section – not Edgells canned variety)Kim chiYoghurt high in culturesRaw apple cider vinegarFermentable fibres in foods: fruits, vege, starches, nuts, seeds: this helps maintain the good bacteria that help produce SCFA. Found in my local health food shop

Fermented vegetables aren’t for everyone, however. If you have a histamine intolerance (due to a reduction in enzymes responsible for breaking down histamine) then it’s best to avoid these. Fermented foods contain histamine, and the accumulation of this in the gut can trigger an immune reaction and mimic allergic reactions.

Those with an inability to digest foods containing FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) intolerance – an inability to break down these carbohydrate types lactose, fructose in fruit, coconut products, sweeteners and sugar alcohols (found in sugar free chewing gum). In addition, it’s best to avoid these if you have severe gut dysbiosis, until there is a better balance of good bacteria.

An easy way to add these into your diet would be to start the day with a tablespoon of raw apple cider vinegar in water, add a tablespoon or two of fermented vegetables to lunch and/or dinner, and for people including dairy in their diet, consume yoghurt that has live cultures or is a kefir-style yoghurt. While you can get yoghurt that contains sugar along with probiotics, it makes little sense to me to consume this as a way to promote good gut bacteria, given that sugar can trigger the growth of the bad guys. If you’re new to the idea of fermented food, it is a good idea to start adding these in slowly – perhaps roll with one of the ideas above and build on that. Too much can trigger further gut distress, particularly if you’ve got some nasties taking up space in your gut.

In addition, if you do have IBS or inflammatory bowel disorder, non-starchy vegetables high in insoluble fibre can further irritate an inflamed gut. These include: Greens, whole peas, (any peas), green beans, kernel corn, bell peppers, eggplant, celery, onions, (and the family), brassica (cabbage, Brussels, broccoli, cauliflower). Take care when eating these and ensure you cook them thoroughly to aid digestion, and don’t eat these on an empty stomach. Including vegetables that are higher in soluble fibre (ie carrots, pumpkin, potatoes, kumara, parsnips swede and beetroot) can also be useful.

As with anything, a whole food diet is a great foundation for healthy gut bacteria – and no amount of sauerkraut will offset the potential damage of a poor diet devoid nutrients. So fight the good fight and clean up your diet first and foremost.

Don’t confuse ambition with ability.

AppId is over the quota
AppId is over the quota

Don’t confuse ambition with ability. This is a standard Mark Watson quote on Radio Sport that he regularly pulls out when describing athletes who mistakenly assume they are more skilled, fitter or more able than they actually are. This confidence is a necessary part of being an athlete and, indeed, I’d be a far better athlete if I backed myself a bit more.* However there are times and situations where your physical and mental skills are not enough to overcome the challenge at hand. This time of year is a perfect example of where many people have the best of intentions of eating well (ambition), yet put themselves in the position where they are without the physiological components necessary to do it (ability).  They struggle to make good food choices as their job necessitates nights out with clients, lunch meetings that involve alcohol, and one function after another. On top of that, every body feels the need to catch up before Christmas – almost like the 25th December is D-day and it’s an absolute impossibility for any of these catch-ups to take place after the presents have been opened. The additional commitments are on an already tight schedule can lead to people relying on increased amounts of caffeine, cortisol and too little sleep in an effort to fit everything in before the Christmas break. When this is combined with fruit cake, mince tarts and an endless supply of Miami wine cooler, it’s no wonder numbers such as ‘5kg’ are bandied about as the expected weight gain.

One common strategy to navigate the Christmas cheer is to drastically cut calories consumed at meals and ramp up energy burnt through exercise to offset the increased intake of Christmas treats. Hunger usually prevails though and, come that afternoon Christmas tea shout, the one fruit mince pie that has been ‘earned’ by not eating breakfast quickly turns into four, along with crackers, Christmas nuts and three chocolate Santas to round off what has turned into an afternoon sugar binge. Throw in a healthy amount of self-admonishment that they’ve been weak in the face of temptation, people often arrive at my clinic already defeated by the prospect of December, and the calendar has barely ticked over to the new month.

The first mistake is that people see themselves as the Master of their Own Destiny – like they are in complete control of their food choices and should be strong (or will be weak) according to their willpower. If people believe they don’t have enough willpower to withstand the temptation around them, it’s more likely they’ll decide to forgo any plans to eat well until New Years, when they draw a line in the sand and ‘start again.’ It’s true that your ability to have just two bites of the Christmas cake (and not two pieces) is down to willpower – however, many people don’t know that self-control (or willpower) is a limited resource. If you’ve exerted self-control in one situation (food related or not), your ability to exert yourself similarly later on in the day is compromised. This research also points to fatigue being a contributor to loss of control later on, and the factors mentioned above can certainly leave you more tired than usual. Unsurprisingly, willpower is related to blood sugar levels. Not only does willpower use up glucose in the body, once our blood sugar levels dip below normal, it’s our natural evolutionary response to seek out foods that will bring our sugar levels up – thus making those mince tarts even more appealing as a way to boost blood sugar (and energy) levels. This makes sense when you consider that the obligate fuel of the brain is glucose – and when you are running on empty in an effort to conserve calories, your limited supply of energy is quickly used up. So don’t beat yourself up about it – blame evolution!

It’s your fault, buddy.

Obviously this does nothing to solve the actual problem. The above scenario certainly is beyond your physiological control; where you can step in and make some difference is that one step before. Some level of personal responsibility will go a long way to help you avoid having to worry about self-control in the first place. And this is where you can back yourself – you have the ability to offset much of fatigue-related diet downfalls that often prevail at this time of year. What you eat really counts. Ten points I’m sure are nothing you haven’t heard before – but it’s always good to remember them:

Eat a good amount of fat and protein in your meals. Not only will this help reduce your hunger and appetite later in the day, it will also reduce your brain’s food-reward response – especially if the carbohydrate component of your meals is comprised of low glycaemic index options. Read: step away from the box of Special K you’ve chosen for breakfast just because it boasts only 112 Calories per serve.Eat a good volume of food at each meal – include plenty of non-starchy vegetables as these will contribute to making you feel fuller and give plenty of vitamins and minerals to help keep you feeling nourished and (for want of a better word) healthy. People eat a similar amount of food regardless of where the energy comes from so (for those who look to maintain or lose a bit of weight as many clients of mine do) ensure plenty of bulk.Don’t confuse paleo-like treats with real food. These are still treats, despite being made with ‘clean’ ingredients. There are definitely a time and a place for them – but not every time you eat, or in place of every meal.Drink enough water so you don’t feel thirsty – especially before hitting after-work drinks. Too many people neck their first beer or wine because they are thirsty. Have a drink of water before ordering your first alcoholic drink. I would also advise you to drink sparkling water in between each drink – but if you are like almost anyone else I’ve ever told to do that, you’ll ignore me. So I won’t.Have something with a good amount of protein in it before turning up to a meal, particularly if you suspect there are going to be a lot of foods on offer that don’t align with how you normally eat. This will help you be a bit choosier than what you would otherwise, as you’re not driven by hunger.Choose 2-3 things to fill your plate at a gathering, rather than 5 or 6. It won’t be the last time you’ll see these foods (I promise you. In fact, you will likely be offered that same sausage roll again next week. If you so desire you can have it then).Step away from the buffet table. This will offset a lot of mindless picking that occurs when you’re close to a table of food.Have a tablespoon of raw apple cider vinegar before meal times to help support digestion and promote good gut health – essential for overall immune function, particularly if you’re running low of sleep and high on stress.Get enough sleep. Really try to. This will help you offset fatigue caused by lack of sleep, thus helping maintain your ability to make decisions and regulate self-control and willpower.Exercise. Don’t forgo your normal exercise pattern because you’re running low on time. Make it a priority. Equally, though, don’t offset those 4 glasses of champagne by an additional 60 minutes on the cross trainer. That’ll only work to drain any ability to withstand the call of the vending machine in the afternoon. Be sensible. Move more during the day where you can in everyday life, and work a bit harder in the time you already spend exercising instead of being mental about it.

Most importantly – think about why you want to eat healthy in the first instance. Often times instant gratification wins out over long term goals for health and wellbeing. And that’s fine – but if that happens then own it, accept it, and move on. Don’t beat yourself up about it, as treats are just that – to be enjoyed. Otherwise, what’s the point? You will though feel so much better if you mindfully choose times where you let you hair down, rather than feel you’ve got no willpower. Take steps necessary to ensure you’ve not confused ambition with ability – that in fact you have the ability to eat well, feel good over the holiday period and really enjoy it.

* Possibly more training and probably more natural talent would also make me a better athlete.

Snapshot of an athlete’s diet: from high to low(er) carbohydrate

AppId is over the quota
AppId is over the quota

A friend of mine sent a link to a debate between Alan Aragon and Jeff Volek on the use of a low carbohydrate (CHO) diet for athletic performance. For those who have a spare hour, I recommend watching it. If you have done a bit of reading around this, you will already know the general premise behind recommending a low CHO diet for athletes, but it is interesting nonetheless. When you watch it you’ll note both Aragon and Volek bring in population health data related to CHO intake. If there’s one way to increase confusion in the low CHO debate, it’s mixing general population and athlete-related information. Comparing the two does little else than muddy the waters. I don’t know that there was a ‘winner’ at the end of the debate, however the one thing both parties agreed upon was that athletes could meet their performance goals over a spectrum of CHO intake. This got me thinking about a friend of mine Dave who sought some advice over his diet and whether he would benefit from eating fewer carbohydrates.

Generally speaking, a ‘low CHO’ diet is a CHO intake of between 50g-150g per day. To give you an idea of what people generally eat, the median usual intake for CHO in New Zealand adults at the last Nutrition Survey in 2008/09 was 207g for females and 273g for males., with a general recommendation of anywhere between 45-65% total energy coming from CHO. Athletes are recommended to consume between 5-10g per kilogram body weight depending on their level of activity.  Dave weighs 68 kg and with the amount of activity he undertakes, (75 min – 150 min 5 days a week across two sessions a day, with a couple of longer sessions in the weekend), that would equate to 7-8g per kg bodyweight, or 476-544g  per day. The equivalent to 35-40 slices of bread. In the past I’ve only recommended the most active of clients (male) a CHO intake within that range – not only is it really difficult to eat that much CHO, but most athletes I know would also struggle to achieve a lean body composition.

Equally though, are those athletes who struggle to maintain their weight under a hefty training schedule, and Dave falls into that category. An avid multisporter who, like many of us ‘enduros’, competes in events fairly often throughout the year, Dave’s training intensity has increased, and the 68kg he’s weighing now is around 3kg lighter than three months ago, despite eating regularly to try and satisfy his ever-present hunger. This would be around race weight – which is great when you are 1-2 weeks out from your goal race – not good when you’ve got around 10 weeks until you toe the start line of the event that matters most. Athletes are in a better position to maintain strength, recover from sessions and be resilient against illness with a 1-2kg buffer of weight that naturally drops off as training gets more race specific. However, Dave has increased the number of group training sessions that (like many guys) end up giving both the body and the ego a workout – being harder and faster than normal. When I was chatting to Dave he said he was heading away for a couple of weeks for work and that he would use the time to train a bit less and ‘relax’ on the healthy eating front to regain some weight. Hmm…. A perfect formula for a bit of extra cushioning around the middle – not quite the weight gain he would like. This could prove more difficult to lose down the line and lead to under-eating in an effort to lean up.  Cue: illness, injury, grumpiness and poor recovery from training – not exactly an optimal training environment. I thought it would be interesting to show you what he was eating, and what I might suggest – (apologies for the ugly table):

Outlined below is the different macronutrient profiles of each diet.

As you can see, the original diet is a quintessential athlete’s diet that Nancy Clark (and Runner’s World in the 90s) would be proud of. However, it wasn’t doing Dave any favours. While he enjoys vegetables and fruit, his meals are based around CHO choices. You’ll also note that it’s less than the recommended CHO guidelines for  ‘best practice’ sports nutrition. At 357g CHO, he’s consuming 120g less than the minimum recommended for his activity level.

Obviously, in order to maintain and potentially gain weight, it would be ideal to increase energy in the diet from good food sources. Going the traditional high CHO route I could tell Dave to include two 750 ml sports drinks during his sessions – that would equate to an additional 110g CHO per day. However that wouldn’t do much to satisfy his hunger and I’m not down with all of that simple sugar; endurance athletes place their body under so much oxidative stress due to the byproducts of training, the additional sugar load does not sit well with me. My advice is to up the dietary energy from fat, and include quality sources of protein – that way he will feel fuller, he won’t be burning muscle mass during his training, and he’ll gain a little bit of weight. The caloric intake isn’t too different between the two plans as for the next two weeks Dave’s training load is reduced. This makes it a perfect time to undergo a dietary change, making adapting to a higher fat diet easier in this instance. As I’ve discussed before, shifting from a high CHO diet to a higher fat diet requires metabolic adaptation that doesn’t happen overnight; the power output takes a hit, therefore it’s best not to do during a heavy training (and higher intensity) phase.

The CHO has decreased, but is at the higher end of the CHO intake of a ‘low CHO’ athlete – and is nowhere near the 50g or less required for nutritional ketosis. Most of the CHO is around his training times and, in addition, his protein sources are of higher quality with the addition of eggs and sashimi at lunchtime. These previously there was a high proportion of protein coming from cereal-based products. When Dave resumes a higher training load, increasing the amount of protein and/or fat at lunch and dinner would help support the increased load. These changes will help Dave become more ‘fat adapted’ while maintaining his weight. An athlete who would like to lose weight would have a lower CHO intake.

Most importantly, these choices were discussed with Dave and he felt confident that he could make these changes. This is one of a number of ways to change the macronutrient profile of the diet to support the training goals of an athlete and this is just one example, designed to give you an idea of how a lower CHO diet can be achieved.

(PS Grain-free, dairy-free, flour-free pumpkin loaf in the recipe section)

A round-up of all things nutrition (and food) this week

AppId is over the quota
AppId is over the quota

On the back of two seminars I was involved in I had a discussion with a friend about whether ‘low carbohydrate, high fat’ (LCHF) was a fringe concept. The seminars were run by Grant and delved into research on the adverse health effects of high insulin levels in the body. While most people understand the health risks of having high blood glucose levels, this might only tell half the story if insulin levels are chronically high to ensure blood glucose levels are kept in check. The seminars focused on an alternative approach to diet, lowering carbohydrate and increasing fat in those who didn’t have good metabolic function. The food Caryn advocated in the seminars focused on whole food: meat, fish, eggs, full fat dairy, an abundant vegetable intake (of lower carbohydrate variety) and natural sources of fat such as butter, coconut and olive oil instead of industrial seed oils and reduced fat spreads. The diet itself clearly isn’t ‘fringe’, however when you break it down and focus on nutrients (as LCHF does), it potentially removes something critical: the ability for people to understand what is being advocated. Focusing on nutrients leaves a large scope for interpretation – often erroneous – based on what people perceive to be LCHF. Often these diets conjure up images of fried eggs, fried bacon, no vegetables and certainly not nutrient-dense – quite different from what is really on the menu. I wonder if this reductionist approach to nutrition is in part is why people think LCHF is fringe. Obviously the portrayal of the message in the media plays an enormous role in people’s perceptions of nutrition – and this week, there was quite a flurry of activity in the nutrition field, with LCHF-related news hitting mainstream media – here and internationally – and garnering a lot of attention along with it. I thought I would compile the highlights below:

In the same week news articles reported that Sweden has adopted an LCHF diet as the national dietary guidelines, a UK cardiologist prints an opinion piece in the British Medical Journal (BMJ) regarding the villanisation of saturated fat to the detriment of our health. Strangely I couldn’t find any information on the Swedish guidelines in the news here – you would think that new dietary guidelines that shun traditional nutrition dogma would make at least page 6 of the North Shore Times. But no. Along the the opinion piece, Dr Aseem Malhorta appeared on a breakfast interview which can be found on the BBC Network. He did a good job of contextualising the inclusion of saturated fat in a whole food diet. It was a less about promoting liberal amounts saturated fat so much as it was a piece for shunning processed food. A few days later the UK Government announced that the food industry had committed to cutting the amount of saturated fat in their products, while the sugar content remains unchanged. A couple of example foods that were targeted included Belvita biscuits. A quick look on Nutritiondata.com backs up the nutrition information given in the article: 1 biscuit (12.5g) contains 0.5g saturated fat and 2.5g sugar. A serving size is four biscuits (and I challenge you to stop at four with these little numbers.) While a proposal like this is clearly months in the making, that there was a media release a couple of days after Dr Malhorta’s opinion piece in the BMJ seemed like a knee jerk reaction. It further perpetuates the idea that saturated fat is the bad guy, and deflects attention away from questioning processed food in general – the main premise of Dr Malhorta’s information that clearly serves to do the food industry no favours at all

A post on facebook by Christine Croncau brought to my attention that, in the US, 3.5 million people tuned in to hear Dr Oz do an about-turn on the role of cholesterol in heart disease (compared to the effect of processed carbohydrates).  It was startling. “Dr Oz, a well respected cardiologist, acknowledges the cholesterol myth…” Hang on, what was that?? Dr Oz is a well-respected medical doctor? That in itself was a revelation to me. The same doctor who showcased raspberry ketones as one of the five top fat-burners you could try?  Anyway, while I wouldn’t always hang my hat on what Dr Oz promotes, he definitely has some influence in the public space. And the clip is definitely worth a watch if you have 10 minutes as Dr Oz interviews Dr David Perlmutter, an experienced neurologist in the US and author of the Grain Brain – a book that explains his findings (through his clinic) and those of numerous studies of the effect that CHO can have on brain function and subsequent neurological disorders. The controversial part of that concept isn’t that sugar increases our risk of dementia – in fact alzheimers has been more recently termed ‘type 3 diabetes’ to reflect this relationship. What was more challenging was the idea that all carbohydrate has the potential to increase risk of dementia, and that Dr Perlmutter was advocating for an almost carbohydrate-free diet. Unsurprisingly when his book came out there was an immediate reaction from some of the influential people in the food industry space. This article from the Food Navigator is one example. To shamelessly cherry pick a quote from those opposed to his recommendations: “I mean, he is advocating people eat salmon and avocado for breakfast, is that realistic?”  Hmm… obviously the Whole Grain Council took exception to Dr Perlmutter’s recommendations, but strangely seemed more offended that he wasn’t advocating totally grain free – recommending the gluten-free grains of buckwheat, quinoa, sorgum, and rice (in moderation). They assert there is no scientific evidence to back up his claims that gluten affects the brain.  Irrespective of numerous articles such as this one I found just by doing a cursory search on Google Scholar, I wonder at what point his experience in the field serves as evidence.

Closer to home, ABC’s Catalyst show, a science journalism show on primetime TV show released the first in two part series that investigates the saturated fat, cholesterol and heart disease myth which is a good watch, and Grant was the focus of a Sunday Star Time’s piece on LCHF this week too.

While I love to see this information hit mainstream media, I often think it’s a double-edged sword. If ever our dietary guidelines did change to reflect an update of knowledge we would have to rely on avenues such as mainstream media to get the message across. And that message gets lost in translation, skewing people’s perceptions of what is being advocated for. Frequently. Take the first sentence on the BBC Network page: “the risk from saturated fat in foods such as butter, cakes and fatty meat is overstated.” Let’s be clear: the risk from saturated fat in processed, refined, sugary cakes is not overstated. If journalists reporting on the story aren’t able to get the facts straight, what hope is there for the general public reading it? Nutrition is confusing; food is not. Perhaps if we focused more on whole foods and less on nutrients the message might be clearer, and might seem less ‘fringe.’ Food for thought.

NCEA Level 1: Adrenal fatigue

AppId is over the quota
AppId is over the quota

Counting down the days until you can switch the ‘out of office’ alert on your email and sign off for a couple of weeks? Same here. So many people I’ve talked to recently have been saying how burnt out they feel this year and, maybe it’s that we’ve all got short memories, but it seems so much worse than last year. One conversation in particular got me wondering at what point does ‘dire need of a break’ switch over to full-blown fatigue that won’t be reversed by two weeks in the sun. Before I actually did much reading around the topic I used to roll my eyes when I heard that yet another person was experiencing ‘adrenal fatigue.’ It seemed like an all-too common diagnosis and fashionable, like running skorts. It’s fair to say this speaks to my ignorance in the topic, rather than any research I conducted on what the potential causes were and how to try to stop them at the pass. A year down the track the reading I’ve done suggests that adrenal fatigue could be more common than I thought – certainly our lifestyles lend themselves to a state where we don’t let ourselves recover from the normal hustle and bustle of everyday life. So when does ‘burnt out’ turn into ‘adrenal fatigue’ and what are some of the things you can do to prevent it? I’m not claiming to be an expert in the area – nor is this going to be a comprehensive post that details all of the complexities of adrenal fatigue – but it will at least provide some basic information on what the condition is, and what dietary measures to take to prevent it from happening to you.

A bit of anatomy: your adrenal glands sit atop of your kidneys and produce hormones that are responsible for reacting to stressful situations in everyday life.  The glands are connected to the hypothalamus and the pituatary glands (collectively known as the HPA axis) and the hypothalamus is the ‘stress centre’; when the body recognises stress, the hypothalamus responds by releasing a hormone called corticotrophin-releasing hormone, which travels to the pituatary gland and stimulates the release of another hormone (adrenal corticotrophin hormone – ACTH) which goes through the blood to the adrenal cortex and stimulates the release of cortisol. Cortisol is one of three hormones the body produces in relation to stress – other hormones are norepinephrine, and Dehydroepiandrosterone (DHEA).

Norepinephrine (or adrenaline) is your ‘flight or fight’ hormone, and is released in response to a perception of threat. Its effects in the body (to sharpen the brain, make your heart pump blood to the muscles faster, increase blood pressure and pain tolerance) were necessary when we went in to battle. Nowadays, though, the battles we fight (peak hour traffic, work deadlines, an unexpectedly large bill) are not the same as they once were – obviously – though your body doesn’t make the distinction between the different types of threats; it recognises these as stress and responds accordingly. Over time these everyday occurrences can build up and suddenly your body’s ability to produce adrenaline is diminshed – leaving you in a position where there is too little adrenaline when you actually need it.

Cortisol is released as a back up to adrenaline to respond to stress. It helps with increasing appetite, releasing stored energy to be used when required (by dumping glucose into your blood stream, ready for quick utilisation), and helps reduce the effects of infection or inflammation on your body’s immune system. However, it’s not designed to cope with stress that is chronic, and therefore constantly high levels of cortisol can have adverse effects on musculoskeletal system (muscle and bone loss), can lead to kidney damage, spiking blood sugar levels (therefore stimulating unwanted insulin release and resulting in roller coaster energy levels) and increased vulnerability to bacteria and viruses through its immunosuppressant activity. The presence of cortisol in the body is proportional to the amount of DHEA. DHEA is the precursor to sex hormones (testosterone and oestrogen) and works much in the same way as adrenaline does– but also guards against the detrimental affects of chronically high cortisol levels.

Under ‘normal’ conditions, your ability to respond to stress is taken care of by these three hormones. However, under periods of prolonged stress, the adrenal glands become exhausted by constantly producing adrenaline, and (as the back ups) cortisol and DHEA. Over time the ability to produce the hormones is compromised, with levels of DHEA being the first hormone to be reduced. This leads to fluctuations in the levels of cortisol and adrenaline being produced, and over time, adrenal fatigue; a diminished ability to produce the hormones. Severe cases can result in very low levels of cortisol being produced.

How can you tell if you are just stressed and tired, or if you are actually suffering from adrenal fatigue? Short of a diagnosis from a qualified practitioner (which is fairly non-invasive, requiring repeated measures of salivary cortisol throughout the day), symptoms of adrenal fatigue can look like any number of health issues:

Inability to wake up and feel on task until mid-morning;Physical fatigue;Afternoon lull between around 2-4pmMood disorders (in part due to blood sugar crashes);Inability to concentrate;Insomnia (though exhausted) and waking frequently throughout the night;Loss of libido;Memory loss;Weight gain;Thinning of hair;Mild depression;Increased allergies or asthma symptoms (as there isn’t enough cortisol to suppress the immune system anymore);Hypotension (low blood pressure) and dizziness if you stand quickly from sitting;Craving for salt (as the adrenal glands require sodium for functioning properly)

So you can see that many of these symptoms are also related to a number of other health conditions, and while you may experience a number of these, it doesn’t necessarily mean you have adrenal fatigue. Regardless, the dietary strategies below could help prevent any stress hormone imbalance  from turning  full-blown adrenal fatigue.

Start with a paleo-approach to diet. unsurprisingly, a whole food diet that is comprised of minimally processed foods, rich in nutrients from vegetables, meat, nuts, fruit and starchy carbohydrates, eating all macronutrients at each meal will help provide stable blood sugars and prevent blood sugar crashes. As cortisol releases stored carbohydrate (CHO) into the bloodstream and there isn’t enough cortisol in the system, this will help balance energy levels.

Don’t go too low on the CHO. It’s likely that you’ll naturally lower your CHO by making a change toward real food but you don’t want to go too low in a misguided belief that the lower the better. This can stress your system more as a low CHO diet will increase cortisol production. You are better to try and eat balanced amounts throughout the day along with fat and protein to maintain blood glucose levels – so try and keep it above 100g CHO per day (if not 150g per day). But again, this is individual and depends on your level of intake now.

Vitamin C: This is stored in our adrenal glands and could be important for functioning – indeed it is thought the Inuit used to eat adrenal glands to prevent scurvy (a disease that occurs through vitamin c deficiency).

Magnesium: this helps stimulate the release of ACTH which is required for cortisol production. I would typically recommend magnesium for anyone under times of stress and a powder form that is in a chelate (combined) with an amino acid to help the body absorb it.

Vit B6: This B vitamin is important for the production of cortisol so supplementing with a good quality B complex vitamin is warranted.

Probiotics: encourage growth of good bacteria (such as fermented foods – sauerkraut, kefir, yoghurt with acidophilus bifidus) which positively influences the HPA axis, and is important in overall health and gut bacteria.

These are recommendations that could be some good initial steps to addressing fatigue and burn out. However if you are already doing these things, or if these make little difference to how you feel, then seeing a practitioner such as a naturopath who is qualified to make some more specific recommendations with regards to adrenal fatigue and supplements is warranted. Friends of mine recommend Adrenalfatigue.co.nz a go-to website for in-depth information on treatment.

On a final note though, all the dietary manipulations and supplements in the world will not help if the underlying reasons for the adrenal burnout in the first place aren’t addressed.

Reflecting on running (and a fudge recipe)

AppId is over the quota
AppId is over the quota

After running my first half marathon since July this weekend, I thought I would take the opportunity to reflect on running, my other passion. (Don’t worry foodies, the last couple of paragraphs are about a couple of ‘paleo’ finds including a fudge recipe ) Runners will understand this; non-runners probably won’t, but I don’t think I can put into words how much I LOVE running. Other activities are just not the same. There’s nothing worse than being injured, and  the option to run is taken away. Unfortunately as a runner, it seems the older you get, the more you accept that you’re either on the brink of being injured, managing an injury, or just getting over an injury. We don’t tend to call it that though. It’s more of a ‘niggle’, or a ‘hot spot’; it’s hard to admit to an injury because then you might have to take the time off let it heal. Weird how, as I write that down I am thinking of how obsessive that is, yet it never feels that way if you’re in that situation. These days though, I’m far more aware of the impact that running every day can have. As much as I love it, I have to integrate other activities to ensure that I’m able to keep running consistently. Where once I would do speed or tempo sessions three times a week in amongst other, slower runs, now I run between 3-5 times a week. My main goal is to be able to be healthy enough to run when I’m 80. So I like to think I have a more balanced approach to my running.

The Keri Keri half marathon was my first since July and the Gold Coast half, which I did on the back of an injury. My time of 1.48 reflected three months of recuperating from an injury, no speed work and my apprehension of running 21km. I don’t toe the start line as often as I used to – and even when I ran more frequently and put more energy into it, I didn’t race that often. I suffer a lot from race anxiety. Some runners enter races because if they didn’t, they would never train. That has never been me. I enjoy the training way more than the thought of racing.  And, when I’m in a race situation I enjoy the challenge of running against the clock. But that is easily forgotten in the lead up to an event. Despite the low key nature of them, I was paralysed with fear in two women’s only triathlons I completed two years ago, literally unable to move for a good 10 minutes before the event. I couldn’t understand how these people could participate in the warm up aerobics when my feet were suddenly glued to the ground below me.

I believe that I could probably have been a better runner had I put into place psychological skills to help me deal with this, but wasn’t ever in a position where it was necessary. I just tend to deal with it by not racing much. When you train properly for an event you are essentially putting it on the line come race day. As an athlete you’re at your most vulnerable; there is no hiding from the clock. Worse than others’ expectations of your finish time are the expectations you place on yourself. You know you’ve trained hard, you’ve (willingly) made sacrifices, you’ve spent a decent amount of money on shoes, gear, massage (it’s a fallacy that running is a cheap sport – this quickly adds up). Race day is where you prove to yourself and others the type of athlete you are, and this is true regardless of your ability. I’ve always thought the term ‘recreational’ athlete was a misnomer.  Ninety percent of people starting a race have put their heart and soul into living their life as an athlete, however that might look in real life. This is no different to an elite athlete. Despite assurances from well-meaning people that ‘it doesn’t matter what other people think’ I don’t know of many athletes who actually believe it. You hear it on the start line all the time: “oh I’ve had a calf niggle… I’ve had this cough… I’ve hardly trained at all” (and then proceed to whip your butt).  People make excuses for a potential sub-par performance before the gun goes off, just in case they don’t run the time that is expected of them. The real fear (for me) is that I’ve given it all during training, had a near perfect race, yet you’ve not performed like the runner I am expected to be.

The last time I did this race I did 1.21.34, my personal best. This time? I ran a good, solid race and crossed the line at 1.30.06. Nine minutes slower which I would have been devastated with in a previous life. However I was pleased to realise that I’m actually pretty happy with it. This isn’t to do with lowering my expectations; it’s more a realistic reflection of the amount of mental and physical energy I have to devote to running outside of other things in my life. I really think that I’m a sub 80 minute half marathoner, and that I’ve got a 2.52 marathon in me, but have yet had the opportunity to actually unleash those times.  (Never say never though, right? )

Despite the stress of racing it was worth taking on and conquering the anxiety demons, and the feeling of giving it your all is a satisfying one. The pain and fear of the process is quickly forgotten as you cross the finish line, and it reinforces the reasons why you do the training in the first place. The same principles apply in life as well. When I started this blog I wasn’t sure what the reception would be like with regards to my shift in nutrition philosophy. Having an opinion is one thing, but putting it out there in the public sphere takes it to the next level which I’m not always comfortable with – but it’s a confidence thing. Therefore (much like racing), the more I do it, the easier it becomes. Ultimately (like racing) the process has been a rewarding one and I’m so glad I spend the time doing it.

Speaking of rewards, at the end of Keri Keri I came across Emma from 180Nutrition – an Australian company producing ‘paleo’ protein powder and bars. I sampled a shake made with the powder, a truffle ball with the powder, and a protein bar. Real food it’s not, but let me tell you all three are delicious. Another example of ‘not real food’… I made fudge for Caryn’s birthday, all with ‘paleo’ ingredients! I came across a link from Michelle’s Primal Journey blog and, with a few adjustments, created a slightly different version you can find in the recipe section. Caryn’s verdict? “If you didn’t tell me it was fudge it would taste great.” Success.

Not really fudge

Create your own Blue Zone

AppId is over the quota
AppId is over the quota

What do Sardinia, Okiniwa, Loma Linda, Ikaria and Nicoya have in common? Other than that I had to Google them to find out where they are located on earth, these cities are all referred to as the Blue Zones. As detailed in-depth on http://www.bluezones.com, and in his book (1), Dan Buettner shares information of investigations by demographers, epidemiologists, medical personnel and ethnographers that discovered the commonalities in the way that people residing there live. The reason? These cities are home to the healthiest, longest living populations on earth, with many people thriving past 100 years of age. The research identified nine lifestyle characteristics which keep the residents in good health and, as we move towards 2014, it is timely to highlight what these are – particularly if you’re looking at setting any New Year resolutions for the year ahead. The goals of eating a better diet or undertaking more physical activity are stock standard for pretty much anyone, and if you’re reading this blog then it’s likely you either eat well or have the intention of doing so in the near future. So take a closer look at the other lifestyle aspects uncovered by the research. Optimal health is about so much more than just a good diet and regular exercise.

Nine aspects of health shared by those living in the Blue Zones (image from bluezone.com)

1. Move Naturally – There is good evidence to show that incidental activity, outside of structured exercise, is equally (if not more, in some cases) beneficial for health. Many athletes I know work hard during their two hour training session and then move very little throughout the day. Taking the opportunity to walk where possible, to garden, clean, stretching , all of these contribute to incidental activity that is important for metabolic health. So, athlete or not, find opportunities to move throughout the day in everyday life.

2. Have A Purpose – In Okinawa it’s “Ikigai” (icky-guy) and in Costa Rica call it “plan de vida”. In other words… “It’s why I wake up in the morning.” Having a sense of purpose can extend the number of healthy years you live.  Without clear goals people can become directionless, leading to poorer mental health outcomes. Depending on your lifestyle, setting goals around family, career, sport, community etc can help motivate and inspire you to get up every day. These don’t have to be monumental – just meaningful to you.

3. No Stress – Stress leads to chronic inflammation, well recognised now as the underlying cause of chronic disease. associated with every major age-related disease. Some stress is important – this is what helps us grow physically and mentally; however too much stress can burn you out and break you down. Perhaps a goal this year is to take time out for you – even a few minutes – to meditate, reflect, or even regroup for the coming day. This year I’m starting a gratitude journal – writing down three things morning and night that I’m grateful for. Not only has it been suggested that writing (pen and paper) help us connect better to the words written on the page, it helps remind us that, even in the most challenging of times, there are people, things and situations around us that we can be thankful for.

4. 80% Rule – “Hara hachi bu” – the Okinawans practice this Confucian principle of eating that is 2500 years old. It’s translation means to stop eating when you are 80% full. This takes some discipline and time to get used to – but a few strategies can help. Eat from a smaller plate and wait 10-20 minutes before seconds. Chew food properly and eat slowly to help digestion. Feel satisfied and not stuffed.

5. Plant based diet – Most Blue Zone people do not have a meat based diet – and similarly the paleo way is to eat a good amount of vegetables, some fruit, then including nutrient-dense animal protein along with nuts, seeds, eggs and good fats that occur naturally (butter, coconut) along with olive oil. Contrary to popular belief, many people following a paleo template would also describe their diet as ‘80% vegetarian.’

6. Wine @ 5?– Other than the Seventh-day Adventists, most people in the Blue Zones (not the Adventists) enjoy alcohol regularly, 1-2 glasses a day. While I wouldn’t encourage you to start drinking if you currently don’t, abstaining from moderate amounts of alcohol in the name of health is unnecessary in the context of other health promoting habits. Ensure you drink a non-alcoholic sparkling water prior to your first drink though, and don’t drink your weekly alcohol quota in one sitting.

7. Belong? In A Community – Most centenarians were part of a community and connected to faith, whether it is a church based or praying to the ancestors. That didn’t seem to matter. It might not be a religion, but it’s a type of spirituality or connection that people can draw from. I don’t have a religious leaning, but, like many people, I have a sense of spirituality that I draw on in certain situations, or in certain settings. For me, being surrounded by bush, typically running, makes me feel more calm and grounded. I can’t think of how else to explain it (and I probably don’t need to for those who also love getting outdoors). There is research to suggest the act of ‘grounding’ and connecting to the earth helps reduce mental health issues and stress levels.

8. Loved Ones – Centenarians in the Blue Zones have close ties to family – both immediate and extended. Your family isn’t necessarily those related by blood – family can equally be your friends and those close to you and who share in your everyday life. Whoever your family might be, take time out to connect with them frequently. While social networking may contribute to the disintegration of some relationships, I now have a relationship with my brother and sister who live elsewhere that I never had when we were younger, thanks to Facebook.

9. Be Part Of the Right Tribe? – The centenarians who live in the Blue Zones chose to spend time with people who share similar behaviour patterns. Many of my friends enjoy training regularly, love healthy food and spend hours waxing lyrical about it over some good wine or craft beer. We never ruin a party by leaving too early – it’s almost expected. While that might seem unexciting to you,  it’s how we roll and wouldn’t have it any other way. If your close friends measure the success of a night by the number of shots they downed, that’s cool – but it’s not going to be as easy for you to follow a healthier lifestyle. Research shows that unhealthy lifestyle habits are ‘contagious’; likewise, living a healthy lifestyle can be too. I’m not saying you need to ditch your friends if they lead you astray on the path to good health, but perhaps you need to start a health revolution among them.

So as you reflect on 2013 and plan for 2014, perhaps you could adopt two or three strategies to create your own ‘Blue Zone’ within the busy-ness of modern-day living. While it doesn’t guarantee that you’ll live for a longer number of years, over time these habits may give you more life in the years you do live.

(1)  Buettner, D. (2012) The Blue Zones. 9 Lessons for living longer from the people who have lived the longest. (2nd Ed.) National Geographic Society: Washington, D.C.

Results may vary…

AppId is over the quota
AppId is over the quota

Is the phrase familiar? It will be if you’ve ever purchased something to do with fitness, diet or weight loss. It’s standard practice to advertise a product or service, then include an asterisk, then have written in smaller font that ‘results may vary’ or ‘results not typical.’ People don’t often read the fine print though. When weight loss is involved, people prefer dramatic, life-changing, knock-your-socks-off success stories. And I agree that the more people share these experiences, the more they will buy into the idea of eating real food for long-term health outcomes, instead of relying on calorie controlled  starvation diets that cause dramatic weight loss and (equally dramatic) weight gain. Success stories  motivate and inspire and (particularly this time of year), encourage others to make changes to their own diets. This is particularly true if people can relate to the person who is telling the story. However results do vary from person to person, and while I would like to tell you that weight loss is immediate and abundant energy is there for the taking, this isn’t always the case. I wanted to share today three emails I have recently received from past clients about their progress to date.

Hi Mikki

Yes I am a new man, down 30kg since embarking on my changed lifestyle. I still want to lose another 10kg+ but am confident that I will get there.

My diet has remained pretty much unchanged from our first consultation back in March or so. I have taken bread, rice, pasta, and potatoes out of my diet. The only dairy I have is cheese. 

Pretty much everything else is the same, I definitely eat more vegetables now and have a new love affair with them as I try so many more different ways of enjoying them. Loving all the good proteins and they definitely keep me feeling full.

Still drink more alcohol than I should but have pretty much cut out all beer and any mixers. I am a bit more sensible around it now and something I will work on for next year. My only other vice is low carb protein bars which fulfills any sweet tooth needs.

I wanted to drop you a note prior to Xmas to say thank you so much for all your help, support, and guidance. I feel so much better and more confident in all the choices I make and the great thing is that they are not hard choices as I don’t miss anything and is just a normal eating lifestyle for me now.

Hope all is well with you

Jason

And, in a similar vein:

Hi Mikki,

I just wanted to give you a progress update on how I am going after seeing you a couple of times.

I have no stomach pain or gas anymore, it’s incredible.  I have not felt this good in a very long time – my energy levels are through the roof and I have lost over 10kg.  Thank you so much for putting me on the right path, it’s been life changing.

 Many thanks for everything!!!

Anne

I love getting emails like this! As a nutritionist I see it as my role to teach clients tools so they don’t need me – and that’s certainly what has happened with both Jason and Anne. Both are confident their dietary changes are long term and are really happy with where they are at. This isn’t always the case though and this email from Jo I received last week tells a slightly different story. I consulted with her and her husband on and had not seen her for around eight months. I bumped into her at a cafe last weekend. This tells a slightly different story (I have bolded sections for emphasis):

Hi Mikki,

So nice to see you last weekend, although, could you tell I was in a bit of shellshock, bumping in to you in an ‘eatery’ ,  as I started to give you a ‘report’?  haha.

Seriously, I was very much thinking, ‘really?  in a cafe?,  when I’m about to chow down with my friend here.’ Dear oh dear. You looked as lovely as ever.  We miss you a lot.   But it was my lack of focus, I was thinking I had to stop and regroup.  But also take on all the information you were giving me.

Fitness wise, I am ok.   Flowing better than before.  And we bought a treadmill.   I have given up the sugar Mikki.   It’s been five months.   I have had a few dessert treats these past few months – It feels, strangely, in control. So, I did the first three months hard out – as per the I Quit Sugar ebook we talked about.  I actually went out and bought the full book and followed recommendations.

And then I guess in the last two months I have let in blueberries on the weekend, in the smoothies.  Have started eating a few apples.  I am really quite happy about giving sugar a miss. I never thought this could happen.  That I can (and have had) treats, and that has been it.  It has not lead to 3 or 4 days bingeing after having that treat.  So…the journalist in the book lost about 4 kilograms.  And so did I.  That was about it.  

I have to say I was pretty disappointed that giving up sugar completely did not lead to weight falling off.  It was very slow. Then, because I gave up weighing, another 2 kilos came off without paying much attention to it all.  That was a surprise.   But really, five months to lose 7 kilo or so.  That’s pretty lame. (This is all post-Mikki self-destruction weight gain by the way). The lack of energy was extreme.   That’s another thing that annoyed me. From this end looking back though, the constant headaches ceased.  Not in the first month, that’s for sure.  But they are gone now. I was at the point where, all week long, I would just have this low grade migraine from first thing in the morning and then a spiking of pain in the afternoon.  Gone.  I just noticed one day, it was all gone. My concentration is better at work, and I generally have better sleeps.  My skin looks better.  And my energy is coming back also. 

I know you will be interested to hear how it impacted me. I never before imagined you could go without sugar. For me it was always something you’d go back to ‘once you lost the weight’ but I never had the self control.  And it is probably the fat that allows me to feel calm and not worried about sugar or dessert, or eating a bar of chocolate.

Anyway, lovely to see you and Merry Xmas from us both,

Jo

So Jo’s story paints quite a different picture to Jason and Anne. The tone itself is more subdued than the first two emails. The focus initially is on how much she hasn’t achieved, rather than what she has. While Jo is aware that there are definite improvements in other areas of her health (the headaches, the sleep, the increased energy), these were a long time coming and, in her mind, not the outcome she was pinning her success on. I read Jo’s email and see a lot of positives in it (as I’ve indicated with the italics) but it doesn’t matter what I think – it’s how Jo views it that is important. This isn’t your ‘whizz-bang-fireworks-frame-it-and-show-it-off’ client success story that you see in many client testimonials used to encourage others to change what they eat. But it’s equally important to share these to show that results do vary. Body composition changes and increased energy levels might happen in an instant, or they might take many months (as they did for Jo). Her success to date is definitely there, you just have to dig a little deeper to find it.

My advice to Jo (as to anyone) is to use yourself and your changed behaviour as benchmarks of success instead of gauging it against another person’s experience. Only you know how far you’ve come, so take the time to reflect back on that. However small they may seem, any dietary change in the right direction is one step closer to where you want to be. Results DO vary, and while the results stories of others may provide motivation to get you started, it’s consistency and good habits that keep you going.

Is Paleo ‘pathetic’? My opinion on Dave’s opinion.

AppId is over the quota
AppId is over the quota

Are you a Nickelback fan? I didn’t think so. The chances are slim as I think there are six of us, including his mum and April Levine. It’s not something I tell a lot of people as it leaves me wide open to be mercilessly mocked. As you will know, music is a really personal thing and when somebody attacks it, it feels like an attack on your character. This week those same emotions were evoked when I read an opinion piece in the Herald about the paleo diet, written in response to a press release advertising a new paleo lifestyle book (Clean Living) by Luke and Scott from My Kitchen Rules (my favourite show). As is standard media, it is far more likely to spark some interest if the subsequent article took an angle that is in opposition to promoting paleo. Regardless of why it was written, I took it personally – an endearing (?) yet flawed character trait that I’m completely aware of. I viewed it as an attack on my personal and professional integrity. That someone would label paleo as ‘pathetic’ is calling into question the foundation of what I believe (and advocate) to be healthy, and I felt the piece was perpetuating misconceptions of what it means to eat paleo. I shared this with Dave (the author) on Twitter.

Ego aside, the other (more important) reason it didn’t sit well with me is that it sends the wrong messages to anyone reading it who is unfamiliar with the paleo approach to eating. For people who eat a paleo diet, an article that bashes it wasn’t going to make or break their dietary habits –they’re likely to have read a lot about it themselves to have begun following paleo anyway, and inevitably be more informed about the topic. However there are a lot of people who might be struggling with their health, their weight, their energy levels and are mildly curious as to what this ‘paleo’ is that they are hearing more about lately. They look to an authoritative voice such as a dietitian for some solid, evidence-based information. Reading an article like this might effectively quash their desire learn more, which could have lead to them adopting the principles and experiencing real health benefits experienced by many who follow a paleo approach to eating.

What were my main issues with the article? Pretty much the reasons that were put forth to NOT follow a paleo diet:

Caveman didn’t eat meat everyday. Most advocating a paleo-approach to diet would advocate a broad range of available animal proteins including eggs, meat, poultry, seafood to enable people to get important vitamins and minerals that are essential co-factors for bone and skeletal muscle metabolism and repair, and help with blood sugar regulation. Eating some form of animal protein at most meals is actually just good health for those choosing to include it in their diet. People preferring to follow a plant-based diet are clearly not in this camp. Yes, 500g rump steak in one sitting is unhealthy. Not many health professionals advocating paleo would advocate that.

Cavemen didn’t eat modern day paleo foods such as bacon and sausages. Can’t argue with that. But that implies that advocates treat bacon as a separate food group. Not so. Most of us view bacon as a condiment, not an obligate part of the diet. And sausages? You can get great sausages of real meat from the butcher. Perhaps not from the Mad Butcher though. Those $10 bags of 20 sausages are barely food, let alone paleo.

Cavemen ate everything available. Yes. Paleo advocates who have done reading around the topic don’t think we evolved to eat one diet. That said, there are certainly commonalities within a lot of ancestral diets. Meat, seafood, seeds, nuts, tubers, milk (for some), fruit, vegetables featured in ancestral diets that have been studied in varying amounts depending on the environment.

Caveman weren’t afraid of fruits. Neither are paleo advocates. Except for nashi pears. (and large amounts of fruit for people who have trouble regulating their blood sugar (and subsequent insulin) levels.)

Caveman ate carbohydrates. Of course they did. Unless someone is metabolically disregulated (as above), a moderate amount of whole food sources of carbohydrate such as potato, kumara, bananas, taro is part of a paleo diet. Paleo isn’t necessarily low carbohydrate but certainly, compared to our standard westernised diet, it will be lower in carbohydrate. As a side note, the dietary contribution of carbohydrate varied quite substantially from one region to the next.

Caveman weren’t training for specific sports. And? This point against paleo confused me, but anyway; nutritionists and dietitians consulting on diet for athletes note that people can really benefit when moving from a standard athlete diet to a paleo approach. The change in diet to a lower carbohydrate, higher fat, nutrient and fibre-rich diet results in marked improvements in appetite, blood sugar regulation, and the ability to burn fat during training and recover after hard sessions. This could be due to less oxidative stress in the body that would typically be caused by sugar being dumped in the system. As a whole, for these athletes, they are able to train consistently – a key factor to improve performance. While we do have a few studies either up and running at AUT or about to begin in the new year investigating these factors in different cohorts of athletes, those experiencing the benefits of paleo don’t need a peer-reviewed paper to prove to them the real effects of eating a whole food diet.

Caveman lived shorter lives. Despite the obvious technological, societal, medicinal advances that are now present in modern society which enable us to live longer, the evidence doesn’t support this, once you examine the data without children and mothers dying in childbirth. In addition, public health experts now believe parents of today could outlive their children due to the pandemic of chronic disease the western world is experiencing.

Caveman ate organic and free range. Yes they did. Those who can afford to do that today also do. However I think overall that as much as possible, people who would like to follow a paleo diet can do so much by swapping out processed food for fresh fruit, vegetables, canned meat etc without breaking their bank accounts.

There are certainly better critiques that examine arguments against the paleo diet (think Chris Kresser, Paul Jaminet, Jamie Scott and Robb Wolf to name a few). I think, overall, Dave has missed the point about my opposition to his opinion piece. A paleo approach to diet is not about emulating all things caveman like. It’s about taking an evolutionary approach to diet and health and applying the lessons learned to modern day living. Dave advocates a whole food diet (as I do), and pointed out that any educated reader would see this. Not the point. To advocate this in one breath and bash paleo in another implies to anyone reading the article that paleo is not that whole food approach to diet. Any reader, educated or otherwise, would see this.

National Heart Foundation: new take on the food pyramid

AppId is over the quota
AppId is over the quota

It’s been a long time coming but finally the National Heart Foundation (NHF) has released their new version of the Healthy Food Pyramid. And, unsurprisingly, it’s a big improvement on previous models. Unlike our food based guidelines, which haven’t been updated for 10 years and therefore still promote a grain-based diet, the NHF model (based on a healthy heart) has gone some way to recognising the impact a high intake of these foods can have on health outcomes, and has also undergone market research to determine what messages may be best understood by the general population.

National Heart Foundation Healthy Heart Visual Dietary Tool

What I really like about this new model is that it’s colourful, bright and it doesn’t try to dictate portion amounts which most people read as a ‘one-size fits all’ approach. It instead focuses on the proportion of the plate that each food group should contribute – a volumetric-based approach. I like that vegetables and fruit are given priority over everything else (the type of diet that most people promoting whole-food advocate also), where previously breads, cereals and grains featured in the ‘eat most’ category (that’s what you get when the US Department of Agriculture has a hand in developing food guidance systems). I also really like that they’ve removed potatoes and other starchy vegetables from the ‘eat most’ category. They are the type of carbohydrate (CHO) foods that I advocate people eat, and if everyone was metabolically healthy and had no problems in regulating their appetite, their presence with non-starchy vegetables wouldn’t be a problem because people might naturally consume appropriate amounts. However, with two-thirds of New Zealanders overweight or obese, it’s not a good idea to promote these in the same vein as you would, say, broccoli. You could argue the same for fruit but from a practical perspective (and what I see a lot in my clinic) I think we are more inclined to half fill our plate with potatoes (i.e ‘vegetables’). This shift is also in line with the WHO, who have (for a few years) deemed potatoes (and bananas) as ‘starch’ and not vegetables.

However, the next food group prioritised is the wholegrain and cereals group – and that’s where I would instead advocate  animal protein sources. These have a higher nutrient content and (in my opinion) more health benefits than breads and cereals with regards to nutrients (when the diet also contains substantive amounts of vegetables and some fruit). The importance of protein was highlighted in mainstream media this week actually, with this study reporting the role that protein has in helping regulate appetite and food consumption. Most of you reading this are probably aware that protein has a satisfying effect on appetite – you only need to have eggs for breakfast one morning and cereal the next to recognise the difference in your subsequent appetite (and mood, concentration, blood sugar, energy levels etc). The review investigated the evidence for the protein leverage theory, a concept which was suggests the changes in the percentage of protein in a diet can dictate our overall energy intake. If you consume a diet that is reduced in protein, you are more likely to increase your energy intake until your protein requirement is met – leading to an overall increase in energy intake and subsequent body weight. The paper reviewed studies looking at this relationship and, on balance, the evidence supported that a low protein intake relative to carbohydrate and fat in the diet promoted appetite and a higher energy intake. When energy intake from protein decreased from 20% to 10%, overall dietary energy intake increased markedly. This dropped off when protein in the diet was reduced to 20% from a greater percentage (i.e. from 30% to 20%). What was interesting here was that, regardless of whether energy from fat or carbohydrate was higher, the body will increase the drive for food to ensure that adequate amounts of protein are consumed. This might mean advocating protein-rich whole foods that by default contain good fats could go someway to reducing overall intake of foods that are high in refined sugar and processed carbohydrates. Something to consider for a population that is predominantly overweight.

However, it’s not just protein that’s important in the diet – it’s good quality protein. I’ve banged on about this before, but in New Zealand our main problem is not absolute protein intake – it’s where it comes from and how it’s spread across the day. The way we typically consume food is to be quite light on protein at the start of the day and more heavy come the end of the day. On average, men have an intake of 102g of protein per day, and women around 71g per day. With around 16.4% and 16.5% of our dietary energy coming from protein. With a range of 15-25% being recommended, while it might be deemed adequate, this is definitely on the lower side. The major contributor of protein in our diet comes from the bread group (encompassing all types of breads, rolls, buns, crumpets and bagels) – all foods that could potentially drive an increase in appetite. As protein from animal sources not only contain all essential amino acids (the building blocks in our body) and are a good source of natural fats (contributing to their nutrient density), increasing our dietary protein from these foods is far preferable to relying on plant-based sources. As a side issue (yet related point), as an island nation surrounded by water where one of our major industries is dairy farming, it’s criminal that people in our population don’t have access to the quality protein sources necessary for a nutrient dense diet and overall health. Bagels and crumpets don’t cut it. Hence why I’d move the eggs, animal sources of protein up one level and promote their importance in the diet.

I also want to add that a diet high in fruit and vegetables is more beneficial when there is enough fat in the diet to be able to absorb the fat soluble vitamins and important phytochemicals etc that are present. Complete ‘nutrition’ isn’t just about just eating the food – you have to be able to absorb the nutrients it contains. This isn’t promoting a ‘high fat’ diet, but higher fat? Certainly. When the general population has carbohydrate-based diet that, if combined with fat, is the main driver of metabolic disorder and subsequent chronic disease, promoting a high fat diet can be problematic. This is certainly true with a dietary guidance system that lists wholegrain cereals high up in the list of dietary priority, and in a food environment where children’s cereals can claim to be ‘74% wholegrain’ yet in reality deliver little more than rampant hunger by 10am.

So what would my pyramid look like?

(ok, so I’m limited by the emoticons on my phone, but you get the drift).

The good thing with the NHF Healthy Heart (and message) is that, for the most part, it is indicating a minimally processed food diet – which most of us agree is the way to go. It’s definitely better than the Food and Nutrition Guidelines which state we should aim for at least six serves of breads and cereals, and at least one serve of food from ‘meat, poultry or meat alternatives.’ While I’m not on board with all the NHF messages, I definitely think it’s a marked improvement on the last one, and one step further in promoting the adoption of a whole food diet.

Hmm.. I know which one I would choose for breakfast.