As we settle into the New Year, many of us will have health goals we wish to achieve. Whatever your goal might be, a sound foundation is where we all need to start.
Nutrition
Over the years there have been so many different diets that have claimed health benefits that, ultimately, most people are left utterly confused. If you dive into research, the Mediterranean diet is the one that consistently comes on top – for a broad population, across a range of health measures.
However, things do get a bit more complicated. I often get asked about specifics of a diet – how much carbohydrate, how much protein, where do I get the protein from, what about timing? The first thing to know is that there is no one right answer for everyone. Let’s look into this:
A woman who is under 35 years old, active, not on hormonal contraceptive and wants to look after her fertility.
Her diet needs to ensure that she is able to ovulate regularly, which is very important, and not just for fertility reasons. Ovulation is essential for production of sufficient oestrogen and progesterone. Benefits of oestrogen include its role in helping build muscle and bone, maintenance of insulin sensitivity and overall positive effects on cardiovascular and mental health. Progesterone, which is produced in the second half of the menstrual cycle, after ovulation, helps reduce anxiety, achieve restful sleep but it also reduces inflammation and regulates immune function.
In young, healthy, women who are not on hormonal contraception one of the main reasons for failed ovulation is undereating (the other is PCOS – but that is an entirely different topic). So, here are some quick tips:
- Daily carbohydrate requirement for regular ovulation is about 130g. I am not advising carbohydrate counting, but having a rough idea is helpful.
- If you are very physically active or an athlete, your carbohydrate requirements might be much higher. Your performance could also benefit from increasing your carbohydrates during the follicular phase of your cycle.
- ‘Special diets’ can be quite restrictive and increase the risk of RED-S (Relative Energy Deficiency in Sport) which can present with vague symptoms such as fatigue, sleep issues and difficulty concentrating.
A menopausal woman, noticing weight gain and – frustratingly – loss of muscle mass
This is a time when oestrogen levels drop, insulin resistance and high cholesterol usually follow and there are ongoing battles with weight gain and body shape changes. It seems like all that has worked before, now no longer works. So, here are some ideas that might help:
- I often tell my patients that after menopause (and perimenopause), our bodies require a ‘change of fuel. Changes in hormonal profile set in motion a cascade of metabolic changes and we are no longer able to use carbohydrates in the same way we used to. In short, intake of carbohydrates needs to be reduced.
- After menopause it is more difficult for women to retain and build muscle (anabolic resistance). This is a real problem as muscle is very metabolically active and helps maintain insulin sensitivity and metabolic flexibility. Both of these are important in helping prevent weight gain and accumulation of abdominal fat. Sufficient intake of quality dietary protein is essential for muscle building and repair. This means about 25-30g of good quality protein per meal.
- How about carbohydrates? It is important to remember that they are not all made equal. Ma-Pi 2 diet was shown to have excellent metabolic outcomes although it is quite high in carbohydrates BUT – they are all complex carbohydrates with high fibre content. Ultimately, the best way to assess how your body reacts to various carbohydrates is to do some continuous glucose monitoring.
A man in his 50s who has been told that his cholesterol is so high that he needs a cholesterol lowering medication
This can be quite a shock. And, it can happen even to active, fit people who (understandably) can feel quite a bit of reluctance when it comes to starting a medication. Here is where to start:
- Rethink your alcohol intake. It helps to think of alcohol as a ‘sugar’ that very quickly gets turned into fat – this is pretty much what liver does with alcohol. Furthermore, alcohol is pro-inflammatory, results in higher insulin levels and this, in turn, leads to accumulation of abdominal fat.
- Very fibre-rich, largely plant based diets are a good start as fibre will actually reduce the amount of cholesterol your body is able to absorb. I often see men who have tried ketogenic diets and, in the process, consumed a lot of saturated fat. For most people this leads to high cholesterol. It is possible to ‘do keto’ without raising cholesterol but this requires a bit of work and planning with focus on lean protein, fats from oily fish, seeds, nuts, avocado and plenty of non-starchy vegetables.
- Protect the lining of your blood vessels (endothelium). If your endothelium is in good health, small cholesterol particles are much less likely to penetrate it and start forming plaques that ultimately lead to heart attacks. There is plenty we can do to protect endothelium – making sure homocysteine levels stay well controlled, providing plenty of antioxidants in the diet and using proven supplements.
Sleep
Sleep is so important that its regulation is hard-wired into our genes. This complex process sets our ‘master clock’, deep inside our brain. This master clock then coordinates peripheral ‘clocks’ which influence functioning of other organs. The system operates on a 24hr cycle and fine tunes itself through detection of light by specialised cells in our retina and subsequent signalling to the ‘master clock’.
When our sleep is disrupted or insufficient, there is a massive knock on effect on organ function. In a classic lab experiment, a 10-day disruption of sleep cycles led to alterations in levels of glucose, insulin, cortisol and leptin (hormone involved in regulating appetite), inducing a pre-diabetic state in 40% of participants. It seems that these metabolic changes, not the composition of diet or the number of calories, is what makes shift workers more susceptible to weight issues and metabolic disease.
Not everyone can achieve uninterrupted, good quality sleep most of the time. However, there are things that we can do to improve the quality of sleep.
- Early morning exposure to bright light helps set circadian rhythm
- Avoiding blue light late and screens in the evening
- Avoiding caffeine after mid-day. Caffeine blocks a compound called adenosine from binding receptors in the brain. This makes us feel less tired but it can also make us more anxious and restless.
- Avoiding alcohol as it disrupts sleep cycles and reduces sleep quality
- Exercise is a great way of regulating hormones that perpetuate anxiety and will actually help you handle stress better in your daily life
Even when good sleep remains elusive (and for shift workers), there are things we can to do mitigate metabolic consequences:
- Timing of meals is crucially important as our bodies use this as another ‘reference point’ for regulating our metabolism. We are much more metabolically responsive earlier in the day, so have a bigger meal early and opt for a light dinner.
- Consuming a high fat diet further exacerbates dysregulation of peripheral body clocks, particularly in the liver. Meals high in whole grains, vegetables, nuts and lean protein can help the body recover better after a poor night’s sleep.
Habits
New year – new habits. If it were that simple, implementing those diet and sleep recommendations would be easy. And, if we are honest, most of the time it is not lack of knowledge that prevents us from achieving the change we want – it is our habits.
We now know that we cannot simply ‘break’ bad habits. They are there for a reason – something in our life and environment triggers a particular behaviour, there is some sort of reward that we crave. That behaviour, that habit, is there because we are trying to fill a need. The trick is to figure out how we can replace the unwanted behaviour with a better one (the one that actually serves you!). Understanding how these habit loops work, can give us a very good chance of changing the unwanted behaviour.
And what about creating a new habit – from scratch? Some of the most reliable strategies involve linking the new desired behaviour with the one that is already well established. For example, do your 5 minute meditation while having that ‘compulsory’ morning coffee.
Ultimately, our lives are built on habits so it is worth spending a bit of time understanding how this works and what is actually happening. A couple of books on this topic that I recommend are Atomic Habits and The Power of Habit.
