Wednesday, 21 May 2014

Are you eating enough?

It is rare that I will get a client who is eating too much food. Often, it’s the other way around. Which makes sense, given what we have been taught about weight loss. It’s simple, really: 

“Eat less. Exercise more”.

Hmm. OK. My job (in terms of weight loss clients) really should be obsolete then, right? If it really were as simple as eating less and exercising more, most of my clients would be Kate-Moss-thin. But they aren’t. Some have just a little bit of stubborn fat that they would like to lose (for aesthetic reasons), others have more that they need to lose (for health reasons). All are exercising their butts off. Too much, in my opinion. All are not eating enough.

So simple, yet so easily forgotten. 
I was taught at university that if an overweight person comes to me and their food record shows they are consuming fewer calories than they are burning, then they must have been lying, because they should be losing weight. How f-ing arrogant of us to assume this. It truly breaks my heart to see people who are literally broken from trying so hard to lose weight using the traditional “eat less, exercise more” dogma”.

I agree. Ridiculous indeed.
So why is fat loss so hard?

Well, it is complicated, and I am the first person to admit that I do not have all the answers. As I mentioned, if weight loss were easy, we would not have an obesity epidemic that is running out of control.

What I do know is that when you consume too few calories, shit is going to hit the fan. Let’s back up a little for some weekly science….

Your resting metabolic rate (RMR) is an estimate for how many calories you would burn if you lay in bed all day (sans hanky panky). Your RMR represents the minimum amount of energy required to keep your body functioning – your heart beating, your lungs breathing, your reproductive system functioning, your thyroid gland humming along nicely, controlling your metabolism and body temperature. Let’s put this into practice and see what some numbers look like:

To calculate your RMR, you can use something called the “Schofield Equation”. While this equation does have some flaws, it provides a pretty decent estimate.

For me (and any other female in the 18-30 age group), the following equation would be used to get my RMR:

{(0.062 x weight (kgs)) + 2.036} x 1000 = 5,942kJ per day (divide by 4.28 to convert to calories)

So my minimum calories that I should consume, based on me staying in bed all day is 1388. MINIMUM! This is not taking into account any sort of exercise, folks.

Let’s say I decide that I am going to walk a little each day. My estimated energy requirements then go up to 2,082kcals per day! Just to do a little wandering here and there.

What is really concerning to me is that I have clients consuming around 1300-1500 kcals per day who are training at high intensity, for long durations, every day of the week. A rest day for them would involve a slow run, rather than a fast one. And this is not just females, it’s the fellas too.

What’s the problem with eating too few calories?

Image by Sara Thurley via Pinterest
When you have insufficient calories on board to fuel basic bodily functions, those functions will slow down. Your brain will recognise this lack of fuel and signal to the thyroid gland (in your neck) that energy needs to be conserved and to slow everything down.

Your thyroid gland controls all of your metabolic processes and your body temperature. If it slows down production of thyroid hormones, your metabolism will slow down, your heart rate will drop and you may struggle to keep warm. What happens when your metabolism slows down, people? You guessed it! Weight loss resistance!  If you are, essentially, starving, do you really think your body is going to give up its fat stores easily? Or do you think it is going to hold on to every last morsel to feed your vital organs (and to keep you warm). (PS have you checked out the Thyroid Sessions yet? They are awesome!)

If this wasn’t bad enough, your adrenals are probably going to kick into gear to help you survive (especially if you are doing high intensity exercise and don’t have enough carbs in your diet). This means cortisol is going to ramp up and give you a nice little pooch around your tummy that you can’t shift, no matter how many crunches you do (as a side note, crunches are not the best exercise for a lean mid-section, so just stop it).

In my opinion, troubles with weight loss are the least of your worries if you are chronically under-eating and over-exercising. I have spoken (at length) about how this can lead to Hypothalamic Amenorrhea (click the labels below this post to read more about this topic), but what about the other consequences, not just impacting the ladies:
  • Compromised bone density
  • Brain fog and inability to focus
  • Decreased performance (in all forms of exercise, including the bedroom)
  • Vitamin and mineral deficiency
  • Low energy
  • Increased risk of heart problems
  • Poor memory
  • Skin breakouts
  • Hair loss
  • Cracked and brittle nails 

Not pretty, right? Moral to the story – eat more and eat well! Or, exercise less. You choose. But don’t do nothing, or you could end up in some ugly (literally and figuratively) places. It might be useful to track your daily food and exercise, using something like “My Fitness Pal” to get a better picture of whether you need a slap in the face with a juicy steak.

Thanks, Ryan. Much appreciated. 

Tuesday, 13 May 2014

Ancient Genes vs Modern World - an event you must attend!

When I first moved to New Zealand, I decided that I was going to make a concerted effort to connect with like-minded practitioners. I wanted to be part of a strong community of health folk. What I didn’t know was how amazing my new-found health-nerd friends would be. Actually, I tell a lie. I had an inkling of their awesomeness. 

Sometimes (often) my images have no relevance to the topic.
I thought this one was pretty cool, though, don't you? 

It's a lizard made out of lime!
Image by Harry Chapin Food Bank via Pinterest
We started off our little NZ adventure in Christchurch. There was a chance, after all, that we would be living there eventually. This also happened to be the home town of one very well known, and very respected, nutritionist by the name of Jamie Scott (who also goes by the name of “That Paleo Guy”).

So I thought I would send him an email. I didn’t expect a response, but I hoped for one. I got one. Almost immediately – welcoming me to the country and an expression of interest to catch up! This was beyond exciting. But wait! There’s more – Jamie’s lady-friend happens to be an amazing doctor (yes – GP, MD whatever you want to call it – she is legit) who is a firm believer in using principles of evolutionary medicine and ancestral health to guide the prevention and management of chronic disease. "She", by the way, is Anastasia Boulais. These crazy cats are so passionate about ancestral health that they started up the very first Ancestral Health Society of New Zealand (AHSNZ), which you can read more about HERE. I am so proud to be involved in this remarkable organization with so many other incredible, like-minded people.

Here's a (relevant) pic of the happy couple (on the right)
with the folks from the Whole 9
After our little tiki-tour around NZ, I had the pleasure of meeting these two inspiring people and, I can tell you, they are freakin’ amazing. Not just because of their knowledge and dedication to spreading the word about ancestral health, but because of how unbelievably kind, considerate and inclusive they are.

Anywho…enough blabbering and butt-kissing. Even more exciting news – AHSNZ is holding its first conference at the end of June (the 29th, to be exact). The following little blurb is 100% plagiarized from the AHSNZ website:

“Ancient Genes vs. Modern World” explores some of the key mismatches that exist between our physiology, having evolved over millions of years, and the novelty of a modern world that has rapidly changed over the last few decades”

Here’s a little breakdown of what you will be learning about on the day (again, plagiarism is at play):
  • “Food for Thought: Nutrition and Brain Health” Dr Mikki Williden, PhD.  Senior Lecturer and Researcher, AUT. Auckland
  • “Are Health Professionals Too Focused on Health?”
 Brad Norris, Director, Synergy Health. Christchurch
  • “Ancestral Health in General Practice: Art, Science or Quackery?”Dr Pam Olver, General Practitioner. Wellington
  • “The Ancestral Woman in a Modern World: Strong, Sexy and Fertile.”Kate Callaghan, Nutritionist. Wanaka (THAT’S ME!!!)
  • “I See Weak People: The Under-Appreciated Role of Muscle in Health and Disease”Jamie Scott, Health Researcher, Synergy Health. Christchurch
  • “Sunlight: Friend or Foe? Skin Cancer Controversies”Dr Anastasia Boulais, Medical Practitioner. Christchurch
  • “Stress in the Modern World”Aaron Callaghan, Peak Performance Coach. Wanaka (AKA Kate’s hubby)
  • “Urban Design and Health: The Spaces in Between”James Murphy, Nutritionist, Synergy Health. Christchurch
  • “Ancestral Principles in Managing Autoimmune Disease”Julianne Taylor, Nutritionist. Auckland
  • EXPERT PANEL: Anti-Fragile in Christchurch: Individual Health Strategies in a Changing City
Exciting right? This conference is the first of its kind in the southern hemisphere – you don’t want to miss it! Plus, you can come and hang out with me. Isn’t that worth the trip in itself (insert winky-face emoticon)?! Oh, and its not just for practitioners and/or Kiwi's. All welcome!

If you’re interested (which you should be) go and save your seat now – tix are only NZ$49 (meaning they are even cheaper for those of you across the ditch). Now THAT is a bargain to be hearing from some of the top experts in the ancestral health community. Hope to see you there!

Tuesday, 6 May 2014

Amenorrhea and bone health

I know a lot of chicks who do not have their period. Most of whom aren’t looking to get pregnant yet, so they don’t really see it as much of an issue. Some even see it as a blessing.  I get that. Periods are a little inconvenient. They are messy. They hurt. BUT they play an important role in our health. As women, getting a regular, monthly period signals that our menstrual cycle is healthy, our hormones are working as they should be and we are capable of reproducing, if we so wish. Our period, in a way, is the canary in the coal mine. 

Image by Manita Brug via Pinterest 
I often refer to my period problems as “hypothalamic amenorrhea” (HA), which is basically a diagnosis of exclusion. I don’t have PCOS. I don’t have a tumour on my pituitary gland. I don’t have a physical problem with my ovaries. I do have a problem with the message getting from my brain to my ovaries to produce sex hormones. Another term for this whole biz is the “Female Athlete Triad” – FAT (or lack there of it, in this case). FAT refers to a constellation of 3 clinical entities:
  1. Menstrual dysfunction
  2. Low energy availability (with or without an eating disorder). When I say “energy availability”, I am referring to the amount of energy left over for all of your bodily functions after taking exercise into account. If you are eating 2000 calories per day and "burning" 2000 calories per day, you're in trouble!
  3. Decreased bone mineral density
Today I’m going to focus on the third point as this applies to all females, regardless of whether they want to make babies or not. I am pretty sure none of us wants a fractured hip before they hit their 40’s (which, scarily, is a more common occurrence than one would think). It's a bit of a long post, but incredibly important (and filled with loads of fun science. You know you love it). If you're time-short, just read the bold points and then take some action. 

Image by Alec Paloumpis via Pinterest
In February last year, I had a DEXA scan, which revealed my bone mineral density (BMD) was less than optimal. My response: Oh. Fuck. Considering my peak bone mass had already been obtained and I would start to lose BMD in less than 2 years, this was not the easiest thing for me to process. So I didn’t. I focused more on the infertility side of things instead, because that was what I was more concerned about at the time.

Let’s back up a bit. Why does amenorrhea cause bone loss? It’s a little bit sciency, but I think you can handle it. Maybe a picture will help? Here you go. Just look at the right hand side. The left hand side is a talk for another day.
Image via
In a normal, fully-functioning, female, part of the brain (the hypothalamus) will release something called Gonadotropin Releasing Hormone (GnRH). You can think of this in 2 parts to make more sense: “gonad” = ovaries, “tropin” = increase/stimulate. So GnRH signals to the pituitary gland (also in the brain) to “release” gonadotropins. These are Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). FSH and LH then stimulate the ovaries to produce and secrete sex hormones (namely estrogen and progesterone) in a cyclic manner.

In someone with HA/FAT, the GnRH secretion is thrown all out of whack due to stress, too low body fat and/or not enough food to play with. As a result, down yonder in the ovaries, no message comes through to produce sex hormones, so they go on vacation. Ergo no estrogen. No progesterone. And, often, no testosterone. Boo. While all of this is pretty crappy, the bone complications come about due to the lack of estrogen, termed “hypoestrogenism”. Big words today, people. Are you still with me?

Why is estrogen important in bone health? I am going to simplify this with a list, given that your brain might be overloaded a bit already:
  1. Estrogen stimulates bone formation
  2. Estrogen suppresses bone resorption (whereby bone is broken down and the minerals are released, resulting in a transfer of calcium from bone to blood)
  3. Estrogen inhibits osteoclast activity (osteoclasts break down bone, as opposed to osteoblasts, which build bone)
  4. Estrogen is responsible for the expression of vitamin D receptors i.e. it plays a role in vitamin D actually doing its job in helping to build bone

Now, the process of bone breakdown and formation is incredibly complex, but this hopefully gets my point across – estrogen is important for bone health. No estrogen, no bones. Well, not really. You probably won’t turn to mush.

45-50% of our peak bone mass is formed during puberty. By the time we are 18, we will have reached ~90% (unless you have HA/FAT when you’re a teenager – then the picture ain’t so pretty). From the age of 30, if all is working well, we will lose ~1% of our BMD per year. HOWEVER

If you have HA/FAT, the rate of bone loss is similar to that seen in menopausal women: ~5% per year. That is 5 times greater bone loss than we should be losing! 

If that doesn’t scare you, then I do not know what will. Maybe go and hang out at a geriatrics ward and take a look at what recovery from a hip fracture looks like.

One study found this: “The lumbar (lower back) BMD of [runners with amenorrhea] was found to be lower than the BMD of an average 50 year old woman”

Shitballs. Here are some more scary findings, just in case that is not enough to get you out of your whole “it’s convenient to not have a period” funk:

The bone loss that occurs in women with amenorrhea is most likely irreversible. I repeat – irreversible. You can take all of the calcium supplements you want, but you probably won’t get it all back. You might get some, if you are very serious about making some changes.

Another study on 27 women with an average age of 21.8 years with functional hypothalamic amenorrhea had reduced bone mass throughout the whole skeleton.

The length of time that someone has amenorrhea is negatively correlated with BMD. Read: the longer you have no period, the shittier your bones will be. Read: go and do something about it NOW!

Exercise is not sufficient protection. When I had my DEXA, the lady said “you should do some more weight bearing exercise”. No shit Sherlock. I’m a personal trainer, group fitness instructor and I have been doing weight bearing exercise all of my life. But thanks for your input.

Hormonal therapy (e.g. the oral contraceptive pill) is not sufficient if satisfactory nutritional status is not achieved. There is no magic bullet, ladies. You have to do the ground work and fix the underlying cause.

So what’s a gal to do?

Well, firstly, don’t ignore it. It will only get worse with time. If you have had amenorrhea for more than 6mths, get a DEXA scan to see how your BMD is looking. Then get another one every year after.

Secondly. Fix it. This is more complicated than I like to admit. I am in the process of writing a book about this now, which will take some time, but I am committed to the cause.  Read my other posts on hypothalamic amenorrhea as a start - HERE, HERE, HERE and HEREYep, there are a few of them. And there will be more, but I am moving from focusing about me to focusing about YOU!

Start with eating more (and eating well), exercising less, but still do some exercise. Yoga is great for bringing everything back into balance. Weight training, in small to moderate amounts, is good for helping with bone and muscle strength.  Don’t run. Don’t do more than 30mins of cardio at any given time. Just don’t. Research has shown that just 20 minutes of quiet standing on a vibration platform can decrease and prevent bone loss. And it feels pretty good – it shakes your body awake!

That’ll do for now. Thanks for hanging in there, friends. Please share this with anyone who you think might benefit from it.  Our skeleton is pretty important. Let’s make sure we don’t lose it before our time. PS have you checked out the Thyroid Sessions yet? They are pretty awesome, and free for a limited time. Fun fact: thyroid problems can cause amenorrhea. Click HERE to watch now. 

Studies used in writing this post:
  • Constantini, NW. & Warren, MP. (1994) Special problems of the female athlete, Bailliere's Clinical Rheumatology, Vol 8, Iss 1, pp199-219
  • Ackerman, KE. et al (2012) The Female Athlete Triad, Sports health, Vol 4, Iss 4, pp 302 - 311
  • Deimel, JF. & Dunlap, BJ. (2012) The Female Athlete Triad, Clinics in Sports Medicine,  Vol 31, Iss 2, pp 247 - 254
  • Nissenbaum, JT. (2013) Long term consequences of the female athlete triad, Maturitas, Vol 75, pp 107-112
  • Pludowski, P. et al (2012) Skeletal status and body composition in young women with functional hypothalamic amenorrhea, Gynecological Endocrinology, Vol 28, Iss 4, pp 299-304