Two lectures this month explains why I have been in hiding for most of the month. That and a crazy er schedule. Here goes....how do we fuel as an athlete and specifically as a runner? This obviously differs as the event goes from very short track events to ultra marathons,. This talk was designed for the middle to longer distance athlete from the 10k runner to the marathon runner in mind.
It's all about timing....
When I say this: I mean your diet should be planned around your workout. As you will see later, you can calculate roughly how many calories you need each day based upon your activity and ideal weight. There are more accurate ways to determine this from resting metabolic rate measurements to heart rate monitors and so on. But we will stick with the rough idea here. If you can determine these two things, you can plan you caloric intake and macro nutrient proportions around you activity for the day. For many of those this is in the morning but this can also be lunch time, dinner time, or even several times a day for those in multi sport. The plan is to consume most of your carbohydrates around that activity period as determined by your activity level and add in a little protein when needed for muscle recovery. This is then split into the before, during, and after periods.
The during period occurs during the activity and event and usually just included simple carbohydrates and electrolytes. During longer events, a little protein has been shown to reduce muscle breakdown ie at least 90 minutes or longer and likely in 2+ to 3+ hour events. For those competing in ultra endurance events, consumption of complex carbohydrates and starches is often necessary but not covered in this post. The after period is the start of the recovery of the event and is key in building muscle glycogen stores as well as starting the process of hydration. This is usually split into two periods: immediately after or within 30 minutes and the post activity meal up to two hours after the event. Again, simple carbohydrates are often easier to consume immediately after a high intensity workout and are likely digested better.
For example: let's take a 130 lb woman on a moderate activity day exercising for two hours with some interval training such as mile track repeats. Her goal would likely be to consume at least 70-96g of protein per day, 47 g of fat per day, and anywhere from 236 to 360 g of carbohydrate that day. Again, this is a rough estimate and might vary with athlete and individual goals and workouts.
I did have some questions about weight loss in the athlete but will actually focus on that in an upcoming lecture so please either listen to the podcast or try to attend that lecture when it is approved by Natural Grocers.
Hydration is another key topic. As we all know, it can be really tricky to arrive at an activity just hydrated enough. Too much as you might miss your start waiting in line at the porta potties or have that dreaded sloshing occur in your stomach. Too little and you might not even finish the race or event due to cramping or other symptoms of dehydration. Guidelines to live by are do what is working on the workout that most resembles your race. Weigh yourself before and after to see how much fluid you are losing. If you are gaining fluid you may be over hydrating or taking in the wrong concentration of fluid. Also watch your urine output for color and amount. No urine after a workout is a bad sign as well as very dark urine since you may be dehydration. Pay attention to how much you sweat and how much residual salt you find on your clothing after workouts. This might indicate you need to increase your salt intake.
What works for one person will likely not work for another. Use your workouts as your prep for your races. Remember nothing is steady state and training and nutrition has to vacillate around your goals for the season with proper training periods as well as recovery periods. I hope you enjoyed this blog post and please listen to the podcast for additional information.
It is going to be hard to cover everything but here goes...Increased food intake can be caused by a multitude of factors. One way to look at those factors is to separate them into interval and external factors. The internal factors can be physiologic or based upon a response from the body or hedonistic which might also come from the body but is more more cerebral in nature. One of the recommendations from AND or the Academy of Nutrition and Dietetics is the goal for a 3-10% baseline weight reduction in those needing to lose weight. The lower recommendation of 3% has been shown to improve blood pressure, lipid profiles, and diabetic factors in some populations still make this an important number even if smaller. The 5-10% is the more effective and harder to achieve guideline but does show significant health benefits as shown by the paper. This is translated to a 500-1000 calorie deficit per day resulting in a loss of 1-2 lbs per week.
The most surprising part of this paper is that the evidence does not support one macronutrient ie low carb versus high protein versus DASH versus Mediterranean over another. The most significant factor of the diet is if there is caloric restriction ie a 500-1000 calorie deficit built in to the diet. Not that these diets are all equal since some are associated with better blood pressure profiles ie DASH or lipid ie Mediterranean but for weight loss; caloric deficit is most important.
Other factors that have been shown to be be effective in weight loss include reducing or eliminating sugar sweetened beverages, portion control/ premade meals/ meal replacements, and consuming more calories earlier in the day. Now don't shoot the messenger with this one. Increased fruit and vegetable intake have not been show to result in significant weight loss in obese patients based on the paper as well as meal frequency/timing or breakfast consumption. To play devil's advocate; I would honestly need to review the papers discussed in this statement to really believe the fruit and vegetable statement.
The paper then focuses on recommendations for physical activity. Besides the guidelines for 30 min of moderate activity on most days of the week or 150 min/week, the focus on physical activity has been shown to improve weight loss when combined with caloric restriction and improve weight maintenance. The other important side of this story. If we up the activity level to >250 min per week; it was more likely that weight maintenance would be achieved. These are some pretty high recommendations meaning that there would need to be some pretty big life changes occurring to produce these results. There wasn't a real explanation of level of physical activity and it's comparison ie high vs low vs moderate such as aerobic activity versus high intensity training.
The best part of this paper is the additional discussion of behavioral interventions. This is a team effort and having a multidisciplinary approach is more effective. Particular behavioral interventions studied included: cognitive behavioral therapy, motivational interviewing, and acceptance and commitment therapy. I will not go into these individually but you can review my podcast for examples of the first two. Additional behavioral interventions include: self monitoring such as self weighing, problem solving help, contingency management, relapse prevention, slowed eating, social support, stimulus reduction, and stress management.
An additional interesting aspect is how technology comes into play with therapy...not just behavioral. Apparently face to face interventions are more effective than computer based interventions. The paper notes that with the smart phone and new and upcoming apps; many possibly successful options are out there that have not been researched. The paper also discussed how community based programs such as weight watchers, gym based, and church based programs have been shown to be effective at weight loss. Additional discussion is covered in the podcast so please see that for more information.
The last couple of things I will note include supplements, medications, and surgical interventions just for completeness sake. To be brief, supplements are just no effective and are harmful at times. Medications have a role with some patients and the studied medications included: orlistat, lorcaserin, and pheneramine/topiramate. The surgical options include: laparoscopic gastric banding, gastric bypass, and sleeve gastrectomy. Again, please see my podcast for a deeper review of these topics. This podcast/lecture was not intended to focus on these topics since they are only briefly reviewed in the paper and require a discussion in of themselves. Other things I would have liked to see the paper discuss include water consumption as well as sleep activity however they were not discussed and do seem to have significant effects on weight loss. Thanks for following!
If you are at all like me, you are usually running around with your hair on fire torn between tending to small animals or children after work, trying to figure out what paperwork you still need to do before the weekend, and picking up whatever has mysteriously deposited itself in your living room between when you left in the morning and arrived home. In the middle of all of this, somehow you can still throw a healthy dinner together while you get other things done. Surprise the amazing roasted vegetable dish!
1 butternut squash or other winter squash
1 bunch of beets scrubbed but not peeled
1 white onion
1 head of cabbage or kale
1/2 cup of chopped fresh sage
1 tablespoon olive oil
salt to taste
1. Turn on oven to 350. Chop all vegetables into small pieces. Place on baking sheet or in baking dish, Toss with olive oil and salt and roast for about 20 minutes. You can even turn off the oven and do other chores and the vegetables will be even sweeter when you come back.
Above the vegetables are served alongside homemade pizza from scratch with roasted veggies as a topping and a side salad.
An uber fast, sustainable, healthy option for a family dinner this week
1 green pepper
1 white onion
3 garlic cloves
4 cups of raw pumpkin or butternut squash
1 28 ounce canned tomatoes
3 cans of smoked clams or 2 cans of boiled clams
2 bay leaves
4 cups of vegetable bouillon *** see my make at home recipe here
3-4 strips of nori (optional adds flavor)
1 teaspoon salt
1 tablespoon olive oil (optional can skip if using clams packed in olive oil)
1. Chop all of the vegetable ingredients from the pepper to the pumpkin or squash and add to the crock pot. Add of the rest of the ingredients. Cook on low for 5-6 hours or high for 3 hours and enjoy.
Probiotics seemed to be the most promising new research that I reviewed for my lecture. The gut is often the location where bacteria, viruses, and other pathogens or disease causing microorganisms first encounter our immune system. That is why our gut health might equate to a healthier immune system. The research on probiotics and the microbiota or current bacteria living in our gut and it's correlation with various disease is promising. I only covered it's correlation with immunity in this lecture.
Obesity, anorexia, or malnutrition also correlate with our immunity. Obesity, or a BMI >30 is determined to be a chronic state of inflammation and has been proven to cause more infections that tend to be worse as well. In fact, a BMI >30 in comparison to a BMI<17 is actually worse for your chance of getting an infection in some cases. Please see my references in the end slide for these papers.
Vitamins have long been used to fight immunity with supplementation. However, the literature usually only supports increased supplementation with Vitamin D when sunlight exposure is low. This would include our region of Denver from the fall to the spring based upon our latitude. It is really hard to get enough Vitamin D from the diet in regions that don't receive enough sunlight based upon the way it is absorbed. Most of the other vitamins are consumed in enough amounts in a diet that incorporates lots of fruits and vegetables and occasional meat. In vegans or vegetarians that don't consume many processed foods, B vitamins may not be consumed in enough quantities and should be supplemented. Vitamin B12 is another vitamin that has poor oral absorption but it does appear like repeated oral absorption in large quantities may be better then a one time injection of large quantities. Another way to look at the above vitamins if the separation between fat soluble vitamins ie A,D,E,and K and water soluble vitamins. Fat soluble vitamins can become toxic in ingested in large supplement forms while water soluble vitamins such as Vitamin C are normally secreted out.
Minerals have also been shown to improve immunity. Many people already take zinc supplementation. However, what they don't know is that sometimes supplementation can change that way the body absorbs other minerals. The charge on the zinc element is similar to copper, magnesium, calcium, and some forms of iron. The absorption of these elements can affect each other. Again, this could warrant a seminar in of itself but is important to keep in mind for those supplementing with large amounts of minerals; the supplement may be inhibiting absorption of other important minerals.
Some of the things I have already discussed are antioxidants. Quercetin is tumeric. Polyphenols naturally occur in many fruits and vegetables and are considered an antioxidant which are known to fight inflammation by combating free radicals in the body. In addition, I discussed polyunsaturated fatty acids and the three principle types of fatty acids: ALA, EPA, and DHA. I additionally emphasized that when taking in these fatty acids it is important to consume them in a ratio of your omega 6 fatty acids ie 2:1 or 1:1 or you may not gain the full benefit of your omega 3 fatty acids.
Sleep is very important to immunity. Studies have shown that decreased sleep can even reduce your immune response to vaccines. The goal is to get between 7 to 9 hours per day of sleep. Anything less then 7 hours and sometimes more then 9 hours is often associated with obesity. Think of sleep as your time to repair the body. My slide above noted how sometimes athletes can require more sleep than someone who is less active. However, that time spent in bed can often be inefficient. Practice good sleep hygiene such as going to bed at the same time and waking up at the same time, avoiding screen time before bed, don't read stressful emails before bed, and avoid eating right before bedtime.
Stress is a hard factor to quantify but there are studies out there that do this. There is a old New England Journal of Medicine article that supports a direct correlation between rates of upper respiratory infections and stress with attempts to control outside factors. The theory behind this mechanism is that the fight or flight response produced by stress limits the bodies ability to fight infection during this stressful period. Ways to deal with this stress include avoiding caffeine, simple sugars, and trying to find ways to self soothe through biofeedback and relaxation techniques such as reading a book or exercising.
Questions asked during this lecture included:
Feel free to substitute with kale, zucchini, beets, or other root veggies.
2 bunches of collards or kale (about 10 cups)
Olive oil spray or 2 tbs of olive oil
1 tsp salt
2 tbs of nutritional yeast
1 tsp of smoked paprika
1/4 tsp of chipotle pepper seasoning if you like things spicy
1. Wash collards in cold water. I like to soak mine while I prepare my other ingredients since they come fresh out of the garden and sometimes have little pieces of hay attached to them.
2. Drain then cut collards into small pieces and remove the central rib or stem from the leaf if you prefer. I don't mind the extra stem since it is easier to hold onto the chip that way.
3. Put the collards in a bowl with the olive oil and salt (you can add the optional flavorings at this time as well). Massage the collards for a couple of minutes until you feel their texture change as they soften a bit.
4. Place the collards in a dehydrator and set to desired temperature for desired time. I usually set mine to work while I am at work or sleeping so I keep the temperature below 100F for 8 hours. The chips are usually done by about 4 hours but you can increase the temperature to 125F if needed to shorten cook time. If you add more oil, sometimes the collards will take longer to dehydrate.
5. If using zucchini, beets, potatoes, or other vegetables you will usually need a longer dehydration time and will need to slice the vegetables to a uniform thickness so some of the chips don't become too tough while others need longer cook times. I use a mandolin for mine.
My goals for this lecture were to discuss the basic attributes of an allergic response, common allergies, and validated tests for these allergies. In addition, we briefly discussed commonly understood food intolerances, and their validated tests.
Disclaimer: I reviewed many papers, text books, and review articles for this topic and presented currently accepted topics from peer reviewed journals. I understand that this field is always growing and developing and there are many papers and discussions out there; some of those results were not discussed. Do not use this talk to replace consultation with a medical provider. If there are any concerns about a food reaction please discuss them with your physician. If there is a concern about a possible allergic reaction, please seek medical attention. immediately.
The slide above shows a way to categorize a food reaction as simply as possible. In other words, a food reaction can be initiated by the immune system or it isn't. Anything that isn't, is not considered an allergy but rather a food intolerance. To further categorize the food allergy reaction, I have fields partitioned into IgE or antibody E mediated reactions, a partial IgE reaction, or some other type of immune reaction that does not involve IgE.
Many of you are probabley wondering what IgE is at this point. IgE is an antibody produced by the body. An antibody is a protein produce by the body that identifies a antigen or foreign substance in the body (that foeign substance is a food particle in this case). Antibody E or IgE is a class of antibody that is particularly involved in the allergic response I am discussing above.This reponse is specific since it produces swelling, hives, flushing, and so many other symptoms that we think about when we think about allergies. This is because the response is linked to a response in the body that produces a substance called histamine. The important thing to remember is that IgE is mostly behind this allergy thing! There are other responses as listed above such as mixed or nonIgE immune responses but I will not go into those reponses in depth.
Food intolerances are the non immune mediated response can be further separated into categories. One category is a known toxic reponse such food poisioning from bacterial contamination of food. Another category is an explained pathway such as: lactose intolerance; fructose/short chain carbohydrate intolerance; and food additives or pharmacologic reactions (ie part of the food may contain large amounts of histamine and can create a histamine like reaction). The last cateogry is food intolerance that is not well explained such as irritable bowel syndrome or functional bowel disorders. There is ongoing research into these disorders that appear multifactorial in nature but I will not go further into this subject.
Allergy Symptoms, Allergies, and Validated Tests
Allergy symptoms are symptoms that occur from the IgE mediated histamine response and can be very serious even life threatening. This includes: itching and swelling of the lips, nose, mouth, and tongue; difficulty breath and swelling in the neck; hives, flushing, and swollen skin; nausea, vomiting, diarrhea, and abdomen pain; and even passing out from a drop in blood pressure as blood vessels enlarge. All of these symptoms can lead to a life threatening condition called an anaphylatic reaction and requires immediate medical attention. There are lesser degrees of these reactions as well and they are also due to the same IgE mediated histamine response. Oral food allergy syndrome is an example of this where there is a cross reactivity from one allergen to another and can produce a response to the mouth area as noted below and can also be life threatening. Below is a slide on examples of food allergies and oral food allergy syndrome. Please note that children may have a different likeliness to develop certain allergies, develop more allergies, but also are more likely to outgrow these allergies.
Below is a list of the common validated tests for food allergies on the left side of the slide with a list of unvalidated testing on the right side. There are basically only three validated tests including: skin prick test, serum testing, and oral food challenge. However, even with those three tests most of the tests have to be interpreted by a clinician that knows the patient and can take the whole clinical scenario into consideration. This means a positive test may not indicate an allergy in one patient but a negative test in a different patient may not indicate there isn't an allergy. I know, confusing stuff. For example, if a patient has already had a concerning reaction to a food ie difficulty breathing and facial swelling, then a test with low reactivity may be positive in comparison to another patient with the same result and no history of such reaction being interpreted That is why testing should be navigated with a clinician that knows the patient and the test.
I did not go into detail on the other categories of allergy briefly touched on above: a response when someone has a response that partially involves IgE or doesn't involve IgE. These responses are still lumped into the category of allergy and include such disorders as milk protein allergy in newborns, food protein induced enteropathy, eosinophilic esophagitis, celiac's disease, irritable bowel disease, and many more.
Food Intolerances....what we know....
As noted earlier, we normally group true food intolerances into conditions we can adequately explain and those we can't. Common symptoms of food intolerance include diarrhea, constipation, bloating, and increased flatulence or farting. I did not discuss extra intestinal symptoms such as fatigue, malaise, migraines, mood changes, etc in my talk.
In the pharmacologic category noted above, there are reactions to food that are known to be explained and occur in many people. The condition is not specific to the individual such as caffeine. Caffeine has commonly been used as a laxative in the hospital setting so to say that it induces diarrhea would only confirm that is a reaction that many people have experienced before.
Lactose intolerance and fructose/ short chain carobyhydrate intolerance are the most commonly discussed food intolerances and can be tested with hydrogen breath testing. Lactose is a sugar found in milk and is an enzyme called lactase aids in it's digestion. Lactose intolerance is due to lactase deficiency and can occur early or later in life. Sometimes small a mounts of lactose can still be ingested in the forms of yogurt ie 15 mg but higher ingestions can lead to the symptoms discussed above. Fructose is another sugar found in many foods such as fruit or even high fructose corn syrup. Fructose intolerance is due to problems with transportation of fructose across the gut membrane and is proportional to glucose, another sugar, that is ingested in the same meal. This means that an ingestion of food containing mostly fructose and not a large amount of glucose can cause symptoms; however, if the fructose ingested is similar in proportion to glucose, the patient might not have any symptoms. In addition, digestion of short chain carbohydrates in addition to fructose and lactose such as fructans, galactans, and polyols can also cause symptoms but please refer to my FODMAP post for this information.
IBS or irritable bowel syndrome is a functional bowel disorder that is currently being researched but has been known about in the clinical world for many years. The etiology is thought to be multifactorial in nature. This topic would warrent a nutrition seminar in of itself. In addition, gluten sensitivity is also another multifactorial condition currently being studied and doesn't fit the exact etiology of celiac's disease. These conditions are can be treated with the FODMAP diet as discussed in a previous post on mine here. There are no direct tests for these conditions as the slide for food allergy testing lists some common unvalidated tests often used for these conditions as well. I would also add additional unvalidated tests include:fecal microbiotic analysis, salivary IgA, and intestinal permability.
1. Mahan L, Escott-Stump S, and Raymond J. Krause's Food and the Nutrition Care Process. 13th ed. Elsvier. 2012.
2. Turnbull J, Adams H, and Gorard D. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Parhmacol Ther 2015; 41:3-25.
3. Lorner M, Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther 2015; 41: 262-275.