Blog - The Dish
Keto- It’s all the Rage, Right!?
Why Keto was Created & Initial Remarks:
The ketogenic diet was introduced in the 1920s to treat seizures in infants and has continued to serve a unique role in the medical world as a therapeutic treatment for pediatric epilepsy. The diet has proven to effectively reduce symptoms for this population.
Somehow, the diet has evolved to become a mainstream “tool” for weight loss with claims to prevent Alzheimer’s disease, support cardiometabolic health and help manage diabetes.
Aside from these health claims is the concerning evidence that most people who claim to be “keto” are not actually following a ketogenic diet and are not metabolically in a state of ketosis. The result? Lots of Americans following a high fat diet while restricting fruits, vegetables, grains and beans… yikes!
How Keto Works:
Carbs are the favorable fuel source for body tissue. When we deprive the body of carbs (<50g/day for most), we first force our body to use glycogen (stored carb in muscle and liver). Once we exhaust our stored energy from carbohydrate, we begin utilizing what are often referred to as “starvation pathways”, gluconeogenesis and ketogenesis.
In gluconeogenesis, we’re using whatever non-glycogen chemical compounds we can to produce glucose. These compounds include amino acids(alanine and glutamine), glycerol and lactic acid. Our body does not convert fat to carbohydrate. Therefore, when glucose production from alternate sources(gluconeogenesis) cannot keep up with our body’s demand, we enter ketosis. I like to think of ketosis as our body’s emergency gear. It’s as though our body says “oh my gosh! I am so low on gas that I can’t even fuel my brain! We must enter a state of energy emergency!”
This is when ketone bodies takeover as the primary energy source.
I’m not going to go into insulin secretion and other hormonal changes that occur, but if you have specific questions, feel free to shoot me a private message. The key thing to mention is that the hormonal changes that do occur support a rapid increase in the breakdown of fat for energy.
How to Know if You’re in Nutritional Ketosis:
When in nutritional ketosis, blood ketone levels typically fall between 0.5 and 3 millimoles/L. Breath and urinary tests can also be used but blood testing is the gold standard method. It takes about 4-7 days for most to transition into ketosis. Once you’ve transitioned, you must keep carb intake low enough AT ALL TIMES. This means no “cheat” meals, no birthday cake and no beer/wine nights with friends.
What is the Keto Diet Like?
A ketogenic diet is high in fat(~60%), moderate in protein(~30%) and very low in carbohydrate(<10%). These percentages vary, but in order for most people to stay in a metabolic state of ketosis, protein needs to stay low enough so that the body can’t sustain itself using gluconeogenesis’ catabolic protein —> carbohydrate conversion pathways.
According to the newly released 2020-2025 USDA Dietary Guidelines for Americans, a healthy diet should emphasize fruits and vegetables, whole grains, reduced fat dairy and lean proteins. The guidelines also recommend limiting calories from saturated fat to <10% beginning at age 2.
Many nutrient-rich foods are sources of carbohydrates, including fruits, starchy vegetables, whole grains, beans, milk and yogurt. On a keto diet, carbs from all sources are severely restricted. With the goal of keeping carbs below 50 grams per day, keto dieters often consume very little of any of these food groups. This raises a big concern of nutritional deficiencies for these dieters.
Sooo is This an Effective Tool for Weight Loss?
When followed correctly, a very low carbohydrate and high fat ketogenic diet HAS been proven to be very effective for RAPID weight loss. I should note that, in its early stages, a significant amount of this weight is water. It is the weight loss that sells this diet to so many. Research comparing 13 trials showed that ketogenic diets can result in more initial weight loss compared to other dieting methods. However, after peak weight loss (around 5 months in), dieters started regaining weight. I always preach that our bodies are incredibly smart and adaptable. We can try and outsmart them but they usually catch on to us, and in the case of keto, it seems our bodies do just that. When you exit ketosis, your body is coming out of a state of starvation and I would expect insulin sensitivity to be at an all-time high. What does this mean? Our bodies become REALLY good at storing energy. What does this mean? You’ll likely gain the weight back and have to regain your body’s trust…. Womp womp.
What Else can Keto Treat?
With regards to the keto diet as a tool for sustainable weight loss and other health benefits, the jury is still out.
Keto was the most researched diet of 2019. Some studies suggest that this eating pattern may be helpful for not only short-term weight loss but managing diabetes and warding off Alzheimer’s disease. When reading articles, please keep in mind that it is too soon to know much about the long-term effects of the diet. There is a clear divide between the publicity hype and the fact-based research.
I personally don’t feel comfortable supporting the diet for the treatment of any other conditions because the science and the research is so controversial. What I will say is that if you are using the diet to help treat/prevent a disease, I hope you have had it approved by at least 2 medical professionals, have been properly educated on how to follow the diet and are being closely monitored. <3
Quick Cons!
· Keto is contraindicated in patients with pancreatic disease, liver conditions, gallbladder disease or removal, fat metabolism disorders, thyroid problems, eating disorders, etc.
· Restricting many major food groups and key nutrients.
· Very hard to sustain, so long-term compliance is low.
· Socially undesirable.
· Lack of research on long-term health outcomes.
· Constipation due to high fat and low fiber intake.
· “Keto flu”- flu-like symptoms typically experienced for about a week while transitioning into ketosis.
· Most dieters are not properly following the diet and are not even in nutritional ketosis.
· High saturated fat intake is linked to poor health outcomes including increased risk for cardiovascular disease.
· When considering the research, it’s important to look at the studies in detail. For example, what were subjects fed to meet their fat goals? Olive oil, salmon and avocados? Or bacon and lard?
Bottom Line & Personal Opinions:
There is no denying that obesity is a major contributor to chronic diseases and ultimately mortality. Even so, I always like to clarify that weight loss does not always indicate improved health. In my opinion(but also based on the science!), establishing and maintaining a healthy diet and lifestyle is always more important than the weight loss itself. For example, heart disease is largely related to obesity. It is also largely related to a high dietary intake of saturated fat. Over the past couple of years, I have visited hospitalized cardiac patients (more than I can count on one hand) who have been previously diagnosed with heart disease, told to lose weight and began following the Keto Diet for weight loss. THIS IS A PROBLEM and this is one reason why I so passionately believe that dietary advice should be given 1. by a registered/licensed dietitian and 2. on an individualized basis.
So when it comes to Keto, the question for me becomes “is following a keto diet conducive to your physical and mental health OUTSIDE OF WEIGHT LOSS?” I speculate that for MOST, the answer is no.
Final Words:
If you are following or have followed a keto eating plan, I would love to hear about your experience! I do know people who have had successful weight loss and enjoy following the diet.
Please don’t ever let my opinion prevent you from sharing your personal experiences with me! I try to stay open-minded and always love to learn from your experiences!!!
Sources
1. Gordon, B. (n.d.). What is the Ketogenic Diet. Retrieved January 20, 2021, from https://www.eatright.org/health/weight-loss/fad-diets/what-is-the-ketogenic-diet
2. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2020 Dec 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/
3. LaFountain RA, Miller VJ, Barnhart EC, Hyde PN, Crabtree CD, McSwiney FT, Beeler MK, Buga A, Sapper TN, Short JA, Bowling ML, Kraemer WJ, Simonetti OP, Maresh CM, Volek JS. Extended Ketogenic Diet and Physical Training Intervention in Military Personnel. Mil Med. 2019 Oct 01;184(9-10):e538-e547.
4. Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019 Apr;93:113-118.
5. Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC. The Ketogenic and Modified Atkins Diet Therapy for Children With Refractory Epilepsy of Genetic Etiology. Pediatr Neurol. 2019 May;94:32-37.
6. Mohorko N, Černelič-Bizjak M, Poklar-Vatovec T, Grom G, Kenig S, Petelin A, Jenko-Pražnikar Z. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res. 2019 Feb;62:64-77.
7. Broom GM, Shaw IC, Rucklidge JJ. The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease. Nutrition. 2019 Apr;60:118-121.
8. Włodarek D. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer's Disease and Parkinson's Disease). Nutrients. 2019 Jan 15;11(1)
9. Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol. 2019 Jan;23(1):143-151.
10. Armeno M, Araujo C, Sotomontesano B, Caraballo RH. [Update on the adverse effects during therapy with a ketogenic diet in paediatric refractory epilepsy]. Rev Neurol. 2018 Mar 16;66(6):193-200.
What is Intuitive Eating?
YOU ARE A VICTIM OF THE RULES YOU LIVE BY
Quit following someone else’s rules. Once you stop trying to follow other people’s rules and focus on tuning into your own wants and needs, you will feel liberated, confident, and yes, healthy.
I can promise you this!
For those of you who have not seen me for nutrition counseling, I hope that this will help serve as a guide so you can learn more about intuitive eating and whether it is something that might simplify what “healthy eating” means to you and ease any anxiety around food.
The Beginning
We are born intuitive eaters. As babies, we cry, we’re fed, we sleep, we do it all over again. As kids, most of us have the liberty to eat what we want when we want and then move on with our day. We’re not always fed on a schedule and we don’t eat the same foods or amount of calories or protein or carbs every day. Heck, we don’t even know what a calorie is! But in the end, our body does it’s thing and we learn to trust it.
The Problem
As we grow older, we start comparing ourselves to other people. We begin associating food with weight and body shape/size. We may blame food for our body shape/size. We may try to eat like someone with the body we want. We listen to social media. We ask others for their opinions. WE ARE JUDGED. We also judge ourselves!! We read “extreme” books. We hear about FAD diets. We are victims of marketing and sales. Ultimately, we are victims of other people’s rules.
The Solution?
Intuitive eating might be your escape from the chaos.
So let’s learn!
Are Mindful and Intuitive Eating the same?
Short answer: No…
The terms mindful eating and intuitive eating are often used interchangeably, but mindful eating is just one skill that can be used within the paradigm of the 10 intuitive eating principles(shared below).
Mindful eating quite literally means being mindful/present and deliberately paying attention while eating. This involves acknowledging all thoughts and judgments that guide food choices and actions around food and tuning into your senses so you can fully experience every bite. In today’s go go go world, it is easy to lose our sense of mindfulness with food and hunger levels. We have so much other stuff taking up our brainspace! Practicing mindfulness can help us slow down so we can better sense our hunger/fullness/satisfaction cues.
While intuitive eating involves mindful eating, it also involves being OK with NOT eating mindfully (say whaaat? I know…). Within the scope of intuitive eating, every meal does not NEED to be eaten mindfully, because… well… LIFE! When intuitive eating is done right, less time is spent thinking about food and what we should/shouldn’t be eating. Spontaneity and pure food freedom are key components of intuitive eating, so chipping away at any diet rules (including what, how much and when to eat) is essential. Sadly, these are lost within the framework of a diet or any sort of boundaries tied to food(This does not include allergies/intolerances/religious restrictions/other specialized diets!). Intuitive eating helps guide eating choices by helping you get back in touch with internal cues, like hunger/fullness, cravings, and how food makes you feel. You have to let go of your rules before you can effectively tune in and respond to your internal cues.
The principle goal of intuitive eating is to kiss goodbye to the diet mentality so that we can make peace with food, body image, movement and nutrition. This is HARD WORK! I would be lying if I said I’ve mastered it myself, but it is a practice that I see tremendous value in and would love to one day master all 10 principles involved. My advice? Focus on mastering one principle at a time.
Mindful eating can help address:
· Binge eating
· Mindless or bored eating
· Picky eating
· Disordered eating
· General nutrition/health
· Anxiety around food(s)
· Food guilt
Intuitive eating can help address:
· Everything above
+
· Weight instability
· Obsession with food
· Obsession with healthy eating
· Feeling a need to track macros, count calories, etc.
· Tired of yo-yo and/or FAD dieting
· Emphasizing external rules over internal cues
· Judgments about food
· Obsession with weight or body image
· Insecurities related to weight/body image/food
· Fear of eating out
· Feeling a need to to be “in control” of food, body shape, weight
Most people can relate to at least one of the items listed above. NO SHAME. A perfect relationship with food/body image does not exist. Instead of seeking perfection, I challenge you to be honest with yourself about your relationship with food and with your body. Without showing judgment or trying to defend yourself, ask yourself if any of the above bullets apply to you. If you answer yes, ask yourself why and what purpose does it serve?
Does your relationship with food and your body serve both your health and your happiness? Because it should!!
Is there anyone I would not recommend intuitive eating to?
Intuitive eating might be contraindicated for some, including certain disease states, the food insecure/homeless, early on in eating disorder treatment (especially when weight restoration needs to happen or hunger cues are no longer present), high volume endurance athletes who may not intuitively be eating enough, etc.
If you have personal questions, please reach out to me on www.kyliekainnutrition.comor send me a direct message on instagram @kyliekainnutrition.
Proven Benefits of Intuitive Eating:
Higher HDL (“good”) cholesterol, Lower triglycerides, Lower rates of emotional eating,Lower rates of disordered eating and eating disorders,Higher self-esteem, Better body image,More satisfaction with life, Optimism and well-being,Proactive coping skills.
(Find referenced studies by clicking here.)
The 10 Principles of
Intuitive Eating
1: REJECT THE DIET MENTALITY
2: HONOR YOUR HUNGER
3: MAKE PEACE WITH FOOD
This means giving yourself permission to eat all the foods you enjoy, including those that may have been off-limits.
4: CHALLENGE THE FOOD POLICE
This will help you look at nutrition in a more helpful way that’s rooted in self care rather than punishment. This might involve unfollowing some accounts on Instagram or even reevaluating your friendships and who you choose to get your energy from every day. Does their energy serve you?
5: RESPECT YOUR FULLNESS
This also involves addressing your hunger…and not waiting until you are starving to do so!
6: DISCOVER THE SATISFACTION FACTOR
Let the experience of food connect you with others.
7: COPE WITH YOUR EMOTIONS WITH OR WITHOUT FOOD
Food can help us cope with emotions, but it also shouldn’t be your only coping mechanism. After a long day of work, a Neapolitan pizza and beer might be what you need. Get a promotion? Maybe you celebrate with a steak and martini! Acknowledge your emotional needs and respond in an honest way that will help improve the situation… Eating the whole box of chocolates probably won’t improve the situation, but having a few might!?
8: RESPECT YOUR BODY
This doesn’t necessarily mean love your body. You can’t force body positivity, but you can always practice treating your body with more kindness and respect.
9: EXERCISE - FEEL THE DIFFERENCE
Learn the art of pleasurable movement - moving your body for fun and for purposes of self care, not as punishment or to burn calories!
10: HONOR YOUR HEALTH WITH GENTLE NUTRITION
Intuitive eating was created by two dietitians, so of course, nutrition is woven in somewhere! Nutrition comes last, because you have to heal your relationship with food before you begin integrating nutrition. Gentle nutrition involves taking a birds-eye view at eating. Every meal and every day of eating is different, but zoomed out, the variety balances out.
Nutrition can be intuitive when you begin considering how food makes you feel and your personal health goals. Contrary to popular belief, you can still work towards your health goals with intuitive eating. If you are honest with and respect yourself, your cravings, your wants and your needs, intuitive eating can be healthy eating for you.
Final thoughts:
One of the reasons I believe mindful and intuitive eating have become so hard for many of us is because of the confusion around food/health, the mixed messages and the unparalleled amount of judgment and criticism that we see on social media. Social media will shame people for eating added sugar, yet it will also mock people for avoiding foods with added sugar… It becomes so hard to focus on yourself and your own mind when your mind is constantly “influenced” by “influencers”.
Simplify, simplify, simplify.
Living a healthy lifestyle does not need to be complicated for most of us, so why make things hard on yourself?
If you’re experiencing anxiety or confusion around food and/or exercise, I would love to talk you through it. I’ve been there. It sucks the fun out of life!
I am here to help you rediscover what healthy means to YOU!!!
Fuel Utilization While Training
Fuel utilization is the heart of where nutrition meets physical performance: How does your body use food to make ATP as an expendable form of energy?
When we’re training/exercising, ATP is continuously supplied to our muscles through various metabolic pathways. These pathways vary in their fuel use and their ability to produce ATP anaerobically (without the use of oxygen). Different exercises, different training modalities/techniques and different sports prioritize different muscle fiber types and different metabolic pathways.
During a training session or competition, three energy systems are active, at least minimally. These include the ATP-PC system, Glycolysis and Aerobic or Oxidative Metabolism. Although all three systems are active, certain movements and intensities may largely prioritize one system over the others.
The ATP-PC system is highly favored during speed/power/max-strength movements. During strength(75-85% 1RM/1 rep max) and hypertrophy training (even lower intensity but higher sets and higher reps than strength), we get two times more ATP from glycolysis than we do from aerobic metabolism. On the flip side, aerobic metabolism yields more of our energy than glycolysis during muscular endurance and aerobic activity. Why is this helpful information? Because if speed/power is part of your sport or training plan, which it is part of movements in most sports, then carbohydrate and phosphocreatine are especially important fuel sources for you. A sports/performance dietitian can help ensure you are eating an appropriate amount of carbohydrate and fat to fuel your training plan/sport.
Let’s look into these systems in more detail:
ATP-PC (aka alactic system): This is our quickest source of ATP. Think 10-15 second 100% sprint at as close as you can get to your VO2max. There are 3 possible sources of this ATP including preexisting endogenous ATP, which we deplete in about 1-2 seconds if not replaced. When ATP/ADP ratio is low(stored energy>available energy), we need to activate the enzymes adenylate kinase and creatine kinase in order to make ATP from ADP and Phosphocreatine (PCr, which yields creatine).
Aerobic/Oxidative Pathway: During low intensity and more prolonged exercise, we make ATP using aerobic metabolism. Although this pathway is typically not favored during endurance exercise, within months to years of training, our bodies can actually adapt to better favor this pathway at a higher energy output. This helps endurance athletes, because they are better able to use fat as a fuel source and potentially postpone the intense fatigue that accompanies glycogen depletion. How is this possible? With endurance training, physiological changes occur that actually increase the metabolic capacity of our working muscles. I’ll dedicate another post to training adaptations sometime down the road, because it’s really its own topic…. and I’m digressing…
Anaerobic Pathway: We need a sufficient oxygen supply to allow aerobic metabolism to continue. When we can no longer circulate oxygen to our working muscles fast enough, we have to depend primarily on anaerobic metabolism. This pathway produces a biproduct…. LACTATE. Not lactic acid… these are two different chemicals! Lactate is a base, not an acid. You do not build up and need to “flush out” lactic acid from your muscles during a hard training session… despite what is commonly said in the fitness world… Lactate is actually an important FUEL during exercise, especially for type 1 skeletal muscle(slow twitch) and cardiac muscle. We actually like lactate. Lactate helps us when we are short on breath.
Some Key Takeaways:
· While lipid and carbohydrate are the main sources of fuel for ATP production, the degree to which each substrate is used varies based on substrate availability, exercise intensity, exercise duration, training adaptations and other factors.
· With increasing intensity, there is a progressive increase in % of energy from carbohydrate and a reciprocal decline in % energy from fat.
· During light intensity exercise, virtually none of the expended energy in your working muscles comes from muscle glycogen (carbs stored in your muscles). Instead, it is coming primarily from circulating free fatty acids with a little coming from muscle triacyglycerol(fat stored in your muscles) and circulating glucose.
· Type II muscle fibers(fast twitch), which are recruited at higher intensities, rely more on carbohydrate than type 1(slow twitch). This makes sense based on what we’ve discussed about intensity and fuel preference.
· Longer duration(which can’t be high intensity because that’s not sustainable.. so at about 60% VO2max…) results in progressively greater reliance on fat with a reciprocal reduction in reliance on carbohydrate. Glycogen supply (muscle and liver stored carb) is limited while our fat stores (in most) are virtually unlimited. Glycogen depletion is the main cause of fatigue during endurance peformance, so by shifting towards using more fat, sustained performance is possible!
Exercise Duration’s Effect on Metabolism:
1). First, we rely on stored intramuscular carbohydrate and fat, which makes sense because it’s already “on site” in muscle and easy to get to. However, this diminishes quickly. Although there is room for about 2,050 total kcals available in the entire body in a 145lb very lean athlete, this energy is locked into the muscle. You cannot, for example, move this energy from your arm to your leg. It also takes training and eating a certain way to maximize these stores for performance. The best way to maximize these stores? Work your muscles and then eat adequate carbohydrate post-training.
2). Blood glucose from your liver’s stored glycogen is a major secondary source, which diminishes with liver glycogen depletion (about 450 kcals of storage available in a 145lb athlete). When liver glycogen is close to full depletion, our liver starts making glucose from other substrates like protein(gluconeogenesis). This is why it’s so important to maintain adequate supply of glucose from carbohydrates/sugars for long training sessions and endurance competitions.
3). Serum free fatty acids is our major long-term source of energy, which increases with duration as other energy sources are expended. This prevents energy depletion of other important substrates (carbs!).
*Protein doesn’t contribute much to ATP production in working muscles except as a last resort (complete glycogen depletion/starvation)… but protein is still very important for other purposes!
Final thought to leave you with: Lipid oxidation rates decrease at higher intensities. In the fitness world, it is often claimed that there is a “fat burning zone” where your body burns more fat. Indeed, research has shown that at about 65% intensity (%VO2max), you’re oxidizing the most fat(meaning absolute rate, not relative to total energy expenditure). This is partly because, at higher intensities, blood flow to adipose tissue (fat stores) decreases and redistributes to working muscles. However, just because this reduces delivery of fat to the muscle, the actual amount of fat mobilized continues to increase. Additionally, high intensity exercise increases post-exercise lipid oxidation.Therefore, although our bodies do have a “fat burning zone”, staying within this zone IS NOT THE BEST WAY TO BURN FAT and build/maintain our muscle mass. Although this is a personal opinion, I think most exercise physiologists and sports dietitians would agree with me.
If you’d like me to provide research articles to support any of my claims above, I am happy to share some with you! However, this information was just taken from my brain and notes from a bioenergetics course I took as part of my masters degree… course’s slides were written by Edward P. Weiss PhD.
I hope you learned something new! : )
Macronutrient Metabolism
Let me just say, this was a really aggressive topic for one blog post and I take full responsibility for that. Oops!
WHAT IS MACRONUTRIENT METABOLISM?
Macronutrient or energy metabolism involves the various pathways underlying food intake, food breakdown to release energy and the storage of excess energy. Utilization involves additional mechanisms for converting stored energy (fat/triglycerides/adipose tissue, carbohydrate/glycogen, and when underfed, protein/muscle) into usable energy or ATP. Ideally, it takes multiple textbooks and literature reviews to explain all there is to know about biochemistry and energy metabolism/utilization… Our bodies are these incredible and amazingly complex energy factories!
I am going to cover some of the basics today. I definitely don’t want to bore you with metabolic pathways/enzymes/intermediates or anything of that nature. Next week, I’ll cover more about fuel utilization at rest and during different types of exercise.
Without further ado….
Macronutrients are the nutrients that supply our bodies with the energy we need to survive and thrive:
Carbohydrates(4 kcals/gram) are an important source of energy during REST and EXERCISE. Carbs are important for all activity, but especially during higher intensity exercises like running and lifting. As a general rule of thumb, if you are breathing hard during exercise, carbohydrate is the preferred energy source. The main sources of carbohydrates in our diet include grains/flours, beans/legumes, starchy vegetables, fruits and sugars. ALL carbohydrates are ultimately degraded into sugars and absorbed from your small intestine into your blood stream to either be used as an immediate fuel source or stored in your liver/muscles. Carbohydrate storage is limited. Therefore, when carbohydrate intake exceeds energy needs and storage capacity, they will be converted to and stored as fat.
Fat(9 kcals/gram) is also an important energy source both at REST and during EXERCISE. Although we do store small amounts of fat in our liver and muscle, the majority of this energy reserve is in adipose tissue. Fat takes longer to absorb into blood than carbohydrates and plays an important role in satiety. In a healthy individual, fat reserves are still quite large!
Protein (4 kcals/gram) is comprised of amino acids linked together by peptide bonds. There are 20 total amino acids, 9 of which are called essential because the body cannot make them and requires them from diet. A “complete” protein is used to refer to a food/supplement that contains all of the essential amino acids in high amounts. Complementing proteins are proteins that, when eaten throughout the day, provide a full complement of all the essential amino acids. Whole grains and beans are a good example of complementing proteins. When protein intake exceeds protein excretion, there is a positive nitrogen balance and new lean tissue can be produced. Eating adequate carbohydrate and protein combined supports a positive nitrogen balance. A neutral or positive nitrogen balance is preferred!
Alcohol(7 kcals/gram) is also considered a macronutrient, but I am not going to talk about alcohol today, because hopefully we’re not getting much of our energy from there anyway, right? : )
ENERGY METABOLISM
Energy metabolism is largely regulated by energy availability and hormones. Hormones help regulate what energy goes to storage and what energy is broken down for fuel. I’m not going to discuss specific hormones today, but in general, when we eat more than our body needs for energy (intake > output), we will store the excess energy for later use. Different organs have different capacity for fuel use and storage, so let’s take a look at the unique metabolic profiles of the major organs involved in converting the metabolites from food into usable energy.
The Liver: Most chemical compounds that are absorbed from the food in our intestine travel to the liver where its fate is determined. The liver is the hub of energy metabolism, meaning it regulates how much of each metabolite is in our blood at a given time. For example, the liver removes metabolites like glucose from our blood, converts them into the needed form of energy or storage, and releases or stores the products. Our liver can store up to 400kcals of carbohydrate(glycogen) before the excess(assuming muscle stores are full) is stored as fat. The liver also absorbs dietary amino acids and synthesizes proteins. In general, when adequate carbohydrate is available, protein is not broken down for fuel. However, especially when carbohydrate availability is inadequate, amino acids can be used as a fuel source. The liver can do all sorts of creative energy conversions!
The Brain: Your brain runs exclusively on carbohydrate. This organ alone consumes about 120 g (~420kcal) of carbohydrate to function properly on a daily basis. That is the equivalent of about 4 slices of whole wheat bread to fuel your brain alone. Fatty acids are bound to albumin and cannot pass the blood-brain barrier. Your brain also lacks all energy storage, so it requires a steady supply of glucose (sugar/broken down carbohydrate). Does this mean that you need to be eating bites of carby foods continuously throughout the day? No, your liver can break down its stored glycogen to supply your brain with glucose, but it DOES mean that adequate carbohydrate intake is important for proper brain functioning. The liver can only store about 300 calories of glycogen. Recommendations for carbohydrate will vary quite a bit from person to person based largely on activity level, but if you are feeling mentally fatigued, it might be worth asking yourself (or a dietitian) if you’re including enough carbohydrate in your diet. I’ll have to talk about glycemic index and glycemic response and simple vs. complex carbs another time!
*During prolonged starvation, the body can adapt to using ketones to fuel the brain. Our bodies can adapt to a lot of things but that definitely doesn’t mean it’s conducive to proper functioning and performance.
Muscle: Skeletal muscle is very different from the brain in that it has the largest capacity for glycogen(stored carbohydrate) at about 150-300g (600-1200 kcals) or 75% of all glycogen in the body. Specific storage capacity varies person to person based on muscle mass and other factors. This stored glycogen can be readily converted into energy for use within muscle cells. Unlike the liver and brain, muscle cells cannot export glucose. This glycogen becomes very important for athletes, but I will get into that more in my next post! Muscle can also store fatty acids, the major fuel source of resting muscle.
*Cardiac muscle is unique in that it functions aerobically (with oxygen), and therefore, functions mainly on fatty acids. Like the brain, the heart is not storing glycogen. The heart can also use ketone bodies and lactate as fuel.
Adipose tissue(connective fatty tissue): This is our largest energy reservoir, about 77% of total body energy is stored in adipose tissue. Here, we store on average 120,000-135,000 kcals, or about 2 months worth of energy from triacylglycerols (stored fatty acids). Fat storage was originally a survival mechanism in case of long bouts of starvation. Most of us are fortunate not to have to worry about that today.
KEY TAKEAWAYS
1. Carbohydrates, fat and protein each plays an important role in human health and performance.
2. Carbohydrate storage is limited which is why it’s important to include a sufficient amount of carbohydrate in your diet on a daily basis (especially following long bouts of exercise when glycogen stores have been depleted).
3. Based on daily activity, body composition/size among other things, macronutrient needs vary on an individualized basis.
4. The body is incredible at adapting. For example, there are pathways to make carbohydrate from amino acids and other substrates when the body is carbohydrate deficient. Most people do not need to count their macros down to the gram. Rather, strive to eat an average of 20-35% of your calories from fat, 45-65% from carbs(at least half complex) and 10-35% from protein. These are large ranges for a reason!
Next post, I’ll be talking about macronutrient utilization, one of my favorite topics and what I did my research on in grad school!!!
Exercise-Induced Inflammation
Client: I think the reason I find inflammation so confusing is because inflammation is a bad thing but exercise is a good thing yet exercise causes inflammation…
You’re finding it confusing, because it IS confusing!
Let me try to clarify:
During intense physical activity, whether it be long-duration or high-intensity, the body experiences injury from nervous, circulatory and respiratory system fatigue, muscle fiber damage and often bruised bones and other ailments. I discussed the immune system’s response briefly last week. The body responds to fatigue/injury due to intense physical activity in the very same way. This exercise-induced inflammation is a normal response to high-output exercise that can cause localized swelling, redness and pain.
According to recent research, exercise can help prevent and even moderate clinical low-grade inflammation(the “bad”, chronic disease-causing inflammation)(2). This may be partly due to conditioning the immune response through the exercise, rest, repeat cycle(1,2). However, there is much more to learn about this relationship and how much/what intensity of exercise is best. It is proposed that moderate-intensity exercise is best for treating chronic inflammatory conditions(4,5,6). However, high-intensity exercise still plays an important role in preventing inflammatory conditions from developing in the first place! This is why individualized care and guidance is so important. If you have health conditions or concerns, consult a qualified health professional to learn what type, duration and intensity of exercise is best for you. I always offer to write personalized exercise plans for all of my clients, because diet and exercise work together like peanut butter and jelly!(Or Sunbutter if you’re allergic to peanuts… Ha!)
Is exercise-induced inflammation ever a bad thing?
Prolonged inflammation can occur as a result of continuous physical over-exertion and lack of rest and recovery. I often tell my clients that the projected value of a hard training session depends on proper refueling and proper muscle recovery. Recovery and diet is what allows for proper growth and energy storage. When under a steady state of inflammation, we experience continuous fatigue, muscle damage and soreness which ultimately limits muscle growth, stunts performance and increases muscle loss. This condition is often referred to as “overtraining syndrome”, a condition of impaired immune system, chronic inflammation, declined performance and varying undesirable outcomes. With all the time and energy athletes spend training, especially at the collegiate and professional level, reducing prolonged inflammation is a key concern for sports dietitians like me. The good news? Nutrition can play a pivotal role! You can also methodically plan your training so you’re targeting different muscle groups on different days and still allowing proper recovery time. That way, by the end of the week, you’ve fully fatigued each major muscle group and still allowed for proper recovery and regrowth.
Nutritional tips to reduce exercise-induced inflammation:
CONSUME PROPER FLUIDS, ELECTROLYTES AND CARBS. Water can help maintain proper blood flow, joint lubrication, flush toxins out of your body and preserve anti-microbial properties in saliva. Dehydration can also lead to weakened immune response and increased inflammation. Adequate carbohydrate ingestion can also attenuate the inflammatory response to acute exercise, reduce cortisol(stress hormone) and support hydration(carbs are stored with water).
SELECT HIGH-ANTIOXIDANT FOODS. Colorful fruits and vegetables have been proven to reduce oxidative stress caused by exhaustive exercise. However, supplements have been shown to actually inhibit muscle recovery and impair training adaptations(3)! This is likely due to the very high content of antioxidants consumed from supplements. PLEASE ALWAYS CHOOSE FOOD OVER SUPPLEMENTS.
My favorite choices? Spinach, kale, citrus fruits, berries, avocado, broccoli, peppers(red is highest in vitamin C!), tomatoes, carrots, sweet potatoes/squash. Try to incorporate a few of these foods into your meals on a daily basis. Don’t know where to start? I’m happy to help!
INCREASE OMEGA-3 FATTY ACIDS to help reduce exercise-induced inflammation(7). Foods like salmon, tuna, mackerel, herring, walnuts, ground flaxseed and chia seed are great sources of these essential fats. Aim for 3 grams/day. 3 grams is the equivalent of 3 ounces Atlantic farmed cooked salmon and 1 Tbsp Flax. A fish oil supplement may be necessary to help certain individuals reach this goal(3-4g EPA + DHA is recommended).
MEET YOUR PERSONAL PROTEIN NEEDS. Protein supports the actual production of immune cells and reduces muscle damage. Aim to get 20-40 grams of high-quality protein (containing all essential amino acids, not just BCAAs!) in post-exercise. Specific recommendations will vary.
GET ADEQUATE VITAMIN D. Vitamin D regulates our body’s inflammatory response and many athletes are deficient due to lack of sun exposure during its peak hours of 10am-2pm. Unfortunately, it isn’t as easy to meet the recommended 2000-5000 IU/day from diet alone. If you cannot get outside for whatever reason, try to include fatty fish like salmon, eggs(YOLKS!) and fortified dairy in your diet on a daily basis. For clients who choose to follow a vegan or dairy-free diet, I typically recommend taking a daily supplement.
EXPERIMENT WITH TART CHERRY JUICE, NITRICT ACID, NITRATES. Tart cherry juice is high in anthocyanins, a potent antioxidant found in red and purple fruits and veggies. Research supports that tart cherry juice can help maintain muscle strength and reduce pain by reducing oxidative stress(3).
Nitrates become nitric oxide, a chemical important for increasing blood flow throughout the body, which can help transport anti-inflammatory factors to sites of local inflammation and support rapid recovery. Beets and leafy greens are good sources of nitrates to include in a post-workout smoothie or recovery day meal.
SEASON WITH HERBS AND SPICES. Ginger, turmeric, garlic, cinnamon and rosemary contain antioxidants and may help combat exercise-induced inflammation(3).
There are many sports supplements that claim to fight inflammation and muscle soreness. Most of the research as a whole is weak in supporting what is claimed in adds, but if you have a specific question about a product or ergogenic aid/chemical/ingredient, I’d love to hear from you! At the end of the day, real food wins again!
I hope this helps! Have a question for me or want clarification on a topic related to nutrition/diet or fitness/sport? Click on the “contact me” button on the upper right corner of this page or let me know on Instagram @kyliekainnutrition!
Sources
Kristen M. Beavers, Tina E. Brinkley, Barbara J. Nicklas, Effect of exercise training on chronic inflammation, Clinica Chimica Acta,Volume 411, Issues 11–12, 2010, Pages 785-793, ISSN 0009-8981
George S. Metsios, Rikke H. Moe, George D. Kitas, Exercise and inflammation, Best Practice & Research Clinical Rheumatology, Volume 34, Issue 2, 2020, 101504, ISSN 1521-6942
Wentz M. Laurel, Balancing Exercise-Induced Inflammation, Collegiate and Professional Sports Dietitians Association.
Grace L. Rose, Tina L. Skinner, Gregore I. Mielke, Mia A. Schaumberg, The effect of exercise intensity on chronic inflammation: A systematic review and meta-analysis, Journal of Science and Medicine in Sport, 2020, ISSN 1440-2440
Pedersen, B. K. (2017). Anti-inflammatory effects of exercise: role in diabetes and cardiovascular disease. European Journal of Clinical Investigation, 47(8), 600-611. doi:https://doi.org/10.1111/eci.12781
Emily M. Paolucci, Dessi Loukov, Dawn M.E. Bowdish, Jennifer J. Heisz, Exercise reduces depression and inflammation but intensity matters, Biological Psychology, Volume 133, 2018, Pages 79-84, ISSN 0301-0511
Nathan A Lewis, Diarmuid Daniels, Philip C Calder, Lindy M Castell, Charles R Pedlar, Are There Benefits from the Use of Fish Oil Supplements in Athletes? A Systematic Review, Advances in Nutrition, Volume 11, Issue 5, September 2020, Pages 1300–1314, https://doi.org/10.1093/advances/nmaa050
The Dish: Anti-Inflammatory Diets
Client Question of the Week: “What’s with all the talk about an anti-inflammatory diet? Is that something I should be following?”
There is SO much information floating around about inflammation and anti-inflammatory food/supplements, and it’s often hard to distinguish fact from fiction. Unfortunately, strategic marketing and the misrepresentation of products and research have interfered with the integrity of many food and health claims.
So let me break it down for you…
What is inflammation?
In general, inflammation is part of the natural immune response our body has to damaged cells and harmful stimuli like bacteria, toxins and viruses. This allows our bodies to heal from intense exercise or injury and helps to remove disease-causing organisms and foreign invaders. Sounds like inflammation is on our side, right?
Well, I should probably distinguish between the two kinds of inflammation: acute and chronic.
With acute, think ‘short-term’. Acute inflammation describes the healthy immune response your body has to damaged cells, allergens, or other harmful stimuli. Your body responds by sending out an army of chemicals/substances to fight the foreign invaders, protect the affected area and promote healing. When you are healed, the inflammation is no longer present. Problem solved!
But…
Chronic inflammation can develop when this immune response is not alleviated and becomes exhausted. While many inflammatory conditions create discomfort and are therefore detectable and treatable, such as arthritis, heart burn or inflammatory bowel disease (Chron’s or ulcerative colitis), we can’t actually feel chronic low-grade inflammation. And when this inflammation persists undetected for many years, we are at increased risk for many health conditions such as diabetes, heart disease, autoimmune disorders, kidney disease, dementia and cancer(1).
Why do dietitians and other health professionals talk so much about anti-inflammatory foods?
Because the typical American diet and obesity both promote inflammation. However, adopting more plant-based dietary patterns(which doesn’t necessarily mean vegetarian or vegan!) may help prevent chronic inflammation from evolving.
Well, how do I know if I have chronic inflammation?
Your healthcare provider can offer a blood test to test for markers of inflammation. Common markers include C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha) among others. Although we know a lot, there is still much more to learn about detecting and treating low-grade chronic inflammation.
What does the research have to say about diet and inflammation?
Research on this topic often involves measuring how certain foods, diets or lifestyle factors impact inflammatory blood markers. It is important to note that most of this research is done on laboratory animals.
There are 2 diets that have been named “anti-inflammatory diets”, because they have been proven to help reduce inflammatory markers, namely C-reactive protein. These include the Mediterranean diet and the DASH diet. Whole30 calls itself “anti-inflammatory”, but because it is only a 30-day plan AND because it bans essentials food groups (grains, beans/legumes, dairy), I do not recommend adopting whole30 as a lifelong anti-inflammatory food guide.
So do you need to strictly adopt one of these diets to reduce inflammation?
Not necessarily! Instead, let’s take a look at what these two diets have in common and discuss practical changes you can make to help protect your cells!
1. Focus on fruits, vegetables and whole grains. A higher intake of fruits and vegetables leads to a decrease in inflammatory markets C-reactice protein and TNA-alpha(2). In unhealthy individuals, markers of inflammation have improved with higher intakes of whole grains(3). It is therefore suspected that the many vitamins, minerals, fiber and phytonutrients in these plant foods work together to ward off chronic inflammation(4).
2. Choose healthy fats. Replacing solid fats with healthy oils is a great first step to promote overall health and longevity. Specifically, olive oil intake has been shown to decrease the inflammatory markers CRP and IL-6(5). In a review of studies that tested the effects of omega-3 fats on inflammatory markers, results were surprisingly inconclusive(6). More important than omega-3 fatty acid intake alone seems to be maintaining a high RATIO of omega-3 to omega-6(6). While omega-6 fatty acids are also essential, meaning our bodies can’t make them and need them from foods, they can actually CONTRIBUTE to inflammation. More research needs to be done on this topic. What you CAN do is continue choosing foods rich in omega-3s, like cold-water fish, fresh ground flax and walnuts. You may want to try a fish oil supplement that is rich in both EPA and DHA. These are the building blocks for hormones that control immune function, blood, clotting, cell growth and structure.
What are the main sources of omega-6 fats in the American diet?
The refined oils often used in snack foods, fast foods, cookies, crackers, and sweets. Think corn oil, sunflower oil, safflower oil, soybean oil. Do you choose these foods often? Try snacking on whole foods instead of processed options. You can also make your own snacks using olive oil.
3. INCLUDE dairy! Dairy foods offer lots of protein, calcium, and other nutrients that may actually help reduce chronic inflammation. In a recent meta-analysis, higher dairy intake compared with low or no intake reduced CRP, TNF-alpha, and IL-6 inflammatory markers (7).
4. Reduce your sodium intake. Processed and restaurant foods are often very high in sodium. When we eat these foods in excess, our cells retain water, which can cause them to swell and increase blood pressure among other things. Try to choose foods high in other minerals like potassium, calcium and magnesium. Fruits, grains, vegetables, legumes, nuts and seeds with minimal added salt/sodium are all great options!
5. Consider reducing your meat intake, especially options high in saturated fat and sodium. As a whole, plant-based foods are greatly associated with overall improvement in inflammatory markers when compared to other diet patterns (4). You don’t have to cut meat out entirely, but simply reduce! : )
6. Maintain healthy habits. Alcohol, smoking, stress, lack of sleep, lack of physical activity and obesity can all contribute to chronic inflammation. Work towards making healthier choices. Don’t know where to start? Let’s talk about it!
Can’t I use over-the-counter drugs and supplements for inflammation?
Many rely on nonsteroidal anti-inflammatory drugs (NSAIDs) like Aspirin to reduce inflammation. Additionally, there are several herbal/spice products marketed as anti-inflammatory like matcha/green tea, ginger, turmeric/curcumin, antioxidants powders, etc. While many compounds in herbs and spices HAVE been shown to help combat inflammation, the dose and frequency needed to achieve the desired outcome is often very high. It is also important to recognize that none of these options negate the damage of poor diet and lifestyle choices. Unfortunately, there is no crutch or quick-fix when it comes to physical and mental health.
The bottom line: Eating with inflammation in mind doesn't have to be complicated or restrictive. In fact, the foods that are anti-inflammatory are typically the same foods that can help support your overall health!
Next week, I’ll be releasing a blog post about inflammation, diet and supplementation as it relates to sport and exercise.
* These recommendations are generalized. Please consult your primary care doctor or a registered dietitian for individualized guidance! You can schedule a consult with me by pressing the button at the bottom of this page.
-Kylie
References
1. Furman, D., Campisi, J., Verdin, E. et al. Chronic inflammation in the etiology of disease across the life span. Nat Med 25, 1822–1832 (2019). https://doi.org/10.1038/s41591-019-0675-0
2. Banafshe Hosseini, Bronwyn S Berthon, Ahmad Saedisomeolia, Malcolm R Starkey, Adam Collison, Peter A B Wark, Lisa G Wood, Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis, The American Journal of Clinical Nutrition, Volume 108, Issue 1, July 2018, Pages 136–155, https://doi.org/10.1093/ajcn/nqy082
3. Rahmani, S., Sadeghi, O., Sadeghian, M., Sadeghi, N., Larijani, B., & Esmaillzadeh, A. (2020). The effect of whole-grain intake on biomarkers of subclinical inflammation: a comprehensive meta-analysis of randomized controlled trials. Advances in Nutrition, 11(1), 52-65.
4. Eichelmann, F., Schwingshackl, L., Fedirko, V., & Aleksandrova, K. (2016). Effect of plant‐based diets on obesity‐related inflammatory profiles: a systematic review and meta‐analysis of intervention trials. obesity reviews, 17(11), 1067-1079.
5. Schwingshackl, L., Christoph, M., & Hoffmann, G. (2015). Effects of olive oil on markers of inflammation and endothelial function—a systematic review and meta-analysis. Nutrients, 7(9), 7651-7675.
6. Natto, Z. S., Yaghmoor, W., Alshaeri, H. K., & Van Dyke, T. E. (2019). Omega-3 Fatty Acids Effects on Inflammatory Biomarkers and Lipid Profiles among Diabetic and Cardiovascular Disease Patients: A Systematic Review and Meta-Analysis. Scientific reports, 9(1), 1-10.
7. Moosavian, S. P., Rahimlou, M., Saneei, P., & Esmaillzadeh, A. (2020). Effects of dairy products consumption on inflammatory biomarkers among adults: A systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases.