Primal scream. Or... are nutritionists stupid?

I consider myself to be a very open-minded person. I base my views on what I read, what I see, and my general experiences of the world around me.  And I’m always happy to be proved wrong. 

In my role as a public health nutritionist, I’m bound by a professional code of ethics that essentially requires me to base what I do on up-to-date scientific evidence and prevents me from giving unsubstantiated advice.  That doesn’t stop me from reading up on some of the more ‘out-there’ dietary theories.  In fact, I really enjoy leaning things that challenge my own views and those of ‘conventional wisdom’.  I always want to delve deeper, learn what the theories are based on, and what people’s experiences of following them are.

As mentioned in previous posts, at the moment I’m really interested in Paleo/Primal diets and have been experimenting with unleashing my inner cave-girl.  I wouldn’t describe these diets as a fad, and think that there’s a lot of merit in following a simpler, more natural way of eating than the processed-to-within-an-inch-of-its-life stuff we tend to find all around us these days.

I’ve been really enjoying reading Robb Wolf’s new book, The Paleo Solution.  Wolf is a former research biochemist, so the book is well-referenced, but it’s also funny, to-the-point and easy to read.  So I was a bit disappointed when I discovered that Wolf, along with, it appears, many of his Primal/Paleo friends, is so vehemently anti-nutritionist.  I’m aware that people who follow the Paleo lifestyle are often evangelical about it.  But surely that doesn’t necessitate intolerance of others who may not share their views.

For example, Wolf states (p. 34) that: “we are being held hostage by an Orwellian nutrition and health research community” while, in response to a recent report on obesity levels around the world, Dr Michael Eades recently tweeted: “Does speaking English make one fat? Or are English-speaking nutritionists just ignorant (or stupid)?” I got back to Dr Eades, asking him how nutritionists were suddenly to blame.  He replied: “Nutritionists make nutritional recommendations. People follow them and get fat. Ergo, figure it out.”  Sounds like a nice man!

A large proportion of the population does not base their diets on the recommendations of nutritionists.  My experience working with low-income families shows me that cost, convenience and taste are often higher on their list of priorities when it comes to food choice.  And cheap, processed food is all around us.  It takes effort to follow a healthy diet.  Recent dietary surveys show us that, while people may have followed government advice to cut down on saturated fat, they still eat too much sugar, and not enough fruit, vegetables and oily fish.  In order to help people eat better, I believe that good quality, healthy food needs to be the easy choice.  And what about the impact of sedentary behaviour on obesity levels?  Certainly in Scotland, most of us are not active enough for health.  Are nutritionists to blame for that too?

A recent article in the British Journal of Nutrition models how East African Paleolithic diets were made up; typically they contained more protein, a similar amount of saturated fat, and proportionately more omega-3 fats (e.g. fish oils) than omega-6 (e.g. vegetable oils), compared to how we eat today.  Plant to animal food ratios varied considerably.  The researchers call for intervention studies to be set up to investigate the effects of Paleolithic diets.  I’d love to see these set up; the potential results really excite me (yes, I am a geek).

Diets in East Africa have changed considerably since the Paleolithic era.  For example, research on elite Kenyan runners has shown that they excel on a diet that is very high in carbohydrate (including simple sugars) and low in fat.  Overall, my opinion is that different people thrive on different diets, and nutritionists can play an important role in helping people to find out what works for them and their health.  There’s no one magic menu plan that will unlock the key to everlasting health.  No matter what the book cover tries to tell you. 

What to eat during a 2-day race

Setting aside the small issue of lack of training, the thing I'm most worried about for next week's Nokia Coast to Coast is what I'm going to eat.  I've been doing well over the past couple of weeks on my mini cave girl experiment, avoiding sugar and refined grains and trying to stick to Primal Fitness workouts.  In retrospect, a month with two races isn't the best month to have decided to experiment with a different nutrition and fitness programme, and I'm lifting the sugar ban for the race weekends.  I also found it difficult to fit in my sprints and resistance training this week, on account of my legs being so stiff and tired from the half marathon last week.  I'm still committed to giving primal living a go, so plan to get properly into it after next weekend's race.  Speaking of which...

What do you eat during a multi-day adventure race?  Despite my love of sugary things, I'm really not a fan of energy drinks and gels.  I tend to stick to water on most of my runs because they're rarely longer than an hour, and eating or drinking anything else makes me feel queasy.  Even on longer mountain bike rides, I find it a struggle to eat.  That's clearly not going to work on a 2-day event, where maintaining a steady supply of glucose to my muscles and brain will be crucial.  I was hoping to avoid the refined stuff by stocking up on natural Honey Stinger gels, but discovered they're no longer available in the U.K. because of import restrictions on honey.  So during last week's Glasgow Half Marathon I took the opportunity to practise fuelling up on Gu gel.  They tasted okay and didn't seem to affect my digestive system as badly as energy drinks usually do.  So I'm planning to stock my backpack with a mixture of Gu gels, Pack Tunch bars, bananas, oatcakes, dried fruit and nuts, all washed down with plain water.  Luckily the run is first on day one, so I should be able to get through that on gel alone and fuel up on the solid stuff on the bike leg, where I'm less likely to feel sick.  In the evening, I'll eat and eat and eat, then eat some more in the morning and during the first couple of hours of the second day's bike leg.  The second day ends with a 14-mile run, which is the scariest bit.  It's going to be really important to refuel as much as possible before I hit that, then I'll go back to the gels and water and hope my poor tummy can cope. 

Do you live in a cave?

As I mentioned in my last post, I'm slightly obsessed with reading.  I can spend hours and hours researching random topics, and especially love delving into theories that challenge conventional nutrition and fitness wisdom.  An ongoing fascination is low-fat versus low-carbohydrate diets.  Initially popularised by the Atkins Diet, a low-carbohydrate diet can be very effective for weight loss, but the vast majority of sports nutrition advice and research concentrates on the importance of a high-carbohydrate, low-fat diet for optimal performance.  However, this has recently been challenged through, for example, Loren Cordain's Paleo Diet for Athletes and blogs such as Mark's Daily Apple, which advocate a 'primal' way of living.

I've been vegetarian for over 20 years now with no major health effects, but I do sometimes worry that I'm not getting enough protein, or missing out on key nutrients from meat like iron and zinc.  I came across another book by Brendan Brazier, a professional Ironman triathlete who is also a vegan, and decided to compare his Thrive Fitness plan to Mark Sisson's meat-heavy primal blueprint.

Interestingly, there are a lot of similarities between the two plans, once the presence or absence of animal products is set aside.  These are the key principles, along with my thoughts:

Thrive Fitness
4 components of vitality:

High return exercise
Brazier seems to focus on quality of training rather than quantity, emphasizing the need to ensure that your programme is effective and that any weaknesses are addressed.  He speaks about needing to strip his own swimming training right back to the basics after realising that his technique was inefficient.  The book includes a fitness programme based on suspension training and free weights.  So far, so sensible.

High net-gain nutrition
The nutrition advice is based on a diet high in nutrient-dense whole foods, which is music to my ears.  Brazier's rationale for avoiding animal products is that they are acid-forming.  He suggests that the process of buffering to balance the pH of the blood after eating acid-forming foods places undue stress on the body, which leads to inflammation.  I wouldn't say that this in itself is enough of a reason to give up meat - eating a range of acid and alkaline-forming foods (vegetables) should balance things out overall.  Brazier also advocates eating foods raw as much as possible.  This is based on the theory that raw foods contain live enzymes, which are destroyed by cooking.  My understanding is that enzymes in food are denatured by stomach acid anyway, and that our bodies can produce all the enzymes we need if we eat a balanced diet.  I've hunted for research that supports or refutes the raw food enzyme theory but haven't been able to find anything in a peer-reviewed scientific journal - I would love to learn more about this if anyone has any references or links.  My opinion is that the benefits of a diet high in fruit and vegetables come from the vitamins and phytonutrients (many of which can also be reduced by cooking) and their fibre content.  I also think that the recipes in the book are a wee bit aspirational - I don't suppose you can get Maca, Salba or Dulse Flakes in Tesco?!  Nevertheless, I'm definitely keen to give the recipe for Banana Fig Cinnamon Energy Bar a go.

Efficient sleep
I agree that this is hugely important in terms of both recovery from exercise and weight management.

Uncomplementary stress reduction
Brazier recommends that we avoid low-nutrition foods, breathing polluted air and worrying.  Some of these are obviously unavoidable, but the principle does make sense.

Primal blueprint
10 rules:

Eat lots of animals, insects and plants
Hang on a minute... insects?  Mind you, I think I've ingested a fair few insects myself this summer through open mouthed bike rides and runs.  Glad to know they might be good for my health.  Alongside a diet based around meat and fish, Sisson recommends that we eliminate grains, sugars, trans- and hydrogenated fats.  On closer inspection, the diet isn't as wildly different to standard healthy eating recommendations as I initially thought.  Around 1.1-2.2g of protein per kg body weight per day is similar to standard recommendations for athletes.  This is attainable for most people, including vegetarians, without having to go out and hunt down a buffalo.  The main difference between the two plans is the proportions of carbohydrate and fat in the diets.  The primal plan is based on how our caveman ancestors ate, before processed grains were available.  Naturally their diets were higher in saturated fat and vegetables, but contained much less carbohydrate overall.  Sisson suggests that we should consume a maximum of around 150g carbohydrate per day, from fruit and vegetables, which is considerably lower than the approx 250g in current UK recommendations.  The remainder of the diet is made up of fat, which we're used to being told to avoid.  The underlying principle is that carbohydrate causes our bodies to release insulin, encouraging fat synthesis, while eating a high fat diet encourages our bodies to become more efficient at burning fat for fuel and conserving our glycogen stores.  I agree that a diet high in refined and processed carbohydrates isn't optimal, but so far the balance of research suggests that high fat diets are detrimental to sports performance.

Move around a lot at a slow pace
Sisson seems to be quite anti-running and recommends that the bulk of our physical activity is low-level hiking, cycling and such like.  He suggests 2-5 hours per week at a heart rate of 55-75% of our maximum.  While this is more than the majority of the population currently do, it pretty much rules out spin classes and tempo runs for people like me who enjoy working hard.  Hmm.

Lift heavy things
Like the Thrive plan, resistance training is an important component.  This involves 2-3 circuit sessions a week, focused on body weight exercises like push ups and pull ups.  I can handle that.  And I definitely want to give the shoulder press push up a try. 

Run really fast once in a while
A weekly session of very short sprints, e.g. 6 x 50m.  This doesn't seem like very much compared to most training plans that are running or triathlon focused.  According to Sisson, you can do this little training and still be ready to run a marathon at a day or two's notice.  This contrasts markedly with the balance of evidence, which seems to suggest that more training is generally better, especially where distance running and cycling are concerned.  But, in the interests of science, I'm willing to give it a go and see if it works.

Get lots of sleep
Again, I can't argue with that.

Play
And who doesn't like to have fun?

Get some sunlight every day
I wholeheartedly agree that getting out and about in the fresh air is vital, not just for your Vitamin D levels, but your whole sense of well-being.

Avoid trauma
I'll try.

Avoid poisonous things
Like Brazier's stresses, this includes environmental pollutants, but Sisson also includes sugar and processed foods.  I wouldn't go as far as to describe them as poison, but yes they're worth cutting down on.

Use your mind
I think this can apply to learning new things, but also being conscious of your mind and body, looking after them and resting when you need to.  

Overall, although I would say that I was initially sceptical of both these plans, they both contain some really useful advice and are definitely worth a read.  Just follow some of the advice with a pinch of (low sodium?) salt, especially the bits where both authors plug their own expensive supplements.

My own opinion is that we can get everything we need by eating a wide range of foods - focusing on fruit, vegetables, good quality protein (whether veggie or meat) and whole grains.  There's no compelling evidence that grains are bad for us and, in fact, some of them (wheat and quinoa being good examples) contain high levels of protein.  My diet downfall has to be my love of sugary things, rather than the fact that I'm a vegetarian.  And as for the iron, I know I can get enough from veggie sources if I plan my diet properly.   So I won't be scoffing steak any time soon, but I will keep trying to go easy on the iron inhibiters.  I'm still managing to avoid my favourite drink, but there have been one or two tea-lapses.

Fad free fitness

I picked up my new issue of Runner's World and had a skim through a couple of the nutrition articles. I started to think, if I were to follow every piece of advice in this and all the other magazines and newspapers I buy, what would I end up eating? Well, in week 1 of my "Perfect running month", I might try supplementing my diet with spirulina powder, co-enzyme Q10, asian ginseng and glutamine. I'd snack on baked potatoes instead of bananas, spread Marmite on my porridge and include some fresh marjoram in all my salads. Hmm. Not very realistic, is it? The thing is, although I have a degree in nutrition and I'm qualified as a personal trainer, I still feel tempted to follow every month's revolutionary new diet or fitness plan. Not any more! This year, I'm inventing my own plan. There will be no detoxes, superfoods, exoticly-named supplements or expensive classes. Just plain old healthy eating and exercise.