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    Episode 20: What we’ve learnt from the ketogenic diet and why you shouldn’t break up with carbs

    en-auJanuary 29, 2020
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    About this Episode

    KETOGENIC DIET

    What is it?

    • Very low-carb, moderate-protein and high-fat diet. It typically contains 75% fat, 20% protein and only 5% carbs.
    • 20g CHO per day  - Eg 1 apple + ½ cup peas + 4tbsp milk  OR sk latte + ¼ cup chickpeas OR 1 small banana   OR 1 small slice sourdough bread 

    Does it work?

    • Weight loss - very low CHO intake leads to increased fat metabolism for ketones. 
    • The rise in fat burning does not necessarily mean loss of fat stores given the intake of fat in the diet has significantly increased. 
    • Studies suggest that the overall body fat balance is equal if not in favour of fat storage!
    • CHO insulin model - reduced insulin so less fat stored. Good in theory but a very intensive $40 million study of 17 men were admitted to metabolic wards for intensive monitoring for 2 months - one month high carb, one month ketogenic. Matched calories on both. Subjects spent 2 consecutive days each week residing in metabolic chambers to measure changes in exergy expenditure and underwent DEXA to measure body composition. The study found that the subjects lost more body weight on the ketogenic diet, but rate of fat loss was 50% slower on the keto diet and instead the on the ketogenic diet that subjects lost more water weight and suffered more LBM (muscle protein) catabolism. Interestingly, this was a study funded to explore their hypothesis which was the opposite!

    https://academic.oup.com/ajcn/article/104/2/324/4564649

    • Epilepsy that is refractory to medication - often as third or fourth line therapy. 
    • Cancer - theory based on Warburg effect that cancer’s preferred fuel source is sugar and that by reducing CHO intake we can deplete tumour tissue of the glucose required for tumour cell metabolism. Unfortunately, that’s the case of most of the healthy cells in our body. Sugar fuels everything and cancer can feed off everything, including ketones. 
    • As it stands, there are no clinical trials demonstrating a benefit of a ketogenic diet in cancer patients. Studies underway exploring the ability to slow the growth of certain brain tumours. 
    • What our best practice guidelines do specify though is that while it may be difficult to induce tumour responses with a ketogenic diet, this does not argue against preferring fat to supply energy to patients with advanced cancer and inflammation-induced insulin resistance - so more avo, nuts, seeds and extra virgin olive oil and less refined sugars. 

    DRAWBACKS

    Gut Health

    • Our carbohydrate sources in our food supply don’t just provide energy. Think about a chickpea. Yeah it’s got carbs, but it’s also loaded with fibre, protein, folate and iron.
    • One important factor that we miss when we significantly restrict CHO intake is fibre, prebiotics and the impact on our gut. 
    • Bowel cancer risk + digestive health 

    Diabetes (T2DM)

    • Some proponents suggest ketogenic diet to manage diabetes
    • Managing the symptoms - high blood glucose levels - rather than the cause - insulin resistance (may be as a result of being overweight, lack of PA + poor dietary patterns).
    • Ketogenic diet has been associated with development of NAFLD and associated hepatic insulin resistance in mice. This can induce or worsen insulin resistance
    • Some human studies show an initial improvement in insulin response on a ketogenic diet but this seems to only be temporary - which makes sense given the KD is reducing the symptoms (high blood glucose levels), but may actually be worsening the cause (fatty deposits in the liver and cells)

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452247/

    Cardiovascular disease 

    • KD are often high in saturated fats
    • Breakfast of egg, bacon, bullet coffee; lunch and dinner of M/C, small amount of veg and some cream for dessert...it’s no surprise that this will take its toll.  
    • The majority of animal studies suggest that when KD are rich in saturated fats they negatively impact blood lipid profiles and cardiovascular disease risk 
    • In human studies, there are really varied results, often depending on the length of time subjects are followed and the profile of their fat intake.
    • Some studies highlight that even in cases where KD show a reduction in total and LDL cholesterol, these were significantly more reduced with a high-protein medium-carbohydrate diet than with a KD

    Compliance

    • Hard! 
    • Even in retractable epilepsy compliance may drop to 50% after a few months. For epilepsy this is disappointing for ability to gain disease control, but for the general population this could be a protective mechanism...children have died from scurvy and selenium deficiency and the long term implication for cardiovascular and gut health just might not be what your human control centre wants. 
    • 20g CHO per day 
    • Eg 1 apple + ½ cup peas + 4tbsp milk OR 1 small banana  OR 1 small slice sourdough bread 

    Exogenous ketones

    • Introducing ketones from external source can mean you will test positive for the presence of ketones - suggesting you're in “ketosis”. Simply because the ketones exist doesn’t mean you’ve gone through the pathways to get there.
    • The presence of ketones signals to the body that you’ve been making them, and therefore may slow or even stop it’s own production of ketones from fat stores. This is a particularly important safety mechanism because ketone blood levels become too high, your blood can become dangerously acidic.
    • Therefore, taking exogenous ketones may prevent body fat from being used as fuel, at least in the short term
    • One benefit of exogenous ketone esters or slats - often taken as a drink - is that they may reduce circulating levels of our hunger hormone ghrelin. One study of 17 people found reportedly lower levels of hunger after taking the ketone drink. But only effective after a fast, not after a meal
    • You’ve also got to bare in mind that ketones contain calories. A single serving of exogenous ketone salts typically contains less than 100kcal or 420kJ, but to maintain a state of ketosis, you’ll need several servings each day = could add up to the energy in a main meal! 

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813183/

    • Bulletproof coffee/ MCT oil - contains medium-chain triglycerides, can help keto dieters add more fat to their diets and stay in ketosis. It’s digested more rapidly than traditional fats but can have digestive side effects and again a caloric load.

    Action

    • If you’re going keto, prioritise unsaturated fats - avo, nuts, seeds, EVOO
    • Make your carbs count
    • Don’t rely solely on the white ones (white bread, white rice, white potatoes, white pasta)
    • Choose CHO sources that offer something else: fibre, protein, vit, min 
    • Eg 
      • Fibre: wholegrains such as barley, bulghur, freekeh, spelt, quinoa, oats, legumes, peas, corn, pulse pasta  
      • Protein: legumes, ricotta or cottage cheese
      • Vitamins: sweet pot, peas, corn
      • Minerals: greek yoghurt, milk, ricotta, cottage cheese

     

    OnCore Nutrition 15 min free phone consults

    https://oncorenutrition.com/15-minutes-free/

     

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    Post-COVID questionnaire: https://chroniccare.snapforms.com.au/form/post-covid-questionnaire

    Post COVID Recovery steps

     

     

     

    References

    https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

    https://www.bmj.com/content/372/bmj.n136

    https://www.bmj.com/content/372/bmj.n136/rapid-responses

    http://www.buckshealthcare.nhs.uk/pifs/nutrition-and-long-covid/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429479/

    NICE (2020) “COVID-19 guideline scope: management of the long-term effects of COVID-19” https://www.nice.org.uk/guidance/ng188/documents/final-scope]

    Leon et al. (2021) ‘More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis”. [ https://pubmed.ncbi.nlm.nih.gov/33532785]

    Afrin et al. (2020) “Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome”. International journal of infectious diseases, 100: 327–332 https://pubmed.ncbi.nlm.nih.gov/17490952/]

    Casas et al. (2016) “The Immune Protective Effect of the Mediterranean Diet against Chronic Low-grade Inflammatory Diseases”. Endocr Metab Immune Disord Drug Targets. 14(4): 245–254. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443792/

    LaTrobe Research

    https://www.latrobe.edu.au/news/articles/2022/release/possible-cause-of-long-covid-brain-fog

    Souvenaid 

    https://nutricia.com.au/souvenaid/

    https://www.cuh.nhs.uk/news/friendly-gut-bacteria-speeds-long-covid-recovery/

    https://www.pomi-t.co.uk/national-trial/

    https://pubmed.ncbi.nlm.nih.gov/35334962/

     

    https://pubmed.ncbi.nlm.nih.gov/33933299/

     

    https://www.bda.uk.com/resource/long-covid-and-diet.html

     

    https://www.buckshealthcare.nhs.uk/wp-content/uploads/2021/10/Nutrition-and-Long-COVID.pdf

     

     

    https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

     

     

    https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-expert-shares-5-early-care-tips-for-people-with-long-covid/

     

     

    https://www.todaysdietitian.com/newarchives/ND21p40.shtml

     

    https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

     

     

    https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

     

    https://www.healthspan.co.uk/advice/long-covid-diet-and-lifestyle-changes-that-can-help

    Smell training

    https://www.fifthsense.org.uk/smell-training/

    https://abscent.org/learn-us/smell-training/how-smell-train

    https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac136/6569364?login=false

    https://www.cidrap.umn.edu/news-perspective/2022/04/global-data-reveal-half-may-have-long-covid-4-months

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    Instagram handles: @reloadphysio

    Facebook page: https://www.facebook.com/ReloadPhysio

     

    Are you exercising to  make you feel good or enhance your health or is it the opposite? Are you feeling compelled to exercise and if you're unable to meet your targets does this cause you concern or guilt?

     

    HAES practitioners (to find personal trainers who promote intuitive movement): https://haesaustraliainc.wildapricot.org/find-a-provider

     

    The Physiotherapy Eating Disorders Professional Network Group https://cpmh.csp.org.uk/content/physiotherapy-eating-disorders

     

    A website Bec has put together to summarise the research/info on dysfunctional exercise, intuitive exercise and physio for eating disorders: https://eating-disorder-physiotherapy7.webnode.com/?fbclid=IwAR0Uz0wrMmvX2tdFnYPueCXagmotGGQwHhVmtC3yJ91RoDnPXziZZ1hqI

     

    Virtual care

    https://chroniccare.com.au/

    Speak to the team to arrange an appointment with the most appropriate professional. 

     

    Platinum Physio 

    Women’s Health Physio 

    Episode 40: Calling all the ladies! What lap dancers have taught us about our hormonal superpowers

    Episode 40: Calling all the ladies! What lap dancers have taught us about our hormonal superpowers

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    OnCore Nutrition Ladies Lunch Series

    Ladies Lunch 1 - Understanding your cycle

    Wed 27th Oct 1-1:45pm

    Ladies Lunch 2 - Lifestyle strategies to harness your health, feel and perform at your best throughout each season of your cycle

    Wed 3rd Nov 1-1:45pm

    Tickets and info via Eventbrite

     

     

     

    Study discussed

    Ovulatory Cycle Effects on Tip Earnings by Lap Dancers: Economic Evidence for Human Estrus? 

    https://www.researchgate.net/publication/228632689_Ovulatory_Cycle_Effects_on_Tip_Earnings_by_Lap_Dancers_Economic_Evidence_for_Human_Estrus

    Episode 37 Re-Release - Tips for starting and progressing your nutrition career

    Episode 37 Re-Release - Tips for starting and progressing your nutrition career

    Episode Summary

    Calling all nutrition students and new grads...talking through tips to finding and fueling your fire and an exciting workshop we have planned just for you.

    Episode Notes

    Find and Fuel Your Fire Workshop

    Tickets via Eventbrite

     

    Getting a nutrition job is HARD! 

    The Dietetics Workforce Report 2018

    • There has been a 95% increase in dietetic grads over the last 7 years.
    • Grads in Vic ↑ from 65 to 127 per year from 2010 to 2016.
    • There is great concern that there is an oversupply of practitioners causing difficulties in new graduates finding positions and inhibiting movement for existing employees.
    • Many grads are still seeking work up to 12 mths post graduation.
    • In this time, grads are driven to volunteering - but not always meaningful
    • You are highly qualified. There is a significant need for your skills. We have an ageing population, chronic disease and dietitians provide such important prevention and management care
    • The report highlighted that Dietitians are highly qualified, however there are obvious gaps in business and professional skills in many courses.
    • Despite working in a clinical role 30% of dietitians had no clinical supervisor.

    file:///C:/Users/laure/Downloads/Dietetics%20Workforce%20Report.pdf

    Potential career pathways 

    Clinical dietetics

    • Popular!
    • When we’ve advertised for grad jobs there have been >100 applicants.
    • A quarter of organisations reported receiving >50 applicants for junior positions and advertisements were rare!
    • Hard to get grad jobs

    Consultancy and private practice

    • Often don’t graduate with skills for business set up and challenging to dive into sole practitioner position without prior experience. Requires ++ mentoring and supervision.
    • Important for your own development but also for the reputation of the profession

     

    Food service

    Media and marketing

    • Don’t expect to get here straight away - need some experience behind you
    • Be responsible with what you put out into the world, social media etc. Don’t know what you don’t know.

     

    Public health and nutrition

    Eventually policy, health promotion, advocacy

    • Often start as a public health dietitian, community dietitian

    Food industry

    • Consulting
    • Food analysis and product development, sensory evaluation
    • Food technology and science
    • Research

     

    Nutrition research and education

    • Generally requires specialisation and smaller projects or honours, masters, PhD

    https://www.deakin.edu.au/exercise-nutrition-sciences/careers-in-nutrition-and-dietetics

    https://www.myhealthcareer.com.au/dietetics-career/

    Our tips

    • Volunteer meaningfully
    • Upskill
    • Get a mentor - a meaningful one
    • Apply for everything - know your limits/hard passes
    • Apply well
    • Prepare for interviews
    • Seek feedback - and actually be prepared to take it

     

    Our upcoming workshop

    https://www.eventbrite.com/e/find-and-fuel-your-fire-student-early-dietitian-nutritionist-workshop-tickets-159824540503 

    Wed 11th Aug 6pm 

     

    Topics to cover 

    How to land the job you want

    • Job application preparation
    • Interview (including phone/video interview) preparation
    • Setting yourself apart
    • What NOT to do!
    • Volunteer / work experience opportunities
    • Professional development

    Finding your career niche / Progressing your career 

    • Specialising
    • Quality projects opportunities in nutrition
    • Education opportunities in nutrition
    • Research opportunities in nutrition
    • Conference / presentation opportunities

    Supervision and mentoring

    • Finding the right supervisor

    Innovation in dietetics  

    • Identifying gaps
    • Pitching your idea
    • Introduction to grants and proposals

    Delivery 

    • Online
    • 2hr workshop
    • 2 sessions - one evening, one weekend
    • ‘Take home’ toolkit of resources

    Episode 38: Coffee - exploring the health, sleep and performance impacts of our caffeinated friend

    Episode 38: Coffee - exploring the health, sleep and performance impacts of our caffeinated friend

    Google Trends

     

    Health and disease risk

    https://pubmed.ncbi.nlm.nih.gov/29276945/

    https://pubmed.ncbi.nlm.nih.gov/28853910/

    https://pubmed.ncbi.nlm.nih.gov/16507475/

    https://pubmed.ncbi.nlm.nih.gov/24671262/

    https://pubmed.ncbi.nlm.nih.gov/25156996/

    https://pubmed.ncbi.nlm.nih.gov/16685044/

    https://pubmed.ncbi.nlm.nih.gov/22591295/

     

    Diuretic effect 

    Despite the fact that caffeine is a mild diuretic, you don't lose more fluid than you take in by drinking coffee, so it cannot dehydrate you.

    While we don’t count coffee towards our fluid targets for the day, it doesn’t throw you into the negatives. It’s a net-neutral sort of scenario. 

     

    Coffee and exercise performance

    The impact of coffee on exercise performance is related to caffeine’s impact on the CNS. It’s a stimulant meaning it enhances alertness, and also  reduces our perception of fatigue and our perception of effort. So you feel like you’re not working as hard, and also feel less tired. 

    Those that are most likely to benefit from caffeine are those involved in team or intermittent sports so basketball, footy etc, endurance sports and high intensity, short duration sports.

    How much do you need? 

    While research initially focused on high doses of caffeine, more recent research indicates that lower doses can provide similar performance benefits with less negative side effects. Around 1-3 mg caffeine per kg body weight are sufficient to improve performance (so for a 60kg athlete this equates to roughly 1-2 cups of coffee).

    Timing is also important - coffee reaches peak concentrations 1hr post intake and will generally last for 3-4hrs. The ideal time to down your coffee is 30-45mins pre-training and often black is best if you’re likely to be sensitive to exercising on a tummy full of milk.

    https://www.sportsdietitians.com.au/factsheets/supplements/caffeine/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867441/

     

    Coffee and sleep

    We all know the joys of caffeine in perking us up, but does it affect our sleep? 

    The stimulating effects of caffeine from coffee last 3–5 hours, and depending on individual differences, about half of the total caffeine you consume remains in your body after 5 hours. It’s no surprise that consuming coffee too close to bedtime can cause sleeping problems. Most studies suggest avoiding caffeine for 6 hours prior to bed. 

    The good news is that a switch to tea in these 6 hrs, including green tea which contains about a third of the caffeine as coffee, will be helpful due to the presence of amino acid L-theanine, which has relaxing and calming properties. 

     

    Coffee and waking! 

    Studies have shown that the ideal time to drink coffee is around 203hrs after waiting.  This is because of our hormones. 

    As we wake up, a hormone called cortisol is at its highest. Cortisol is responsible for balancing our energy levels, blood pressure and how we respond to stress or danger. 

    So, drinking coffee when cortisol is already at its highest may not be giving you any additional energy. In fact, it may be making you feel more tired and stressed or anxious later in the day. 

    Science suggests waiting 2-3 hours after waking when cortisol is slowly declining to have your morning coffee for the most bang for your buck.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2257922/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684472/

     

    Coffee naps

    Some research suggests that combining caffeine with naps is more energising than caffeine or sleep alone. Enter the coffee nap. The theory is that if you drink coffee (or anything caffeinated) before sleeping for a short period, you can boost your energy levels by increasing your brain’s capacity to receive caffeine. 

    This is related to caffeine competing with adenosine for receptors in your brain. 

    Adenosine is an organic compound whose derivatives are important for energy processes in the body amongst other things. Adenosine circulation increases when we feel tired and the act of sleep brings these levels down. But coffee might give us a double whammy by blocking some of the adenosine being registered in our brain. This can make us feel even less tired when we wake. 

    Most of the research suggests the best way to take a coffee nap is to have some caffeine right before taking a 15–20 minute nap (and no more than 30mins).

    https://pubmed.ncbi.nlm.nih.gov/9401427/

    https://pubmed.ncbi.nlm.nih.gov/14652086/

     

    Fun facts

    • Coffee is the world’s most valuable traded commodity next to petroleum.
    • Globally people consume about 2.25 billion cups of coffee every day.
    • Coffee beans are fruit pips and not beans.A coffee bean is  the pip inside the bright red fruit often referred to as a the coffee cherry or coffee berry. 
    • Millennials spend an average of $2008 oer year on coffee https://www.ngpf.org/blog/budgeting/question-of-the-day-how-much-do-millennials-spend-every-year-on-coffee/
    • Coffee grounds sprinkled on the ground around plants and the garden will stop snails and slugs from eating the plants.
    • Studies have found an association between regular moderate coffee consumption (2-4 cups per day) and a reduced risk of suicide. Go for less the 8 cups per day.   https://pubmed.ncbi.nlm.nih.gov/23819683/ https://pubmed.ncbi.nlm.nih.gov/31254722/
    • Scientists have successfully turned ground coffee into biodiesel, so one day coffee may be fuelling your car
    • laws of physics have proven that coffee with milk cools about 20% slower than black coffee - due to the colour. viscosity and rate of heat radiation. 
    • The Guinness World record holder for the "Oldest Cat Ever," a 38-year-old cat named Creme Puff - drank coffee every morning her whole life.

    Episode 37 - Tips for starting and progressing your nutrition career

    Episode 37 - Tips for starting and progressing your nutrition career

    Find and Fuel Your Fire Workshop

    Tickets via Eventbrite

     

    Getting a nutrition job is HARD! 

    The Dietetics Workforce Report 2018

    • There has been a 95% increase in dietetic grads over the last 7 years.
    • Grads in Vic ↑ from 65 to 127 per year from 2010 to 2016.
    • There is great concern that there is an oversupply of practitioners causing difficulties in new graduates finding positions and inhibiting movement for existing employees. 
    • Many grads are still seeking work up to 12 mths post graduation.
    • In this time, grads are driven to volunteering - but not always meaningful 
    • You are highly qualified. There is a significant need for your skills. We have an ageing population, chronic disease and dietitians provide such important prevention and management care
    • The report highlighted that Dietitians are highly qualified, however there are obvious gaps in business and professional skills in many courses. 
    • Despite working in a clinical role 30% of dietitians had no clinical supervisor.

    file:///C:/Users/laure/Downloads/Dietetics%20Workforce%20Report.pdf

    Potential career pathways 

    Clinical dietetics

    • Popular!
    • When we’ve advertised for grad jobs there have been >100 applicants. 
    • A quarter of organisations reported receiving >50 applicants for junior positions and advertisements were rare! 
    • Hard to get grad jobs 

    Consultancy and private practice

    • Often don’t graduate with skills for business set up and challenging to dive into sole practitioner position without prior experience. Requires ++ mentoring and supervision. 
    • Important for your own development but also for the reputation of the profession 

     

    Food service

    Media and marketing

    • Don’t expect to get here straight away - need some experience behind you 
    • Be responsible with what you put out into the world, social media etc. Don’t know what you don’t know. 

     

    Public health and nutrition

    Eventually policy, health promotion, advocacy

    • Often start as a public health dietitian, community dietitian

    Food industry

    • Consulting
    • Food analysis and product development, sensory evaluation
    • Food technology and science
    • Research 

     

    Nutrition research and education

    • Generally requires specialisation and smaller projects or honours, masters, PhD

    https://www.deakin.edu.au/exercise-nutrition-sciences/careers-in-nutrition-and-dietetics

    https://www.myhealthcareer.com.au/dietetics-career/

    Our tips

    • Volunteer meaningfully
    • Upskill 
    • Get a mentor - a meaningful one
    • Apply for everything - know your limits/hard passes
    • Apply well
    • Prepare for interviews 
    • Seek feedback - and actually be prepared to take it 

    Our upcoming workshops

    https://www.eventbrite.com/e/find-and-fuel-your-fire-student-early-dietitian-nutritionist-workshop-tickets-112762650122

    Wed 26th Aug at 6pm 

    Sun 29th aug at 2pm

    Topics to cover 

    How to land the job you want

    • Job application preparation
    • Interview (including phone/video interview) preparation 
    • Setting yourself apart 
    • What NOT to do! 
    • Volunteer / work experience opportunities
    • Professional development 

    Finding your career niche / Progressing your career 

    • Specialising 
    • Quality projects opportunities in nutrition 
    • Education opportunities in nutrition 
    • Research opportunities in nutrition 
    • Conference / presentation opportunities 

    Supervision and mentoring

    • Finding the right supervisor

    Innovation in dietetics  

    • Identifying gaps
    • Pitching your idea
    • Introduction to grants and proposals 

    Delivery 

    • Online 
    • 2hr workshop 
    • 2 sessions - one evening, one weekend 
    • ‘Take home’ toolkit of resources