In a two part special for the Natural Ketosis Company blog, guest blogger Richard Chessor, the lead nutritionist for Scottish Rugby, discusses the implications and considerations of vegetarian diets as a way to improve athletic training and performance.
PART 1- THE PRIMARY CONSIDERATIONS
[Note – this article refers to vegetarians as lacto-ovo-vegetarians (those that eat dairy and eggs but avoid eating meat, fish and poultry) as this is the most commonly adopted vegetarian diet in UK]
Vegetarian diets are commonplace in Western society and the reasons for selecting a vegetarian diet are numerous and diverse. Many athletes adopt a vegetarian diet not for ethical or religious reasons but in an attempt to maximise their athletic performance. This two-part blog begins by highlighting some of the primary nutritional considerations for the vegetarian athlete before Part-2 delves into some of the more often overlooked ‘pitfalls’ of athletic vegetarianism.
There are few estimates of the prevalence of vegetarian diets in athletes, but it would appear to be more popular in endurance athletes (cyclists, runners and triathletes) who require a consistently high carbohydrate intake whilst maintaining a low body weight to support optimal training. The popularity of vegetarianism in strength trained athletes appears lower perhaps due to the higher requirement for protein (or increased diversity of protein sources) required to maintain an elevated muscle mass. Whilst in the general population a vegetarian diet is associated with a decreased morbidity from chronic lifestyle diseases (although lifestyle factors independent of diet may partially explain this) this is often not the primary concern for the athlete considering vegetarianism. Of greater relevance to the athlete is to query if their nutrient needs can be met and performance maintained or improved by adopting a vegetarian diet.
The primary nutritional challenges to the vegetarian athlete are to meet their demands for energy, protein, iron, zinc, calcium and omega-3 fatty acids.
ENERGY – The energy demands to support training and competition performance can often be difficult to achieve through a vegetarian diet for two main reasons. Firstly, vegetarian diets tend to be higher in fibre and bulk which provides a greater satiety effect thus reducing overall food intake. Whole grains, legumes, nuts, seeds, fruit and vegetables all provide a significant fibre source to the diet and are staples for most vegetarians. Secondly, the absence of animal meats removes a sizeable proportion of fat from the diet which may not be fully replaced with plant based sources such as vegetable oils, avocado, nuts and seeds thus making the vegetarian diet a lower fat diet than their omnivorous counterpart. Carbohydrate tends to have a greater overall contribution to energy needs and therefore the vegetarian athlete may place greater reliance on high carbohydrate food sources to achieve their energy targets and inadvertently create macronutrient imbalances in their diet or compromise the quality of their food intake.
o So, is energy an issue? Not necessarily, but the vegetarian athlete must be aware of their individual energy needs and should be able to react to the varying energy needs of training and competition without compromising the quality of their food intake.
PROTEIN – Protein recommendations for athletes are greater than that of the general population however vegetarian diets consistently report lower protein intakes than meat eaters. This creates a significant challenge for the vegetarian athlete to consume a sufficient amount of protein to support optimal performance, recovery and adaptation. Further to this, few vegetarian sources of protein provide the full range of amino acids necessary for optimal muscle function and therefore potentially leave the vegetarian athlete at risk of compromised performance. When foods are limited in one or more essential amino acids, a variety of protein sources should be consumed to ensure the correct balance of amino acids is achieved. Of particular concern is the amino acid leucine which plays a critical role in orchestrating the production of new muscle proteins. Leucine is abundant in animal sources of protein and thus the vegetarian athlete may need to pay greater attention to their intake of eggs and dairy products to meet their leucine needs.
o So, is protein an issue? Yes, not only must the vegetarian athlete pay close attention to their total protein intake they must also carefully consider the composition of their protein intake which requires increased knowledge, planning and preparation.
IRON – Iron plays an essential role in the transport of oxygen within our body. Athletes (especially endurance athletes) are at greater risk of depleting iron stores and if untreated this can develop into anaemia which severely affects exercise performance and overall health. Iron is primarily consumed through meat, seafood and poultry and naturally vegetarians report lower iron levels than omnivorous eaters. Although iron is present in plant-based foods such as grains, legumes, vegetables and fruits its bioavailability (the amount of iron that your body can actually extract) is much lower than that of animal-based iron. Furthermore, iron absorption can be enhanced or inhibited by other nutrients in our diet. Vitamin C and some fermented foods greatly improve our absorption of iron whereas phytates from grains, peanuts, soy and polyphenols from strong tea and coffee can inhibit iron absorption. Therefore, the challenge for the vegetarian athlete (as with their protein consumption) is not only to consume enough iron but to maximise their iron absorption by careful integration of iron-rich foods alongside iron absorption enhancing foods whilst minimising iron inhibiting foods.
o So, is iron an issue? Yes, significant consideration should be put into the iron intake of a vegetarian athlete (especially endurance athlete) to prevent depletion in iron stores without compromising the intake of other key nutrients.
ZINC – Zinc is essential for immune function and in the regulation of many enzymes in the body. Zinc requirements are higher for athletes than the general population due to increased zinc losses through sweat. Similar to iron, it is abundant in the vegetarian diet but is not readily absorbed from plant foods. Beans, whole grains, nuts and seeds all contain high sources of zinc but are also high in phytates which inhibit the absorption of both iron and zinc. So despite good zinc sources in a vegetarian diet the low absorption efficiency may result in a deficiency for the vegetarian athlete which could compromise immune function, training adaptation and testosterone production.
o So, is zinc an issue?Yes, as with iron, careful planning is required to meet zinc requirements without compromising the intake of other nutrients.
CALCIUM – Calcium is essential for optimal bone formation and muscle function. Vegetarians who consume dairy products are often not at risk of suboptimal calcium intake (especially if an increase in dairy foods is being used to support protein intake). However, calcium deficiency is a key consideration for vegan athletes as few foods apart from dairy products provide a concentrated source of calcium.
o So, is calcium an issue? It’s unlikely to be an issue for athletes unless dairy products are avoided. However, calcium fortified foods may be necessary for vegans or those who avoid dairy.
OMEGA-3 ESSENTIAL FATTY ACIDS – The Omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential fatty acids which positively contribute to heart and brain health but they also play important roles in the modulation of the post-exercise inflammatory response. Most commonly found in cold water oily fish they are almost completely absent in the vegetarian diet. However, alpha-linolenic acid (ALA) is another omega-3 fatty acid which can elongate to produce EPA & DHA in the body and is commonly found in flaxseed, walnuts and pumpkin seeds. The conversion of ALA to EPA & DHA is not particularly efficient therefore to avoid a deficiency of EPA & DHA a high intake of ALA-rich foods is required.
o So, are omega-3 fatty acids an issue? Yes, although these key fatty acids can be produced from vegetarian foundations this is an inefficient process and as we will see in Part 2consuming the appropriate balance of omega-3 fats is a crucial consideration for athletes.
So, can a vegetarian diet be appropriate for an athlete? Yes, with suitable knowledge, planning and a diverse food intake it is certainly possible for an athlete to meet their primary nutrition goals through a vegetarian diet. It may be easier for the endurance athlete than the strength training athlete due to the natural tendency for vegetarian diets to be higher in carbohydrate and lower in protein. In comparison to the omnivorous athlete the vegetarian should have greater knowledge of their nutrient requirements, their practical application and the various food interactions that positively and negatively contribute to nutrient absorption which may impact exercise performance.
However, although it may be possible for primary nutrient needs to be met through a vegetarian diet this does not necessarily mean that vegetarian diet is the optimal diet for athletic performance. In Part 2 we will explore some of the more often overlooked aspects of the vegetarian diet and reflect on their relevance to athletic performance.
Following the American Diabetes Association’s change of position on the effectiveness of low-carb treatments to manage diabetes, research published this week in Neurology further supports the importance of lowering blood sugar levels overall, and has suggested that a lower blood sugar level may improve brain function.
The study by Charite University Medicine in Berlin looked at memory function and blood sugar levels of individuals with an average age of 63. The results obtained showed that individuals who had a higher blood sugar level exhibited a shorter memory span than those who had blood sugar levels within the normal range. This research builds on from previous studies which have also established the link between high blood sugar levels and impaired brain function.
With the rise in diabetes and pre-diabetes diagnosis, this new evidence further proves the importance of managing blood sugar levels via diet.
Here at Natural Ketosis we understand the importance of managing blood sugar levels via the diet whilst still enjoying real food. Our programme is not about avoiding carbohydrates but about choosing the right types of carbohydrates to help manage blood sugar levels effectively.
One of our Natural Ketosis members has just shared some good news. In just 3 days she has managed to significantly lower and stabilise her blood sugar levels!
Prior to starting the programme her blood sugar was an average of 16.5. Today she is at an average 6.7 – a fantastic drop of 9.8!
While some dieticians believe that weight loss triggers improvement in blood sugars, and suggest that a low fat/low calorie diet will deliver improved blood sugar over time, the great thing about low carb diets such as the Natural Ketosis programme is that even before the weight loss kicks in, you can improve your blood sugars.
This lady also suffered from ‘Dawn Phenomenon’, where the liver releases large amounts of glucose into the bloodstream in the early hours of the morning. Due to such high blood sugar levels caused by this so called ‘liver dump’, her GP had suggested that the next step in her treatment would have been the prescription of insulin pumps, as her pancreas has stopped producing insulin.
Her GP has since had to re-think his diagnosis.
Our member’s experience once again re-iterates the effectiveness of a low carbohydrate diet as a tool in managing type 2 diabetes.
As early as next year certain fizzy drinks will be able to advertise themselves as being “good for your health” even if they are not calorie free; so long as the only sugar is ‘fructose’. The reason for this change is the new ruling from the European Food Safety Authority, the European version of the Food Standards Agency.
The EFSA has decreed that if sucrose and glucose (two other forms of sugar) are substituted by fructose, than such items would be beneficial for “the target population [of] individuals who wish to reduce their post prandial glycaemic responses” – in other words… people who want to lose weight. Clearly there are no bio chemists or endocrinologists sitting on this committee, who would never support such a claim.
For biochemists and endocrinologists, who are experts in human metabolism and in particular the operation of the hormone insulin, this does sound like madness.
Fructose may well be low GI (have a low glycaemic index score) but it does not cause the body to produce insulin and leptin – hormones required for controlling appetite, essentially the chemicals your body produces to tell you that you’re full. Fructose intake has been shown to contribute to insulin resistance, weight gain and hypertension.
The EFSA have cited two studies which apparently conclusively indicate the health benefits of fructose – both of which were carried out in the 1980s, but on close reading and in light of more recent research – these are not robust scientific support for the statement that fructose is better than glucose.
To confuse matters further, in their conclusions the EFSA Panel go on to state that high fructose intake is damaging to health, as it may give rise to dyslipidaemia, insulin resistance and visceral fat accumulation.
So why on earth would you allow a fizzy drink with fructose to be described as healthy?
The American Diabetes Association (ADA) has recently published its revised guidelines concerning the nutrition therapy recommendations for the management of diabetes.
The breakthrough that excited us most at Natural Ketosis is that they finally acknowledge that carbohydrate restriction is indeed a viable therapy for the management of diabetes.
“The amount of carbohydrates and available insulin may be the most important factor influencing glycaemic response after eating, and should be considered when developing the eating plan” –ADA, 2013.
Furthermore, the ADA report grades this statement as ‘A’, meaning that strong evidence from multiple studies suggests similar findings.
The ADA’s statement finally recognises something that we at Natural Ketosis have known for a long time. Our programme is designed to keep insulin levels stable by controlling the amount of carbohydrates taken into the body. This is not only beneficial from a diabetic point of view, but also for everyone concerned with their health.
Although the ADA acknowledges the importance of low carbohydrate in diabetes management, they do not go one step further and explain how a low-carbohydrate lifestyle can be achieved and incorporated into their recommended diet. The ADA still advises several portions of fruit and starch daily – counteracting their own guidelines!
Having said that, the importance of these guidelines is that they are the first step in giving low-carbohydrate diets the credit they deserve.
if you would like to learn more, you can read the American Diabetes Association's report here.
A study looking at the diets of Chinese women consuming a calorie-restricted diet versus a low-carbohydrate diet has shown that those women following the low carbohydrate diet had beneficial effects on blood lipid profiles, as well as weight loss.
Traditionally, the habitual Chinese diet is high in carbohydrates due to its rice and pastry/bread food based items. Women on the calorie restricted diet were provided with main meals, along with up to 125g of rice daily, together with steamed bread. They did not have snack options. Women on the low-carbohydrate diet were allowed the same meal options, minus the rice and bread. However they were allowed to snack as much as they wanted on pre-approved items.
The results of the study revealed that although both diets were acceptable, the women following the low-carbohydrate diet lost weight faster and had lower hunger levels throughout the day. The Low-Carb test group of women also experienced favourable changes in their cholesterol levels.
The importance of this study is that it is the first one to look at the beneficial effects of following a low-carbohydrate diet exclusively within an Asian population. This study, together with other such studies carried out in Western populations continues to show the overall beneficial effects of following a low-carbohydrate diet.
When people hear the term low-carb, they instantly think “Atkins diet!” - This confusion can be excused however, because the media rarely differentiate between low-carb diets and no-carb diets, such as Atkins.
To clear things up, the Atkins diet follows a ‘High-Fat, No-Carb’ structure, as opposed to the ‘High-Fat, Low-Carb’ structure of many other carbohydrate restrictive diets, including Natural Ketosis. Even health professionals are frequently confused, so how are you expected to make an informed decision that is going to benefit your health?
The Natural Ketosis way of doing things is quite simple. We promote a low-carb, high-protein, moderate-fat diet. Although we are in the same school of thought as Atkins, our approach to diet and lifestyle is different.
On our program we embrace carbohydrates that are based on ‘dietary fibre’, rather than differentiating between simple and complex carbohydrates. The difference between these carbohydrates is the way they are digested, and used up within the body. By choosing the correct vegetables and fruits, Natural Ketosis ensures that essential nutrient requirements are met, whilst ensuring no blood sugar spikes in the progress.
The importance of fat in a diet is often overlooked, as fat has been on the receiving end of bad press for years. Fat is an essential part of a healthy diet, as it is an important carrier of fat-soluble vitamins such as Vitamins A, D, E and K. Once fat is removed from the diet, deficiencies of these vitamins start to become apparent. Having said that, it is equally as important to differentiate the good fats, i.e. those found in full-fat dairy items which are full of essential micronutrients, from bad-fats, i.e. those found in deep-fried products, and mass-produced confectionary.
Protein in the diet is also critical, as our bodies cannot store protein. Because of this, we need a constant supply of fresh protein each day. The Human body requires protein to build muscle and repair any internal damage. In other words, it is essential!
One of the main arguments critics put forward against a high-protein diet is that it causes kidney damage, however there have been no published scientific studies to show that high-protein diets cause any kidney damage, or indeed any other risks to human health.
Therefore the Natural Ketosis way is not only about being healthy and making the right choices, but it is also about being slimmer forever.
A report published last month by the Swedish Council on Health Technology Assessment (SBU), the Swedish equivalent of the National Institute for Health and Clinical Excellence (NICE) here in the UK, has endorsed Low-Carbohydrate diets as being the most effective treatment for obesity and its related diseases, including Diabetes.
According to the SBU’s report, individuals following a Low-Carbohydrate diet not only see weight loss, but also an improvement in their cholesterol profile. It also goes on to suggest that advice on following low-carbohydrate diets should start making its way into the healthcare system as a viable therapeutic alternative to other weight loss interventions, such as low-calorie diets.
With the endorsement of the SBU to Low-Carbohydrate diets, we at Natural Ketosis are hopeful that other expert committees in other countries, especially here in the UK, start revising their opinion on the matter and realise that fats are not the enemy.
A review paper looking at the effectiveness of low-carbohydrate diets versus low-fat diets has recently been published in the British Journal of Nutrition. This paper is one of the first challenges to the long held belief that low-fat, high-carbohydrate diets are the most efficient method of losing weight, which are currently recommended by the Government and other Health agencies.
In a nutshell, what this paper did was to review and analysis previous studies to compare the outcomes of both types of diets in terms of body weight, triglyceride levels, and HDL- and LDL- cholesterol levels. The end result was that these markers improved, and were more beneficial, for the participants following the low-carbohydrate ketogenic diet.
This will come as no surprise to those who have been reading previous research published in the Low-Carb/High-Protein domain. This most recent study confirms the message that substituting carbohydrates for protein and fat does not lead to adverse health.
Unlike previous studies in this area, this review looked at studies without using date or language restrictions. Hence a broader spectrum of studies was incorporated into the review, meaning less biased results.
What is disappointing however is that - notwithstanding the results published and the previous published studies - there is still a consistent fear that a low carb diet has hidden health problems whilst no evidence of these fears has ever been published.
Any keen follower of health and nutrition will have received their notification of the next SACN meeting, due to take place on 9th October 2013. We at Natural ketosis have taken keen interest in this year’s SACN agenda.
Traditionally, the agenda would simply contain an update from the Carbohydrate Working Group, but this year SACN have, as their lead session, a Closed Session on Carbohydrate and Health – which has next to it the term “Chapter 8”.
NKC are keeping a close eye on what comes out of this closed meeting, and why it is required in addition to the usual working group meeting which appears further down the official agenda.
We would love to guess what the session will be about, but we wouldn’t be surprised if this session is the first step in an embarrassing reversal manoeuvre out of the current ‘EAT WELL Plate’ - which has been adhered to for the past 30 years, and has guided the thinking of every single health professional in the UK during that time.
We know from the minutes of previous working groups on carbohydrates, that SACN are expecting a change, and we also know that this change is likely to give rise to further research or investigation into the benefits of fats and protein, and the restrictions of the EAT WELL Plate. If this assumption is correct, then this is good news for health and weight loss in the UK - but what it won’t do is ensure that we don’t repeat the same mistake again.
When the change to the EAT WELL Plate is made (probably privately, and without fuss) the powers that be will simply say “new evidence in carbohydrate metabolism has triggered the review and change of position”… however behind this bland statement is a denial of responsibility and liability which is unfair to both those that have become fat as a result of misguiding advice over the past 30 years, and those experts who have been written off as mavericks.
It further avoids the very tricky question of “What the hell was everyone doing for the past 10 years since the first big publications on carbohydrate metabolism were published?”
The Natural Ketosis Company will wait with eager anticipation of the outcome of this closed session as well as the open one, later that day. If the decision is to reduce the amount of carbohydrate in our diet, then the quicker the government shares this insight the better. Every day hundred’s more people will be visiting the EAT WELL Plate and looking to follow that guideline to improve their health, whilst only making things worse for themselves.
Welcome to The Natural Ketosis Company’s blog. We are fed up with the abundance of weight loss myths and miracle solutions that constantly appear in the press. Therefore, we have decided to expose the ridiculous claims that are prevalent in the diet industry and, hopefully in a humorous way, give you our honest opinion about them. We love to hear your opinions so please do not be afraid to comment!