Articles by ST founder Kit Laughlin

[Find all of Kit Laughlin’s articles to do with back pain at OvercomeBackPain.info]

Read Kit’s BLOG at kitlaughlin.wordpress.com

Unlocking the Yoga Poses, or what stops you doing a pose perfectly?
Originally prepared for Australian Yoga Life magazine

This note provides a deeper look into how the Stretch Therapy system can help the keen yogi to improve her postures.

In this article I will consider what real, physical limits might stop someone from doing a technically perfect Adho Mukha Svanasana, or down-facing dog pose. Many beginning yogis struggle to do this pose well; most generally and in most schools, the pose is said to be done well when both heels are held on the floor, the inside edges of feet parallel and the knees held straight, the whole spine gently extended from the hip joints and that line continued by the arms and, in the final stage, the face, or top of the head rests on the floor.

Being able to position the body in this way requires multiple capacities: ankle and calf muscle flexibility, the sciatic nerve needs to glide along its full length (more on this later), sufficient hamstring length to allow a significant degree of anterior pelvic tilt while all posterior line muscles and fascia of the hips and lower legs are under strong stretch, and enough strength in the arms, shoulders, and trunk to hold the desired shape against these forces. The beginner’s body has many ways to avoid these requirements: the heels may lift off the floor, the knees may bend, the hamstrings may limit anterior pelvic tilt (with the result that the lower back flexes, instead of extending slightly) and the shoulders may not flex enough to allow the desired line (the shoulder angle will be ‘closed’ rather than open, the position of the arms continuing the visual line of the spine). And there simply may not be enough strength in the trunk to hold the middle and upper back straight against the calf and hamstring forces that are trying to flex the spine, let alone the gentle whole-spine extension that aesthetics require. Let’s look at each of these restrictions in turn.

It is sometimes said that structural limitations in the ankle in some people will not permit a perfect execution of this pose, but this is not my experience. Many people cannot squat in the West either and will often blame structural limitations, but everyone in the pre-industrial world can squat. There are many reasons for this, but the main one is that we do not squat to rest as is normal in the non-Western world and we spend significant time in daily life sitting on something. And it is true that many students do feel compression in the front of the ankle joint when squatting (or trying to perfect down-facing dog); this is because until soleus (in the squat) and both gastrocnemius and soleus (in down-facing dog) are sufficiently flexible, the forces required to lengthen them are resolved as compression forces in the front of the ankle: this is because we are levering off this joint (talus and the tibia) to generate the stretching force. When the muscles, fascia, and tendons have sufficient length, the compression sensation will disappear. Until that time, this compression will be experienced as a “blockage” or a physical restriction.

An aside: many people feel a cramping in the shins when trying to squat: this is because anterior tibialis is contracting as hard as it can to pull the knees forward far enough so that you don’t fall backwards; a lack of ankle flexibility is the first reason people can’t squat lower than a certain point with their parallel feet flat on the floor—they simply cannot move their whole-body balance point (centre of gravity) far enough forwards to counteract this tendency. Either they stop lowering their hips, or fold the trunk forwards strongly at the hips to move the centre of gravity forwards. And, a further aside: any muscle that is asked to work hard in the contracted end of its range of movement is liable to cramp; try pointing your foot hard as you read this and you will feel what I mean. To relieve the cramp, you lift the toes towards the knees. And in the case of anterior tibialis cramping while squatting, the opposite movement will be needed: you need to point the toes.

Perfect execution of the full version of down-facing dog pose requires mastery of what we call the “Single Leg Dog Pose” (“SLDP”) as the first step, we believe: because only one leg is worked at a time, and the non-working or lifting leg is used to position the pelvis (more on this below), the weight and strength of the whole trunk and non-working leg can be used against the tension of the stretching leg; this version is significantly easier than the full version and, because you will be able to feel and reposition the pelvis as well as extend the middle and upper back, the essential whole body awareness that the full pose requires will be able to be developed over time.

Kit demoing SLDP on a recent workshop in Singapore.

Kit demoing SLDP on a recent workshop in Singapore.

A description of the SLDP follows; suitable for beginners and intermediate students, instructions on what to be doing at each step in the pose are included. Ideally, one will be working in a room that has a mirror off to the side so you can see what shape your body is making and your hands and feet will be on a sticky mat. The first task is to stand, bend at the waist and the knees, and place the hands on the floor, straighten the knees, and walk the hands away from the feet. Keep walking out until the heels start to come off the floor: you have now reached the limit of your active ankle flexibility. In the process you have already established the fundamental geometry of the pose, which is how far away from the heels should the hands be. Now bend one leg at the knee and let us call this the ‘non-working’ or ‘lifting’ leg and rest on the ball of its foot. Most of your weight is now on the stretching leg, and you will feel its heel pressing harder on the floor as a result.

Take in a breath and, as you exhale, raise the lifting leg out behind you so that its knee is straight and the ball of the foot is about 300 mm from the floor. Put all your attention into the hip of this leg and drop it down towards the floor as much as you can; in this process you will become aware of the outer hamstring of the stretching leg. One of the ways that the body avoids the stresses of the single leg dog pose is to lift the hip of the non-stretching leg so that the pelvis rotates away from the outer hamstring on the stretching leg. Now move your awareness to the stretching leg and use the strength and weight of your body to press its heel down onto the floor firmly again and make sure that its arch is lifted away from the floor. If your ankles have a tendency to pronate you can try externally rotating the stretching leg (in both the ankle and the hip joints; the pelvis remains still) using external rotators. As you do this you will see and feel the arch lifting away from the floor.

Now move your head and neck so that you can look up between your hands resting on the floor. We strongly recommend pressing the arms firmly away from the body as far as possible: this shoulder girdle positioning is how gymnasts do handstands and they are among the strongest athletes on the planet. As well, we have seen many people who rest their body’s weight on the shoulders and let the shoulder girdle rest on the rib cage can develop shoulder injuries in time. If you press the arms out, actively away from the body (scapula elevation), you will be holding any position on your trapezius muscles and tensed shoulder and triceps muscles instead of on the shoulder joints themselves and the pose will be active rather than passive in this part of the body. By looking up between your hands on the floor you will also slightly tighten the upper trapezius muscles and this will help the essential thoracic extension to occur (more below). As well, you can try lifting the sternum in the direction of your chin; this too will have the effect of starting the extension of the thoracic spine.

But suppose that you are slightly kyphotic, or have difficulty in straightening your thoracic spine in normal daily life, as many who work at computers do? When you give yourself the cue “lift my chest” do you think you’ll be able to do so in this strongly loaded position? Of course, the answer will be ‘no’. And if this restriction is present in your body, you will benefit from doing a passive back bend before you practise the SLDP next time. Doing a passive back bend (draping the body backwards over a firm, curved surface) will open the chest and the rib cage, the intercostals, and stretch the abdominal muscles, too. This experience will show you how to lift your chest and flatten the thoracic spine, in all poses, eventually. The key point here is that unless you have had the experience of moving or holding your body in a particular way you will not be able to move it this way when you want to, especially when all the involved structures are loaded. By draping ourselves over a curved surface we can more easily experience the movements in the body that will translate into movement in the pose when we give ourselves the self cue “lift my chest”. Until this movement is experienced with awareness, with full attention on what it feels like—to put this more starkly—unless you can do this in other words, it will not be a movement you can call on at will. It will remain a concept.

Now move your awareness into the lifting leg. Extend that leg behind you as though you were trying to reach the wall behind you and immediately you will feel the glute (gluteus maximus) on that side tighten. Use the gluteus maximus muscle to slowly lift the straight leg away from the floor and, in the process, you will feel the lumbar spine extending as the pelvis is anteriorly rotated. Here we are using gluteus maximus to lift the leg but it is the hip flexors on the other side of the spine that pull the spine into extension during this movement. And as you lift the non-working leg up you will feel any elevation increases the stretching sensation in both the calf muscle and the hamstrings on the stretching leg; this is partly because in the process of anteriorly tilting the pelvis while in ankle dorsiflexion the sciatic nose is stretched maximally. The other reason is that this movement of the pelvis moves the ischial tuberosities, where the hamstrings originate, further away from the knee. One needs to elevate the non-working leg slowly for this reason; the sensations of increased stretch get stronger rapidly.

Where do you feel the main effects of this leg movement? If you feel it mainly in the outermost calf muscle of the stretching leg (gastrocnemius) you have just uncovered your first restriction in this pose. Various options are open to you at this point: you could exit the pose and use a wall calf stretch to lengthen gastrocnemius. Or, while staying in the pose, you can try gently pressing the ball of the foot into the floor without lifting the heel, an isometric contraction (muscle activation without limb movement). This will increase the sensation in gastrocnemius strongly. We recommend doing contractions for 5 to 10 seconds; the exact duration is not important we have found, but putting your full awareness into the sensations in gastrocnemius on the stretching leg is a critical aspect of the technique. Following the contraction, release all effort in the leg and foot, and take a full breath in. On a breath out, press the heel of the stretching leg firmly onto the floor and, if possible, try to walk your hands a little further away from your feet. If you are successful, you have just decreased the angle between the stretching leg and the floor and just opened up gastrocnemius and soleus as a result. This is step one. Remind yourself to do a strong calf stretch before you attempt the SLDP the next time you practise.

Now move your awareness to looking up between your hands. Make sure that the knee of the stretching leg is pressed gently straight and the heel is firmly on the floor. Take another deep breath in and, as you breathe out, press the hands further away from the body and while still breathing out use your hip flexors to pull your chest towards the floor slowly. At the same time the non-working leg is reaching out behind you and lifting up away from the floor until the leg is in the same line as the line of the spine. Make sure that the hip of the non-working leg does not lift (rotate) away from the floor; in countless beginner’s classes this is the correction that is most often necessary to make. If you do have the benefit of working with a partner I will describe partner assistance below.

In the process of trying to get into the position I have just described, where do you now feel the major effects of this pose? If the main sensation is in the hip joint of the stretching leg or strongly in the outer hamstring (and perhaps the outer calf muscle) then it is possible that piriformis (one of the external rotators of the hip) is limiting the movement of the sciatic nerve itself. Modern chiropractic research suggests that piriformis syndrome is the major cause of sciatica in about 60% of the general population. We may assume that at least a percentage of your students will feel the restriction in the same place. An option here is to exit the single leg dog pose once again and to do one of the stronger piriformis exercises and then re-enter the pose. If you find that the sensation in the hip and the outer hamstring has changed you have learned something more about how your body is organised and the next time you attempt the single leg dog pose make sure you do a piriformis stretch first. We have the best ones on our YouTube channel; search on ‘piriformis’.

One of the great virtues of the single leg dog pose are its strengthening aspects and the other is the extent to which the positioning of one’s various body parts become clear in one’s awareness. We have found that working the single leg dog pose yields much faster results with respect to one’s capacity to do the full version of the pose than working the full version of the pose for the same amount of time. We believe this is because the ‘partial’ version of the pose allows identification and rectification of restrictions more easily.

Let me describe partner assistance for a moment. One of the features of our work is that we have a huge range of partner assistance techniques. A sensitive partner allows you to make much faster progress towards the final solo version of the pose than working alone. This is because the partner can help you make the corrections that you may not be strong enough or flexible enough to make yourself at that point and this changes the involved structures more efficiently. For example, a partner can stand in between your hands and gently press the sacrum down in line with the stretching leg with a straight arm, as I am demonstrating in the image (below). As the partner’s weight is felt, you can relax part of the heel-pressing effort and you can then use this energy for making a other corrections. The stretch in the lower leg will be greater, but is more easily tolerated; part of this effect is having the tactile experience of being assisted by another human being—it is not only a matter of some extra weight in the right direction! As well, if a partner is helping hold your heel onto the ground you will be able to walk your hands a little further away and hence the stretch in gastrocnemius and soleus will be increased. If the partner then looks at your thoracic spine and gently places a flat hand on the roundest part of it, you will have another tactile cue: your work is simply to try to lift the sternum so that the roundest part of your thoracic spine flattens; this immediately improves the pose.

ayl-article_image-partner

Assisting a student to get a deeper stretch; my weight is mainly in my R arm–hand; this keeps the heel on the floor. Taken at a recent workshop in Berlin.

A partner can help in other ways too. If you find the major restriction in the single dog pose is felt in the calf muscle, ask your partner to feel the skin on this part of the body and ask them to try to move the skin sideways or up and down a small amount. If fascial adhesions are present your partner will not be able to move the skin even an millimetre or two; it will feel as though the skin is stuck solidly to the muscles underneath. This fascial adhesion, if present, will physically limit your capacity to further dorsiflex the ankle. Robert Schleip explained to me that if the superficial fascia adheres to any muscle and that muscle needs to lengthen more to complete the pose, the brain senses the facial adhesion as a genuine physical restriction and will not let the movement occur. It is experienced the same as trying to do a pose while wearing tight non-stretching jeans: deeper movement simply stops. If a partner can mobilise this fascia (which is a simple matter of literally moving the skin across the muscle or up and down along the muscle or both) the person being worked on will immediately feel that they can go deeper into the stretch. This is not a psychological effect: it is a genuine restriction in the superficial fascial body. In our system we have developed a collection of techniques called RollStretch: someone trained in our system could use a stick or the heel of a palm to gently mobilise the skin and the fascia while the person is in a strong calf muscle stretch, for example; the result is an immediate increasing range of movement. Similarly, someone who is trying to do the full forward bend over straight legs (paschimottanasana) can feel that there are restrictions in their hamstrings in this position, and yet in other poses their hamstrings can be quite loose. If a partner checks the skin and fascia over the lumbar and thoracic spines, often one can uncover the same stuck fascia phenomenon, and following a simple movement of the skin over the top of the muscles (both in cross friction fashion and in longitudinal movement) one’s capacity in this pose can be improved hugely. Your partner does not need to be some kind of body work expert to effect this change.

I discovered this on a workshop when my partner Olivia (who has very flexible hamstrings) was trying to do paschimottanasana (called the “pike” in diving and gymnastics). She had her body just below 45° with respect to the floor. When I became aware of the restrictions in the fascia over her thoracic spine I loosened them (this took about 30”). As soon as I did, she was able to put her face on her shins immediately with a back that was straighter than before. She can now do a perfect paschimottanasana without any preparation. The important point here is that until this fascial release was done she felt that the restrictions were in her hamstrings and calf muscles, and the further important point is that the effect of the release was immediate.

There are other ways in which fascia can restrict movement. Going back to the sciatic nerve for a moment, consider its full length: it runs from the segmental nerves of the lumbar spine all the way down through the leg, bifurcates behind the knees and runs down the lower leg, around the back of the heel and lateral malleolus and ends in each of the toes. One of the reasons the down-facing dog is so difficult to do well is that the sciatic nerve must be able to be pulled taut through its full range of movement to get the body in the position. Down-facing dog is one of the strongest stretches for the sciatic nerve. If there is any restriction to this movement (this restriction is called nerve tethering in some bodywork schools) strong pain will be experienced. Tethering can occur in piriformis in the hip; in a small ligamentous loop on the tibial plateau through which one part of the sciatic nerve passes; or in the calf muscle itself. There may well be other locations in which this tethering can occur but to this point they remain undocumented. We use the location of pain or a strong stretch phenomenon as the indicator of where to go in next. As mentioned above, for example, if the main sensation of trying to do the single leg dog pose is experienced in the calf muscle, then a calf muscle stretch in isolation is done and the pose returned to and the person will be asked, ‘is there any change in the sensation’? In the majority of cases the original pose will be easier to do and the person doing the pose will be deeper in the movement. In this way we regard all movements or positions as potential diagnosis and treatment. The key question to keep on asking oneself or one’s students is, ‘where do I feel this’ and ‘how can this sensation be changed?’

Let me return to the idea of one’s structure limiting one’s potential movement. In the Stretch Therapy system we personally have worked with well over 20,000 students over the last 30 years. Many of those students came to class with the idea that their bony structure was a limitation to movements they wanted to acquire but in very few cases was this idea accurate. The vast majority of people are limited in their attempts to master any yoga pose by simple inflexibility or lack of strength and/or awareness. “Inflexibility” is nothing more or less than the movement patterns of the lifestyle the person has engaged in up to this point. There is usually a ‘directionality’ to these changes. We call this an individual’s developmental trajectory. The body is adapting to the demands that one places on it all the time and, for the majority of the population, most of these adaptations are the changes that we call ageing or dysfunction. By adding a weekly stretching or yoga class or two you are changing your developmental trajectory. What we described as an inability in any movement pattern is simply the result of a lifestyle where that movement pattern is not present. As I mentioned above, many Western people cannot squat easily, and their experience is that they can’t do it. As soon as one incorporates a few practices that lead to the doing of the squat the perspective in the mind changes to “I can squat”. It is too simple to say that the restrictions all “in the mind” because we do not have a conscious access to the many processes that control function. If one engages in practices that change one’s movement patterns and one’s physical range of movement however, then the somatosensory cortex has been remapped and then one’s experience in the body is that which was not possible now is. The perception and the experience of this changed capacity is the change. Very little in the muscles, tendons, ligaments and other fascial structures changes a great deal, we believe. In our system we are using bones ligaments tendons and skin explicitly to re-map this part of the brain which is not consciously accessible. From the outside of course it just looks as though someone is stretching or doing yoga and over time they become more flexible and stronger.

Progressing from the SLDP to the full, both legs, version of the pose is a simple matter, once the SLDP is mastered. By “mastery”, I mean that one is able to do the complete version of the SLDP on both legs—I mention this because it is common to have asymmetrical flexibility! Once you can do the SLDP on both sides without a great deal of effort, and without a partner’s help, then it is time to try the full pose. All cues (apart from raising the leg behind you) are attended to. Key is keeping both heels on the ground, pressing the arms away from the body, lifting the chest and, on an exhalation, gently pulling the chest towards the floor.

Here is the SLDP on YouTube: use of the ladder bars enables the unloading of the arms and shoulders to a degree, which can allow you to hold the position for a long period – many people have found that their calves respond well to a long-held stretch.

 

Additional resources

Two programs on our Vimeo channel contain numerous exercises for calves, hamstrings and piriformis. Check them out below!

Staying agile and pain free as you age

Published in “The Retiree”, Autumn 2011 edition

As a culture, we are obsessed with our body’s appearance, and it’s not possible to open a magazine without seeing articles on obesity, how to lose weight, and a bewildering variety of dietary regimens that are presented and seem to contradict one another (high fibre, high protein, high carb, and high fat diets – and all backed up by science, too, apparently).

Yet an even more life-threatening condition threatens the middle-aged and elderly daily: the insidious loss of strength and balance that can make many ordinary activities potentially life-threatening events. And we know that osteopini, or osteoporosis (significant loss of bone mass) are on the increase too, which means that any fall can have very serious consequences.

In 1995 in Australia, 13.4 per cent of all deaths were from falls, and the majority of these were sustained by those aged over 45 (see reference below). There is no doubt that a reduced capacity to balance, a reduced capacity to react effectively to a loss of balance, and reduced strength overall contributes to this trend. And a much larger fraction of the ageing population suffer neck and back pain, and many complain of an overall loss of suppleness in their middle and later years. Is this the future we can look forward to?

No, definitely not. The capacity to balance and to recover one’s balance if one loses it, are skills that can be enhanced with simple exercises that require no equipment at all. ‘Balance’ is a capacity that emerges from a neural system that is awake, and aware of what’s happening inside and outside the body without concentration being directed specifically to this task. As well, one’s neural and muscular system needs to be able to react quickly as conditions change, and this capacity needs to be ‘tuned’ in an on-going way.

There’s more to the story, though. We lose around 0.5 – 1 per cent of our muscle mass annually after the age of 25 – and as this is compounded over time, the result can be the loss of half one’s muscle by age 50 – a frightening thought. Similar processes are responsible for bone mass loss, too. Reduction in whole-body strength coupled with reduced range of movement in all the joints of the body are the major causes of hip, lower back, and neck pain, as well.

Many of the most dangerous falls happen in the shower or bath, so one of the most effective ways to protect yourself is to install safety handles at the recommended height. These inexpensive installations will allow simple and effective exercises to be done too, and this is where we will begin. Note that any stable support (the edge of a solid table, any rail that you can hang on to safely, or a column – even the edge of a door frame) will do for this purpose.

It is conventional to begin any article on exercise with a caution like “check with your physician or health professional before beginning any exercise routine” – and you may care to do that, but if you have no obvious health problems, and you are presently walking around unaided, these simple exercises may be embarked upon immediately. They are not taxing aerobically, and affect coordination and neural patterning more than other aspects of the mind/body complex.

Reference:
www.nisu.flinders.edu.au/pubs/bulletin17/bull1701.html

Download the full article to view the three exercises

YouTube clips

The clips below are support videos for the article, called “Staying agile and pain-free as you age”. (View in high definition.)

How can I improve my golf?

Of all the many skills you need to have to be good at golf, few are as important as a good swing. And the main aspects of a good swing are repeatability and power. Let us analyse these terms to find out how one might go about improving them.

Proprioception

Being able to precisely repeat one swing after another is essential to improving your game; without this, correction of faults and improvement are difficult indeed. What does this mean, though, exactly? The main aspect of repeatability is a combined physical and mental sense called proprioception, often called the ‘sixth sense’ by anatomists. This sense is the awareness of the parts of our body in time and space; together with the middle ear, proprioception tells us in minute detail what is going on in our body at any given time in terms of patterns of tension, and changes to this base state over any given time gives us our sense of movement and our memory of the feeling of movements.

When we replay a golf swing in our mind to assess its effectiveness, it is proprioception we rely on to tell us whether we hooked or sliced the shot, and tells us where in the chain of muscles (and movements) the problem originated. This sense has been heavily researched over recent years by neurobiologists the world over for what it can tell us about how we remember and experience certain aspects of being alive, and consciousness itself. As far as golf is concerned however, all we need to know is that this sixth sense can be enhanced enormously using simple techniques. Proprioception relies on receptors in the muscle spindles and tendons. Richly supplied with nerves, these organs tell the brain what states are being experienced. But to tell it in this conventional way is to miss a most important point: the brain doesn’t exist only in your head; it is in fact diffused throughout the body via its nervous system.

The brain in the body

The brain is in all the body, and the body is in the brain, manifested as sophisticated maps of one’s various capacities. A particular area of the brain, the somatosensory cortex, assesses and controls these patterns of tension in the muscles of the body. The different receptors in the spindles are either position-dependent and position-and-time-dependent, and this suggests that they can be influenced in different ways. The position-dependent ones are most easily influenced by slow stretching exercise, and can have their awareness most radically enhanced by the use of the Contract–Relax (C–R) approach to stretching. This technique is by far the most effective way to enhance proprioception. The somatosensory cortex is not amenable to conscious control (try to ‘tell’ those tight muscles in your neck to relax, and see how far you get!) but in contrast to conventional stretching the use of the C-R approach changes one’s awareness – and experience of – of held tension patterns immediately.

Improving proprioception

The significance for golfers, or any athletes or ordinary people who want to feel the joy of enhanced awareness, is that a few simple stretching exercises done in a particular way can make you aware of a tension block that is limiting your swing. When you watch an athlete perform, have you noticed how easy they make it look? That’s an enhanced sense of proprioception at work. Anyone can get it – it just takes work. And the right stretching is the easiest way to get it. The right stretching ensures that you have the requisite rotational flexibility too: watch the professionals and see what sort of rotation in the spine they display. And doing rotational stretches in the opposite direction to the direction you swing will offset one of the down sides of an asymmetrical activity like golf: the ubiquitous neck and back pain.

As far as the time-and-position sensitive receptors go, how do you improve them? By remembering the first three rules of any skill: practise, practise, practise, as the old saying goes. What happens when you practise (providing you do so with what the experts call ‘relaxed concentration’) is that you ‘groove’ the desired movement into the 660-odd muscle of the body – and the myriad nerves (recalling that the nerves are the brain’s ‘eyes and ears’ in the body) into being able to repeat the task on demand. The most practised movements of the body are the best remembered, and the best performed. When was the last time you thought about how to walk? This is one of the first-learned skills of the body yet one of the most difficult, and one on which many other skills are overlain. The point is that you learned this complex skill so long ago that you’ve forgotten how you learned it, but be assured that it took you years to learn it to the present level of performance. So, the right sort of practise is needed.

Adding strength to the mix

Once you’ve got the swing grooved, the next consideration is power: how far can you drive that ball reliably? The best swings are those that are both consistent and powerful; the iron you choose then determines the distance the ball goes. How do you get more power? Recall your school physics: power equals force times distance over time. Which of these can be most easily altered? The right stretching exercises can increase the ‘distance’ part of the equation: as you become more flexible, you are able to apply your strength (the ‘force’ part) over a greater range of movement. Accordingly, even if your absolute strength levels do not change your power will increase and this will be reflected in longer drives. And if you include a couple of exercises that increase the rotational strength of the trunk into your weekly routine your capacity to generate force will increase as well, adding to the effect.

There are many good exercises that you can do at home and others that require the use of a plate weight, found at any gym. Most strength routines contain only a token exercise for the abdominals but a far better training regimen requires the golfer to spends at least a few weeks working on the trunk muscles: the obliques and transverse abdominals in addition to the familiar rectus abdominis group (the ‘six-pack’ of the body building world), and other critical trunk muscles. After initial conditioning, progress to doing similar moves on an exercise ball: the unstable surface triggers the righting and tilting reflexes of the body and ensures that all the trunk muscles are coordinated in the task. Taken together, the right stretching and strengthening exercises will only require about twenty minutes per week to do, done in two ten minute sessions. If you do this work and spend an additional half hour per week grooving your swing, enhanced performance on the range is a certainty. Get to it!

What makes a good massage good?

The first time an expert massage therapist lays his or her hands on you, you know immediately whether they know what they are doing; or to put it another way, whether it is going to be a good massage. How does the body (or you) know this subtle thing so quickly? The answer lies in understanding the elusive qualities of pressure and rhythm, and what these qualities communicate throughout the body. In this note, I am going to explore this concept, and try to give you a different way of thinking about this most ancient of therapies.

The sense of touch

As we all know, of all the senses, the one we call touch is perhaps the most resistant to the rather blunt tools of language, both in terms of description and analysis, and when we consider touch from the perspective of the many sense organs involved (and at the many scales they operate), what I call the ‘bliss dimension’ of the experience of massage disappears altogether in discussions of afferent/efferent nervous systems, Golgi bodies and stretch receptors. So much has been written about the cellular and structural aspects of the sense of touch, rather than ‘re-invent the wheel,’ I will simply refer the reader who wants more detail to Deane Juhan’s excellent book Job’s Body. There is one aspect of core idea of his book that I wish to pursue here, though.

Going beyond the rules

You may recall the parable of Job, a man caught in a contest between Lucifer and God, Job was a righteous man, healthy and prosperous, and who followed the dictums of the scriptures. Unfortunately, in the contest between Lucifer and God, following the rules was insufficient: Job was sorely afflicted with numerous illnesses, and the received wisdom of the scriptures and the exhortation by his peers to increase his faith proved ineffectual. Job had to turn his attention inwards. In so doing, he discovered much about the processes of living that wasn’t covered in the scriptures, and in looking beyond the truths that he inherited, was able to perceive the workings of God internally, and which itself was a new wisdom. Juhan uses this parable as a stage for his own examination of the processes of touch and massage; it is a book that no one (massage therapist or not) should be without. Juhan is able to show how massage actually alters the way the body perceives itself, and how that image may be remade (if dysfunctional, as when the body is in pain) or enhanced for optimal health. The parable of Job, however, is a powerful injunction to seek wisdom within as well as without, and it distinguishes between external constructed and derived knowledge, appropriate for some inquiries, and other sorts of knowledge, necessary to understand other kinds of problems.

First impressions

The process of how massage can alter the way the body works (as it might be assessed objectively) and feels (both from the therapist’s point of view as well as the person receiving the massage) lies in the relationship between the place in the brain where the body’s image (I’ll explain this in more detail in a minute) is represented, and the myriad sensory organs found in the skin, muscles and connective tissue, which is what the brain uses to construct its picture. These nerves in a real sense are the brain’s ‘eyes and ears’ in the body: the brain is constantly assessing patterns of tension, temperature, pressure, the sense of effort of a movement or position of a limb, and much else besides. So, imagine the first time someone lays a hand on you, and the various sensations involved. First impression for most people is the temperature of the part of the body in contact with the skin – the hand must be warm. If it is cool or cold, the hand will not generate the desired sensations; instead the recipient will recoil slightly, retreating into themselves. The essence of a massage is that the patient lets the pressure of the various hand techniques ‘enter’ – the worst response is that the patient tightens up.

Going further

The next impression we receive is what I call confidence: if the pressure is the right pressure, the patient will yield. By ‘yield,’ I mean that the patients lets the pressure into his or her body rather than rejecting it. Here, ‘right pressure’ is neither too light or too heavy; it must be ‘just right!’ If it is even just a little too firm, the muscles tighten further; if too light, many patients feel that the massage therapist is floating about on the surface, refusing to engage more deeply, either physically or mentally, or to put it another way, the therapist may give the impression of not wishing to grapple with the problem the patient came to you with in the first place. The other disadvantage of too light pressure is that the recipient may feel that the practitioner simply lacks confidence, or doesn’t want to hurt you. Obviously the practitioner treads a fine line between too little and too much pressure. The ability to distinguish these limits marks the professional (or the gifted amateur), and in the instants you are assessing the therapist, he or she is equally engaged too in sensing your feedback, through a variety of indicators.

Speed of movement

The final sense dimension in this simple analysis is rhythm, or the frequency and cadence of the pressures being applied to the recipient. We may imagine at least two parts to this dimension, the speed of the hands across the body, and the increases and decreases of the pressures being applied during any traverse of the part being touched. Another way of thinking about this is to imagine two axes, at right angles to one another: the vertical axis is pressure, sometimes light, sometimes going deeper, and the horizontal axis is the speed of the movement. Together these twin dimensions give the massage its characteristic qualities: we resolve the pressure and speed dimensions as a third dimension, the quality of that particular touch – and every touch is unique. And just as the improvisations of a jazz saxophonist may delight you but leave another unmoved, so too will the rhythms and pressures of one massage therapist move you, and another leave you cold. Knowing these things can help you reach an understanding with the therapist; for example requesting faster or slower movements, firmer or lighter pressure, or even a different oil, which will influence the qualities of the friction and heat produced.

The brain is in the body

The image that the body has of itself has been the subject of intense study over the last ten years or so. A fascinating book charting these discoveries for the general reader is Antonio Damasio’s Descartes Error. There is an area in the brain called the somatosensory cortex, and represented there is an image of the body, in the form of specific ‘settings’ of muscular tension; what might be normal tension (or sometimes called ‘tonus’) for the biceps muscle in normal daily life, for example. Among Damasio’s more fascinating conclusions is that we experience emotions as changes to these base settings. For example, if something makes you angry (an idea or an experience) we know that we are reacting angrily – or feeling angry – by both the characteristic patterns of tension produced (shoulders pulled up to the ears and fists clenched, say) and the brain becoming aware of these changes is how we know or become aware of the emotion. Of course the story is much more complicated than this brief recapitulation can do justice to, but the fundamental idea is true to the original.

Protective mechanisms can be negative

In our workshops, we explain the efficacy of the particular approach to stretching we use to treat neck or back pain using some of Damasio’s ideas. We know that the tension in muscles is a property of the muscles, but we also know that the tension settings are not usually controlled from within the muscle in the chronic patient. We make this distinction because tension is controlled from within the muscles in the acute phase of trauma. In fact with the chronic patient we believe that it is a lingering, but now redundant, protective mechanism that is often the source of pain. That is, the natural process that the body uses to ‘splint’ or protect an injured part lingers on after its usefulness has past, and it will continue to linger until it is altered in some way. Using the Contract–Relax (C–R; this technique is detailed in my book Overcome Neck & Back Pain) approach, we gently signal to the body that the range of movement that moments ago elicited the pain response can now be safely moved into, and if used successfully can immediately alter the patient’s movement and pain patterns. I am certain that Damasio’s mechanisms are what allow us to do this, and which not coincidentally also facilitate the massage experience.

Beyond treatment

For both Damasio and Juhan from different starting points have been able to show that working on the body using massage can alter this image, in reality teaching the body firstly how to be a different way, and secondly that this new way is safe, or desirable, thought the pleasurable feelings that ensue. On the one-day workshops we run for private individuals (as distinct from the six-day ones we run for practitioners) we have been amazed at the instantaneous change that the use of the right stretching exercise can have on people who have in some cases had very long-standing problems. We feel that our techniques are extremely useful to the massage therapist, for they allow you to teach the most effective two or three stretches to your patients, and give them something tangible to take with them. Combining massage with stretching is the most efficient way to help the patient help themselves, and this empowers the patient as well. We all know that unless the patient takes responsibility for themselves, any intervention is likely to be temporary and palliative.

The downside of the high heel

The average person’s most common problems are (in order of likelihood) tight necks, tight upper/middle back, and sore lower backs. Some of the causes of these problems are well known, but in this note I would like to consider a possible cause of all of these problems, and one that is more likely to be suffered by women rather than men (but you never can tell!) Everyone knows just how sore the feet will be after a night of dancing in elegant stiletto heels, but is that the only negative aspect of wearing high heels? Recent research from the University of Hong Kong suggests that the medium and long term effects of high heels may be more far-reaching than anyone has suspected so far, and is very likely to contribute to common musculo-skeletal problems.

Seeing inside the hip

Researchers have done some pretty high-tech manipulations of X-ray images of the hip joints in coming to this view. These ‘Fourier transforms’, as they are called, can give a highly accurate two-dimensional image of the three-dimensional structure inside bones. When applied to X-ray images of the hip joint, the researchers are able to determine the three dimensional arrangement of what’s called the ‘cancellous’ bone, the familiar porous honeycomb-like interior. The cancellous structures appear to follow the theoretical lines of force experienced by any joint, and anatomists have long believed that the structure of the bone co-evolves with the changing forces on the hip, both in an ontogenetic sense (what the individual experiences in his or her lifetime) and a phylogenetic sense (how the species evolves). The same processes drive bone deposition (and the absorption of calcium from the bloodstream) and the result is one’s characteristic internal bone structure, as well as bone density, clearly important in osteoporosis.

How long does this take?

These processes were assumed to be reasonably slow, in line with the body’s conservative approach to maintaining its resources. Imagine the researchers’ surprise when one of them happened to repeat a set of images for a young woman who had started wearing high heels for the first time in her life: in just two weeks of daily wearing of the new shoes the cancellous structures had altered in line with the changed forces on the hip! The researchers were not saying that this change necessarily had any negative connotations, but everyone was amazed at how quickly the second-hardest substance of the body can change (the enamel of the teeth is the hardest).

Height

How high is a ‘high’ heel? This depends on the person and the length and shape of their feet, but these effects have been noticed in some people with heel heights of two inches (5 centimetres) or less. The main determinants of when a particular height of heel is likely to become significant appear to be the width of the foot (in respect of problems in the metatarsal area), and the length between heel bone and the forefoot, that part of the front of the foot that presses onto the floor, and the weight of the person. As a general rule, the lighter you are, the less a pair of high heel will press undue weight onto the forefoot, but this also depends of course on how high the heels are –  as everyone knows, the really high shoes force you to virtually walk on tip-toes, putting a great deal of force through the joints of the toes in positions for which they are not ideally suited. Bunions can be a long-term result.

Other effects

In addition to changing the forces on the hip joint, what other effects might there be? The most important one for overall posture seems to be the effect of high heels on the lumbar lordosis. As the heels of the feet are elevated, the top of the pelvis tends to tip forwards and the lumbar spine’s normal curve backwards (the ‘lumbar lordosis’) is increased. This doesn’t happen in isolation, of course: as the pelvis tilts the curve in the upper back can increase too, and if this happens the small curve backwards in the cervical spine is increased as well, to maintain the head’s normal position in relation to the centre of gravity of the body and to keep the head more-or-less level. Increasing the three curves of the spine means that all the muscles of the spine have to exert greater forces to maintain any posture. This extra effort can cause patterns of increased muscular tension anywhere along the spine and into the neck, and certainly can contribute to headaches. This is more likely if the patient’s job involves working behind a computer: the normal tensions experienced by these sorts of occupations are then given a new focus by the changes to the body’s posture.

Another better known effect of long-term high-heel wearing is shortened calf muscles, which can make the taking up of running or roller blading much more uncomfortable that it needs to be. If you are a high-heel devotee, make sure that you stretch the calf muscles well before and after these activities. If you are a massage therapist, spend a little extra time on your patient’s gastrocnemius and soleus. Shortened calf muscles is the main reason some patient’s calf muscles cramp at night, and is particularly common in the elderly.

Cause of other problems?

A less well-known and more insidious effect is related to the tilting of the pelvis already mentioned. Recent data collected from the workshops we run around the country suggests strongly that tight hip flexors (the muscles that lift the knee to the chest, and the ones implicated in the old now-discredited sit up exercise) are a major and often undiagnosed cause of both neck and back pain. These muscles are quite difficult to stretch using conventional methods, but there are two effective exercises offered in the revised editions of Overcome Neck & Back Pain and Stretching & Flexibility. One is a solo version, and one is done with a partner. I feel that the partner one is the best, just because the stretch effects of the standard exercises can be avoided so easily, and this version is the one the therapist can use easily in the clinic.

Avoiding discomfort

As a general rule, we have found that the body is expert at avoiding a necessary stretch, and the more someone needs to do one, the more likely this is to be the case. In the workshops we find that if tight hip flexors are a cause of back pain, usually one or two strong repetitions of the exercise makes the area feel more comfortable immediately. If that happens, you can be reasonably certain that these muscles are involved, and the patient will be strongly motivated to do the stretch themselves, which we suggest best be done twice a week.

So, if you love being those vital few inches higher than Nature intended, make sure that you do the right stretching exercises (forwards bends, side bends done on the floor, and rotations also done on the floor plus the core hip flexor stretches; all are illustrated in the book) and dance the night away! Be aware though that the extended wearing of high heels does seem to have long-term implications for posture, and if you have neck or back pain, you might suggest reserving those high shoes for special occasions only.

Maintaining the scholar

As post-graduate students, you will have listened to lecturers or Professors talking about how to manage the complex of tasks that is a Masters or Ph.D. degree. This includes fundamental suggestions about how to manage your supervisor (including becoming aware of your own responsibilities), basic advice about the structural differences in science and arts theses, suggested time frames for when to end the research phase and begin the writing-up phase and so on. All this is helpful, even if only as a means to thinking anew about these problems. And suggestions made (to overseas students, especially) in regards to attending writing courses, if taken, will ease the burden of the writing-up phase enormously. If you are not a natural writer (by this I mean someone who thinks in sentences and paragraphs, and has no problems in envisaging the larger structure into which this will all fit) then please avail yourself of this service. It is often argued that attending to the details of the writing craft is the surest way to hone your thinking skills – and my experience in writing a couple of books and editing quite a few theses strongly supports this position.

Once the supervisor is under control…

However, I am going to assume that all this is under control. In this short note, I will address another set of problems – problems that I argue are even more fundamental than the ones mentioned above in respect of successful completion of your thesis – and that is the problem of how to look after yourself and those around you in the process. I will address this by considering how best to ensure that you are getting enough physical exercise (what kind, how often, and so on), how to best feed yourself, and how to manage the personal relationships you have, from friends to lovers (but not including supervisors).

Reducing the effects of stress

Many students and post-grad students have come through our courses run at the Sports Union over the last dozen or so years. We teach strengthening as well as stretching exercise, so when I recommend the latter over the former, it is not because of bias. There are many reasons to stretch, but two are highly relevant to you. The first is that efficient stretching is simply the best way to rid the body of the effects of stress. And who of you is not, or will not be maximally stressed by the research and writing process? Certainly no one I have met here, including myself: we all need this. It is partly a matter of being able to sleep well – who has not had the experience of having eight hours sleep, yet waking up feeling exhausted? This occurs because your body is not sufficiently relaxed physically to take full benefit from the sleep. The second reason is to prevent – or fix – any overuse problems in the neck, shoulders and arms. These problems are rife among research students. If untreated, a minor annoyance can become a major health problem, and such problems have stopped many a thesis from completion. I recommend a few simple exercises be done at the computer while you are working and one proper stretch session a week. If you do some kind of aerobic exercise, the time to stretch is after the activity. Keep warm while you do this.

Nutrition

A diet of convenience food will hinder your research efforts considerably. The short suggestion is small meals more often – the harder you are working the more important this is. This means the right kind of snack at morning and afternoon tea, rather than the sweet biscuit you may be having now! And beware the recommendations about increasing the proportion of complex carbohydrates in your diet (in relation to fats and protein) – for at least half of you, too much carbohydrate is the reason you feel sleepy an hour after lunch, and for many others it is the reason you are putting on too much unwanted body weight. This is also an explanation for mood swings in some people, too. Increase the proportion of protein at each small meal, decrease the proportion of carbohydrate, and feel your energy return. The reasons for this recommendation are too complex to go into here, but a good place to start is Enter the Zone, by Dr Barry Sears, if you are interested in understanding more.

Significant others

All I want to say about relationships is that you are well advised to discuss the implications of the sort of pressure you will experience with your partner before it happens. Many relationships founder on the rock of writing a thesis, as I am sure you have heard. Suggestions include making sure that you have one day off a week (no matter how hard your supervisor expects you to work – he or she may not have a life, but if you want your relationship to survive, you will need one outside the department) and spend a good fraction of it with your loved one. Another is to make sure that you have a quiet place to work. Yet another, perhaps paradoxically, is to avoid working late into the night.

When to work

Many will tell you that this is the only way to get on top of the work, but for most people getting to bed at a reasonable hour (11:00 p.m.) and getting up early (although I did not like this myself, in the beginning) will yield more productive work by week’s end. It is true that you get the impression that you are working well as time passes into the wee hours, but so doing will guarantees a late start the next day, and after a month or two your health will suffer. From experience, it is possible to write a Masters’ thesis in three or four months, and only writing from 08:00–12:00, six days per week, assuming that you know what you want to say before you start writing. Read in the afternoons, go to the gym late afternoon, and don’t work at night. Sounds radical, perhaps, but your effectiveness will be maintained and so will your health and your relationships.

My final suggestion (made to me by my uncle) is, moderation in all things. Especially moderation! The point here is that, every now and again, especially if you are organised and being effective, you need to break out. The thesis process can be enormously enjoyable and rewarding, too, if you feel that you are (more or less) on top of all major aspects of life.

Do you want to diet? Don't!

In this article, I consider alterations to one’s ordinary eating routine as a means of getting the muscle weight to fat weight ratio that you want (not “How to lose weight!”) and, in particular, I compare various approaches to eating as a means to this end.

Excess fat vs “overweight” distinction

We are all tired of hearing that a huge and growing fraction of the Australian and American public are classified as “obese”. You can’t open a newspaper or magazine without reading about this ‘crisis’, and I am sure everyone had a laugh about the very recently-published research that (amazingly!) claimed to have shown a link between hours spent in front of the television, and propensity to being overweight. “Overweight”, of course, properly means that one is carrying excess body fat, and that needs to be said clearly at the outset. I will have more to say on this below, but one’s body weight is an entirely different matter. If you assess your overall condition by the bathroom scales alone, you need to know that if you lose 10 kilograms the chances are half of that weight will be muscle – which you can ill afford to lose – and about half is fat. In this article, I want to consider alterations to one’s ordinary eating routine as a means of getting the muscle weight to fat weight ratio that you want (not “How to lose weight!”) and, in particular, I want to compare various approaches to eating as a means to this end. What you will not find here is any explicit form of calorie counting, or the word “diet” – except insofar as it applies to the concept “combinations of food”.

Net energy balance, and eating AND exercise patterns

Two basic propositions to begin with: in order to lose weight – muscle and/or fat – you will need to have a net negative energy balance; in other words, the calorific value of your food needs to be less than your total expenditure. How this might be done is part of what this article addresses. The second is to note that, long term, changing your eating or exercise patterns alone are not as likely to be successful in changing your body composition as doing both together.

Lifestyle and diet changes in recent times

Are you a sugar burner or a fat burner?

Diets don’t work: everyone who has dieted knows this; and ever more research is showing what everyone knows to be true. What is the real problem – by this I mean: why is our population getting fatter? There are two broad categories of answers: lifestyle and diet. The major increases to the rate of these changes, I argue, have happened in the last 30 or 40 years, and this the time over which both more research into obesity has occurred and over which increases in obesity has been observed. And this is the era of every kind of diet – from high carbohydrate to low, from high fat to low, and from high protein to low. These ‘eating plans’ can be arrayed on various conceptual axes. However, to make sense of the many apparently-contradictory recommendations, I will suggest that one place to start is to determine whether you burn sugar or fat as your energy source. The reason is that your choice of main fuel has important effects on your internal hormone environment and, consequently, how the nutrients in your food are likely to be used.

How did our ancestors eat?

If we go back in time (or look to the surviving traditional peoples left on the planet) you can envisage the hunter-gatherer. This mode of survival characterised the vast majority of our specie’s time on the planet, and the forebears of our species, too. The point is that our body and its hormones evolved together under this dietary regime. It is characterised by “feast and famine” supplies of nutrients: when the group hunted successfully, everyone ate – fat and protein, mainly, and as quickly as possible. Our hormones support this style of eating: when the body is fed an excess of certain calories (proteins or carbohydrates) the pancreas secretes insulin.

Important hormone #1: insulin

Creating new fat: lipogenesis

Insulin is the body’s most anabolic hormone and it is described in these terms because it is the body’s number one storage hormone. When insulin levels are high, glucose (from carbohydrates) is stored first in the liver (to replenish its supplies, about 150g) and then in the muscles – assuming you have been active enough to use the glycogen ordinarily stored there. After this, excess glucose is turned to new fat, in a process called lipogenesis. At the same time as the glucose storage is happening, whatever fat is in the bloodstream at the time is stored in your fat cells, as well. So, the crucial point here is that when insulin is high, insulin stores glucose and fat. Most people are not aware of this fat storage aspect of insulin’s role. The body is storing fuel for the famine that experience has shown it is just around the corner – except that in out environment of constantly-available food, this storage mechanism has become somewhat of a liability for many people. This is only half the story, though.

Important hormone #2: glucagon, insulin’s twin

Lipolytic, or ‘fat accessing’; insulin/glucagon axis

Insulin has a twin, the hormone called glucagon. Like many twin hormones and other substances in the body, glucagon’s actions are the opposite: it is lipolytic, or fat accessing. Glucagon allows various enzymes to be released so that one’s stored fat can be used as a high-grade fuel for most activities. It is how we evolved to be able to use stored energy when there was no food available – and understanding how this all works helps us to understand one of the main reasons people get fat today. Glucagon cannot do its job if either blood sugar or insulin is high. This relationship is sometimes called the insulin/glucagon axis, or ratio. The rule is that blood sugar rises after eating, insulin follows a short time after this, and storage of any fuel that cannot be used immediately begins. So, in short and put simply, because of a combination of frequent feeding and the composition of the food we eat, we are favouring the action of insulin over the action of glucagon. Before we look at things more closely, let us consider the main macronutrients.

Macro-nutrients

Protein

The macronutrients are water, protein, fat and carbohydrates (micronutrients are vitamins and minerals). About 70% of the body is water, so I assume that its importance is already obvious. I will add a few remarks re. recommended daily volumes and just where you source this crucial macronutrient below. Protein (from the Greek meaning “of first importance”) is composed of amino acids; nine are essential (meaning that all nine are needed by the body, and in certain proportions to each other for all to be able to be used; babies require 11). Your body turns over a large “pool” of these every day (from breaking down and recycling parts of yourself) – the protein you eat each day “tops up” this pool. This pool contains about 150g in an adult male, and proportionately less in a female (depends on lean muscle mass, mainly (Akerfeldt, 2000, p. 105)).

Fatty acids

There are two essential fatty acids – so-called omega-3 and omega-6 (these names refer to their structures and the number of carbon atoms they contain). Most Western people do not get enough of the former, and too much of the latter, the reason that supplementing one’s diet with flaxseed oil and similar foods is often recommended. If the body has these two fatty acids in the right proportion (roughly one to three), it can make all the other fatty acids it needs (Erasmus, 1997, p. 45).

Carbohydrates

The final macronutrient is carbohydrates – and it is worth bearing in mind that there are no essential carbohydrates. This is despite the claims of the necessity of glucose mentioned above. The fact is that we almost certainly evolved without carbohydrates in any great quantity: our present bodily needs reflect their relative scarcity in the hunter-gather environment. This changed radically with the advent of agriculture, reckoned to be somewhere around 7,000 to 10,000 years ago—a very short time ago, evolutionarily-speaking.

Calorie density vs nutrient density

The modification of native grasses that resulted in the grains that most people eat today (wheat, rice, barley, etc.) had many far-reaching effects: a significant change in the fat/protein/carbohydrate ratios, very heavily favouring the carbohydrate content (think about what wild rice looks like compared to white rice, for example) and a shift from nutrient-dense and calorie-sparse carbohydrate sources (like vegetables and pre-agriculture fruit) to calorie-dense nutrient-sparse food (think of pasta, for example). As an aside, sourcing one’s carbohydrates from vegetables means that you are getting more nutrients per calorie than if you source from pasta – and every mouthful of pasta has many more calories than a mouthful of vegetables, too.

US Government findings, 1977

For another vital part of the story, we need only to go back to 1977. The U S Senate Select Committee on Nutrition and Human Needs commissioned research to find out why Americans were getting fatter and were suffering increased cardiovascular disease. The main findings led to the recommendations to cut saturated fat intake (as a fraction of total calories, from 40% to 30%) and to increase the consumption of complex carbohydrates and naturally occurring sugars (from the then-current 28% to about 50%; Grills & Bosscher, 1981, p. 444ff.). The U S Department of Health and Human Services, together with the U S Department of Agriculture, jointly published a booklet “Nutrition and your Health” (1980), recommending how to do this (Grills & Bosscher, 1981, p. 446).

Cholesterol

Casualties in these recommendations (aimed in part in cutting blood cholesterol levels) were the dairy and egg industries: this was the beginning of the “cholesterol is the enemy” era (and we see this still today in the “no cholesterol’ labels on foods like olive oil and avocados). As most people know these days, however, one’s consumption of this vital substance is only poorly correlated with the levels found in the bloodstream. More on this later.

So these pronouncements heralded the shift that we have seen in macronutrient proportions – changes that have had the opposite to the intended effect: as the consumption of saturated fat has decreased, most significant research indicates that cardiovascular disease has increased (this may be due in part to us living longer) AND people have become fatter. What’s going wrong?

Shift in dietary proportions of the macro-nutrients

In simple terms, the shift in calorie source has pushed the glucose-insulin axis mentioned above towards fat storage and away from fat use – the very reason for its storage. Specifically, the change in eating from roughly one-third protein, one-third fat, and one-third carbohydrates to 20%, 30% and 50% respectively has had this significant effect. Add to this the often-made claim that “eating fat makes you fat”, and the aggressive promotion of the very high carbohydrate diets (70% of total calories and over) that many athletes eat helps us to further understand the problem. (This dietary recommendation is standard in most popular magazine article one finds, too.) This sort of diet may be suitable for an athlete training hours a day – but simply is not suitable for the average largely sedentary person.

You are what you eat?

Before I make my suggestions about how to eat (and for what purpose), let me make a few remarks on dieting in general. Your past and current choice of food and your past and current activity levels is precisely what has made the you body you live in today – nothing else. We need to amend the old axiom “you are what you eat” to “you are what you eat and do”.

Why cutting calories does not work

If you need 2,000 calories to maintain your present body weight, then eating only 1,800 calories will cause you to start metabolising your own body – your muscles as well as your fat, unfortunately (about 50/50, as mentioned), if not exercising; more on this below. There are three problems with this approach: you lose muscle which you cannot afford to lose and your body detects what’s going on and (within two weeks or so), down-regulates your metabolism … to around 1,800 calories a day. You stop losing weight. You cut a further 200 calories from your diet, and you start to lose weight again – until the body again down-regulates your metabolism. And this is not the worst of it: when you either have a blowout day, or give up the diet, your body does the opposite: it puts in chain a series of hormonal events that result in your body storing the extra calories as fast as it can – as a hedge against the “famine” it has just weathered. This is the third problem; often called “rebound effect” – sound familiar? This is most dieter’s worst nightmare.

Muscle-sparing effect of exercise

What if we exercise and diet (leaving aside what we mean by “diet”, here)? The good news is that (under a suitable regime) 200 calories’ worth of exercise (I will expand on type of exercise further, below) will burn 200 calories and (more good news) a further proportion of muscle is spared in this cannibalising process (this is a precise use of the term: you are consuming yourself to lose ‘weight’ – ideally, fat). The old idea is that there is a “fat-burning zone” – true, but not the whole story. It is true that low-level intensity aerobic exercise burns mostly fat (more on using this fuel below), but the amount is very small, and confined to the exercise duration.

Increasing your metabolic rate to burn more fuel – while at rest!

Other higher-intensity exercise burns glucose and fat – but raises the metabolism in the process. If you train with weights, for example, you can elevate the rate significantly – and use the 200 calories and more after the exercise – while you are at the office, for example. This rate elevation can range from six to 24 hours in duration. High-intensity exercise is weight training or intervals on a bike (or running); any activity that gets you in to the anaerobic zone (so, you need to get out of breath!). Aerobic and anaerobic exercise can be mixed for this purpose; some people can do high intensity interval training (HIIT) following weight training and others will feel better doing it on non-weight-training days. Another advantage of weight training is that a further muscle-sparing action occurs (this makes sense, if you think about it – you are signalling to the body that this tissue is important to you). More precise recommendations follow.

Fat burner vs sugar burner

I mentioned above the important distinction between being a “fat burner” and a “glucose burner”. Very likely you are the latter – because you have been taking current dietary (and possibly current “fat-loss” exercise advice, too). There are a number of ways to become a fat burner. In the process you will teach your body to use fat instead of glucose for most of its energy needs and maximise your lean muscle mass. This advice is suitable for both men and women, and assumes ordinary health. This is NOT the right advice for someone with kidney problems – so check with your doctor if you are not sure. As well, this is not a ‘diet-for-life’ recommendation – it is a set of strategies to get your body composition to where you want. After that, other dietary strategies will be better (see more on this below).

And if there are no carbs?

I mentioned that there are no essential carbohydrates. What does the body do if there aren’t any to be had? A number of interrelated events occur (I will describe these over a timeframe of a few days, then a longer one of three weeks or so). Eating plans follow.

How the body adapts; ketogenic diet mechanism

If you reduce carbohydrates to less than 100g/day to begin (the amount to keep the process going tapers over time), or less, then your blood sugar steadily decreases (this assumes that you are burning glucose for fuel). The rate can be calculated fairly precisely but that is unnecessary for our present purposes. As blood sugar decreases, glucagon is secreted (by the same organ that secretes insulin, the pancreas). This signals the liver to start releasing its stores of glycogen (the form glucose is stored) to maintain your blood sugar at their normal levels; this process lasts for about 12-16 hours (McDonald, 1998, p.43), during which glucagon continues to rise and insulin falls. At some point, when the liver has run out of glycogen, lipolytic enzymes are released and your body starts to access, then burn, its fat supplies for fuel. This is the essential mechanism of all “ketogenic” or low-carbohydrate diets.

Does the brain really need glucose?

We are told by the vast majority of nutritionists that ‘glucose is the best fuel for the body’ or that ‘the brain can only function on glucose’. Neither of these statements is entirely true; in fact both are true and false – depending on the internal environment of the person in question. No doubt you will have heard also that the brain needs glucose for its operation (or, the brain can only use glucose for its energy); this is true, if you are a sugar burner. If you are not, then it still does – but a small amount only and what it does need is supplied from sources other than carbohydrate. This is how it works: the brain needs about 100g of glucose a day. Deprived of carbohydrate, the body empties its liver glycogen stores, as mentioned, to satisfy this need. This is accomplished by the end of the first day. For the next couple of days, the body converts protein – either your muscles or what you eat—to glucose, via a process called gluconeogenesis. X grams of protein produces Xg of glucose. As the brain is used to using glucose, this means that about 100g of protein is converted per day in the first few days. For this reason, if you are going to try a ketogenic diet you need to have extra protein in the first few weeks of causing the body to adapt.

What is normal blood sugar level?

And how does the body adapt while ‘going keto’?

Also during the first few days, blood levels of glucose drop from ‘normal’ (that is to say, normal if you are a sugar burner) of 80-120 mg/dl to about 65-75 mg/dl – and there they stay (these will rise slightly to 80-85 following a protein meal). [In Australia, we use a different measure: blood sugar is said to be normal if it falls in the range 4-8 mmol/L; Diabetes Australia.] The body maintains that level via a number of pathways, discussed below. Insulin, too, drops from 40-50 micro Units to 7-10 micro Units (McDonald, 1998, p.39). After the third day, 90% of the body’s energy requirements are being met by Free Fatty Acids (FFA) and ketones. Ketone production is up to its maximum by the third day, but blood levels do not plateau until the third week (McDonald, 1998, p.40), as they are being used partly for feeding muscles in the early stages of adaptation.

What does fat break down into?

The changing role of ketones during adaptation

Fat, or triglyceride (TA) is broken down into FFAs (90%) and glycerol (10%); glycerol is further converted to glucose in the liver. This means that an average sized person (70kg) may catabolise up to 160-180 g of fat and produce about 16-18 g glucose a day (McDonald, 1998, p. 44). Muscles derive up to 50% of their energy from ketones during the first few days of adaptation, but this, too, shifts: by the third week, only 4-6% is being met by ketones, the rest coming from FFAs (McDonald, 1998, p. 46). The TA conversion operates on dietary and stored fat alike. And over the three weeks of adaptation, the brain changes over from using glucose for all its energy requirements to deriving up to 75% from ketones. By the end of the second week, the protein-sparing aspects of the ketogenic diet are manifesting themselves: by the body getting all its energy requirements from FFAs and by supplying the brain with ketones for its energy requirements, the protein needed for glucose production drops from 100g/day to about 20g/day, which remains relatively constant from that point on.

Cortisol

Downside of long-term ketosis

During this process, a large array of other hormonal changes are occurring, too, but the one of concern at this scale is cortisol, one of the “fight-or-flight” hormones. Cortisol is one of the catabolic hormones (that is, involved in the breakdown of substances in the body) and is necessary in both the use of protein to make glucose, and fat breakdown. Cortisol is released from the adrenal glands in response to both calorie deprivation and exercise, and thought to be necessary in the building of new muscle, too (McDonald, 1998, p. 212). Too much cortisol in the bloodstream for too long is not good, though: it is characteristic of the highly-fatigued state and long-term elevation of cortisol may even be involved in auto-immune disorders. Elevation of cortisol levels is one reason to avoid long-term ketosis if exercising, even though fat lost will be maximised under this regime, because we want to maintain as much muscle mass as we can. Cortisol levels can be reduced by having some carbohydrates from time to time, a point to which I will return below. Let us look now at the various low-carbohydrate eating regimes that have been popular in recent times, and attempt a comparison.

The Atkins diet

The concept of ‘self-limiting calorie intake’

The best-known of the ‘lo-carb’ diets is probably the Atkins diet. Dr Atkins, a cardiologist, has been promoting various lo-carb diets since the publication of Diet Revolution, 1972, and with various modifications since, the latest being the New Diet Revolution. Simply stated, he recommends a very low carb. diet (40g/day or less) and he attracted some criticism when he first published when he claimed that “you can eat all the meat and fat you want” – which some detractors saw as defying the basic laws of thermodynamics. It turns out, though, that when one confines one’s diets to these foods, there is a self-limiting phenomenon at work – you tend to limit your total calories in a day to 2,200-2,400 naturally and without conscious choice. This is probably a combination of satiety (mostly a function of total fat consumption) and a kind of ‘boredom’ through lack of variety. The point is that if you are in a calorie deficit (eating less calories than you are burning) then you will lose weight, and if you are in ketosis, then more of that weight is likely to be fat, rather than muscle.

LDLs and HDLs explained

Dr Atkins claims that his diet has helped a great many cardiac patients, and through a number of mechanisms: improvements in the Low Density Lipids (LDL) to High Density Lipids (HDL) ratios (the highs increase and the lows decrease); these are regarded as far more reliable markers of likelihood of heart problems than the popular measure of cholesterol. As well, due to ketosis, unwanted body fat is shed. My reservations about the Atkins diet is that there is insufficient carbohydrate in the diet to facilitate weight training or any other high-intensity exercise. There is no doubt, though, that this dietary regimen will help you lose unwanted fat. You will also lose muscle, which I regard as a substantial negative.

The Zone diet

Zone macronutrient proportions; concept of nutrient density

What about the Zone Diets (in their multiple manifestations)? Dr Sears, a biochemist, recommends a diet that attacks what he calls “the four pillars of aging” (Sears, 1999, p. 50): excess insulin, excess blood sugar, excess cortisol, and excess ‘free radicals’ (substances produced by oxidative reactions, like those produced by overheating cooking oils). He recommends a diet that carefully combines “blocks” of protein, fat and carbohydrates in a precise ratio: 30%:20%:50% (percentages, by nutrient amount). His reasoning is based on his understanding of the hormones we have discussed above, but his overall approach is explicitly calorie restricting (from “The Anti-Aging Zone” book onwards, at least; this hidden aspect was one of the grounds for criticism in his earlier books), but “without hunger or food deprivation” (Sears, 1999, p. 55ff.). As well, because he recommends getting the day’s carbohydrates from low density sources – this means vegetable and fruit – his plan is relatively nutrient dense (these are the best sources of phytonutrients, those vitamin-like substances found only in plants – over 10,000 in all).

How hard is it to follow the Zone diet?

If you are comfortable with his approach (which despite his critics is easy to implement), I can recommend it, with the following reservations. If you are a weight trainer or another sort of athlete whose calorie requirements (and protein requirements) are substantially higher than sedentary folk, you will need to ‘upwardly adjust’ the meal sizes. This can be done easily. The downside of doing this is, for those who are more insulin resistant (meaning that the key cells’ response to insulin’s effects are reduced, leaving sugar in the blood for longer and keeping insulin levels elevated for longer, too) may be consuming an undesirably high total amount of carbohydrates (recall that carbs elicit a greater insulin response than other macronutrients). People who are likely to be insulin resistant are the overweight, and the older members of the population, especially if you have been overweight for a considerable time.

Zone diet and ketogenesis

The standard Zone diet is not ketogenic, per se; it achieves its fat reduction by calories restriction and by normalising the insulin/glucagon ratio. It is possible to do intense training on this diet, in my experience, with the provisos mentioned above. It is essential, however, to follow the recommended number of meals and small between-meal ‘snacks’ to avoid a blood sugar ‘crash’.

Cyclic ketogenic diets

Having your cake and eating it, too

Are there any other approaches to ketogenic diets that avoid the problems with the Atkin’s diet? Yes, and I will discuss these under the heading “Cyclic Ketogenic Diets”. These will include the recent and (IMO) deservedly best-known populariser of the keto diet, Lyle McDonald (author of “The Ketogenic Diet”, 1999, and still the benchmark), a relative newcomer, Rob Faigin (author of “Natural Hormone Enhancement”, 2001) and an explicitly bodybuilding approach by Torbjorn Akerfeldt (“The ABCDE Diet”, 2000). The key concept here is “cyclic”: this means that carbohydrates are eaten from time to time over particular cycles. The advantages of these approaches are that you can eat all your favourite ‘naughty’ foods – just at certain times, rather than all the time! By so doing, you can replenish your glycogen stores (to facilitate intense training), you avoid food boredom, you can lose body fat, you can create the optimal hormone environment to push both anabolism (the storage I mentioned above, essential if you want to increase lean muscle) and catabolism (the using of the body’s fat for most of the fuel you need). This approach is really the best of possible worlds, in my view, and these approaches readily lend themselves to ‘tweaking’ in subtle ways, to favour particular desired hormone responses. By this I mean that you can favour muscle building over fat loss, or vice versa quite easily. As well, no calorie counting!

Lyle McDonald’s book, The Ketogenic Diet

In The Ketogenic Diet, Lyle explains the biochemistry of ketosis in great detail; it is a fascinating read. As he is minutely concerned with the biochemistry, I have relied on his book for most of the numbers I have cited here; all are drawn from a fair and representative sample of the scientific literature on the subject. I will not expand on this further here; get his book if you are interested. The essence of his approach can be stated simply: his Standard Ketogenic Diet (SKD) is more-or-less identical with Atkin’s original book (1972) in its approach: cut carbohydrates to 50g a day, obtain the rest of your food from protein and fat sources, assess the presence of ketones in the urine using Keto Diastix (available from chemist stores; diabetics use these for measuring ketones and glucose; you will use them to make sure that you don’t go too deeply into ketosis). Now watch the fat disappear. Note that for anyone doing intense exercise, this is not the recommended approach, for the reason given above. To enable weight training (by replenishing muscle glycogen) but mainly staying in ketosis to maximise fat use, Lyle offers the Targeted Ketogenic Diet (TKD), the CKD (the Cyclic version) and the Advanced CKD. It is important to note here that Lyle explicitly mentions that neither the TKD or the CKD are optimal for increasing muscle weight, so if that is your top priority, you might consider a mixed, non-ketogenic diet, below.

Targeted Ketogenic Diet (TKD); pre- and post-workout feeding

The TKD is simplicity itself: within a context of a SKD, and once ketosis is established (three weeks on his account; four to five for complete stabilisation in my experience; I will elaborate on this below), you have some carbs and protein before a workout (he recommends 50g glucose and 30g protein powder as a starting point) and some after, as well. He feels that the insulin spike from the pre-workout carbs maximises the uptake of the post-workout carbs, also taken with protein. The amount will depend on both your Lean Body Mass (LBM) and just how much work you will do in the gym. In this way, you target the muscles with glucose, and the blood sugar spike will elicit enough insulin to push the glucose into the muscles you have just worked. You can assess your energy levels in the workout (assuming that you are an experienced trainer) and increase carbs if low, or decrease to maximise fat loss over the period in question.

Cyclic Ketogenic Diet (CKD)

The CKD involves a SKD all week (and a weight training routine designed to deplete muscle glycogen to a prescribed amount), then eating high-carb relatively low fat and protein meals (he recommends high Glycaemic Index (GI) carbs for this) and, if your body fat levels are low enough, a second carb-up day, where lower GI carbs are favoured.

The Advanced CKD

The Advanced CKD mixes the TKD and the CKD: carbs and protein pre- and post-workouts; and a carb-up day (or two – if you are lean enough!) on the weekend. Advantages of this approach are that one’s eating fits most people’s social lives better, one really can eat one’s favourite foods, once or twice a week, and fat gain is minimised (or can even continue, depending on the total amount of carbs and one’s mix of cardio and weights). Note that there is little fat gain in the carb-ups – an interesting ‘partitioning’ phenomenon occurs: assuming ketosis, incoming glucose is not used to replenish liver glycogen stores; instead it goes to the muscles that have been worked. Much more detail on these approaches can be found in his book.

Rob Faigin’s book Natural Hormone Enhancement (NHE)

Rob Faigin’s approach relies on a similar understanding of hormone interaction as we have discussed, but he emphasises the role of Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1). His critics suggest that he has over-emphasised this aspect. I do not intend to recapitulate his arguments here, but will say that, in sum, his book is a fascinating read too, and gives a wide and deep historical perspective for his recommendations. Rob’s book is more emotional in tone than Lyle’s, but this observation should not be construed as a criticism – it is both lively and informative and I consider it, with Lyle’s book, to be essential reading by anyone interested in ‘going against the mainstream’, diet-wise!

NHE method; starchy vs. surgary carbs distinction

Rob recommends a very low regime of low carbs to prime the system (20g/day for seven days). He does not discuss the use of the stix. The main difference in Rob’s dietary recommendations is that, contrary to Lyle, he recommends against pre-and post-workout carbs (and especially against using glucose in this way); instead he favours a three-day lo-carb cycle (50g/day, after the seven-day starting cycle) followed by an evening high-carb low-protein, low-fat meal (where starchy carbs are favoured over sugary ones (70%:30%). The next four days are lo-carb too; and followed by the second hi-carb meal of the week. This recommendation is for relatively sedentary people; his bodybuilding version suggests lower carbs on the lo-carb cycles, and more carbs in the carb-up meals, which may be split over two meals (so hi-carb late lunch followed by hi-carb dinner). The reason for the difference in the recommendations for bodybuilders is to increase the intensity of the ‘rebound’ effect, and to consume more carbs in total, to increase muscle resupply of glycogen. Rob recommends starchy carbs on the basis that these are less likely to be used to replenish liver glycogen (in contrast to sugary carbs that may, especially if sucrose: this disaccharide contains both fructose and glucose – the former being favoured for liver replenishment). It must be mentioned here that this distinction is somewhat simplistic, as all carbs enter the bloodstream as either glucose or fructose – this includes the ‘complex’ (or starchy) carbohydrates, too. Adding an understanding of Glycaemic Index (GI) to the equation may help here: high GI foods will generally replenish muscle glycogen preferentially.

For bodybuilders: Torbjorn Akerfeldt’s ABCDE diet

Deliberately under- and over-eating

Finally in this note, I want to canvas an interesting bodybuilding-specific approach, developed in Sweden by a biochemist-bodybuilder named Torbjorn Akerfeldt. He is the originator of the Anabolic Burst Cycling of Diet and Exercise (ABCDE) method and it, too, relies on manipulating the insulin/glucagon axis to favour using fat for fuel and using raised insulin to store glycogen, triglyceride and amino acids in the muscles. The basic approach is two weeks of underfeeding and two weeks of calorie excess – the underfeeding cycle is to lose body fat and to prime the metabolic system for storage, and this is capitalised upon during the following two weeks. ABCDE requires that you work out your Lean Body Mass (LBM), and thus your basal metabolic requirements (that is, how many calories you need to maintain your present body weight). Once you know this figure, you calculate the number of calories you eat during the ‘under-feeding’ two weeks (usually around 800 calories less than maintenance) and the ‘overfeeding’ (usually about 1,600 calories above maintenance). The results are said to be very significant: about 1-2.5kg bodyweight increase in the two week’s calorie excess (about 30% fat; 70% muscle, on his account), and the majority of that new fat is lost during the next low calorie phase. As one’s LBM increases, one’s calorie requirements do too, so these figures will need to be revised. Be aware that Torbjorn’s claims (re. amount of muscle gained in the overfeeding phase) have been questioned – the change in body weight may be mostly water.

Concept of protein cycling

An interesting aspect of Torbjorn’s recommendations is that it is good for a bodybuilder to cycle protein too: he claims that a few days of low protein (75-100g, LBM dependent) during the low-calorie period ‘resets’ the protein pool ‘turnover’ point to an optimal low, so that when you do increase protein intake once again in the following weeks, the body will use it to build muscle. His point is that if you are always eating a high protein diet (his example is 400g/day, not unusual in the bodybuilding world) the body gets used to this and continuing to eat these high levels no longer has the stimulating effect these amounts would otherwise have. As far as I can tell, this claim has not been tested by the research community. I can direct readers to a very technical discussion if interested.

How hard is it to go ABCDE?

Disadvantages of the ABCDE approach are maintaining the low calorie two-week period (low blood sugar levels, feelings of weakness in the gym, and so on) and (perhaps surprisingly) the difficulty of eating enough during the high calorie phase. Some people will not find this difficult, but I did – and the low calorie weeks affected my concentration levels at the computer, too. You may care to consider the ABCDE diet though – it may be effective if you can live with the side effects I mention.

Making sense of it all

Kick-starting ketogenesis; the importance of enough water; blood sugar swings

So – how to make all this work for you? I will intersperse my own experiences with these diets from here on. To recap, the real advantages of going keto (and doing weight training, or some sort of relatively high intensity exercise) is that you should be able to maintain more of your LBM than eating other ways. You will still need to be in calorie deficit for this to work, but in my experience it is truly effortless to do this on a ketogenic diet. If you are going to experiment in the ketogenic world, you will need to make a real commitment for the first week of low carb—and if you are addicted to them (as many people are) this will not be the easiest week. Don’t do it if you are really stressed at work, or embarking on a new project! Personally, I had no problem with this, but I ‘kick started’ the approach by fasting for 24 hours. I rested, drank plenty of water (extremely important on any diet, I will argue; I filter my own and drink 2-3 litres/day). Get some Keto Diastix and use them; this is an unambiguous way to know if you are in keto. Perhaps atypically, I found the fourth week to be harder, in the sense of having my mood adversely affected and I cannot trace this to any deficiency in following the plan (why I mentioned four to five week’s acclimatisation above). Once past that point, I have found mental function to be clearer, food craving entirely absent, no discernible blood sugar swings (and as those that know me can attest, this has not always been the case in the past!). As well, my body does not anticipate food as it used to and delayed meals have no effect either. This suggests that the new normal blood sugar (65-75 mg/dl, as mentioned) is more stable in its low phases and less elevated in its high phases – and that this stability suits me personally. It may suit you, too.

Can I have the odd drink?

Re. alcohol: be aware that alcohol consumption stops ketosis stone cold (the chemistry is complex; I can recommend an article if you are interested). Experimenting with the stix tells me that the worst kind of alcohol is Carlberg’s wonderful Elephant beer: two of these small bottle very high alcohol (9%!) beers stopped my brother’s ketosis from 8:00p.m. to 12:00 pm – the next day. Do not underestimate beer’s effects in this regard (possibly due to the fructose and maltose content on top of the alcohol). Conversely, one glass of red wine seems to stop ketosis for only an hour to an hour-and-a-half. This amount (and type) of alcohol is all that can be recommended, if fat loss is your goal. I suggest drinking even this minor amount only once or twice per week, if you are serious.

The crucial importance of enough dietary fibre

Protein shake composition; flaxseed oil

I suggest having two protein and water ‘shakes’ at morning and afternoon tea times – buy a good quality whey protein powder; it will mix with water immediately without a blender. Recall the body’s additional need for protein during the first three days, especially. Always add psyllium husks to all shakes – some people will suffer irregularities in bowel movement due to reduced food volumes and reduced fibre, otherwise. The psyllium husks take care of that perfectly. Do not use too much of these (start with half a teaspoon – experiment to determine your tolerance; some people cannot handle them well). I have kept the shakes going as a matter of course; for various reasons, males need 150g protein per day if weight training IMO (assuming 75kg bodyweight); you may need more or less. Getting 60-80g of this in two quick shakes seems like a good way to go. The protein and water mix can be augmented with a tablespoon or two of fresh cream once in ketosis proper (although technically three days, probably safe to either allow a bit longer, or use the stix to be sure) – remember that fat is not the enemy to someone in keto! The fact is, I have found it difficult to eat enough calories on a keto diet – I have found that adding the right oils/fats to the shakes is the easiest way for me to have enough. As well, the shakes can be a good opportunity to make sure that you are getting the essential fatty acids: put a tablespoon of flaxseed oil in the mix, too: delicious.

Personal experiences on CKDs

I should mention at this point that over a period of four months, my body fat has gone from about 15% to 10% (both estimates by competition bodybuilders at my gym) and I have maintained the majority of my body weight in the same period (down about 2kg from 79.9 to 77.5). This means that I have put on (in muscle weight) most of what I have lost in fat, which I regard as a fantastic outcome, and it exceeded my expectations. Realistically, it means that I have put on a kilogram or possibly two during a training phase where I lost a considerable amount of fat. I have not been able to do this on other eating approaches.

Java, Arrabica, or just coffee!

Re. coffee: coffee is your friend, especially to a first-thing-in-the-morning-weight-trainer. Caffeine releases the catecholamines: adrenaline and noradrenaline. Both help fat mobilisation, in addition to waking you up! If you do your training first thing in the morning, here’s another time to have a protein shake: a shake 30 minutes before you hit the gym, and breakfast afterwards seems to work well for me.

What should I eat when I do the ‘carb-up’?

Re. carb-up composition: Rob’s reasoning re. starchy vs sugary carbs seems right to me (if you factor in the GIs of the foods), but that may be a prejudice I have against sweet things. Lyle is strongly for glucose in pre- and post-workout carbs, but I found that seemed to give me a lightheadedness that I attributed to rapid increase in blood sugar, followed hard by insulin. I also know that his method works just fine for many people (like my bodybuilding friends at the gym) – so you will have to try it yourself and see what works for you. I have found the two carb meals (à la Faigin) a week are working very well – but I can also eat a reasonable amount of vegetable carbs daily without going out of keto – providing I don’t drink alcohol. Again, for me, the carb up day (following Lyle) didn’t suit my tastes or my body, but if you are a big eater (and plenty of weight trainers are!), then this aspect will suit you down to the ground. Please experiment.

And when I have remade myself, what then?

Re. what to do once your composition and weight are to your liking? I am going to write a separate article on this, but interested people may care to download a chapter from may last book, available from my web site in .pdf format so you may download it. It is called “Sensible eating” and is largely what I would recommend for maintenance. This was written in 2001, and on re-reading, there is very little I would change now. It recommends a roughly “isocaloric” diet (Dan Duchaine’s great term); so roughly equal amounts of fat, protein and carbs, the latter derived from vegetables mostly, with some fruit, to maximise phytonutrients. The URL will be found below.

Keto diets and longevity, and a couple of other questions …

A couple of concluding remarks: I was asked to answer a question or two on keto diets from one of my more insistent students, and I will answer here. Can ketogenic diets contribute to a longer life? Yes, possibly, with qualifications, I believe. The main advantage of going keto is to maintain your body fat at optimal levels – and all the hormonal advantages that entails. Longevity is more a function of one’s genes than any other factors, but exercising and maintaining optimal LBM is definitely advantageous (and enhances one’s functionality as well; no point in living long if you can’t function well!).

Kidney disorder caution

Keto diets and metabolic rate

She also wanted to know the effects on one’s kidneys; I will not dwell on this aspect except to note (following Lyle) that ketogenic diets are the treatment protocol of choice for children with epilepsy – and they stay on strict keto for years with no apparent ill effects. Of course, as mentioned above, no one with pre-existing kidney disorders should go keto; seek medical advice is the best advice here. Her last two questions are interrelated: do keto diets raise basal metabolic rate (BMR) and is doing so good from the perspective of longevity? As far as I know, BMR is related to total calories, more than other factors – the central reason Sears recommends an explicitly calorie restrictive diet. Briefly, his argument is that the only animal research re. dietary protocols that correlate with increasing life span is calorie restriction – and the mechanism is a slowing of the BMR (down-regulation of many metabolic processes). So, a ketogenic diet, if you are losing fat, suggests that (other influences like change in exercise routine aside) calories are lower than maintenance – hence I would assume that BMR would be down on your normal BMR too; this is conjecture, however. I will leave that to the experts.

The second part of her question can be clearly answered, though: if only longevity was the goal, then reducing BMR may help – but if optimising function is added to the list of desired goals, then exercise of various sorts is indicated – and BMR will be raised thereby.

Resources

There are a number of resources that you should use, rather than relying on this précis. First the references (I am trying to stock both Lyle’s and Rob’s books on my web site; I will advise via the home page when successful); the others are freely available:

Akerfeldt, T., 2000. Get ready to grow. Article in four parts, Muscle Media 2000. Interview of TA by Bill Phillips, available from the net on:

www.musclemedia.com/training/abcde/v58_abc1.asp (this gets you to part one; links there to remainder).

Erasmus, U., 1986. Fats that heal; fats that kill. Alive books, Burnaby, BC, Canada.

Faigin, R., 2001. Natural Hormone Enhancement. Extique Publishing, P.O. Box 694, Cedar Mountain, NC, USA

Grills and Bosscher, 1981. Manual of Nutrition and Diet Therapy. Macmillan Publishing, NY, USA

McDonald, L., 1998. The Ketogenic Diet. Morris Publishing, Kearney, NE, USA. A .pdf version of this is available from Lyle’s site:

www.theketogenicdiet.com/

Sears, B., 1999. The Anti-aging Zone. Regan books, NY, USA

Acknowledgements

My sincere thanks to Elzi Volk, a biochemist colleague in the US with a special interest in diets – her comments headed off some of the more egregious errors. All of the other ones are my fault entirely! As well, the article benefited greatly from being read a number of times by Dr Gregory Laughlin (he of the Elephant beer story fame); he is looking a lot leaner after following the advice contained in the article. My friend and colleague Bill Giles read the article and we had a number of lively discussions – it seems he and I have converged on similar recommendations (diet-wise) from completely different starting points. Thank you.

Kit Laughlin, June 7, 2003

Sensible Eating

Chapter from Stretching & Pregnancy, 2001

Some basic concepts

It is helpful to begin with some terms commonly used in discussing nutrition. This will be of assistance in understanding the recommendations contained in the rest of the chapter.

The components of food can be classified into three broad categories of macronutrients. These are protein, fat, and carbohydrate. All contain micronutrients. These are vitamins and minerals.

The energy content of food is now measured in kilojoules. Energy content used to be measured in kilocalories – commonly called, simply, Calories (with a capital C). One Calorie equals approximately 4.2 kilojoules.

Protein

Protein (from the Greek proteios, meaning ‘primary’), is made up of amino acids. There are nine essential amino acids (eleven for premature babies).

The proteins made up of these amino acids are the basic elements of:

  • more than 50 000 enzymes (essential to all chemical reactions in our bodies);
  • blood plasma; and
  • the structural proteins (for example, collagen, part of connective tissue, and muscle proteins).

Foods supplying proteins include:

  • meat, eggs, fish, and dairy products (these are high in proteins);
  • legumes, such as beans and lentils (moderately high);
  • whole grains (medium);
  • vegetables and fruit (low, but still significant).

Women require about 50 grams of protein daily. Pregnant women need an extra 30 grams per day (80 grams in total), and lactating mothers require about 20 grams extra per day (70 grams per day). Men require approximately 75 grams daily. These intakes of protein must include the essential amino acids in proportions suitable for our bodies.

Protein contains approximately 16.8 kilojoules (4 Calories) of energy per gram.

Fat

Fat is comprised of fatty acids. Some fats are said to be saturated (for example, animal fats) and others are said to be unsaturated (for example, olive oil). These terms refer to their chemical structure.

Just as there are essential amino acids, there are also essential fatty acids (EFAs) that our bodies must have daily. These are used to make all other required fatty acids. Fats make up (in part):

  • hormones;
  • cell membranes;
  • nerve sheaths; and
  • cellular transport mechanisms.

They are therefore essential to life.

Our bodies are made mostly of protein and fat, with some minerals.

Because fat contains 37.8 kilojoules (9 Calories) per gram, it is a concentrated source of energy.

Carbohydrate

Carbohydrate is the preferred energy source for our bodies. All vegetables, fruit, and grains are sources of carbohydrate. They are usually classified as being simple carbohydrates (sugars) and complex carbohydrates (starches).

Gylcaemic index (GI) is a useful measure of carbohydrate activity in the body. This indicates how rapidly a food is converted to glucose and how quickly blood glucose, the body’s fuel, rises.

Carbohydrate, like protein, contains about 16.8 kilojoules (4 Calories) of energy per gram.

Micronutrients

The micronutrients are:

  • vitamins (the absence of which leads to specific disease); and
  • minerals (which are essential for chemical and metabolic processes).

Some vitamins are antioxidants. This means that they bond with free radicals – which are byproducts of oxygen reactions in the body, and harmful in excess. This bonding leads to elimination of the antioxidants from our bodies.

Taking a new look at food

The majority of articles on food tend to concentrate on the kilojoule (or Calorie) content of food. Because fats contain the most kilojoules, these articles therefore tend to concentrate on the fat content of food. This has serious limitations for pregnant and lactating women. It is better to think about food in terms of the combinations of foods that will provide optimal nutrition for you and your child.

Expectant women (indeed, any person interested in health!) should try to minimise or avoid less desirable foods and maximise desirable foods in their diet. Desirable foods maximise nutrition and thus provide kilojoules that are beneficial. Less desirable foods have high kilojoule density and low nutritional density. The term ‘nutritional density’ refers to the extent to which the fifty nutrients that are essential to life are found in a particular type of food.

Let us look at a few examples.

White bread is very dense in kilojoules. One slice of white bread has roughly the same number of kilojoules as more than three and a half cups of broccoli – but the broccoli contains a huge range of additional vitamins, minerals, and phytonutrients (see below for more on phytonutrients).

White sugar is rich in carbohydrate, but contains no other nutrients –in fact, its digestion removes various micronutrients from the body, and its kilojoule density is relatively high. In contrast, spinach is rich in a large variety of nutrients. However, because of its vegetable structure, it is low in kilojoules.

As far as possible, you should try to eat food that is relatively kilojoule sparse and relatively nutrition rich because this ensures that the amount of nutrition you get in each mouthful of food is optimised. In the process, you will be avoiding unwanted weight gain (body fat). The total amount of energy that you need will depend on your activity level.

Another way of understanding this is to say that if you eat more of your food from the list of ‘What to include’ (below), you can eat a greater amount of food to achieve your desired kilojoule total, and each mouthful is giving you more in terms of nutrition.

And remember that all foods eaten in excess of energy requirements are stored as fat.

When choosing food, it is helpful to know that some complex carbohydrates have a very high glycaemic index (GI). In general, lower GI foods are preferable to higher GI foods because foods with a lower GI provide energy over a longer period. Pure glucose is given the highest rating of 100 and is the benchmark against which other carbohydrates are measured. The basic GI of a food can be altered significantly by refinement. For example, a boiled new potato has a GI of 62, whereas instant potato from a packet has a GI of 83. Whole grains have low GIs (for example, crushed wheat used in Lebanese food is less than 50), but refined grain products (bread and biscuits) can be 90 or more. Although many grain products are described as ‘complex carbohydrates’, they can behave like a simple sugar once digested, so consideration of GI can be helpful.

Notice that many refined foods are found in the list of ‘What to minimise or exclude’ (below). The refining process generally increases carbohydrate density (the amount of carbohydrate in any volume of food). The refining processes also usually remove essential fatty acids and other highly reactive food substances. The result is a tendency to lower nutrient density. These substances are removed in refining to increase the food’s shelf life.

Therefore, if you are concerned with maximising nutrition, you should eat more unrefined food sources. Of course, some foods are nutritionally and relatively kilojoule dense (for example, meat).

Desirable foods

These lists are only a rough guide. They are designed to help you look at food a different way, and to assist you to choose food that is better for you.

High-quality protein and low-to-medium saturated fat

  • lean meat (beef, lamb, pork, venison, game meats)
  • chicken (remove skin)
  • fish (especially salmon, tuna); fresh, smoked, or canned

Medium-quality protein and medium-density carbohydrates

  • dried beans
  • kidney beans
  • lentils
  • chick-peas
  • cracked wheat
  • brown rice
  • soy beans (canned beans are OK)
  • tofu

Medium-quality protein and beneficial fat; high nutrition

  • brazil nuts
  • pecan nuts
  • almonds
  • cashews
  • hazel nuts
  • avocado

Low-density carbohydrates; high nutrition (fruit with medium-to-high GI)

  • grapes (black grapes best; but also green grapes)
  • bananas
  • oranges and other citrus fruits
  • apples and pears
  • figs (fresh)
  • dates (fresh)
  • cherries

Low-density carbohydrates; high nutrition (vegetables with relatively low GI)

  • capsicum
  • spinach
  • broccoli
  • cauliflower
  • potatoes (boiled)
  • celery
  • zucchini
  • Chinese vegetables
  • onion
  • garlic
  • ginger
  • peas
  • beans
  • carrots (raw)
  • Brussels sprouts
  • other sprouts (mung, soy, alfalfa)

Medium-high density carbohydrate; low-medium protein; good nutrition

  • ‘heavy’ breads (dark rye, pumpernickel)
  • slow-cooking oats
  • whole-grain pasta
  • skim milk
  • skim-milk yoghurt

Less desirable foods

Medium-high GI carbohydrate; low protein; kilojoule-dense

  • breakfast cereals (packaged)
  • rice (white)
  • bread (white; ‘light’)
  • pasta
  • potatoes (instant)
  • rice (instant)
  • fruit juices
  • sugar (raw)
  • honey
  • potato chips
  • biscuits
  • cakes
  • instant noodles
  • soups (packaged)
  • chocolate
  • fruit (canned; versions with no added sugar better)

High saturated fat; trans-fatty acids; low-medium protein; kilojoule-dense

  • ‘TV’ dinners (including ‘low-fat’)
  • pizza
  • hamburgers
  • ‘fast’ or ‘junk’ food

Medium-low density carbohydrate; low protein; high GI

  • carrots (cooked)
  • potatoes (baked or fried)
  • parsnips (cooked)
  • broad beans
  • dried apricots
  • baked beans (canned)

Foods with no known nutritional value

  • cordials
  • sweet carbonated drinks
  • white (refined) sugar
  • sugar-coated food

Some suggestions for meals of the day

In the pages that follow is a list of what foods to include in a sensible eating plan (and what to minimise or avoid), followed by a discussion of the reasons for our recommendations.

What to include

Breakfast

  • grain-based source (unrefined if possible);
  • protein source, or health shake (recipe suggestions below);
  • piece of fresh fruit.

Mid-morning snack

  • piece of fruit plus piece of cheese; or
  • closed handful of raw mixed nuts and piece of fruit; or
  • two to three tablespoons of cottage cheese and fruit; or
  • small tin of tuna or salmon and piece of fruit; or
  • meal replacement (drink or bar).

Lunch

  • palm-sized lean protein source;
  • two-hand-sized salad; or
  • hand-sized lightly cooked vegetables; or
  • half-and-half salad and cooked vegetables (approximately two-hand-sized);
  • piece of fruit (optional).

Afternoon snack

  • same as mid-morning snack.

Dinner

  • protein source;
  • fresh vegetables (starchy and leafy);
  • piece of fruit.

What to minimise or exclude

  • recreational drugs;
  • coffee and tea;
  • refined packaged food sources;
  • ‘fast’ food;
  • fried food;
  • foods that are kilojoule-rich and nutrient-sparse (high GI foods);
  • excessive kilojoules;
  • foods rich in saturated fats;
  • sweet carbonated drinks and refined sugar;
  • low-fat packaged foods; and
  • ‘convenience’ food.

Reasons for recommendations

Breakfast

In our list of ‘What to include’ (above), the following recommendations were made for breakfast:

  • grain-based source (unrefined if possible);
  • protein source, or health shake (recipe suggestions below);
  • piece of fresh fruit.

Some thoughts on each of these is included below.

Grain-based source

There are two traditional Australian breakfasts – which might be termed the ‘bacon-and-eggs approach’ and the ‘cereal (grain) approach’. Both have good aspects, and not-so-good aspects. (Cereals are considered immediately below; for bacon and eggs see under ‘Protein source’, below.)

The best grains for breakfast are ordinary oats. Not only are they a source of slow-release energy (low GI of around 40), but also they contain gamma linolenic acid. Indeed, oats are one of the very few plant sources of this desirable fatty acid. You can add some honey, fruit, and milk (dairy or soy) if you wish. Note that the more ‘instant’ forms of oats generally have a higher GI.

Less-desirable sources of carbohydrate are the more-refined breakfast cereals. Try to get organically sourced and wholegrain cereals if you can. The least desirable grain-based carbohydrate sources are the even more refined versions of these foods, and the worst ones have the individual flakes covered in sugar.

Other desirable sources of unrefined carbohydrates are the heavier (in weight) of the wholegrain breads, pumpernickel (dark rye) bread, and mixed-grain breads. Less desirable are the ordinary brown breads, and the least desirable is white bread – even if the label does say that it is fortified with extra fibre. If you are eating sensibly, fibre will not be a problem.

Protein source

There are many sources of protein.

If you eat animal protein, a couple of soft-boiled or poached eggs, or an omelette made of two or three eggs (with your favourite filling) is an excellent choice. If you are concerned about excess cholesterol intake, simply do not eat some of the yolks. (The yolk contains some cholesterol, but many nutritious substances too.) If you have two or three soft-boiled eggs for breakfast, you can choose to have the yolk of one and eat only the whites of the other two. (However, it is always a good idea to have at least one yolk.)

Bacon and eggs supply a good amount of protein – often missing in many modern breakfasts – but can supply significant amounts of saturated fat. Reserve for special occasions, and use lean bacon!

Other good protein sources are cheese and yoghurt (especially good with mixed raw nuts, fresh fruit, and/or honey for additional flavour).

Health shake

A health shake is a good way to ‘jump-start’ your morning with excellent quality nutrition.

The basic liquid into which the other ingredients is blended is a matter of choice. You can use 50:50 fruit juice and water, or you can use a low-fat high-calcium milk source (or a soy-milk equivalent). If you prefer, you can use whole milk. However, if you are adding yoghurt and other products to it, the end mixture can be quite thick and heavy.

To the basic liquid, add two or three generous tablespoons of yoghurt (flavoured or non-flavoured). The organic ones are best, or you can make your own. If you look at the contents of many of the brands of yoghurt that you find on the supermarket shelves, you will be amazed at how much sugar they contain. The best of the organic yoghurts are flavoured with real fruit and do not contain preservatives or any other extra chemicals. A raw egg or two can be added.

Add some fresh fruit. Bananas taste good, and they blend extremely well, but any ripe fruit can be used. Some people don’t like the idea of mixing citrus fruit with a milk-based drink (if you are using milk or similar as the base), but the resulting mixture has an excellent taste.

If you feel that you need additional protein at the beginning of the day, you can add about 10 grams (about a tablespoon or two) of a suitable protein powder. Whey protein powder is said to have the highest ‘biological value’. This means that more of the protein in the powder is taken up by the body than a similar amount of another protein source, but really any powdered protein will do. If you are on a budget, use two or three tablespoons of skim milk powder. Skim milk contains casein which is an excellent high-quality protein. Vegetarians can fortify their shakes with soy protein, available from a health food shop. If you need extra fibre, Psyllium husks (one or two teaspoons) can add the right kind of fibre – good insurance with no ‘down’ side, in any case.

The final part of the health shake is a tablespoon of an oil containing the essential fatty acids (EFAs). These are linolenic acid (LNA) and linoleic acid (LA). Research suggests that the average Western diet is low in LNA. The addition of oil to the basic mixture makes the resulting shake taste creamy and delicious, even if you haven’t used yoghurt. Flax seed oil is the best source of LNA, and is obtainable from a health food shop. It is stored in dark bottles and must be kept in the refrigerator.

This is a useful place to discuss the fats that everyone is afraid of. Cholesterol, a saturated fat, is an essential substance in the body, but does not need to be eaten. Cholesterol is produced by the liver and is a major fraction of brain tissue and the nerves of the body. High blood cholesterol is usually a result of genetics, but good dietary habits (increasing EFAs and fibre) and adopting the relaxation strategies described in Chapter 2 can be beneficial. Trans-fatty acids are toxins produced by heating and refining oils, and using oils to fry. In the pursuit of good health, these cooking practices need to be minimised. Sufficient EFAs and antioxidants (such as vitamins A, C, and E) should be included in your diet to help your body process transfatty acids.

LNA is also found in soy bean and walnut oils, and dark green leafy vegetables. The other essential fatty acid, LA, is found in safflower, sunflower, soy bean, sesame, and flax seed oil. Buy oils that contain EFAs from a health food shop, and choose coldpressed organic sources. These oils cannot be used for cooking.

A note for lactating mothers: the Nursing Mothers Association of Australia (NMAA) states that ‘if you are eating enough for your own energy requirements, the fatty acid pattern in your milk will resemble that of your diet’ (Carafellam ,1996). This is good reason for asking yourself if you have sufficient EFAs in your diet.

The breakfast is finished with an optional piece of fresh fruit (discussed below).

Mid-morning snack

In our list of ‘What to include’ (above), the following recommendations were made for mid-morning snack:

  • piece of fruit plus piece of cheese; or
  • closed handful of raw mixed nuts and piece of fruit; or
  • two to three tablespoons of cottage cheese and fruit; or
  • small tin of tuna or salmon and piece of fruit; or
  • meal replacement (drink or bar).

Some thoughts on each of these are included below.

Piece of fruit plus piece of cheese

Any ripe fresh fruit is a good source of simple (and some complex) carbohydrates, minerals, vitamins, and fibre. Ripe bananas are especially good. The notion of complex carbohydrates can be a bit misleading however, because the bonds between the glucose molecules (that give rise to the term ‘complex’) are easily broken down. This process begins in your mouth (during chewing) and is normally completed in your stomach (during the first stage of digestion). Some complex carbohydrate sources can raise your blood sugar level quite quickly. However, because you are having only one piece of fruit and a small amount of protein together, this will not be a problem. Any cheese will do, but if you are concerned about your intake of cholesterol, consider a low-fat variety.

Closed handful of raw mixed nuts and piece of fruit

All nut varieties contain beneficial fatty acids. If the nuts are roasted, the chemical composition of some of the fatty acids can be changed, so it is probably best to eat nuts raw. Eating mixed raw nuts ensures that a greater variety of essential fatty acids is consumed. Nuts are also a good source of protein, contain no cholesterol, and have minimal amounts of saturated fats.

Two to three tablespoons of cottage (or ricotta) cheese and fruit

Cottage cheese is made from milk and contains casein, an excellent high-quality protein. It is also low in saturated fat. Add this to a piece of fresh fruit and you have an excellent snack.

Small tin of tuna/salmon and piece of fruit

Fish is a form of protein that cans very well. Two fatty acids found in the oils of coldwater fish are part of the same omega 3 fatty acid family that includes LNA. Salmon is a migratory fish, and it has a high oil content.

The oil found in fish is good for your body. Recent research suggests that increasing your consumption of these fatty acids can help prevent cardiovascular disease. The extent to which these fatty acids are changed by the canning process is unclear. A better source of these oils is sliced smoked salmon (found in supermarkets).

Together with a piece of fruit, you obtain a small amount of excellent-quality protein and a small amount of easily digested carbohydrate.

Meal replacement (drink or bar; check label for the ‘extras’)

There is an increasing variety of meal-replacement bars or powders on the market. Careful reading of the labels reveals an extraordinary variation in the proportions of carbohydrate, protein, and fat in these products. If you want to use a meal replacement, choose one in which these various nutrients are present in approximately equal amounts in terms of kilojoules. Many manufactured substances can be used to make the final product taste and feel like food. Check the labels!

Be aware that if you use low-fat or fat-free meal replacements, the rate at which the carbohydrate enters your bloodstream is faster than it would be if some fat is present in the product, and this can raise the blood sugar level of some people a bit too rapidly. For this reason, the bars that have some fat in them (depending on the kind of fat) are generally preferable to the ones with little or no fat.

Lunch

In our list of ‘What to include’ (above), the following recommendations were made for lunch:

  • palm-sized lean protein source;
  • two-hand-sized salad; or
  • hand-sized lightly cooked vegetables; or
  • half-and-half salad and cooked vegetables (approximately two-hand-sized);
  • piece of fruit (optional).

Some thoughts on each of these are included below.

Palm-sized lean protein source

The basis of our sensible eating plan is to maximise the amount of nutrition in the food that we eat and minimise the number of ‘empty’ kilojoules (little or no nutrition). A quick way of assessing your diet is to consider it in terms of how much carbohydrate, protein, and fat are likely to be in it.

The various Zone books by Barry Sears, and Body of Life by Bill Phillips, both recommend an ‘eyeballing’ method for assessing protein and carbohydrate quantities. This is because the body can assimilate only about 25 grams of protein at any one sitting. The rest is excreted or stored. Accordingly, it is a good idea to have just the right amount of any nutrient. A palm-sized piece of lean protein will contain 25–40 grams of protein, depending on its thickness (and the size of your palm!). To help you assess, 100 grams of steak contains about 25 grams of protein. Vegetarians (vegans or lacto-ovo vegetarians) will need to give some thought as to how much protein (and what proportion of which amino acids) is being consumed in their favourite food sources.

Two-hand-sized salad

Have some raw vegetables at most main meals, before or during the rest of the meal. Raw vegetables contain many enzymes that the body can use to help digest proteins, carbohydrates, and fats in the food that you eat. To ensure the greatest variety of phytonutrients, try to have as many colours in the salad as you can.

Many vegetables can be added to salads. These include varieties of lettuce (common in many salads), beetroot and carrot (can be grated), beans and peas (added raw), and broccoli and other brassicas (lightly steamed before adding). There are, of course, many other vegetables that can be added.

Nuts can be added to salads to increase the protein and (beneficial) fat content.

If you use one of the recommended oils as part of your dressing, salads provide a very convenient way of getting some of the two essential fatty acids.

Eat roughly ‘hand-sized’ if you are having other vegetables; increase the salad serving size if not.

Because these foods are low in carbohydrate density, you can eat as much as you like.

Hand-sized lightly cooked vegetables

The recommendation of a ‘palm-sized’ piece of lean protein (above) provides a simple assessment of how much protein to eat at each meal. This also applies to the suggestion to have a hand-sized serving of lightly cooked vegetables. This amount provides a good balance to the palm-sized protein source that you are combining with this meal. Together, you will get an excellent source of carbohydrates, proteins, and fats.

In addition, the vegetables (raw or lightly cooked) will provide you with many of the vitamins and minerals that are needed in daily life. Your body requires nutrition ‘as needed’. This means that you need to have all of the fifty essential nutrients (discussed below) almost every day. This means, for example, that it is not good to have a big serving of spinach on Monday, and not eat any other dark-green leafy vegetables until Friday.

Food is cooked to make it more palatable, and some nutrients are released by the process. However, many enzymes are denatured or destroyed if food is cooked for too long or too hot. This is why we recommend lightly cooked vegetables.

The best way to cook vegetables is to use a non-stick pan, or to cook in a quarter of a teaspoon of butter or coconut oil. Add a quarter of a cup of water, fit a tight lid, and steam the vegetables. Add some of your favourite oil as a dressing after cooking. Recommended oils include virgin olive (Australia is making some wonderful olive oils now) or a mixture of the oils that will supply the essential fatty acids.

Half-and-half salad and cooked vegetables (approx. two-hand-sized)

An even better suggestion to increase enzyme and nutrient intake in the diet is to have a salad and some cooked vegetables which, together, form roughly a hand-sized serving. This is fiddly, however, and you might choose to have your cooked vegetables at lunch and your salad at dinner, or vice versa. Have a slice of a heavy bread, if you wish.

Piece of fruit (optional)

To finish lunch, you can have a piece of fruit. But this is optional, and you might simply be too full to eat another thing! If you do leave fruit out of your lunch, you can have it for an afternoon snack.

Afternoon snack

Same as for mid-morning snack.

Dinner

In our list of ‘What to include’ (above), the following recommendations were made for dinner:

  • protein source;
  • fresh vegetables (starchy and leafy);
  • piece of fruit.

Some thoughts on each of these are included below.

Protein source

We need a protein source at dinner too. We have suggested using the palm of your hand as a rough assessment of the desired 25–30 grams of protein. But where does that leave someone who wants to eat spaghetti bolognese or similar for dinner? The answer is that the same ‘palm-sized’ vs ‘hand-sized’ proportion as a guide still applies, but consider a small kitchen ladle to be equivalent to a palm-sized serving. Assuming a sauce that contains protein and carbohydrate, consider the ladle volume to be the protein part, and have an equivalent amount of the pasta. Compared with vegetables, pasta is carbohydrate dense, so a smaller amount is required for balance. Have some additional low GI vegetables on the side.

A salad with many different kinds of vegetables is an excellent complement to this meal. However, starchy vegetables are denser carbohydrate sources and, if you choose a lean palm-sized protein source, you will probably want to include some of these starchy vegetables as well – to make sure that you are getting sufficient carbohydrates. (You might also have a slice of one of the heavy breads.) Starchy vegetables include the tubers (including potato, sweet potato, and pumpkin).

Avoid deep-frying these vegetables. Deep-frying in otherwise good vegetable oil changes the oil and creates substances called trans-fatty acids, which are no good for your body at all. It is far better to steam or boil the vegetables and add some sort of good oil at the serving stage.

If you wish, have a tasty ripe piece of fruit to finish the meal.

Reasons for minimising or excluding

Recreational drugs

This might seem obvious as a suggestion for a pregnant woman, but it is nevertheless worth emphasising. Once you know you are pregnant it is very wise to avoid all recreational drugs – including alcohol. The most important reason is that in developed countries, folate deficiency is often linked to excessive consumption of alcohol. Alcohol limits the absorption of this vitamin. Inadequate folate is definitely associated with neural tube abnormalities in the foetus (producing disorders such as spina bifida) and might well be associated with miscarriage. A list of foods containing folate can be found below.

Another reason for our strong recommendation against the use of recreational drugs during pregnancy is the increased likelihood of various other birth defects. Apart from alcohol, recreational drugs include tobacco, stimulants of various kinds, marijuana, and other non-prescription drugs.

You should also check all prescription drugs with your doctor to make sure that these drugs pose no threat to the developing foetus.

Tea and coffee

Green teas, in particular, have been found to be good sources of various antioxidants. This is good news if you like tea! However, tea is a mild diuretic (that is, it causes the body to lose water), so make sure that you have your tea reasonably weak and have a glass of water for every cup.

Coffee, unfortunately, doesn’t seem to have any benefits according to many researchers – unless you count its great taste! If you consume too many cups (usually reckoned at more than three per day) you will encounter one of the disadvantages of this drink – too much caffeine. This can make you irritable and can make your hands tremble. Coffee, depending on the strength, is a stronger diuretic than tea, so have a glass of water with every cup you drink to offset this effect.

Anecdotal evidence suggests that coffee can affect the foetus. Many women note increased foetal activity if they drink coffee.

Expectant women are advised to limit both tea and coffee.

Refined packaged food sources

These are not recommended because of the refinement process which removes some, and sometimes many, of the original nutrients.

The exception is packaged frozen vegetables. Unlike supermarket produce, it is picked and ‘snap frozen’ when ripe. Research suggests that some of the desirable phytonutrients form during the ripening period. With fruit, this is in the last few days of ripening. Canned fruit can be used when fresh fruit is not available. Use the ‘no added sugar’ varieties.

Because ripening is so important, organic fruit and vegetables are desirable. They are picked closer to this ideal time before being brought to market.

‘Fast’ foods

‘Fast foods’ include takeaway hamburgers, pizzas, and the like. The carbohydrates of these foods are usually kilojoule-dense and nutrition-poor, and a high proportion of the fats are saturated.

In addition, the method of manufacture of these foods tends to produce trans-fatty acids. Trans-fatty acids are broken down much more slowly in your body than the recommended fatty acids, producing much larger amounts of free radicals. Some researchers have linked high amounts of trans-fatty acids to an increased susceptibility to various cardiovascular and degenerative diseases.

Fast foods also usually contain a large (often surprisingly large) amount of sugar and salt.

Margarine vs butter

Trans-fatty acids, in addition to being found in fried foods, are also found in hydrogenated vegetable oil products, in many packaged foods (check the label to be sure), and in margarine. All margarines start their life as vegetable oils – some of which are unsaturated and some of which are polyunsaturated. All are liquid at room temperature.

During manufacturing, these oils are hydrogenated (an artificial saturation process) to make them more or less solid at room temperature, and thus able to imitate the spreadability and texture of butter. This process leaves the final product full of trans-fatty acids (which, as explained above, should be minimised).

Products that are a combination of butter and margarine must be treated with caution for the same reasons.

Butter might be better, after all.

Fried food

The inadvisability of eating deep-fried food has been mentioned above, but how can you cook all of the other food that you eat?

One way is to use a variation on a traditional Chinese method of stir-frying. Instead of throwing oil into the bottom of the wok or a non-stick frying pan – and heating vigorously until it smokes, as some recipe books suggest – put in a ladleful of water or stock, instead of the oil. Depending on the recipe, you can substitute canned or fresh tomatoes. To this, add garlic and the other seasonings. Once the seasonings and other condiments have been cooked sufficiently, add the vegetables and other ingredients. Immediately cover the pan or wok with a tight-fitting lid.

Cooking this way ensures that the minimum amount of nutrients will be lost and that the food will be steamed and partially boiled.This method will ensure that the cooking temperature of the foods will not go above 100 degrees Celsius – the highest temperature that cooking water can reach.

Keeping the cooking temperature at or below 100 degrees Celsius reduces the conversion of fatty acids to trans-fatty acids. In addition, because the temperature is relatively low, some of the enzymes and other volatile food elements remain largely unchanged.

When you remove the lid and are ready to serve, you can add a good-quality oil. Olive oils and other oils can be added in this way, and the taste is different from cooking with oils. It is, in fact, delicious.

As well as the other benefits, the oil itself hasn’t been changed by the cooking process. Therefore, the benefits of the particular oil that you add will be experienced.

Most foods that are traditionally fried can be cooked in this way. Of course, you can’t make chips like this! However, chips and other fried (or roasted) vegetables should not be part of your usual diet. Keep these for special occasions!

Foods that are kilojoule-rich and nutrient-sparse (high GI foods)

The ratio of kilojoules (or Calories) to nutrients, and the GI, of any food can be changed by its method of preparation. For example, carrot juice has a much higher GI than a whole raw carrot, and is missing most of the beneficial fibre contained in a whole raw carrot. To take another example, whole grains are excellent sources of all sorts of vitamins, minerals, fibre, essential fatty acids, proteins, and carbohydrate. However, the refining process used to produce the final form of the food that most of us eat removes almost all of the nutritional components except the carbohydrate.

As mentioned previously, although white bread is often described as a good source of complex carbohydrate, it can have a GI as high as 90. Surprisingly, ordinary white table sugar has a GI of only 65, which suggests that its rate of conversion to glucose is significantly slower than white bread. (For a quick comparison, according to Brand Miller et al. 1996, cherries have a GI of only 22, apples 36, and bananas approximately 55.)

The biggest surprise in looking at GIs is that many ‘complex’ carbohydrates are treated like simple sugars by your body. Foods in the ‘desirable’ list above have lower GIs on average, and foods in the ‘less-desirable’ list have higher GIs. (Some foods in the ‘desirable’ list have relatively high GIs, but these are nutritionally dense as well.)

Don’t cut out all of the things that you really love to eat. Rather, use the lists to think about whether or not the food you are about to eat is located more at one end of the nutrition spectrum than the other, and make adjustments to suit. During pregnancy, the food that you eat feeds both you and your baby. Every nutrient advantage that you can manage is to the benefit of both of you.

Sweet carbonated drinks and refined sugar

These drinks are a perfect example of a kilojoule-dense nutrient-sparse food. The amount of refined sugar contained in sweet popular beverages is extraordinary. For example, a standard can of drink can contain 10–20 teaspoons of refined sugar. If you consume one or two cans (or bottles) of these drinks a day, you are getting a huge number of extra kilojoules that are of no nutritional benefit.

Minimise these products as far as possible. Much the same goes for the commercially made fruit juices. These also contain lots of sugar and not too many nutrients. You are much better eating a piece of fruit instead.

Some years ago, a book came onto the market with the alarming title Pure, White and Deadly. The book referred to ordinary refined white table sugar (sucrose). It now seems likely that the alleged dangers of white table sugar were exaggerated, but it is a good idea to minimise the amount of additional sugar added in cooking – simply because sugar is pure carbohydrate with no other nutrients. There might be some benefit in using unrefined sugar (rather than the refined version), but any nutritional benefits are likely to be small.

So what should you do about desserts? Desserts (like chips) are best reserved for special occasions. This is because desserts are usually relatively kilojoule-dense compared with the rest of the meal. Of course, you can calculate the approximate number of kilojoules (Calories) that you want to eat in a meal, and make the necessary adjustments. But if you are eating for two people, there are grounds for reducing the consumption of desserts and increasing the consumption of more nutritious foods.

There are, however, some desserts that are nutritious in their own right. These sorts of desserts can simply be considered as part of the total meal.

Low-fat packaged sources

Labels advertising ‘low cholesterol’ can be found on all manner of foods these days—including avocados in supermarkets and greengrocers’ shops. This preoccupation with ‘cholesterol’ is reflected in the stated goals of a US Senate Select Committee on Nutrition and Human Needs which published its report in 1977 (Grills and Bosscher 1981). These goals focus on the prevention of diet-related diseases such as obesity, cardiovascular diseases, diabetes, and dental disease. Among the goals was a recommendation to reduce overall fat consumption from approximately 40% to about 30% of energy intake (not a huge reduction) and a further recommendation to reduce cholesterol consumption to about 300 milligrams per day. Most people have absolutely no idea of what 300 milligrams a day of cholesterol means. (I certainly don’t!)

Much has been made of the association of cholesterol and other saturated fats with cardiovascular disease, and this is one of the reasons for fat-free and low-fat foods being promoted so aggressively. The problem with this recommendation is that it makes no distinction between beneficial and harmful fats. A further problem with very low-fat products is that the remainder of their composition is largely carbohydrate. Above, we noted that if complex carbohydrate is eaten without the GI-lowering effects of the right kind of fat and fibre, the conversion of complex carbohydrate to glucose can be very rapid.

Another associated problem is that in the effort to make the processed food as low in fat as possible while retaining the ‘taste’ of fats, the use of various substances not found in the original food has increased. For example, commercially prepared yoghurt contains all sorts of chemicals that are not in the original milk (soy, dairy, or goat’s milk) that is used to make traditional yoghurt. Minimising the intake of these additional substances is probably prudent.

Artificial sweeteners should also be regarded with caution. Sears (1999, page 281) states that aspartame ‘should never have become part of the food supply’. Use natural sweeteners sensibly.

‘Convenience foods’

Many of the remarks made about other foods also apply to convenience foods. The only real ‘convenience’ here is preparation time. If one is eating with nutrition in mind, the ‘convenience’ might turn out to be an illusion.

The basis of the sensible eating plan

The following section provides more detail on certain elements of nutrition. You might feel that you already have enough information on which to base your eating plan. However, if you feel that more detail will assist your food choices, read on!

Fifty nutrients are essential to support human life. They are discussed below.

Essential amino acids

There are twenty-two amino acids, but only nine (or eleven for premature infants) are ‘essential’ in your diet. If your body has the full spectrum of these essential amino acids your body can make the remainder.

All animal sources of protein are ‘complete’ – meaning that all the essential amino acids are present in a ratio that is favourable for humans. However, all animal protein sources contain saturated fat as well.

Vegetarian sources vary in the favourability of their ratios. For example, corn has been traditionally eaten with beans in some parts of the world. Corn on its own lacks an amino acid called lycine, but beans have this amino acid in abundance. Together, corn and beans contain all the essential amino acids in a favourable ratio.

Recent research suggests that your body has an amino acid ‘pool’ – which exists for half a day to a number of days. If you are a vegetarian and you eat a protein source that is low in a particular amino acid, you probably don’t have to worry too much. At the next meal you will probably eat a food containing the missing amino acid. However, if you wish to be meticulous, and you think that there is a benefit from eating complete proteins at every meal, give some thought to combining your proteins.

Another traditional protein combination is rice and sesame seeds. There are several other similar combinations. Diet for a Small Planet, an excellent source of nutritional advice, is an invaluable source of this kind of information. Note that all the grain sources have some high-quality protein, and this content is higher if the grain source is unrefined (unprocessed).

Essential fatty acids

There are only two essential fatty acids. If you have the two essential fatty acids in your diet in the right proportion, your body can make all of the other fatty acids needed for health.

The opinions of researchers differ considerably on the ideal proportion of omega 3 to omega 6 fatty acids. Erasmus (Fats that Heal, Fats that Kill) suggests that most people in the modern Western world are significantly deficient in LNA, an omega 3 fatty acid. If your diet in the past has been high in saturated fats and you have eaten a lot of fried foods (and hence have had significant amounts of trans-fatty acids in your body), Erasmus recommends adding extra omega 3 fatty acids to your daily intake for six months or so.

The best vegetable source of this particular fatty acid is the oil derived from flax seeds. This is available in the refrigerated section of health food shops. This is a particularly reactive substance, and for this reason it is sold in opaque containers, and must be kept refrigerated. Never use this for cooking. It is best added to foods after cooking, or on top of other breakfast cereals or yoghurt. A tablespoon or two is the recommended daily amount. Once you feel that you have achieved some sort of balance in the fatty acids in your body, you might wish to change the proportion of the two essential fatty acids.

Apparently hemp oil contains a more or less ideal balance for human consumption – but I haven’t seen any hemp oil available in my local health food shop! A better way is to combine flax-seed oil with one of the other cold-pressed vegetable oils that is rich in omega 6 fatty acids. These include safflower oil, sunflower oil, and sesame-seed oil. Again, do not use these oils for cooking—they are damaged by heat. They should be mixed up and used as a salad dressing, or used as a topping on other foods.

The main fatty acid of olive oil is oleic acid. This is not an essential fatty acid, but it might have benefits for people at risk of cardiovascular disease—provided it is virgin or extra virgin olive oil. These terms refer to the pressing process that removes the oil from the olives, and virgin or extra virgin olive oil are produced in a way that maintains the maximum nutritive value of the oil. The term ‘light’ (and other terms that you see on oil labels) tells you that it is not virgin—and hence processed in some way. Such oils should be minimised or avoided.

Minerals

In Australia, until recently, vitamin and mineral preparations were not permitted to contain selenium – even though Australian soils are said to be the poorest in selenium of any soils in the world. The reason for this prohibition was that, like many substances, selenium is toxic in large doses. However, selenium is now a permitted mineral in supplements.

The results of a full blood assay can be very helpful in planning food choices and possible mineral supplementation. This test is available on Medicare if recommended by a doctor, so you might wish to discuss this with your medical practitioner.

Of particular interest to expectant women are three minerals – iron, calcium, and magnesium.

Anaemia (low haemoglobin level) is caused by insufficient available iron. Sometimes women can feel tired and be told that their haemoglobin levels are ‘within normal limits’. Despite this apparent ‘normality’, many women find that iron supplements can help, and can increase their energy significantly. A daily supplement of one tablet per day (each containing about 100 milligrams of elemental iron) is recommended. These are available ‘over the counter’ at pharmacies.

You might prefer to address this problem through diet rather than supplements. Constipation can be a side-effect of iron tablets, if there is insufficient fibre in your diet. Everyone Jennifer talked to about this problem, including midwives, believes constipation is a problem regardless of dietary fibre intake. Consider a couple of teaspoons of Psyllium husks with all meals if this is the case for you. Dark-green leafy vegetables are an excellent source of dietary iron.

Calcium and magnesium are required for healthy bones – both in yourself and your baby. The recommended daily allowance of calcium is 800–1200 milligrams per day, and the recommended allowance for magnesium is 300–400 milligrams per day. Some recent US research suggests that magnesium is also an important mineral in avoiding or reducing the likelihood of cardiovascular problems. To be on the safe side, it is probably a good idea to have a daily mineral and vitamin supplement obtained from some reputable source. (Floridix is a preparation that Jennifer used.)

The best supplements contain different forms of the various minerals, some of these being described as ‘chelated’. This means that the element is coated, or prepared with a particular amino acid, so that the substance in question can be better assimilated by your body. If you are concerned about any possible effects that such a supplement might have, discuss it with your doctor.

Vitamins

There are thirteen recognised vitamins. No new vitamins have been named since 1954, even though thousands of phytonutrients (compounds contained in plants) have been discovered since then. The term ‘vitamin’, and how it can be applied to particular substances, is subject to two strict criteria. The first is that the absence of the substance in the diet must be causally linked to a particular disease. The second is that the addition of that substance to the diet must be able to reverse the course of the disease. For example, the absence of vitamin C causes scurvy, and the reintroduction of the vitamin reverses the disease process.

However, these criteria have proven to be too restrictive in terms of adding to the list of vitamins. Some researchers feel that many phytonutrients (not classed as vitamins) have important health-giving properties – even if they are not essential. Certain phytonutrients are likely to be extremely important in helping your body deal with cancer cells that are produced every day. For example, the brassica family (including cauliflower, Brussels sprouts, and broccoli) is said to contain a number of phytonutrients that are beneficial in halting the course of some cancers. This is another good reason to get a significant fraction of your day’s carbohydrates from a variety of vegetables – because they each contain different phytonutrients in various proportions.

Some of the vitamins are called ‘antioxidants’. These include vitamins A, C, and E. If you are going to supplement vitamin A intake, it is better to take beta-carotene (a double molecule of vitamin A that your body breaks down as needed), or to make sure that you eat as many different coloured vegetables as possible. The antioxidants combine with substances called ‘free radicals’ – which are produced in all oxidative reactions in the body (such as those required to metabolise trans-fatty acids). Some researchers claim that excess free radicals in your body can damage your chromosomes, and hence compromise your body’s ability to reproduce its cells accurately. This might be a significant part of the ageing process. Most of the cells in your body are renewed within a brief two-year period – that is, at the end of a two-period you are actually composed of different molecules. In this sense, ‘we are what we eat’ – because our bodies can be ‘remade’ only from the things that we take in each day.

Among the B group of vitamins is folic acid (vitamin B9). This vitamin is essential to the developing foetus. Below, you will find a chart reproduced from a recent source showing which ordinary foods contain folate, and in what amounts.

The recommended daily allowance of cobalmin (vitamin B12) is extremely small (0.006 milligram per day). However, it is a crucial nutrient, and vegetarians should know that strict vegans are likely to have low B12 stores. If you suspect that you might be low in vitamin B12, it is worth getting a vitamin and mineral supplement that has adequate amounts of this vitamin.

Vitamin D is manufactured by the body and its manufacture is accelerated by exposure to ordinary sunlight.

Be aware of the interaction between vitamins and minerals on the one hand, and the macronutrients (protein, carbohydrate, and fat) on the other. As mentioned, all the minerals and vitamins are necessary for the effective metabolism of the macronutrients.

Foods containing folate

Folate helps to prevent neural tube (spinal cord) abnormalities in the foetus. These abnormalities include spina bifida. Folate might also be important in preventing miscarriage in the early stages of pregnancy.

The recommended daily allowance (RDA) for folate is 400 micrograms. This should be taken by all women who might become pregnant because it is important to have adequate folate at the very beginning of pregnancy (indeed, before women know that they are pregnant), as well as during confirmed pregnancy. Women who have a history of giving birth to babies with neural tube disorders should take as much as 4 milligrams per day.

Adequate folate must therefore be consumed, and most women should probably take supplements in addition to being aware of the following dietary sources. If you have any queries about this important matter, consult your medical practitioner.

Folate and food sources (pdf, 204kb)

Energy sources

There are no essential carbohydrates in the way that there are essential amino acids and essential fatty acids. However, everyone needs good sources of energy.

The best sources of carbohydrates are wholegrain products, fruits, and vegetables. Commonly, food pyramids separate these foods, giving the impression that the carbohydrates that they contain are somehow fundamentally different – but they are not. Most of the food pyramids have grain sources at the bottom, and recommend that they should form the major fraction of your carbohydrate intake. If the food from these grain sources is largely unrefined, this is good advice. Such food is full of minerals, vitamins, good-quality protein, beneficial fatty acids, and carbohydrate. However, in the refining process, much of the good nutrients are lost and you are left with relatively nutrient-poor carbohydrate.

All vegetables and fruits are excellent sources of carbohydrate and are comparatively rich in nutrients. It is therefore advisable to use these for your carbohydrates – rather than emphasising the grain-based sources.

Another consideration is the glycaemic index of a food source. In one sense, the concept of a glycaemic index is deceptive. For example, if you combine a high GI food with a low GI one (depending on the precise nature of the foods involved), the glycaemic index of the whole meal will be a figure between the index of each food. It is desirable to get a balance of high and low glycaemic foods in the same meal, to avoid excessive increases in blood sugar following eating.

A further dimension to consider in assessing energy sources is the amount and kind of fat and fibre present in the same meal. Both of these decrease the overall glycaemic index of the meal.

Finally, individual reactions to particular foods will vary the GIs by very significant amounts. A variation of 20% or more can be seen in the figures cited (see Brand Miller et al. 1996, pages 207–40).

Oxygen

This element is an obvious necessity. No one can survive more than a few minutes without oxygen. Make sure that you have enough fresh air blowing through your house during the day. If you work in an office, it is essential to get out of the office environment at some time – perhaps at lunchtime – and expose yourself to cleaner air (it is to be hoped that it is cleaner!) than you find inside a typical office. Walking at any time of the day that you can manage it is good too.

Light

The action of light on the skin helps your body create the essential vitamin D. The action of light on the retina also stimulates the pineal gland and helps some people to avoid the unpleasantness of seasonal mood disorder – sometimes called ‘seasonal affective disorder’ (SAD).

Water

Recommendations for how much water one should consume daily vary quite widely. It depends on your body weight, level of activity, and so on. However, a minimum recommendation for water consumption is two litres per day.

If you are concerned about your water intake, substitute a glass of water for the cup of coffee or cup of tea that you might otherwise have.

Because water forms approximately 70% of your body weight, it is wise to give some thought to the purity of the water you drink. Benchtop water purifiers can be helpful, or drink best-quality bottled water. Read the label on bottled water to determine the source – the information might surprise you. Tap water in Australia is usually safe to drink. Another way to increase your fluid intake is to have nutritious soups at mealtimes. If you like fruit juices, but are concerned about getting too many kilojoules, dilute the juice by half with water.

Movement

In a book concerned with stretching and strengthening exercises, the recommendation for movement might seem superfluous. However, it is an essential consideration on a daily basis and, when taken together with the need for oxygen and light, provides a good reason for getting out of the house or out of the office at least once a day, and going for a walk.

Every authority considers walking to be excellent exercise – provided that walking doesn’t give you neck or back pain, or aggravate some pre-existing condition. If this is the case, swimming can be substituted for walking. Going for a walk gives you a chance to open your lungs fully, to breathe deeply, and to make sure that you get enough direct sunlight (to stimulate your brain and help your body make vitamin D).

Walking is also fun! Of course, if the conditions are too hot or too bright, make sure that you go out with a hat on and cover your skin. The last thing you want is a case of sunburn while pursuing your health goals.

Breastfeeding

Breastfeeding is desirable. Apart from the health benefits – the full extent of which have become obvious only in the last ten years or so – women tend to return to their previous weight much more quickly if they breastfeed. One reason for this might simply be the huge energy requirement of lactation.

Maureen Minchin (Breast Feeding Matters) identified what she called the ‘six o’clock starvation syndrome’. This can be attributed to the energy cost of lactation. Breastfeeding mothers should eat as many nutritious snacks as you feel you need. The reasons for this are obvious—not only do you need to run around and do the normal things that people do in their daily lives, but also you need to have enough energy to produce sufficient milk for your new baby. When you are breastfeeding, you will need to give additional regard to what you eat. In Jennifer’s case, for example, eating chick-peas had an undesirable effect on her daughter immediately following breastfeeding.

Sign up for our occasional newsletter

Be alerted to upcoming workshops, new programs as released, and other Stretch Therapy news.

Subscribe