Thankful Thanksgiving

Thanksgiving 2018: Giving Thanks

            We are quickly approaching one of my most favorite holidays: Thanksgiving! I love it for 2 reasons. First, I love food. Secondly, I love to give thanks. While reason #1 can often overshadow reason #2, I believe giving thanks is something we should all consider as we approach what can otherwise be quite a glutinous holiday. At the very least, humor me.

Scientific research has proven the benefits of expressing gratitude! Reflecting upon and expressing our gratitude can actually make us happier and better people. Specifically, here are some scientifically proven benefits of gratitude:

  1. Be happier, less depressed. People who give thanks tend to report less depression and being overall happier individuals.
  2. Strengthen your relationships. Individuals who express gratitude tend to be more attractive and individuals that others want to be around.
  3. Sleep better (!). Yes, really. Individuals who jot down what they are grateful for tend to report improved sleep.
  4. Improved mental strength. Expressing gratitude can actually help to make us more resilient when dealing with stress and trauma.
  5. Improves self-esteem.

Giving thanks and gratitude can be quite simple. Some individuals take 10 to 15 minutes each night to jot down in a notebook/journal something from the day for which they are grateful. Others may reflect upon the day in their drive home to think about positives of the day. In our family, every night at the dinner table we go around and say what we are grateful for that happened during the day. This doesn’t have to be a long or exhaustive process, but just taking some simplest steps to express our gratitude can truly make a difference in our quality of lives.

Now, onto the food! I recommend checking out 2 previous blogs I have written that address making a game plan for the Thanksgiving Holiday which can be found in the Nutrition Vault: (1) Tips for Surviving the Thanksgiving Holiday, and (2) The Holidays 2017 – there are some great, practical and helpful tips for maintaining your health goals over the holiday season. Check them out! In the meantime, here are some of my favorite healthier sides recipes for the Thanksgiving holiday that can literally save hundreds of calories. After all, did you know the average American consumes about 4,500 calories for the meal (including drinks and apps)?! Yikes! Here are some ways to cut down on some of the unnecessary calories while still enjoying some delicious food:

  1. Healthier sweet potato casserole:
  2. Garlic parmesan green beans:
  3. Creamy cauliflower puree (instead of mashed potatoes) – you have to trust me on this one!:
  4. Wild mushroom stuffing:
  5. Oven roasted parmesan Brussels sprouts:
  6. Skinny Pumpkin Pie:

Nutrition and Injuries

Nutrition & Injuries

            All athletes can experience an injury, and CrossFit athletes are no exception. (As a note, if you are interested to learn if CrossFit athletes are at greater risk for sport-related injuries, checkout my recent post ‘CrossFit and Injuries’). The topic of this blog, however, focuses on the relationship between nutrition and injuries.

While nutrition rarely is a direct cause of injuries, there certainly is a relationship between nutritional status and injury risk. In the short-term, entering a workout in a low-energy state (such as when you have not eaten all day and then head to the gym after work) can decrease coordination, mental focus, and concentration. Errors in judgement that result from an altered cognitive state can increase the risk of accidents and other injuries. Additionally, the feeling of muscle glycogen depletion (low stores of muscle carbohydrates from inadequate fueling), particularly in the athlete that is used to consuming a macro-balanced diet, can also increase injury risk. Perhaps you had not fueled very well during the day, and then go to snatch what is normally an appropriate amount of weight in the afternoon workout. Athletes have dropped the bar due to their lack of energy for an effective movement. This could have very dangerous repercussions for both themselves and others.

Long-term nutritional status also influences risk of injury. Female athletes are at much greater risk for engaging in fad diets and disordered eating habits (though men are not immune). Over time, significantly under-consuming calories in efforts to lose weight can result in an inadequate intake of calories, specific or all macronutrients, and vitamins and minerals. This nutritional inadequacy can result in loss of bone mineral density and places the athlete at greater risk for stress fractures and other bone injuries. All athletes that fail to consume a sufficient, balanced diet, particularly one high in fruits and vegetables, risk an inadequate consumption of vitamins and minerals. Overtime this can result in a compromised immune system and predispose the athlete to getting sick and/or injured. Finally, athletes that are not focusing on proper hydration practices can risk dehydration during exercise; in severe situations, this can result in heat stress injuries including heat exhaustion and stroke.

These are only just a few examples of how our nutritional status affects our risk for injury. It also cannot be overemphasized how important our nutritional intake is for our recovery from injury. Recovering from an injury, including bone and musculoskeletal injuries, requires the appropriate amount of calories, protein, and vitamins and minerals, among other nutrients, for optimal healing. Without an adequate intake of nutrients, injury recovery is prolonged and can heighten the athlete’s frustration.

Some general tips if you are recovering from an injury include the following:

  • Consider adjusting your calorie intake. Refer to the Icon calculator for an adjusted calorie recommendation. Specifically, you will want to revise your activity factor, which will likely lower your calorie needs. Some individuals will have an activity factor as low as 1.3 or 1.4, depending upon the extent of the injury and how much movement has been limited. Adjusting your kcal intake can help prevent unintentional weight gain related to decreased activity
  • A note on calories: avoid going too low in how much you are eating. Some athletes worry excessively about weight gain during this time period and underestimate how many calories their bodies still need to support recovery, which still requires energy from the foods we eat. If we go too low in calories, we can lose significant amounts of muscle mass and will prolong the time for the injury to recover. See recommendations above for an appropriate amount to be eating.
  • Ensure an adequate protein intake. For a musculoskeletal injury, the amino acids that we get from the metabolism of protein intake become the building blocks for repairing the damage. A protein intake of 1.4 to 1.8 grams of protein per kg of body weight is typically appropriate. This protein intake also helps to preserve our lean body mass when our activity (and stimulus for muscle) is decreased.
  • Get more fruits and veggies! Fruits and vegetables are powerhouses of vitamins, minerals, and other antioxidants needed for tissue repair. This includes, but is not limited to, zinc, vitamin A, vitamin C, vitamin E, selenium, lycopene, and beta-carotene. Unfortunately supplements are not an adequate replacement – they just do not work as well as food. Aim to get at least 5 to 7 servings a day of fruits and vegetables, and ideally up to 8 to 11 servings!
  • Eat more fish. Healthy fats, particularly the polyunsaturated fats we find in fish are high in omega-3 fatty acids, which help our body’s anti-inflammatory response system (& inflammation contributes to our experience of pain). Consuming sufficient omega-3’s – and again, from food, not supplements, supports recovery as well. Aim to get fish at least 2 to 3 times a week. Other sources of omega 3’s includes flax seed, walnuts, and canola oil.

Time and patience, of course, are essential ingredients for recovery as well. However, what I love about nutrition is that while an injury (either getting one, or recovering from one) can feel like it is out of our control, nutrition is something that we have complete control over. So let us use it to support our maximal performance and overall health and well-being!

CrossFit: Higher Rates of Injuries?

CrossFit: Increased risk of injuries?

      I am surrounded by naysayers. I am a professor in a Department of Nutrition & Integrative Physiology, which is a newer term used for exercise physiology. As such I am surrounded by many exercise physiologists that have pre-determined beliefs about certain types of activities. And, while high intensity interval training is well established as an effective and efficient way of increasing fitness (amongst other significant health benefits), for some reason CrossFit maintains a negative connotation. My clinical practice is in a sports medicine facility where I work with 3 sports medicine physicians, all of whom seem to think of CrossFit as an 8-letter sweat word. I also have a sister who is a physical therapist, and even after 7 years thinks I am crazy for participating in this ‘hellish’ sport. Maybe I am, but maybe not for the same reasons they believe.
Many of the above mentioned professionals – exercise physiologists, sports medicine physicians, and physical therapists – seem to have a preconception about CrossFit that it predisposes individuals to injuries, that there is a high rate of injuries among CrossFit athletes. That’s why when I saw the article by Klimek and colleagues published this year in the Journal of Sports Rehabilitation, I was intrigued. What does the science have to say?
The research design was a retrospective cohort study that reviewed any paper published in the past 10 years comparing injury rates among CrossFit participants and individuals participating in other fitness sports. Three article met the inclusion criteria, and included other sports such as gymnastics, Olympic weightlifting, military conditioning, track and field, rugby, and distance running.
What the researchers found may be of no surprise: rates of injury among CrossFit participants was equal to or lower than those of participants in the other included sports (gymnastics, Olympic weightlifting, military conditioning, track and field, rugby, and distance running). Some important notes identified in the discussion of the article include the comment that the three articles defined ‘injury’ differently; also the articles differentially defined CrossFit athletes (some were actively training with coaching/supervision, while some were engaging in CrossFit workouts but perhaps independently. One article defined types of injuries and reported that shoulder injuries were the most commonly reported injury (25%), followed by lower back (14%) and knee injuries (13%).
One article by Hak and colleagues found that 73.5% of the 132 survey respondents experienced an injury while engaging in CrossFit. The total injury rate of 3.1/1000 hours trained during CrossFit training was similar to injury rates reported in: Olympic weightlifting, gymnastics, and rugby. Sports with higher injury rates, as per report, than CrossFit include high school football, ice hockey, and soccer. It is also significant to note that the rates of injury as reported by the 3 comparison articles were all different, limiting the equality of comparison between the 3 articles. Given that the authors identified the differential criteria of ‘injuries,’ and categorized ‘CrossFit Athletes’ differently, this can be understood.
And of course I must note, this is not a free pass to neglect the importance of good form, stretching and warming up, cooling down, optimal nutrition (though I am biased on the big importance of that!), and listening to one’s body. These are all essential strategies to avoiding risk of injuries and staying safe while training.


Link to the study:

Organic Debate

Organic or not: That is the Question…

            The question of organic is probably one of the most commonly asked questions that I receive. I’ve posted on this previously, but given some more recent questions I thought I would address it once more. First, it is helpful to look at what the issue is surrounding this topic. Contrary to commonly held beliefs, organic produce is not necessarily any healthier than conventional produce. That is, the nutrient profile is not much different (this is a generalized statement. Some studies do show a slight nutrient profile difference, but most studies do not). However, where we do see a difference is in the pesticide residue amount found on conventionally grown produce and organically grown produce. This makes sense – because organically grown produce, in order to be certified organic, cannot use most commercial pesticides, the residue amount is significantly less.

While many of the most harmful pesticides have been banned from use by the FDA and USDA, organophosphates are still approved and may have many neurotoxic effects, particularly on children. Neurotoxic means these effects are seen mostly on the brain and central nervous system; in fact, the human brain is significantly more sensitive to the neurotoxic effects of organophosphate chemicals than the brains of the laboratory animals (the ones being studied for toxic effects). Yikes. There are also significant links to intake of conventionally grown produce and fertility issues in both men and women.

Luckily for our wallets, not all conventionally grown product have the same amount of toxic residues. The Environmental Working Group (EWG) published the ‘Dirty Dozen’ and the ‘Clean Fifteen.’ These lists identify the produce with the most, and least, amounts of pesticide residues found when examined. The most recent lists are:

Dirty Dozen












Sweet bell peppers


Clean Fifteen


Sweet corn




Frozen sweet peas








Cauliflower and broccoli


Based on these lists. I recommend individuals to prioritize what they purchase organic and that which they purchase conventionally. A simple rule of thumb is if you can peel the skin (banana, onion, etc.), the less likely it is to be contaminated. And, always wash your produce! This helps to wash off some of the residues as well. Organic produce will ripen faster, which also means that it spoils faster, so you might notice you have to buy it more regularly… But the health benefits are likely significant, so I always suggest you do what you can. The most important message, however, is that it is better to eat any sort of fruit or vegetable – conventionally or organically grown, than not. So ultimately, eat your fruits and veggies!


Making a Nutrition Plan for Murph

Making a Nutrition Plan for Murph

CrossFit athletes have a love-hate relationship with Memorial Day – you either love Murph, or you hate it…  I am (blessed?) to be in the former camp, and many may be in the latter. Regardless it is a great benchmark for tracking your progress over the past year. However, I have seen enough athletes get derailed by a poor nutrition plan that I thought I would provide some tips for Monday’s big event.

Times for Murph can range from really fast (30 minutes?!) to over an hour. For those who are finishing faster may not need to be as worried about their nutrition as those who will take longer than an hour; weather will also make a big difference. If it is cool outside then there is less of a concern. But if you’re running that last mile outside in hot, sunny weather and you’re sweating a substantial amount, there are some pieces to consider.

  • For all athletes: have something to eat before you go. Murph is long enough and intense enough that you can use up all of that stored glycogen (aka fuel) in your muscles. It doesn’t necessarily need to be a huge meal, but even something like toast with almond butter and a banana can make a big difference. Otherwise you’ll start heading out on that 2nd run feeling tanked and that mile can all of the sudden feel like a marathon.
  • For timing, eat when you’re used to eating. If you normally give yourself 2 hours before you train, aim for that. If you can eat and head right out the door, that is fine too. Go by what you are used to.
  • During the workout: for workouts 60 to 90 minutes or less we typically don’t need to replace nutrients during a workout. What you will likely want to do is make sure you have water available.
  • If it is going to be hot and sunny, think about some electrolyte replacement. If you’re not a heavy sweater, this may not be an issue for a workout like Murph (less than 2 hours). But, if you anticipate being out there a while you can buy electrolyte replacement at most sporting goods stores (REI, example), or, buying a commercial sports drink that has electrolytes is great too
  • Recovery! This is important for Murph. Keep in mind the recovery principles we have posted in the Vault: aim to have 10-20 grams of high quality protein (eggs, Greek yogurt/milk/cottage cheese, soy, meat, protein supplements – ideally whey-based) plus some carbohydrate within 30-60 minutes after the workout. This could be something like some oatmeal with almond butter and a smoothie with Greek yogurt and berries; it could be a quinoa, chicken, black bean salad with some fruit on the side; you could try a 2-3 egg omelet with vegetables, some whole wheat toast and fruit. The possibilities are endless J. Then for the rest of the day, space out regular meals and snacks as usual and ensure a good protein source at each meal. Your total protein goal for te day is not higher than your recommended range, it is just really importance to make sure you are getting that amount and that it is well timed (right after the workout and then every few hours). Aim for at least 3 servings fruits and 3-4 servings vegetables – these foods are high in antioxidants that are helpful in the recovery process. Also be sure to hit your carbohydrate goals – similar with protein you don’t need more than usual, just be sure to get the carbohydrates in your range. A low carb diet following a workout like Murph can exacerbate muscle soreness and delay recovery.

And of course, Have Fun!! Murph is a great benchmark workout to track your progress. Just don’t let a poorly planned diet get in the way…

Diets and Body Composition

Summary Points from Position Paper on Diets & Body Composition

            The International Society of Sports Nutrition (ISSN) recently posted a position stand on diets and body composition. The ISSN is a reputable body that publishes timely and quality research on the topic of nutrition for sport and exercise. This position paper summarizes the most recent findings that address nutrition and body composition and only includes research studies that meet specific high quality criteria. The full article was published by Aragon et al. in 2017 in the Journal of the International Society of Sports Nutrition (reference at the bottom); however, I thought I would highlight a few of the key points the article made as at least one or more are likely to be relevant to Icon athletes:

  1. Diets that have the primary goal of reducing fat mass have a sustained calorie deficit at their core. The higher the level of body fat at baseline, the more aggressive one can be with the calorie deficit. However, for lean individuals a slower rate of weight loss will better preserve lean body mass.

Kary’s summary & comments: to lose weight, you need to eat less calories than what you burn. If you are not significantly overweight to start with, aim for a low to moderate calorie deficit (250-500 kcals/day – my preference is 250 kcals) to avoid losing weight from muscle mass and to maintain muscle mass.


  1. Diets that have the goal of increasing lean mass are primarily driven by a sustained calorie surplus which supports an anabolic (= building) environment and meet the increased demands of resistance training. The composition and amount of the surplus (quality and quantity of kcals), as well as the training status of the individual (untrained vs. well-trained) affects the amount and type of weight gain.

Kary’s summary & comments: you can increase muscle mass without a calorie surplus (such as those on the perfector track) but gains will be minimal to moderate. For those on the gainer track and looking to really focus on increased muscle mass, a calorie surplus is needed (= eat more calories than you burn on a daily basis). Approximately 250-500 kcals a day for surplus is ideal to avoid excessive weight gain. It is the kcal surplus that really triggers the anabolic hormones needed for building.

The quality of calories matters as well. Most individuals know to eat more protein, and indeed, upwards to 3 grams per kg of body weight may be beneficial (though some studies to not show added benefit of protein intake greater than 2 g/kg). However, it is also important to increase carbohydrate intake as well. One well-designed study had 2 groups consuming a calorie surplus. Both groups started at 1.6 grams of protein/kg. One group had the surplus come just from carbohydrate, another group had the surplus come from protein and carbohydrate together. The carbohydrate group gained 3.4 kg of lean mass and lost .3 kg of fat mass, the carb + protein group gained 2.9 kg of lean mass and gained .2 kg of fat mass. Differences were not statistically significant but indicated an increase beyond 1.6 g/protein/kg did not improve lean mass gains, but that adding carbohydrate did…


  1. A wide variety of dietary approaches ranging from low-fat (20-35% of calories) to low carbohydrate (including ketogenic diets) diets can be effective for improving body composition.

Kary’s summary & comments: there are many approaches to support weight loss and may include the keto diet, the zone diet, or lowfat diets – one is not necessarily better than the others if the calorie deficit is the same. That being said, if one approach is more sustainable, thus making that calorie deficit easier to achieve and maintain on a day to day basis, then that is likely your best approach. If you find the keto diet sustainable and helps you to reduce your intake, then go for that. An important note: the article specified that the ketogenic diet does not show any performance benefits for high intensity exercise and if anything has hindered performance at high intensities according to the current body of evidence.


  1. Increasing protein intake to amounts greater than current recommendations (up to 2.3-3/1 grams per kg of fat free mass – not total body mass) may improve body composition by maximizing lean mass retention in lean, resistance trained individuals when the individual is following a calorie deficit.

Kary’s summary & comments: there are certainly some interesting research studies out there regarding protein intake. When someone is following a calorie restricted diet, consuming up to 3.1 grams (or more!) may enhance preservation of muscle mass/lean body mass. Protein is also more satiating (= helps us feel full) and has a higher thermic effect (that is, requires more energy to be metabolized). Some studies have even shown when calories were increased by over 800 calories (all coming from protein) weight did not increase.  For those of you looking to lose weight and are on a calorie deficit, consider consuming at least 2 grams protein/kg of body weight.


  1. When combining the research together, intermittent fasting/intermittent calorie restriction research does not demonstrate a significant advantage over daily caloric restriction for improving body composition.

Kary’s summary & comments: specific to the effects on improving body composition, intermittent fasting does not seem to have an advantage over daily caloric restriction (such as a 250-500 calorie deficit a day); some research shows a slight benefit but most does not. There may be other metabolic advantages of intermittent fasting that are still being explored. Some individuals report it is just easier, for example, to restrict calories significantly on 2 days a week and then eat ‘normally’ on the other 5 days (such as with the 5:2 Intermittent Fasting approach) and in that case, if that is more sustainable, than that might be a better approach for that individual – not because it will result in better results than regular calorie restriction, but because it is more sustainable. This is where you need to find what works best for you. I do know a lot of athletes have a hard time training on the fasting days, and the morning after a fasting day, so you want to take into consideration how this might affect your training and performance.


  1. Long-term success of a diet depends upon compliance, as well as the suppression or avoidance of factors that may weaken the effects of a diet such as adaptive thermogenesis.

Kary’s summary & comments: adaptive thermogenesis (AT) is truly an intriguing phenomenon that I actually are area of research that I am interested in.  AT is complex and multifactorial, but to try and simplify it AT describes the decrease in energy expenditure when significant weight has been lost that is not accounted for by loss of metabolic tissue. The exact mechanisms are unclear, but there is some research to indicate that the effects of AT can be mitigated with higher protein intakes. See point #4 above. If you are interested in AT let me know and I can devote an entire blog to this topic!


From: Aragon AASchoenfeld BJWildman RKleiner SVanDusseldorp TTaylor LEarnest CPArciero PJWilborn CKalman DSStout JRWilloughby DSCampbell BArent SMBannock LSmith-Ryan AEAntonio J. International society of sports nutrition position stand: diets and body composition (2017). J Int Soc Sports Nutr. 2017; 14:16.

Caffeine as an Ergogenic Aid for Strength & Power?

Caffeine as an Ergogenic Aid for Strength & Power?

            For some time now caffeine has been known to be an ergogenic aid (a substance that enhances performance) in aerobic activities. While the initial mechanism of action was thought to be the increased reliance upon fat as an energy source (since caffeine is known to increase fatty acid availability), it was later discovered that caffeine’s performance benefits largely come from its action on the central nervous system. That is, caffeine has been shown to decrease ratings of perceived exertion (you feel as though you are not working as hard as you actually are, allowing you to push harder) in aerobic activities.  So, athletes participating in aerobic activities should consider caffeine consumption to allow them to train slightly harder, and perform slightly better. Effects are small (don’t expect a HUGE increase in performance); but, as we all know sometimes small differences can make what ends up being a big difference in outcomes.

There was been more question and inconsistencies when looking at the research on caffeine’s effects on anaerobic performance. A recent meta-analysis attempted to provide some clarification on this important question. In their examination of the effects of caffeine on muscle strength and power, here is what Grgic and colleagues (2018) found. First, they noted that following caffeine consumption there were acute increases in maximal upper body strength. Results for lower body strength were inconsistent, though two studies did show an increase in isometric lower body strength, but other studies did not show an increase in lower body dynamic strength. The reasoning behind these disparities is not yet fully known and further studies are necessary. As for power, the meta-analysis supports the benefit of caffeine consumption for increasing muscle power as expressed by vertical jump height (a common measurement of power). In fact, the benefit of caffeine consumption was of the same magnitude as that seen with 4 weeks of plyometric training. Additionally, the article noted previous studies have shown improvements on the Windgate test as another measure of power output following caffeine consumption.

The results also indicated that training status of the athlete did not matter, that both trained and untrained individuals experienced similar results. This is contrasted with some previous studies on mostly aerobic performance where trained individuals experienced a greater benefit compared with untrained individuals. Finally, while male athletes seemed to exhibit greater strength gains compared with male athletes, caution should be used in these findings since the studies done on females are limited and very small in sample size. Further studies are needed before we can make more confident claims regarding sex differences and benefits of caffeine consumption.

The article noted that most of the studies demonstrate a benefit of caffeine consumption when taken in pill form; authors noted that further studies are needed to understand if the benefits extend to caffeine consumed in liquid or gel form.

So what does this mean? This meta-analysis indicates caffeine may improve training ability and performance for upper body muscle strength and power output. The study did not note how much caffeine is necessary for benefit, though previous research indicates about 3 mg per kg of body weight is likely sufficient (so, if you weigh 70 kg, you would want to consume 210 mg of caffeine). It is important to note that adverse effects of caffeine are seen at doses greater than 6 mg per kg of body weight and so it is highly discouraged to take amounts great than this. Caffeine peaks in the body 30 to 60 minutes after consumption and thus should be consumed accordingly before exercise. Because caffeine has a half-life of 5 hours, it is advised to avoid taking it later in the day to avoid problems sleeping that night.

Caffeine really is one of the few substances that has been found to have an ergogenic effect, let alone in a variety of contexts (aerobic performance, HIIT, and strength activities). At the very least I recommend giving it a try and seeing how it impacts your training and performance. And as always, never try it on the day of a big event (like, the Open…) since you’ll want to practice with it in training first. You just never know how your body will respond to your first time of taking something!


Grgic J, Trexler ET, Lazinica B, and Pedisic Z. Effects of caffeine intake on muscle strength and power: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2018; 15(1).

What to know about the Keto

What to know about the Keto

            This keto diet is a common source of questions, and so I thought it would be helpful to revisit the topic for new (and returning) members. This is a great prompt for me to revisit the research and see what’s new…

Keto stands for ketogenic – the ketogenic diet is one where the body is in ketosis. This state occurs when the body is starving or is severely restricted of carbohydrates. Essentially, when the body is depleted of dietary and stored carbohydrate, it breaks down fat energy (facilitated by lower levels of insulin that typically promote storage); a by-product of fat metabolism are ketone bodies (particularly acetoacetate and beta hydroxybutyrate). While the brain and central nervous system prefer glucose as an energy source and cannot use fat (there is a blood-brain barrier), the brain can use ketone bodies in the absence of sufficient carbohydrate.

Traditionally ketogenic diets were used in the treatment of epilepsy – for many individuals with this life-threatening medical condition, a ketogenic diet can all but ‘cure’ their epilepsy (as long as they remain on the diet). However, in more recent years, the ketogenic diet has been applied to a variety of other health conditions. Interestingly, ketogenic diets have shown quite favorable results regarding metabolic and cardiovascular health outcomes which includes the management of diabetes. To be clear, using the ketogenic diet for management of disease is outside of the scope of this blog and anyone with a metabolic or cardiac condition (including diabetes) should absolutely consult their physician before initiating this dietary approach.

However, we are also seeing the application of the ketogenic diet for weight loss and sports performance. Indeed, there is sufficient research to indicate the ketogenic diet can be quite helpful in facilitating weight loss while also supporting preservation of lean body mass (= muscle). What is still unclear is how it compares with other healthy, low calorie approaches (that is, moderately low, not excessively low) that can also facilitate weight loss and maintain muscle mass. That is, is the keto approach better than other healthy, moderate approaches to weight loss? Maybe, but the results are still inconclusive (some show keto is better, some do not).

There is also uncertainty regarding the application of the ketogenic diet in the performance arena. It is well established that even after just several days of following the keto diet that we see an upregulation of ‘fat burning’ machinery – that is, an increase in the enzymes and pathways that oxidize fat; over time, we see that adaptation to the ketogenic diet results in enhanced fat oxidation at higher exercise intensities. The benefit of this is that athletes can burn fat at higher intensities and thus are not limited by muscle and liver glycogen that otherwise would limit exercise performance.

What is interesting to see is that while indeed individuals on the keto diet do upregulate fat oxidation, and downregulate carbohydrate oxidation, there is actually very little research to indicate that this improves performance. Most research has been conducted on endurance and ultra-endurance athletes who adapt to the ketogenic diet. Indeed, these athletes are significantly more ‘efficient’ at burning fat at higher intensities, but it is important to keep in mind that this is relative – higher intensities may indicate they are burning more fat at, say, 70% of ones VO2 max, compared with 60% of ones VO2max. This is not considered to be ‘high intensity’. What is more, research does not actually show that this enhanced fat oxidation improves performance. Huh.

As it pertains to anaerobic performance (such as high intensity interval training that correlates best with most CrossFit workouts), a recent examination of the few studies that have been done concluded that a keto diet resulted in impaired performance in 4 of 7 studies, and did not improve or worsen performance in 2 of 7 studies, with the last study inconclusive. So yes, the majority of studies in this analysis demonstrated impaired anaerobic performance when following a ketogenic diet. This should be noteworthy. One of the two studies that showed performance was not worse (but not better) is a study commonly cited in this field looking at elite gymnasts. The authors (and other keto proponents) emphasize that these gymnasts were able to lower their body fat while maintaining (but not gaining) muscle mass. There is certainly some notable benefit to this, and the ketogenic might be a feasible approach for individuals looking to decrease fat mass while maintain strength. It is unlikely one will see increases or performance gains, but given one of the biggest risks of severely restricting calories to lose weight is loss of muscle mass, this is not insignificant.

So what is my take away from this? Here are my thoughts. First, when an athlete comes to me and asks if they should go keto, I ask a couple of follow-up questions. Are they aware of how restrictive the diet is? This approach only allows for net 20 grams of carbohydrates a day. That means no grains or starches, no legumes or soy, very, very little fruit, and small to moderate amounts of non-starchy vegetables. Considering that even a 1-ounce serving of almonds has 6 grams of carbohydrates (and 20 grams is the daily total), even nuts have to be limited to some degree. This is a very high-fat diet including oils, butter, and cheese. And, contrary to what many think, it is actually a moderate (and not high) protein diet. While meat and other high protein foods are quite low in carbohydrates, protein itself results in glucose production via gluconeogenesis and thus to be correctly done this diet is not high in protein (Atkins diet this is not). In fact, many ‘purists’ in the keto world recommend only .6-.8 grams of protein per kg of body weight – this is half of what is normally recommended for strength athletes. So really, it is just a really high fat diet, moderate in protein, and very limited carbohydrates.

I then ask if individuals would find this sustainable. Can beer-lovers give up beer? Even wine has about 4 grams of carbohydrates and is recommended to only be consumed sparingly. Seemingly healthful foods like fruits and yogurt need to be restricted. AND, perhaps the biggest challenge to this, is that there is no wiggle room. You can’t have your ‘cheat day’ or even your ‘cheat meal’ – even just a moderate amount of carbohydrate takes you out of ketosis and you have to start the process all over. And let’s just say entering ketosis – particularly for the first time – can be quite an unpleasant experience for many – individuals report feeling foggy, light-headed, dizzy, lethargic – and this can take up to 2 weeks to start feeling ‘normal’ again. Once in ketosis, most individuals report feeling great with good energy levels and easily managed hunger and fullness levels. However, most report that high-intensity exercise is very difficult and recovery can be quite slow.

I ask about lifestyle factors – are you okay to miss social events that revolve around food and celebration? Or are you okay to go to these events and pass on just about everything that is served? Going out to restaurants can be challenging (but doable). I know as a mother of 2 young girls, I could never role model this dietary approach because of the message I would be sending to them – I am not okay to start them thinking at age 5 and 6 that there are ‘good’ foods and ‘bad’ foods and that certain foods should be avoided at all costs. I see firsthand as a dietitian that specializes in eating disorders how this exposure can start a lifelong unhealthy relationship with food.

There is still a lot of research that needs to be done before we can provide more conclusive statements regarding the ketogenic diet. I would not call it a balanced approach by any means, but one that may promote fat loss and may have a performance beneit for ultra-endurance athletes (this has yet to be clearly shown. Otherwise I believe there are many other dietary approaches that have shown to enhance performance (and can still support weight loss if desired).


What’s the Deal with Dairy?

What’s the Deal with Dairy?

            There’s a lot of debate and questions surrounding dairy. Is it the nutritious and health food it is sometimes touted to be, or is really a toxic food that is promoted by a corrupt and powerful industry? While I do not subscribe to either extreme, I will take a side on this one (& deviate from my typical, middle-of-the road stance).

First let’s examine some concerns with dairy. Lactose is a simple sugar naturally occurring in many dairy foods, including milk, yogurt, cheese, and ice cream. Lactase is the enzyme our bodies produce to digest lactose. As we age we lose some amount of lactase and this can result in lactose intolerance (gas, bloating, and discomfort experienced when consuming lactose-containing foods). It’s important to acknowledge, however, that we all lose different amounts of lactase – some ethnicities produce very small amounts of lactase as they get older and thus experience a greater degree of lactose intolerance (particularly African American, Hispanic, and Asian populations). Other populations, such as those of Northern European descent, have evolved to continuing producing higher amounts of lactase throughout the lifespan since dairy is a core component of their diet; These individuals tend to be able to drink milk into their 80’s and 90’s without problem. So there is certainly a genetic component to this and this also demonstrates that it is not necessarily true that we weren’t ‘meant’ to drink milk after infancy (given that some populations have adapted just fine to drinking milk for their entire lives).

It is also important to note that lactose intolerance is not all-or-nothing – some individuals experience gas and bloating after eating ice cream or a large glass of milk and incorrectly assume they should not have any dairy at all. This is simply not the case. Usually as we age we decrease our lactase production, but by degree – maybe a bowl of ice cream is problematic, but a cup of yogurt (that has live, active cultures and enzymes that can assist with digestion) can be digested just fine. Unfortunately, it’s a ‘use it or lose it’ phenomenon – if you cut out all dairy foods, you’ll decrease your production of lactase even more, thus exacerbating your digestive symptoms. So if you enjoy dairy but just can’t handle a big bowl of ice cream, you may continue to have yogurt daily, smaller amounts of milk with cereal, lower lactose-containing cheeses, etc…

All in all, I do think dairy, and particularly dairy foods such as milk, yogurt, and cottage cheese (and to a smaller degree, cheese) can be part of a healthy diet. Milk is actually quite nutrient dense (a high amount of nutrients relative to its weight) – it is a great source of protein, vitamin A, potassium, riboflavin, calcium, vitamin B12, iodine, phosphorous, and Vitamin D. Many of these are nutrients Americans tend to be quite low in, including calcium, potassium and Vitamin D. So for many individuals, milk, yogurt, and cottage cheese can be excellent ways to get these nutrients they may not be getting otherwise.

Does this mean that we need to consume dairy to follow a healthy diet? Absolutely not. There are many cultures and groups of people that consume little to no dairy (particularly many Asian and African cultures) and have very healthful eating patterns that are associated with positive health outcomes. We do not need dairy to be healthy. The challenge is, these eating patterns are not the same dietary patterns Americans tend to follow, and so for many Americans, consuming milk and yogurt may increase the healthfulness of their diets compared with not consuming these foods.

The dairy industry is powerful and influential, and it certainly has influence over governmental guidelines and recommendations. I don’t think this has to negate the health properties of some dairy foods. I have also seen it to be an industry that is genuinely passionate about its food and its animals – having visited many dairy farms it is apparent it cares about its cows. Here’s the thing I have learned – healthy, happy cows produce more milk, and it really is that straightforward. It is not in a farmer’s best interest to mistreat and ‘drug up’ their animals as it would significantly decrease production. As far as antibiotics go, there is practically zero tolerance for antibiotics in milk. All milk that leaves a farm is tested with stringent standards, and if there is even a trace of antibiotics in the milk, the entire supply (thousands of gallons) needs to be dumped. Any cow treated with antibiotics related to infection is removed from the milk production line until they are completely clear of antibiotics. So as consumers, it is very unlikely we are exposed to antibiotics from dairy.

I would not argue that dairy is a ‘perfect’ food; nor is it necessary for health. I do believe it can absolutely be part of a healthy diet, however. Several research studies have demonstrated this, showing that diets including 2-3 servings of dairy a day, for example, can help with weight management, lower blood pressure and manage other chronic diseases. If someone doesn’t like dairy then dairy alternatives are fine, just know that almond milk would not be an ideal replacement for dairy milk – almond milk has virtually no protein, and the calcium in almond milk is supplemental calcium (not naturally occurring) and thus is not as bioavailable as the calcium in dairy milk. I would recommend soy milk as a healthier alternative to dairy milk because of its higher protein and calcium content.

Finally, let’s address the question of dairy fat. A lot of the fat in dairy products is saturated fat. Our understanding of saturated fat is evolving and there is research suggesting the type of saturated fat in dairy (as we now know not all saturated fats are created equally) is not as problematic as the saturated fats in meat, for example. There is even research to suggest some dairy fat found in milk, yogurt, and cheese, may have health benefits or at the very least may be ‘neutral’ (versus causing atherosclerosis which causes heart disease).

Until the science is more conclusive and we have a better understanding, I tend to recommend lower fat dairy products to patients. I do think it’s appropriate for younger children to drink whole milk as they need higher fat contents in their diets; I also think higher fat-containing dairy products such as milk and yogurt can help individuals wanting to gain weight to get more calories in their diets. For individuals wanting to lose weight I do recommend non-fat or lowfat dairy products and this is simply due to their lower calorie content. There is some research to suggest individuals wanting to lose weight may benefit from whole fat dairy because it is more satiating (provides a greater feeling of fullness) and so I recommend individuals experiment with this – if drinking a glass of whole milk is so filling it ends up decreasing what they eat throughout the day, then this can help with weight loss. Otherwise, non-fat and lowfat dairy may be more helpful.

And finally (did I mentioned this is certainly a complicated issue?!) a quick note about dairy for athletes.  I will attach an article (not funded by the dairy industry) that demonstrates why lowfat chocolate milk is an effective, and possibly superior, recovery beverage compared with other commercial beverages – milk has a high composition of necessary amino acids including branched-chain amino acids needed for recovery; chocolate milk has needed carbohydrate for recovery; milk provides fluids required in the recovery process; and milk is also high in needed electrolytes (potassium and sodium) that are necessary for fluid retention. While lowfat chocolate milk would not be necessary after a 30 minute run, it would be appropriate after a more exhaustive workout.

As always, let me know your thoughts and questions!!


Article: Recovery beverages

Mindless Eating: tips from the podcast on Mindless Eating

Mindless Eating: Tips for getting rid of these problematic behaviors

Do you fall into the ‘clean your plate’ club? Have you ever been eating chips/popcorn/pretzels/nuts while you’re on the computer or watching television to look down and find that the bag is empty? Do you always find yourself leaving certain situations (restaurants, social events, etc.) where you are uncomfortably full? So many of these scenarios are the result of mindless eating and can really work against our nutrition goals. While decreasing portion sizes may be particularly important for those on the Lean Machine track, almost all of us can fall into the mindless eating trap where were overeat (and not usually on the healthy food we’re trying to focus on!).

I first recommend listening to the podcast I posted in January 2018 on Mindless Eating. Here is a summary of the tips I shared. And of course, follow-up with me if you need any other suggestions or tips!

  • Think 20% more or less:
    • Serve yourself 20% more fruits and vegetables
    • Serve yourself 20% less of just about everything else. You can always get more if you are still hungry, but so often we over-serve ourselves and 20% less might just be the perfect amount!
  • See all that you eat: regardless of what you are eating, put it on a plate/bowl/etc. first. Don’t eat out the bag or box! Pre-plating our food can result in eating 14% less.
  • Re-package food that is in Costco-sized bags/boxes into smaller packages (using ziplocks or Tupperware) – when we serve ourselves from these larger containers, we actually serve ourselves 20-30% more than if we served ourselves from smaller boxes/containers!
  • Consider using smaller plates & bowls – the average plate size has increased by 2-3” over the past few decades, and just a 2” increase in plate diameter results in eating 30% more – wow!! If we tend to overeat certain foods or meal, at those times try using smaller plates and bowls (such as serving yourself ice cream from a mug instead of a bowl ;).
  • Make overeating a hassle. Keep serving dishes in the kitchen so you don’t keep picking and nibbling when you are done eating.
  • De-convenience tempting foods. Tend to overeat tortilla chips? Stash them in the back of the cupboard – out of sight, out of mind.
  • Only snack at a table and again use a plate. Snacking while we are distracted (driving, on our computer/smart phone/television) can result in eating up to 50% more food.
  • Do you find you’re always the first one done (maybe in certain situations like parties, etc.), and then go back to get more? Try:
    • Aiming to be the last one done. This can significantly slow the pace of eating and help you to feel fuller on less food.
    • Try being the last one to sit down.
  • Know your danger zones! Perhaps you’re not worried about losing weight, but you notice whenever you go to a restaurant, or party, etc. you end up feeling uncomfortably full. Or perhaps you tend to munch mindlessly while you’re in the car. Know where your danger zone is and try some of the re-engineering strategies above.
  • Always aim to leave something on your plate. If you try and do this every time you sit down it can help break the ‘clean your plate’ mentality.
  • Find that you end up munching mindlessly, such as while you’re cooking or in the kitchen (and by the time the meal is done, you are full)? Try chewing on gum – this can keep you from mindlessly stuffing food in your mouth you weren’t planning on eating.

These are just a few ideas. Most of these ideas come from ‘Mindless Eating: Why we eat more than we think’ by food psychologist Dr. Wansink. This is an excellent read – quick, easy, and entertaining – and can be incredibly elucidating.

If you’re interested in learning more about mindful eating, I highly recommend reach Dr. Susan Albers – an excellent read for cultivating more mindful eating habits. She also has a great book on addressing emotional eating if that is a challenge for you: ’50 Ways to soothe without using food.’ Both are excellent and quite practical. Finally, Thich Nhat Hanh wrote ‘Savor’ which is a wonderful read on eating more mindfully.

Let me know what questions you have!

Realistic Resolutions

Millions of individuals set New Year’s resolutions each year; however, the likelihood of actually sticking to these resolutions is actually quite low. In fact, up to 40% of Americans will set a New Year’s resolution, while approximately only 8% will follow through, according to a recent Forbe’s magazine poll.  There are many reasons why we may fail, which include setting overly complicated goals, goals that are not realistic, and not being specific enough on our resolutions. Here are some simple tips for setting – and achieving – a New Year’s resolution:

  • Keep it simple. I recommend setting just one, maybe two goals. Once you achieve those you can always set one (or two) more, but if we set too many goals at once, we are less likely to achieve them.
  • Be specific. This helps to make our goals more tangible. Instead of saying, I will get stronger, set a goal that says I will hit a PR in my deadlift, or I will be able to back squat 200 lbs, or I will decrease my body fat percentage by 2 percentage points. These are all specific, tangible goals and thus gives us something concrete towards which we can work.
  • Consider breaking your goal up into smaller parts. If your goal is a lofty one – say that you are clean and jerking 95 lbs and you want to get to 125 lbs, set benchmarks along the way with time frames – perhaps you aim to be at 105 lbs by May, 115 lbs by September, and 125 lbs by December. You get the picture.
  • Set some accountability. Chris did this with on the FB site a month or so ago – he had everyone post their goal(s) on the group page. This creates accountability. If your goal is to eat more fruits and vegetables, tell your partner what your goal is so that they can support you in this. When we share what we want to do we know we are 4 times more likely to achieve our goals.
  • On that same note, make it visible. Set the background picture on your phone as an image that represents your goal, write it on a whiteboard at home or at the office, have an image in the kitchen that visually demonstrates your goal (such as a picture of the plate method) – set yourself up so that you see your goals daily.
  • Avoid goals that are all-or-nothing. (This also supports the recommendation to make it a realistic goal.) We have this inner-rebel that rebels against these absolutes. Instead of saying, ‘I will have no sweets this year,’ think of what your current pattern is and adjust it downward in a realistic way. Perhaps you have a sweet a couple of times a day. Instead of having no sweets at all, your goal can be only having one sweet a week.

Overall goals should be SMART – specific, measurable, attainable, realistic, and timely – so when you are setting your goals be sure to set yourself up to be successful!

Nutrient Periodization: Part 2

In part 1 of this nutrient periodization series we discussed how to periodize our calorie and macronutrient (carbohydrate, protein and fat) intake on a daily basis according to our training demands and lifestyle factors (days of low activity/high sedentary behaviors compared with very active days). In part 2 we discuss more precise strategies to periodize our intake of carbohydrate and protein specifically to optimize our response to the training stimulus.

‘Train low’ has become a catchphrase that is surprisingly variable in the scientific literature and does not refer to one specific nutritional state. In a general sense, ‘train low’ refers to training with limited or low carbohydrate availability. This could be the result of training with low liver and muscle glycogen stores (AKA endogenous carbohydrate availability) or the result of inadequate carbohydrate intake before and/or during longer training sessions (AKA exogenous carbohydrate availability). The thought behind training low is that it provides the stimulus to up-regulate lipid oxidation pathways and ‘spare’ the body’s glycogen stores. This is based upon the well-understood fact that when our bodies becomes depleted of glycogen and do not have exogenous carbohydrate available, that athletes quickly experience fatigue. This can significantly impair performance and is often experienced as ‘hitting the wall’ or ‘running out of fuel.’

The concept backing all of this research is that carbohydrate is the muscle’s preferred energy source. It is the most efficient substrate to provide ATP for the muscle, or the currency of the cell. Lipids (= fat) can be broken down for energy but require oxygen and are an important energy source for cardio exercise. But, at high intensities when oxygen availability is limited, the body relies upon stored and exogenous carbohydrate. If carbohydrate is not available, exercise intensity and duration quickly becomes limited.

If we can ‘spare’ muscle glycogen (save it for later), we can delay that experience of running out of fuel. Thus, training the body to burn fat at higher intensities sounds great, since it would spare us the need to rely upon carbohydrate.

Indeed, studies have shown that when training ‘low’ (whether from low endogenous stores, or from limited exogenous carbohydrate availability), there are physiological adaptations that enhance fat oxidation. Specifically, we see enhanced activation of cellular signaling pathways and up-regulation of cellular enzymes required for fat oxidation. Unfortunately, there are also some challenges with chronically training low (such as what would happen in a ketogenic or lower carbohydrate/Paleo‘ish’ diet).

First, in the face of chronic low carbohydrate availability, an athlete is likely to be unable to sustain a higher training intensity level (since carbohydrates are needed to fuel these high intensity exercises). This would result in poorer training adaptations Secondly, both long duration and high-intensity training undergone consistently with low carbohydrate availability (such as when following a low carbohydrate diet) can make an athlete more susceptible to illness and infection; this is related to carbohydrate’s role in off-setting exercise-induced immunosuppression. We also see increased muscle protein breakdown in those chronically exercising in the presence of low carbohydrate availability. I cannot imagine any athlete wanting to promote great muscle protein breakdown! Eventually this could lead to decreased skeletal muscle mass. Finally, chronically training in this states actually down-regulates the body’s ability to oxidize carbohydrate. So, for the athlete who perpetually trains low, but then consumes a lot of carbohydrates right before a key event is likely to be significantly less efficient at being able to utilize those carbohydrates they just consumed. Bummer.

What to do? First, it should be noted that as of yet, there are no quality scientific studies that actually show a benefit of low carbohydrate/ketogenic diets on performance, and especially not on exercise done at higher intensities (such as CrossFit). However, this does not mean that there may not be benefit to training smart, instead of training low. By this, I would suggest (as would many sports dietitians) that undergoing key training sessions with low carbohydrate availability may be a smart strategy. This will support improved fat oxidation and all of the cellular and metabolic adaptations outlined above.

However, being ‘smart’ is the name of the game here. If you are undergoing an important, key training session where you want to optimize your training capacity and consequent training stimulus, you want to start that session with optimized carbohydrate stores (training ‘high’). This is done by consuming adequate carbohydrates (see Icon nutrition calculator for recommendations) in the 24 hours leading up to the training session, and ensuring you’ve consumed a carbohydrate-rich snack or meal in the few hours before training.

If, however, you are undergoing a second training session that day, for example, that will be of less importance (a lower training load) or of low to moderate intensity that is not prolonged, you likely can afford to enter that training session ‘low’ by not replacing the carbohydrates you previously burned. That is, your recovery nutrition in between the 2 training sessions can be low in carbohydrates so that you enter the second session low. Other practical strategies to training ‘low’ include training in the fasted state, or restricting carbohydrate intake in the post-recovery period.

Other tips to facilitate the process of training low for particular sessions is to consider consumption of caffeine (such as what would be consumed in a cup of coffee) and/or carbohydrate mouth rinse that is not actually swallowed before training; research indicates this can be registered by the central nervous system from sensors in the mouth and can stimulate some of the benefits achieved from actually consuming carbohydrate. This may help to achieve higher training intensities in the face of low carbohydrate availability. Additionally, when training ‘low’, athletes should consume 20-25 grams of protein before, during, or immediately after training to attenuate muscle protein breakdown and to stimulate muscle protein synthesis that is otherwise more likely to occur when training low.

Keep in mind, training low should only be considered for less important training sessions that include a lower training volume and decreased intensity. Athletes should continue to train ‘high’ for important, key training sessions. For athletes hoping to enter competition, training ‘high’ should be undertaken during training sessions that mimic competition – that is, practice training with a carbohydrate-rich meal that will be similar to what is consumed before competition and even practicing different carbohydrate-rich meals that can be consumed in the 24 hours prior to competition. This all supports positive training adaptations and avoids any ‘surprises’ on game day.

Alright, that was a lot of info… What questions do you have?!?