What If It Was Easy?

Of the three macronutrients, protein, fat and carbohydrates, only protein and fat are essential - they must be included in our diet. We can create glucose endogenously as required. That doesn’t mean that we might not feel and perform better with some dietary carbohydrates, particularly if we are very active.

A surprising number of digestive complaints are driven by eating in a rushed, stressed state. The release of various digestive juices, acids and enzymes, as well as the peristaltic contractions of the gut are mediated by the parasympathetic branch of the autonomic nervous system. If we’re fired up, they power down. A practice of 3 ‘physiological sighs’ before eating can make a significant difference to digestion. We can take this opportunity to smell the food in front of us, waiting for the salivary release that indicates that our brain is diverting resources towards the digestive process.

The mechanical breakdown of food by chewing, as well as the enzymatic action of salivary amylase and lipase are an important precursor to the digestive processes of the stomach. By chewing each mouthful 30-40 times, we dramatically improve our absorption of nutrients, and avoid common digestive issues. It sounds trite, but it really matters.

Many of us suffer from heartburn, assuming that our problem is gastric hyperacidity - too much stomach acid. It’s possible, but more likely that the lower oesophageal sphincter, the muscle that controls access to the stomach has lost tone, allowing acidic chyme to move back up into the oesophagus from the stomach. This can even be driven by low stomach acid - hypochlorhydria.

Autoimmune diseases sit on a 3-legged stool, requiring a genetic predisposition; epigenetic changes to the way genes are expressed (like dietary factors, lack of activity or sleep, exposure to chemicals or pathogens etc); and some element of cross-reactivity/molecular mimicry, whereby the immune system confuses the cells of the body with a similar-looking antigen, whether that be a protein from food, or an invading pathogen.

Gluten can trigger autoimmune flare-ups, not just in the case of Coeliac Disease, where it directly causes the immune system to attack the cells of the gut, but also indirectly: Gluten can open the tight junctions of the gut lining, allowing undigested proteins and peptides to cross into the bloodstream. So why doesn’t everyone who eats gluten have autoimmune disease? Because we also need to have some loss of immune self-tolerance, and perhaps some degree of compromised digestion: If proteins are being completely denatured by pepsin in the stomach, it won’t matter so much that intestinal permeability has increased - there won’t be intact protein structures remaining to cross that barrier in the same way as if digestion is poor.

While we assume that our hunger is driven by a need for energy, for calories, it’s primarily driven by the need for nutrients, in particular protein. We also have hunger drives for essential fats and electrolyte minerals like sodium, potassium and magnesium. If we satisfy our need for protein and micronutrients, we will be able to control hunger and sidestep ‘empty calories’. However, that doesn’t mean that we won’t make poor food choices for emotional reasons, or out of habit.

The microbiota, the bacteria we host in our gut, have the ability to affect our glucose tolerance, immune function, intestinal permeability, risk of cardiovascular disease, risk of autoimmune disease, mood and level of anxiety amongst other things. It seems that each new study reveals their ever more far-reaching effects on our systemic health. However, we still can’t really say exactly what a healthy microbiome looks like, and we have only limited means of deliberately influencing it.

Bile, made in the liver, concentrated and secreted by the gallbladder is responsible for the emulsification of fats in the digestive tract, the carrying of conjugated toxins out of the liver for excretion and the removal of surplus cholesterol and redundant hormones. If we don’t regularly move our bowels, these waste products can be reabsorbed into the body. This is a primary benefit of dietary fibre.

The role of fibre in increasing stool volume and throughput, and so the potential to carry waste out of the body before it is reabsorbed, is perhaps more important than the notion that insoluble fibre acts as fuel for our microbiome. Lots of things can feed our microbiome in the absence of any dietary fibre - like butyrate and amino acids.

Dietary cholesterol typically makes little difference to our serum lipid profile, which is primarily determined by the creation of lipoproteins in the liver. The cholesterol we eat is esterified - too big to be absorbed in the gut. But non-esterified cholesterol from bile can be reabsorbed from the gut lumen. Soluble fibre, like psyllium for example, can increase the excretion of this cholesterol, reducing our serum levels. Drugs like Ezetimibe act on this pathway to reduce the uptake of cholesterol at the enterocytes - the cells of the gut lining.

Sleeping less than 6.5 hours a night makes us tired, less able to concentrate, less insulin sensitive, crave sugary foods and more impulsive. Ideally we need 7.5-9 hours of sleep per night. We must also account for the fact that we lose around 10% of the time we spend in bed to wakefulness.

To improve sleep we might limit caffeine after midday, avoid strenuous exercise in the evening, practice mouth-taping, eat our last meal at least 3 hours before bedtime, sleep in a cool room (17°C), avoid bright screens and electric lighting, particularly blue light in the evening and keep our room as dark and quiet as possible.

It’s a contentious issue, but sometimes our most significant sleep disruptor is our partner. We don’t necessarily need to sleep in separate rooms. Separate beds, or even separate duvets on the same bed can make a big difference.

Stomach acid activates pepsin to break down protein, eliminates pathogens, cleaves minerals like calcium for later absorption, and enables the release of intrinsic factor for the absorption of vitamin B12. Too little stomach acid - hypochlorhydria, is a common digestive issue.

In the battle with high-glycaemic junk food, we may find that we endlessly re-write our own rules in order to permit it. Sometimes it’s as if reason is temporarily disengaged. 1. Avoid true hunger: Regular, high protein, nutrient-dense meals avoid the level of hunger that makes resistance impossible. 2. Don’t keep junk food in the house: By removing it, we force a decision-making process between ourselves and that which we’re trying to avoid. We have to actively decide to leave the house and go to the shop. This gives our reasoning, analytical brain a chance to intervene in our compulsive behaviours.

It’s surprising how often family members will attempt to derail our efforts to eat well. Others find it threatening - it implies that they should do the same and they don’t want to. They may do everything from tacit temptation - leaving sugary snacks lying around, to gentle persuasion - ‘Oh come on, a little bit won’t kill you’, all the way to actually putting elimination diet ingredients into food. Familial support is important, but ultimately we must take personal control of our shopping, cooking and food environment as much as possible.

It’s important that we base our progress on the end points we’re actually interested in. When we talk about losing weight, we’re really talking about changing our body composition: Losing fat, while gaining, or at least not losing lean mass. Of course, scale weight is going to reflect the fact that we’re shrinking, but it can’t tell us how much of that lost volume is water, fat or lean mass. In an ideal world, we’d have regular DEXA scans, but they’re inconvenient and expensive. Instead we can take measurements, particularly around our waist, we can see how our clothes are fitting, and can track our strength in the gym. If our waist is shrinking and we’re maintaining, or gaining strength, we’re probably going in the right direction.

We’re not going to achieve our body composition goals with cycles of unsustainable crash dieting. These diets deeply restrict both calories and nutrients driving the rapid loss of both fat and lean mass. By definition, the diet will have to end, and when it does we will regain fat very easily, but the lean mass will be difficult or even impossible to replace. As these cycles continue, our scale weight will swing up and down, but our lean mass will gradually deplete and our body fat percentage will creep up. A better strategy is to change the composition of the diet, skewing it in favour of nutrients and away from energy. A subtle calorie deficit in the context of a nutrient dense diet will allow us to gradually lose fat, while retaining our lean mass, particularly if we also strength train. As we don’t experience the hunger of deep caloric restriction, this is a sustainable approach - we can stick to it indefinitely.