Solace Paleo Challenge Paul Grewal, MD

Meta - Diet -Willpower -Food Environment and Control -Accountability -Sustainability

-self-tracking - n = 1 -sleep -stress -implementation

Willpower -view it as a muscle that can be fatigued but also exercised -it’s best not to have to use it -habits don’t require willpower

1. prepare in advance 2.  time-limited,

defined goals 3. use it to create

habits 4.  forgive yourself

willpower

Food Environment -plan ahead, anticipate challenges (i.e. work) -restaurants -social situations -change default decisions

If you are an overeater/sugar addict, you will probably notice that controlling your food choices is much easier when you are in control. Walking into the office and seeing free

cupcakes throws off your carefully controlled and constructed environment and is when you need to use your willpower or

play a mental game like imagining the food as a poison, among others. Doing this when underslept and in chronic

stress makes it doubly hard so don’t tempt fate.

Once you Pop, you can’t Stop Hyperpalatable foods: Food products that are engineered by food scientists to create insatiable overconsumption are considered hyperpalatable. Salt, sugar, fat, and wheat flour are combined to maximize pleasure in the brain's reward system, simulating properties of addictive substances. Further reading Food Addiction – A Serious Problem With a Simple Solution by Kris Gunnar.

Hyperpalatable foods are designed to be addictive or

overconsumed, echoing Pringles' slogan of "Once you pop,

you can't stop." The sweet, salty, or fried properties

ofhyperpalatable foods target the brain's reward centre,

drawing parallels to drugs.

Sugar is the primary variable that links to addiction, as it

releases dopamine, resembling adrug of abuse, and can

potentially even surpass the effects of cocaine.

easy to overeat “just a little bite” is an invitation to meltdown. These foods are uniquely designed to #$%# up your brain and metabolism. If weight loss is your goal - avoid Paleo cookies, etc. “Administration of a drug to an addict will cause reestablishment of chemical dependence upon the addictive substance.”

Accountability -built into the challenge with self-tracking program -Look to the right or left, pick a partner, exchange phone #s and start MMSing your meals at each other

Sleep -  Growth Hormone release

blunted if you don’t hit slow wave sleep

-  you will subconsciously eat 550cal extra per day if you are sleeping <5-6 hours

-  decision impairment, less likely to resist temptation

-  Critical Component of the Challenge

Meal frequency & metabolism

What works for you? -  meal frequency doesn’t matter. Your metabolism is the

same with 1 meal a day vs 6 meals. -  When you are fat-adapted, you have flexibility -  Willpower - is it easier to make 6 healthy food decisions

per day, or 2-3? -  Do you get more satiety out of larger meals? -  what fits with your social lifestyle? (I like steak.)

The two states of metabolism Fed / Fasted or Anabolic / Catabolic Time course - important when fasted for 3+days… when we refer to fasting, we are talking about less than 3 days (more than that and your body is not fasting, it’s starving) -  your body can’t tell the difference between

no food and little food

Fed, or Fasted?

Insulin - the master Hormone . Insulin is the primary anabolic hormone and major regulator of fat stores.

●  Insulin is a one-way valve on a fat cell. When it is present, it turns the fat cell into a Roach Motel. Calories can go in, but they can't come out.

●  chronically elevated insulin levels and resistance means that potentially one single bit of junk sugar can spike you for 2+hours and put your body in a relative starvation state/hypoglycemia causing you to mentally crash and break your diet. Sugar in an insulin resistant individual is Kryptonite.

●  low insulin levels are a precondition, necessary and often sufficient, for fat loss ●  the modern obese phenotype is mediated primarily by insulin resistance and high circulating insulin levels. ●  insulin is secreted mostly in response to carbohydrate intake. (in lesser amounts to very high protein intake) ●  almost any dieter will benefit from an initial period of drastic carbohydrate restriction to reset insulin sensitivity.

o  this can range from 20-75 grams per day, titrate to effect, which should consist mainly of green vegetables. Initially, the lower, the better. Visually, 1 teaspoon of sugar is only 4 grams, so when something has 8 grams of sugar, you are basically eating two spoonfuls of the white stuff. no bueno

●  Your entire circulating blood volume (5 Liters) has a grand total of ONE TEASPOON of sugar in it. Your body does not need it for fuel.

●  20% of people are obese without insulin resistance, low carb may not be as effective in this population. ●  Low carb is not a license to eat processed cheese and industrially raised red meat and processed polyunsaturated oils with

abandon. see attached approved foods

Insulin - the master hormone

Doesn’t my brain need sugar?!? -your brain can run on 25% sugar and 75% fat but only after a few days of Lower-Carb -your liver will make sugar out of protein after 24-36 hrs of low carb, calorie restriction, or fasting

Paleo vs Low-Carb paleo

-sensitive balance for athletes (you are all athletes!) -for most newbies, eliminating wheat/sugar/processed foods will naturally lower carb intake and insulin levels -if not meeting fat loss goals on paleo, limit fruit and starch

weight loss vs weight maintenance -permanent metabolic slowdown?

Changes in Energy Expenditure Resulting from Altered Body Weight

● http://www.nejm.org/doi/full/10.1056/NEJM199503093321001#t=article

● The reduction in energy expenditure to a level 15 percent below that predicted for body composition, as a result of a 10 percent (or larger) decrease in body weight, is large when one considers that an average daily intake of 2500 kcal would be associated with a positive energy balance of approximately 375 kcal per day.

Date of download: mm/dd/yyyy

Copyright © 2012 American Medical Association. All rights reserved.

Date of download: 2/3/2013 Copyright © 2012 American Medical Association. All rights reserved.

From: Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance

JAMA. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607

Each summary box (shown in cyan) with error bars indicates mean (95% CI) change from a common baseline period preceding weight loss obtained from analysis of crossover experiment and adjusted for sex, age, order of diets, baseline weight, and mean weight during the 4-week diet period. Connected lines indicate individual outcomes for each participant. Both resting and total energy expenditure showed a significant linear trend in mean change from low-fat to low–glycemic index to very low-carbohydrate diets (P < .01).

Figure Legend:

Date of download: mm/dd/yyyy

Copyright © 2012 American Medical Association. All rights reserved.

Cortisol - not the “stress hormone”? -  primary catabolic hormone -  liberates fat, glycogen, protein for use as fuel- In that

order (important!) -  natural circadian release, helps you wake up -  carbs in the AM turns on insulin -  now you have activated the catabolic AND anabolic

hormone at the same time -  insulin is a one way valve on fat cell, soooo -  cortisol now eats your muscles instead -  this causes 11am sugar crash and hunger

Cortisol carbs at breakfast: -  increase insulin all day -  blunt Growth Hormone

breakfast calories vs total daily consumed for every 100 additional calories eaten at breakfast by an obese person, daily calorie consumption goes up by about 65 calories

Growth Hormone, sleep, and fasting (don’t focus on this if it’s your first paleo challenge)

In adults, GH functions primarily to preserve lean mass during a fasted state. Maximizing endogenous GH production is critical if not for the initial weight loss, then for body recomposition. GH secretion is suppressed by the following:

●  Eating, even small amounts ●  excess cortisol (avoid stress) ●  less than 7 hours of sleep (GH circadian max level is just prior to waking)

GH is increased by orders of magnitude by the following: ●  fasting - anywhere from 14 hours onward for a female, and 16 hours onward for a male.

o  Functionally, this means creating a daily eating "window" of about 8 hours. o  For most people, it is socially more acceptable to eat in the evenings, so meals should occur between noon-8pm

or 2-10pm o  other "intermittent fasting" regimens are also perfectly acceptable, including:

§  every other day, 24 hour fasting (eat dinner, don’t eat again until the same time the following day §  once to twice weekly fasting of 36 hours (eat breakfast, dont eat until dinner the following day, or

eatdinner, then dont eat until breakfast 2 days later o  these are somewhat more extreme, so sticking with the daily restricted feeding window is the most psycho-

socially acceptable for long term success (my opinion.) o  Pick one method and stick to it for the entire 4 weeks. Schedule your fasting days ahead of time if this is an

option for you.

GH release with exercise Intensity

GH in fasting

24 hrs

Ghrelin, meal timing and basal metabolic rate.

The hormonal intricacies here are less important than the fundamental fact that "small frequent meals to boost the metabolism" is total hokum. Metabolic chamber studies show that whether you eat 1 meal a day, or 6, your basal metabolic rate is exactly the same. This is liberating because it provides lifestyle flexibility, allows having a large meal and feeling full, and helps keep the

amount of time insulin is circulating to a minimum. ●  Ghrelin stimulates hunger and is secreted in response to eating and not sleeping ●  It increases before meals and decreases after meals ●  it increases the number of meals you eat but not the amount you eat at each meal ●  this could theoretically be modulated by reducing meal frequency

Prolonged calorie/carb restriction -unnecessary with paleo & crossfit -if prolonged calorie/carb restriction (weeks to months), negative effects on testosterone, estrogen, thyroid hormone

Leptin

Leptin and periodic carb re-feeding:

There is a very complex interplay with leptin, insulin, and both leptin and insulin resistance in the brain, but the basic principles are thus:

●  leptin deficiency acts in the hypothalamus to stimulate appetite and prevent fat loss ●  during calorie restriction and exercise, leptin drops, prompting the brain to increase calorie intake and regain the weight ●  obese people have chronically elevated circulating leptin (leptin resistance in the brain- higher leptin should mean more

satiety but this is not the case) ●  people who have lost weight have chronically lowered leptin, which acts to increase hunger, and decrease thyroid

activity, sympathetic tone, and energy expenditure in skeletal muscle. This accounts for the unfortunate physiology of the weight-reduced patient to have a lower basal metabolic rate than someone who started out at that weight(i.e. a 250lb person who diets down to 200lb burns about 3-400 cal per day LESS than someone who started out at 200lb)

●  Recent studies suggest that low carb diets can restore some of this metabolic disadvantage ●  This might be mitigated with periodic carb refeeds.

Carb timing (advanced) Carbs and resistance training - Glycogen depletion in the muscles causes translocation of the glut-4 receptor to the cell membrane --- this enables insulin-independent transport of glucose into the tissues and makes this time the least likely time for you to store carbs as fat. In addition, when you are insulin sensitive, high glycemic carbs work well because it reduces the area-under-

the-curve for insulin and increases the amount of time you are running on fat for fuel.

For someone not doing intense exercise, post-workout is still the best time to consume carbs if you are going to consume them. Carbs should be viewed as a performance-enhancing drug, and work best to replenish glycogen after it's been depleted.

In this way, after a 10-14 day low-carb run-in phase, one would theoretically be in a state of cyclical ketosis. This means that the brain has adapted to run on about 75% ketones, blood sugar is maintained almost exclusively by gluconeogenesis in the liver (the

body is exceptionally adept at maintaining blood sugar within a very narrow range in the absence of dietary carbohydrate. alcohol can be problematic as it inhibits hepatic glucose production), and the occasional carb meal does not make the brain revert back to

glucose dependency. When the brain is keto-adapted, drops in blood sugar do not materially affect brain function. The carb meals help reset leptin sensitivity and mitigate the metabolic deficiency of the weight-reduced patient. (In theory)

Carb cycling (not recommended if this is your first paleo challenge) -more carbs on days you work out (and most of those carbs after your workout) -will ensure that the carbs you do eat are preferentially going to replenish your muscle glycogen to power your next anaerobic workout -

Summary - hormone by hormone Insulin - needs to be low for fat loss -drops subconsciously for most people with Paleo, which is the primary reason Paleo works for fat loss -if you are insulin resistant (80% of you), even small amts of high glycemic carbs will spike your insulin for hours - you have less wiggle room -needs to be present for muscle building - post workout meal important! - range of carb tolerance can be from 20g per day to 150+ . If weight loss is your primary goal, start low and increase slowly. Carbs required to support varying activity levels.

Growth Hormone -  goal is to naturally maximize levels -  improves insulin sensitivity and blood sugar - get enough sleep! - Intense exercise - occasional fasting periods are OK, skipping the occasional meal is OK. Remember, total calories can remain the same, but the extra GH will help preserve lean mass

Cortisol -  avoid chronic elevation (will redistribute body

weight to truncal fat stores)- stress, anxiety, sleep deprivation, social isolation, prolonged calorie restriction

-  not the enemy - it just liberates energy for you to start your day

Ghrelin -  increases hunger when you are used to

having a meal, i.e. 10am, noon, 6pm. If you are going to change meal frequency, be aware that you will be fighting it, at least initially

-  blunted by intense exercise (yay Crossfit)

Leptin -  When it goes down, you get hungry -  prolonged drop when you lose weight -  can be reset with occasional higher-calorie

day + carbohydrate -  Probably not worth thinking about unless you

are already close to ideal weight

Others epinephrine - released in intense exercise, fasting (in men only). Supresses hunger CCK - makes you feel full when you eat protein + fat

Further Reading http://simplesciencefitness.com/ Why We Get Fat - Gary Taubes Salt Sugar Fat - Michael Moss The Primal Blueprint - Mark Sisson It Starts with Food - Melissa Hartwig