Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather
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Sunday, 9 March 2014

Runner's Diet: low carb, high fat research and experimentation

First of all, I am not going to pretend I am an expert on optimized fat metabolism (OFM). It is a popular term in endurance running these days. Normally I would just kind of ignore it and think it was a fad. But I am not ignoring it (and in fact, I am obsessing over it) for a few reasons:

1. I have been able to fight quite a few health problems and improve my running with a radical, though gradual change in my diet over the last year and a half. The diet I have somewhat coincidentally ended up eating is nearly the exact same diet endurance athletes such as Zach Bitter and Casper Wakefield use to optimize fat metabolism. I have to thank both of them for being so open about their eating strategies for ultra training.

Since switching their diets, Zach and Casper have gone on to set amazing records in long distance running. And here is Zach's cholesterol profile before and after switching to a low carb, high fat diet.
2011 - high carb diet

2012 low carb, high fat diet (N/A next to LDL since it was undetectable)
I had heard in medical school that, despite all odds, some guy with a personality disorder in Scotland who ate 2 dozen eggs a day had a "perfect" cholesterol profile (details may have been exaggerated :-). But Zach's cholesterol levels indicate he is indeed very healthy.

2. I have been asked to give a lecture to Sparta Atletik on April 3rd entitled "Runner's Diet" and, while I feel comfortable with general physiological concepts, as well as eating and drinking before and during races, what runner's optimally should eat on a daily basis, is a topic I have not looked into extensively before.

My previously unhealthy relationship with food (just because you start out "bad" doesn't mean you can't change)

I used to have a very simple way of looking at food and calories. Burn more calories than you take in and you will be thin and fast. Candy is bad and why not try to follow the food pyramid and avoid getting deficient in anything?

Probably the lowest point I reached in my diet was getting over half of my calories from flødeboller and then drinking diet soda and chewing sugar free gum to stop myself from eating more, though I was constantly hungry. I also tended to eat white bread and butter for breakfast. I always heard this was unhealthy, but come on, "the proof is in the pudding"!

I replaced the flødeboller with chocolate (much better?!) and .. it's embarrassing to go into too great of detail, but the truth is, I ran really high mileage and even won the Mad City 50k in 4:09 on this very diet. Heck, things weren't really that bad.

But what started the change in my diet was, despite weighing only 49 kilos, I was too embarrassed to wear anything tight or go swimming without a big towel around me because I looked like I was 4 months pregnant. Also, I had been on PPI pills for acid reflux since I was 18 years old and couldn't survive a day without them.

An ophthalmologist friend of mine pointed out the connection between diet soda and big bellies over Facebook. I cut out artificial sugar and my belly shrunk - over only one week (check out the purple and green lines over just 8 days after stopping diet soda and artificial sugars):


Around the same time, I decided to see if I could give up my PPI stomach acid medications. I started taking probiotics instead and after about a month, my acid reflux had greatly improved.

I was so amazed by how much better I felt that I decided to give up gluten. Around this time, a rash I had had around my eyes for two years disappeared. I started gaining muscle and energy. I ran PR times in the 5k, 10, ½ marathon and marathon within 3 months. My reflux and irritable bowel syndrome are gone and it is no coincidence, but pointing to one change is hard when I changed so much at once. I will only suggest that people reconsider eating modern day wheat (the semi-dwarf GMO (edit: thanks Robyn and SR; it is NOT a GMO, but created by cytogenic hybridization), when it is theoretically implicated in many autoimmune diseases, at least one type of dementia and lymphoma.

About two months ago, Robyn challenged me to try the Whole30 diet. I didn't. But what I did was I cut sugar out of my diet, except two Clif Builders bars for breakfast - they are all natural, low sugar (Edit: thanks, Pam- not really low, 20 g per bar), high protein bars (also 20 grams per bar). You probably don't believe I ate that much sugar going into it, but try 3 packages of pålægschocolade a day on for size.



Suddenly I was on a very low carb, gluten-free, pesco-vegetarian, basically sugar free (no artificial sugars!) diet. It took a couple of weeks before I started watching my body change before my very eyes. I would not be writing this if it weren't for the changes I have experienced, mostly positive, some negative.

Fat Oxidation/Metabolism

My understanding of fat oxidation is it is using fat for fuel. One can improve their ability to metabolize (use for energy) fat though lifestyle. Endurance exercise improves our ability to metabolize fat. And insulin sensitivity improves our ability to metabolize fat. This means that people with diabetes, who are insulin resistant (not type 1, but type 2) have a remarkable inability to oxidize fat. Their fat sits there, basically unused. The final thing one can do to improve their ability to metabolize fat is to eat less carbs and more fat. From the research I have read, medium-chained fatty acids work the best, rather than long (olive oil is long and butter is medium, for example). My personal theory is it is the lack of carbs and not the type of fat that matters most.

Through the above exercise and dietary habits, one can preferentially oxidize fats at a higher and higher percent of one's VO2 max, which means that one can run ultras at say 60-70% of VO2 max with very, very little reliance on carbohydrates and stored glycogen. This means you won't have to eat carbs constantly while running. This is a big deal since nausea and stomach upset is the number one reason people drop out of ultras.

All of this has been demonstrated through sound science. The real question is if it can improve performance.

For the last 7-8 weeks, on my accidental OFM diet I have noticed a lot of changes.

1. My cellulite has disappeared. I never thought I would write this. But (as kinky as this sounds) I have SR do the skin squeeze test on me often and he can't find any cellulite anymore. Though I weigh the same. I do indeed see this as proof that I am preferentially burning fat- at least more so than before when I had these cellulite pockets (on my thighs and waist) that wouldn't move regardless of my weight or training.


Ok, not that impressively muscular, but an improvement!


Here is Robyn at the end of the Whole 30 diet-- maybe I should have tried to follow those rules strictly after all :-)


2. My blood sugar feels constant. It is great to not lose energy during the day. Eating things with a high glycemic index (white bread has the highest... see below) causes wild blood sugar swings. The only exception to this is when I am out on my long runs, it takes very little time before I hit a sort of wall. The interesting thing is, the energy comes back once I get past that initial wall. I have not run a marathon or ultra since I started on this diet so I am really curious what is going to happen. I honestly doubt it will mean I have to drop.



3. I have been running some tempo PRs in training. Though my coach doesn't like me to, I go entirely after feel and not after pace. A faster pace feels easier than it did last spring. There is no doubt about that.

4. If I get a small injury, I recover within 1-2 days. A benefit of having a stable blood sugar and insulin sensitivity is inflammation (which is fed by sugar) is decreased and you heal faster. People with diabetes (similarly fluctuating blood sugars to people with a high carb diet) are notoriously slow healers and this is one of the reasons.

5. I can do pull-ups for the first time in my life and up to 70 push-ups at a time. This is a good guage to me that my muscles are growing.
I never thought I would do a pull-up. Here was number 3 (on our home bar, which once fell down when SR was using it. He claims he blacked out when his head hit the trashcan)
6. Low carb/low sugar food is insanely expensive. At some point I would like to do a blog post called low-carb, gluten free, natural eating on a shoe string. I think this will take years of research, though, and really depends on which country I live in. The WHO now recommends less than 6 tsp of sugar a day. They just don't mention how expensive this is.

7. I get irritable on my long runs (see number 2)

8. I smell and have acne. I could not figure out why this was until today, but after reading more about whey and how bovine products cause insulin production out of proportion to the amount of sugar they have, I do believe my increased cheese intake is to blame. I don't drink milk, but eat cottage cheese and other cheeses, which contain a small amount of whey. I suspect this is the reason for my increased odor :-) and acne. I did not know that milk had been so convincingly implicated in increased teenage acne. Milk and high carb diets. It is amazing how much whey is used as an additive in processed foods, by the way.

In summary:

My feeling right now is a low-carb, all natural, gluten-free, low sugar diet is the way to go for a healthy life, or at least a major improvement on where I have been. And once you start following it - at least after the initial two weeks, you don't want to stop. I just think the night before long races that it will be important to fill up the glycogen stores so I don't go into a race ready to go cold. Also, it is really important that when running at high effort for many hours that you replace the carbohydrates you lose otherwise you WILL go cold. So don't skimp on carbs if hungry while racing and probably not on your long runs either. Pam Smith does well with liquid carbs + fat + protein (ensure, white soda). I do well with potatoes and salt + juice + Clif Builders bars. I'm not about to change this race strategy until it stops working. I just think with an improved ability to metabolize fat that I will not need to eat as much while racing, minimizing stomach problems and maximize energy.

Something for you all to chew on...

A few pictures from our weekend. SR ran a potential double baby jogger world record 5k in 18:01 (on dirt) and I took 27 seconds off my time on the same route from 4 weeks earlier.


and I took 27 seconds off my time on the same route from 4 weeks earlier (19:28, just as a tempo). I love free races!



But not as much as I love my boy!

Running song of the day... (so poetic the way she enunciates the "e" at the end of each phrase)

Wednesday, 5 March 2014

The big decision

I haven't exactly hidden the fact that I love living in Denmark. I annoy my readers with this opinion often. SR suggested I tone down the "double citizenship argument" since no one cares but me. Fair enough. 

What exactly is going on in our lives is weird and confusing. SR has a full time job in the US; I have a full time job in Denmark. 

A few weeks ago, the kids moved to Denmark with me and SR spent time alone in the polar vortex (Duluth). He returned to Denmark last week, to a warm apartment in (relatively) balmy country; to happy kids and home-made chick-pea pancakes and most importantly, biathlon on Eurosport. Oh and his wife. These days he says often that he wants to move back to Denmark. He says will quit his job in Duluth this summer.

But the night he arrived, I had to decide whether or not I would withdraw from or stay in the American residency match, to start a 3 year training position in Physical Medicine and Rehab in the US (place to be determined). We agonized over the list I had to rank of most desirable programs (only those I had been invited to interview at) over least-desirable. Rasmus agonized over my desire to rank Stanford higher than his desire to live in Palo Alto (he won). But what really mattered to me was we were saying we would move to the US for 3 whole years. The country that wouldn't give me more the 15 days maternity leave or any understanding or compassion as a young female soon-to-be mother physician. That culture of working 80 hours a week and thinking nothing of it. The culture of medicine that doesn't tolerate ... moms. Mothers who sign up and sign away their lives are asking for conflict. American society wonders how you can't be there for your kids at 2:30 PM when they get out of school and go to after school activities (and you wonder yourself) and your residency program expects nothing to trump working and learning. 50% of young American moms don't work ... America- why even educate women who want to have kids?

3AM Feb 26th was the deadline to decide- is it any wonder I was up until 3 AM?

If I were any other blogger, I would say it was "a privilege" to be able to make this decision, that I was "filled with gratitude" for the opportunity, but those are big empty words. I don't like them. 

Instead of being filled with gratitude, I was filled with tears. But I followed through on the plan SR and I had made together. And we will be closer to his kids starting July of 2015- for 3 years.

And then, I will bring the speciality of Physical Medicine and Rehab back to Denmark, where it currently doesn't exist. I'm excited about that.

Since the big decision, we have been enjoying the magical weeks of all being together again. 


Christian's running has suffered in American public schools and Duluthian snowdrifts, but his drive for accomplishment hasn't.
After the race, he became the king of Fastelavn by breaking the barrel with the poor cat in it. Or was it a giraffe? Actually these days there is no animal inside the barrel, only candy.
 This past weekend, SR and I went to Møns Klint, Denmark, which looks like this from a distance:
Klintejagten_2006(1).jpg
from campingmoensklint.dk

It is good to meet a husband who is willing and ready to discuss the pathways to gluconeogenesis and the genetic makeup of Trinidad on long runs.
And ask me why on earth I am panting while running uphill. (the explanation is not rocket surgery)

He says my running technique keeps getting better, which I am so proud of. I just can't figure out how he started out with proper running technique, but he did!
We like grimacing, or not.

We pretend he looks fast, but perhaps we are looking at the scenery?

One of the essential elements of being an upper class (respectable) mom in Denmark is the perfect scarf for every occasion. Buffs are not accepted in most circles- I learned at a Christian's pre-kindergarten meeting.

Sudden mist storm.

And trash.

No one every said life would be easy. They did say life would be beautiful, though, and they were right.


Running Song of the Day: Tom Odell's "Another Love" (Zwette Edit)