Ten top tips (10TT) weight control trial

This BLOG looks at the outcomes of an interesting study on weight control.

GP’s are often the first port of call for weight control advice. However they aren’t in a position to provide specialised therapy in this area. The researchers identified that although healthy ‘habits’ are the aim of many weight loss programmes, very few draw on the theory of habit formation.  So they designed a simple effective intervention that could be delivered without specialist skills and based on the fundamentals of building habits.

The essential feature of the psychological theory of habit formation is that habits are stimulated by environmental contextual cues. The intervention took the form of a leaflet called ‘Ten Top Tips’ (10TT) and it incorporated this idea. It listed target behaviours with advice on repetition and context. It also recommended self-monitoring during the habit acquisition phase.

A pilot study was carried out and then a small scale randomised control trial (RCT) with a volunteer population.  Subsequently a larger RCT was carried out with 537 primary care patients.

Pilot RCT weight loss results at 8 weeks and 32 weeks

8 weeks 10TT 8 weeks
No action
32 weeks
10 TT
Comments
Weight loss-2.0 kg- 0.4kg-3.6 kg54% achieved the 5% weight loss associated with beneficial health effects

Larger RCT weight loss results 537 participants after 3 months

 10TT group‘Usual care’*Comments
Weight loss- 1.68 kg- 0.84 kg16% achieved a 5% weight loss compared to only 8% in the control group

* N.B. Usual care refers to the standard care provided by GP’s versus the 10TT leaflet.  In the pilot study the volunteer pilot RCT the control group didn’t receive any kind of care. The participants in the larger RCT were recruited from GP surgeries whereas the pilot study recruited volunteers.

The interesting thing to note is that in the pilot study weight loss continues after the intervention ended.  Maintenance of weight loss is often the biggest challenge for most people.

The 10 Top Tips (10TT)

I’ve reproduced the top 10 tips in full above as per the study.  My main comment is that I am not necessarily a fan of reduced fat products as they often use sugar or artificial flavourings to replace the fat content.  However monitoring your total fat intake is useful and especially any trans-fat intake as this will hamper weight loss efforts. I often refer clients to the BANT healthy plate https://bant.org.uk/bant-wellbeing-guidelines/.  My other comment on the ‘top ten’ is re sugar free squashes.  These will often use sweeteners which are neuro toxic and confuse the body.  It’s best to wean yourself off these kind of drinks entirely.

  1. Keep to your meal routine by eating at roughly the same times each day whether this is two or five times a day.
  2. Go reduced fat (I advise caution here as often reduced fat items are full of sugar or flavourings)
  3. Walk off the weight – walk 10,000 steps which is equivalent to 60-90 minutes of moderate activity. Use a pedometer to count the steps.
  4. Pack a healthy snack – if you snack choose a healthy option such as fresh fruit or yogurts instead of chocolate or crips.
  5. Learn the labels – be careful about food claims (see point 2).  Check the fat and sugar content on food labels when shopping and preparing food.
  6. Caution with your portions – Don’t heap food on your place (except vegetables). Think twice before having second helpings.
  7. Up on your feet – break up your sitting time. Stand up for 10 minutes out of every hour.
  8. Think about your drinks – Choose water or sugar-free squashes.  Unsweetened fruit juice contains natural sugar so limit to one glass a day (200 ml/1/3rd pint). Alcohol is high in calories: limit to one unit a day for women and two for men.
  9. Focus on your food – Slow down.  Don’t eat on the go or while watching TV.  Eat at a table if possible.
  10. Don’t forget your 5 a day – Eat at least 5 portions of fruit and vegetables a day.

They calculated that these habits would generate a calorie deficit of between 800-900 calories daily.

References

Beeken, R.J. et al. (2012) Study protocol for the 10 Top Tips (10TT) Trial: Randomised controlled trial of habit-based advice for weight control in general practice; BMC Public Health; 12 pp. 667

Beeken, R. J. et al. (2017) A brief intervention for weight control based on
habit-formation theory delivered through primary care: results
from a randomised controlled trial; International Journal of Obesity 41 pp.246-254

Intermittent fasting and fasting for health

Fasting
Intermittent fasting
Health
Weight loss

Intermittent fasting is in the limelight at the moment but many traditions have been incorporating fasting for millennia.  Humans have historically fasted overnight, for religious reasons or during periods of food scarcity. Some monks have a precept called ‘no meals after noon’ and religions such as Taoism, Sikhism, Hinduism, Christianity, and Buddhism all fast.

Fasting principles

What we eat at mealtimes is our primary fuel source for 3-4 hours.  After 4-12 hours we utilise sugar (glycogen) stored in the liver, muscle and brain.  Somewhere between 10 or 12 hours we will start to burn fat out of the liver to produce glucose for energy (gluconeogenesis).  It takes 2-3 days for fat to become the predominant fuel source.

The body will often store toxins in fat cells waiting for an opportune moment to detoxify.  It’s a bit like us putting things in cupboards, pending a rainy weekend for a clear out. When we are constantly digesting this moment doesn’t materialise. The body never gets chance to undertake any longer term regeneration or deep cleaning projects and our cells and guts can become overwhelmed.

"fasting is the body's equivalent of spring cleaning your house or servicing your car"

The digestive system

The inside of our gastro intestinal (GI) tract is still considered external to the human body. The cells lining the GI tract act as the gatekeeper to our body’s internal environment. The lining is delicate about half the width of a human hair.  Nevertheless it underpins all of our health by protecting our immune system and blood stream from toxins and pathogens.  The lining is covered in a mucus layer which contains our gut flora (microbiome) and this forms a selective barrier between us and the outside world.

Host microbiome axis: Interaction between the GI tract, the mucus layer and our immune system

Source: Esser, D. et al. (2019) Functions of the microbiota for the physiology of animal metaorganisms; Journal of Innate Immunity; 11(5), pp. 393-404

The immune system

Just behind our gut lining sits our gut associated lymphoid tissue (GALT) which is host to the majority of our immune system. Most people eat at least 3 meals a day plus snacks. This means our immune system is on duty 14 hours a day assessing anything that filters through the gut lining for potential toxins and pathogenic material. 

With constant stimulation and no rest, our immune system can’t build up reserves of antioxidants or take care of any long-term building projects. It then risks developing faults or errors of judgment which scientists believe can make us susceptible to:

Types of fasting

There are a number of different types of fasting (see below)*.  There are also hybrid diets such as the fasting mimicking diet (FMD). This is low in calories and protein but high in fat and maintains micronutrient content. Time restricted feeding (TRF) when food is kept to an eating window of 12 hours (7am to 7pm) or 8 hours (8am to 6pm) will provide an overnight fast of 12 and 14 hours respectively. These variations may be more suitable for some people depending on their state of health and unique physiology.  

Longer fasts of up to 5 days can promote autophagy which is a process of programmed cell dissolution.  This takes place once all of our glycogen stores have been utilised c. 24-72 hours around the 4th or 5th day. With this process the body breaks down any damaged cells  such as mis-folded proteins, ameloid plaques, damaged DNA etc. It’s a process of self-eating where the body recycles damaged materials for alternative use. Shorter fasts such as Intermittent fasting help the body to train into longer fasting periods. Fasting shouldn’t be undertaken without due consideration of your current health status and reference to your health practitioner or GP.

“You get rid of the junk during starvation — and once you have food, you can rebuild… The damaged cells are replaced with new cells, working cells — and now the system starts working properly.”

Dr Valter Longo

What fasting does

Your autonomic nervous system (ANS) carries out all the functions which basically run your body on a day to day basis.  Fasting seems to press the reset button on your physiology and all the functions of your ANS including:

Gut / immune system reset - fasting appears to reset our metabolism and rejuvenate the immune system as it gets chance to rest and recover and restore our antioxidant reservoirs.

Gut hormone/stress reset – fasting resets our hormonal systems and avoids the constant adrenaline state to which so many of us have become accustomed.

Gut / brain reset – fasting can help to change our emotional relationship with food as we challenge the body to adapt to different levels of food supply.

Liver reset – fasting facilitates detoxification as we burn fat and sugar out of our liver compartments. 

How fasting improves health

Studies in humans and mice of different types of fasting demonstrate improvement in multiple health indicators such as:

My approach and cautions

I don’t introduce fasting until I believe the client is sufficiently healthy to follow the protocols safely.  My approach is personal to each client. Before starting to restrict food intake we work to ensure that they are well nourished from a micronutrient perspective, have a well functioning liver and detoxification pathways and are hormonally stable.  In addition they will preferably be trained in the breath-work I teach.  This helps clients to work with their autonomic nervous system to manage their stress levels and emotional state in general, but also around food.

We typically start with 2-3 days of intermittent fasting.  Usually it’s from the last evening meal at around 7 pm until about 1 pm or lunchtime the next day. This provides an 18 hour break for both the digestive and the immune systems.

Hydration is also important.  I have a specific hydration protocol for clients to follow when they are preparing for or undertaking a fast or intermittent fast. There are some contraindications to fasting so I always recommend working with a health practitioner.

What the research shows

Most of the research is currently in mice but it seems to demonstrate:

Get in touch on 07740 876233 for more information or if you would like or to discuss your health concerns and how I might be able to support you.

Please note: This article is intended for information purposes so readers can gain an understanding of the benefits of fasting for health.  I highly recommend working with a health practitioner if you plan to try this as there are many aspects to take into consideration.

References

Chaix, A. (2022) Time-restricted feeding and caloric restriction: two feeding regimens at the crossroad of metabolic and circadian regulation; Methods Molecular Biology; 2482 pp 329-340 DOI: 10.1007/978-1-0716-2249-0_22

Cheng, C-W. et. Al. (2014) Prolonged Fasting Reduces IGF-1/PKA topromote hematopoietic-stem-cell-based regeneration and reverse immunosuppression, Cell Stem Cell; 14(6) pp.810-823 http://www.cell.com/cell-stem-cell/fulltext/S1934-5909(14)00151-9

Longo, V.D. and Panda, S. (2016) Fasting, circadian rhythms, and time restricted feeding in healthy lifespan; Cell Metabolism;14; 23(6); 1048-1059.

Mattson, M. P., Longo, V.D. and Harvie, M. (2018). Impact of intermittent fasting on health and disease processes. Ageing Research Reviews: 29 pp. 46-58.

Rangan, P. et. al. (2019) Fasting-mimicking diet modulates microbiota and promotes intestinal regeneration to reduce inflammatory bowel disease pathology; Cell Reports; 5;26 (10); pp. 2704-2710.e6. doi:10.10.16/j.celrep.2019.02.019

Sutton, E.F. (2018) Early time-restricted feeding improves insulin sensitivity, blood pressure and oxidative stress even without weight loss in men with pre diabetes; Cell Metabolism; 5; 27(6); 1212-1221,e3.

Wei, M. et al. (2017) Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease; Science Translational Medicine; 15;9(377)

Vaughn, K.L and Mattison, J.A. (2018) Watch the clock not the scale; Cell Metabolism, 27 pp.1159-1160.

Training

Zach Bush Biology Basecamp (2020)

Pending:- Intermittent fasting: personalization for better outcomes by Amanda Swaine, DipION, BANT, CNHC

* Fasting types:- intermittent fasting (60% energy restriction on two days or more), fasting mimicking diet, time restricted feeding (8 hour food window) and periodic fasting (5 day diet providing 750-1100 kcal).

Breathing-pattern - could it be the missing link?

The way we breathe is intricately linked to the way our body functions on both a physical and psychological level. When we breathe correctly we oxygenate our organs to maximise their function.

Between 50-80% of the general population have some level of breathing-pattern disorder

The researcher and professor of physical therapy, Kiesel (2017), has found that between 50-80% of the general population have some level of breathing-pattern disorder.  The Oxygen Advantage® programme is designed to reset and optimise your breathing-pattern to improve your overall health and well-being.  It also works specifically on performance for sports and exercise.

Signs and symptoms that your breathing is disordered

Signs that your breathing may be disordered or that you need to improve your breathing include.

Why consider learning to breathe correctly?

Correcting how you breathe may be the missing link in your health journey.  For example if you wake up tired or struggle to focus in the morning this may because of how you breathe during the night. 

When we learn how to breathe properly we can impact all kinds of health issues such as:

DigestionImmune function
Weight lossEnergy levels
AnxietyChronic fatigue
AsthmaExercise induced breathlessness
ConcentrationFocus
Sleep problemsSnoring
Sports performanceCOPD

How is breathing connected to weight loss, energy levels, chronic fatigue and anxiety?

There is a close link between breathing and metabolism which is connected to energy and weight. There seems to be a relationship between the amount we eat and over breathing. Exercises designed to stimulate the para sympathetic nervous (PNS) system seem to bring the body back into balance. This PNS stimulation helps to lower anxiety levels, reduce emotional eating and appetite as well as improve the basal metabolic rate. This is through complex interactions between respiratory rate, heart rate, and the increased capacity of the blood to carry oxygen.

What about asthma and breathing difficulties?

This is one of the key reasons people undertake the programme.  The mechanics and depth of how we breathe affects the amount of air and blood in our lungs. If we breathe well our lungs will protect us against pulmonary infections and we will generate an important molecule called nitric oxide. This molecule is generated in the nasal passages and is our first line of defence against foreign particles. Nitric oxide is anti-inflammatory, anti-bacterial and anti-viral and it dilates our airways and blood vessels to enhance delivery of oxygen and micronutrients to the tissues. Generating nitric oxide has been found to have significant health benefits especially with regard to chronic and age related disease.

By learning to breathe correctly, improving oxygen uptake and controlling the amount of air you breathe asthma symptoms may reduce or resolve and the need for medication can diminish.

Why does our breathing affect our digestion and our immune function?

Our gut membrane is the barrier between our internal and external world. It is the vital link between what we eat and the nutrients our body digests and absorbs. It’s surface area is as big as two tennis courts but it is delicate, only one cell thick and half the width of a human hair. Most of our immune system is situated just behind this membrane which starts in the sinuses and runs all the way down our throat to the stomach and intestines. It works to protect us from any unwanted substances we may ingest.

Many of us eat on the run, in a rush or whilst feeling stressed.  When we learn to breathe correctly we oxygenate our gut so it can relax, digest and function optimally which in turn supports our immunity.

How can changing how we breathe improve our exercise performance?

Many of us gas-out too soon when we exercise.  This breathlessness can actually put us off exercising.  We instinctively think this is because we can’t get enough oxygen. It has much more to do with being unable to tolerate the build up of carbon dioxide and lactic acid in the body combined with weak respiratory muscles. This chemical oversensitivity can be retrained and reset so the body can do more with less.  We can also retrain the mechanics of breathing to improve the strength of our diaphragm, and the inspiratory and expiratory muscles.

What is the Oxygen Advantage® programme ?

The Oxygen Advantage® programme teaches you the science and the practice of breathing right.  You learn the science of breathing and the ‘how to’ practical part which has two stages. The first stage is to assess your breathing and then learn how to retrain and repattern this for optimal function.  The second stage of the programme uses exercises which simulate high altitude training.  This teaches the body to do more with less, improving athletic performance for both recreational and professional sports people. 

Once you have learnt the exercises and reset your breathing receptors you simply incorporate it into your daily activities.

Benefits

The physiological benefits will depend on how your body responds to the core benefits of:

We pay little attention to the way we breathe because it’s such an automatic process. The Eastern philosophies such as yoga and Tai Chi have always taught that it is a key component of health.  We have never been taught to address it but with the Oxygen Advantage® programme you will learn the science and the practice from a fully qualified instructor.

You can read more about the Oxygen Advantage® programme here.

Helen Maxwell

www.helenmaxwellnutrition.co.uk

Helen@helenmaxwellnutrition.co.uk

07740 876233

References

Kiesel, P.T. et al (2017) Development of a screening protocol to identify individuals with dysfunctional breathing. The International Journal of Sports Physical Therapy 12(51), DOI: 10.16603/ijspt20170774

Djupesland, P.G. et al. (1999) Nitric oxide in the nose and paranasal sinuses – respiratory tract physiology in a new perspective; Tidsskr Nor Laegeforen 119(27); pp.4070-4072.

Bryan NS, et al. (2017) Oral microbiome and nitric oxide: the missing link in the management of blood Pressure. Current Hypertension Reports:19(4):33.

Stephan BCM, et al. (2017) Cardiovascular disease, the nitric oxide pathway and risk of cognitive impairment and dementia; Current Cardiology Reports: 11;19(9):87.

Weight loss: What’s breath got to do with it?

Excess weight is often thought to be the result of an imbalance between energy from food consumed less energy spent throughout the day. However, well known researchers such as Zoe Harcombe, have pointed out that weight is not simply the end product of calories in less calories utilised for metabolism and exercise. Weight loss is more complicated than adjusting food intake, nutrients and exercise levels although this is usually part of the picture. Apart from the emotional and mental aspects of eating there is also a close link between breathing and metabolism. 

Metabolism is the biochemical process by which your body combines food and drink with oxygen to convert it into energy. Your basal or resting metabolic rate (BMR) rate is how much energy you burn at rest to perform autonomic functions breathing; heart rate; digestion etc. determined by your: age; sex; body size and composition (muscle uses more energy). This rate is generally fairly consistent although physical activity and exercise can have an impact. However our respiration rate (speed, volume), our breathing mechanics (upper/lower chest, lung capacity) and the cadence (rhythm) of our breath affect this metabolic equation and ultimately tissue and organ function.

I first came across Butekyo breathing when I studied at Westminster University, whilst learning about the pathophysiology of asthma and nutritional support strategies.  Dr. Konstantin Butekyo was a Russian Doctor, who taught breathing techniques to his asthma patients.  This method is now taught by Patrick McKeown. He has combined Butekyo with other exercises to improve breathing for both sport and health into the Oxygen Advantage® technique in which I am trained.

Through over a decade of working with thousands of people to improve their breathing Patrick has observed that there seems to be a relationship between breathing volume and food consumption. Many of his clients would be using the techniques to resolve asthma, anxiety, stress or snoring but report a secondary benefits such as reduced appetite, weight loss, increased water intake and less craving for processed or unhealthy food choices.

When we eat less our energy expenditure often reduces in tandem. Carrying extra weight can also make exercise more challenging.  This is partly because of the extra pounds but often being overweight leads to the development of poor breathing habits such as hyperventilation, sighing, upper chest breathing and mouth breathing.  This means breathing increases during rest and quickly becomes erratic during exercise.

Poor breathing habits are common. One study estimates as many as 50-80% of the general population have some element of dysfunctional breathing.  The drivers are believed to be: pollution; poor quality food; central heating; lack of physical exercise and so much time spent sitting down. In addition many holistic practitioners and some forms of exercise such as yoga and pilates promote the idea of big, deep breaths. If the breath is taken into the upper chest it will activate our sympathetic nervous system or stress response. This way of breathing can become a habit. If we regularly take even occasional large upper chest breaths throughout the day this can upset pH balance, blood oxygen saturation and even food digestion and absorption can suffer. It is not a time to digest food if the body is primed to run away from a predator.

Using the Oxygen Advantage® breathing techniques to reduce and normalise breathing helps to bring the body back into balance. Reducing and softening the breath helps to normalise blood pH which is often too acidic. The resulting stimulation of the para-sympathetic nervous system can help to reduce emotional eating.  Some of the exercises simulate high altitude training and we have known for many years that animals and people lose weight at high altitudes. At altitude blood oxygen saturation reduces which seems to diminish appetite. Reduced breathing and breath holding temporarily lowers oxygen saturation in the blood inducing an anaerobic state which forces the body to burn fat stores.  The body adapts by releasing hormones to raise the concentration of red blood cells in the blood to increase oxygenation levels and aerobic capacity.

In 2018, researchers Yong, et al., found a significant increase in VO2 max and the BMR of healthy subjects when they tested them pre and post diaphragmatic breathing exercises.  This is important because 70% of our energy supports our BMR and as lean tissue requires more energy than adipose tissue (fat) to maintain itself, lean tissue may be preferentially lost when we try to lose weight. So raising BMR may be another way the technique supports healthy weight loss.  

Our blood vessels, airways and organs including our digestion system are lined with a hundred thousand miles of smooth muscle.  If we over breathe and don’t move much our tissues receive less oxygen and constrict, impairing function and sensitising our sympathetic nervous system.  When we correct how we breathe tissues dilate and function improves, stimulating our metabolism to self-regulate and correcting issues such as breathlessness, constipation and gastroesophageal reflux disease (GERD).

Breathing is first on the list when it comes to survival, before food and water but often it’s last on the list of our health priorities. We pay little attention to getting it right. It is a very overlooked aspect of health and can be a key component to achieve weight loss and better health with less effort and less focus on food intake.

Get in touch to see how the Oxygen Advantage® training can help you to lose weight, address dysfunctional breathing, breathe better during exercise or just to improve your overall health.

Signs that you may have sub-optimal or dysfunctional breathing: feeling tense; cold hands and feet; a low body oxygen level test score; frequent sighing or yawning; mouth breathing at night; exercise induced asthma; snoring.

Helen Maxwell

www.helenmaxwellnutrition.co.uk

Helen@helenmaxwellnutrition.co.uk

07740 876233

REFS

Harcombe, Z. (2010) The obesity epidemic, Columbus Publishing.

Kiesel, et al. (2017) Development of a screening protocol to identify individuals with dysfunctional breathing’, International Journal of Sports Physical Therapy’, 12 (5), pp.774-786.

Mayo clinic staff (1998-2020); ‘Metabolism and weight loss: how you burn calories’; [available at]: https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/metabolism/art-20046508.

McKeown, P. (2015) The Oxygen Advantage, Harper Collins Publishers: New York.

Parkes, M.J. (2017) Reappraisal of systemic venous chemoreceptors: might they explain the matching of breathing to metabolic rate in humans? Experimental Physiology https://doi.org/10.1113/EP086561

Rothenberg, R.L., (2020) Restoring Prana, Singing Dragon, London and Philadelphia.

Yong, M-S. et al., (2018) Effects of breathing exercises on resting metabolic rate and maximal oxygen uptake, Journal of Physical Therapy Science; 30(9), pp.1173-1175.