When Everything Changes in Seconds: Traumatic Brain Injury (TBI) + Initial Recovery

One decision, one slip in judgment and everything can change in seconds….

I want to use this post to discuss my accident along with the initial protocol I implemented as a result. My goal is to show those that have suffered you are not alone and for those who may suffer in the future hopefully offer some hope and guidance that there is a lot you can do to help. However, it is important to not get caught up stressing around doing everything but to do what you can because at the end of the day the most important thing is to be stress-free and rest and remember we are all different

Why Bintan 70.3 Ironman?

At the beginning of this year, I set two pretty ambitious goals, targeting World Championship qualification in both Half and full distance Ironman, something I previously never perceived as possible.

In my pursuit to attain an early qualification for 2020 Taupo 70.3 World Championships, I flew over to Bintan, Indonesia to race a Half Ironman. Everything was going perfectly to plan with a solid swim and on target for an awesome bike on a very challenging technical & hilly course, I was racing my perfect race, feeling great with everything going to plan, in fact, if I kept tracking as I was I would have won my Age Group (I needed a podium to guarantee my qualification spot) and also came in the top 5 overall. However, this was not meant to be as at the 75km mark of the bike everything went blank….

I couldn’t tell you what happened first hand because I have no recollection but from what I was told, I came flying around the corner towards two speed bumps, the first I bunny hopped and then hit the second of the two with my front wheel off-centre (according to my Garmin Computer at 42kms) sending me flying over my handlebars headfirst into a curb, with my right side taking most the impact/ road rash but I must have rolled as well because I was cut up on my left as well. I am not sure how long I was out for but I don’t recall anything from my time at the crash site but apparently, I was repeatedly asking the same questions over and over “what happened??” “Is my bike ok??” Once told I would ask the same question straight away again. Not surprisingly the volunteer that was helping me knew I was not in a good place so he called in the doctor to assess me, you would think at this point my race was over but the doctor said if I want to keep going I can and those who know me I am extremely stubborn and a sucker for a challenge so there was no choice in my head (not that it was working anyway) I assume, this is when I jumped straight back on my bike and went on autopilot. This is the part that really scares me because I still have no memory of any of this, I am not sure why the doctor let me go, maybe it was because I was being difficult wanting to jump back on my bike and not listening (I wouldn’t be surprised, I put a lot into the prep of this race) but he should have never given me the option in the state I was in, he should have pulled me from the race. The volunteer that helped me at the time of the accident found me after the race and filled me on all of this he couldn’t believe the doctor let me back on the bike, he also could believe I had finished the whole race.

With no one stopping me there was no way I wasn’t getting back on my bike. Dazed and confused it wasn’t until after the race I looked back to my Garmin Computer for answers and they truly shocked me! Turns out I spent 17mins at the crash site…… No clue how much of that I was unconscious or what was going on and then back onto the bike on autopilot with 15kms left of the 90km bike course. Still with no memory of this, I wonder what was going through my mind because this was quite possibly the stupidest thing I could have ever done, not just because I was back on the bike but the speeds I was going with an extremely beaten up mind, body and bike (Bike had $3700 worth of damage….). My Garmin once again highlighted my stupidity although overall last 15km was slower than it would have been it showed multiple times where I exceeded 60km/hr and if you know anything about concussions the absolute worst thing you can do is have another in close concession… Even within up to 3 weeks. Thankfully I survived this very silly decision.

In to transition and onto the 21km run, this is where I somewhat came to. Dazed and confused and with no memory of losing 17min at the crash site or my slow last 15km, I did my best to keep my mind on what I came here for a podium finish to qualify. Again not a smart move in hot humid 35-38 degree conditions and with a whole host of injuries and road rash that I never took the time to assess my situation. It didn’t take long until I turned my Garmin off the speed setting because I wasn’t even close to my target pace and I just focused on getting to finish as fast as possible. This was not easy as I had also pulled my right calf in the crash so I felt each and every step.

Long story short, I got through the hottest run of my life (thank god for all the sponges) and pretty much collapsed across the line and mumbled the words “medical, I need medical” I was in an absolute state, I could no longer stand and had to be helped and lost all control of my body (even my bladder….) even sitting wasn’t possible. I spent the next 3-4hrs or so getting checked and monitored in the medical tent trying to figure out the extent of everything.

Everything seemed to come somewhat better and was I able to hold a conversation but it wasn’t until I got back to my accommodation (maybe due to all the movement?) things really hit me and went downhill. Travelling alone this can be scary but thankfully I was surrounded by a really nice Italian man, who had also raced and some really helpful resort staff. Although none of their English was great I managed to get my message across (google translate was our best friend). I got them to monitor me every couple of hours and then made the decision if I was not better by 9 pm I would go to the hospital. Reluctant as being on isolated island I can’t imagine they had assessment tools like MRI that I would need to assess a brain bleed etc. Thankfully by 9 pm I felt slightly better and decided to stay and rest.

I used my high pain threshold to my advantage and endured the pain and passed on any medication offered (I got some pretty confused/weird looks saying no). Why would I refuse? TBI on their own result in extreme gut damage so I didn’t want to cause further damage by adding them to the mix. Plus I would rather be conscious/mindful of the pain to ensure I can truly assess my symptoms and ensure I am not doing anything to aggravate them.  I am not saying you have to say no to drugs if needed, this is just my personal choice as I like to be in tune with what my system is telling me not masking it. If you do choose to take drugs you do need to be careful especially if there is any chance of a brain bleed as non-steroidal anti-inflammatory drugs (NSAIDs) will increase the bleeding so try your best to stay clear and stick to traditional painkillers eg paracetamol.

I was lucky I didn’t have to leave until the day after the race and my Italian friend broke down and packed my bike for me because there is no way I could even fathom doing that. I spent the rest of my time taking things very slowly which wasn’t too hard as I couldn’t walk after pulling my calf and running a half marathon on it, you could say it was not too happy so walking was very slow with a massive limp. The upside I was thankful to be in paradise, so just chilled and got straight onto my rehabilitation.

Initial treatment

This is the part where I want to share what I did initially to support my TBI and hopefully can help as a resource for others struggling or know someone struggling.

Obviously, on an Island, I had very limited access to support or interventions but luckily I always travel with supplements for optimal health and performance which in this case I was lucky as some of them are also the first line of call for brain health and repair.

Below is a list of the things I implement with dosages and why they were applied, to provide you with a greater understanding. You may note some of these are a little higher than recommended doses so please check with medical professional first. Obviously I had to work with what I had in an isolated location, in the future I will endeavour to provide a detailed protocol of what I would do in an ideal world but for now, here is what I implemented:

Sleep/ Rest:

Why: When it comes to TBI nothing comes close to rest so that became my primary focus. I have an Oura Ring which is one of the leading personal sleep trackers so this was great for me to monitor and assess my sleep. Although sleep is the best thing for a TBI, poor sleep is also often associated in particular REM sleep can be affected. I designed my day around maximise my sleep. Priming the circadian rhythm with early morning

Dose: I aimed for more sleep than normal targeting 9-10hrs. However, I did not always get that

Daily Routines:
Morning:

  • Meditate: to relax the mind
  • Sun Exposure (no sunglasses with as much skin as exposed as possible)
  • Grounding (bare feet),
  • Movement (or should I say limping…)

Day:

  • Napping: As required but no later than 3 pm as I didn’t want to impact my sleep during the night

Evening: Focused on winding down early

  • Early Dinner
  • Blue-blocking Glasses (which were also godsent when over stimulated throughout the day)
  • Meditate: to relax the mind

Meditation:

As mentioned above

Why: Not only is mediation powerful for cultivating a positive perspective but it is great for unloading the exhausted mind. I ensured I had a solid foundation of daily meditation (morning and night) and whenever I overloaded the system and felt symptoms worsening I would take a step back and meditate and straight away fell a release in the pressure within my head.

Dose: 10-20min Morning and night and when needed throughout the day

Exogenous Keytone Salts
Brand: Pruvit

Why: Quite possibly the most important thing I could take early on. Keytones are known to be the most efficient clean fuel for the brain and they can provide up to 70% of the brains energy. Even more importantly a TBI resembles Alzheimer’s disease (AD) as they both present with a reduced ability to utilise glucose for energy. With the reduced capacity to utilise glucose (carbohydrate) for energy, ketones are even more vital in supplying the brain fuel.

Dose: 1 Max Packet per day (half in the morning and the other half in the afternoon)
To increase ketones in the body across the day

DHA (Docosahexaenoic Acid)
Brand: BePure Three

A high strength DHA/EPA Omega 3 Fish oil with Vitamin D and natural vitamins A and E.
Why: DHA is recognized as an essential nutrient for the proper development and function of the brain. In a number of TBI animal trials have shown an improvement in cognitive function, reduction in nerve swelling, stabilisation of cellular energy production and increase nerve repair with the supplementation of DHA & Omega3.

Dose: 2 capsules Morning and Evening

Probiotic
Brand: BePure

Why: Probiotics offer a health benefit to brain function and promote the diversity of gut microbiota.
TBI has shown to greatly impact the gut-brain axis. The communication pathway that has lead to the gut being known as the second brain. TBI results in increased colon permeability, leaving individuals 12 times more likely to die from blood poisoning which is often caused by bacteria, and 2.5 times more likely to die of a digestive system problem, compared with those without such injury. However, a good probiotic can mitigate these effects and help in assisting the healing of the gut.

Dose: 2 capsules Morning and Evening

Antioxidant:
Brand: Viberi Powder

Why: Following a TBI there is a significant increase in reactive oxygen species (ROS). It is the ROS which causes the cascading of events and the primary stress to the brain following a TBI. Antioxidants are important early on as they can fight the increase ROS, reducing the load on the brain allowing it to heal.

Dose: 1 sachet/day (However sadly ran out over there so split them over a few days)

Magnesium
Brand: Bepure

Why: Depletion of magnesium is observed in the animal brain and in human blood after TBI. Magnesium is critical in restoring brain plasticity and for improving cognitive function. Researchers showed that with magnesium supplementation they could reverse brain ageing by as much as nine to 14 years. Anything that helps the health of the brain long term can be assumed is helping in the short term acute situation like a TBI. Not only this but magnesium is great in regulating inflammation along with assisting in sleep which can be challenging when suffering from a TBI

Dose: 2 capsules Morning and Evening

Diet: Fasting + Whole Food Antioxidant-Rich Diet

Why: Fasting: Purpose of fasting is to naturally increase levels of ketones in the body, reduce inflammation and along with providing the gut a period to heal and repair following the onslaught of racing and the TBI. However, important to note I was not strict, I did not want to place any unneeded additional stress on my system so when hungry I would eat.

Outside of the fasting, I tried to limit carbohydrates as much as possible and a trend towards a more keto approach. Although this turned out to be challenging to do due to limited food choices over in Asia. Interestingly, I did find myself craving carbohydrates more, I am not sure if this was due to having more than normal or if my body was requiring them so I would listen to the body and not restrict when craving carbohydrates.

Aside from the fasting and minimising carbohydrate where possible I aimed to eat a diverse wholefood rich diet. With a special focus on getting in vibrant colourful foods as vibrant colours are closely associated with nutrients and antioxidant properties. Also in a new country presented a great opportunity to try new foods and develop a bit more of a diverse microbiome.

Does: Length of Fasting is dependant on your ability and adaptation to do so. The key thing to keep in mind is you need to listen to the body. I can happily do 16-18hrs but this is never a target! I just listen to what the body was telling me and adjust accordingly.

Activity:

Walking: Broken and chronically exhausted I couldn’t do much but walk/limp so I took it easy and stayed well within my limits and walked as much as possible and gradually increase easy day.

Why: Movement is phenomenal for recovery as long as you stay within limits as it increases blood flow, Neurotransmitters, (the chemicals in your brain that transmit messages between neurons) and activates neuroplasticity (the brain’s ability to rewire and repair itself after brain injury)

Dose: Every morning and as much as my mind/body would allow throughout the without aggravating symptoms. Gradually increasing each day as my body/mind allowed. For me mornings where best by the afternoon-evening I was exhausted and just rested

Two days post Crash: Bintan to Singapore

 

Then Tuesday rolled around and it was time to leave and catch the ferry back to Singapore and straight to the airport to fly home. Still waiting to hear back from my travel insurance I slowly and painfully got myself to the airport. While waiting to check-in, they finally got back to me and told me to get straight in a taxi to the hospital to be cleared before catching my flight home. At the time, however, this just seemed like too much! I just wanted to get home even as much as I was dreading the flight. However, after talking to my mum, as I was in no state to make a decision she made me realise they were right, you only get one brain and I have worked hard on mine so just not worth the risk. I thought I would only have to stay one night but the insurance company still wouldn’t let me fly so I ended up staying for another 4days in Singapore going back and forth from the hospital for assessments, scans and then for my road rash which became infected. In this time I persisted with my protocol as listed above the best I could.

When it comes to assessment for concussion there is not much they can do in the way of identifying the extent of damage, all an MRI can do is look for a brain bleed which would be a worst-case scenario. Thankfully I was cleared to fly home which by this time I had exhausted my supply of supplements so I was keen to get home to get back on to them to regenerate my brain.

Home:

Finally back home with access to all the resources I need and touched base with a couple of friends of mine a special mention to Cliff Harvey who was really helpful to bounce some ideas and get his thoughts and advice. Especially with a foggy mind, this was extremely helpful as reading literature wasn’t really possible at this time. I then distilled what I knew and what Cliff and others had suggested into a protocol. In my next post, I will discuss what I have implemented in the month or so since coming home.

Time Restricted Eating: What you need to know

In one of my previous article (Let’s talk Science: High Carbohydrate Vs High Fat), I  talked about starting your day with a high fat meal (eg avocado and eggs, fat smoothie etc) vs the traditional approach of refined high carbohydrate breakfast (Eg. toasted muesli, cereal and toast). But why stop there! The benefits achieved  by this can be taken one step further by not eating at all and extending your overnight fasted period.

 

“Break” + “Fast” = Breakfast

Whether you like it or not you fast every night, while you are asleep. Therefore, the term “breakfast” is defined by breaking the overnight fast. Breakfast is known as one of the most important meals of the day. I will not debate this because I believe this to be true as it will set you up for your day. However the time when we consume it does not necessarily need to be first thing in the morning.

Isn’t skipping breakfast bad for you? What are the benefits of fasting? Is there any science behind this? Is it dangerous? These are all the questions that people will often ask as soon as you hear the word ‘fasting’

 

Do I fast?

Yes, in fact most days I fast from 14-18 hrs (7pm-11am ish). It is one of the most liberating things I have ever done and has allowed me to free up my mornings. My mornings are now more productive than ever before, I have a clear mind and do not waste time,  instead I can jump straight into the task at hand.

Why would I suggest people try fasting?

If you are interested health, longevity and sporting performance fasting is something that you should consider.

Let’s take a look at the research

Although intermittent fasting is a relatively new area of science fasting is ingrained to our history and is a component of almost every religion. It is only recently that we have been able to gain a deeper understanding of the physiological mechanisms at play and therefore identifying the positive benefits associated with intermittent / prolonged fasting/ time restricted eating as a powerful longevity enhancing strategy.

 

Animals Studies (9-12 hr eating window)

The majority has been performed in animal studies which have shown increased muscle mass, fat loss, glucose tolerance, improved lipid profiles, decreased inflammation, increase mitochondrial volume, protection against mild age fatty liver, protection against obesity, gene expression, increase production in ketone bodies. This list alone should be enough to highlight the amazing potential of fasting. But while this does appear in animal studies, will we see the same benefits in humans?

 

Humans Studies:

This is a growing body of literature and is still in its infancy in terms of research. Intermittent fasting/ time restricted eating (11 hr eating window) has been shown to decrease breast cancer risk (36%). It has also been shown to increase fat loss in overweight and obese people and interestingly for each 3 hr increase in time of the  overnight fast duration there was a 20% fall in HbA1c (long term marker of blood glucose levels and an indicator of normal, pre-diabetic and diabetic status).

Human Eating in 12 hr window:

Even with a more lenient fasting/ eating window of time, research has shown a number of significant benefits such as: improved sleep, weight loss, and decrease in inflammation.

 

HFLC vs Fasting

In previous post we have discussed the positive attributes associated with a high fat diet such as increased insulin sensitivity and reduction in inflammation. All of these benefits are seen with fasting and in most cases are substantially greater along with a few other added benefits that you are unable to achieve from a HFLC diet alone.

Fasting compared with HFLC, especially prolonged fasting,  presents a dramatic increase in autophagy and apoptosis followed by a massive increase in stem cell production. Autophagy is a genetic program which clears always damaged protein/s and organelles within the cell (think of it as cell ‘house cleaning’) while apoptosis is a process where damaged cells self destruct and break down, a controlled process that is part of any organisms growth or development.. Essentially the two process work to prevent the accumulation of senescent cells (old cells) within the body. The body is dynamic and is constantly turning over cells, manufacturing new ones or clearing damaged organelles within cells and in doing so this helps to maintain the health and functioning of the body (for the science nerd, it maintain homeostasis). The prevention of senescent cells accumulation can assist in reducing tumor growth. Increase in autophagy and apoptosis have been linked to longevity, with research in mice demonstrating that when these two processes are increased the life span can increase by ~20%.

Fasting also appears to impact the stem cell number and production. It is stem cells regenerative nature that helps in mitigating the effects of aging.

One of the biggest difference in comparing fasting to a HFLC diet is mitophagy.  Mitophagy is a process which clears damaged mitochondria (the cell power houses, where we generate our bodies energy source) and recycles their defective components which is followed by generation of new mitochondria through process of mitochondrial biogenesis. Once again this minimises the effects of ageing. HFLC has been shown to modestly increase mitochondrial biogenesis but not as much as mitophagy. Therefore to gain full benefit of mitophagy you would want to look at including fasted windows.

NAD (Nicotinamide adenine dinucleotide) increases in a fasted state and decreases in a feed state. NAD is an essential component for a wide range of enzymes to function properly. Your mitochondria need NAD for energy production from glucose or fatty acids and any time there is damage occurring in the body it sucks up NAD causing the mitochondria to suffer. Therefore the act of fasting offers the ability to up-regulate NAD in the absence of fuel.

Additionally, fasting promotes repair of DNA along with improved blood sugar regulation, insulin sensitivity, blood lipid profile and inflammatory markers (CRP, TNF alpha)

 

Application

There are varying opinions on what consists as a fast. Some are of the opinion, like Rhonda Patrick who follows the strictests of definitions. She states that consuming anything other water constitutes as ‘breaking the fast’. Others, define a fast as the window void of any calories and that you can have black coffee etc to help extend the fast.

Which definition you select to comply with will greatly depend on your life circumstances and the goals and benefits you are wanting to achieve.

With results being shown in human with even a 12 h fast window, it all comes down to designing a method that suits your lifestyle. The classic and most renowned intermittent fasting/time restricted eating method is the 16/8 (16 hour fast & 8 hour eating window). Grant Schofield, Caryn Zinn, & Craig Rodger from New Zealand recently released their new book following on from “What the Fat” This time focusing on fasting with “What the Fast”. I was lucky enough to be at their book release, this is a great resource packed full of evidence based practice for anyone looking for some guidance and with an alternative approach to intermittent fasting. In their approach they provide a great lifestyle approach to fasting which allows you to maximise your benefits without impacting and restricting

you. Their approach involves a monday tuesday full day fast with a very low carb/ fasting mimicking meal on monday and tuesday night. The rest of the week they encourage you to eat LCHF and on the weekends relax and prepare for the monday/tuesday fast. Their book is full of great recipes and if you are interested in fasting this is a great resource to get started!

When it comes to fasting I believe you need to view it as another tool and I don’t believe that you should be too strict on applying it. I find when most people begin especially your A-Type personalities they go all in and start pushing the limits far beyond what is needed and end up in a catabolic state. Instead my advice would be to listen to your body and when it wants fuel have fuel and as you train your body over time to become fat adapted and break free from your eating habits you will begin to thrive off your fasted windows. It is important to understand your fasted windows should not be tough! You should not be hungry, if you are then EAT! I am also not saying you should restrict your food intake during your eating window, this is not a starvation diet. During your eating windows, nourish your body with good wholesome food and enough to meet your energy and or training demands.

 

My approach:

I personally follow the less strict definition as most people tend to do and will have black coffee in a fasted state and often will even break this rule and add some MCT oil (Not true fast) to extend my fast or help assist with a fat adapting training session (I will discuss the in great detail in future posts)

 

Eating Window Consideration:

Circadian Impact (metabolism changes throughout the day)

Just like our bodies responds to light, our metabolism functions on a 24 hr cycle and changes throughout the day. Timing of food consumption can have altered effects on your body. For example, it has been shown that there is a greater postprandial (following meal) glucose response at dinner compared to breakfast. This is due to humans being dayianal creatures (function during the day). Therefore eating late at night will have a greater impact on our health. For each 10% increase in calories consumed after 5 pm was linked to a 3% increase in the inflammatory biomarker CRP.

 

Summary:

Reduction in systemic inflammation is thought to be one of the greatest predictors of health and longevity. Reduced inflammation is linked to improvements in age, prevention of cancer and mental health issues. Therefore a strategy like fasting or time restricted eating or anything that greatly impacts systemic inflammation is a positive and should be considered.

View fasting as a tool to add to the toolbox that can enhance your health and longevity, don’t get caught up and or get too strict.  Listen to your body and remember shifting to utilise fat for fuel takes time so don’t rush the change.

 

References:

Baker, D. J., Childs, B. G., Durik, M., Wijers, M. E., Sieben, C. J., Zhong, J., … van Deursen, J. M. (2016). Naturally occurring p16Ink4a-positive cells shorten healthy lifespan. Nature, 530, 184. Retrieved from http://dx.doi.org/10.1038/nature16932

Chaix, A., Zarrinpar, A., Miu, P., & Panda, S. (2014). Time-restricted feeding is a preventative and therapeutic intervention against diverse nutritional challenges. Cell Metabolism, 20(6), 991–1005. https://doi.org/10.1016/j.cmet.2014.11.001

Choi, I. Y., Childress, P., Brandhorst, S., Navarre, G., & D. Longo, V. (2015). Periodic Fasting Mimicking Diet reverses age-dependent decline in neurogenesis and enhances cognitive performance.

Cohen, L. J. (2018). Fasting the microbiome to treat diabetes. Science Translational Medicine, 10(441). Retrieved from http://stm.sciencemag.org/content/10/441/eaat8529.abstract

Gabel, K., Hoddy, K. K., Haggerty, N., Song, J., Kroeger, C. M., Trepanowski, J. F., … Varady, K. A. (2018). Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: A pilot study. Nutrition and Healthy Aging, 4(4), 345–353. https://doi.org/10.3233/NHA-170036

Gill, S., Le, H. D., Melkani, G. C., & Panda, S. (2015). Time-restricted feeding attenuates age-related cardiac decline in Drosophila. Science (New York, N.Y.), 347(6227), 1265–1269. https://doi.org/10.1126/science.1256682

Gillette, M. U., & Tischkau, S. A. (1999). Suprachiasmatic nucleus: the brain’s circadian clock. Recent Progress in Hormone Research. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10548871

Hatori, M., & Panda, S. (2015). Response of peripheral rhythms to the timing of food intake. Methods in Enzymology, 552, 145–161. https://doi.org/10.1016/bs.mie.2014.10.027

Hatori, M., Vollmers, C., Zarrinpar, A., DiTacchio, L., Bushong, E. A., Gill, S., … Panda, S. (2012). Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet. Cell Metabolism, 15(6), 848–860. https://doi.org/10.1016/j.cmet.2012.04.019

Hine, C., & Mitchell, J. R. (2014). Saying no to drugs: Fasting protects hematopoietic stem cells from chemotherapy and aging. Cell Stem Cell, 14(6), 704–705. https://doi.org/10.1016/j.stem.2014.05.016

Hussain, S., Bloom, S., Gardiner, J., Hussain, S., Richardson, E., Ma, Y., … Gardiner, J. (2015). Glucokinase activity in the arcuate nucleus regulates glucose intake Find the latest version : Glucokinase activity in the arcuate nucleus regulates glucose intake, 125(1), 337–349. https://doi.org/10.1172/JCI77172.tive

Lee, C., & Longo, V. (2016). Dietary restriction with and without caloric restriction for healthy aging. F1000Research, (February). https://doi.org/10.12688/f1000research.7136.1

Longo, V. D., & Mattson, M. P. (2014). Fasting: Molecular mechanisms and clinical applications. Cell Metabolism, 19(2), 181–192. https://doi.org/10.1016/j.cmet.2013.12.008

Longo, V. D., & Panda, S. (2016). Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan. Cell Metabolism, 23(6), 1048–1059. https://doi.org/10.1016/j.cmet.2016.06.001

Longo, V. D., & Panda, S. (2016). Perspective Fasting , Circadian Rhythms , and Time-Restricted Feeding in Healthy Lifespan. Cell Metabolism, 23(6), 1048–1059. https://doi.org/10.1016/j.cmet.2016.06.001

Marinac, C. R., Sears, D. D., Natarajan, L., Gallo, L. C., Breen, C. I., & Patterson, R. E. (2015). Frequency and circadian timing of eating may influence biomarkers of inflammation and insulin resistance associated with breast cancer risk. PLoS ONE, 10(8), 1–11. https://doi.org/10.1371/journal.pone.0136240

Martinez-Lopez, N., Tarabra, E., Toledo, M., Garcia-Macia, M., Sahu, S., Coletto, L., … Singh, R. (2017). System-wide Benefits of Intermeal Fasting by Autophagy. Cell Metabolism, 26(6), 856–871.e5. https://doi.org/https://doi.org/10.1016/j.cmet.2017.09.020

Medsker, B., Forno, E., Simhan, H., Juan, C., & Sciences, R. (2016). Prolonged Nightly Fasting and Breast Cancer Risk: Findings from NHANES (2009-2010) Catherine, 70(12), 773–779. https://doi.org/10.1097/OGX.0000000000000256.Prenatal

Melkani, G. C., & Panda, S. (2017). Time-restricted feeding for prevention and treatment of cardiometabolic disorders. The Journal of Physiology, 595(12), 3691–3700. https://doi.org/10.1113/JP273094

Nas, A., Mirza, N., Hägele, F., Kahlhöfer, J., Keller, J., Rising, R., … Bosy-Westphal, A. (2017). Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk. American Journal of Clinical Nutrition, 105(6), 1351–1361. https://doi.org/10.3945/ajcn.116.151332

Mattson, M., D. Longo, V., & Harvie, M. (2016). Impact of Intermittent Fasting on Health and Disease Processes. Ageing Research Reviews (Vol. 39). https://doi.org/10.1016/j.arr.2016.10.005

Study, M., Jimenez, J. J., Marcos-gragera, R., Perez-gomez, B., Llorca, J., Fern, G., … Fern, T. (2018). Effect of mistimed eating patterns on breast and prostate cancer risk (MCC-Spain Study ) 4,5,6 , 00(June), 1–10. https://doi.org/10.1002/ijc.31649

Sutton, E. F., Beyl, R., Early, K. S., Cefalu, W. T., Ravussin, E., & Peterson, C. M. (2018). Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes. Cell Metabolism, 27(6), 1212–1221.e3. https://doi.org/10.1016/j.cmet.2018.04.010

Youm, Y., Nguyen, K. Y., Grant, R. W., Goldberg, E. L., Bodogai, M., Kang, S., … Crawford, P. A. (2015). Ketone body β-hydroxybutyrate blocks the NLRP3 inflammasome-mediated inflammatory disease Yun-Hee, 21(3), 263–269. https://doi.org/10.1038/nm.3804.Ketone

Zarrinpar, A., Chaix, A., & Panda, S. (2016). Daily Eating Patterns and Their Impact on Health and Disease. Trends in Endocrinology and Metabolism: TEM, 27(2), 69–83. https://doi.org/10.1016/j.tem.2015.11.007

Zeevi, D., Korem, T., Zmora, N., Halpern, Z., Elinav, E., Segal, E., … Weinberger, A. (2015). Personalized Nutrition by Prediction of Glycemic Article Personalized Nutrition by Prediction of Glycemic Responses, 1079–1094. https://doi.org/10.1016/j.cell.2015.11.001

 

Combat Jet Lag

After dealing with Jet Lag first hand recently and it is something that most people have to deal with at some point or another, I thought it would be a great opportunity to address Jet Lag and the strategies that I personally utilise to prevent and overcome from Jet Lag.                                                                                                                                                                                                                                                                  

What is Jet Lag?

Jet lag or desynchronosis is a temporary disorder that causes fatigue, insomnia, a result of air travel across time zones. It is a disorder which is a disruption to the internal body clock circadian rhythm.                              CircadianRhythm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Cause of Jet Lag?

Jet lag is caused by the inability of the body to immediately adjust to the time in a different zone. To fully grasp jet lag we must first address circadian rhythm, our bodies internal biological clock that follows a 24-hour cycle, which is running in the background of your brain and cycles between sleepiness and alertness at regular intervals. It is the disruption of this internal body clock that leads to the Jet Lag.                                                                                                                                                                                                                                                                                                                                         Combat Strategies

When it comes to combatting Jet Lag there is an endless amount of strategies that you can utilise, I will share my personal strategies and hopefully, you will find them helpful in the future. I take a very scientific based approach, so each of the methods below you will find are grounded in science.

 

During Flight:

Stay Hydrated: With the reduction in oxygen and lack of humidity, dehydration is inevitable if you are not careful. To put it in perspective the air inside the cabin of a plane usually has a humidity level of 10 to 20 percent — much lower than a comfortable typical indoor humidity of 30 to 65 percent. Across 10 hour flight, men lose approximately two liters of water and in women around 1.6 liters Stay hydrated! My rule is always say yes to water but also carry a drink bottle to regularly sip on and don’t hesitate to ask the flight attendant for water. Most importantly, stay clear from alcohol as it will only further dehydrate you.  

Keep Moving: The human body is designed to be in locomotion. For this reason, I always select aisle seat, to ensure I can regularly get up and move and stretch (Key focus: opening up the hips and chest and increasing blood flow in lower limbs). I also take some time to complete isometric calf raises. All of these exercises and stretches are key in the prevention of deep vein thrombosis (DVT). (I also wear  compression socks to help in prevention of DVT as well)  

 

While seated:                                                                                                                                                                                                                                                                                           
Ankle Circles (Clockwise / Anticlockwise)

Ankle Point / Lifts (Plantarflexion / Dorsiflexion)
Pelvic Tilts: Sit upright position and tilt your pelvis back and forth between anterior and posterior positions

Shoulder Shrug / Depression / Retraction: Key focus of the exercise is hold the depression and retraction for approx 30sec each rep

Chin Tucks & Gentle Neck ROM: Sit upright position tuck your chin in and then relax and repeat. Shift your head gently around (Clockwise / Anticlockwise / Back / Forward) if desired you can add some gentle resistance with one of your palms

 

Standing:

Isometric Calf Raises: 2x45sec each leg every 2hours

Deep Squat: Find some space and drop into a deep squat and shift around back and forth aiming to open up the hips and lower back. Aim for 2min but more is always better.

Forward Bend: Relax into this position with straight legs and if you can touch toes link fingers underneath (if not bend knees as needed) start with oscillating the hips around then aim to gradually fall deeper into the stretch. Complete a few rep of bending knees to straight.                                                      
Back Bend: Either place your hand high on a wall or overhead compartment and gently fall into the stretch driving your hips forward while also opening up through your shoulders

Groin Stretch: Stand with a wide stance and shifting your weight to one leg bending into it while keeping the other leg straight. Shift back and forth from side to side.90 degree Chest stretch: Find a corner or a wall, step to the side and place one forearm up against the wall in a 90-degree position from the upper arm and gently fall in and out of the stretch opening up through your chest.

 

Supplements:
Melatonin: Your sleep hormone is found naturally in the body which is a key component of regulating the circadian rhythm. I take this when it is time to sleep. A healthy version of a sleeping pill.

Magnesium: Naturally relieve stress by ensuring your muscles and nerves function properly. Magnesium is also a natural sleep aid, which makes it the perfect companion for overnight flights, and can help relieve the tension of muscle spasms and cramps, which are inevitable after hours in a stationary position. I take this before and regularly throughout each flight.

Exogenous Ketones: There is new research stating that being in a state of ketosis has the ability mitigate the impairments of sleep deprivation and this can be achieved through the use of exogenous ketones, diet (HFLC) or fasting. I use ketones for training and mental state but I have not yet used personally while traveling. However, I will definitely be introducing this next time I fly.

 

Transit:

Get moving: Take the stairs and walk as much as possible, this is a great opportunity to get some blood pumping.

Stretching / Yoga: If you have the time, find a quiet space where you can unwind and do some stretching or yoga. I normally carry a towel in my carry on as it can be tough to find airports with a soft surface to stretch on.

Refuel: While flying your diet is extremely restricted to what is given to you and airline food which is notoriously unhealthy. Flying at 30,000 feet dulls the taste buds and dries out the ingredients which impact the passenger’s’ ability to sense flavor by 30%. To overcome this issue, chefs utilise extra sugar, salt and spice to improve palatability.

What sort of foods should I be looking for? It can be dependant on the airport you are in but aim to get some healthy whole foods that are high in antioxidants, fiber, zinc, magnesium. Which comes through; fresh vegetables, fruit, meat and if limited on time grab a freshly squeezed juice.

 

Destination:

Light Exposure: No sunglasses! Exposure to light or to darkness is key in the regulation of the circadian rhythm. Exposure to light stimulates a nerve pathway from the retina in the eye to an area of the brain called the hypothalamus. This prevents the excretion of melatonin which therefore hinders your circadian rhythm.

Remove Blue Light: Just like sunlight the LED light that our electronic devices produce is just as impactful in affect our circadian rhythm. Most phones these days have blue light filters or you can download an app like F.Lux which syncs devices screen with the light to mimic circadian cycle of a set time zone. This is a key hack I use every day not only when flying, I suggest implementing this simple hack now for better sleep.

Adapt to new time zone: Flight the sleepiness! Stay awake until you are within an hour of your normal bedtime and wake with an hour of normal time.

Avoid naps: If you do nap, make sure it is before 3 pm and keep them tactical 20 mins only! Otherwise, you will impede your circadian rhythm.

Flotation Therapy: Long haul flights are a stress on the body and flotation therapy is a great way for disconnecting from that stress and unwinding. It also assists with the inflammation associated with long-haul flights. I personally make sure I visit
“New You” for a float before and after each flight.

Nutrition: High fat will help stabilise blood sugars and help avoid the big peaks and troughs associated with high carbohydrate diets. Aim to eat plenty of antioxidant-rich food (berries, pecans, dark chocolate) to help fight all the free radicals built up.

Cold Showers: Energy is produced through the mitochondrial (intracellular powerhouses) and cold showers is one of the quickest ways to induce neurogenesis
(the production of new mitochondria) therefore resetting the system and boosting energy levels.

Grounding: Kick your shoes off, get outside and connect with the earth whether is grass, sand or the ocean. This may sound a bit airy fairy but there has been a strong association with grounding and re-energising the system. This is done through soaking up the earth’s negative charge, which reduces inflammation and leaves you feeling more refreshed and recharged.

 

Supplements:

Flights are bacteria pits so always a good idea to boost your immune system with some vitamins. I personally use and love BePure products and have not come across anything better on the market.

BePure Vit C Boost: Quickest way to boost your immunity is a good quality source of Vitamin C, this high potency Vitamin C is unbeatable!

BePure One: A whole food supplement with such a diverse selection of nutrients it is a full proof method to ensure you not missing anything through your diet.

BePure Three: This would have to be the strongest Omega 3 on the market and one of the best ways to fight inflammation. With a long haul flight you are guaranteed inflammation, therefore, it is important to reduce it as soon as possible.

Exogenous Ketones: Due to the mitigating effects of sleep deprivation as discussed earlier this would definitely be a supplement to concider.

 

Hopefully, these tips and tricks help you avoid the nasty effects of jet lag ensuring your next trip is not wasted away trying to recover.