Aidan:
Welcome to the Ideal Nutrition podcast. My name is Aidan Muir. I’m here with my co-host Torrin Irkins. This is episode 244. We are going to be doing a Q&A episode. I didn’t write down which number it is. Do you know which number Q&A this is?
Torwen:
Number 12.
Aidan:
Number 12, yeah. Once again, we checked the stats. People listen to these. So, we’ll keep doing them. Easy content for us. So yeah, another Q&A.
Torwen:
Cool. We’ll rapid-fire through like we did last time. And we’ll ask each other one question each. I’m going to ask Aidan first. Would you recommend NAD+ supplements for over-40s?
Aidan:
NAD+ stands for nicotinamide adenine dinucleotide. That’s why we say NAD. It’s a coenzyme essential for energy metabolism. Specifically, ATP production. It also supports DNA repair. Levels naturally decline by up to about 50% by age 40. That is part of why this question exists. It is also part of why it is popular.
Since NAD+ is not absorbed well by itself, most supplements marketed this way contain precursors. If you Google NAD plus supplements, you’ll find a lot like this. The front label says NAD+. Then you turn it over. It addresses the issue I was talking about. The ingredients aren’t NAD+ itself. They’re usually precursors. Sometimes they’re precursors. That way it doesn’t seem misleading.
Animal studies look promising. Human studies are more limited. There’s some small-scale promising data. It includes energy levels, insulin resistance, and VO2 max. It seems more so in amateurs than in elites. And it also includes cognitive function. Those things sound promising.
I still put it in the category of something I don’t actively recommend. That’s partly based on the research. If I lowered my bar, what I’ll say is that low. There’s a long list of supplements I’m going to be recommending. I don’t think the case is strong enough for me to go down that route.
There are a lot of other things I’d recommend first. Still, it falls into a category. If somebody wants to take it, I wouldn’t tell them not to take it. There’s enough behind it. I can see the logic there. It makes sense. My question for you then, Torwen, is this. Should you be worried about water weight with creatine supplementation?
Torwen:
Not necessarily. However, it is one that a lot of people are concerned about. I see it specifically with young females. So, people worry the water weight will make them look puffy or bloated. That’s not always the case. The increase in water weight is at least 50% intracellular. That means inside the muscles. Some research skews this higher. It can be more than 50%. If anything, that makes you look a little fuller and more muscular.
It’s worth noting the intracellular water signals you’re also increasing muscle mass. That’s a benefit of creatine. Still, it’s complex. It depends whether the water retention is ongoing. We see an increase in water weight in studies. This includes placebo versus people doing a loading phase.
Often after the loading phase, they have an increase in weight. It’s likely water weight. After a period of maintenance, this goes back. It becomes practically non-existent or much smaller. So my advice is this. If you’re worried, skip the loading phase. Go straight to maintenance. It will take longer to increase your creatine stores. But, you might not notice that acute increase in weight.
Aidan:
Yeah, I do that with so many people as well. It avoids that problem. You still get the benefits. It might take longer. I don’t think some people care about that. Some people don’t. If you care, do the loading phase. If you don’t care, do the lower dosage. Do it consistently for longer.
Torwen:
Cool. For Aidan then, what are your thoughts on dextrose? Someone said they need to eat more carbs. However, they’re struggling to eat more calories.
Aidan:
I view dextrose kind of like sugar. It’s high GI. It’s low in micronutrients. From a GI perspective, it comes in at about 100. That’s the same as straight-up glucose. One reason it has a reputation is this. It has a health halo in the fitness community. It’s digested super quickly. Glucose is the same.
That only matters if glycogen repletion needs to be done quickly. So, if somebody is training multiple times per day. If they train the same muscle groups, I’d care. This question was around struggling to get more calories in.
If you went down the dextrose route, you could go down the anything route. You could have basically any carb source. It would be equally as good, if not better. I’d encourage going down the route of something with micronutrients. It could also include fibre and other stuff.
So, it falls into that odd category. It has that health halo due to replenishing glycogen. In most cases, that doesn’t matter. It would come out basically the same as sugar. So I don’t recommend it for this.
Torwen:
And if you’re looking for more calories, you may as well have something else. If we’re looking at volume factors, focus on healthy fats. Choose something lower volume. It will give you more bang for your buck than straight dextrose powder.
Aidan:
Yeah, potentially. It depends if somebody is also trying to keep fat low. There’s a lot of logic here. Still, I wouldn’t recommend it. Okay. Somebody said they have strong textural sensitivities. They don’t have many fruits and vegetables. How can they cover their micronutrient intake?
Torwen:
Firstly, can we work around the textural sensitivity? Can we make fruit puree? Can we put veggies into smoothies or sauces? Then blend it. Or can we do the opposite? Roast things until they’re crispy and crunchy. That would be my first line. Can we make the food work?
If none of that is an option, and we truly cannot get those foods in, then I might use supplements. Generally, without fruit and vegetables, there are common gaps. That includes vitamin C. It includes potassium and magnesium. It includes fibre, antioxidants, and folate.
So when we don’t have that, we could use a general multivitamin. It can help cover a general lack of micronutrients. We could add a fibre supplement. It can help keep bowels regular. Then we can target specific gaps too.
Aidan:
Yeah, I like that. I come across many clients in that situation. I always get kind of excited. Especially if they’re not doing a multivitamin. It’s a good and easy win.
Torwen:
Yeah, I think so too. All right. Aidan, is the RAVES model the gold standard for managing binge eating disorder?
Aidan:
It’s highly respected among dietitians. It’s developed by Shane Jeffery. I know Shane. Not super well. I was thinking about this. I don’t want to talk it up too highly. If I was mates with anybody, I would never do that. If they developed a model, I’d never say it’s so good. He’s still just a guy. Yet I also don’t want to rip on it. In case he heard it.
What it stands for is this. It’s an acronym. The R stands for regularity. That means eating five to six times a day. A stands for adequacy. That means meeting energy and nutrient needs. V stands for variety. That means challenging good and bad food rules. It also means having a varied intake.
E stands for eating socially. That means reconnecting with others over food. It also means connecting in general. S stands for spontaneity. That means being flexible and intuitive with food. If you’re doing all of those things, you’re very far from disordered eating.
It’s also laid out in order. We probably work through those things in order. A lot of it aligns with what I do with binge eating disorder. Another key thing is this. It’s very rare to come across somebody. They do all of those things. They also binge. So it is a solid model. It ticks a lot of boxes.
Regularity and adequacy come first for a reason. They solve a lot of the biological urge to binge. If somebody is restricting heaps, hunger is upregulated. That increases the odds. The last three are more psychological. They move somebody from disordered eating towards normal eating.
There’s a lot in there. It gets rid of the restriction side of things. It requires psychological input on top of that. That’s kind of assumed with this question. On the one hand, it’s developed by one person. Then it was refined over the years. On the other hand, I can’t really find any faults in it.
Any faults you could find, Shane could address them. He can go more in depth. He does full two-day workshops on this. What I’ve described took a minute. In those workshops, he goes deeper. There are many more things beyond this. So at this stage, I’d call it the gold standard. Yeah, that’s how I view it.
Torwen:
Yeah, I think it’s useful to have as a guide for sure.
Aidan:
So what are your thoughts on PHGG supplementation?
Torwen:
So, PHGG stands for partially hydrolysed guar gum. I really like PHGG. It’s a slowly fermentable, low FODMAP, prebiotic fibre supplement. It helps support health. It feeds beneficial bacteria. And can help aid stool regularity. It doesn’t necessarily affect stool bulk or transit time.
It’s typically well tolerated. That’s because it’s low FODMAP. It’s not a terrible texture either. So, I like using it in certain cases. For example, after a dose of antibiotics. Especially when people are also doing probiotics. It’s also useful with restricted prebiotic intake. A low FODMAP diet is one example.
As with any fermentable or fibre supplement, start low. Start at maybe three grams a day. Then work up to five to 10 grams per day.
Aidan:
Cool. That answered my follow-up questions.
Torwen:
So Aidan, can you reverse or rebuild lost bone mineral density?
Aidan:
You absolutely can. I get surprisingly excited about this. I did my systematic review back in university. It was on vitamin D and calcium supplementation for fracture risk. I got pushed in that direction. Still, you spend six weeks on anything. It becomes interesting. So I got interested in bone mineral density from there.
Now we also have a DEXA business. It’s the Ideal Dexa Clinic. We see this all the time. We see it on Dexas all the time. I have a skewed sample size. People are interested in health and activity. Still, it’s more common for us to see bone mineral density increase. It happens between scans. It used to be more common to see it decrease.
A lot of people think bone mineral density peaks in your 20s. Then it drops for the rest of your life. That absolutely is not true. We see changes all the time. What matters is exercise stimulus. You need something for your body. It needs a reason to strengthen its bones.
Protein intake matters. A large percentage of bone is made up of collagen. Collagen is a form of protein. Then you’ve got micronutrients. The classic one is calcium. Everyone knows about that. Vitamin D matters as well. We get it from the sun. We can also supplement. Certain foods have it.
Vitamin K2 is slept on. That’s why many supplements combine calcium, vitamin D, and vitamin K2. It’s a bit deeper than that. There could be an increased risk in cardiovascular disease. Some people point to vitamin D. It is probably more likely due to calcium. Calcium can be stored in places it shouldn’t be. Vitamin K2 could potentially offset that risk.
If we look at vitamin K2 in isolation and bone mineral density, we typically see an increase on average. Going back to that systematic review, it was common. When people took their supplements, bone mineral density tended to increase. It increased even more in people with low vitamin D. Addressing that helped.
That was my first exposure to this idea. You change one variable. A lot of people’s bone mineral density increases. What if we change more? There are other nutrients. That includes potassium, phosphorus, and magnesium. Often you change one key variable. People weren’t doing it well. Then you see improvements. What if you improved everything?
One rabbit hole I haven’t got a good answer on is this. To what extent can you do this as it progresses? You can do it for somebody with solid bone mineral density. And you can improve it to great. You can also help someone around the osteopenia route. What I don’t have a good answer on is this. Is osteoporosis reversible?
I’m sure there are cases. What gets hard with osteoporosis is probably two factors. One, somebody has lived a certain way for a long time. You would need to change many things. It’s hard to see large sample sizes changing that. I don’t think that’s the biggest barrier though.
I think the biggest barrier is the exercise stimulus. The further you progress, the harder it is to do certain things. It’s harder to get a good stimulus. Lifting helps. The heavier you lift, typically the better this is. On our DEXAs, every powerlifter comes through. They have insane bone mineral density.
Another stimulus is impact. That includes running and jumping. As bone mineral density gets lower, those activities become less safe. So the earlier you get onto this, the better. But, you can reverse and rebuild in many cases.
The final question for today is this. Do you need protein immediately after training?
Torwen:
I would say the anabolic window is a gym bro myth. I’ll explain why. The idea is you need protein immediately after. That’s not necessarily true. For optimal muscle growth, total daily protein intake matters more. Rather than precise timing.
There are reviews that indicate your window of muscle protein synthesis is highest around four to six hours after training. It may stay elevated for 24 to 48 hours after resistance training. So, that’s why we prioritise daily protein distribution. We prioritise it over acute timing.
Aim for 1.6 to 2.2 grams per kilo of body weight daily. Spread it across multiple meals. If you haven’t eaten around training, then 20 to 40 grams post-workout can work. If it’s convenient, it works. Still, it’s not a magic window. It won’t make you gain a lot of muscle.
Aidan:
Cool. We’ll wrap up there. So, this has been episode 244 of the Ideal Nutrition podcast. Thank you to everyone who asked questions. Thank you to everyone who has listened.