Weight & Diet

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GLP-1 receptor agonists for weight loss: What are they? 

If you've been paying attention to the news, you’ve probably heard about weight loss drugs like Wegovy and Zepbound, which are in a class of medications called GLP-1 receptor agonists (for the purpose of this article, we will refer to these medications as GLP-1s). While these drugs were originally developed to treat people with type 2 diabetes and come by different names (for example, Ozempic or Mounjaro), some are approved to treat obesity due to their significant effects on body weight. In this article, we’ll delve into the science behind GLP-1s, exploring how they work in the body, what the clinical evidence shows, and their potential as a treatment for obesity along with alternative treatment options that don’t require medication. What are GLP-1 agonists for weight loss? Glucagon-like peptide-1 (GLP-1) is a hormone produced in cells of the intestine. Its main action is to stimulate the release of insulin in response to rising glucose levels after eating a meal. It also blocks the release of glucagon, which is a hormone that works opposite of insulin to raise blood glucose by promoting the release of glucose from the liver into the bloodstream. This results in a reduction of glucose spikes after eating. (1) GLP-1 also acts in the brain and gastrointestinal (GI) tract to reduce appetite and slow gastric emptying, resulting in increased satiety after meals and a reduction in food intake. (2) When naturally produced in the body in response to food intake, GLP-1 is rapidly metabolized and inactivated by the enzyme dipeptidyl peptidase IV (DPP-4) even before the hormone has left the gut. (1) This is where GLP-1 receptor agonists come in. An agonist is a substance that mimics the action of a hormone to produce a response. Scientists were able to develop a GLP-1 receptor agonist, which means the molecule can bind with GLP-1 receptors and produce the same physiological actions as the hormone (increase insulin, decrease glucagon, increase satiety, slow down gastric emptying), without being rapidly degraded by DPP-4. GLP-1 isn’t the only gut hormone with glucose-lowering effects (called incretin hormones) that scientists have targeted. Glucose-dependent insulinotropic polypeptide (GIP) also lowers glucose and was discovered to have an additive effect when administered with GLP-1. (3, 4) One such drug (tirzepatide) on the market today targets the effects of two incretins and is a dual GIP and GLP-1 receptor agonist. Most of the GLP-1s are injectable medications and approved for people with type 2 diabetes. However, three drugs have been approved by the FDA for the treatment of obesity when used with diet and exercise: GLP-1 receptor agonists for type 2 diabetes: Byetta™ (exenatide) Bydureon Bcise® (exenatide extended release) Ozempic (semaglutide) Rybelsus® (semaglutide, oral form) Trulicity® (dulaglutide) Victoza (liraglutide) Mounjaro (tirzepatide) All GLP-1 medications approved for type 2 diabetes require a prescription and should only be considered with the help of your doctor. GLP-1 receptor agonists for obesity and excess weight with weight-related medical conditions: Zepbound (tirzepatide) Wegovy (semaglutide) Saxenda (liraglutide) Tirzepatide, semaglutide, and liraglutide for weight management also require a prescription. They have been approved for weight management in people with a BMI of 30 or higher or those with a BMI of 27 or higher who also have one weight-related comorbidity such as hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease. (5, 6, 7) They are taken as once-weekly (semaglutide and tirzepatide) or once-daily (liraglutide) injections in combination with diet and exercise to promote weight loss. (8) Beyond weight management, one drug (semaglutide) is approved to lower risk of major cardiovascular events such as death, heart attack, and stroke in people with excess weight or obesity and known heart disease. (9) Why are GLP-1 agonists used for weight loss? Along with GLP-1 medication’s effect on insulin and glucagon as mentioned, they also play a significant role in the central and peripheral nervous system and GI tract. While originally used for their ability to reduce both fasting and after-meal glucose levels in people with diabetes, GLP-1s have also been found to reduce food intake by direct interaction with GLP-1 receptors in the brain that regulate appetite. (2) These medications also inhibit meal-stimulated gastric acid secretion and gastric emptying, thereby reducing postprandial glucose (the amount of glucose in the blood after eating) as well as helping people feel fuller, longer. (2) It has been thought that this slowing down of gastric emptying after meals may be more important to regulate postprandial glucose than GLP-1 medication’s effect on insulin and glucagon because nutrients take longer to reach the small intestine, thereby reducing the postprandial glucose spike. (2) While a medication for weight loss might sound appealing, these drugs are not intended for those who are just looking to drop a few pounds. Clinical trials have found that for people with a significant amount of weight to lose, the use of a GLP-1s can result in weight loss around 15% of body weight as well as improvements in cardiovascular risk factors such as better blood pressure and plasma levels of LDL, HDL, and triglycerides. (10, 11) However, clinical trials showed that once these medications are discontinued, weight is regained and improvements in markers of cardiovascular risk, like blood pressure, are lost. (12, 13, 14) Because of this, most prescribing information recommends staying on GLP-1s long-term to sustain weight loss and other health benefits. (15) Additionally, studies of GLP-1s show that between 10-50% of the total weight lost comes from lean body mass. (16) While this is in line with other methods of weight loss such as a reduced calorie diet or bariatric surgery, it should not be overlooked. Maintaining lean body mass (aka muscle) during weight loss is crucial because it helps preserve metabolic rate, supports physical function, and contributes to a healthier body composition. All of these are essential when it comes to keeping a healthy metabolism and promoting long-term weight management success. Whether pursuing weight loss via medication, surgery, or diet and lifestyle, incorporating physical activity is a prerequisite for any obesity treatment; exercise helps to preserve as much lean mass as possible while also losing fat. (10) Eating sufficient protein and incorporating strength training are other strategies that may be used to combat loss of lean mass when losing weight. (17, 18) Emerging research is starting to look at strategies that support the discontinuation of these medications while also sustaining weight loss and the other positive metabolic effects achieved while taking them. One recent study published in Diabetes Therapy showed that carbohydrate-restricted nutrition therapy (aka a very low-carb diet) supported via telemedicine allowed patients on GLP-1s to stop the medication while sustaining both weight loss as well as improvements in glycemic control. (19) What are the side effects of GLP-1 agonists? GLP-1s represent a substantial therapeutic advancement in the treatment of excess weight and obesity. Many weight loss medications of the past have come with serious side effects that don’t always outweigh the reductions in fat mass. (20) While these medications can offer significant benefits for some, others may not want a pharmacological approach due to personal, medical, or cultural preferences or needs. Gastrointestinal issues tend to be the most common side effects when taking these medications. In a “real-life” cohort study of 175 patients taking semaglutide, 49% experienced adverse side effects including nausea and vomiting (37%), diarrhea (9%), fatigue (6%), constipation (6%), and abdominal pain (5%). (21) These side effects tended to be mild to moderate and stabilized after dose-escalation was stopped but 3% of people ended up discontinuing the medication due to side effects and 9% required the dose to be reduced or not escalated to the max dose. (21) One thing to also note is that while the significant weight loss seen in clinical trials is enticing, real-world application of these medications does not always produce the same results. (22) Additionally, current contraindications include anyone with a personal or family history of medullary thyroid cancer or diagnosed with multiple endocrine neoplasia syndrome type 2. The medication should be stopped at least two months before a planned pregnancy and should also be stopped prior to any surgery due to its effects on gastric emptying. (20) When it comes down to it, if you are someone with obesity or type 2 diabetes, whether you should take a GLP-1 medication is a conversation reserved for you and your doctor. A focus on lifestyle, including healthy blood glucose, attention paid to hunger and fullness, and physical activity is useful for anyone trying to manage their weight, whether on these medications or not. Diet and lifestyle changes that mimic GLP-1 agonists It is possible to achieve similar effects of GLP-1s through diet and lifestyle. (23) While their original action of helping to regulate glucose after meals was the reason these medications were first approved for people with diabetes, they also persistently slow gastric emptying, especially after a meal. This is one of the reasons why they are so effective for weight loss. This slow-down delays the time glucose enters your system, allowing insulin to more easily match the glucose consumed and reduce the overall insulin demand. (24) The slowed gastric emptying and more stable post-meal glucose delays hunger after eating and increases satiety. An alternative way to do this would be to choose foods that help you avoid these glucose spikes in the first place and eat foods that are slower to absorb (like low-glycemic foods) and foods that promote satiety (like protein and fiber), similar to what a GLP-1 receptor agonist would do. Eating a diet that is low in carbohydrates or focusing on low-glycemic foods can have similar effects to a GLP-1 medication (24), including: Eating slow-to-digest carbohydrates such as non-starchy vegetables, beans and legumes, or whole grains results in lower postprandial glucose and insulin. (24) Protein and fat digest more slowly, leading to less glucose spikes and less insulin secretion. (24) Low-glycemic diets have been shown to decrease leptin (a hormone that promotes fullness and helps regulate metabolism). A decrease in leptin suggests an improvement in leptin resistance, which is common in obesity, meaning your body can better regulate appetite and metabolism. (24) Low-glycemic diets may also reduce ghrelin (the hunger hormone) and increase adiponectin (a protein involved in cells response to insulin as well as fatty acid breakdown). (24) Low glycemic diets have been shown to increase GLP-1 naturally. (24) If you do decide to take a GLP-1 medication, a focus on lifestyle, including healthy blood glucose, is a good idea in conjunction with these medications. Appetite changes induced by these medications may cause your eating patterns to shift and tastes for foods to change. (25) Additionally, with any weight loss strategy, it’s important to pay attention to the foods you eat to minimize the loss of lean mass (aka muscle) while losing fat. Prioritizing protein, strength training, and eating foods that help keep your glucose steady are key components to help maintain a healthy metabolism while losing weight. A final note from Lingo Lingo’s Director of Clinical Research, Amy McKenzie, PhD, has studied the interaction of GLP-1s and nutrition. She said: “Weight care is important for most of us in the United States. Three out of four adults live with excess weight or obesity and prevalence among children and adolescents is growing. The role of GLP-1s or any other medication in weight care is a decision only a person and their doctor can make, but regardless of whether we choose to include medication in a weight care plan, nutrition plays a foundational role. With medication like GLP-1s, which have the power to significantly reduce food intake, we need to be sure we’re fueling the body with adequate protein, vitamins, and minerals to support maintaining our muscle – it’s critical as we age. On the other hand, research shows that reducing glucose exposure through diet changes can help some people achieve as much weight loss as a medication could do for them and it can help them transition off the medication if they can’t be or don’t want to be on it for a lifetime. So no matter where we are in our weight journeys, getting our fuel right is key.” Whether you choose to use a GLP-1 medication or not, focusing on lifestyle is essential to maximize benefits, with or without medication support. Using a continuous glucose monitor (CGM) like Lingo can offer valuable data on your unique response to foods. This understanding can help to guide nutrition and exercise to support your weight loss journey and even enhance adherence to a low-carb or low-glycemic approach to nutrition. (26) Additionally, a CGM can give you insight that can help to improve the quality of your diet, not just the quantity of what you are eating. In a study of 40 adults, it was found that those who were wearing a CGM and able to see the data in real-time were able to better adhere to a low-glycemic diet versus those who did not have access to CGM their data. (26) Another small study found that having access to glucose data in real-time actually changed the participants preference for food, preferring a lower glycemic option over a higher glycemic option after the study. (27) This can impact your overall health and how you feel day-to-day, prioritizing your health beyond just weight loss. Being aware of foods that promote satiety and reduce glucose spikes can support weight loss goals, complementing lifestyle changes whether you choose to use a medication or not. * Other trademarks are the property of their respective owners.

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Image for Balanced vegan diet: How can you get the nutrients you need?

Balanced vegan diet: How can you get the nutrients you need?

The start of the year is a new chance to revisit your overall nutrition. This year, you may be curious about Veganuary—a 31-day vegan diet challenge throughout the month of January that encourages participants to stick with the diet year-round. Veganuary is also a non-profit organisation that started in England and Wales in 2014 to support and encourage people to eat a plant-based diet. Plant-based diets have continued to increase in popularity in recent years. From 2014 to 2018, there was a 600% increase in Americans subscribing to a vegan diet. (1) The British Nutrition Foundation reports that 2-3% of the UK population follow a vegetarian or vegan diet, with interest in reducing meat consumption on the rise. In 2017, 28% of people in the UK reported an interest in reducing their meat consumption, compared to 34% in 2018. (2) While “vegan” and “plant-based” are often used interchangeably, there are some distinctions. A plant-based diet is any dietary pattern that includes a low amount of animal food and high amounts of foods from plants, like vegetables, fruits, nuts, seeds, legumes, and whole grains. A vegan diet is a type of plant-based diet that is free from any animal products (e.g. no meat, poultry, fish, dairy, eggs, or other foods derived from animals). For the purposes of this article, we will be using both terms to refer to the avoidance of animal-derived products in the diet. Whether you’re aiming to focus more on plants to get most of your nutrients or deciding to cut animal products completely, it is important to identify the best sources of protein, carbohydrate, and fat that fit into a plant-based diet. You may set out with the intention to better your health, but without careful planning, cutting out animal-based foods can leave you filling up on carbohydrates and ultra-processed foods, which aren’t best for your energy levels (due to blood sugar spikes and crashes), or your overall health. Below, we break down why people may choose to eat a vegan diet and what a healthy, balanced vegan diet truly looks like. Why people choose to eat a vegan diet There are many reasons people may be interested in trying a vegan diet, a major one being for the desired health benefits. Plant-based eating has been linked to lower BMI (body mass index), weight loss, lower cholesterol, lower risk of diabetes, intestinal diseases, heart disease, cataracts, certain cancers, and more. (3)(4) Adopting a vegan diet is also a lifestyle for many people who choose it for ethical reasons, including animal cruelty and environmental considerations. Many of the health benefits of plant-based diets are linked to the higher fibre content compared to animal-based diets. Since vegan diets are based around complex carbohydrates, vegetables, and fruits, plant-based eaters tend to get closer to the 30 grams of fibre that is recommended daily. (5) Picturing a vegan diet may bring to mind brightly colored vegetables, fruits, and other healthy plant foods. However, many foods are technically vegan that aren’t health promoting (think: sugary soda, biscuits, greasy chips). So while the goal for many of eating a vegan diet is to eat more plants and plant-based foods, it can unintentionally lead to eating an unbalanced diet that is lower in protein and higher in carbohydrates, specifically refined and ultra-processed foods (UPFs). A 2021 study published in the Journal of Nutrition found that vegans consumed the most UPFs of any plant-based diet. (6) Eating a diet high in UPFs has excessive amounts of added sugar, unhealthy fats, salt, and low in micronutrients and fibre. This can wreak havoc on your glucose, energy levels, and overall health. In other words, vegan diets are not automatically healthy. (7) A high consumption of vegan-friendly foods like sugary drinks, refined grains, potatoes, desserts, and fruit juices has been associated with a higher risk of chronic disease and overall mortality. (4) In contrast, a balanced vegan diet can be health promoting. One of the ways is through better blood glucose levels due to increased fibre intake. A 2023 study found that diabetic participants on an animal-based diet had a six times greater risk of having uncontrolled blood glucose levels compared to those who adopted a vegetarian or vegan diet. (8) If you’re interested in eliminating animal products, it’s important to limit added sugars and get enough protein from plant-based sources to steady glucose. Eating protein, especially pairing a source of carbs with a protein, is key to helping balance blood sugar. Eating a vegan diet comes with extra challenges, especially attaining proper nutrition from vegan foods. Trying a vegan diet this year? Keep reading to learn how to get the nutrients you need with a balanced vegan diet. Sources of nutrients for vegans Since vegan diets are free from any animal products or byproducts and often plant-based, it’s important to understand which vegan foods fit into each macronutrient (protein, carbohydrates, and fat) category for balanced vegan nutrition. Here are the best sources of vegan nutrition for each macronutrient: Protein sources: Beans, peas, and lentils; nuts, seeds, and soy products (such as tofu and tempeh). Carb sources: Whole grains (quinoa, barley, oats), whole-grain bread and pasta, brown rice, potatoes, and other starchy vegetables. Fat sources: Plant oils (canola, olive oil, coconut), avocado, nuts and nut butters, and seeds It’s important to note that many meat alternatives on the market that are designed to replace animal-based foods like burgers and sausages are often not a healthier option. These foods can be low in protein and high in salt, oil, and sugar. If searching for a meat alternative, look for whole soy-based products like tofu and tempeh that have few additives. Healthy vegan nutrition should revolve around the rule of three: Fill ½ of your plate with non-starchy vegetables (e.g. asparagus, Brussels sprouts, peppers), ¼ with high-quality protein (e.g. tofu), and the remaining ¼ with complex carbohydrates (e.g. sweet potato, brown rice, quinoa). Don’t forget to include healthy fats (e.g. avocado, nuts, seeds, or a drizzle of olive oil) as well. Vegan nutrition advice If you follow a vegan diet, it’s crucial that you eat a balanced diet that satisfies macronutrient and micronutrient (vitamin and mineral) needs, as vegans are more prone to nutritional deficiencies that can lead to future health problems like anemia, stroke, cognitive impairment, decreased bone health, and more. (9) Nutritional deficiencies are common among people who follow an unbalanced vegan diet, like those who eat an abundance of ultra-processed foods. Common micronutrient deficiencies include vitamin B12, vitamin D, calcium, selenium, iodine, iron, zinc, riboflavin, and omega-3 fatty acids. (7) Additionally, because plant-based sources of protein are not as easily utilized by the body and have a different mix of amino acids compared to animal sources, it’s important to ensure you are getting enough protein from a variety of sources to ensure you get all of the amino acids your body needs. (10) Soy (tofu, tempeh, edamame), quinoa, and buckwheat are complete proteins that provide all nine essential amino acids, and other plant-based foods that aren’t complete proteins but provide a good number of amino acids include beans, spirulina, hemp seeds, pumpkin seeds, walnuts, and flax seeds. To eat a balanced vegan diet, some of the recommendations from the National Health Service include: (11) Eat at least 5 portions of a variety of fruits and vegetables every day. Have some fortified dairy alternatives, such as soya drinks and yoghurts (choose lower-sugar options). Eat some beans, pulses, and other proteins. Eat nuts and seeds rich in omega-3 fatty acids (such as walnuts) every day. Have fortified foods or supplements containing nutrients that are more difficult to get through a vegan diet, including vitamin D, vitamin B12, iodine, selenium, calcium and iron. Drink plenty of fluids (the NHS recommends 6 to 8 cups or glasses a day). While these are broad recommendations for people following a vegan diet, Lingo recommends that you tailor your own vegan diet to include foods that allow you to keep your glucose levels steady. This may mean: Base meals on a quality source of protein (like tofu or tempeh) and make sure to include protein at every meal. Tailor carb portions based on your own blood sugar response and choose whole grain carbs whenever possible. Eat fruits and vegetables that don’t cause your blood sugar to spike rapidly. Vegans should also still focus on limiting ultra-processed foods that are high in added sugars, simple carbohydrates, unhealthy fat, and sodium. Although many foods may be vegan-friendly, it does not mean they are nutritionally sound. To adhere to a balanced diet for good nutrition, follow the rule of three as outlined above to balance non-starchy vegetables, protein, complex carbohydrates, and healthy fats. A final note from Lingo Since many people are looking to eat healthier and increase their consumption of fruits, vegetables, and other whole foods, a plant-based diet might be something to explore. Plant-based diets have grown in popularity in recent years, and some studies point to health benefits such as improved BMI, lower cholesterol, and reduced risk of heart disease. (11) However, if a balanced vegan diet is not followed, it can create nutritional challenges. Nutritional deficiencies can be common for vegans, but can be avoided with fortified foods and supplements such as B12 and vitamin D. (9) Although eating a vegan diet higher in carbohydrates and lower in protein may lead to glucose spikes, using a continuous glucose monitor like Lingo can help you understand your habits and patterns and work towards eating a more balanced diet to limit glucose spikes.   Lingo is not a medical device and not designed to treat or diagnose any disease or illness. If you have medical questions or concerns regarding your glucose, please contact your doctor.

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Image for Why is losing weight after 40 harder? Advice from a Lingo Dietitian

Why is losing weight after 40 harder? Advice from a Lingo Dietitian

Why is it that after about age 40, it seems those extra pounds start creeping on and it’s harder to shed extra weight? In this article, we’ll discuss the reasons it may be harder to maintain a healthy weight after 40 and effective strategies to either maintain your weight or lose weight and improve body composition. How hormones impact your weight As we get older, for both men and women, hormones levels such as testosterone and oestrogen gradually start to shift. For women, this tends to be more of a dramatic shift. Many women report that it can be hard to not only lose weight but maintain the weight they stayed at for years. This change in body composition and weight is typically associated with menopause when there is a dramatic shift in hormones. However, menopause does not happen overnight. It is typically a gradual shift from perimenopause, which is when women first start to see irregularity in their menstrual cycles and may experience other symptoms such as sleep disturbances, to menopause, which is 12 months after a women’s last period (1). Weight loss or even weight maintenance can feel harder during these years, which is typically around age 40 to 55 and lasts on average around 7 years, but can last as long as 14 years for some women. (2,3) A change in hormones does not just happen to women as they age, but for men as well. While the side effects may not be as dramatic, the gradual decrease in testosterone can also make it more challenging for men to maintain muscle or lose weight. (3,4) Why you may struggle to lose weight One impact of the shift in hormones as you age is a natural decline in lean body mass (aka muscle). It has been shown that the ageing body needs more stimulus to maintain and build muscle than it does at a younger age. (5) What does this mean? There are two main components to building and maintaining muscle: Using the muscle (e.g. strength training) Eating enough protein to stimulate muscle protein synthesis. Does the chicken come before the egg? As people get older, they tend to be less active. Is this decrease in activity because of muscle loss? Or is the muscle loss because we decreased activity? Likely both. Hormone shifts can contribute to the loss of lean mass, and the decrease in activity also creates less stimuli for the body to maintain the muscle it has, much less build any new muscle. The way our body metabolises protein can change also as we get older. Studies have shown that muscle protein synthesis (MPS), or how much protein our body needs to stimulate muscle growth, increases as we age. (6) To put it simply, you need more protein to stimulate muscle growth than you did when you were 20. Because of these changes, not only does it seem like it’s harder to maintain or lose weight, but you also may notice that your overall body composition is changing. If nothing is done to mitigate this, you can start to lose muscle mass while putting on fat mass. On top of the physiological changes that happen with age, many adults over 40 may experience lifestyle shifts that can impact weight management. Taking care of children, a stressful job, or other life changes can impact things like sleep, eating habits and activity compared to when you were younger. Studies show that poor sleep can impact your metabolic health and promote weight gain. (7) Additionally, chronic stress can impact weight management by disrupting the body’s hunger and fullness signals and a change in eating habits that induce weight gain. (8,9) So we've covered the major reasons why your weight may change as you get older, or why it may be harder to lose weight after 40, but what can you actually do about it? The good news is, there are several strategies that you can use to effectively lose weight no matter if you are in your 40s, 50s, or older. Tips to manage weight after 40 Prioritise protein Eating enough high-quality protein is one of the most important things you can focus on as you get older. Protein will help you maintain lean muscle mass, which burns more calories at rest than fat, meaning you can eat more and maintain your weight. It also helps to keep you full, meaning you are less likely to crave the carb-heavy, sugary, and calorie-rich foods that make weight management harder. Remember that you’ll need more protein for it to trigger all these beneficial effects. Aim for 1.5 grams of protein per kilogram of your ideal body weight daily, with at least 30 g per meal to maximise muscle protein synthesis. Some high-quality protein sources include salmon, shrimp, chicken, beef, eggs, whey protein powder, cottage cheese, and tofu. Strength train In combination with eating enough protein, strength training is the other major contributor to maintaining and/or losing weight as you age. Lean muscle mass requires more calories to maintain than fat, meaning you can eat more calories (especially calories from protein) and still maintain your weight. Strength training helps your body use the protein you eat more effectively (5) and can also help preserve metabolic health by increasing insulin sensitivity and lowering blood pressure. Stabilise glucose Eating nutrient dense foods that promote stable glucose will help to ensure you are curbing the glucose spikes and crashes that can stimulate hunger and cravings throughout the day. Using your Lingo CGM can help to identify the foods that help you minimise glucose spikes and maintain your energy throughout the day. Check out more information on how to avoid glucose spikes here. Try time restricted eating Sleep and stress can impact your circadian alignment, which may increase your risk for weight gain and metabolic consequences with age. One way to combat this is a type of intermittent fasting called Time Restricted Eating (TRE). TRE means restricting your food intake to specific periods of the day to synchronize your body's internal clock with your external environment. Set a specific time frame, usually lasting about 8-12 hours, in which you will only eat within that period. For example, you may eat breakfast at 9-10 a.m. and dinner around 5-7 p.m. with lunch and/or snacks in between, but limit any other food outside of that window, especially 2-3 hours before bed. TRE has been found to help with weight loss and improve metabolic health such as improved insulin sensitivity and blood pressure. (10, 11) Cut out or decrease alcohol intake When trying to lose weight, alcohol ends up being empty calories that your body must burn before it can metabolise fat or carbs. What does this mean? You may end up storing the food you are eating because your body can’t store alcohol and puts fat and carb metabolism on the back burner. Additionally, depending on the type of alcohol you consume, it can impact your glucose by increasing or decreasing it, which subjects you to the effects of the glucose roller coaster. This can impact hunger, fullness, and your ability to maintain stable glucose. Lastly, alcohol may lower your inhibitions making it harder to choose glucose-friendly food choices. (16) When trying to lose weight, it may be best to limit or cut out alcohol altogether. Limit ultra-processed foods and focus on whole foods Along with stabilising your glucose, focusing on whole foods and limiting ultra-processed foods can help you manage your weight as you get older. It has been shown that people eat an average of 500 more calories per day when the food is highly processed vs. minimally processed. (12) Not only are you missing out on important nutrients when you eat highly processed food, but this can lead to weight gain in as little as two weeks when compared to eating a diet of unprocessed foods. (12) Focusing on food quality is one of the best things you can do. (13) Keep your ultra-processed food consumption to a minimum, and aim for your diet to consist of primarily whole foods such as: - Fresh or frozen meat and seafood - Vegetables, especially non-starchy veggies and leafy greens - Unprocessed carbohydrates such as beans, legumes, and whole grains - Dairy like milk, yoghurt, and cheese - Healthy plant-based fats: olive oil, coconut oil, avocado, nuts, and seeds Get quality sleep Poor sleep can impact not only weight, but also your glucose, metabolic health and overall mood and energy. (14) The NHS recommends 7-9 hours of sleep per night for adults. Having trouble getting quality sleep? Check out our tips for improving sleep and getting a good night’s rest. Manage stress Finding ways to relieve stress can not only help you manage your weight but can also lead to other benefits like reduced blood pressure and more steady glucose. (15) Identify ways you can destress, which may be different for everyone. Find something that works for you: breathing exercises, yoga, walking in nature, journaling, practising gratitude, or taking a warm bath or shower are all things you can implement to reduce daily stress. A final note from Lingo While getting older means your hormones and lifestyle may change, you can still work with them to reach your body composition goals. By focusing on the foods you eat, working to maintain and/or build muscle, and looking at your overall lifestyle including sleep and stress, you can still lose weight in your 40s and beyond.

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Image for Menopause and weight gain: What you need to know

Menopause and weight gain: What you need to know

As we age, we may notice it's harder to maintain our weight or even experience unwanted weight gain, despite no major differences in our eating or lifestyle habits. For women, these changes tend to start during menopause (typically in your 40s or 50s). While menopause is a natural change that happens to all women, this increase in weight can be frustrating. The good news is, while you can’t avoid menopause, there are things you can do to mitigate the symptoms, including unwanted weight gain. We’ll explore when and why these changes happen, potential health risks, and ways you can take action to minimise weight gain and improve your metabolic health during this life stage. When does weight gain start during menopause?  While menopause is defined as the point in time 12 months after a women’s last period, (1) the hormonal changes and associated symptoms start to take place well before. Perimenopause, the transition stage when your ovaries gradually stop working before full-on menopause, typically starts with the onset of menstrual irregularities. Women typically reach perimenopause in their mid to late 40s, (2,3) and this is often when women start to notice weight changes. While these shifts do stabilise with time, perimenopause lasts on average about seven years, but can be up to 14 years for some women. (4) Why am I gaining weight during menopause?   While weight gain during this time is most often correlated with overall ageing versus menopause per se, one of the predominant features of the menopause transition is a change in overall body composition. A decrease in oestrogen often causes increased fat mass and redistribution of fat to the abdomen. (3) Additionally, changes to the gut microbiome and metabolism (especially glucose metabolism) and lifestyle factors such as exercising less, poor sleep quality, and social factors may also contribute to weight gain at this stage in life. (5) Research confirms that post-menopausal females consume more sugar, report poorer sleep overall, and tend to be more sedentary, all of which can be attributed to the decline in oestrogen and can play a significant role in weight gain during this time. (6) The hormonal shift and accompanying loss of lean mass and redistribution of fat to the abdomen can disrupt metabolism, further exacerbating the other causes of weight gain that are observed. More abdominal fat has been associated with increases in cholesterol and triglycerides as well as disruptions in carbohydrate metabolism, (6) meaning our body has a harder time maintaining steady glucose, especially when eating foods rich in carbohydrates. This is due to increased insulin resistance and hyperinsulinemia (higher-than-normal levels of insulin in the blood), which we will discuss in more detail below. Studies have also shown that contrary to common opinion, hormone replacement therapy (HRT) has not been shown to cause weight gain and in some women may help reduce the accumulation of abdominal fat that occurs when oestrogen starts to decline. (3) The use of HRT has been shown to mediate some of the side effects of lower oestrogen, including less visceral fat and reduced blood biomarkers such as fasting blood sugar, insulin, and inflammation. (6) Every woman is unique, and you should discuss the pros and cons of HRT with your doctor. Are there any health risks associated with weight gain during menopause?  Weight gain and changes to overall body composition can have a significant impact on metabolism. Disruptions in lipid and carbohydrate metabolism increase risk of cardiovascular disease and type 2 diabetes, most likely related to hyperinsulinemia, insulin resistance, and visceral obesity. (6) This means that the way our bodies process the food we eat changes, which can have an impact on our weight and body composition. Emerging research highlights the value of monitoring these risk factors throughout the menopause transition. CGM data has unveiled that post-menopausal females had significantly higher fasting blood glucose, hemoglobin A1c (HbA1c), and markers of inflammation as well as higher overall sugar intakes, and poorer sleep compared with pre-menopausal females. Also, post-meal spikes, glucose variability, and time in range were worse post-menopause vs pre-menopause. (6)    How can I minimise weight gain during menopause?  The good news is, while you may not be able to stop menopause from happening, there are many lifestyle interventions that you can utilise to minimise the weight gain during this phase of life, including: Nutrition Adjusting your nutrition can have a positive impact on overall weight and body composition. One of the most important things you can do heading into menopause is to prioritise protein, which is one of Lingo’s Fundamentals. Not only is it harder for our bodies to properly metabolise carbohydrates as we get older, but we also need more protein to stimulate muscle growth, (7) which is a key component of regulating the body composition changes that occur during menopause and maintaining healthy muscle as we age. Additionally, eating more protein can help to keep you full after meals. This means you’re less likely to crave carbs, sugar, and calorie-rich foods that make weight management harder. Aim for at least 1.5 g of protein per kilogram of ideal body weight. If your goal weight is 68 kg (about 150 lbs), that means at least 102 g of protein per day. Try to get at least 30 g per meal to maximise muscle maintenance and growth. Here’s what 30 g protein looks like: 113 g cooked chicken breast 3-egg omelet with a couple slices of Canadian bacon 270 g cottage cheese 160 g cooked firm tofu Another nutrition staple is to eat more non-starchy veggies, especially leafy greens. This is in line with another Lingo Fundamental: go with green. Research shows a more favourable microbiome profile may help reduce inflammation and visceral fat as well as fasting and postprandial glucose, which can also help mitigate weight gain and body composition changes during this time. (6) Incorporate a vegetable at every meal, whether it’s a salad, roasted veggies, mixed into a dish, or eaten raw. Including more plants in your diet overall is a great way to improve your microbiome. Fibre is also important. In addition to veggies, beans, legumes, and whole grains all contain healthy fibre. These fibre-rich options help blunt the rise in glucose from carbs and high fibre foods tend to be more filling for fewer calories. Choose these options over highly processed foods or simple carbohydrates like sugary treats and pretzels. Exercise While we all know that exercise can be a good strategy for weight management, strength training in particular during the menopause transition is extra beneficial. Not only does this type of exercise help maintain and build muscle (which is a key component to healthy ageing), but it also helps your body use the protein you eat more effectively. (8) Having more muscle also means you burn more calories at rest, making it easier to maintain your weight. Additionally, maintaining muscle during this period can help preserve your overall metabolic health by increasing insulin sensitivity, meaning you are better equipped to handle the changes to metabolism that occur. (10) Aim to strength train at least two days a week focusing on free weights, resistance bands, bodyweight exercises, or machines. Gradually increase the intensity or difficulty of each session, which will help you maintain the muscle you have as well as stimulate new muscle growth. Other lifestyle habits Focusing on quality sleep and reducing stress are great ways to support steady glucose, which has been shown to play a positive role in weight loss and weight maintenance. (9) Try to get 7-8 hours of sleep each night and find ways to reduce daily stress. Check out our tips for better sleep, and try stress-reducing exercises like deep breathing, yoga, taking a hot bath, journaling, or whatever you find to help calm your nervous system. It is recommended that lifestyle changes, such as physical activity and dietary adjustments be the first choice to combat any metabolic changes seen during menopause, including weight gain and body composition changes, (6) however some may benefit from pharmaceutical interventions as well such as HRT or weight loss-specific medications. It is important to discuss these options with your provider to find a combination of strategies that will work best for you. A final note from Lingo     Menopause can feel daunting, especially as you start to notice changes that feel out of your control. Knowing what is going on in your body, as well as taking proactive strategies to address these changes, is the first step. Using a continuous glucose monitor (CGM) like Lingo can give you insights into what is going on in your own metabolism and help you navigate these changes effectively. With Lingo’s real-time coaching, you can make the adjustments needed and address the metabolic changes that occur. Additionally, having a support system is key. While a seemingly universal phase of a women’s life, menopause is not talked about as openly as it should be. Finding others who are going through similar life changes can be a great way to gain support and accountability during this major life transition.

Image for Ask a Nutritionist: I have PCOS, what foods should I eat and avoid?

Ask a Nutritionist: I have PCOS, what foods should I eat and avoid?

Question: I was recently diagnosed with polycystic ovary syndrome (PCOS) and have learned that lifestyle factors are important to manage symptoms, especially diet. I’ve seen some conflicting information on what I should avoid (do I need to give up gluten, dairy, and sugar forever?) and what foods to eat (is dietary fat good or bad?). Can you please provide insight? — Amanda P. Answer: Dear Amanda, PCOS is an endocrine (hormone) disorder that affects around 10% of women. (2) Among women with PCOS, it’s estimated that between 50-80% have insulin resistance. (1) Insulin is a hormone that acts on glucose in the body. Insulin resistance is when cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells. (3) Insulin resistance can result in inflammation, blood vessel damage, high glucose levels (hyperglycaemia), and more than half of women with PCOS develop type 2 diabetes by age 40. (4) While there is no treatment for PCOS, you’re right in that lifestyle can have a major impact on insulin resistance and other symptoms of PCOS. According to clinical studies in women with PCOS, making diet changes brought positive results in terms of clinical appearance of the syndrome, specifically weight loss and body composition, as well as improving insulin resistance and lowering testosterone (a hormone that’s elevated in women with PCOS). (5) So, you’re already ahead of the game in reevaluating your diet with PCOS. Making intentional food choices, especially when it comes to carbs, can help manage symptoms caused by insulin resistance. I know there’s a lot of conflicting information out there, and there’s still so much that’s misunderstood about PCOS. However, after combing through the research, I’ve outlined my best tips on how to navigate your food choices with PCOS. Foods to eat with PCOS Prioritise protein: In a long-term study in women with PCOS, significant improvements were observed when sugar and starchy carbohydrates in the diet were replaced with vegetables, fruits, nuts, and a daily protein intake of 1.6 grams of protein per kilogram of body weight. Protein sources focused on meat, eggs, fish, and dairy products due to the higher carb content of plant-based proteins like beans and legumes. After just 6 months, the women experienced significant decreases in glucose, body weight, and body fat. (6) Put it into practice: Ensure all your meals and snacks are built around plenty of protein. Especially your first meal of the day, when you break the overnight fast. Starting your day with a protein-rich breakfast like eggs, Greek yoghurt, or a high-protein smoothie that won’t cause a huge glucose (or insulin) rush will set you up to feel your best. Aim for at least 30 grams of protein per meal. Fuel with healthy fats: Foods like walnuts, chia seeds, flaxseeds, olive oil, and fatty fish are beneficial in multiple ways. Not only do they not cause a glucose spike, but they also contain anti-inflammatory compounds, which work to reduce the dietary factors that activate pro-inflammatory pathways in the body. (7) In a study where women with PCOS were provided a Mediterranean-inspired low glycaemic load anti-inflammatory diet (including 40 g of flaxseeds a day), after 12 weeks they had significant improvements in body composition, hormones and menstrual cycles, blood pressure, glucose homeostasis, dyslipidemia, and markers of heart disease risk. (7) Put it into practice: Add a source of healthy fats to every meal. Top salads with walnuts or chia seeds, make your own salad dressing with olive oil and lemon juice or vinegar, or add salmon or tuna to your lunches. Low-glycaemic carbs: Green leafy vegetables, berries, and whole grains are nutrient- and fibre-rich options that provide some carbohydrates, but with less of a spike, allowing insulin to work more effectively. Carbs like pasta, rice, or potatoes can be cooked, cooled, and reheated to create resistant starch that will have less impact on glucose and insulin, (8) and should also be eaten last as part of a balanced meal with vegetables, protein, and healthy fats. Put it into practice: Start your meals with non-starchy veggies and protein and save the carbs for last. Cook rice at the beginning of the week and cool it before reheating for lunches or dinners throughout the week. Swap berries and cream for cake or cookies when reaching for something sweet. Foods to avoid with PCOS It’s important to note that you don’t need to give up any type of food forever (unless you’re allergic!). A healthy eating plan should include some of your favourite treats in moderation, so you don’t feel deprived and aren’t tempted to overeat down the road. That said, there are some foods that can exacerbate PCOS symptoms and are best to eat less often: Carbs disguised as protein: Breaded and fried foods like fish sticks or chicken tenders have less protein than you think and are laden with carbs and fats not great for glucose or PCOS. Fried foods should be reduced as they can contribute to inflammation, and fried meats in particular have been shown to impair glucose homeostasis. (9) Put it into practice: Swap breaded meats for grilled meats and look for words like roasted, grilled, baked, steamed, or broiled on menus when eating out (avoid: crispy, crunchy, or battered). Ultra-processed foods high in fat and sugar: Women with PCOS may be more susceptible to the psychologically rewarding intake of ultra-processed foods, increasing the risk to consume them in addictive-like ways and lead to weight gain, inflammation, and metabolic issues like altered glucose control. (10) Put it into practice: Pick whole foods that are minimally processed over ultra-processed foods. For example, instead of chips or crisps for a snack, try an apple with almond butter or roasted and salted edamame beans. Sugary beverages and high-glycaemic carbs: Foods with free sugars like soda and other sugar-sweetened beverages, bakery goods like cakes, cookies and candies, and high-glycaemic carbs like breakfast cereals, oat milk, and white bread provide a large glycaemic load, which further perpetuates insulin resistance. (11) Limiting sugar, refined carbohydrates, and high-glycaemic carbs can help manage insulin levels effectively. (11) Put it into practice: Limit these foods as much as possible, and if eating them occasionally, consume with or after a balanced meal centred around protein, vegetables, and healthy fats. While there is some discussion online about whether or not women with POCS should avoid gluten and dairy specifically, there isn’t research to support this claim. However, you may choose to avoid these food groups if you notice they cause you unpleasant symptoms such as GI distress. It’s best to speak with a qualified health care provider, such as a registered dietitian nutritionist or doctor, to discuss a more personalised nutrition plan. While there is no treatment for PCOS, symptoms can be managed by following the guidance provided here on dietary choices, including foods to eat and those to limit. Keep in mind that this article is for informational purposes only and not a substitute for medical advice. Additionally, using a continuous glucose monitor (CGM) like Lingo can add valuable insights into how your dietary and lifestyle choices are impacting your glucose levels, which are closely related to insulin. It’s important to consult with your healthcare provider about your individual needs. - Andrea Givens, Registered Dietitian and Nutritionist

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Image for What is the connection between sleep and weight loss?

What is the connection between sleep and weight loss?

Ever since you were a kid, you’ve probably heard how important sleep is. This wasn’t just your parents being a buzzkill — quality sleep supports physical and mental health and impacts your energy, mood, focus, metabolic health, and more. (1) Additionally, good sleep habits are connected to weight management. (2) If you’re looking to lose weight and curious how important sleep is, keep reading to discover why good sleep is a key piece of the puzzle and how it supports your metabolic health. Does sleeping help you lose weight? Sleep doesn’t cause weight loss per se, but it is a critical part of successful weight loss efforts. The optimal amount of sleep for adults varies from person to person, but in general, science says sleeping 7-9 hours per night is needed to support good health. (3) It’s clear that disrupted sleep patterns contribute to increased calorie intake, poorer food choices, and undesirable changes in metabolism and the hormones that regulate it. (2) Metabolic syndrome and obesity are also associated with disrupted sleep patterns; research shows adults who consistently sleep less than 6 hours per night weigh more and have a higher body mass index (BMI). (4) The underlying connection between sleep and weight loss centers around metabolism. Below, we explain the science and provide tips for optimizing sleep for your health goals. The sleep-metabolism-weight connection Circadian rhythm is your “internal clock” that regulates your sleep-wake cycle, but did you know it also affects many physiological processes including glucose and fat metabolism? (5) During the daytime when the sun is up and you’re awake, your metabolic rate is churning and kicks into high gear after each meal, which raises body temperature slightly. Conversely at night in order to sleep, your body temperature lowers, and since you’re in a post-absorptive state (meaning you haven’t eaten in a while), your metabolism isn’t revved up. If any part of this pattern is disrupted, such as staying awake for extended periods, sleeping less than 7 hours, being awake late into the night or overnight (e.g. shift work), or consuming food during nighttime hours, your circadian alignment will be thrown off. Your metabolism isn’t geared towards processing food efficiently at night when it should be sleeping. Eating late at night, especially sugary or carb-rich foods this time of night when cells are more insulin resistant, causes higher and more variable glucose levels, and storage of calories as fat. (6) Without adequate down time, normal restorative processes are disrupted, which over time can wreak havoc on your metabolic health and weight loss goals. How sleep can support weight loss Adequate sleep allows proper functioning of your appetite hormones. Short sleep duration increases ghrelin (hunger hormone) and decreases leptin (satiety hormone), (7) not the combo you need when you’re awake longer and have more opportunity to eat. Studies show it’s not vegetables and protein that you’ll reach for when you haven’t slept enough, but rather ultra-processed, calorie-dense foods. (8) A good night’s sleep promotes daytime energy levels, making you more likely to be energized to work out. Exercise helps with weight loss as it increases the number of calories you burn in a day, helping to create a negative energy balance and gradual weight loss over time. Strength training specifically helps build muscle, which burns more calories at rest. Sleep stages are important for rest and recovery from exercise, allowing your body to get stronger and improve body composition: build muscle and burn fat. The body’s natural production and secretion of growth hormone, which is responsible for supporting healthy muscle and burning fat, occurs just after sleep onset and continues to rise during the first 4 hours of sleep. This becomes blunted without enough sleep. (9) Even if over time your total body weight on the scale doesn’t change much, eating right, strength training, and adequate sleep can help you lean out and have favorable changes to your body composition. Sleep tips for your weight loss journey Aim to spend more time in bed than you hope to sleep. Not everyone dozes off as soon as their head hits the pillow. This means if you got into bed at 11 p.m. and woke up at 6 a.m., you probably weren’t asleep the full 7 hours. Consider keeping a sleep journal or using an app or wearable device that can paint a slightly more accurate picture of your actual sleep time. Documentation can help keep sleep time a priority and top of mind. Consistency is key. Social jetlag refers to sleep and wake times varying more than 2 hours day to day and is associated with greater weight gain over time. (10) In reality, you will stay up later some nights, but try not to make varying sleep and wake times greater than 2 hours a habit. Consistent mealtimes can help anchor this habit and provide stable energy and physiological cues that it’s time to be awake, eat, or rest and sleep. The body thrives on routine. Awake at night? Go low carb. Research suggests that shift workers who follow a low-carb, ketogenic diet may protect themselves against some of the adverse consequences of consuming calories at suboptimal circadian phases. (11) Restricting carbohydrate intake can help create a calorie deficit for weight loss, as well as reduce fasting and postprandial glucose, both of which are linked to numerous chronic diseases. Schedule an early dinnertime. Eating too close to bedtime, especially if it’s a particularly large or high-carb meal, can inhibit processes that help your body get to sleep and stay asleep. Early time-restricted eating, for example only eating meals between 10 a.m. and 6 p.m., is a proven method to successfully reduce daily calorie intake to facilitate gradual weight loss over time. (12) Give yourself a caffeine curfew. If you need a pick-me-up in the afternoon, instead of reaching for coffee or an energy drink, try having a snack with protein and healthy fats. This choice not only supports stable glucose levels and sustained energy, but also promotes satiety, potentially aiding in portion control during dinner and helping you stay within your daily calorie budget. Limit alcohol. Alcohol has 7 calories per gram (in addition to calories in mixers), lowers inhibitions, and disrupts sleep quality — all things that can derail your weight loss goals. While you may have experienced that alcohol helps you fall asleep, it tanks sleep quality and reduces time in each sleep stage. Effects carry over to the next day when you’re feeling hungover and tend to reach for ultra-processed foods, which are high in added sugars, salt, and fat. All of this can derail your weight loss plan. A final note from Lingo When you’re putting in the extra effort with your nutrition and exercise to lose weight and keep it off, make sure you’re not overlooking sleep. Reaching your weight loss goals takes a holistic approach that considers many lifestyle factors including nutrition, exercise, stress, and sleep. Insights into your metabolism with a continuous glucose monitor like Lingo can help keep your diet and sleep habits on track.

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Image for Why meal planning matters

Why meal planning matters

When you hear the words meal preparation, you may envision hours in the kitchen on what is supposed to be a relaxing Sunday afternoon. It doesn’t have to be daunting, and meal preparation has been associated with a quality diet. (1) Meal planning and prep can be broken down into a few easily managed categories. Map out a menu. Taking stock of what you have in the cupboards and what’s on sale at the supermarket, plan out meals for the week, paying close attention to the meals that fall in your Focus Area or eating occasions that tend to derail your steady state. Plan your grocery runs. Make a list to ensure you’ll pick up all the ingredients you need to make your meals for the next few days. In the days that follow, you’ll spend less time and potentially less money as you avoid last-minute supermarket runs. Make quick work of your weekday dinner prep by cleaning and chopping base vegetables like lettuces, onions, carrots, and celery ahead of time. You’ll save time throughout the week when these ingredients are ready to be added to your plate or recipe. Any extra that you don’t use throughout the week can be frozen or stored and used later. Pre-portion your snacks. Rather than reaching for the entire bag of almonds when you’re hungry, portion out your snacks. Portioning snacks can save you calories too. If you know your time is tight this week, prepare a meal that can be frozen and then removed from the freezer and put directly in the slow cooker, similar to slow cooker chicken fajitas recipe. Find aspects of meal preparation that you feel most comfortable with and fit your skill level and time constraints. You might make a week’s worth of dinner meals, a few side dishes, or simply stick to portioning out snacks. Whatever investment you make in meal planning will pay off with less hectic, more balanced meals in the days that follow.


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