 Please welcome her. Thank you, Alex. I decided to change my title the last minute to Low-Carb Kiwis purely because it had just a better ring to it than what you have on your piece of paper. But essentially, it's the same presentation. So I'm a New Zealand registered dietitian, and I've been practicing dietetics or nutrition for around almost 20 years. And I also work as a senior lecturer and researcher for Auckland University of Technology. And our research centre is called the Human Potential Centre. But before I begin, I just want to clarify two things about New Zealand. And the first thing is in relation to the actual country and where it is. Not too long ago, I had a conversation with a lady who was from your beautiful country who asked me if the Harbour Bridge was the bridge that connected Australia and New Zealand. So if anyone thinks that is the case, I'd just like to set the record clear. It's not. We are a very different country. We have our own harbour bridges. And Australia have their own harbour bridges. The second thing is I thought I'd just put up a picture of the Kiwi bird, which is the bird that is endemic to New Zealand. And I thought you might want to see what it looks like because contrary to popular belief, it doesn't look like a kiwi fruit with legs. It actually looks like a bird. So now that we've clarified those two, I'd like to talk to you about a study that I was involved with regarding multi-sporters. Actually, before that, I'll just let you know that that little red dot is Auckland. That's where I'm from. And South African born, of course, for those who might be a bit confused about my accent. And that's where we do our research. So quite different to normal studies. We didn't recruit for this study. I was actually recruited to do the study because these athletes were actually my friends. They're my mountain bike buddies. And one weekend, we went away to do a race. And they convinced me to put them on a ketogenic diet because I had been talking about it for a couple of years prior. So they wanted to see what such a diet could do to their performance and to anything else. So they were completely open. And I know I've got photos of them here. They were all consented to be shown. And they are all really strong athletes, good multi-sporters that put out a lot of exercise. So the study itself, it's a case study. And it was eight weeks in duration. And the diet itself was ketogenic. So standard definitions had a carbohydrate content of less than 50 grams a day, which in reality turns out to be about 25 to 30 grams a day, which you actually need to get into ketosis. Protein we kept at 1.5 grams per kilogram of the body weight. And fat ad libs. So they could eat as much fat as they wanted to. This wasn't a case study looking at weight loss at all. Let's see what happens to my performance. They were just intrigued. But we looked at body composition measures. We looked at performance. And we looked at some well-being measures as well. One of the most important things that I do in my work with my general clients, as well as my athletes, is get them to learn about nutrition and learn about where you find carbs, protein, and fat in food. So they can take control of their nutrition. And so they're not reliant on me long term. Not a particularly good business model, but I just prefer it in terms of my ethical stance with treating people. But in New Zealand, we're really lucky. We've got this new diet app called Easy Diet Diary. And unfortunately, it's only iPhone. It's iPhone or iPad only. But it's great because it's got a New Zealand and Australian database of food. So it's relevant for our people. So we get them to track their food intake. Hopefully a lot of you here are familiar with my fitness pal, which is an American-based diet tracker. Unfortunately, I've found a lot of discrepancies and inaccuracies with my fitness pal. So I always tell my clients to use Easy Diet Diary. But that is that one, therefore, non-iPhone people, only a few of them left in the world. We also gave them ketone meters to make sure that they were consistently in... Once they got into ketosis, so that they were consistently in ketosis as a double-check measure against their dietary intake. So looking at outcomes, body composition outcomes, we looked at two aspects of body composition. So we looked at weight and we looked at skin folds. So just looking at the weight, I haven't got any stats up because it was purely case study. We looked at individual responses. And you can see that the weight change ranged from 9.4 kilos in our first female participant to 1.4 kilos in one of our other females. We had one male who lost 3.6 kilos. Now, just an aside, an interesting story. The female that lost the most, her name is Sue. And she's always been around 63, 64 kg. She's a top cyclist and she's very short. So she actually carries quite a lot of excess weight that she was always trying to get rid of. Using standard practice of food and nutrition guidelines, high carb, low fat dieting, which she always did, she could never drop those 5Ks no matter how hard she tried. And she was very, very, very good at sticking to anything. She was very strict. She weighed and measured everything. And she actually works for a top wine company in New Zealand and doesn't drink any alcohol. So she's very strict, but still could not shed those last 5Ks. And the weight absolutely just fell off her in this study, which was just remarkable, even though that wasn't the goal. Skin folds wise, again, some nice ranges there, ranging from minus 20 to minus 37.4 millimeters. So we did some of eight skin fold, which is the ISAC accreditation that we tend to do on our athletes. Again, pretty substantial losses for a case study or an intervention that wasn't designed, necessarily, to drop weight. So great outcomes in body composition. Performance outcomes. Here we've got the bad news. There was either a decrease in performance outcomes or no change in performance outcomes. So we looked at peak power, which is pretty much the maximum amount of power that the athlete can achieve. And VO2 max, which is the maximum oxygen uptake. And we looked at the anaerobic thresholds of both power and VO2 max, which is pretty much the threshold at which the athlete can maintain their effort for an extended period until they cross that line and head towards exhaustion. So not particularly good on the performance side of things. I did warn them, because this is what the literature shows us anyway. There isn't a performance enhancement necessarily with ketogenic diet for endurance athletes, in general. And they knew that, but they just wanted to try it out anyway. What was most interesting for me, and I think for them as well, were these other outcomes which were completely unexpected. The first one is skin conditions. So two of the participants, one male, one female, experienced dramatic improvements in their skin condition. One of them was Sue, who goes to the lady who does her face, facial lady, every couple of weeks. And she commented, she was, what are you doing? What are you eating? Because there is nothing wrong with your skin. I can't pretty much do anything. And the other one was the male. His name was Rod. And my colleagues and I called him Reptile Rod, because when we first took skin folds, he was very scaly, very, very scaly skin. We didn't call him that to his face, obviously. And then after eight weeks, we repeated the skin fold measure, and his skin was absolutely clear, no hint of a scale anywhere to be seen. And he, of course, commented on that as well. It was remarkable. Second one was recovery. So from a recovery perspective, two to three of them found that they had dramatic improvements in recovery and muscle soreness. Or two of the athletes were training for the Kepler, which is a renowned New Zealand 60K off-road running race in the beautiful areas of the South Island. And they found that during their training, after their massive runs, the next days they could hop on a mountain bike and go biking with their colleagues, which they couldn't do before. So recovery was a massive change for them. And they found that they had a lot of potential improvement. Inflammation was another one. One of the other ladies, she was in her mid-50s. She basically went through her multi-sport life with a sore ankle. And she just thought, well, she obviously got it checked out, nothing wrong. She just basically sucked it up, tough kiwi chick, and that's what happened. She just got a sore ankle. And she lived with it. With a ketogenic diet, her ankle problem disappeared, which she found quite remarkable. And she was quite resistant to going on the ketogenic diet in the first place, because she wasn't a big fan of vegetables. And even though vegetables do need to be restricted to a certain extent, if you're not a big vegetable eater, it's going to be tricky. So she was pretty much convinced. And then, of course, prostate issue. That was obviously the male participant. And what he noticed was, well, what he said to me half a through the study, he said, Karen, I'm not sure if you're interested in this kind of outcome. But I just want to tell you, I've always had an enlarged prostate. I don't have, I don't have cancer or anything, but I've got an enlarged prostate. And I've never been able to get it under control. My GPs changed my medication. I've done acupuncture. I've tried everything. And I'm always up in the middle of the night, unable to urinate and just had big problems with it. Basically, his prostate issue picked itself up and walked out the door. It just disappeared. And that was something that I was just astounded. And he was too. And so was his partner. So that, to me, was pretty staggering. So we've got some interesting outcomes there. So putting it together, what do we know about ketogenic diets and endurance athletes? But we know that it can be very good for body composition or for reducing body fat, which is what athletes are really looking for or what endurance athletes are looking for. We know it's really good for endurance. We know that to be able to use fat as a fuel is an advantage in endurance sport. We know that it reduces inflammation. And we've heard all sorts of applications of low carb or ketogenic to other conditions which confirms this or verifies this. And we know it enhances recovery as well. We also know that it's not particularly good for an athlete being able to tap into their top end performance or their power. So what do we do? It might seem like a strange slide. I have noticed in being in California, you've got a lot of hybrid cars around here. So half electric, half petrol. And in New Zealand, we don't have a lot of hybrid cars. The ones we do have are really expensive and also really ugly. So you might seem to be a little bit better. But the reason I put this picture up is to just make a nice analogy when it comes to fuel sources and fuel utilization with the athletes. So if you can liken the petrol to carbohydrate, petrol is not particularly good for the car. It's not particularly good for the environment. It's expensive, but it allows you to go fast. Whereas carbohydrate is a little bit the same in that it causes oxidative damage, particularly for those who've got such a high output of expenditure. But it allows you to go fast and allows you to tap into that top end high intensity exercise. Similarly, we've got electricity, which electric cars require considerably less maintenance than petrol cars. They're better for the environment. They're a cleaner fuel. And they're long lasting. They'd be longer lasting if the charging was better. So it's not a perfect analogy, but it's pretty good, I reckon. So the same with fat. It's a long lasting fuel source. It's a cleaner fuel source. And I think that we need to try and get our athletes to be like hybrid cars to get the best of both, to tap into that fat when they need the fat and to tap into that carbohydrate when they need the carbohydrate. So to become metabolically flexible. And that doesn't happen overnight. So the next phase is for us to build the perfect athlete. And I think that, I don't think the ketogenic diet is something that people need to stay on for long periods of time if you're an athlete. You can, but you don't necessarily need to. I think you'd probably get the best out of it if you cycle in and out and start introducing the carbohydrates to the athletes when they need the carbohydrate. And we have done that and our multi sport athletes almost a year down the track are doing that. None of them have gone back to their complete old habits. Sue, who lost a little bit too much weight actually, managed to, she's added some carbs, managed to find her top end and has managed to pick up some weight as well. Unfortunately, Rod, who I just talked to the other day, he, I asked him how it's going and he said he's, unfortunately some of his old ways are slipping back. And I said, how's your prostate issue? And he said, yeah, it's starting to come back. Which is really, really interesting. So for him, it's even more important to find that line between optimal health, optimal performance. So for my last slide, I just thought I'd give you a little bit of an idea about what we're doing down under, which down under refers to both Australia and New Zealand. In our little red dot of the Human Potential Centre, we're doing quite a lot of research in the area of LCHF or allocarpia fad. Not necessarily ketogenic, but we might head in that way as well. We've got a study going on with New Zealand rowing and that's going to be a particularly interesting one because we're looking at performance outcomes, body comp outcomes, and we're looking at immune markers as well. So there's a lot of literature linking carbohydrate intake with the immune system, so we're really interested to see how the immune system is affected on a low carb diet. We're not going to go ketogenic because there's no reason for these rowers to be in a ketogenic state. In its lightweight rows, we want to see how much weight they can lose in a safe way and a healthy way so they can optimize their performance. We're also doing some work with New Zealand rugby and we are reducing their carbs, upping their fat, and looking at performance measures with them. We've got a study going on with some New Zealand weight lifters and power lifters as well. We're particularly interested in seeing, again, dropping weight in a safe way, eating well and making sure that they don't drop any strength or power in building up to a competition. We're working with the Navy, the Defence Force, so we've got a couple of projects going on with them, both with the not-fit-for-service guys, trying to get them fit-for-service, and then another study with the Special Forces. Primal Pacific is an interesting study we did with our indigenous population, our Pacific Islanders, and it's a great study to look at implementing low carb, high fat with real people who don't pay for your service. So my colleague, Dr. Mickey Willidan, is going to be presenting our study tomorrow, so if you're interested, please go along to that. We've got another study going on, looking at menopausal women and low carb, high fat, but more so in terms of the acceptability of the diet and the integration with their family and their social life, so it's got more of a qualitative angle. And finally, something which is really exciting, we've got a study called Low Carb Kids. We've managed to secure $250,000 from the Health Research Council, which is one of our largest funding bodies, to look at a feasibility study of low carb, high fat for obese children, which has really been good for us. We've copped a lot of flak amongst the health professionals in various industries in New Zealand, with going forward with this whole movement, if you like, and it's really nice to see that a funding organization has supported us to see what kind of outcomes we get, so we're busy recruiting for that at the moment. So that's my last slide. I'd just like to thank everyone for coming, rather than for going off shopping on this last session today, and I'd just like to welcome any questions. Are the power output numbers, were they adjusted for the loss of body weight? Yeah, they were. Okay. Yeah. And I think it's also important to consider what type of event, right? So if you're doing, say, an Ironman triathlon, well, it could be 9, 10, 11, 12 hours. You might never get into that place where you've lost power anyway, right? So at that point, it's all advantage. Well, yes and no. I guess it depends on if you want to win it, or if you're just a finisher as well. What I'm saying is if the event is long enough, so if you look at, say, the woman's Ironman champion, her heart rate never gets above 144, say. So, you know, for her, she's never going into that zone that would be glycolytic anyway. So for her, I think the gains would all be positive. Yeah. Yeah. I just want to make a quick comment. While the literature is showing no performance benefit for ketogenic diets, we have in practice come across some people who have chronically adapted to the ketogenic state. Initially, the performance was reduced, but over the years, or the months and years, their performance has actually improved. So I know research to back this up, but I actually think that there's more to it in terms of being in that chronic state and that adaptation so that perhaps performance will be improved. Okay, fantastic topic. Thanks. Hi. So I was a little curious why you picked rugby players and weight lifters. So I was hoping you could elaborate a little more on that. Well, weight lifters are often trying to, getting to weight classes and cut weight, and we know that they do it in unsafe ways. So what we want to offer them is a safer and more sustainable way, a healthier way to drop weight without risking a loss of power. So that's why we chose them. Rugby players, why do we choose them? I guess it's just an untapped group. Rugby is a big sport for us in New Zealand, and we want to see some health benefits as well as some performance either, maybe not performance benefits, but some, we want to see their performance is not reduced, but we might be able to get some health benefits from these players, yeah. Why would you expect their performance wouldn't be reduced? Given like, I just think it's such an anaerobic sport, I don't see why this would really work for them. Work, I guess what we are planning on looking at is looking at body composition mainly rather than performance. Yeah, because a lot of them again, they are told to drop their skin folds. A lot of our rugby franchises are governed by skin folds and have skin folds done every week. So it's really from a body composition angle that we're targeting this. Thank you. First of all, thank you for great talk, but my question would be, you mentioned sort of integrating carbohydrates back into the diet. Can you sort of speak to the strategies of how you would go about adding carbohydrates to someone who's been using the ketogenic diet? Yeah, I guess it's looking at timing really and making sure that this carbohydrate brought in during lengthy sessions and as a recovery strategy as well. So you might go from something like 30 or 40 grams of carbohydrate a day, right up to 100 grams of carbohydrate a day, but strategically putting that carbohydrate packaging it around the training sessions so that they are able to tap into that top end. And something I really, really need to say is that you can't just put anyone on the ketogenic diet in the middle of their training season. It's pretty nasty starting off a couple of weeks as we've heard. So it's all about timing and I've got a few athletes that I've put them on the ketogenic diet because they've come to me going, look, standard practice is not working and I wanna lose some weight. And they are in a phase they've just, one of them's just finished an Ironman so she's in a massive period of rest. The other one's coming back off an injury so it's a great time where they're not doing a whole lot. Then when their training increases in duration and intensity, that's a great time where you can start building up that carbohydrate. Now you won't know if they're feeling better because their fitness is getting better or they can use their carbs, but in practice it's irrelevant as long as overall they're feeling better. Do you find it's better? You mentioned pre and post. Do you find it's pre or post being more optimal in terms of a weight or like an emphasis? Yeah, I go for during and post. I also think you need to look at what type of session you're having. Even in conventional nutrition now, conventional sports nutrition, they are looking at training on low carbs in low carb states. So in the old days they'd say have lots of cereal and then go for a bike ride. There are some decisions they're saying go on empty. So I think the carbohydrate needs to come in during and afters to recover properly. And then just go by the athletes feel, how they feel. Thank you. Just following up on a gentleman before, looking at someone like a rugby player or perhaps a jiu-jitsu fighter, have you, aside from your research, or maybe you have some results you can share, but has there been research in terms of sports that you need a ton of power output? The performance level relative to a lot of the sort of endurance stuff you've studied. Do you know of any results so far yet? No, we don't. These studies, a lot of them I've been done by a masters and PhD students so we don't really have anything as yet. But there's not a lot of research out there. In fact, I think there's only two studies that have been done on strength sports and one they put them on a ketogenic diet for a week, surprisingly enough. And they found even in a week a substantial change in body composition and no strength reductions. So that was really interesting. And the other one was by Clement and it was a case study type of paper where they had a couple of power athletes, a couple of gymnasts, a couple of triathletes and it was all individual responses but we're certainly not having, we're not seeing any strength reductions. Great, thank you. I just have a similar question to the power to weight ratio, a question earlier. When you put up the VO2 max results there, it was in liters per minute, so it was absolute. So I just wondered whether you considered the weight reduction and the impact that would have on VO2 max relative to body weight is where it's normally obviously expressed as millilitres per kilogram per minute. So because just plausibly to me, there might be a ketogenic diet that may have an impact on AMPK activation which might stimulate mitochondrial biogenesis. So you might expect to see either a maintenance or potentially an improvement in VO2 max. Obviously in terms of absolute values that seems to have been reduced in this case at least. So I wondered whether you had looked at the relative values. I'm not entirely sure if we did because we had an exercise scientist that was handling that side of it. So he might have and these are, I'm sorry, these are the only kind of outcomes that he's presented to me. I think probably because it wasn't a study. It was a bunch of our mates who managed to get funding to cover the performance test. We haven't done it as rigorously as we could have. So I'm sorry, I can't answer that. My question is kind of along the same lines of the previous two, but I wonder, I guess you didn't have any experience with fighters as athletes like boxers or MMA fighters. What would be your opinion though, like if you had to extrapolate, like do you think that a targeted refeeding associated with the ketogenic diet would help support performance pre-fight and fight performance in such an athlete? Well, I'm not convinced that such an athlete needs to go on a ketogenic diet, really. I think that low carb high fat is ample for people who are trying to improve their body composition status and not risk their performance outcomes. So, you know, what is LCHF? There's a range, really. And it could be 99 grams and it could be 75 grams. And yeah, that would be my recommendation is to not really go into a ketogenic diet for that kind of athlete. So restrict the carbs, but keep them study at the lower level without going into ketosis. Yeah, absolutely, yeah. Thank you. Hi there. I just wondered if you could give some guidelines for youth athlete, still growing, and just trying to balance out the carbs with the protein and kind of when that can fall into play with their recovery meals and things like that? Yeah, I think with kids it's kind of interesting because the people that I know, the families that I know that are doing low carb high fat themselves, their kids are doing it, but that I know they're doing it and I think that's kind of important. And that sort of goes nicely alongside that whole food approach, really. So again, I wouldn't put a child into ketosis unless they were seeking therapeutic advice for epilepsy. So again, you go low carb high fat and you just use whole food carbohydrate sources. I would probably up the protein. I'd probably take it up to two grams per kg for growth, body weight. And add the carbohydrate in there as you see fit, like as normal. I think one of the biggest problems we have is that we look at our standard carbohydrate recommendations for even young athletes, eight to 10 grams of carbohydrate per kilogram per day. It's ridiculous. And then when you see people perform incredibly well on half of that and you think, well, really, do we need that amount? So I think if we take the carbohydrate right down, or not right down, we take it down, improve the quality and up the protein, then there'll be ideal.