 It is my very special pleasure—hoi—to settle down, people—too much coffee this morning, I think. My very extreme pleasure to introduce a fellow New Zealander to speak to you all this morning. Mickey Willidan is a very good friend but also part of the founding group of the ancestral health society of New Zealand under the inspiration of Brent and his team. We've decided to set up our own society down in our little corner of the world. As you'll be very well aware, these things don't happen on the back of one person or two people. You need a very good team behind you. Mickey has kindly stepped forward and she's one of our key members helping us out. I think just about all the kiwis that we've dragged over here are involved in some way or another. I'll leave you in the very capable hands of Mickey as she talks about her experiences with Primal Pacific and our experiences down in New Zealand trying to get this ancestral paradigm underway. Mickey. Thank you, Jamie. Good morning, everyone. Before I go through my presentation, I'd just like to go through a few acknowledgements. Of the people who made our research possible. So first, obviously the participants in the Primal Pacific study, which were Pacific employees of Middlemore Hospital, which is a large hospital, one of the three hospitals in Auckland, New Zealand where we are based. Also, our Faculty of Health and Environmental Sciences for the Research Grant, which enabled us to conduct the research and resources provided by County's Manukau District Health Board, which is the health board where the hospital, which is part of the hospital, is part of the system of. The Human Potential Centre, which is our research group who provided a lot of the resources and managing of the project. And finally that this research was approved by the AUT University Ethics Committee. So like many indigenous populations, if you look back in the literature about references to people in the Pacific Islands, you'll see comments such as this as illustrated by Westinay Price, which is just up in my slide there and I won't read out. But Pacific populations were revered for their physical health, their physical attributes, their strength and their agility by navigators and I guess anthropologists alike. However, this is what modern-day prowess really looks like now. So Pacific population in New Zealand makes up about 7.5% of our New Zealand population and Pacific nations are not limited to but are predominantly Samoan, Tongan, Nuaian, Cook Island and two-thirds of those people reside in the Auckland area, which as I mentioned is where I'm from. However, they are disproportionately represented in our health statistics. So 59% and 64% of male and female Pacific people are obese and that's compared to 28% and 32% respectively of New Zealand European. The diabetes rates are three times greater in Pacific people and there is three and a half times the amount of chronic kidney disease in Pacific people compared to the general population. Cardiovascular disease is four times greater in Pacific people and there is one and a half times the mortality from ischemic heart disease. And finally, life expectancy is four years lower in Pacific people. And like other populations around the world, they are disproportionately represented in our lower socioeconomic statistics also. So there is a higher rate of food insecurity. So there's limited access to quality food, there are higher rates of unemployment, there are lower rates of literacy and also lower rates of access to health services as well. And typically, as you know, these things do come hand in hand. With the Pacific people, their culture is centred around family, faith and music and every celebration is punctuated by a feast and a large feast. However, you'll probably agree with me that the traditional food choices of Pacific people are likely not the contributing factor to their poor health outcomes. Because their traditional diet is centred around the types of foods that we've been hearing about and discussing over the last few days. Traditional Pacific foods are abundant fresh fruit, tropical fruit, vegetables, fresh meat and seafood and starchy tubas such as taro and plantains and coconut as well. Of course though, both in New Zealand and back in the Pacific islands, this traditional diet is, I guess, overlaid with that standard westernised diet. So foods which are nutrient poor, energy dense, easily accessible, convenient are foods much as we find everywhere else in the world. It is this combination of a food-based culture and the standard westernised diet which is a large contributor to the health problems that I was describing earlier. Now because of this, there are a number of organisations which are set up to try and help promote healthy physical activity patterns and healthy eating within these at-risk groups. One such group is the Pacific Health Development Team which sits inside Middlemore Hospital and Counties Manukau District Health Board. Now the Pacific Health Development Team are responsible for administering the Lotomoi programme and this is a church-based programme which promotes healthy eating physical activity components within the Pacific churches around the Auckland area. And while Lotomoi is well received by the participants, it has made little traction with regards to improving the health outcomes of the Pacific people. And therefore the PhD team approached us to try and find a different way to promote healthy eating in such a way that would actually make a difference to those health outcomes. And that is how we developed the Primal Pacific programme which effectively the Primal Pacific project wanted to test the effectiveness of a lower carbohydrate, higher fat whole food diet culturally appropriate to Pacific people compared to New Zealand best practice recommendations for weight loss. So the two diet groups, and I'll explain the design of the study in a moment, the two diet groups that we looked at were these best practice recommendations and our Primal Pacific plan. And you'll likely be familiar with at least the best practice recommendations, which was based on a calorie restricted diet that was low in fat, moderate in protein and moderate in carbohydrate intake. And that is, as I'm sure you're aware, the conventional approach to weight loss and improved health outcomes which the programme Lotomoi is predominantly based on in their health messages. Our Primal Pacific plan was a much more whole food approach to diet. So it was carbohydrate restricted at 100 grams or below and those carbohydrate choices were based on those traditional based Pacific tubers of taro, but also kumara or sweet potato, potato and fruit as well. As I said, it's minimally processed and the type of fat that we promoted was what was higher in fat, but also the naturally occurring fats such as coconut oil, coconut cream and things like that. So people in our Primal Pacific group were encouraged to incorporate dishes which they may have traditionally eaten such as palasami, which is coconut cream baked in taro leaves and also otta, which is fresh fruit or sorry, fresh fish in a coconut cream base. The diet trial itself lasted for eight weeks and we had a follow up period of 12 weeks. At baseline, we collected dietary information to base our calorie restriction on for the best practice recommendation group and also physical activity information. I've just listed the measures there that we took at both baseline and at week 8 as well and they included blood lipid measures, body fat percentage measured by biological impedance. We looked at mood based on the profile of mood state scale, weight waste, HBA1C etc. and we started with 26 participants. We also had intensive one-on-one nutrition counselling at the start so we provided them with really thorough information on their dietary protocol and we caught up with them every two weeks to do limited anthropometrical measures and also a mood scale and for that additional nutritional support. Throughout the eight-week period, we also had an 0800 number set up which is, I believe, a 1 800 number in the United States so if ever there was a question about diet, we were at hand to provide dietary information. And then at week 8 we did the same baseline measures to see what effect the different dietary protocols had on these health outcomes. There was no contact in between week 8 and week 20 because we wanted to see how the participants went when they were just left on their own and then we followed up with a focus group. What I would love to be able to now tell you about is the amazing changes in health we saw from the participants of our primal Pacific protocol when compared to the best practice recommendations. However, some of you may be able to see that down at that right hand side of my slide I've got complete results for just five participants out of the 26 that started. So we had six participants drop out from weeks one to eight and then we had a focus group with just six of the participants at the end of our overall study period. The results we got were wildly unspectacular actually. And so I figured there was no point in showing you slide after slide of these minimal changes and no difference in health outcomes when we compare what we have for those under the best practice recommendations for weight loss and also the primal Pacific approach. I've got these as percentage changes from baseline to post-intervention. And you can see there the percent change in weight and body fat. There was minimal movement over weeks from week zero baseline to week eight but just minimal. And in fact participants from week one and two on these slides were from the best practice recommendation group and participants three, four and five were from primal Pacific. Likewise if we look at blood pressure, there's very minimal difference with our changes in blood pressure as you know an independent risk factor for heart disease and also weight and also insulin as well. Possibly the main result from this study is illustration that when you work with people who are not paying for your nutrition services it's really difficult to motivate these people and actually research with real people is incredibly challenging to administer and roll out and get buy-in. Even when you've got the buy-in of those people within that organisation to begin with and key people in the organisation. When we ran our focus groups we asked them about what the challenges were with regards to the dietary protocol and I've basically got them listed up there. Because food is such a massive part of Pacific culture there was always going to be these social gatherings or support for dietary changes is necessary to enable them to happen. Now due to our funding constraints and when we had to spend the money we had to conduct this research in the latter part of last year. In the lead-up to Christmas actually so the time of year also made it challenging for our participants. When we went through the dietary protocol for those undertaking in fact both the best practice recommendations and our primal Pacific diet. And the time taken to prepare the food when you're advocating for a minimally processed diet was certainly a factor for some of our participants. And some of them really just didn't like the concept of a higher fat approach to diet. They probably appreciate that it wasn't that they didn't like it but more likely that they didn't really trust it. Of course those who did do the primal Pacific diet actually really enjoyed the level of satiety they got from eating a higher fat diet and some of them did enjoy the food. One of the aspects that we looked at and were interested in was the cost of our primal Pacific approach to just a typical diet. And in fact this was a positive for our participants. So they noticed if anything that was a benefit of our approach. And equally because we tried to encourage a more culturally getting them back to eating some of those dishes that are traditional in their culture some of them really did enjoy the food. So some of the limitations of our research was the timing of when the study was conducted and also the design. So the Pacific Health Development Team thought it was more appropriate that participants self-selected into which group they wanted to go into and researchers in the audience would appreciate that that's not the best design for a study. However it was one of those I guess challenges of working with that we were working in with. And also engagement of our participants as well. Obviously if you end the study and you've got just complete results for five participants there were also challenges there. However the whole purpose of primal Pacific was to test the feasibility of our primal Pacific approach at improving health outcomes. And part of it was the accessibility and the acceptability of this approach. Because there is no point in conducting this type of research if the overall goal is not to somehow get it out into the community and help those most at need of improving their health outcomes. So we do have in development a larger trial underway that does include a physical activity component as well. And equally our whole food carbohydrate restricted approach is going to be trialled in other groups as well. And those of you who were listening into Dr Karen Zinn's research yesterday will be aware of our low carb kids trial that has got funding from our Health Research Council which is quite a big deal for us in our Human Potential Centre in New Zealand. And I do actually have a video which I would love to be able to show you because the Primal Pacific trial was showcased on a Pacific television programme that runs on our free-to-eat TV but I have run out of time which is a shame. So I am made sure a little bit. So thank you and I just need to pop out of my slides. It's not only the exercise that will help keep you healthy and to be honest for me it's about the food honestly. I struggle with my weight. And often regarding diets we're often told to keep the fat out of our diet. Yes but could fat hold the key to weight loss and I think that's what I've been telling people. Here's John Utanga with the latest on a new way of looking at food. Middlemore Hospital South Auckland. It's like your whole body went into shock. It's almost like you have withdrawal symptoms. We're giving some feedback. The first thing I was scared of was what's my cholesterol going to be like and I'm not really going to do this. It's feedback about a nutrition plan they've all been on. I can have my pork, I can have my bacon and egg for breakfast and that's very filling which it will last me until lunchtime. They're talking about the Primal Pacific eating plan. It was part of a trial which took place over Christmas where participants were told to eat fewer carbs. Carbs like our staple and instead eats more fatty foods foods made from say coconuts like coconut sauce and rich coconut cream. AUT University researchers Karen Zinn and Mickey Willidan conducted the trial while aware the high fat low carb diet is controversial in the academic world. Lots of variety, this is what we are after. The interesting thing is that the concept is actually not new at all. We used to eat in a low carbohydrate high fat way before that. We were doing fine. The trial puts one group on a standard nutrition plan and the other on the Primal Pacific plan just before Christmas. Possibly not the best time to do a food trial as there were dropouts from both groups. But a key message for the Primal Pacific group eat fat. One message is eat fat but keep carbohydrates and sugar low. Because it was a Primal Pacific focus the emphasis was on coconut products such as coconut flesh, coconut milk and coconut cream to use within their cooking as one would in the islands. For trial participants denying themselves some Pacific staples was a huge ask. Every time you cook meat you expect taro to go with it. But when they say none of that that was really, really hard to adjust to because it means almost for me it means I'm denying my heritage. However the results speak for themselves. I was 110.9 when I first started this but now I'm 96. Through the Christmas time because that's the hardest time because it's a festive season eating all these different food. So from that time up to now I managed to keep my weight. When I tried it for like two or three days and then weighed myself oh I've lost a kilo and that was like strictly no carbs and so I thought okay this can work. The individual changes we saw were really promising and it would be really great to take these lessons learnt from the focus groups and design another trial and this is what we are intended to do with a larger group. One other thing researchers have learnt in this exercise eating plants have also got to work in the real world. I think one of the main things that we want to do with Primal Pacific is show that a whole food diet which is essentially what this is with a Pacific flavour if you like is actually achievable at that household level because there is no point doing research and recommending people eat this way if they cannot actually afford it and if it's not able to be translated into the household and to take that message out to the community. Thank you.