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So it’s 2021, and you want to take you goals by storm. Like most of us, you're probably hitting the gym pretty hard, but, to get the best out of your training, you need to nail your nutrition - a key pillar building your foundations for success.
In this article, we are going to simplify nutrition and give you the basics you need to set yourself up for success.
The topics we’ll cover in this article include:
Diet and Mental Health
So let’s kick it off with diet and mental health. This is less about what foods are good for the brain (although we’ll cover that), and more about your relationship with food, which in our pursuit of fitness goals can sometimes be sacrificed. We'll discuss what to look for, and how to avoid falling into certain traps with the way you think about food.
The first thing to understand is ‘disinhibited eating’, which is the technical term for when you think eating a bite of one cookie that wasn’t quite on your plan turns into eating the box.
This is not your fault. I repeat: not your fault.
You’re human, and we can set ourselves up to fall into traps like disinhibited eating when we label food as “good” or “bad”. Listen, ‘good’ or ‘bad’ are moral values, not nutritional values. Scientifically there is literally no such things as good or bad foods. There are good or bad diets, however, and the difference is that diet is the totality of the food choices you make on a daily basis.
So, to clarify - if you’re ticking your nutritional boxes with plenty of vegetables, fruit, lean proteins, and healthy fats (scroll further down for more on these), then a brownie or burger on top of that isn’t going to be “bad”, because the total diet is meeting your needs.
Here is a New Year’s Resolution for you: food neutrality. In 2011, a large study looking at eating behaviours found that being rigid about diet, and thinking in ‘black-or-white’, all-or-nothing approaches to diet were associated with disinhibited eating. Basically, when we adopt all-or-nothing approaches to our diet, we end up eating something we didn’t plan or that we had labelled “bad”, it makes us think we’ve “blown it”, and we’re more likely to overeat with reckless abandon.
This can become a vicious cycle; often we think that the best thing to do is to then is double-down on the all-or-nothing approach, telling ourselves we’ll be more disciplined this time and have more willpower. But, because black-or-white approaches to your diet don’t bend, they break, then inevitably we’re back in the same position when willpower gives out.
Why is this? Because research shows that ‘willpower’ is a myth. Willpower is like a muscle with energy; we waste energy when we use the muscle, just like we waste our willpower when we make decisions. Researchers call this ‘decision fatigue’, because willpower seems to deplete based on the number of decisions we have to make, which is why willpower is less in the evening after a long day in work or college.
"Less reliance on willpower, and less thinking about food in black-or-white terms, will help free up your mindset with approaching your diet."
So what do you want to aim for with your diet?
A flexible mindset.
Two different types of dieters have been identified in research, flexible restraint and restrained eaters. Flexible restraint is where people make conscious decisions based on their intake, so for example, if they had a bigger meal than planned at lunchtime, they might have a lighter dinner. Restrained eaters, however, are continually trying to avoid foods they label as ‘bad’, are deliberately trying to restrict energy intake, and have the ‘black-or-white’ approach to diet we talked about above.
In a 3-year study that looked at behaviour change in flexible vs restrained eaters, the research found that people who made the most behaviour changes to move from restrained eating to flexible eating behaviour were the most likely to maintain weight loss successfully.
So you know you should be flexible with your approach to diet, and not adopt all-or-nothing approaches. You may now be wondering what the ‘best diet’ is to do this with. Here’s a truth: there isn’t one. In a major study that reviews up to 96 clinical trials, the authors found that the only consistent finding was nothing to do with the diet: it was adherence. Adherence was the extent to which they could stick to the plan.
Don’t let diet be a drag on your mental health. We are the average of what we do 80-90% of the time, and that is more than enough to meet any goals you have. Understanding these factors, without doubt, is the best thing you can do for your mental health - adopting less rigidity, fewer rules and restrictions, and less reliance on the limited resource of willpower. Start with the smallest possible adjustment o get you going moving towards your larger goals. By starting with small, minor changes, you give yourself something to build on.
You have a clear path of progression in front of you. You’ve nowhere to go but up, you build on your momentum and progress gives you confidence. It’s the sum of these small changes that will add up to make a difference over time.
Food groups that we know from research have a beneficial influence on mood and brain health:
Oily Fish: The best evidence for brain lies with the marine omega-3 fatty acids, EPA & DHA; as little as 1 oily fish meal per week is associated with benefits. Aim for 2 per week: salmon, mackerel, sardines, herrings, and anchovies, are all good sources.
Green leafy vegetables: Several nutrients vital for brain health are provided by this broad food group, which encompasses foods like spinach, kale, Swiss chard, lettuce, rocket, cabbage, broccoli etc., especially vitamin E and vitamin B9. Aim for one large salad every day, around 2-cups of green veg.
Berries: The compounds that give berries their dark purple and red colouring are important for brain health, and may improve memory. Aim for 1-cup serving regularly, 3-4 times per week.
Cruciferous vegetables: Foods like broccoli, cabbage, and cauliflower contain compounds which are important for protecting the brain. Aim for regular servings of 1 cup, and try to eat raw or lightly steamed.
So that covers diet and mental health. You’ve got some foods to incorporate regularly in your diet that are associated with positive impacts on the brain, and mood. And you know what type of mindsets to avoid, and implement when approaching your nutrition.
Now it's time to look at the concept of energy balance, and how it relates to your goals, whether that is fat-loss or muscle gain.
Before we talk about energy balance, we need to understand what we mean by energy in a nutrition context. In nutrition, a particular food will provide macronutrients, which are proteins, carbohydrates, and fats: a calorie (written as ‘kcal') is a measure of the energy in these different nutrients.
One gram of protein yields 4kcal of energy, one gram of carbohydrate yields 4kcal, and one gram of fat yields 9kcal.
Ready for a bit of maths? If an item of food has 17g protein, 25g carbohydrate, and 9g fat, then it would have approximately 249kcal (17 x 4 = 68, 25 x 4 = 100, 9 x 9 = 81: 68+100+81 = 249). While this is a very basic example, broadly speaking it illustrates the point; a calorie is a unit of energy, macronutrients have a certain amount of energy per gram, and the calorie content of a given food will depend on the macronutrient composition of that food.
There is an absolute minimum requirement that you need on a daily basis, if you were just lying in bed and not moving at all: this is known as your ‘resting metabolic rate’. This is the number of calories you would need each day just to keep your brain and body functioning and is influenced by factors like your height, weight, muscle mass, age, and sex.
To start a hypothetical example of energy balance, let’s say that an individuals RMR is around 2000kcal per day. But let’s also say that this person weight trains 4 times per week, and cycles to and from work at a very low-intensity. All this adds up to extra energy requirements, so let’s say that their RMR + activity puts their daily energy requirements at 3000kcal. If they consumed 3000kcal per day, they would be in a state of energy balance, because the amount of energy coming in matches their energy going out.
But let’s say this person now wants to gain some muscle. They will now have to increase their energy intake to be in a state of energy surplus, or positive energy balance. This is because the process of building new muscle tissue is energetically costly, and like a business needs an injection of cash flow to grow, the body needs an increase in energy to grow. Now, how much of an increase is impossible to say in general terms, because everyone is different.
"Factors like how long someone has been training, their body composition, and yes, genetics, all play a role in determining responses to training stimuli, including diet."
These differences all add up to variations in metabolic rate, and some people simply find that they need significantly more food to put on muscle than others. Generally speaking, start with small increases to your daily calorie intake of around 200kcal per day (over a 7-day period), and increase each week based on progress. So in our hypothetical example, the person in a state of energy balance consuming 3000kcal per day now increases their intake to an energy surplus at 3200kcal per day, and monitors their progress before making a further increase (if necessary).
Remember - your daily body weight will fluctuate, so keeping your calorie intake and activity consistent over a period of time will help you access what adjustments are required in relation to your goals.Now let’s look at the opposite example, and say this person wants to lose fat. They will have to decrease their energy intake to be in a state of energy deficit, or negative energy balance. This is because for the body to use up energy that's stored in adipose tissue (a fancy term for body fat), it has to be getting in less energy than it actually needs.
So in our hypothetical example, the person in a state of positive energy balance consuming 3000kcal per day now decreases their intake to create an energy deficit, and monitors their progress again before making an adjustment. Generally, a deficit of 300-500kcal is what people aim for. This is based off the fact that 0.5kg of body fat contains approximately 3,500kcal of stored energy: a deficit of 500kcal per day hypothetically adds up to 3,500kcal over a week, and if the numbers all added up this person would lose approximately 0.5kg per week. However, again, the numbers are never exact.
Early in a diet, there may be changes in body water stores that make the scales look like more weight was lost, or sometimes the initial calculations were off, and what this person thought was a 500kcal per day deficit in fact wasn’t: again, there are no tools on the internet that give us insight into our complex metabolisms.
So, let’s say in our hypothetical example this person was aiming for a 0.5kg loss per week, and started their diet by creating negative energy balance dropping their calories from 3000kcal per day to 2700kcal per day. And in week 1, let’s say they lost 0.7kg, then 0.3kg the following week, then 0.2kg the week after. The first week may have been due to water losses starting a diet. But the following weeks, they are just a little short of the target. Adherence has been good, so they would increase that deficit to 500kcal, and start consuming 2500kcal per day. For the following two weeks, they lose 0.4-0.6kg per week; right on target for the average, so they keep going until they plateau again.
There is a lot of arguing back and forth about whether a calorie is a calorie. So here is the answer: Yes. Because it is just a unit of energy, a calorie is always a calorie.
But are calories all that matter? No. Why ’no’? Because there are factors that influence energy balance which come from both diet and also our lifestyles. For example, not getting enough sleep influences positive energy balance, as people are tired and want extra energy.
The ’thermic effect of feeding' is the heat lost in the processing of food.
The heat lost in processing nutrients amounts to 2-3% of the total energy from fats, 6-8% of the energy from carbs, and 25-30% of the total energy from protein. The thermic effect of feeding as between carbs or fat is relatively insignificant, but the thermic effect of protein is substantial; which is one reason why higher-protein diets are beneficial for fat loss. The fibre content of the diet is another factor, as fibre increases fullness and reduces hunger levels. But having a diet that doesn’t require calorie counting does not mean that a calorie is not a calorie.
Energy Balance Recap
Energy balance = energy coming in matches energy requirements. Weight is stable.
Energy surplus/positive energy balance = energy coming in is greater than energy requirements. Weight is gained.
Energy deficit/negative energy balance = energy coming in is less than energy requirements. Weight is lost.
Each condition serves a purpose at different times in your fitness journey, depending on your goal. But if you keep those simple principles in mind, you’ll be able to stay focused on the big picture as you progress.
Ah, protein: the darling macronutrient on the tip of most gym-goers tongues. Even if you know nothing else about nutrition, you've probably heard some statements from piers and gym-buddies. Let me guess:
"You need 1 gram of protein per pound of bodyweight every day…”
"You need to eat protein every 2-3 hours…”
"Your body can only absorb 20 grams of protein at one time.."
"You need 'the anabolic window’ and start drinking your shake immediately post-workout…”
“Whey is the best form of protein…"
Any of that sound familiar? Let’s sort this out and clarify some myths about protein, and give you the facts.
Let’s start with how much you need. This depends on energy balance: If you’re dieting and in an energy deficit, then the research supports a higher protein intake to minimise muscle loss, stave off hunger, and lead to greater total fat loss over the course of the diet. A range of 1.8-2.2g per kg body weight is the most effective in preserving lean body mass. For strength athletes eating for maintenance, or in a caloric surplus, consume in the range of 1.2-1.8g per kg bodyweight. So how much you need is relative: higher intakes of 1.8-2.2g/kg for dieting, lower intake of 1.2-1.8g for hypertrophy or maintenance phases.
Factors such as your age (ageing increases protein needs), your strength training age (people who have done more strength training require less protein), and what sport and activities you participate in also influence where within these daily protein ranges you need to aim. In short, no one size protein requirement is right for everyone.
No, you don’t need to consume protein every two hours. At this point, the majority of the research says that what matters is your total protein intake over the course of a given 24-hour period, and that very low [1-2 meal] or very high [>6+] meal frequencies are suboptimal and unnecessary. Practically, splitting up your protein amongst 3-4 meals in the day seems like the best approach, evenly spaced throughout the day.
The idea of high meal frequencies related to the myth that the body can only absorb 20g of protein per meal, but this came from research looking at whey and egg proteins, which are very rapidly absorbed and both caused a maximal stimulation of muscle proteins using only 20g servings of whey or egg protein. In fact, these sources of protein are rich in an amino acid called leucine, which directly activates muscle protein synthesis (the geeky term for muscle building). 20g whey or egg would yield about 1.8g leucine, which is the dose that maximally stimulates muscle protein synthesis, and the 20g threshold was a reflection of the leucine content of the protein, not the protein dose itself. So it’s not that your body can’t absorb more than 20g at one time, it’s that depending on your source of protein, you’ll need more or less of that source to hit your leucine threshold. For example, 113g of lean beef would get you 30g total protein and 8-10g essential amino acids with 2g leucine, but you would need around 48g of a rice protein powder to hit the same threshold.
Muscle protein activation will remain maximally elevated for 1-3hrs after resistance training, and whether you consume protein 1-hour or 3-hours after, the anabolic response will be the same (provided you have had a protein-rich meal in the 3-hours pre-training). So there is no need to have tight protein-consumption windows around your workout. For before training, eating a meal containing 30-45g protein 3hrs before your workout, and then consuming a protein-rich meal or supplement in the 1-3-hours after your workout, will be enough to stimulate hypertrophy signals maximally.
What about the source of protein and the obsession with whey? Research that suggested whey was superior to other forms of protein – like soy, pea, or brown rice – was comparing the same total dose, i.e. 20g whey vs. 20g brown rice protein, and not considering the leucine content. In fact, once the leucine content between different proteins was the same, researchers found that activation of muscle protein synthesis was the same between different types of protein. For example, 48g of rice protein or 25g pea protein, which both provide 2g leucine, were equivalent to 20g of whey in stimulating muscle proteins, because the leucine content 1.8-2g was the same. This is a relevant consideration for those of you following a plant-based diet, and for people who find whey causes flatulence. For those of you opting for a plant-based protein, pea protein appears to be the best due to its high leucine content in a manageable 25g dose.
In terms of food-based examples of what contains 20-30g protein with 8-10g essential amino acids and 1-2g leucine:
Meat inclusive diets: 120g lean beef / 150g chicken breast / 120g pork / 120g tuna steak or salmon fillet
Plant-based diets: 100g firm tofu + 30g pumpkin seeds / 180g white, pinto or navy beans
Here are some action points for protein:
Total protein intake over the course of the day matters most, and you don’t need to eat every 2-hours or have a very high meal frequency. 3-4 meals spaced throughout the day is enough.
If you’re eating at maintenance or in positive energy balance (surplus), 1.2g-1.8g per kg of body weight per day is appropriate.
If you’re in an energy deficit, 1.8-2.2g per kg may be more appropriate, but remember the higher you go with one macro means another has to be lower, so generally around the 1.8-2.2g/kg marks allows you enough protein but also room to keep extra carbs in.
You don’t need tight windows of eating protein around your workout. Eat a high protein meal (30-45g) in the 3hrs before training, which should contain 8-10g of essential amino acids (which pretty much all animal-based protein sources will contain). For plant-based athletes, consuming foods life tofu, pumpkin seeds, and beans, can all help, as can a pea protein powder.
Consume a similar protein-rich anytime from 1-hr up to 3-hrs after training.
Carbs have become a bit of a scapegoat recently, and low-carb diets have surged in popularity. But as a strength training athlete, is that the best option for you? There are a lot of myths about carbs, so let’s clear the common ones out of the way before we get into some practical tips. Firstly, no carbs don’t magically make people put on fat. Secondly, cutting carbs out of the diet does nothing magical for losing fat. Finally, carbs are pretty essential for performance for anyone interested in getting stronger and can help sustain training intensity for people trying to get leaner.
Let’s start with the role of carbohydrates in health. The most important dietary constituent provided by carbs is arguable fibre. Fibre is a component of plant foods that are resistant to digestion and absorption in the small intestine, and pass through to the large intestine where bacteria feed off the fibre This creates byproducts which research is starting to show has significant positive impacts on human health, from the gut to the brain. Fibre is also important for body weight regulation, and fibre-rich diets have been shown to increase fullness and reduce calorie intake.
By increasing fibre intake, you, in turn, decrease the energy that is available from the diet, as fibre cannot be used as a direct source of energy. For example, take two diets, each consisting of 200g carbohydrates per day. Diet A consists of 200g of glucose, and Diet B consists of 150g glucose with 50g fibre: the available energy from Diet B is confined to the glucose, despite that the total carbohydrate content is the same.
Plant foods also contain rich sources of phytochemicals, a technical term for the type of compounds that relate to the colour of the food, for example, the reds of tomatoes indicate a different phytochemical make-up than the purple of blueberries. These phytochemical compounds are important for health, and are one reason why emphasising plenty of plant foods in the diet - vegetables, fruit, and grains - is one of the cornerstones of nutrition advice. These health factors are important as health should never be sacrificed for fitness: the two should go hand-in-hand, mutually beneficial outcomes for improving our diet and training.
So in terms of friend or foe, carbs are definitely a friend, to your health and fitness journey.
Now, what about performance? Traditionally, performance nutrition has focused on linear nutrition approaches, maintaining a constant level of daily intake for macronutrients, and dividing that intake relatively equally throughout the day. This has also applied to carbs, with the traditional advice to maintain a constant, linear high carb intake before, during and after training in order to sustain performance.
However, recently there has been more emphasis on what is called periodised nutrition. In effect, periodised nutrition means that intake fluctuates based on your requirements. This has been termed “fuelling for the work ahead”, meaning exactly that: carbohydrate intake is tailored based on need. For example, if it was a rest day, you may need less overall carbs and could focus meals around protein, healthy fats (covered in the next blog), and non-starchy vegetables and fruit. Remember, lower is not zero.
On days where you may only be doing some low-intensity cardiovascular training, you also wouldn't necessarily have as high carb intake as you would for your strength, functional, or high-intensity training. This is because carbs are stored in the body as glycogen (the technical term for stored carbohydrate energy), and higher intensity training (including strength training, powerlifting, Crossfit, or conditioning) relies on muscle glycogen, so performing these sessions while glycogen is depleted would impair your ability to train with intensity and to increase performance. In addition, depending on size and body composition, the body can store around 300-600g of glycogen. So, if you continually perform higher intensity training and don’t replace that depleted glycogen, eventually performance will suffer.
You can also periodise carbs within the same day. Let’s say you’re doing low-intensity cardiovascular training in the morning, followed by a resistance training session in the evening. You don’t necessarily need to have carbs on board for your morning session, but would then start to consume higher carb meals throughout the course of the day prior to your strength workout in the evening – where you then have the carbs on board to train with intensity.
A simple way to think about periodisation:
Strength training/Crossfit/high-intensity conditioning: Higher carb intake
Low-intensity cardiovascular training/moderate-intensity conditioning: Moderate carb intake
Rest days: Lower carb intake
In general, it can be beneficial to consume more carbs earlier in the day, between your first couple of meals. This is because our ability to digest and utilise the carbs we eat is enhanced earlier in the day, and reduced in the evening. If you resistance train in the evening, this does change the rule somewhat, but even still, you don’t necessarily want a carb-heavy meal at 9pm.
Having the bulk of your carb intake across the daytime will have you fuelled for heavy training in the evening, and additional carbs not needed for exercises can be utilised for muscle protein synthesis (remember, you need the right amount of protein for that).
If you do train later in the evening, distribute more of your total daily intake - and carb intake - to before the workout, and have a lighter, protein-rich meal with a small quantity of carbs (assuming this is past 8pm or 9pm). If you strength train in the morning, then the bulk of your carbs will come after that training session either way, but to be fuelled for the morning session you would still want to have a moderate carb meal for dinner, topping up your glycogen stores for the next morning’s workout.
There has been plenty of attention around what is called the ‘glycemic index’, or ‘GI’, of carbohydrates. GI is a measure of how quickly a carbohydrate food increases your blood sugar levels. However, it is not a good tool for assessing the impacts of carb intake on performance, but nonetheless, it can be helpful to think about carbs in terms of ’slow-acting’ or ‘fast-acting’ sources.
Fast-acting sources would generally be low in fibre, like white rice, white potatoes, white bread, isotonic sports drinks, or sugary snacks such as jellies. Slow-acting sources would be higher in fibre, like lentils, beans and other legumes, oats, wholegrain versions of rice, pasta, bread, and grains such as couscous. Fruits are often thought of as fast-acting, but because much of the weight of fruit is fibre and water, it is somewhat in between. Non-starchy vegetables, like spinach, broccoli, tomatoes, etc., are not high enough in carbs to consider for performance purpose, but they should always be in the diet for health reasons.
In your general day-to-day diet, you want to emphasise fibre intake, and by default, that means plenty of non-starchy vegetables, fruit, and starchy sources like legumes, oats, and whole grains. However, fast-acting carbs can be beneficial in the meal before and after a training session, particularly if you train twice a day or twice within a 24-hour period.
In terms of keeping things simple, consider this approach:
If your next training session is not for a full day - say 24hrs or more - than you don’t necessarily need to consume fast-acting carbs, as you have plenty of time for slow-acting carbs to refill your glycogen stores.
If you have trained in the evening, and your next higher intensity session is the following morning, then fast-acting carbs after your evening training session would be helpful.
If you train twice a day, then fast-acting carbs are also helpful to quickly restore glycogen levels before your next training session.
Carbs are important for our health and performance, serving numerous purposes. Think about your carb intake in terms of “fuelling for the work ahead”, and periodise your carb intake accordingly. Then strategise the sources you need based on the demands of the session, and also the overall structure of your weekly training plan.
Whatever you do, remember that plenty of veg, fruit, and whole grains like oats and legumes, are a key characteristic of healthy diet patterns.
Ok, so let’s round out this article with the final one of the macronutrients: dietary fat. Dietary fat plays several important and critical roles in the body, including:
The body can store excess energy from fat directly into fat tissue, or can convert excess energy from carbohydrates into fat, to be stored in fatty tissue.
Fat can be broken down and released into circulation to be used (or in common parlance, burned) as energy. Fat oxidation is the primary energy-producing route in aerobic conditions.
The vitamins A, D, E and K are all fat-soluble, meaning they need to be absorbed with fat, and we require a minimum of 7% fat in the diet to effectively absorb these vitamins.
Reproductive hormones like testosterone and oestrogen require dietary fat intake for synthesis.
These are just a few examples, from which you can plainly see one inescapable fat: dietary fat is essential for human health. But it is somewhat less important than protein and carbohydrates from a strength training performance standpoint. Dietary fat's main relation to general health functions like hormonal function and fat-soluble vitamin absorption mean it's consumption of timing is less relevant, just aim to get a good balance of healthy fats overall across the day.
In addition, when you periodise your carbohydrate intake, you will by default also do so with dietary fats. For example, on days you have lower overall carbs, you’ll likely have more fat, and on days you have more carbs, you’ll have lower fats. This tends to take care of itself with the food choices you make on either day, so don’t sweat the small print.
Dietary fat comes in three main forms:
found in all animal foods, like red meats, butter, and processed meats, and in certain plant foods like coconut.
found primarily in plant oils, like extra virgin olive oil, and foods like avocado, nuts, and nut butter.
found primarily in oily fish, seeds like chia seeds, flax seeds, nuts like walnuts, and other oils like rapeseed oil.
As a general rule, the following two points can be made about dietary fat and health:
For a higher fat diet to be healthy, unsaturated fats should be the dominant fat type (so a mix of monounsaturated and polyunsaturated).
High saturated fat intake is not encouraged for heart health, particularly where saturated fats exceed unsaturated fats.
When it comes to cardiovascular health, the ratio of saturated fat to polyunsaturated fat is particularly important. The higher the ratio in favour of polyunsaturated fat, the better. Generally speaking, this can be achieved by opting for leaner sources of meats, low-fat dairy, and emphasising oily fish a couple of times per week, in addition to adding fats from seeds, nuts, and oils.
Monounsaturated fats are the type of fats primarily associated with the Mediterranean diet pattern: extra virgin olive oil, nuts and avocados. Adding these plant-based monounsaturated fats can promote heart health, particularly in the context of a diet that is also high in fish and legumes.
Like the ratio of polyunsaturated to saturated fats, a higher intake of monounsaturated fat (for example, through an average of two tablespoons extra virgin olive oil and one ounce of mixed walnuts, hazelnuts and almonds per day) increases HDL "good" cholesterol and decreases LDL "bad” cholesterol.
So, adding plant-based monounsaturated fats to your diet, in addition to your polyunsaturated fat intake, is what we mean by “healthy fats”. Rather, however, than think in terms of ‘monounsaturated’ or ‘polyunsaturated’, let’s think in terms of foods. The mainstay for your dietary fat intake should be oils like extra-virgin olive oil and rapeseed oil, hummus, avocados, eggs, nuts and seeds, and regular (2-3 times per week) oily fish intake.