dietitians

This is the safefood Nutrition podcast series presented by Dr Aileen McGloin, safefood’s Director of Marketing and Communications, which shares research and knowledge on key issues like obesity, food poverty, social prescribing and community food initiatives on the Island of Ireland. In this episode, we talk to Joana da Silva, expert in Human Health and Nutrition at safefood and UK based Food Poverty expert, Lindsay Graham about food poverty and community food initiatives on the Island of Ireland and food insecurities in the UK.

Dietitian

• Tertiary qualification in nutrition and dietetics recognised by national authorities.
• Dietitians apply the science of nutrition to the feeding and education of groups of people and individuals in health and disease
• Dietitians are also qualified to provide evidence based nutrition services to individual dietary counselling, medical nutrition therapy, group dietary therapy, food service management, public health nutrition, policy and research, food industry and community health.
• A dietitian has undertaken a course of study that included substantial theory and supervised and assessed professional practice in clinical nutrition, medical nutrition therapy and food service management.
• APDs work in hospitals and private practice, government, research and teaching, public health and community nutrition, the food and medical nutrition industries, and nutrition marketing and communications.
• All APDs are automatically able to use the AN credential, because as part of their qualification in human nutrition, an APD has undertaken a course of study that has included supervised and assessed professional practice in public health nutrition, medical nutrition therapy and food service management.
• Accredited Practising Dietitian is the only credential recognised by the Australian Government, Medicare, the Department of Veterans Affairs and most private health funds as the quality standard for nutrition and dietetics services in Australia. APDs are committed to the Dietitians Association of Australia Code of Professional Conduct, continuing professional development and providing quality services. A register of all current APDs can be found on the DAA website.
• To maintain APD status, nutrition and dietetic professionals are required to undertake a specified level of continuing education and professional development to ensure currency of practice. APD status is reviewed annually by DAA.

https://daa.asn.au/what-dietitans-do/dietitian-or-nutritionist/

Nutritionist

• May be tertiary qualified, but also may not be!
• It’s important to note that the term ‘nutritionist’ is not regulated, therefore, this title may be used by dietitians, nutrition scientists and nutrition graduates – and also those with very limited qualifications in nutrition.
• The Nutrition Society of Australia (NSA) has developed a voluntary Register of Nutritionists in Australia to help determine the level of training someone has undertaken.
• These Nutritionists may work in a number of other roles, including research, nutrition consultants and advisors, public health and health promotion officers, community development officers, quality and nutrition coordinators, food technologists, media spokespeople and more.
• APD = AN but AN does not = APD. ANs not qualified to provide medical nutrition therapy which includes individual and group dietary interventions.
• Any responsible ‘nutritionist’ will not be allowed to provide individualised dietary advice for any underlying medical condition - from diabetes to high cholesterol to IBS.
• There are currently no Medicare health fund rebates for clients of Nutritionists, and there is only limited private health insurance fund rebates for Nutritionists with some funds.

https://www.nutritionaustralia.org/national/resource/nutritionist-or-dietitian

Naturopath

• Naturopathy takes a holistic approach to wellness.
• Interventions - see below

Source: https://www.researchgate.net/publication/331789476_An_evidence_based_overview_of_naturopathic_practice_in_Australia

A professional naturopath is someone who has completed, at a minimum, an Advanced Diploma in either Naturopathy or Health Science, is registered with a professional body and is insured appropriately.

Aus gov warnings:

Naturopathy is not a treatment for specific illness or disease. Naturopathy is a complementary therapy in that it may be used alongside other medical and therapeutic techniques. Always be guided by your doctor or specialist before using naturopathy for any serious or chronic illness. Treat as suspect any practitioner who advises you to abandon your conventional medical treatment.

Regulation = self regulation only - voluntary and not governed 

https://www.nhaa.org.au/mediareleases/be-informed/regulation-of-practitioners

https://www.nhaa.org.au/mediareleases/be-informed/regulation-of-practitioners

https://www.abc.net.au/news/2010-10-21/unregulated_naturopaths_putting_lives_at_risk/40276

Whilst developments such as the Code of Conduct for Unregistered Practitioners certainly help, they do not replace proper regulation of major professions.

End of insurance subsidies in 2017 due to lack of evidence to support efficacy

https://sciencebasedmedicine.org/australia-ends-insurance-subsidies-for-naturopathy-homeopathy-and-more/

Impact 

https://www.researchgate.net/publication/331789476_An_evidence_based_overview_of_naturopathic_practice_in_Australia

https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2016-17~Main%20Features~General%20practitioners~2

https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf

https://www.abc.net.au/news/2010-10-21/unregulated_naturopaths_putting_lives_at_risk/40276

https://www.researchgate.net/publication/331789476_An_evidence_based_overview_of_naturopathic_practice_in_Australia

https://www.ncbi.nlm.nih.gov/pubmed/30785315

What an influencer does

Research from the University of Glasgow found that almost 90% of social media influencers are sharing inaccurate and potentially harmful nutrition and weight loss advice.

https://www.medscape.com/viewarticle/912360

Dietitians

Dr Nicole Kiss - follow on Twitter @NicoleKiss

Dr Tim Crowe - follow on Twitter @CroweTim, listen to podcast Thinking Nutrition

Hayley Blieden  - https://austsuperfoods.com.au/ 

Nutritionists

Melissa Eaton - follow on Instagram @eatonbalanced

Jules Tellidis -  follow on Instagram @wholesomehungry

Naturopaths

Abby Dolphin - https://olivewellnessinstitute.org/admember/abby-dolphin/

Bianca Potenta - https://hwstudio.com.au/

Beyond Blue - 1 in 7 Australians will experience depression in their lifetime and 1 in 4 will experience anxiety.

Mood disorders are something we can’t ignore.

One area that’s gained a lot of traction is the way food, dietary patterns, dietary quality and lifestyle are having a profound impact on our mood and mental health.

Usually pharmacotherapy (medication) and psychotherapy are used as firstline treatment of depression, however remission can often be challenging to achieve.This has prompted the need for further strategies in relation to diet and lifestyle in the treatment of depression. What we eat can have an impact on our brain chemistry and brain health.

Whilst there is no single food that can help improve depression, we are discovering that what and how we eat as a whole can have an impact.

We often consider the brain for it’s psychology and forget it’s biology. The brain is an organ. Incredibly complex one. We need to care for it like we do any other organ. A heart that is not cared for will show signs of damage eg arrhythmias, blood pressure issues, poor exercise tolerance  A brain that is not cared for will also show symptoms. The trouble is these symptoms are those related to brain function - mood, personality, decision making and processing and memory. These are biological symptoms of a biological organ. It’s not just psychology. Often these type of symptoms are brushed off. They’re easier to ignore than palpitations or tightness in the chest or wheezy breathing. The reality is that our brain cells are made up of essential fatty acids that we can only get from our diet. Our neurotransmitters require essential nutrients that you can only get from your diet We can look after our brains and take a preventative nutrition and lifestyle approach just as we would look after our heart and lungs 

Lancet commission 2017

https://www.thelancet.com/commissions/dementia2017

Food, hormones and neurotransmitters

• Carbohydrates - when we eat CHO’s this triggers a release of insulin to help transport the CHO’s into the cells to be used as energy. This insulin trigger also stimulates the release of tryptophan, which is an AA which is a precursor for serotonin (which is associated with improved mood and feeling happy). Low GI carbs are seen to be the most beneficial whereas high GI carbs will give an immediate but temporary effect in regard to serotinin release. 
• Protein -  There are specific amino acids can affect our brain health as a number of neurotransmitters are made up of AA’s.In particular  the neurotransmitter (messenger) dopamine is produced from the AA tyrosine and as mentioned above serotonin is made from the tryptophan. A  lack of these particular AA’s, will result in downregulation of these neurotransmitters, which can precipitate lowered mood. 
  • There is a condition called phenylketonuria the buildup of AA can also result in brain damage and mental retardation. e.g the excessive buildup of phenylalanine can cause brain damage and mental retardation.
• Omega-3 fatty acids - The brain is one of our organs that contains the most amount of fat in the body (~60% fat). There have been studies which support that sufficient intake of long chain PUFAs (particularly DHA), may reduce the risk of depression. DHA is also essential for brain growth and development in children.
• Vitamins 
  • B12 - may be beneficial in the context of reducing dementia risk and assist with cognitive function in older adults. Sources include: beef, liver, chicken, fish, shellfish, dairy, eggs 
  • Folate - Researchers have found links between folate deficiency and depression. Still unclear if the poor nutrition, relating to the depression, causes the folate deficiency or the folate deficiency results in depressive symptoms. Sources include leafy greens (spinach, broccoli, peas, lentils, legumes)
  • Vit D - ensuring levels are therapeutic has been found to have a positive benefit in the context of depression. In cold/dark countries where Vit D deficiency is more prevalent, as can be depression. Sources include eggs, oily fish and sunshine!
• Minerals:
  • Iron - Important in supplying oxygen to our brain and for the production of neurotransmitters and myelin (lipid rich layer/sheath that surrounds our nerves). Sources include red meat, fish, legumes, green leafys
  • Lithium - well known in the mental health field and is present in many medications used for depression, bipolar, etc...
  • Iodine - through the thyroid hormone supports energy metabolism in the cells of our brain. Iodine is particularly important during pregnancy as deficiency may result in cerebral dysfunction.
  • Zinc - antioxidant which can protect brain cells and can also improve the uptake of antidepressant medication, sources include: meat, poultry, legumes, pulses, nuts, seeds

Dietary patterns:

• SMILES trial (undertaken locally in Melbourne & Victoria)- An interventional study which used dietary improvements as a treatment modality for patients with pre-existing depression. The dietary intervention group received 7 sessions with a clinical dietitian for personalised nutrition advice and counselling. Also followed a modified med type diet.The control group received an interesting intervention known as ‘befriending’ or ‘social support’ which included trained professionals discussing topics of interest e.g. such news, music or sport. For subjects who were difficult to engage, cards or board games, were used as a tool to keep them engaged. The results found that participants in the dietary intervention group had a greater reduction in depressive symptoms over the 12 week period ( in comparison to the social support group). At the end of the trial, ~33% of the subjects in the dietary support group were considered in remission of their depression, in comparison to 8% in the social support group.
• Another interesting point was that there wasn't a change in weight or BMI - dietary quality may be more valuable than weight loss.
• Economic evaluation - cost saving in using this treatment approach
• In summary those who made the greatest change to their diet saw the greatest benefit in regard to their depression
• This also highlights that we need improved pathways and access to dietetic care in the treatment of depression.
  
   
• Depression in children and adolescents is hugely important because the average age of onset of anxiety and depression is in this group
• Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review - Showed a relationship between diet which was high in foods containing refined CHO’s, saturated fat and processed foods, and poorer mental health in both children and adolescents. We know the onset of anxiety and depression is coming up at a much younger age, therefore early intervention strategies such as improving dietary quality and a population level may be beneficial.
  
   
• The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials - This paper reviewed the findings from RCT to assess the impact of dietary interventions (whole-of-diet approach) on both depression and anxiety. The good news is that many of the papers concluded that dietary interventions were effective in the management of depression, and at times was comparable to medication and psychotherapy. The evidence was less strong regarding anxiety management. 

MedDiet

• Rich in fruits, veg, nuts, seeds, legumes, fish, lean poultry, EVOO
• Preference for selecting wholefoods and low in processed foods.
• Eat in a social environment - promotes social engagement
• Long-term treatment with the Mediterranean diet on depression for patients may be beneficial. 
• Anti Inflammatory foods seen as in the MedDiet - reduction in proinflammatory cytokines which can assist with neurotransmitter development/uptake.

Western Diet 

Study of 110 healthy 18-22 year olds were randomised to either a Western diet for a week or their usual diet. Those on the Western diet (toastie and m/shake or waffles for breakfast and fast food meal for lunch and dinner)

showed impairments in learning and memory and also reduced appetite control. 

https://royalsocietypublishing.org/doi/10.1098/rsos.191338

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056912/

Gut microbiome - bidirectional communication between gut and brain

• Our gut bacteria can have a profound impact on our mood and mental health - many animal and human studies have looked into this.
• Animal data + human data - bacteria important for physical and mental health. Diet is the most important component to affect the gut microbiota.
• Gut microbiota interact with all cells in the body and also have an impact on our genetic profile
• Prebiotic fibres to feed our gut bacteria - when gut bacteria and thriving this is likely to have a positive impact on our mood and mental health  - diversity of fibre (diversity is a marker of food gut health). When our bacteria ferment dietary fibre they also produce neurotransmitters - more than 90% of serotonin is produced in the gut (still unsure if that makes it to the brain across the blood brain barrier). 
• Probiotics -  Probiotic supplementation showed a significant reduction in depression - particularly Lactobacillus and Bifidobacterium. Include probiotic rich foods - kombucha, kimchi, yoghurt, kefir.
• Polyphenols can also help increase the growth of our gut microbiota.
• Poly + monounsaturated fats - from fish, nuts, EVOO
• Listen in to episode 3 but also stay tuned for an update on gut health in episodes coming soon!

Other mood boosting strategies

• Covered nutrition in depth.
• Exercise has been linked to improved mental health
• Eating with others - mediterraneans do this well
• Sleep - aim for 7-8 hours per night
• Meditation has been shown to help build more brain cells = better long term brain health. Exercise does the same. Improved connectivity. 
• Novelty - learning a new skill, language, dance, route home from work, meeting new people, changing hair colour or clothes style -  may increase plasticity of the hippocampus (the ability to create new connections between neurons). 

Upgrade Your Health Guide 

http://oncorenutrition.com/eat-our-words/

Food and Mood: Improving Mental Health Through Diet and Nutrition

- link in shown notes to online course for anyone interested in learning more or using diet as a tool to support good mental health.

Coronavirus 

The WHO COVID-19 Situation Report as of March 5 reports 95,333 confirmed cases globally, including 3,282 deaths

Our immune systems declines by about 2-3% a year from our 20s, which is why older people are more susceptible to infections

Mortality rates from diseases like pneumonia and bronchitis are three times higher among elderly people.

Our top 10 tips to optimise your immune system

1. Spice up your life. 

Use of garlic (allicin may boost our immune system), onions, ginger, turmeric, cayenne pepper, chilli, cinnamon, cloves, star anise, ginger, cumin in your cooking will boost your antioxidant intake. They may also assist with natural detoxification processes and may possess antimicrobial properties.

2. Get plenty of polyphenols. These can help in numerous ways to activate our immune system and initiate immune responses. 

• Drink green or black tea, red wine
• Use herbs in cooking (Peppermint, oregano, sage, rosemary, thyme, basil, lemon verbena, parsley, marjoram), dark choc, berries (the darker the colour the better)
• Add nuts and seeds to salad, brekky, snacks
• Cook with EVOO and enjoy olives
• Eat plenty of fresh fruit + veg 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925142/pdf/JIR2018-1264074.pdf

3. Sweet dreams

7-9hrs sleep can boost the spread of T-cells which fight infection in the body. One study also showed that just one night of 4 hours’ sleep depleted the body’s natural killer cells by 70%.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/

https://www.ncbi.nlm.nih.gov/pubmed/8621064

4. Remember that you’re sweet enough

Eating or drinking high GI carbohydrates and simple sugars can reduce our immune response. Studies have suggested that after a dose of sugar, certain white blood cells called neutrophils were far less aggressive in attacking bacteria. Some viral studies suggest sugar may help!

The body, and immune system needs glucose - we;re best off getting it from complex, slow release or low GI CHOs so we don’t have spikes in BGL. And if you’re keen to indulge, you might be better off doing so after exercise, so the uptake goes to the liver and muscles to replenish what you’ve used. 

https://academic.oup.com/ajcn/article-abstract/26/11/1180/4732762

https://www.theatlantic.com/science/archive/2016/09/glucose-inflammation/498965/

5. Get your vitamins and minerals - but don’t jump for a pill.

Various micronutrients are essential for immunocompetence, particularly vitamins A, C, D, E, B2 (riboflavin), B6 (poultry, seeds, fish, chickpeas), and B12, folic acid, iron, selenium, and zinc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212925/

https://www.frontiersin.org/articles/10.3389/fimmu.2018.03160/full

Include brightly coloured fruits and vegetables, including berries, citrus fruits, kiwi, apples, red grapes, kale, onions, spinach, sweet potatoes, and carrots.

Omega-3 fats - nuts, seeds, oily fish (and shellfish for Zn), avo

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834330/

6. Take care of your gut

• Our intestines encounter more antigens than any other part of the body
• As many pathogens enter the body via the intestinal mucosa, it is vital the gut-associated lymphoid tissues (GALT) can provide effective immune responses when necessary.
• GALT represents almost 70% of the entire immune system and about 80% of plasma cells (mainly IgA-bearing cells) reside in GALT.
• Probiotics, prebiotics and gut health -  Imbalances in the gut microbiota may dysregulate immune responses.
• Listen in to our next few weeks where we’re planning an extra special gut loving episode

https://www.nature.com/articles/nri3738

https://www.immunology.org/public-information/bitesized-immunology/organs-and-tissues/immunity-in-the-gut

7. Stress less Easier said than done if you’re running out of toilet paper!

The brain and the immune system are buddies. They’re  in constant communication. When we’re stressed, the brain produces more cortisol to  prepare the body for emergency situations. But in doing so it depresses our immune system. Relaxation exercises like yoga, meditation, mindful colouring, get into nature, paint your nails, walk the dog, play with puppies take a bath, light a candle, whatever works for you!

8. Exercise - studies suggest you’re more likely to get colds if you don’t exercise. The impact that exercise has on sleep quality might also indirectly strengthen our immune systems. We know CV is a virus which attacks our lungs, the better our lung function is the better you will be able to cope with the virus. If you don’t exercise, now is a great time to get started!

9. Keep warm 

Cold viruses may be more infectious at temperatures lower than 37°C, which is the average core body temperature. Despite this, most health experts agree that the reason winter is "cold and flu season" is not that people are cold, but that they spend more time indoors, in closer contact with other people who can pass on their germs.

Some experiments with mice suggest that cold exposure might reduce the ability to cope with infection.

10. Drink up! Staying hydrated helps your body naturally eliminate toxins and other bacteria that might cause illness. Aim for 35-45ml/kg/day.

We’ve spoken about this before - chicken veggie soup kill multiple birds with one stone - warm liquid, protein, vitamins and minerals. 

Supplements:

• Many over-the-counter products claim to ‘boost’ your immune system, but there is little evidence to show that they do. 
• If you have a poor diet, it may help to take a daily multivitamin, but the preference is to get all your nutrients, including vitamins, minerals and bioactive compounds from food, negating the need for supplements
• If you include a diet with lots of veg, fruit, wholegrains or legumes, nuts, seeds or oily fish – your immune system should have everything it needs to run optimally.
• NAC or N-Acetyl Cysteine is the supplemental form of cysteine, a semi-essential amino acid. It’s considered semi-essential because your body can produce it from other amino acids, methionine and serine, and it only becomes essential when we don’t get enough methionine and serine. NAC and glutathione also boost immune health.
• A test-tube study indicated that in other immune-compromised situations, such as the flu, NAC may hamper the virus’s ability to replicate. https://www.ncbi.nlm.nih.gov/pubmed/19732754
• Most protein-rich foods, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds and legumes contain cysteine
• For your body to make the amino acid cysteine, you need adequate amounts of folate, vitamin B6 and vitamin B12, which you can get from beans, lentils, spinach, bananas, salmon and tuna.
• NAC has low bioavailability as an oral supplement, meaning that it’s not well absorbed. High doses can cause GI upset. 
• Zinc - An analysis of several clinical trials show that short-term use of zinc lozenges may reduce the length of a cold if started within 24 hours of cold symptoms.
• Blends such as ‘Armaforce’ - blend of herbal and nutritional ingredients andrographis, echinacea, olive leaf, vitamin C and zinc
• Andrographis - Indian Echinacea - may reduce reduce duration and severity of cold and flu symptoms
• Echinacea - studies are mixed and generally don’t support its use. One clinical trial supports the use of echinacea for reducing the length of colds, but not the severity of symptoms. One large trial suggests a specific echinacea formulation could be as effective as a prescription drug to treat influenza, with fewer side effects.
• Olive leaf extract - In vitro studies show that OLE has antimicrobial activities against some infective agents including E. coli, Pseudomonas aeruginosa, Staph. aureus, Klebsiella pneumoniae and Candida albicans 

https://www.ncbi.nlm.nih.gov/pubmed/12870202

https://www.ncbi.nlm.nih.gov/pubmed/17873849

• Vitamin C - Absorption is also to some extent dependent on the dosing regimen, e.g, there would be better absorption with 250 mg taken four times daily than 1,000 mg taken once daily. 1000 is the prudent upper limit and it’s very easy to get the RDI of 45mg/d with fruit + veg 
• AVOID vitamin E supplements - no significant evidence that supplements support the immune system and research suggests possibly more harm than good (stroke and cardiac issues)
• Essential oils  - Some EOs have demonstrated immune enhancing properties but caution in pregnancy, blood pressure issues or epilepsy

Most supplements have dosage and interaction warnings. If you have any medical conditions or take any medications or supplements please check with your doctor, pharmacist or dietitian to ensure no interactions. 

https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/search

Definition: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

What is orthorexia?

A fixation/preoccupation with so-called ‘healthy eating’ or ‘clean eating to a point where it becomes obsessional and begins in infiltrate their life - causing anxiety, stress and impacting in relationships. More common with the rise of the #cleaneating #sugarfree #dairyfree, etc.. phenomenon on social media. 

It is an eating disorder, however  there are no diagnostic criteria at present. There is a lot of work happening at the moment to help characterise it. Hopefully it will be able to be incorporated in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)in the future. This makes it increasingly difficult for doctors or dietitians to characterise this condition, particularly those who work within a weight centric paradigm.

It’s difficult to pick up because there are so many food and nutrition fads. Orthorexia can be quite easy to hide behind because a person can appear as if they are focused on ‘health’ and ‘wellbeing’ where as they’re battling a mental illness people may not know about. A person may often be at a healthy weight and not have any nutrient deficiencies (others will) - everyone is different depending on their restrictions. 

There can be many ways which orthorexia can develop e.g. previously mental illness or ED (many clients can transition from anorexia to orthorexia - meaning they may restore weight and start eating but the obsessions thoughts continue to infiltrate) or a health condition (e.g. autoimmune disease or bowel issues) or it may be a desire to just feel better and because we are inundated with health messages everywhere we go, it can be difficult to escape.

Warning signs and symptoms

• Compulsive checking of ingredient lists and nutritional labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Unusual interest in the health of what others are eating
• Spending hours per day thinking about what food might be served at upcoming events
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
• Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
• Body image concerns may or may not be present

Ref: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

Common theme of when it becomes a problem:

• It’s impacting your mood
• Impacting your social life
• Compulsive checking of ingredient lists and nutritional labels
• You’re cutting out food groups or consistently skipping meals
• You feel guilty if you miss a training session or eat out of plan
• You fear losing control.
• You feel stressed or anxious about straying from your plan/usual actions
• It becomes too high on your ‘priority list’. Absorbs too much of your brain time. E.g. choose between brother’s bday dinner and gym / eating your planned meal and you choose the latter
• You skip work, school, or social events to exercise or to avoid particular foods/eating behaviours
• You feel the need to hide your behaviour - eating / training in secret
• You continue to exercise when injured or sick
• Friends, family, or your provider are worried about your eating or exercise habits.
• Food and exercise are no longer fun
• You are overly critical of friend and family food choices + exercise habits
• Obsessively checking food labels

Bottom line: If food is causing anxiety/stress- alarm bells. If you can’t eat a slice of cake on your boyfriend's birthday because it’s ‘unhealthy’, then there is a problem. Being healthy means being flexible and eating intuitively.

Treatment

At present there are no clinical treatments developed for orthorexia. We are reliant on the skills/experience from eating disorder clinicians to manage this condition - strong links with AN and OCD. Treatment team usually involved a psychologist (psychotherapy & anxiety/stress mx) and dietitian (aim to increase the variety of foods and manage anxiety relating to foods). Weight restoration may be required if the patient is underweight.

At the core it is an inability to deviate and a sense of feeling ‘out of control’ if the rules and restrictions set can not be adhered to. One of my favourite lines that I heard from Dr. Stefanie Reinold (who also has her own brilliant podcast which we will link in the show notes) is “It’s not about the food”, there is a lot more going on underneath that we need to uncover to get to the core of the obsessive need to control food. 

Strategies:

• Understand what is at the root of the obsession, as we know it’s not about the food so what is it about? Is it feeling out of control in your life and therefore feeling the need to control food? Are you having a stressful time with a loved one? Did something happen in your past?
• Adoption of a balanced mindset (which is easier said than done) - it would be important to seek professional help and work to increase flexibility with eating. Develop strategies to help manage anxiety or stress around food.
• Rules = guilt/shame - be more liberal with rules you put on yourself
• Acknowledge everyone is different, what works for one doesn’t work for another - social media detox and following positive people.
• Knowing recovery is challenging, because rigidity and rules have been created and you need support to help break those down and remodel. Sticking to a particular diet can make you feel safe (even though it is not safe or ‘healthy’).

Further information and support

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

https://thebutterflyfoundation.org.au/

https://headspace.org.au/

https://daa.asn.au/

Disease prevention

Heart disease

• Vitamin E (almonds, peanuts, hazelnuts, sunflower seeds, avocado) and Beta Carotene (sweet potato, dark leafy greens, cantelope, capsicum) are often studied as it is hypothesized that these antioxidants can prevent the accumulation of atherosclerotic plaques.
• Results of larger trials haven’t shown as profound as we had hoped for, however we have rational for this!
  • Women’s Health Study - 39,876 healthy women took 600 IU of natural source vitamin E or a placebo every other day for 10 years. 
  • The study did not see a reduction in CVD events, however it did find a 24% reduction in total cardiovascular mortality. 
• Women’s Antioxidant Cardiovascular Study - 8,171 women randomised.
• looked at beta-carotene, vitamin E, vitamin C.
• Modest benefit for vitamin E among women with existing cardiovascular disease.
• Women in the active vitamin C and E experienced fewer strokes 
• Patients taking vitamin E had significantly more heart failure. Vitamin E was linked to a 13% higher risk of heart failure and a 21% increased risk of hospitalization for heart failure
• Lott, E. The Journal of the American Medical Association, March 16, 2005; vol 293: pp 1338-1347. Brown, B.G. The Journal of the American Medical Association, March 16, 2005; vol 293: pp 1387-1390.
• .https://academic.oup.com/ajcn/article/69/6/1322S/4715025
• a recently published analysis of clinical trials involving nearly 136,000 people who took vitamin E for one reason or another found that the overall risk of dying was greater in those who took higher doses, compared to those who took lower doses.
• https://www.health.harvard.edu/press_releases/facts_about_vitamine
• Not a huge benefit when it comes to supplementation - this was also supported in a very highly regarded medical journal called The Lancet. We know that antioxidants in fruits and vegetables, which also contain valuable fibre can have a profound impact on heart health and prevention of heart disease.

Cognitive conditions (dementia, alzheimers)

• Oxidative stress caused by free radical damage can contribute to brain aging, cognitive deterioration and conditions such as alzheimers or dementia. .
• The literature has some mixed results, however again we know there is more to this complex puzzle.
• Prevention of Alzheimer's Disease by Vitamin E and Selenium Trial (PREADViSE).
• This study aimed to determine if vitamin E or selenium supplements used alone or in combination can prevent dementia older men.
• 3,700 men aged 60 or older for 6 years
• Unfortunately the antioxidant supplements did not prevent the onset of Alzehimers disease.
• Physicians' Health Study II (PHSII), - 5,956 men age greater than 65 years.
• The average treatment duration was 18 years - very long!
• Subjects were given 50 mg beta-carotene supplements or a placebo.
• Long term supplementation showed positive cognitive outcomes.

Statement by the Alzheimers Society regarding use of antioxidants:

“Though lab-based experiments on different types of antioxidants seem promising, there is only limited support for the claims that antioxidants may protect against Alzheimer's disease from studies involving people.

However, increasing fresh fruit and vegetables in the diet has numerous benefits aside from increasing antioxidant intake and is highly recommended, especially as part of a Mediterranean diet”

We know there is data to suggest that eating a Med type diet (which is rich in antioxidants) is beneficial in reducing the risk of dementia.

Cancer 

• Carotenoids and breast cancer risk
• Dietary patterns and bladder cancer- looks at fruit and veg rather than supplements
• Dietary Soy Isoflavones (flavanoid family) and colon cancer
• http://oncorenutrition.com/dont-fight-yo-nutrients/

We know that eating a diet rich in antioxidant rich fruit and vegetables and protective against a range of different cancers. Whilst there are some gaps in the literature there are some really exciting trials currently underway.

Longevity & anti-aging 

If we can prevent the onset of chronic diseases through increasing our intake of antioxidants, we can lead a healthier life for longer!

“Free Radical Theory of Aging” (FRTA), also known as “oxidative damage theory of ageing” is a concept that free radicals and other reactive oxygen species are a byproduct of metabolism and occurs as a result of a number of exogenous factors; and it is the accumulation of damaged cells are the reason we experience age-related diseases and aging. Why antioxidants are of interest in terms of aging and longevity, is because they can block or downregulate these damaging pathways.

http://www.actabp.pl/pdf/2_2000/281.pdf

There are a number of different antioxidants that are of interest when we focus on anti-aging. These include - Ascorbic acid (Vit C), alpha-tocopherol (Vit E), Ubiquinol (Coenzyme Q10), Melatonin, Curcumin, resveratrol, etc.. 

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982418/

Ubiquinol (Coenzyme Q10)

• It is a unique lipid-soluble antioxidant and is essential for mitochondrial electron transport chain (ETC), which is a fancy way of referring to energy production within our cells.
• Benefits from heart disease risk, kidney disease, inflammation, fertility, aging, metabolic syndrome.
• In regard to CVD a cochrane review in 2014 found that supplementing with Co-Q10 showed a significant reduction in systolic blood pressure without improvements in other CVD risk factors, such as diastolic blood pressure, total cholesterol, LDL- and high-density lipoprotein (HDL)-cholesterol, and triglycerides.
• Endothelial function
• Inflammation - Meta-analysis explored the effect of CoQ10 on C-reactive protein (inflammatory measure), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with inflammatory conditions such as multiple sclerosis, obesity, rheumatoid arthritis, diabetes, etc... It found that Co-Q10 doses between  60 to 500 mg/day for a 1-week -4-months significantly reduced production of inflammatory cytokines. 

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807419/#B39

Food sources:

• Organ meats: Heart, liver and kidney
• Some muscle meats: Pork, beef and chicken
• Fatty fish: Trout, herring, mackerel and sardine
• Vegetables: Spinach, cauliflower and broccoli
• Fruit: Oranges and strawberries
• Legumes: Soybeans, lentils and peanuts
• Nuts and seeds: Sesame seeds and pistachios
• Oils: Soybean and canola oil

Resveratrol (RSV) - A polyphenolic compound that stimulates cell defense pathways.

• Protects these plants against UV rays and some fungal infections.
• It has been hypothesised that it is RSV that is responsible for  the ‘French paradox’ - low rates of heart disease in France, despite a diet rich in cheese and red wine.
• There is evidence that resveratrol may be beneficial in the context of diabetes, CVD and cancer.
• Meta Analysis which looked at the evidence regarding RSV across a number of different species. It found that there are a few species that found life extension in response to RSV.
• Metabolic function
  • https://academic.oup.com/biomedgerontology/article/67/12/1307/605425
  • https://www.sciencedirect.com/science/article/pii/S155041311100386X
• Be careful of high doses of resveratrol if history of breast cancer
• Food sources: Red wine, grapes, peanuts, pistachios, dark choc, cacao, strawberries 

Causes and triggers

• Brain-gut axis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/pdf/AnnGastroenterol-28-203.pdf
• Gut microbiome - https://onlinelibrary.wiley.com/doi/full/10.1111/apt.12728
• Environmental factors 
• Post infection - (e.g. gastroenteritis infection or campylobacter pylori) 
• Beatty JK, Bhargava A, Buret AG. Post-infectious irritable bowel syndrome: mechanistic insights into chronic disturbances following enteric infection. World J Gastroenterol. 2014;20(14):3976-3985.
• Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.
• Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009;15(29):3591-3596.
• Thompson JR. Is irritable bowel syndrome an infectious disease? World J Gastroenterol. 2016;22(4):1331-1334.

Investigations and Diagnosis: 

• Blood tests, stool samples, family history, colonoscopy, gastroscopy 
• Hydrogen Breath Tests

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgh.13689

http://shepherdworks.com.au/fodmaps-breath-testing-are-you-blowing-your-money/

• Rome Criteria

https://irritablebowelsyndrome.net/clinical/new-rome-iv-diagnostic-criteria/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704116/#!po=31.2500

Dietary interventions

• Low FODMAP diet (Fermentable, Oligosaccharides, Disaccharides,Monosaccharides and Polyols)
  • Management: 6-8 week elimination diet and slow reintroduction (under close guidance from a DT)
• Fibre
  • Soluble vs Insoluble - depends on your symptoms.
  • Soluble fibre (e.g., psyllium husk) may assist in the management of IBS and can improve symptoms of patients.
  • Supps may cause bloating - important to introduce this gradually. 
• Probiotics/Prebiotics
  • Some evidence for use of probiotics in the context of GIT infections and diarrhoea. About 7–30% of patients with infectious diarrhoea can develop IBS. Probiotics may help to improve the barrier that lines our gut.
  • There is no specific probiotic that is recommended. If you choose a probiotic, take the same strain and dose for 4-weeks. If you feel better, continue with the same probiotic. If you do not feel better after 4-weeks, try a different dose or strain. We can guide you where to start depending on your Sx. 

Summary: Diets for the treatment of IBS symptoms are complex and multifactorial. Due to huge amounts of patient variation in severity of symptoms and intolerances, it can challenge to point point an exact method. 

Many different diets have been studies in the treatment of IBS, however there have been huge limitations in many of those published. At present the diet with the best level of evidence is the elimination diet (low fodmap and reintroduction) under the guidance of an APD.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2036.2004.02267.x

Medical management references:

• American Gastroenterological Association Institute Technical Review on the Pharmacological Management of Irritable Bowel Syndrome- https://www.gastrojournal.org/article/S0016-5085(14)01090-7/fulltext
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291563/
• American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome - https://www.gastrojournal.org/article/S0016-5085(14)01089-0/fulltext 

Dr Carly Ymer

Dr Carly Ymer is a clinical psychologist who practices holistic psychotherapy, using her passion for mental and emotional wellbeing to help clients be their best. She believes and practices within an integrative and holistic framework of the synergy between thinking, emotions, and behaviour. Carly is passionate about working with children, teenagers and young adults, with a range of emotional, social and behavioural difficulties. 

https://beingwellclinic.com/

SHOW NOTES

WEIGHT  LOSS

• In order to lose weight we do need to be at a caloric deficit
• This is calories in vs calories out, but the in and out are far more complicated than you think
• Energy in: fat, alcohol, carbs, protein. Fibre not absorbed 
• Energy out: BMR, non-exercise energy, activity factor, thermic effect of food (protein 30%, carbs 8-10%, fat 2-3%, fibre 30%) 
• For fat loss, we need to access fat stores = lipolysis (very complex), gluconeogenesis or ketogenesis
• For weight loss we need a negative energy balance

1. Reduce energy in - (water, fibre)
2. Increase BMR - enhance lean body mass, heat, cold, glycaemic index, green tea, oolong tea, capsaicin, sleep (insulin, ghrelin, leptin balance), coffee, MCT vs LCT
3. Increase thermic effect of food - increase protein, reduce fat = increased energy output
4. Increase non-active energy expenditure and activity factor - increase energy output. HIIT has the added benefit of burning energy and enhancing LBM.

Golden rules

1. Aim for <1% body weight loss per week (0.5-1kg).  Any quicker than this and the body adjusts - alterations to our metabolism and hunger make more than this detrimental - i.e. metabolic slowing and increased appetite that accompanies rapid weight loss, sustained weight loss requires a persistent calorie deficit that isn’t sabotaged by our slowed metabolic rate and increased hunger. Hunger is a biological drive - to tell someone with increased hunger to not eat is like asking someone to not breathe. Nothing to do with will power. Managing hunger is vital - alterations to types of carbs and fats, amount and timing of protein and fibre and fluid intake is really important. 
2. Increase your BMR - lean body mass, sleep. Tea, chilli and some other compounds can help but the impact is minute. 
3. Increase activity factors - both incidental and planned

ADRENAL FATIGUE

Adrenal fatigue… does it exist?

Adrenal glands

• Mayo clinic: ‘Perched atop each of your kidneys, your adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure and other essential functions.’They produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol
  • https://www.mayoclinic.org/adrenal-glands/img-20008674

The Theory

• To keep it simple, the concept around adrenal fatigue is that under ongoing stress our body places pressure on our adrenal glands and over produces our stress hormone known as cortisol which essentially causes our adrenal glands to burn out and not work properly.
• As our adrenal glands don’t work properly, this means they are unable to produce the necessary hormones to help our bodies function properly and therefore result in symptoms such as fatigue, trouble sleeping, weakness, brittle nails, weight gain/loss and alopecia. 
• Sadly this is a diagnosis given to patients from many alternative practitioners which gives them hope and a diagnosis for their problems/health issues.. 
• Many supplements on the market targeted at ‘adrenal support’ with an expensive price tag

The evidence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997656/

• Large systematic review published in 2016.
• From 3,470 articles found, only 58 studies met criteria for proposed adrenal fatigue.
  • 33 were carried in healthy individuals, and 25 in symptomatic patients. 
  • The researchers found it difficult to draw conclusions, this is because there were many different methods used amongst the studies (when it comes to research consistent methodology & the use of validated tools are important) and this made it difficult to draw conclusions, the measures of fatigue were poorly documented and standardised tools were not used, the way cortisol was assessed was not endorsed by endocrinologists and I could keep going.
  • As a result of these findings (or lack of findings) this systematic review concluded that adrenal fatigue is not a true medical diagnosis.
• So if you are someone who has had this diagnosis, don’t feel lost, rather focus on managing your stress levels rather than putting a label on the way you feel.
• Eg. Try to get into bed earlier and get more sleep, try meditation or yoga, make an effort to eat a more balanced diet.
• Be careful when it comes to supplements, many of the drugs are not regulated or tested for safety.
• If you’re unsure, contact your healthcare provider, GP, Endo, dietitian, etc..

FRESH VS FROZEN VEGETABLES

https://www.sciencedirect.com/science/article/abs/pii/S0889157517300418

• The study mimics typical consumer purchasing and storage patterns of produce.
• The study compares key nutrients in fresh, fresh-stored, and frozen produce.
• Fresh produce loses vitamins over time during refrigerated storage.
• Consumers’ assumption that fresh produce has much more nutritional value than frozen is incorrect.
• In some situations, frozen produce is more nutritious than its 5-day fresh-stored counterpart.
• Reduced food waste

Benefits of frozen

• Nutritional profile - same if not better
• Convenience
• Reduced food waste
• Lower cost
  • Cost - e.g. broccoli -  true cost by weight of fresh vs frozen = $7.38/kg fresh ($4.70 if use every single bit!) vs $5 frozen

Downsides of frozen:

• Variety
• Carbon footprint - look for local produce. Reduced waste may counterbalance this. 
• Packaging 
• Starchy veg
• Less inspiring 

Tips 

• Frozen winter veg, kale, spinach, stir fry mixes
• Big packs vs little steam fresh - need about 4 of these for one serve!
• Good way to eat more which is really the moral of the story - A recent meta-analysis into fruit and vegetable intake and the risk of cardiovascular disease, cancer and total mortality, by scientists, published in the International Journal of Epidemiology suggests that while disease risk can be reduced by consuming 5 portions of fruit and vegetables a day – the ‘5-a-day’ campaign – the largest benefit can be gained by eating around 800g, approx. 10 portions, per day. https://academic.oup.com/ije/article/46/3/1029/3039477

SHOW NOTES

Australian Bushfire Donations:

Wires

Red Cross

CFA

Food Bank

OnCore Intermittent Fasting Guides - https://store.oncorenutrition.com/collections/all

Physiological benefits

http://oncorenutrition.com/to-fast-or-not-to-fast/

Coffee https://www.ncbi.nlm.nih.gov/pubmed/28177691

Practicalities / sustainability / contraindications

http://oncorenutrition.com/the-fast-and-the-furious/

Guides: http://oncorenutrition.com/intermittent-fasting/

https://store.oncorenutrition.com/collections/all

IF and calorie deficit similar weight loss outcomes
Some find IF mentally challenging than consistent cal deficit, others find the opposite

• Science currently unclear if IF vs CR is responsible for the body composition changes and good health.
• Why the evidence is unclear is that many studies have been conducted in animal based models which we know has limitations
• Human studies have been relatively poor (e.g. short duration) and mainly focused around weight loss (in the short term) rather than aging and disease risk.
• https://www.ncbi.nlm.nih.gov/pubmed/28459931
• 100 obese participants - 6 women and 14 men, aged between 18–64 (the mean age was 44). Note they did not have metabolic conditions (e.g. T2DM).
• Looked at different dieting patterns
  • Alternate-day fasting - consumed 25% of their daily energy requirements on fast days and 125% of their daily requirements on alternate days.
  • Calorie restriction diet plan where the subjects consumed slightly less than their energy need (~75%) each day.
  • Another group with no dietary intervention.
  • Results: With regard to the two dieting groups, they both lost a similar amount of weight and showed no significant difference regarding, blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance & inflammatory markers at month 6 or 12.
  • Of note there was a higher drop out rate within the alternate fasting day group, which may indicate adherence and consistency may be a challenge with this method,
  • Our recommendation: No real difference between the fasting vs calorie restriction group. There is no magic pill when it comes to weight loss. Do what works best for you and work with a professional who understands your needs.
• https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-789X.2011.00873.x
• Intermittent CR and daily CR diets appear to be equally as effective in decreasing body weight, fat mass, and potentially, visceral fat mass. However, intermittent calorie restriction protocols may be superior in that they help conserve lean mass at the expense of fat mass. More research + longer term studies are required.

Circadian rhythms

According to your circadian rhythm, nighttime is for resting, not eating.

On average - we eat every 3hrs and 6 minutes and for a duration of approx 15hrs per day

Mice that eat in opposition to their circadian rhythm gain significantly more weight than mice that only eat during waking hours, even if they eat the same amount of food. Not all studies in humans support this notion.

At night, you may be more likely to choose unhealthy, calorie-dense foods.

• Access
• Convenience
• High risk time for high fat, calorie dense foods
• Emotional / non-hungry eating
• Appetite changes when tired - https://www.ncbi.nlm.nih.gov/pubmed/20357041 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/
• Restriction/insufficient intake during the day → compensation

The first RCT in humans was published half way through 2019 to determine how meal timing affects 24-hour energy metabolism when food intake and meal frequency are matched

• Small n= 11 men + women aged 25-45
• two groups of people who ate the same three meals per day for 4 days but with different timings: the early time-restricted feeding (eTRF) schedule and the control schedule.
• 8am - 2pm (18hr fast) vs 8am - 8pm (12hr fast)
• On the fourth day, 24‐hour energy expenditure and substrate oxidation were measured by whole‐room indirect calorimetry, in conjunction with appetite and metabolic hormones
• No effect on 24hr energy expenditure
• May enhance fatty acid oxidation - i.e. using fat for fuel rather than carbohydrates
• TRF Decreased ghrelin levels, enhanced fullness, decreased desire to eat
• Meal‐timing interventions facilitate weight loss primarily by decreasing appetite rather than by increasing energy expenditure. eTRF may also increase fat loss by increasing fat oxidation.

https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22518

Another study 6am-7pm

• Nothing unless than the hrs to adhere to - no type, amt of food, no record keeping
• Ate fewer calories and lost weight

Another study

• Same kJ at BF vs dinner - when given at BF = less weight gain
• https://www.ncbi.nlm.nih.gov/pubmed/23512957

Another study

• 3 meals vs 1 meal - same calories
• Normal-weight subjects are able to comply with a 1 meal/d diet. When meal frequency is decreased without a reduction in overall calorie intake, modest changes occur in body composition, some cardiovascular disease risk factors, and hematologic variables. Diurnal variations may affect outcomes.
• Both late eating
• Improvement in weight loss, but blood pressure and chol levels suffered!
• https://www.ncbi.nlm.nih.gov/pubmed/17413096

Early TFR

• eTRF (6-hr feeding period, with dinner before 3 p.m.) or a control schedule (12-hr feeding period) for 5 weeks and later crossed over to the other schedule.
• eTRF improved insulin sensitivity, β cell responsiveness, blood pressure, oxidative stress, and appetite.
• We demonstrate for the first time in humans that eTRF improves some aspects of cardiometabolic health and that IF's effects are not solely due to weight loss.
• https://www.ncbi.nlm.nih.gov/pubmed/29754952
• Even 10-11hrs TRF beneficial - weight loss, improved energy levels, improved sleep

https://www.ncbi.nlm.nih.gov/pubmed/31808043

https://www.ncbi.nlm.nih.gov/pubmed/26693661

IF and breast cancer risk

https://www.ncbi.nlm.nih.gov/pubmed/26305095

These findings suggest that eating more frequently, reducing evening energy intake, and fasting for longer nightly intervals may lower systemic inflammation and subsequently reduce breast cancer risk. Randomized trials are needed to validate these associations.

Breast cancer prognosis

- 2413 women (mean [SD] age, 52.4 [8.9] years)

- mean (SD) fasting duration of 12.5 (1.7) hours per night.

- fasting less than 13 hours per night was associated with an increase in the risk of breast cancer recurrence compared with fasting 13 or more hours per night but wasn’t associated with mortality rates

NO RCTs YET!

https://www.ncbi.nlm.nih.gov/pubmed/27032109

Diabetes

• Very small study n = 3 men who had had type 2 diabetes for 10-25 years.
• Medical supervision
• Fasted every other day or 3 days a week.
• Within a month, all of the men were able to stop taking insulin. And in less than a year, they were able to cut down on or stop other diabetes medications.
• Another small study, 10 obese men with type 2 diabetes followed a time-restricted eating plan. They improved their fasting glucose and lost weight over 6 weeks.
• Bigger studies are needed to confirm those findings and to see how long the results last
• The American Diabetes Association notes that if you’re overweight or obese, weight loss can help lower your HbA1c level (a gauge of your blood sugar control over the last 2-3 months) and lower your risk for heart disease.

Important to:

• Talk to Dr/endocrinologist first
• Adjust your insulin
• Monitor for lower BGL
• Beware of large carbohydrate load on first meal

Cell Metabolism: “Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes."

BMJ Case Reports: “Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin."

Joslin Diabetes Center: “Yom Kippur and Diabetes.”

BMJ Open Diabetes Research & Care: “Recommendations for management of diabetes during Ramadan: update 2015."

SHOW NOTES

Food labels

• Labels must also have a list of ingredients. Ingredients must be listed by weight in descending order (i.e. the first ingredient contributes the largest amount to the product and the last ingredient contributes the least).
• Regarding additives, products must show the number or the name of any additives they contain (e.g. monosodium glutamate may appear as MSG or 621). If you know you have sensitivities to any additives, it’s important you know their corresponding numbers so you can keep an eye out for them,
• If the product contains any major allergens such as nuts (peanuts, cashews, almonds, walnuts, etc.), shellfish, fish, eggs, sesame seeds, soybeans, wheat, gluten, they must be declared on the label.
• Sugar No added sugar: No added sucrose, glucose, honey, malt, fruit juice, etc.
• Un-sweetened: No added intense (artificial) sweeteners, sucrose, glucose, honey, malt, fruit juice etc.    Diet: At least 40% less kJ than regular product
• Comparative claims eg ‘reduced’, ‘increased’, ‘light’ or ‘lite’ must refer to the reference food 

Look out for:

• Sugar aliases    - dietitian colleague of ours has put together a list of 48 sugar aliases! Some derived from cane sugar, some from fruit, corn, beets, alternative sweeteners like agave and rice malt syrup, 
• Don’t be fooled by fancy marketing, sugars can have many different names, and we will put this list in the show notes for you all to have a look at. Just because a food contains rice malt syrup or coconut sugar, this is still sugar.

(https://foodwatch.com.au/blog/carbs-sugars-and-fibres/item/48-shades-of-hidden-sugars.html)

• Foods containing more than 10mg sulphite preservatives/kg must be labelled as containing sulphite as this is the level that may trigger 

Health claims 

• These are claims about something in a food and how it can affect your health. E.g. ‘Fibre helps keep you regular ’;.  ‘This food is low in sodium (salt). A diet low in sodium may help reduce blood pressure’. Only pre-approved ‘food-health relationships’ for high level health claims are allowed to be made. All health claims must be supported by scientific evidence. Can’t  refer to the prevention, diagnosis, cure or alleviation of a disease, disorder or condition 

https://www.legislation.gov.au/Details/F2017C00711

https://foodregulation.gov.au/internet/fr/publishing.nsf/Content/31BDC68CEC4A1964CA25801B00166C1F/$File/Getting-Your-Claims-Right-2018.pdf

https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/food-labels/what-are-health-claims-and-what-do-they-mean/

Health Star Rating 

• The Health Star Rating is a front-of-pack labelling system that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars.
• Aims to provide a quick, easy, standard way to compare similar packaged foods.
• Developed by Aus Gov with collaboration from industry and public 

Drawbacks

• Opt in, voluntary, all, some or none of their products
• Compares products of the same category eg cereals with cereals 
• Food manufacturers and retailers are responsible for the correct and accurate use of the Health Star Rating system
• Nutrients in isolation do not represent the value of a food 
• Doesn't differentiate between whole foods and processed / packaged foods
• Putting a health star rating on a processed food undermines message of good nutrition 
• Added sugars are not differentiated from natural sugars - eg a muesli bar with oats and dried fruit vs bar with tonnes of sugar 
• Products containing additional dietary fibre can get bonus points which can be used to offset negative points they get for saturated fat or sugar,
• This is how Nutrigrain - 4 stars  despite the fact it's still literally 27 per cent sugar. Add inulin = bonus points. Very easy to manipulate. 
• Milo (4.5 stars, only IF consumed with a specific amt of skim milk, otherwise 1.5 stars if eaten alone!) literally receives a higher health star rating if eaten with ice-cream
• Certain brands of clean, unsweetened Greek yoghurts sit at 1.5 stars. Some lolly bags sit at 2.5.
• Salmon sits at 3 stars, beer battered chips sit at 4.

Shelf, fridge and freezer life

https://www.foodsafety.gov/food-safety-charts/cold-food-storage-charts

• Serve size vs Per 100g

We look for (depending on the food of course) 

1. Total kJ
2. Total protein per 100g
3. Sugar per 100g - check ingredients list to explore if natural vs added
4. Saturated / trans fats
5. Sodium
6. Fibre / Vit / Min 

https://livelighter.com.au/Assets/resource-vic/wallet-and-postcard/traffic-lights-wallet-card.pdf

Food Switch App 

Source of product and ingredients

Source : https://www.accc.gov.au/consumers/groceries/country-of-origin

Source: https://www.australianmade.com.au/media/477079/amcl_code_of_practice_2017.pdf

Remember, some of the healthiest foods may not have labels or health claims (e.g. fresh fruit and vegetables, nuts, lentils, beans, fresh meat and fish).

Trends in the New Year

Google trends data

Source https://noobgains.com/gym-membership-statistics/

https://fitness.org.au/articles/fitness-australia-annual-reports/fitness-australia-annual-report-2018-19/14/1880/19

Behaviour change

• According to well known Clinical Psychologist Dr. Howard Rankin, who is an expert on behavioral change, a large part of the problem is that we think we have control over our behavior, when really we don’t.
• Lauren and I see this regularly in practice. It’s wonderful to have goals and aspirations, but the psychology and motivation behind behaviour change in complex.
• We know that habits (which often take 21 days to break) and stress, reduce our conscious control over the choices we make
• What drives our behaviour is not always logical, as humans we are emotional! You guys would know, sometimes we do things we know aren’t good for us, but we don’t know what drives us to pursue them!
• Quote by Dr Rankin: The more primitive, emotional brain generally has precedence over the newer, more rational brain.
• This is really important to note when it comes to setting achievable goals for the new year.
• Knowing this, we want to make sure you set yourself up for setting positive and realistic goals in the new year!

Why New Year's resolutions don’t work

• Abrupt change too quickly
• Expectations too large therefore setting self up for failure
• To successfully achieve these resolutions, small, short-term goals are the most effective and taking resolutions one step at a time is the best way to succeed
• Fear is such a powerful emotion it can override our priorities and goals we set. Fight/flight. We run away from fear before we run towards pleasure. We can have a fear of failure, success, or just fear of change—stepping outside our comfort zones—that stops may of us in our tracks before resolution become habits.

How to make them stick

• Make resolutions tangible and achievable. For example, instead of stating you will 'lose 20kg in 2020,' plan that you will 'walk everyday for 2 weeks' or ‘avoid choc after 8pm for 2 weeks’.
• Say it out loud. Write it down. Tell someone. Anyone. Be accountable. 
• Enlist a support crew. Cheerleaders 
• Make your goals EXTREMELY SMALL. Like stupid small. For example, she suggests instead of aiming to workout three times a week, you start with two squats a day. The change is so small, you won’t stop with just two. Walk only to the letter box. No chocolate on Tuesdays. Walk only to the letterbox.  And that's how these small habits grow from ridiculously small to big. It's hard to resist not doing more, because it's just so easy. 
• Anchor it to something. Your squats for eg, tether it to something you already do every day, like brushing your teeth. It’s only 2 mins. And all of a sudden it’s achievable.
• Opt in vs opt out. What are the things you always do? Eat lunch, brush your teeth, attend your specialist appts, go to work. Put your goals in that category. A MUST DO unless something major trumps it. Physically put them on your to do list, your calendar, your reminder list on repeat.  
• More positive less negative. - Set your phone calendar to give you positive messages or reminders about your goals a few times per day. Remind yourself to walk. Set an alarm that call your 8pm cut off time. 
• Time - it takes 17 to 21 days to form a habit; therefore, keeping a goal for those 21 days will support success

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535950/

https://insights.ovid.com/article/00006205-201501000-00002

https://www.ncbi.nlm.nih.gov/m/pubmed/26671434/?i=6&from=/15604158/related

Top Tips for navigating Festive Feasts

1. Don’t overthink it. So you ate too much cheese. Acknowledge it then move on. 😊

2. Move when you can. A brisk walk with the fam is a wonderful way to pull yourself out of a pudding nap. 🚶🏽‍

3. Food envy? Have a little bit of everything. But just a little bit. Recruit a friend and remember sharing is caring 👫

4. Eat mindfully. Listen to your body. Stop when you’re satisfied. 🧠

5. Savour every mouthful. The festive season is delicious. Enjoy it with your loved ones! 🕯🎄💝

6. Refer to point 1. 🧀😉

FREE Mindful Eating Guide

FREE Mindful Eating Meditation 

Overeating is completely normal. It is our thoughts, feelings, and reactions to overeating that can be damaging beyond the overeating moment

Overcompensating by restricting is not the solution...

Our bodies need a regular supply of food to stay alive and perform all of the various chemical reactions and daily bodily functions (like keeping our heart beating, allowing our diaphragm to expand and relax with each breath, our kidneys as they remove our waste, our growing nails, cell turnover in our gut...etc).

Restriction → deprivation → protection through overcompensating

When our bodies feel the threat of scarcity (i.e. starvation from a evolutionary perspective)- even if that is in the form of intentional restriction- our bodies will look to protect us through eating more to compensate. This is a natural biological reaction..

Our suggestion is to in fact NOT skip breakfast! Many people skip breakfast in anticipation of the big festive meal, but in many cases that just makes it more likely that you'll be ravenous at lunch or dinner time meaning you're less likely to actually enjoy the food (i.e. scoff it!)and more likely to eat to the point of discomfort.

Give yourself permission to eat how you would want a loved one to eat. Should they skip the xmas pudding? Should they feel bad about enjoying the xmas ham? And therefore should you?

Revisit your values and goals. Give yourself the time and space to allow your actions to align your behaviours with these values

Feel and respect your fullness - but I would add a big caveat to this one: it’s okay if you eat past the point of fullness.There’s a lot of delicious food and a lot of food that we don’t get a chance to eat very often and we want to enjoy it all with the people who put the thought and care into making it. Notice and check in with how your body is feeling but know that it’s okay if you eat past the point of comfortable fullness. Notice it. Be curious but do not be judgemental! You’re allowed to eat for more reasons than just pure hunger.

Honour your fullness. Give yourself permission to not eat also! Social pressure, “eating for others”

Some tips:

• “Thank you, this looks great but I’m actually feeling satisfied already.”
• Postpone, save for later

SHOW NOTES

Green Powders 

https://www.budgetdirect.com.au/home-contents-insurance/research/average-grocery-bill-statistics.html

http://oncorenutrition.com/eat-or-drink-your-greens/

Cheese 

http://oncorenutrition.com/the-bees-knees-of-cheese/

Why we might not weigh you

http://oncorenutrition.com/weight-bias-what-are-we-weighting-for/

SHOW NOTES

Diet soft drinks

Diet soft drinks often replace sugar with artificial sweetener, often aspartame. Aspartame is around 200 times sweeter than sugar, so a very small amount is all that is needed to sweeten a product.

Aspartame safety

Studies performed in 1980 by Joint Expert Committee of Food and Agricultural Organization + World Health Organization (JECFS) established the Acceptable Daily Intake (ADI) of Aspartame as 40mg per kg of body weight, meaning that the average person can safely consume around 3400mg of aspartame daily without any adverse side effects. Can of Diet Cola is around 180mg = 18 cans per day. 

Health impact of artificial sweeteners

• Some observational studies have found high intake of artificial sweeteners and diet soft drink is associated with an increased risk of obesity and metabolic syndrome
• Diet soft drink may increase appetite by stimulating hunger hormones (Grehlin), altering sweet taste receptors and triggering dopamine responses in the brain
• Predispose us to want sweet, calorie dense foods and fluids 
• Observational (diet soft drink leads to weight gain) vs experimental studies (swap to diet soft drink leads to weight loss, but beware of funding source and bias)
• Link to weight gain possibly from above, possibly from pre-existing poor dietary habits. One study of over 300 overweight  participants - drink 710ml diet soft drink or water per day for a year. At the end of the study, the diet soda group had experienced an average weight loss of 6.21 kg compared to 2.5 kg     https://www.ncbi.nlm.nih.gov/pubmed/26708700
• Bias in the scientific literature - some studies (including this one) funded by the artificial sweetener industry have been found to have more favorable outcomes than non-industry studies, so we need to be careful when interpreting results.
• Observational studies have found a link between high intake diet soft drink and the development of kidney disease ? related to acid load on the kidneys from high phosphorus content.
• Gut microbiome: Artificial sweeteners alter the gut flora, leading to reduced blood sugar control. This may be one way diet soft drink increases the risk ofT2DM, but more research needed. https://www.ncbi.nlm.nih.gov/pubmed/27090230   https://www.ncbi.nlm.nih.gov/pubmed/25831243
• Be careful if you have low bone density - particularly with phosphorus containing drinks, so cola, and those with caffeine. PO4 interferes with Ca absorption. 

At the end of the day, diet soft drinks offer no nutritional benefit. The ingredients list is empty and doesn’t offer anything positive to our health. 

If you’re a regular drinker, set yourself a challenge. 21 days to change a habit. Set a target, recruit some friends, get a calendar going to mark off days and set yourself a challenge. Try our sparkling iced teas. Challenge to break the habit so you can enjoy sugar-free soft drink on occasion, but it’s not a must have each day. 

https://www.nature.com/articles/s41430-019-0407-z

Carbonated water and teeth

https://www.ada.org/en

Milk 

Cows milk full vs skim = change in ratios, no sugar added. Permeates ensure consistency in nutritional composition of milk.  

Soy - similar nutritional profile - has to be by food standards law, plant-based, sometimes sweetened

Almond - low protein, low kJ, low fat, low CHO, low Calcium. Some are sweetened, some calcium fortified.   

Rice milk - low is kJ, protein, high in natural sugars. Hypoallergenic. 

Coconut milk - low in carbs and kilojoules, but is significantly higher in saturated fat than other non-dairy alternatives, lacks protein and calcium (unless fortified).

Oat milk - same kJ as cows milk, half protein, low fat, higher CHO, equiv Ca,  beta-glucans (soluble fibre reduce chol reabsorption)

Comparison table: 

https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Milk-Allergy-Foods-and-Ingredients-to-Avoid.aspx

Heart Foundation guidelines 

https://www.heartfoundation.org.au/news/new-advice-from-the-heart-foundation-on-meat-dairy-and-eggs

Types of Intermittent Fasting

1. ADF - 25% energy reqs one day, nil restrictions on the next 
2. Complete alternate-day fasting (or total intermittent energy restriction) - no energy consumed on fast days
3. modified alternate-day fasting (or partial intermittent energy restriction) - up to 25% of daily energy needs on fasting days instead of complete fasting.
4. Most studies are in this method - mice and human 
5. In humans, Monks semi-fasted every other day with 1L milk + 500g fruit on fast day for 3 years
6. > Less time in monastery infirmary & lived longer (but not sig).
7. Periodic fasting 
   1. 5:2 (Michael Mosely) - not a whole lot of evidence yet, but more emerging
   2. The 2 Day Diet (Michelle Harvie) - 2 days 500-600Cal then eat & drink normal for rest of week
   3. 24hr fast
   4. Valter Longo– 5 day consecutive fast (800Cal/day) then normal for rest of month > evidence for protection against cancer.
   5. more extreme versions with several days or weeks of fasting. 
   6. During the fasting days, it may be allowed approximately 500 to 600 calories or about 25% of regular daily caloric intake instead of complete fasting.
8. Time-restricted feeding / TRE - eating only during a certain number of hours each day. Eg 16:8. This schedule is thought to leverage the circadian rhythm.
   1. Timing - earlier may be better. BF not most important meal of day but BF and lunch better for circadian rhythm and glucose tolerance the next day than lunch + dinner. 

Physiological benefits

http://oncorenutrition.com/to-fast-or-not-to-fast/

Coffee https://www.ncbi.nlm.nih.gov/pubmed/28177691

Practicalities / sustainability / contraindications 

http://oncorenutrition.com/the-fast-and-the-furious/

Guides: http://oncorenutrition.com/intermittent-fasting/

https://store.oncorenutrition.com/collections/all

One of my favorite people, I could talk to her for hours. Cathy takes on big problems, lives life to the brim and then tries to do more, has a unique perspective, and dominates in all aspects in life.  Cathy is the Director of Prevention & Screening Services & RD Professional Practice Head at TBRHSC, Artisic Director of the Chaban Ukrainian Dance Group, a wonderful wife, and mother of two.  From career, to parenting,  to adventure, to the arts, to marriage, to health, I have so much to learn from Cathy and am lucky to know her. 

What you’ll learn:

• What to think about Cancer screening?
• What she's learned managing 100 people
• Her #1 tip for managing managers
• Biggest dietary misconception
• One of the keys to success in her marriage
• Her parenting tip to me
• Biggest challenge she's facing Why you should visit the Ukraine

I would love to hear your feedback on what you like and what you think I could do better.

a guy trying to figure life out,

Colin

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