Category Archives: Nutrition Education

IBS and the Microbiome

Priya regularly writes for Network Health Digest (NHD Magazine), here is her latest article.  The microbiome is such an up and coming area with so much we are still to research and find out.

Click the link below for the article.

Issue 126 fermented foods IBS and microbiome

Messy Home, but Top Nutrition Tips.

When the BBC ask if they can come and film you in your home what do you do? 

Firstly –  Say Yes.

Secondly  – Flap about in panic at the state of your house and kitchen. People who know me well will know that my kitchen is rarely tidy and usually full of our home life. Pictures from the kids, plates ready to go in the dishwasher, toys on the floor. ARGH. 

Thirdly – Wonder what on earth they are going to ask your to talk about. Oh well, that can wait, I have a house to tidy.

So, when the crew turned up, their first statement was “Wow lovely kitchen, it’s very lived in” which I read as “It’s certainly not pristine and clean”. SIGH. I did tidy, I promise. 

Then when they ask to look in your freezer…. OH MY GOODNESS. Really? I can’t say No, but I didn’t see that coming. My freezer is outside the house and definitely NOT TIDY or video viewing. 

So you have been warned, this is a “lived in”, mum with 3 kids, messy life video. Or maybe I should say it is REAL LIFE.

Love to know your thoughts. 

 

 

Reduce your risk of breast cancer.

Today, a report entitled “Diet, nutrition, physical activity and breast cancer” came out from the World Cancer Research Fund. When you are a dietitian, this kind of thing excites you – why? Well it included a good review and analysis of the research on breast cancer. Looking at 119 studies worldwide and over 250,000 women, the evidence has been categorised into strong and limited evidence. 

Here is a little summary and a vlog I did as a Facebook Live.

 

Diet:

There is strong evidence for alcohol increasing the risk of breast cancer. The report states that a glass of wine or small beer a day (equivalent to 10g alcohol content) is linked to a 5% increase in breast cancer risk in pre-menopausal ladies and a 9% increase in post-menopausal ladies. We all know alcohol is a toxin for the body, I’m not sure I’m ready to give it up entirely though. Other evidence from the Mediterranean diet tells us that red wine can be good for heart health. So I think the take home message here is to stick to small amounts and to have plenty of alcohol free days too.

Limited evidence was found for

  1. Eating non starchy vegetables (broccoli, mushrooms, peppers, beans, green leafy veg etc).
  2. Eating catotenoids – orange and red fruit  (orange peppers, sweet potatoes, tomatoes, carrots) and veggies plus dark leafy greens.
  3. Having a high  intake of dairy foods. Increasing these by 200g led to a 5% decreased risk. 

Exercise:

We all know we should be getting active. The research supports this showing exercise that increases your heart rate was helpful in reducing the risk of breast cancer. Swimming, running, fast walking, cycling – anything that gets you a bit out of breath.

A strong link was found with weight. Being a healthy weight could prevent 16% of cases in the UK. 

Having Children:

Pre-conception and pregnancy are key times for getting on top of your eating as what you eat will help lay the foundation for baby. Your diet at this point can influence your baby as an adult, Birthweight was found to be a predictor or later growth and being a healthy weight is linked to reducing the risk of so many chronic diseases including breast cancer.

Having children reduces your risk as does having a pregnancy before you are aged 30 yrs. 

Finally breastfeeding was found to reduce the risk for you as a mummy.

Lots of great take home tips that centre around eating well and being active. We already knew that waa a good idea, now there is more proof. 

Coeliac Disease: The Facts and Frustrations.

Coeliac Disease is often referred to as a gluten intolerance or allergy. Which makes sense as the treament for it is to follow a strict gluten free diet. However it is actually an autoimmune disease, which means it is a disease in which the body produces antibodies and  attacks it own tissues. In the case of coeliac disease there are 3 antibodies produced in response to gluten and these can be tested for: 

  • anti-tissue transglutaminase (tTG) antibodies
  • endomysial antibodies (EMA)
  • deamidated gliadin peptide (DGP) antibodies

The immune response leads to damage to the villi in the intestinal linings. The villi are where nutrient absorption occurs, they produce enzymes that help digest carbohydrates and proteins, they absorb nutrients into the capillaries around them so the nutrients can then go to the blood stream. Destruction of the villi means that there is firstly less surface area available, so less absorption of nutrients occurs. Secondly the enzymes are not there to digest the food. This may mean that you eat food but just don’t absorb it, instead you excrete it, leaving you lacking nutrients and suffering with digestive symptoms such as abdominal pain and diarhoea. Over time this can have a major impact on your body and be very confusing. If you know you are eating a well balanced diet but you are showing symptoms of nutritional deficiencies or digestive problems this is definitely the moment to see your GP and get advice.  

 

The treament for Coeliac disease is a lifelong strict gluten free diet. This is not a fad diet, or a “choose to be gluten free for a while diet” but a gluten free diet that has to be followed to the letter. I’m not a coeliac but I can’t eat wheat, it won’t harm my villi but it can cause me to be unwell for a few days and is linked to a some digestive issues I have. When I eat out I have to double check and often I find things on my plate than I can’t eat! This can be very dangerous for a coeliac. Even a few crumbs of gluten can cause problems. When on a gluten free diet the villi should recover and nutrients should start be be better absorbed. 

What can be frustrating is that Coeliac disease is under-diagnosed and so there are people with it who have no idea. The rise in gluten free diets also means that there are more gluten free options around, but sometimes it can take aware from the severity and the need for a strict gluten free diet. I’ve seen quite a few places advertising gluten free foods with statement such as “we cannot guarantee these foods are made in  an area free from gluten”. So gluten free food that is not suitable for a coeliac! 

Coeliac Awareness Week is a great time to spread the word and to get people knowing more about these issues so please share and get talking.

Is having a cuppa soon to be history?

Britain has historically had a love affair with tea. In fact it was the British who introduced it to India in order to compete with the Chinese production of it.  According to the recent Cost of Tomorrow report, people between the age of 50 and 64 spend £31.20 on tea annually, but for millennials this drops to £10.40. So are we drinking less tea? If so what are we drinking instead?

© Tatjana Grinberg | Dreamstime Stock Photos
© Tatjana Grinberg | Dreamstime Stock Photos

Currently, the average household spends £1,475 on tea over a lifetime and  £2,585 on coffee over the course of their lives, so coffee has definitely overtake in the hot drink department. Soft drinks have definitely increased with smoothies, fruit juices, fizzy drinks and milk shakes being more popular now. All of these contain more calories and sugar than your average cuppa. 

Sadly, coffee shop culture means we spend a lot on the treats that go with that cuppa. The Cost of Tomorrow report suggested we spend £11,520 on cakes, buns and biscuits to complement our favourite hot drinks; 4.2% more than we spend on fresh fruit (£11,034) over a lifetime. 

So the take home message on National Tea Day 2017? 

  1. It is perfectly safe to drink 2-3 standard caffeinated cups (400mg) of tea or coffee a day. If you are concerned about the caffeine then try herbal/fruit tea or decaff versions.
  2. Tea contains polyphenols and there are health benefits stated for dental health, diabetes, heart disease and cognitive function. 
  3. Tea is a natural sources of fluoride so has benefits for dental health.
  4. The polyphenols in black tea are thought to be responsible for the links between tea and reduced risk of cardivascular disease. 
  5. Soem studies show a reduced risk of diabetes with 2-3 cups of tea a day (presumably tea without sugar).
  6. With less calories and sugar (if you don’t add it by the spoonful) tea is a good option to be drinking, better than a fizzy drink. 
  7. Tea does hydrate you. Studies have shown it to be equivalent to water!
  8. Tea provides calcium (from the milk), manganese and potassium as well as flavanoids which are potent antioxidants. 

Now who is for a cuppa?

Chocolate: the good, the bad and the portion. 

Chocolate originates from cocoa beans from the Theobroma cocoa tree. The beans are fermented, ground and separated to cocoa butter and powder. 

Cocoa has been used for many used as a medical aid. It is rich in flavonoids which have potent antioxidant functions. These include being :

  1. Anti-inflammatory 
  2. Helping blood vessels to dilate so helping reduce blood pressure. 
  3. Increasing insulin sensitivity 
  4. Decreasing the risk of atherosclerosis. 
  5. Positive affect on cholesterol: increase HDL (the good guys) and decrease LDL oxidation. 
  6. A reduction in cardiovascular risk factors. 

However we don’t eat cocoa on its own. Milk chocolate has a variety of other ingredients added in. It is high in energy, free sugars and saturated fat. One point to note here is that not all chocolate is equal. The darker the chocolate (higher % cocoa) the higher the flavanol content and the less sugar. White chocolate is not actually chocolate as it doesn’t contain any cocoa powder or cocoa solids but cocoa butter mixed with milk and sugar. The chocolate in eggs can be of a lower quality with lower flavanols and mineral content so watch out! Check the cocoa solids. 

An easy way to remember a portion of chocolate is “the size of your index finger”. That is about 2 squares for a child and 4 squares for an adult. 

© Magdalena Żurawska | Dreamstime Stock Photos

So chocolate is something that can definitely be enjoyed as part of a balanced diet. The key is thinking about the quality of the chocolate you are having and the portion size. Space that chocolate out and enjoy it, rather than gorging on it all in one go.  Savour it and eat it mindfully, 

 

Eating Mediterranean to beat the bills

One thing I love about nutrition and dietetics is the conundrum that is complex science that usually translates down to simple health messages. The Mediterranean diet is a great example. The science behind how it all works on the body is long winded actions of  polyphenols and antioxidants. However you don’t really need to worry about all of that. What we really want to know is:

  1. What does the summary of the research say about the health benefits.
  2. How can I translate that into my everyday life.
  3. What do I need to eat and how often. 

A team from Ghent University analysed the research on the Med diet, looking at 8 meta analysis and 10 cohort studies, they founds some pretty huge results.  If we convinced 2% of the UK to eat a more Mediterranean diet it could lead to a saving of £1 billion. Increase this to 10% of the population eating more plant foods, olive oil, soya, nuts and seed would potentially save £5 billion.  Reductions through a decrease in hospital admissions, doctors bills and keeping people healthy to work more days a year. Isn’t it amazing that such simple changes can lead to such huge savings.

A summary of the research showed that a Med diet can:

  • Reduce diabetes risk by 26% 
  • Lead to a 42% reduction in CHD in men and 25% in women
  • 37% reduction in stroke
  • 33% reduction in breast cancer
Med diet reduces disease risk Women Men
Colon cancer

40%

44%

Stomach cancer

42%

29%

Lung cancer

25%

23%

Diabetes

28%

28%

Stroke

36%

9%

Prostrate cancer  

30%

Postmenopausal breast cancer

36%

 
coronary heart disease

4%

4%

Soya beans, soy products and tofu contain phyto-oestrogens. These are bioactive substances in plant foods that have naturally occurring oestrogen activity. Photo oestrogens have been widely studied and there is evidence they can help with menopausal symptoms such as hot flushes and night sweats. Some bone sparing effects in osteoporosis and they may reduce the risk of certain cancers. They can reduce the risk of heart disease due to their cholesterol lowering effects. Eating more soy can displace the saturated fat intake from meat. 

 

 So the plan from this for you? 

Eat more fruit and vegetables – aim for over 5 portions a day if you can and include soy products in your eating (25g a day = 1 portion).

Eating to help in Chronic Fatigue

Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (M.E.) is one of those areas that I didn’t ever set out to work in. It just came along and found me. An Occupational Therapist who I had worked with previously approached me and asked if I would be interested in joining their team. With every bit of work I take on I have to ask myself – is my heart in this. If the answer if No then I don’t accept it. Now my heart was very much in this, as years previously, as a teenager, my mum suffered from CFS. She went from being a very bubbly, energetic, full of life person, to someone who had to rest 95% of the time. Thankfully, she recovered and now lives life almost to the same capacity as before, perhaps with a bit more caution! So, working with this client group holds a special interest for me.

I work with South Coast Fatigue and Associates, a team who are full of care, in fact the most caring bunch I’ve worked with. Plus we have the most amazing Christmas meal ever! I don’t get to hang out in the office often but I feel very privilieged to be part of the team and to be trusted to give advice to the clients. This is a very vulnerable area, some people are literally bed-bound, others are able to do small day to day activities but there is a lot of loss, resting and frustration around. Everyone wants a magic fix and the internet abounds with diets that will cure, magic supplements and herbal remedies. This is where I come in.

I work on a 1-2-1 basis with people giving advice on IBS, healthy eating, weight loss, weight gain, special diets – whatever is needed. I also run a monthly nutrition group, which is usually a very interesting couple of hours due to all the questions people bring. So here are my top 5 tips on eating well for energy.

1. Eat regularly. Skipping meals is not a good idea. The body needs a energy to heal and to function. I completely understand that the nature of CFS means that sometimes people are too tired to prepare a meal, so this is where the planning comes in. Having instantly accessible healthy snacks that can be grabbed.

2. Focus on the balance and the portion control. I encourage people to fill their plates with 1/2 vegetables and then 1/4 lean protein and 1/4 wholegrains or starchy foods. If you are less active than before, then portions will need to reduce. This can be a tricky to work out, so I do sometimes recommend a portion plate.

3. Plan, plan and plan. Build up a folder of meals, recipes and snacks. Some that are fast to make (beans on toast, ready meals, tinned soup and a roll, hummus and pitta, peanut butter and rice cakes), some that take more preparation (jacket potatoes, fish cooked in a parcel, stir fry, pasta dishes) and some you can get help to bulk cook (slow cooker meals, bolognaise, fish pie). Then do an online shop and stock up the cupboards with easy meals.

4. Use the freezer. Frozen veggies and fruit are very nutritious and quick to use. They save peeling and chopping, which saves you energy and time. There is now so much variety in frozen vegetables, it isn’t all peas and sweetcorn. Bulk cooking meals and freezing them is also so useful so there is a stash of good food for days you need it.

5. Step away from the sugar. Although you may feel like you need a sugary boost to keep your energy levels high, that can lead to a sugar peak and crash effect. Instead fuel your body with low glycaemic index foods that will provide sustained energy over the day. Foods like oats, wholegrain bread, bulghar wheat, yoghurt, hummus, apples and nuts.
See this link here for a fact sheet and here for a table of the Glyacemic Index of Foods.

Vitamin D for under 4’s

I’m writing this post after a few people have asked me if they should be giving vitamin D to their children. The answer is Yes. In 2016 the guidance on vitamins D changed and now the recommendations are that everyone in the UK takes 10 mcg a day. Especially in the autumn and winter months.

Usually as a dietitian I would encourage people to get their nutrition from food first, but with Vitamin D it is hard to meet the bodies’ requirements through food and UVB rays alone.

The original Dietary reference values for vitamin D were set back in 1991 by COMA. It was thought then that people aged 4-64yrs would synthesise enough vitamin D in the summer months to cover their winter needs. A review by SACN in 2016, found this not to be the case. If you live in the UK it will come as no surprise to know there are not that may days in the year that we have enough sun at the right position for this is happen. During autumn and winter we definitely do not have the sunlight we need to make vitamin D. Those with darker skin tones may also not get from sun exposure in the summer so taking a supplement all year round is a good idea.

Bones, Bones, Bones.
Low vitamin D is linked to increasing the risk of rickets in children. In adults, vitamin D is shown to reduce fracture risk and falls in those aged over 50yrs living in the community. There is also a beneficial effect of vitamin D on muscle strength and function.

Vitamin D advice for children under 4yrs:

Children aged 1-4 years should take 10 mcg per day, all year round.
Babies should take 8.5-10 mcg per day as a precaution unless they are having more than 500ml of formula milk a day, as this is fortified.
Data for children under 4 yrs is limited so it is hard to know how much vitamin D should be recommended, SACN have been cautious and set a safe intake of 10 mcg.

You can buy Vitamin D supplements in liquid form from supermarkets, Boots, Superdrug and pharmacies. Good examples are Abidec and NHS Healthy Start vitamin drops.

 



Disclaimer: I was sent some Vitamin D supplements courtesy of SuperDrug, which has not affected my views in the post above.

Restriction and Eating Disorders.

Having an eating disorder can make you feel invincible, it can sometimes be hard to see how being underweight and restricting your food intake can cause physical health issues, but there are so many knock on effects of being a low weight. When your body is not getting the nutrition that it needs it can lead to knock on consequences for your bone health as the minerals are take from yoour bones for use elsewhere in the body. Another big one is  muscle wasting throughout the body including your heart. Your brain will start to conserve energy and shut down some less vital functions, brain power, memory, reactions and concentrations can be impaired. The blood may not be pumped as well around the body leading to cold extremities. Mood swings and poor sleep are common. Skin, hair and nails will start to suffer. I’ve had some people who have lost their hair in large clumps.  Less of a physical symptom, as your body craves nutrition your mind becomes increasingly pre-occupied with food, recipes, the next meal, it can become all consuming. 

Dietitian UK: Restriction and eating disorders infographicIf you or someone you know is struggling with restricting their eating, it can be helpful to think through the physical affects on the body and use these as a motivation to focus on slowly eating more. If you need help with this, seek out an eating disorders therapist, dietitian or see your GP for signposting. 

I work with people with Skype, so get in touch if you need support.