Category Archives: Dietitian Advice

Diet and Mental Health – Part 2

Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_

As mentioned in Part 1 of this blog post, health is not just a physical concept but involves mental and social wellbeing too. Therefore, by definition it is impossible achieve a healthy status if one of these aspects is jeopardised for the other i.e. regardless of what you are eating, if your dietary choices are negatively affecting your mental wellbeing you cannot reach state of health. 

The mass of dietary information available from unreliable and unqualified individuals has made food choices complicated and confusing. We know that social media use is associated with an over-fixation on eating ‘the correct way’, which can have a profound impact on our mental health (2). It is unsurprising that what we eat can often have a psychological impact when words and phrases such as ‘bad’, ‘guilty pleasure’, ‘naughty’ and ‘clean’ are used to describe the food we eat. An overemphasis on our dietary choices as a measure of our self-worth is dangerous and likely to result in low self-esteem and can lead to eating disorders and other mental health conditions.

In a society where disordered eating behaviours have become normalised e.g. removal of food groups, calorie counting and earning the right to eat via exercise, it can be difficult to recognise (in ourselves or others) when our dietary habits may be having a detrimental effect on our mental health. Here are some signs to look out for:

  • Preoccupation with food
  • Anxiety at the thought of straying from your meal plan or last-minute changes to eating plans 
  • Avoidance of social eating and self-isolation 
  • Feelings of guilt or shame associated with food
  • Compensating by restricting/skipping meals 
  • Justification of eating with exercise
  • Basing self-worth on dietary choice
  • Chronic under-eating 

Take Home Messages 

  • Diet is an important part of our overall wellbeing and a poor diet can both be a contributing factor and consequence of mental illness. However, it’s important to recognise that mental illnesses have complex aetiologies and require multicomponent treatment strategies. Whilst diet may be a tool to improve symptoms, it is not a cure (note that in the SMILES study (1), all participants remained on their current treatment plan throughout).  
  • Nourishing yourself properly and eating regular meals are likely to have a positive impact on your mental health. Research suggests that the Mediterranean diet may be associated with a decreased risk of depressive symptoms. However, eating well when struggling mentally can be extremely difficult. Feeling guilt or shame due to being unable to prepare meals will only make things worse. It is so important to be kind and compassionate towards yourself-you are doing the best you can.
  • Our relationship with food should always allow us to be able to fully engage with other aspects of our lives. Being too anxious to attend a friend’s birthday meal will always be worse for your health than any food you would have eaten. 
  • Please remember you can have poor health as a result of your relationship with food without experiencing weight changes. Health is not just physical and weight should never be solely used as measure of our health. Feelings of anxiety, shame and guilt are never healthy, no matter what your weight and you deserve the support to overcome these feelings.
  • People often roll their eyes at the word ‘balanced’. It may sound boring and it’s not as eye-catching as celebrity endorsed dietary products but it’s the truth. Regular and healthy meals are likely to have a positive impact on our mental health. But equally, an obsessive and restrictive approach to our dietary choices will never result in happiness. 

Resources and Support 

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk 

References 

1. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).

2. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.

Diet and Mental Health PART 1.

Huge thanks for this guest blog post by Bethany Francois. MSc Eating Disorders and Clinical Nutrition. Find her on Instagram: bethany_laura_

The 13th-19th May 2019 is Mental Health Awareness Week. In the UK, mental health problems affect 1 in 4 adults and 1 in 10 children and up to 18% of NHS expenditure on treating and managing long-term conditions is associated with poor mental health and wellbeing1. Furthermore, depression is a major contributor to global overall disease burden and is the leading cause of disability worldwide2.

In the media, the term ‘health’ is often represented by an image of a thin person, with a low body fat percentage and visible muscles, but this definition couldn’t be further from the truth. Health is far more complicated than aesthetics and although often not visible, mental illness can have a serious impact on the overall health of an individual. The true definition of health is a state of physical, mental and social wellbeing-all of which can be impacted by our dietary choices. 

We’ve probably all heard the term ‘food and mood’, but what does this really mean? This article will take a look at current research and what we know about how our diet can impact our mental state.

What we Know about Food and Mood 

The best evidence we have currently, in terms of diet and mental health, is the impact of the Mediterranean Diet (MD). This diet is generally high in fruit and vegetables, legumes, beans, nuts, cereals, grains, fish and unsaturated fat sources such as olive oil and lower in meat, saturated fats and added sugar. The first causal data showing improvements in depression whilst following the MD were seen with the publication of the SMILES trial3. This was a 12-week randomised control trial, where individuals with depression either implemented the MD or received social support (control) alongside their normal treatment programme (such as psychotherapy or medication). Results showed a significantly greater improvement in depressive symptoms in the dietary group compared to the control, with 1/3 reaching remission at 12 weeks. The specific mechanisms by which dietary patterns may impact depressive symptoms is unknown, however, hypotheses include via inflammatory and oxidative stress pathways as well as the gut microbiota and the gut-brain axis. What I think is important to note is, the improvements seen in the study were independent of weight change. Often weight is overly relied on as a measure of health and I think it’s worth making clear that improvements in mood were not a result of weight loss. 

Eating Well with Mental Illness 

Severe mental illness is associated with poorer health outcomes and a significantly reduced life expectancy4. Reasons for this may include decreased income due to an inability to work, self-neglect, poor diet, the effect of some psychotropic medications and the effect of stress and trauma on the immune system. As well as exclusion and stigma within healthcare services and a reduced likelihood of seeking medical help5. In other words, those suffering with mental illness face significant health inequalities.  

Research into diets that may improve mental health is incredibly important. However, for somebody in the depths of mental illness, being able to eat an adequate diet and look after themselves in general can feel impossible. Social media is inundated with art-worthy bowls of oats, influencers spending hours making the perfect ‘Buddha bowl’ and green smoothies containing 10+ ingredients. For individuals struggling with their mental health, getting out of bed and showered can be a difficult task, let alone recreating these meals. To be bombarded with images like this and the message that this is what it takes to be ‘healthy’ (not true by the way), can exacerbate feelings of low self-worth and inadequacy. Please know that if all you can manage to do is reach for a sachet of instant porridge or put a piece of toast in the toaster, then you are doing great. Do not let social media or the wellness movement make you feel guilty for this. 

Tips for Eating Well when Struggling

Don’t complicate things 

Meals do not need to be complicated and require lots of ingredients. Try to aim for a portion of carbohydrates (wholemeal if possible) e.g. bread, pasta, rice or potatoes, a portion of protein e.g. meat, fish or veggie sources (beans, tofu, soy, eggs), a portion of fruit or vegetables and a source of fat e.g. cheese, olive oil or nuts at each meal. It can also be a good idea to freeze meals so that on difficult days they can simply be re-heated. 

For example, a simple and balanced meal could be wholemeal pasta with tuna mayonnaise, sweetcorn and grated cheese. 

Fresh isn’t always best  

Convenience is often seen as a negative connotation when it comes to diet. However, contrary to what we are often told by wellness influencers, convenience doesn’t automatically mean food is unhealthy. For example, it can be really useful to use frozen or tinned vegetables rather than fresh. These are not only cheaper but require less preparation and also means you don’t have to worry about not managing to use something before it’s use by date. Jarred or packet sauces can also help to enhance a meals flavour without considerably adding to preparation time. 

Food, family and friends 

Often the thought of socialising can be difficult when struggling with mental illness, resulting in isolation and further adding to feelings of low mood.  Although it can be difficult to reach out to those around us, food can be a useful way to interact with others, whether that is seeing a friend for lunch or preparing and eating dinner with family members. Social eating is also a key concept of the MD discussed earlier. 

Comfort  

When we hear the term ‘comfort food’, we automatically associate this with an unhealthy habit. We are told that comfort eating is bad for us, that emotional eating is something that should be avoided. Using food as our only way of coping with our emotions is not ideal, however, eating or cooking your favourite meal in an attempt to boost your mood is not something that should be frowned upon. Nourishment is an act of self-care, something some people with mental health problems struggle with. Often individuals feel underserving of things that make them feel good. Spending time preparing a meal you enjoy or perhaps used to have as a child can be an important way to show yourself some compassion and kindness. 

Resources and Support 

Mind: https://www.mind.org.uk/

Young Minds: https://youngminds.org.uk/

Mental Health Foundation: https://www.mentalhealth.org.uk/

Rethink Mental Illness: https://www.rethink.org/

Samaritans: https://www.samaritans.org

Beat: www.b-eat.co.uk 

References 

1. The King’s Fund and Centre for Mental Health (2012). Long-Term Conditions and Mental Health. The Cost of Co-morbidities. London.

2. Who.int. (2018). Depression. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/depression [Accessed 12 May 2019].

3. Jacka, F., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M., Brazionis, L., Dean, O., Hodge, A. and Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(1).

4. Chang, C., Hayes, R., Perera, G., Broadbent, M., Fernandes, A., Lee, W., Hotopf, M. and Stewart, R. (2011). Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE, 6(5), p.e19590.

5. Makurah, L. (2019). Health Matters: Reducing health inequalities in mental illness – Public health matters. [online] Publichealthmatters.blog.gov.uk. Available at: https://publichealthmatters.blog.gov.uk/2018/12/18/health-matters-reducing-health-inequalities-in-mental-illness/ [Accessed 12 May 2019].

6. Turner, P. and Lefevre, C. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(2), pp.277-284.

Nutrition Tips for a Plant based Diet

Eating a more plant based diet or switching to a vegan diet is definitely on trend right now and whilst normally I’d not be recommending you jump onto the lastest fad in terms of nutrition, this is one I do agree with. I spoke about this at Womens Health Live so thought it was time I blogged on it too.

We all need to be doing our bit to help our planet. Eating more plants, preferably those grown locally and not wrapped in lots of plastic, is one step in the right direction towards a more sustainable diet.

But are there any nutrition concerns with eating a vegan, vegetarian or plant based diet? Whilst it is well known there are health benefits there are also some health risks if you are not consciously eating certain nutrients.

CALCIUM

If you are reducing your dairy intake then you are also reducing your calcium. To help with this check that the milk you use is fortified and focus on non-dairy calcium rich foods being in your diet. The higher calcium content foods are chia seeds, fortified plant based milks, yoghurts and tofu.

An adult needs 700mg calcium per day, the requirements are higher if you are breastfeeding.

Non dairy calcium foodsCalcium mg
30g chia seeds178
1/2 pint Calcium enrich plant milk (rice, oat, soya)330-370
100g tofu350
1 pot Soya yoghurt150
1 tbsp tahini130
150g baked beans
80
2 slices wholemeal bread75
23 almonds75
1 large orange70
2 tbsp cooked greens70
30g cashews28
3 dried apricots20
3 tbsp cooked lentils25
1 tbsp kidney beans25
1 tbsp hummus12

IODINE

The body needs iodine to make thyroid hormones which play a key role in metabolism. Iodine is also needed in pregnancy for proper bone and brain development. There is an rise in iodine deficiency in the UK so it’s a nutrient to be mindful of.

Iodine deficiency is a potential concern if you do not eat meat, fish or dairy, so it’s important to be aware of other sources of iodine. Symptoms of iodine deficiency can include a swelling in the neck where the thyroid hormones are struggling to be made so the thyroid gland is on overdrive, fatigue and weakness, inability to concentrate/recall information, hair loss and dry flaky skin.

All is not lost, you can get your iodine in. Firstly, check your plant based milk as some are now fortified with iodine. Iodised salt is a good option (but not too much salt of course 6g max a day), seaweed limited to once a week and dried prunes are other options.

See this great food fact sheet on Iodine.

IRON

A nutrient that comes up a lot in terms of vegan and vegetarian diets. Can you meet all your iron needs on a plant based diet? Yes, totally but you need to plan things and be on the ball.

The iron you get in plant based foods is less readily absorbed by the body so you need more of it (1.8x). If you focus on eating iron rich foods daily and utilise some top tips you should be fine.

Iron Rich FoodsIron/mg
Baked beans1.4
Butter beans1.5
Chickpeas2
Kidney beans2
Tofu1.2
Dried Figs3.9
Dried Apricots3.4
Almonds3
Brazil Nuts2.5
Smooth peanut butter2.1
Hazelnuts3.2
Sesame seeds10.4
Sunflower seeds6.4
Broccoli 1
Spinach1.6

Including vitamin C with a meal helps with absorption. So having a glass of fruit juice or a smoothie with an iron rich meal will help. Keep your tea and coffee away from meal times as these contain phytates which prevent the iron absorption. Cooking, soaking and sprouting your nuts, seeds and beans can help with absorption too.

For more on iron check out the British Dietetic Association Factsheet.

VITAMIN B12

Mainly found in animal products with a few exceptions of fortified foods (fortified milks, nutritional yeast and breakfast cereals) this is one that you are going to need to take a supplement of if you stop eating animal products.

B12 is needed for nerves, for DNA production and for brain function as well as healthy red blood cell production. A pretty key nutrient. If you aren’t eating many fortified foods then you likely need a supplement which you can buy as part of a multivitamin and mineral over the counter. Chat to your medical team if you have any further concerns as there are also B12 injections.

So can you meet your nutritional requirements on a plant based diet? Yes with some careful planning and a couple of supplements. Remember you do not have to go fully vegan, eating a few days a week in this way has benefits.

The misconception of sugar.

By Rosie Jasper, student dietitian.

Many thanks to Rosie for this blog post. Carbs are a huge topic that I myth bust on and talk to clients about every week… so I know you will find this helpful.

 I don’t know about you but I’m sick and tired of seeing celebrities, Instagram influencers and articles in the media encouraging us to cut out key components of our diets, for example carbohydrates!
Apparently cutting out sugar and therefore carbohydrate sources is the key to losing weight according to some top celebrity influencers such as Jennifer Lopez, who was promoting a 10 day no sugar, no carbohydrate challenge!

Sugars are carbohydrates; when we consume foods containing carbohydrates (such as those previously mentioned), our bodies break these down into simple sugars called glucose. Glucose is an essential part of our diet as it provides our body, including our brain with the energy it requires to function on a daily basis.

Carbohydrate containing foods also contain essential vitamins and minerals that are required to keep our bodies working as effectively as it should; a lack of nutrients could cause lead to a decrease in energy, mood and brain function. A decrease in mood may mean that we’re more likely to opt for ‘comfort foods’, that are often high in fat, salt and refined sugar, which defeats the object of the aimed weight loss and the vicious cycle begins. Therefore, by cutting out all carbohydrates in the diet, it’s subsequently removing important nutrients our bodies need.

As suggested by the Eatwell Guide, a third of the food we consume should be starchy foods and carbohydrates should form 50% of our energy intake daily. It is recommended that when choosing starchy foods, we should opt for wholegrain varieties where possible instead of their white/refined varieties. 

Examples of wholegrains:

  • Wholegrain bread
  • Wholegrain pasta 
  • Brown rice 
  • Quinoa 
  • Bulgur 
  • Wheat based cereals e.g. – Wheat biscuits, Bran Flakes, muesli (opt for the no added sugar or salt variety) 

White/refined products have been processed and includes foods like white bread, white pasta and white rice. During processing many of their nutrients including B vitamins, vitamin E, fibre and minerals are removed; however, we need all of these nutrients as they provide many health benefits such as providing energy, having antioxidant effects, keeping our digestive system healthy and for maintenance of bone, teeth, nerves, hair etc. Wholegrain carbohydrates include the whole grain and therefore maintain its nutrients. 

Carbohydrates do not naturally lead to weight gain if eaten in moderation, however it is true that eating carbohydrates excessively can lead to an increase in weight. Carbohydrates have many important roles in the body and shouldn’t be avoided due to the fear of weight gain.

The important role of carbohydrates in the body:

  • Our main source of energy – starchy foods are broken down more slowly than free sugar products and therefore provides us with a steady release of energy during the day 
  • Brain function – the brain requires a steady glucose supply in order to function properly 
  • Wholegrain starchy products contain B vitamins, vitamin E, fibre and minerals 
  • Fruits and vegetables contain naturally occurring sugar and are packed with essential vitamins and minerals to help keep our bodies healthy 
  • Fibre is a type of carbohydrate and helps to keep our digestive system healthy, reduce likelihood of constipation, reduce cholesterol and a diet high in fibre has also been associated with a lower risk of bowel cancer 
  • A diet low in carbohydrates is associated with low energy levels, a decreased brain function and low mood 

It is recommended that we aim for 5 portions of starchy foods per day (260g).  To put it in to perspective this is what 1 portion of a starchy carbohydrate looks like. An easy portion guide is for your cooked carb to fill your cupped hand. There is no need to weigh foods out each time you cook then, just weigh it once and find something it fits in like a tea cup to use as a household measure.

  1. 50 dry oats/ ½ cup
  2. 2 wheat biscuits 
  3. 1 slice of bread
  4. 1 bagel 
  5. 1 naan bread
  6. 100g dry cous cous/ ¾ cup/approximately 2 hands full
  7. 75g dry pasta/ ¾ cup/approximately 2 hands full
  8. 75g spaghetti (when bunched together should be the same width as a £1 coin)

The portions of pasta, cous cous and oats may look small when uncooked but when water is added to them and they are cooked, they increase in size and weight. Then when vegetables and/or lean meat is added the portions will bulk out more to create a balanced dish. Meals should be based around starchy foods and adding extra ingredients will contribute to a healthy, balanced diet and increase the nutrient content. 

Fibre is also a type of carbohydrate that is found in plant-based foods, however it’s not absorbed or digested and therefore doesn’t impact our blood sugar levels, so doesn’t need to be classed as part of your daily CHO. 

Benefits of fibre:

  • Promote regular bowel movements 
  • Prevents constipation 
  • Helps to control blood glucose levels 
  • Reduces cholesterol 

Wholegrain varieties of starchy foods, fruit and vegetables especially when eaten with their skin on, e.g. – potatoes, apples and pears are all excellent sources of fibre. 

Meal ideas including their carbohydrate and fibre content

Meal Carbohydrate content (g) Fibre content (g)
50g oats made and water 80g berries 37 6
2 wheat biscuits 135ml semi skimmed milk  Sliced banana 53 5
Wholegrain bagel Low fat spread Salmon Cottage cheese  42 7
2 slices of wholegrain toast  Low fat spread  Peanut butter  31 7
75g dried pasta ½ tin of chopped tomatoes 80g peas 80g broccoli 20g spinach  64 16
Medium sized jacket potato  ½ tin of baked beans  30g cheddar cheese 63 15

T

Endorsement of faddy diets in the media should be taken with a pinch of salt (or sugar in this case!), remember a lot of these people have personal dietitians, chefs, personal trainers, photoshop and surgery to achieve their ‘dream bodies’ that you see online. Removing main food groups, even for a short period of time is not healthy or sustainable and shouldn’t be encouraged.

Eating for a healthy gut

PRE/PROBIOTICS – EATING FOR A HEALTHY GUT

Huge thanks to Melissa Kuman for this guest blog. Melissa is a Registered Associate Nutritionist. She can be found on instagram or check out her blog.

TOP FACT! Can you believe that the bacteria inside us can weigh up to 2kg and around 10% of what we eat feeds them?

In a nutshell, you can improve your gut by eating certain prebiotic foods and/or take probiotics. This is important as a lot of our immunity is dependent upon our gut (70% of the immune cells are located in the gut) and the microbes that live in it. Plus, 90% of serotonin, the happy hormone is produced in the gut. So basically good nutrition = healthy gut= serotonin and immune system= happy mind and body! Now lets get into this in a bit more detail… 

What is the difference between pro and prebiotics?

Great question! Well probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host FAO/WHO (2002). Where as prebiotics are certain fibrous foods (like banana, onions and oats) that help feed the bacteria.

What do probiotics do?

Probiotics rarely colonize in the gut, but rather intermingle with microbes there. As they go through the gut, they interact with gut cells, immune cells and food, giving their benefits. There’s so much research talking about the benefits of probiotics! Studies show that probiotics can improve digestive health and our immunity, including: decreasing antibiotic‐linked diarrhoea; improving resilience to infections; and improving digestion of lactose. There is even some early evidence of benefits in weight management and glycaemic control, depression and anxiety (Jacka 2017).

There’s no harm in taking probiotics but they’re quite expensive, so you could go for prebiotic foods that help feed the good bacteria like oats, bananas, onions, greek yoghurt and Kombucha.

It is important that the probiotics you are taking have research on the certain bacteria they include and that a health benefit has been proven. 

Prebiotics

Prebiotic foods are fibrous foods but not all fibrous foods are prebiotic, see table below. Overall, we need 30g of fibre a day and on average, in the UK, we are consuming just 18g. Both observational and interventional studies show that fibre influences gut health. As Burkitt, 1972 said ‘Dietary fibre has a role in the prevention of certain large bowel and other diseases present in Western countries’. Prospective studies also show it can decrease the risk of bowel cancer and insulin resistance in type 2 diabetes.

So how can we increase our fibre? Why not try eating more nuts and seeds and whole fruit and vegetables. For example you could add banana onto your morning cereal and make a big pot of vegetable curry with whole grain rice.

Interestingly Tim Spector, Professor of Genetic Epidemiology at King’s College London followed his son’s ‘Fast Food Diet’ to investigate the changes in the microbiota over the 10 day period. Tim ate 2 x Large McDonalds Meal [Big Mac/chicken nuggets, fries & Cola], 1 packet crisps & 2 beers for 10 days. After the 10 days, he lost nearly 40% of bacterial species with the good bacteria diminishing. Tim felt constipated, tired and grumpy. Not surprising really.

Other factors influencing the gut

‘Exposure to stress, both physical and psychological can modify the composition of the microbiota, due to increased permeability of the gut, allowing opportunistic bacteria to grow and potentially cause damage.’ Rhee et al. (2009).

It is important to put a bit of self-care into your day to reduce stress like running a bath and to be mindful when eating. Both these can help you have a happy gut.

Prebiotics Probiotic 
banana Yakult- Lactobacillus casei shirota
chicory Codex- Saccharomyces Boulardii
onion Actimel- Lacobacillus Casei
asparagus Mutaflor- Escherichia Coil Nissle
garlic Dicoflor- Lactobacillus rhamnosus
leeks Tempeh
Cocoa Kimchi
Flaxseeds Miso
Artichoke  Kombucha
Barley Live yoghurt
Oats Kefir
Apples Sauerkraut
References

Heiman ML, Greenway FL. A healthy gastrointestinal microbiome is dependent on dietary diversity. Mol. Metab. 2016;5(5):317-320. doi:10.1016/j.molmet.2016.02.005. 

Rhee et al. (2009) Nat Rev Gastroenterol Hepatol; 6: 306-314. 14.

Hooper B, Spiro A, Stanner S. 30g of fibre a day: An achievable recommendation? Nutr. Bull. 2015;40(2):118-129. doi:10.1111/nbu.12141. 

https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564

Jacka BMC Med 2017 ‘A randomized controlled trial of dietary improvement for adults with major depression’ 

FAO/WHO (2002) updated Hill et al (2014) Nature Rev Gastro Hepatol 

https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564


What is Orthorexia Nervosa and what can I do?

Orthorexia Nervosa is the newest eating disorder phrase on the block. It was devised by Steven Bratman in 1996, after he noticed a trend in his patients. Ortho means rich or correct.

Orthorexia = an unhealthy obsession with healthy eating. It can have elements of anxiety disorders and OCD with it.

Orthorexia Nervosa

Whilst there is an overlap here with anorexia nervosa and people with orthorexia may end up developing anorexia, there is also a big difference. Orthorexia is taking healthy eating to the extreme, it has an aspirational, wellness culture ideal associated with it. This means it is less about weight and more about purity and an ideal lifestyle. Social media has certainly heightened this and fuelled it. With role models who life perfect pure lifestyles of food, exercise and spirituality, it can seem as if that ideal is achievable and realistic. Striving to achieve it leads to feelings of failure and guilt.

The Bratman Orthorexia Self-Test

This is a test devised by Steven Bratman to help identify if you are at risk of orthorexia. If you answer YES to ANY of these questions you may be at risk.  I think it is useful test to read through and think to how much you identify with the statements.

(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)

(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

If you identify with anything in this post then I highly recommend that you reach out to your medical team, GP, a friend, a parent, a dietitian who works in this field like myself. You can also contact B-Eat.

Top tips for Orthorexia:

Here are some steps you can take to help combat Orthorexia, I suggest these are done with the support of a therapist and dietitian.

  1. Unfollow anyone on social media who fuels the thoughts of having to eat a pure diet/lifestyle. Or try a social media detox for a week.
  2. Focus on eating a variety diet. There are no wrong or right foods it is all about the balance and variety that you eat. Nothing is off limits. Nothing is wrong to eat. 
  3. Work with someone qualified in this area to redefine healthy for you. This may include food, movement, quiet space, social time, family time.
  4. Develop alternative coping skills. Can you see how food helps you feel in control and also makes you anxious? Using distraction after a meal and journalling your thoughts can be a good initial step.
  5. Write out a list of your food rules/beliefs. These need to be challenged.
  6. Only allow yourself to get your nutrition knowledge from someone with a minimum of a degree in nutrition    a registered nutritionist or dietitian.
  7. Stop tracking your nutrition. This may take time to do so start with doing it at one meal at a time. 

Should I count calories?

With all these calorie counting apps that are around and the pressure is better on us to look a certain way calorie counting can be an easy trap to fall into. Whilst it can be useful in some clinical instances I don’t think it is helpful for the general purposes of dieting.
 
Formally, a Calorie is a measure of the amount of energy required to heat one kilogram of water one degree Celsius. It was first used in engineering and physics, but eventually found its way into nutrition, we have Wilbur Atwater to thank for that.
 
Whilst it may make sense that tracking your calories, macros and nutritional intake will help you with your weight, overall health or dietary intake in fact it can have the opposite affect. It can lead to you becoming obsessed with counting everything you eat and feeling you have to stick within a certain number of calories per day. This will stop you enjoying your food and impact your socialising too.  What if you are out with friends in a cafe, a once a week occurance and the cake you is 450kcals plus a coffee 150kcals but you are only allowing yourself to eat 1500kcals a day? That cake is 1/5th of your calorie intake for the day, so is it worth eating it? Do you choose to eat it knowing you will be over your calorie limit for the day but that you have enjoyed your cake and time with friends, do you choose to eat the coffee and cake but then restrict your calories the next day to make up for it or do you decline the cake and feel deprived and as if you cannot join in?
 
Dietitian UK: Why I don't like calorie counting
 
I’d suggest that calorie counting can be a useful guide and tool for one off occasions but over the long term it has the potential to become obsessive.  Following a calorie restrictive diet does not make it a balanced diet. You could be getting all your calories from just fruit and veggies or be skipping a whole food group out.
 
There is also the question of is it even accurate? There is no way to accurately know the exact calories of the food apart from using a calorimeter in a laboratory. I don’t know about you but I don’t want to burn my food up each time! Yes this is worked out for us on food labels but that is a guide. A slightly different portion size, a different way of cooking, a slight change to a recipe and it will have a small affect. Does that matter? No not really as the calories are just a guide. 
 
Delving deeper,  your body will also not necessarily absorb all the calories that you eat. For some foods such as nuts for example, a proportion of the calories are excreted. So even know you may be eating  X  amount of calories you are not necessarily going to be absorbing all of those. Other foods can make your metabolism work harder, again showing calorie counting to not be a 100% accurate tool.
 
Personally I do not think counting calories on a daily basis is helpful and it can be a negative trap that you fall into. Instead look at the balance of your diet. Think about getting a range of nutrients in to your day and a wide variety of foodstuffs. Ensure you cook from scratch as much as possible, eating wholegrains and starchy foods, fruit and veggies, protein and healthy fats regularly. Enjoy what you eat, stop when you are full, eat when you’re hungry and be mindful of the food that you consume but not consumed by it.
 
 

How to eat for Brain Health

We all want a healthy, functioning brain for as along as possible. How we eat and drink really does impact it.
 
Studies on cognitive function and brain health show that overall a wholefood plant-based diet with a limited intake of animal and high saturated fat foods is the way forward. A big piece of research on this is call the MIND diet. Researchers at Rush University Medical Center in Chicago created the MIND diet –  this identified food groups and nutrients from the Mediterranean diet and the DASH diet that had been linked to lower risk of dementia.  Over 900 older men and women’s diets were analyzed and  people who stuck closely to a MIND diet were 53% less likely to be diagnosed with Alzheimer’s over the 4.5-year study period, compared with people who adhered least to the diet.
 
10 brain healthy foods identified by the MIND diet:
Green leafy vegetables
Vegetables
Nuts
Berries
Beans/lentils/soybeans
Wholegrains
Seafood
Poultry
Olive Oil
Wine (in moderation).
 
5 foods identified to not be good for brain health by the MIND diet:
Red meat
Butter and margarine
Cheese
Pastries and sweets
Fried or fast food
 
See you can see that a brain healthy diet really does go along the lines of a Mediterranean diet and general healthy eating. Other research on 447 adults showed that they performed better in cognitive tests after four years on a Mediterranean diet compare to a control diet.
 
Here is my meal plan published in the Daily Mail as part of Twinstitute for BBC2.
 
Let’s dig a bit deeper….there are some specific nutrients that have been highlighted as improving cognitive function.
 
B vitamins and folate :  shown to have a link to improved cognitive function, possibly by decreasing homocysteine levels. The evidence is not robust but suggestive. For example a study on elderly people with an increased risk of dementia showed that high doses of B vitamins slight brain shrinkage over 2 yrs.
Specifically looking at vitamin B12, cohort studies have suggested that dementia rates are highest in those with a lower B12 status.
 
Omega 3’s: the brain comprises 60% fat and is one of the fattest organs in the body. With such a high percentage of fat in the brain it’s no surprise that fatty acid’s are important nutrient. Specifically we need to know which fatty acids are important. The research we have suggests that it is the omega three fatty acid‘s to focus on. These have the potential to slow cognitive decline. Fit to focus on therefore our fish, shellfish, algae and the plant foods walnuts, linseeds and chia seeds.
 
Antioxidants including Vits A,C and E: Oxidative stress is one of the primary reasons are brain function declines. Therefore antioxidants are of upmost importance. This brings us back to the good old fruit and vegetables once again proving that we just need to be eating more of them. There has been some research looking specifically at berries and berry juice linking this to increasing memory scores, also the famous avocado for its vitamin E content. Similarly flavonoids found in red wine, dark chocolate, green tea can also help fight oxidative stress. There are some small scale, low power studies that look at blueberries, green tea and red wine that suggest these can be helpful. We have some limited research suggesting that nut intake (specifically walnuts) is associated with better brain function. This fits in with the Mediterranean diet, they contain antioxidants including vitamin E and so it makes sense.
 
Water: about 75% of the brain is made up of water therefore dehydration even in small amounts can have a big affect. Therefore staying hydrated is key.
 
So top foods to eat more of?
Oily fish
Green tea
Plenty of fruit and veggies
Green veggies
Colourful berries
Nuts, seeds including walnuts
Avocado
Wholegrains
Drink water
 
And then a little of the red wine plus dark choc makes a perfect combination.

 

 

Back to school lunches

Back to School. It’s that time again. My girl loves having packed lunch is and actually I quite like knowing what she’s having. But it can become repetitive, so one of our aims is to get inspiration and vary each of the food groups. We always go for a carbohydrate option, some protein, raw veggies and fruit as the basics. Then we add in a few extras such a yoghurt, a muesli bar or some cake. Of course one of the biggest factors is what your child actually likes! It’s no good giving them beautiful looking nutritious food if the won’t eat it.
 
I’d love to say that we spend time each weekend baking for lunches or that we whip up spectacular salads each week. Truth be told, packed lunches are made quickly after dinner whilst I tidy up the kitchen, usually before I teach Pilates and while the kids run around the house like crazies. It’s doesn’t have to be complicated, but balance and variety are 2 of the keys 🔑.
 
Carbohydrates: Bagels, wraps, pitta, bread, baguette, crackers, rice, pasta, couscous.
 
Protein: tuna, cheese, ham, salami, peanut butter, cottage cheese, cream cheese, eggs, turkey, chicken, hummus.
 
Raw veggies: cucumber, 1/2 avocado (with a spoon), tomatoes, peppers, carrots, gherkins, olives, sweet corn, peas, mange tout, sugar snap peas, mushrooms.
 
Fruit: melon, apple, berries, satsumas, pear, grapes.
 
Extras: malt loaf, yoghurt, cheese portion, popcorn, cheesy biscuits, cereal bar, dried fruit bar, homemade flapjack.
 
 
 
 
 
Sandwich Filling Ideas:
Cheese and pickle 
Hummus and ham 
Egg and hummus
Salami and cream cheese
Avocado and cream cheese
Avocado and egg salad
Tuna and mayo
Mashed chickpeas, avocado and mayo
Peanut butter
Nut butter and banana
Cheese and marmite
 
Alternatives to Sandwiches:
Sushi (make a batch and use it for 3 days)
Pasta, rice or couscous  salads
Pizza Whirls – use your choice of toppings
Picky Box – crackers, cheese, veggies and let them make their own lunch at school
 
I’d love to hear your ideas! I share packed lunches regularly on my inst-stories so do give me a follow
 

Should I eat more plant based diet?

What are the benefits?

Plant based diets (PBD’s) are better for the environment and provide a more sustainable way of eating. There are also health benefits due to eating more plants altering the nutritional profile of your body. 

PBD’s tend to be lower in saturated fat due to less meat. They usually contain higher amounts of fruit and vegetables which means higher fibre content for digestive health (those bowels) and a greater range of antioxidant plus phytochemicals. 

The inclusion of wholegrains provides B vitamins and fibre, beans/pulses for soluble fibre and these help with blood sugar control, soy products provide phytoestrogens that can be helpful in the menopause plus nuts and and seeds that are packed with antioxidants and micronutrients.

Some specific health benefits:

Research shows us that PBDs can lead to lower levels of total and low-density lipoprotein (LDL) cholesterol levels. This is going to reduce the risk of cardiovascular disease.

 Also improvements can be seen in serum glucose levels which helps in overall health and in type 2 diabetes control. 

There has been shown to be a lower level of overall inflammation in the body. These factors combines are thought to contribute to a reduced risk of chronic diseases. 

Does this mean we should all go vegetarian/vegan? Well not necessarily. What I do think it means is that having a greater emphasis on eating plants sources of food is helpful and healthful. As with all ways of eating there are many ways to do it, so the benefits you see on paper will depend on how you actually approach this way of life. This in my mind is about adding in plant foods more than taking things away. 

Will I be missing out nutrients?

It is perfectly possible to meet your nutritional needs on a PBD. However you will need to be more intentional about it. Planning and being thoughtful about some key nutrients plus a couple of supplements will ensure you get all your body needs.

Protein : It can be easier to get protein from animal sources. However this doesn’t mean we shouldn’t be eating plant proteins! Most people in the UK are exceeding their protein needs, especially with the focus on protein in so many snack foods right now.  When calorie needs are met it is more than possible to meet your protein requirements on a PBD. However it is a good idea to vary your protein sources through the week so that cover all those essential amino acids the body needs.

  • Mycoprotein, soya protein and pea protein 
  • Beans and lentils
  • Nuts and seeds 
  • Tofu
  • Eggs and dairy (if these are eaten)

Iron : The recommended daily amount of iron for vegetarians is 1.8 times higher that for non-vegetarians, as iron which comes from plant sources (non-haem iron) is less efficiently utilised in our body than iron which comes from animal sources. Eat iron rich foods daily and all should be well. 

  • Iron fortified breakfast cereals
  • Beans
  • Nuts and seeds 
  • Wholegrains 
  • Dried fruit 
  • Green leafy vegetables 
  • Yeast extract 
  • Eggs, fish and poultry (if these are eaten)

johnny-mcclung-702726-unsplash

Calcium: one of my hobby horses, as I like to look after my bones. Calcium can be lower on a plant based diet but there are plant foods that will help those bones stay strong. Check your plant based milk is supplemented and get on those leafy greens. Some studies show a lower bone mineral density in those not eating dairy, so this is definitely a nutrient to think about. 

  • Fortified dairy alternatives (like: soya or nut milks and yoghurts)
  • Fortified juice drinks
  • Green leafy vegetables
  • Dried fruit
  • Tofu
  • Beans, lentils and chickpeas
  • Nuts and seeds
  • Bread

Photo by rawpixel on Unsplash

 

Vitamin B12: as this is mainly found in animal products it is one of the nutrients you may end up lacking. It is found in yeast extract and most multivitamins/minerals.

Omega 3 : mainly talked about as being in oily fish but also found in seaweed, linseeds and walnuts. If you know you won’t take in many of these foods you could take a supplement.

  • Seaweed (not recommended more than once per week) 
  • Chia seeds, linseeds/flaxseeds, hemp seeds 
  • Rapeseed oil
  • Walnuts and walnut oil
  • Soybeans and soybean oil
  • Tofu
  • Spreads and breads which are fortified with omega 3
  • Oily fish (if this are eaten)
  • Eggs and dairy which are fortified with omega 3 (if these are eaten)

Photo by rawpixel on Unsplash

Iodine: highlighted in some studies as a nutrient that can be low on a PBD, but also on a meat eaters diet too!

  • Iodised salt
  • A limited amount of fortified dairy alternatives (e.g. specific brands of oat milk) 
  • Seaweed (but this is not recommended more than once per week) 
  • Dairy products and seafood (if these are eaten)

Selenium: mainly found in Brazil nuts so not necessarily a problem on  PBD but a good one to be aware of.

  • Brazil nuts 
  • Eggs and fish (if these are eaten)