By Charlotte Foster BSc (Hons), MSc, RD

What is Intermittent Fasting?

Most diets focus on what to eat… but intermittent fasting is all about WHEN you eat!

With intermittent fasting, you only eat during a certain time period. This can be done in a number of different ways. The most common ways to do this is the 5/2 method where you calorie restrict on 2 days (usually 2 consecutive days) and then eat a balanced diet on the other remaining 5 days or the week, or the 16/8 method, whereby you fast for 16 hours and only eat during an 8-hour window throughout the day. Some people even go as far as a weekly 24 hour fast, but I would never recommend this! This basically means you will be eating dinner one night, and then not eating anything else until dinner the next day.

Many people argue that our bodies are practically made to survive and thrive by partaking in intermittent fasting, given that when humans were hunters and gatherers, our bodies evolved to go without food for many hours or even days. Whilst our bodies are indeed capable of doing this, now that we are no longer living in the prehistoric age – this isn’t exactly necessary!

However, it is true that a lot has changed since then! It is no longer so easy to maintain a healthy weight. 50 years ago, we didn’t spend our days working from home (30 seconds away from the fridge!), or spend our evenings sat down watching TV for hours. Being less active, as well as eating high calorie, fatty and sugary foods has made it more difficult to keep weight off.

Research has shown that intermittent fasting could be an effective way to combat extra calories and less activity – but I must stress that it is not the only way!

How Does it Work?

Whilst it is absolutely not unhealthy to eat 3 meals a day plus snacks, if you aren’t in a calorie deficit then you might be struggling to lose weight.

Even though there are lots of different ways that you can engage in intermittent fasting, they all work by the same principle. When you are consistently eating without enough activity, your body just burns the calories you have eaten. Therefore, intermittent fasting works because after going hours without food, your body will have already burnt through all of the calories from the last time you ate, so will start burning through your fat stores instead, in order to find energy.

What Are The Benefits?

Intermittent fasting has been proven to lead to weight loss. This could be to do with the fact that once your blood levels of insulin drop, it is easier for your body to burn fat. This could also be because you are eating within a smaller window throughout the day, so consuming less food in general (calorie deficit). Whilst there are many other bold health claims made, such as increased brain function, cancer prevention, reduced inflammation and cellular repair… there is little to no evidence suggesting that any of this is true. The only benefit that has been seen in clinical trials is weight-loss.

What Are The Negatives?

During trials, intermittent fasting has one of the highest dropout rates of all the different clinical diet trials. This is not surprising, because it really is so hard! Whilst it might sound easy to only eat within an 8-hour window, or just have 1 big meal per day, in reality this is much harder than you think. Symptoms that are commonly reported include headaches, faintness and nausea.

Is It Effective?

The reason intermittent fasting tends to work well for weight loss, is that by removing 1 or 2 meals per day, you actually put yourself into a calorie deficit.

It is so important to stress that intermittent fasting is NOT for everyone! Whilst it is proven to aid weight loss, the same weight loss can be achieved in easier ways. I absolutely would recommend sticking to your 3 meals a day and focusing on the nutritional content. If you are looking to lose weight, you should start engaging in label reading and opting for lower calorie options where possible. Instead of missing out meals, make sure you have a balanced diet full of wholegrains, fibre, lean proteins and healthy fats! In my opinion, this is the most sustainable way to lose weight.

If you are the type of person who can easily skip breakfast and just have a herbal tea, it might be right for you but if you are the type of person who feels faint and can’t concentrate after skipping breakfast… this is not the approach for you!

You should always consult a medical professional if you’re looking to engage in intermittent fasting, but if you have diabetes, a history of disordered eating, digestive problems or are pregnant/breastfeeding, I would stay well away from it. 

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If you are looking on advice for losing weight or want to speak to someone before starting intermittent fasting, you can always drop me an email, or fill out a contact form here.

By Charlotte Foster BSc (Hons), MSc, RD

What Are Multivitamins?

I’m sure we all know the basic concept of a multivitamin pill, as it’s pretty likely you have taken them before. Put simply, multivitamins are just supplements that contain different vitamins, minerals and sometimes other ingredients such as green tea or cranberry extract. Given that there are no regulated standards for what constitutes a multivitamin, their nutrient composition can vary massively by brand. Most of these pills are taken once or twice a day, and are available in the form of tablets, capsules, gummies, powders and liquids. Nowadays, you can really buy a multivitamin anywhere, even in very high doses.

Can vitamin pills cover for a bad diet?

This is a really common misconception, as multivitamins are not capable of compensating for a bad diet! There is so much more to your diet than vitamins – think of fibre, protein, prebiotics and healthy fats… You can’t get these through a vitamin pill, yet they are essential for a healthy gut. In my view, most healthy people can easily get all the vitamins and minerals they need through eating a balanced diet, and this is much more likely to ensure good health in the long run!

Have you heard of hypervitaminosis?

We live in a society where we can learn so much from social media and the internet. However, the problem with this is taking advice from people who aren’t medical professionals! When you read one article that tells you to take this multivitamin for beautiful skin, that multivitamin for your immune system and that OTHER multivitamin for gut health, you end up mixing quite the concoction of vitamin pills! Unlike medicine, multivitamins do not list side effects, recommended doses and interactions with other pills, so it is easy to end up taking too many.

Hypervitaminosis is a condition that occurs when a person has too much of a particular vitamin in their body. This can happen if you have too high of a dose or take too many different multivitamins. This is known to often occur with vitamin A, and sometimes vitamin D. It is worth knowing that we practically never see cases of hypervitaminosis from diet alone, and this is almost exclusively caused by excessive amounts of supplements! Unfortunately, it can cause some really nasty symptoms such as vision problems, skin problems and bone pain – so it’s really best to avoid this!

When should you take a supplement?

Whilst I don’t believe that you need to waste money on multivitamins if you are healthy and eating a balanced diet, there are several instances where I recommend you take a supplement. The Department of Health and Social Care recommends certain supplements for some groups of people who are at risk of deficiency.For example, if you are anaemic, you will benefit from taking an iron supplement due to your deficiency. Equally, there is evidence to suggest that vegans and vegetarians are often lacking in certain nutrients such as vitamin B12, calcium, iron, omega-3 fatty acids and vitamin D (due to the absence of animal products in their diet), so will also benefit from supplementing these nutrients. There are also other cases such as very low-calorie diets that could benefit from vitamin/mineral supplementation (however you should always consult with a medical professional if this is the case for you).

The one vitamin pill I do recommend for everyone to take is vitamin D! Everyone during the winter months should take a supplement. Your body cannot produce enough vitamin D due to lack of sunlight. In the UK it is recommended that all people over the age of 1 take 10 micrograms / 400 IU of vitamin D. As vitamin D is fat-soluble, it is best to take your supplement with meals or a source of fat to increase absorption. It is worth noting that in many countries, 10 micrograms/400iu s is considered too low for adults with the upper limit being 10x that for adults. It is worth chatting to a Dietitian or your GP for more guidance about doses if you feel you need more.

What is my view?

In my opinion, supplements should be taken to correct a deficiency. Whilst they can be essential for some people, if you are eating a healthy diet with no underlying conditions, managing foods from all the food groups then it is unlikely that you need to be taking a multivitamin (except vitamin D). If you are taking vitamin and mineral pills, then make sure you don’t exceed the recommended nutrient intakes (RNIs).  High end vitamin and mineral pills can end up costing nearly £30 a month and will most likely contain exactly the same as an own brand multivitamin – so read the labels and don’t fall for marketing ploys. Another thing to think about is how different vitamins are metabolised. The fat soluble vitamins (vitamins A,D,E & K) are stored in the liver whilst vitamins B & C are water soluble which means that the body cannot store them and will excrete them out in your wee! So with certain vitamins (B vitamins and vitamin C) if had in high doses, you are basically paying for expensive urine! 

Not forgetting that there are exceptions such as anaemia, vegan diets and low-calorie diets which do require supplementation! If this is the case for you, it is important to consult with a dietitian to make sure you are getting a balanced diet full of all the nutrients you need!

If you are worrying that you aren’t filling your diet with the correct vitamins (or are having too many!) do get in touch! Drop me an email at [email protected] or complete a contact form through our website.

By Charlotte Foster BSc (Hons), MSc, RD

What Exactly Is Organic Food?

The main difference between organic and non-organic food has to do with how it is produced. Whilst the standards do vary internationally, in the EU organic producers are obliged to comply with a set of regulations in order to classify their product as organic. These regulations include ensuring livestock is free range, there is limited use of naturally derived pesticides, no GM ingredients, no antibiotics, no growth stimulating hormones and no artificial colours or preservatives.

Organic vs Non-Organic

There is evidence to show that thanks to the EU regulations, organic food does indeed show lower levels of pesticide residue, antibiotics and hormones than conventionally produced food. Worries about the effects of these unnatural substances on the human body are normally what lead people to opt for organic produce.

Visually, there is often not much difference between organic and non-organic food, but you might sometimes notice that your organic veg can be slightly smaller and not so perfectly formed. In terms of taste, many people cannot tell the difference between the two. However, if you manage to source organic fruit/veg/meat/dairy from a local supplier, the freshness can often result in a much better flavour!

Another difference is that organic food tends to have a much higher price, which can be very off putting for those with a lower budget. Organic farms tend to be a lot smaller than conventional farms and have a higher cost of production due to avoiding pesticides and other chemicals that speed up the process. Therefore, the premium price for organic food cannot be avoided.

So, Is Organic Healthier?

Whilst organic food has been proven to have lower levels of chemicals, it is important to remember that food is not our only source of chemical exposure. Where we live, how we travel, the cleaning products we use and so much more can influence this. There is equally no concrete evidence to suggest the levels of pesticides, antibiotics, hormones and additives you find in non-organic food are actually detrimental to our health.

Several studies have been carried out which suggest that organic food can potentially provide more nutrients such as vitamin C, iron and magnesium. However, there isn’t quite enough evidence to support this claim just yet and the difference in your health will likely be minimal. As long as you are including lots of nutrient dense foods in your diet, it should not matter if they are organic or not.

There is also evidence to show that people who consistently eat organic foods have a healthier gut and suffer less with weight gain than those who don’t eat organic foods. However, this is probably down to the fact that people who chose to eat organic tend to lead a healthy lifestyle in other aspects, with a nutrient dense/balanced diet.

There are a lot of bold health claims when it comes to organic food. From preventing cancer, to curing acne to reducing inflammation… the list goes on. The problem is that the evidence against these claims is largely inconclusive and there are much more effective ways to treat your health problems. However, one trial has wielded an interesting observation, suggesting that switching to organic dairy can improve skin conditions such as allergic dermatitis.

What is my view?

In my view, there are many facets to the organic debate! If you feel more comfortable eating organic foods and you are in a position to afford it then go for it! At present, there is no concrete evidence to show that it is healthier or more nutritious to eat an organic diet compared to consuming non-organic foods.  I will always advocate that it is much more important to focus on having a balanced diet full of whole grains, lean proteins, healthy fats and lots of fibre then worry about whether it Is organic or not.  

By Charlotte Foster BSc (Hons), MSc, RD

What are probiotics?

Probiotics are live bacteria and yeasts which are often promoted as having various health benefits. You can find probiotics in supplements, live yoghurt and fermented foods. Probiotics are often described as ‘good’ or ‘healthy’ bacteria, because they are thought to restore the natural balance of bacteria in your gut if it has been disrupted by illness. 

Are probiotics a miracle cure?

Unfortunately, there is a lot of misinformation surrounding probiotics, convincing readers that they can fix any problem. I have really seen it all – ridiculous claims that probiotics promote weight-loss, banish colds and flu, and even cure sepsis…! Do I think that probiotics are a miracle cure to solve all your health problems? Absolutely not! However, they can be a great supplementary treatment if you are looking for symptomatic relief from a condition such as IBS or antibiotic-associated diarrhoea.

If you are in good health, there is little evidence to suggest that taking a probiotic supplement is useful. However, if you are struggling with a gut symptom that you are looking to manage, in some cases it may be advisable. It is important to remember that different probiotics have different uses… You wouldn’t take an antihistamine to help with a headache because there is no evidence to suggest it will help. In the same way, you will not see benefits from taking a probiotic that isn’t clinically proven to help your symptoms. Inside our gut, there are between 300-500 different kinds of bacteria!

So how do you know which probiotic to take? Whilst there is constant research happening in the world of probiotics, we are not quite at the point where we can confidently identify which strains of bacteria are the most beneficial for certain conditions, and what the most optimal doses of these probiotics are. So if you are considering taking a probiotic the best thing to do is to pick a brand and try it for at least 4 weeks – you are not going to see results overnight. Sometimes taking a probiotic can make your bowels a little overactive initially but this should settle after a few days. If you do not notice any symptom improvement after this time it is worth considering trying a different type.

There is some evidence which shows that for people with constipation, taking a probiotic with Bifidobacterium lactis can be beneficial. Here is a useful probiotics guide which gives a summary of different probiotics, the symptom-based benefits and the recommended dosage.

Even though there is limited evidence to suggest probiotics offer health benefits for those without gut issues, many people are still interested in taking them for overall gut health and to ‘feed’ their microbiome! If this is the case for you – go ahead. Taking probiotic supplements will not hurt you and they have very limited adverse side effects. Many people also like to include probiotic rich/fermented foods into their diet for some added microbes!

Here are a few suggestions to try and include throughout the day…

Breakfast

– Live yoghurt (such as Greek yoghurt, skyr yoghurt or any yoghurt with live cultures)

– Kefir (a fermented milk drink which resembles a milkshake – there are loads of flavours to choose from!)

– Sourdough bread

Lunch

– Kombucha (fermented green tea – this also comes in many yummy flavours)

– Cottage cheese

– Tempeh (this is made from fermented soybeans and is a great source of plant-based protein)

Dinner

– Sauerkraut (fermented cabbage – trust me it is nicer than it sounds!)

– Kimchi (fermented veggies with Korean seasoning)

– Miso soup

In conclusion, probiotics can be a great supplementary treatment if you are struggling with gut issues or taking a course of antibiotics. However, it is important that you don’t view probiotics as a miracle cure, because they probably won’t be. If you are struggling with gut issues, be sure to consult a medical professional to get help. Whilst most of the time it is nothing serious, you should always rule out more serious bowel conditions.

If you’re feeling like you have tried everything and are looking for symptomatic relief for your gut issues, do get in touch! Drop me an email at [email protected] or complete a contact form via our website.

By Charlotte Foster BSc (Hons), MSc, RD.

So, what actually is PCOS?

PCOS is a common condition that affects how your ovaries work. The root cause of PCOS is related to abnormal hormone levels including raised testosterone and insulin resistance. Symptoms often include irregular or absent periods, difficulty getting pregnant, excess facial/body hair, weight gain, thinning hair and acne. However, not everyone with PCOS will have all of these symptoms and they can vary in severity from person to person. Unfortunately, there is not yet a cure for PCOS, but symptoms can be managed with medication and lifestyle changes such as exercise and a healthy diet. 

Is there a link between PCOS and diet? 

Given that PCOS can lead to weight gain, healthy eating is always encouraged in order to maintain a suitable weight and reduce the risk of diabetes and heart disease. However, it’s not just about weight… there is evidence to suggest that the diet you consume could offer some symptomatic relief! When thinking about what foods to eat with PCOS, it’s important to be realistic. 

There is strong evidence to suggest that a low glycaemic index (GI) diet can balance hormone levels, reduce insulin resistance and regulate periods. You can simply alter your diet to make it more GI friendly by reducing your consumption of refined carbohydrates (such as white bread/rice and sugary food/drinks). These foods can cause your blood sugar to skyrocket, creating a sharp peak in insulin which is not ideal for individuals with insulin resistance. 

This doesn’t mean you need to cut out ALL carbohydrates… it just means making smarter decisions about the processed, high sugar treats you eat. A low GI diet can be easily achieved through taking the advice of our trusty old friend, the Eatwell Guide! The Eatwell Guide recommends a diet full of good fats, lean proteins and complex carbohydrates such as brown rice and wholewheat pasta… And this works perfectly for a low GI diet too! If you want to learn more about the low GI diet, you can click the link to this factsheet by the British Dietetic Association.  

There is also some evidence to suggest that a Mediterranean diet can also help to reduce PCOS symptoms. This diet is full of fish, vegetables, beans, pulses, wholegrains, nuts, olive oil, herbs and spices. By nature, it also tends to contain very few refined, sugary and processed foods, which explains why it may have a similar effect to the low GI diet. 

So, what do I recommend? As always, I recommend working to include the following into your diet:

– High fibre foods (leafy greens, beans and lentils, sweet potato)

– Lean proteins (chicken, oily fish)

– Complex carbohydrates (wholegrains, brown rice, wholewheat pasta) 

If you’re suffering with PCOS and can’t seem to get your diet under control, we would be happy to help. Drop us a message through our online form or email us at [email protected] to get a consultation arranged. 

By Charlotte Foster BSc (Hons), MSc, RD.

How many times have we heard “You are what you eat”?

To an extent, there is some truth in this – most of us have the ability to make food and lifestyle choices that impact our bodies and health.  However, when we look at the evidence base, we start to see a different message emerge.

There is a hypothesis known as the “thrifty phenotype hypothesis” which has been studied in several populations (1) but has been subject to rigorous questioning and debate (1).

The concept of a thrifty phenotype was devised by Hales and Barker who suggested that if a mother has suboptimal nutrition the foetus will undergo adaptions to metabolic tissues e.g. the liver and pancreas (2).

These adaptions appear to become permanent.  If the baby is born into an environment where food is scarce, having this adaption can be a very advantageous as they will be able to cope better in a nutritionally deprived environment compared with those without this thrifty adaption.

However, if babies carrying this thrifty adaptation are born into an environment where food is abundant (which is the case for many of us in the west), complications can arise as they are most likely to develop diseases associated with over consumption of nutrients e.g. obesity, diabetes and heart disease etc.

There has also been research looking at pregnancy and an excess of nutrients where mothers are overweight/obese which has demonstrated negative effects to the offspring’s health giving them an increased risk of diet-health related diseases (3). However, as obesity has multifactorial causes and therefore difficult to isolate one causative factor.

But all is not lost! What we do know is that partaking in diet modifications and exercise can help with maintaining a healthy weight and reducing the risk of diseases and complications associated with obesity.

So folks, listen up! If you’re of childbearing age and trying for babies your maternal and paternal health matters! It seems that the evidence would say that “you are what your mother ate”, reinforcing the importance of healthy eating throughout conception, pregnancy and beyond!

References

(1): Wells., J.C.K. (2009) Thrift: a guide to thrifty genes, thrifty phenotypes and thrifty norms. International Journal of Obesity 33; 1331–1338.

(2): Hales., C.N. and Barker., D.J. (2001). The thrifty phenotype hypothesis. British Medical Bulletin 60; 5-20.

(3): Ruager-Martin., R., Hyde M.J. and Modi N. (2010) Maternal obesity and infant outcomes. Early Human Development 86; 715-722.

Useful Links

• Wells., J.C.K. (2009) Thrift: a guide to thrifty genes, thrifty phenotypes and thrifty norms. International Journal of Obesity 33; 1331–1338. Available at http://www.nature.com/ijo/journal/v33/n12/full/ijo2009175a.html
• British Dietetic Association – Pregnancy 
• NHS UK – Pregnancy
• NHS UK – Have a healthy diet throughout pregnancy 

By Charlotte Foster BSc (Hons), MSc, RD.

How many people do you know believe gluten is toxic and should be eliminated from the diet of all human beings? For a while, being gluten-free was very “in vogue” before being vegan ousted it as the latest dietary trend! Interestingly, on a vegan diet, sources of gluten seem very acceptable…

For some people, a gluten-free diet is essential to maintain good health (e.g. in coeliac disease) and other certain conditions. But what about the majority of us who may be blessed with good health and are striving to maintain a fit and healthy lifestyle?

According to the research published, there is no evidence to suggest that following a gluten-free diet leads to a better quality of your overall diet.

Many people believe that by cutting out gluten you are more likely to lose weight. Now, if we think about where gluten lurks (wheat, rye, barley and oats) it will be found in many manufactured processed sweet (e.g. cakes, biscuits and pastries) and savoury (e.g. bread, pasta and couscous) products.

So if you simply swap to a gluten-free diet including suitable versions of these sweet and savoury products you might be disappointed if the pounds don’t start to fall off! The reality is, most of these gluten-free substitutes are even higher in fat, sugar and calories (to help compensate with taste and texture) than non-gluten containing equivalents.

However, if you suddenly excluded certain gluten-containing foods -cakes, biscuits, pastries, bread and pasta and switched to naturally-gluten free foods e.g. quinoa, rice, potatoes, fruits and vegetables you might start to see progress in the weight loss department.

But wait a second, this sounds familiar…where have we heard that advice before? Oh wait! It’s healthy eating guidelines!!

The only difference is, is that healthy eating guidelines promote the consumption of wholegrain foods- so wholegrain gluten-containing foods for those who can tolerate them are encouraged. All the evidence suggests these provide us with energy, B vitamins, iron, folate and fibre and are beneficial for heart health and cancer prevention.

So  irrespective of whether you need to exclude gluten for health reasons or not,  the advice for us all remains the same – more unrefined wholegrain carbohydrates, less high fat and sugar foods and more fruit and vegetables.

Josephine Townsend (MNutr, RD).

We look at 5 common myths about Diabetes to help you know the truth about the disease.

Myth: Diabetes is reversible

I often see worrying headlines bandied about, such as this classic from a well-known sensationalistic tabloid newspaper “I reversed my diabetes in just 11 days – by going on a starvation diet” ! This statement is concerning for several reasons:

• It may give false hope.
• People may decide to put themselves on very restrictive diets without support from their healthcare team. This could result in nutrient
• deficiencies and further health-related complications, in addition to potential harm if medication is not appropriately adjusted.
• Not everyone will be appropriate or fit for extreme changes to diet, exercise or other. Certain co morbidities and possible risks should be assessed beforehand to establish safety.
• Some people may develop unhealthy eating behaviours, such as eating disorders.
• The ability to reverse diabetes may be confused between the different types, and we know that certain forms of diabetes cannot be reversed (e.g. type 1 diabetes).

However, it’s not all doom and gloom!

The positive news is that evidence does exist to show that Type 2 diabetes may be at least temporarily ‘reversed’ in some circumstances.. Normalisation of blood glucose levels has been observed in many people following bariatric surgery (1) , and success has also been seen with the use of “Very Low Calorie Diets’”(VLCD) to promote quick and significant weight loss. A VLCD tends to consist of meal replacement drinks, an extra allowance of non-starchy vegetables and plenty of sugar/calorie-free fluids to avoid dehydration.

However, the success of this diminishes with the duration of diabetes, and possibly with age and greater requirements for treatment too.

One study demonstrated that in a group of 29 people following an 800 calorie per day diet for 8 weeks and with an average weight loss of around 14 kg, 87% of those with a diagnosis of diabetes for less than 4 years were able to achieve ‘non-diabetic’ fasting blood glucose levels compared to 50% of those who had had diabetes for more than 8 years (2).

When breaking it down according to those who achieved a ‘non-diabetic’ HbA1c (see section on diabetes), an indication of longer term blood glucose control, 40% of those with diabetes for the shorter period managed this versus 14% of those who had had diabetes for longer. However, it is important to note there were limitations to this study, such as the small number of participants. This study was also controlled, whereas in real-life adherence to VLCD’s can be poor due to possible side effects including hunger, fatigue, dizziness, nausea , headaches, diarrhoea/constipation etc. It’s not the most sociable diet either!

There is a lack of evidence for the long-term effectiveness of VLCDs, and as we know it is also difficult for many to maintain weight loss once returning to normal eating, it is possible that diabetes will return with any weight regain or if pancreatic function deteriorates with age. It is not a miracle cure!

VLCD’s can be very helpful for some to aid weight loss and improve diabetes control, if not reverse it, but it is important that these diets are followed with the appropriate support, and are only short-term due to the risk of nutrient deficiencies. The positive effects are therefore only sustainable with the continuation of a healthy lifestyle – balanced diet, avoiding excessive food consumption and maximising physical activity.

Myth: Eating too much sugar causes diabetes

Please don’t punish yourself with the idea that you have given yourself diabetes due to eating lots of sugary things, as this simply isn’t the case!

It’s not the total amount of sugar we eat that causes diabetes (as confirmed by scientific studies).  However, if we do eat lots of sugary things which leads to excess energy (calorie) intake and weight gain, then we are more likely to develop type 2 diabetes (whereas weight is not linked to type 1 diabetes). This is because it’s the excess weight we carry that affects the body’s ability to regulate glucose levels in the blood.

However, a recent report by the Scientific Advisory Committee on Nutrition (3) did conclude that there is evidence to show an association between greater consumption of sugar-sweetened beverages and the incidence of type 2 diabetes.  So choosing diet sugar-free drinks is preferable.

Myth: Everyone with diabetes should eat a low carbohydrate diet

Media attention around this topic can certainly be overwhelming and confusing, but also very appealing when you hear all the promises of disappearing muffin tops or achieving a body not too dissimilar from a Victoria’s Secret model!

To keep it simple, there is insufficient evidence to suggest that a diet specifically low in the food group known as carbohydrate is beneficial for people with diabetes of any type (or for the general public without diabetes for that matter). It is for this reason that organisations including the British Dietetic Association and Diabetes UK do not actively advocate it.

Cutting down on carbohydrate intake can certainly aid weight loss in the short-term, which isn’t surprising when you think about how much carbohydrate foods contribute to our typical daily diets and therefore, how many fewer calories we are likely to consume! This would also mean a reduction in the extra butter we add to bread, cream added to pasta or cheese we top a jacket potato with, which again would significantly cut down on energy intake thus promoting weight loss. Of course this isn’t necessarily a bad thing if we are able to reduce our fat intake too.

But is this sustainable? And what about side effects, including fatigue, bad breath, constipation, headaches, etc? What about all the nutrients we’d be missing out on by removing certain carbohydrates from the diet  such as the fibre, vitamins and minerals found in whole grains, fruit, veg, pulses and some cereals?

There isn’t any evidence to show greater success from low carbohydrate diets than other dietary approaches in the long-term. Maybe portion sizes of carbohydrates have increased over the years and do need reducing, but this doesn’t need to be to the extent that would be classed as a low-carbohydrate or carbohydrate-free diet!

The SACN report highlighted evidence for the benefits of certain carbohydrate (3). This included an association between a greater intake of whole grains and/or dietary fibre and a reduced risk of high blood pressure, stroke and cardiovascular disease, and of course not forgetting the added benefits for bowel health including a reduced risk of bowel cancer. In fact, some research suggests that higher consumption of cereal fibre may actually reduce the incidence of type 2 diabetes mellitus!

An additional concern regarding a low carbohydrate/no carbohydrate diet would be a tendency to compensate with a greater intake of high fat/protein foods. This is likely to lead to an increase in saturated fat intake, which is linked to higher cholesterol – not good for heart health.

So whilst it may be beneficial for many to cut down on the quantity of carbohydrate piled on their plates, this does not have to mean a very low carbohydrate or carbohydrate-free diet. General guidelines are:

• ~ 50% of our total daily energy intake should come from carbohydrates- including a minimum of 3 servings of whole grains and 5 portions of fruit and vegetables per day.
• Aim to keep “free sugar” (sugar added to food products e.g. fizzy drinks, sweets, cakes, chocolate or the sugar/honey/syrup we add ourselves to drinks and cereal) to less than 5% of energy intake – ~ 7 tsp sugar per day (NB: a can of cola = 9 tsp of sugar!). 

However, if you do decide to pursue a low-carbohydrate diet, your healthcare team should work with you to ensure the safest possible outcome.

Myth: Foods marketed at people for diabetes are better for you

Anything labelled as diabetic, sugar-free or no added sugar is certainly tempting but it may not be all it’s cracked up to be.  Sugar-free can be better when it comes to versions of certain products, such as fizzy drinks, fruit squash or the odd mint. This is because they often are genuinely sugar-free and calorie-free (but it is always best to check the label to make sure).

However, if you decide to compare the labels of regular and diabetic marketed versions of chocolate, ice cream or biscuits it’s not unusual to discover that the latter contains the same amount, or if not more fat (and saturated fat) and therefore calories. This is because fat improves the flavour and other sensory qualities when sugar content is reduced (a key reason why we tend to gravitate towards fatty foods and we’ve seen the subsequent expansion of our waistlines over the years). These foods will also still be likely to contain a certain amount of sugar as they won’t have replaced it all, so please don’t assume they are sugar-free.

Thinking something is suitable for diabetics may also lead us into a false sense of security so that we think it’s ok to eat more of it, even though it’s still high in fat and calories. We are all human after all!

If everything so far isn’t enough to put you off then another particularly unpleasant downside is the particular type of sweeteners commonly used in these products to add flavour; polyols (erythritol, xylitol, sorbitol, etc). When consumed in larger amounts these may trigger a laxative effect, which I’m sure for most people is an unwelcome side effect. In fact if you check the back of a packet of sugar-free chewing gum you may see the phrase “excessive consumption may produce laxative effects”, as it often contains the same sweeteners’.

Of course the usual hefty price tag that accompanies these products is another off-putting factor and I rarely come across someone who has said they’ve tried and liked Diabetic products. The most sensible option is therefore to have a small of the good old tasty regular treats, as long as we know how to moderate ourselves and avoid overdoing it.

Myth: I can’t eat out as the food isn’t suitable for people who have diabetes

Please be reassured by the fact that there is NO such thing as a special diabetic diet! Life does not need to be miserable by cutting out all yummy foods or being the awkward friend at a party requiring a different menu.

In theory, the same healthy balanced diet is recommended for everyone, regardless of a diagnosis of diabetes. However, people with diabetes may need to be more careful around portion sizes of carbohydrate foods and/or adapting their treatment regimens according to what they’re eating and which medications they’re taking. And of course, if overweight it’s advisable to reduce energy intake. Despite this you can eat out at restaurants or have a piece of birthday cake on occasion! You can even scan the menu for healthier options or reduce a hefty portion size by taking half your meal home in a doggy bag if you want to be really virtuous. The only things that really ought to be cut out from the diet are sugar-sweetened drinks (e.g. fizzy drinks) and sweets, which cause quick spikes in blood glucose and are of no nutritional value.

However, there is nothing wrong with the odd treat here and there as long as the phrase ‘in moderation’ is understood and aims are being met, from good blood glucose control to managing weight and optimising cholesterol levels. But maybe a diagnosis of diabetes is a good reason to change up the regular routine when it comes to unhelpful eating habits and preparing meals – try new foods or get experimenting in the kitchen to create healthy but tasty meals for all the family and help prevent diabetes rearing its ugly head in each generation!

References

(1): Ardestani, A., Rhoads, D. and Tavakkoli, A. (2015) Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes Care 38(4):659-664.

(2): Stephen, S. and Taylor, R. (2015) Restoring normoglycaemia by use of a very low calorie diet in long- and short-duration Type 2 diabetes. Diabetic medicine: a journal of the British Diabetic Association 32(9):1149-1155.

(3): SACN (2015) Carbohydrates and health. Norwich: TSO. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf [ last accessed 21 March 2016].

The Fat Debate

DINE reviews the latest publication on the topic of the fat debate

DINE takes a look at nutrition in the news, by examining a report published by The National Obesity Forum in association with the Public Health Collaboration surrounding claims that eating fat, cutting carbs and avoiding snacking can reverse obesity and type 2 diabetes.

Make sure you watch DINE’s video on Diabetes and Healthy Eating Guidelines for more evidence- based information.

Useful Links for further information:

Report behind the headlines – The National Obesity Forum in Association with the Public Health Collaboration 

Healthy Eating Guidelines & Weight Loss Advice For The United Kingdom- Public Health Collaboration

Response to The National Obesity Forum by British Dietetic Association 

Article  in response to The National Obesity Forum by NHS UK

Article in response to The National Obesity Forum by Centre for Evidence Based  Medicine

Article in response  to The National Obesity Forum by The British Nutrition Foundation

By Charlotte Foster BSc (Hons), MSc, RD.

With the desire to live a “sugar-free” existence becoming more popular, the food industry has responded with a boom in sales of sweeteners (with the sweetener sector now valued at ~£60million) (1).

Sweeteners can be derived from natural sources and so are deemed to be “natural” as well as being synthetically created and labelled as “artificial”.  Both give the same sweetness to food that sugar does but with substantially less calories.

With over one quarter of British households buying in sweeteners, DINE has decided to look take a closer look into these sweet-tasting products.

Useful Links:

• NHS Choices (2014) The Truth about artificial sweeteners 
• Diabetes UK (2016) Sugar, sweeteners and Diabetes 

References

(1): Chatsudthipong, V. and Muanprasat, C. (2009) Stevioside and related compounds: Therapeutic benefits beyond sweetness. Pharmacology & Therapeutics 121 (1); 41-54.

(2): Chan, P., Tomlinson, B., Chen Y., Liu, J., Hsieh, M and Cheng, J. (2000) A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. British Journal of Clinical Pharmacology 50 (3):215-220.

(3): Hsieh, M., Chan, P.,Sue, Y., Liu, J., Liang, T., Huang, T., Tomlinson, B., Chow, M., Kao,P. and Chen, Y. (2003) Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: A two-year, randomized, placebo-controlled study. Clinical Therapeutics 25 (11); 2797-2808.

(4): Greggersen, S., Jeppesen, P., Holst, J., Hermansen, K. (2004) Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism 53. (1); 73-76.

(5): Geeraert, B., Crombe,F., Hulsmans, M., Benhabiles, N., Geuns, J.M. and Holvoet, P. (2010) Stevioside inhibits atherosclerosis by improving insulin signaling and antioxidant defense in obese insulin-resistant mice. International Journal of Obesity 34 (3); 569-577.

(6): Roberts, M.W. and Wright, T.J. (2012) Nonnutritive, Low Caloric Substitutes for Food Sugars: Clinical Implications for Addressing the Incidence of Dental Caries and Overweight/Obesity.  International Journal of Dentistry 2012; 625701.

(7): Noda, K., Nakayama, K. and Oku, T. (1994) Serum glucose and insulin levels and erythritol balance after oral administration of erythritol in healthy subjects.European Journal of Clinical Nutrition 48(4); 286-292.

(8): Honkala, S., Runnel, R., Saag, M., Olak, J., Nommela, R., Russak, S., Makinen, P.L., Vahlberg, T., Falony, G., Makinen, K. and Honkala, E. (2014) Effect of erythritol and xylitol on dental caries prevention in children. Caries research 48 (5); 482-490.

(9):Arrigoni, E., Bronus, F. and Amado, R. (2005) Human gut microbiota does not ferment erythritol, British Journal of Nutrition 94(5); 643-646.

(10): NHS (2014) Is xylitol good for your teeth? Available at http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-xylitol.aspx [last accessed 25/03/16].

(11): EFSA (2011)   Scientific Opinion on the substantiation of health claims related to the sugar replacers xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol, D-tagatose, isomaltulose, sucralose and polydextrose and maintenance of tooth mineralisation by decreasing tooth demineralisation (ID 463, 464, 563, 618, 647, 1182, 1591, 2907, 2921, 4300), and reduction of post-prandial glycaemic responses (ID 617, 619, 669, 1590, 1762, 2903, 2908, 2920) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal  9(4); 2076. Available at http://www.efsa.europa.eu/sites/default/files/scientific_output/files/main_documents/2076.pdf [last accessed 25/03/16].

(12): Commission of the European Communities (1985) Food Science & Techniques – Reports for the Scientific Committee for Foods.  Available at http://ec.europa.eu/food/fs/sc/scf/reports/scf_reports_16.pdf [last accessed 25/03/16].

(13): NHS (2014) Sorbitol: helpful for diabetics? Available at http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-sorbitol.aspx [last accessed 25/03/16].

(14): Gupta, A.K. and Kaur, N. (2000) Carbohydrate Reserves in Plants – Synthesis and Regulation, Elsevire 2000.

(15): NHS (2014) The truth about aspartame. Available at http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-aspartame.aspx [last accessed 25/03/16].

(16): Soffrirri, M., Belpoggi, F., Degli Esposti, D., Lambertini, L., Tibaldi, E. and Rigano, A. (2006) First experimental demonstration of the multipotential carcinogenic effects of aspartame administered in the feed to Sprague-Dawley rats. Environmental Health Perspectives 114 (3); 379-385.

(17): Soffrirri, M., Belpoggi, F., Tibaldi, E., Esposti, DD., Lauriola, M. (2007) See comment in PubMed Commons belowLife-span exposure to low doses of aspartame beginning during prenatal life increases cancer effects in rats. Environmental Health Perspectives 115 (9); 1293-1297.

(18): EFSA Panel on Food Additives and Nutrient Sources added to Food (2013) Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. EFSA Journal 11(12); 3496.

(19): NHS (2014) Saccharin Link to cancer discredited. Available at http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-saccharin.aspx [last accessed 25/03/16].

(20): International Agency for Research on Cancer (IARC) (1999) Volume 73 -Saccharin and its salts. Available at http://monographs.iarc.fr/ENG/Monographs/vol73/mono73-24.pdf [last accessed 25/03/16].

(21): Commission of the European Communities (1995) Opinion on saccharin and its sodium, potassium and calcium. Available at SALTS http://ec.europa.eu/food/fs/sc/oldcomm7/out26_en.pdf [last accessed 25/03/16].

(22): NHS (2014) How safe is sucralose? Available at  http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-sucralose.aspx [last accessed 25/03/16].

(23): Patel, R.M., Sarma, R. and Grimsley, E. (2006) Popular sweetner sucralose as a migraine trigger. Headache 46 (8); 1303-1304.

By Charlotte Foster BSc (Hons), MSc, RD.

At certain points of the year, mainly New Year and the run up to summer,  it there tends to be an onslaught of social media posts and comments relating to the “let’s get bikini ready” movement. This includes numerous hashtags left right and centre relating to “#detox” “#clean eating” “#paleo” and countless selfies of gym joiners and photos of mealtimes!

Every year certain foods make their catwalk debuts into many peoples’ diets following media claims about their apparent health benefits.

We decided to look at some of these fashionable foods and examine the evidence as to whether these really are worth the “designer label” of beneficial for our health.

Quinoa

Available in three coloured varieties (red, white and black) this versatile, gluten-free seed has muscled its way into our diets, becoming a food phenomenon in recent years.

Quinoa is often promoted as being a food staple for anyone trying to lose weight/ shape up. It is often found lurking in many recipe books as the carbohydrate base to dishes and yet, compare to other carbohydrate sources, is the highest protein containing “grain” (containing all the essential amino acids we need) and a good source of fibre (1).

Quinoa is a dietary source of magnesium, zinc, potassium, and iron. However, it also contains phytic acid which can inhibit the absorption of these minerals and oxalates which can inhibit calcium absorption (1). Soaking quinoa before cooking it can help reduce the phytic acid content.

Quinoa also contains some plant based antioxidants and flavonoids. Research has showed that flavonoids called “quercetin” and “kaempferol” have been shown to have anti-cancer (2)  and anti-inflammatory (3). However, these findings were found in animal studies and so further research is needed to ascertain whether this would be the same for humans!

Once upon a time, sourcing quinoa in the UK was quite a challenge. Quinoa tended to be available at a high cost exclusive to whole food and independent shops. However, nowadays you can pick up a bag in your local supermarket relatively easily and cheaply making it an accessible cupboard food item for all budgets.  However, this has come at a cost for the local populations where quinoa comes from. Native to populations in the Bolivian Andes quinoa used to be a staple crop, but nowadays due to demand from western markets causing high prices, many locals with low incomes can no longer afford this nutritious grain (4).

Conclusion: Due to its versatility, nutritional value and ability to accommodate a range of special dietary requirements, quinoa seems to offer many appealing qualities. However, for ethic-conscious eaters the cost-benefit to the local populations and impact on carbon foot print may not justify the buy!  

Kale

This designer leaf comes in number of varieties. They come dressed in green or purple with curly or smooth leaves and are members of the cabbage family.

This nutritious cruciferous vegetable is packed with antioxidant vitamins, particularly vitamin A (beta-carotene) and vitamin C (needed for the body’s structural protein “collagen” production). These antioxidants help minimise oxidative damage which is linked to cancer development.  Similarly to quinoa, kale contains the flavonoids “quercetin” and “kaempferol” associated with anti-cancer and anti-inflammatory properties in animal studies (see above) (2, 3). It is a good plant source of calcium and contains sources of potassium and magnesium.

Conclusion: As one of your 5 a day this leafy number has many antioxidant vitamins and minerals to enhance your diet. However, we need to remember it’s variety and an array of different fruits and vegetables which will give us the spectrum of the nutrients we need for a healthy and balanced diet.

Matcha Powder

This popular food supplement powder comes from the same plant as green tea or “Camellia sinensis”.  However, matcha powder undergoes several different processing stages compared with green tea. This processing boosts the amino acid content of the leaves compared with standard green tea. Unique to both green tea and matcha powder (in a higher concentration) is the amino acid “L-theanine” (5).

Matcha powder is made using the whole leaf being crushed into a powder whereas in green tea water is infused with the leaves to leach out the nutritients.   Therefore, it is recommended that no more than 2 cups of matcha tea are consumed/day due to the high concentration of nutrients and contaminants (e.g. heavy metals and pesticides which are associated with all types of tea) (6). Too much matcha tea has been linked with causing nausea and liver toxicity (7,8).

What are the health claims associated with matcha powder?

• Antioxidants – containing ~ 3x more antioxidants compared with green tea (9).
• Possible improvements on blood lipid and glucose levels (although only demonstrated in mice studies) (10).

What are the health claims associated with green tea?

• Weight loss – green tea is thought to help increase metabolic rate, it is a popular ingredient in weight loss pills. However, a study in 2012 found there were no statistically significant findings to support this (11)
• Possible improvements on cholesterol levels (NB studies were done in American populations) (12, 13).
• Relaxation – the unique amino acid “L-theanine” in green tea and matcha powder has been linked to inducing mental relaxation without initiating drowsiness (5).

Conclusion: It would seem that compared with green tea, the benefits are minimal. Yes, gram for gram matcha powder is 3+ times more antioxidant rich, but too much of a good thing can be detrimental. Green tea is cheaper on the wallet too! Either way, let’s not kid ourselves that by drinking matcha or green tea we are going to miraculously lose weight (unless that was all that we drank!) and at the risk of getting liver/kidney damage, we don’t think it’s worth the risk!

Nut butters

We all recognise peanut butter as a sandwich filler staple, but nowadays you can find food retailers selling all kinds of nut and seed butter alternatives such as:

• Peanut butter & peanuts = one of the highest protein contents (14)
• Almond butter & almonds =high in vitamin E (14)
• Cashew butter & cashews = rich in magnesium (14)
• Pistachio butter &  pistachios = high in lutein (antioxidant found in green leafy veg) (14)
• Walnut butter & walnuts = high in omega-3 and antioxidants (14)

Pros and Cons of nut butters:

Pros:

• Usually rich in mono unsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) which can help lower low density lipoprotein (LDL) cholesterol levels (14,15).
• Good source of protein, vitamins and minerals (14).
• Energy and protein dense – useful for fortifying foods for those trying to gain weight.
• The variety of nut butters available can be useful for people with peanut (only) allergy
• Smooth varieties (no chunks of nuts) can be enjoyed by people who have difficulty chewing or who may have been advised to follow textured modified diets.

Cons:

• Often energy dense (high in calories) – watching portion sizes is important for those trying to lose weight.
• Due to processing, the fibre contents are lower in comparison to whole nuts.
• Varieties can have hidden salt/sugar/ fat added (check the labels).

Conclusion: Nuts and seeds are very nutritious for the reasons outlined above. Nut butters can be enjoyed as part of a healthy and balanced diet and may be a useful depending on your dietary aim.  If you are simply wishing to follow a balanced diet and maintain a healthy weight, one could argue that having a handful of unsalted whole nuts would be beneficial giving you the nutrients with a higher fibre content which helps to reduce the amount of fat absorbed compared with blended nut butters. As well as this, whole nuts can often be bought at a cheaper price without the additions of extra salt/sugar and oil.

Coconut oil

2015 saw this exotic number strut not only into our diets but also our beauty regimes!

Coconut oil is produced from the white flesh of the nut which is compressed to extract tropical tasting oil. It is solid at room temperature (similar to butter/lard) due to the high in saturated fat content.  >90% of the energy (calorie) content comes from saturated fat compared with 14% in olive oil (16). However, unique to coconut oil its saturated fat composition comes from medium chained triglycerides (MCTs) – which are metabolised differently. MCTs are converted into ketone bodies which have demonstrated to have effects on the brain (16).  – with research ongoing into the effects on Alzheimer’s and epilepsy. However, further more robust research is required in order to confirm health claims.

Coconut oil also contains lauric acid which is broken down in the gut to “2-mono-laurin”  which helps to dissolve the lipid membrane of certain pathogens (17).

Another claim that has us hooked is that coconut oil can supposedly help lower our total cholesterol by raising the high density lipoproteins (HDL), good cholesterol. However, saturated fat can increase the low density lipoproteins (LDL), bad cholesterol associated with heart disease (18).  Sticking with the “old-school” advice of choosing unsaturated fat alternatives e.g. olive/sunflower/vegetable oil has also demonstrated to have an effective way to help reduce LDL cholesterol levels (18), so surely these would be healthier and more cost-effective options?

Conclusion: Whilst there may be several possible benefits of coconut oil, it is nonetheless still a type of fat! Like all sources of fat in the diet they are energy (calorie) dense. Whilst it’s fine to use in moderation within the diet, the hype around this product can often encourage people to use the oil in excess. Diets high in saturated fat are associated with increased risk of cardiovascular disease. We aren’t quite convinced that the health claims are built on robust evidence and like all fats we would advise these are limited (unless advised otherwise by a dietitian/ medical professional).  

Coconut water

Bananas are soooo last season! Move over and make way for this potassium fuelled beverage!

Coconut water comes from the young green coconuts – different to coconut milk produced from the white flesh of the matured nut.

Once marketed as “super hydrating” and “nutrient packed” due to its electrolyte content, coconut water may not be all that its cracked up to be.  Ironically, a study funded by a brand of coconut water “Vita Coco” demonstrated that there was little difference in the performance or hydration of men who drank bottled water, coconut water or a sports drink (19).   

With no evidence to support such health claims a lawsuit was filed against the company to revise the falsely advertised health claims.  Click here for a further information about the lawsuit. 

Conclusion: It appears that we’ve gone coco-nuts in believing the claims and marketing behind this juice. If you’re looking for dietary sources of potassium then this might be something to consider, but it’ll cost you! Bananas contain excellent sources of potassium and fibre for under 20p a pop! However, if you’re bored of water one could argue that compared with most sports drinks which are often loaded with excessive sugar, this may be a more nutritious option.  

Chia seeds

Tiny in stature, these South American mini seeds are mighty and nutritious in number! A distant relative of the mint plant, chia seeds are famous for being a good plant based source of omega-3 fatty acids known as alpha linolenic acid (ALA) which are essential to our diet as they cannot be produced by the body (20).

The nutrition CV doesn’t stop there! These seeds are rich sources of soluble fibre, protein, vitamins (A&B) and minerals (calcium, magnesium, manganese and phosphorous.

With a mild flavour, these can be added to smoothies, sprinkled on cereals, salads and nowadays are popular in forming puddings and deserts due to the fact that they swell to form a gelatinous texture when in contact with liquid. When soaked in water they can also be used as an egg replacement, giving a perfect solution for those with egg allergies! Simply mix 1tbsp chia seeds with 3 tbsp water (per egg equivalent).

Conclusion: Arguably, linseeds (flax) seeds are another fabulous source of omega-3 and are often more cheaper than chia seeds. However, the overall nutritional profile of chia seeds appears to be slightly superior.

References

(1):Food and Agricultural Organisation (FAO’s) International Year of Quinoa 2013 website (http://www.fao.org/quinoa-2013/what-is-quinoa/nutritional-value/en/ )

(2): Murakami, A., Ashida, H. and Terao, J. (2008) Multitargeted cancer prevention by quercetin. Cancer Letters 269 (2) 315-325.

(3): Stewart, L.K., Soileau, J.L., Ribnicky, D., Wang, Z.Q., Raskin, I., Poulev, A., Majewski, M., Cefalu, W.T. and Gettys, T.W. (2008) Quercetin transiently increases energy expenditure but persistently decreases circulating markers of inflammation in C57BL/6J mice fed a high-fat diet. Metabolism 57 (7); S39-46.

(4): ResponsAibility Investments (2015) Quinoa: Exploring the market dynamics of an Andean staple- Case study. Available at http://www.responsability.com/funding/data/docs/en/15566/rA-Case-Study-Quinoa-EN-final.pdf [last accessed 21/03/16].

(5): Nobre, A.C., Rao, A. and Owen, G.N. (2008) L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pacific Journal of Clinical Nutrition 17 (1); 167-168.

(6):  Schwalfenberg, G. Genuis, S.J. and Rodushkin, I. (2013) The benefits and risks of consuming brewed tea: beware of toxic element contamination. Journal of Toxicology 2013:370460.

(7): Galati, G., Lin, A., Sultan, A.M., O’Brien, P.J. (2006) Cellular and in vivo hepatotoxicity caused by green tea phenolic acids and catechins.  Free Radical Biology & Medicine 40(4); 570-580.

(8): Mazzanti, G., Menniti-Ippolito, F., Moro, P.A., Cassetti, F., Raschetti, R., Santuccio, C. and Mmastrangelo, S. (2009) Hepatotoxicity from green tea: a review of the literature and two unpublished cases. European Journal of Clinical Pharmacology 65 (4); 331-341.

(9): Weiss, D.J. & Anderton, C.R. (2003) Determination of catechins in matcha green tea by micellar electrokinetic chromatography. Journal of Chromatography 1011 (1-2); 173-180.

(10): Xu, P., Ying, L., Hong, G. and Wang, Y. (2016) The effects of the aqueous extract and residue of Matcha on the antioxidant status and lipid and glucose levels in mice fed a high-fat diet. Food & Function 7 (1); 294-300.

(11): 5: Jurgens, T.M., Whelan, A.M., Killian, L., Doucette, S., Kirk, S. and Foy, E. (2012) Green tea for weight loss and weight maintenance in overweight or obese adults. Cochrane Database Systematic Review 12.

(12): Kim, A., Chiu, A., Barone, M.K., Aving, D., Wang, F., Coleman, C.I. and Phung, O.J. (2011) Green tea catechins decrease total and low-density lipoprotein cholesterol: a systematic review and meta-analysis. Journal of American Dietetic Association 111(11); 1720-1729.

(13):  Zheng, X.X., Xu, Y.L., Li, S.H., Hui, R. and Huang., X.H. (2011) Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials.American Journal of Nutrition 94(2); 601-610.

(14): Ros, E. (2010) Health Benefits of Nut Consumption. Nutrients 2(7); 652-682.

(15): Kelly, H. and Sabate, J. (2006) Nuts and coronary heart disease: an epidemiological perspective. British Journal of Nutrition  96(2); S61-67.

(16): Bhatnagar, A.S., Prasanth Kumar, P.K., Hemavathy., J. and Gopala Krishna, A.G (2009). Fatty Acid Composition, Oxidative Stability, and Radical Scavenging Activity of Vegetable Oil Blends with Coconut Oil. Journal of The American Oil Chemist’s Society 86; 991–999.

(17): Enig, M.G. (1998) Lauric oils as antimicrobial agents: theory of effect, scientific rationale, and dietary applications as adjunct nutritional support for HIV-infected individuals. In: Watson RR (ed) Nutrients and foods in AIDS. CRC Press, Boca Raton; 81–97.

(18): British Heart Foundation (2016) I’ve heard coconut oil is good for you. Is this true? Available at https://www.bhf.org.uk/heart-matters-magazine/nutrition/ask-the-expert/coconut-oil [last accessed 21/03/16].

(19):  Kalman, D.S., Feldman, S., Kreiger, D. and Bloomer, R.J. (2012) Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men. Journal of International Sports Nutrition 9;1.

(20): Academy of Nutrition and Dietetics (2013). Aztec Diet Secret: What Are Chia Seeds? Available at http://www.eatright.org/Public/content.aspx?id=6442472548 [last accessed 21/03/16].

By Charlotte Foster BSc (Hons), MSc, RD.

Talk on following a “sugar free” diet has become so prevalent in recent years that I’m pretty sure that even tribal communities in far flung regions of our planet have had conversations about this latest dietary craze!

We feel it is important to examine the evidence around the concept of the sugar free diet by looking at some key points.

What is sugar and can we actually eat a diet which is sugar free?

The problem today is that there is a liberal use of the term sugar which has instilled fear into food lovers.

Fact – most foods will contain sugar. The term “sugar-freer” seems to have been used as a marketing tool and attached onto a plethora of food products/ recipes and diets. The problem is, it has left us more confused than ever before about what is in our food and what implication that does or doesn’t have on our health.

So let’s unpick the different definitions to discover the sweet truth!

The definitions of sugar…

• Carbohydrates – organic compounds made from molecules of carbon, hydrogen and oxygen. “Carbohydrate” refers to sugars, starches and cellulose (fibre) and contributes as a source of energy in the diet for many animals. They are categorised by their chemical structure into monosaccharides, disaccharides, oligosaccharides and polysaccharides.
• Starch- Many dietary sources of starches (e.g. rice, potatoes and cereal grains) will provide B vitamins, iron, and folate. In the UK, potatoes provide a large dietary source of vitamin C (usually containing ~11-16mg of vitamin C per 100g of potatoes) because we eat so many of them!
• Fibre – structurally they are classified as polysaccharides (3 or more monomers) and are found in plant sources. They are neither digested nor absorbed in the small intestine. There are soluble and insoluble forms of fibre, both of which are needed in the diet for a healthy digestive system (to help with stool formation).
• Naturally present sugars – e.g. found in fruits as fructose or in dairy products (such as milk and yoghurt) as lactose.
• Refined sugars (processed sugars added to foods) – These come from sugar cane or sugar beets, which are processed to extract the sugar. It is typically found as sucrose, which is the combination of glucose and fructose.
• Intrinsic sugars – integrated into the cellular matrix of foods e.g. sugar found in fruit and vegetables
• Extrinsic sugars – sugars that are not integrated into a cellular matrix e.g. lactose in milk.
• Non-milk extrinsic sugars (NMES) –sugars that are not integrated into a cellular matrix and not from a milk/ dairy source e.g. honey, fruit juices, table sugar. This term has now been replaced by “free sugars”.
• Free sugars – alternative name for NMES (see above).

Where did concerns over the health effects of sugar arise from?

A lot of concern and discussion around sugar arose off the back of a commentary by a Professor of Clinical Paediatrics at the University of California  ⁽¹⁾. This commentary expressed the author’s opinions on the role they believe sugar has to play in the development of diet-health related disease and was not a robust scientific review or a presentation of novel research ⁽¹⁾. However, they do mention a couple of published research papers to support their case, one of which is written by Lustig (introducing possible bias) ⁽¹⁾.  Also, there was no critical appraisal (carefully critiquing the results to decipher their impact) of the evidence regarding the relationship between sugar and diet-related disease development. It would seem that these headlines may be portraying a slightly false picture.

A report published in 2015 by Scientific Advisory Committee on Nutrition (SACN) looked at randomised controlled trials and found that sugar-sweetened drinks (compared to low calorie drinks) resulted in increases in weight gain and body mass index in children and adolescents. It is being overweight which increases a risk of diet-health related diseases.  SACN’s report emphasised that no association between developing type 2 diabetes and total or individual sugars intake. However, prospective cohort studies associate greater consumption of sugar sweetened drinks with an increased risk of developing type 2 diabetes ^(2).

Should we try and reduce our sugar consumption?

We are all individual and therefore this is not an easy question to answer.

Sugar is a highly dense source of energy (calories) and so can be useful for those trying/needing to gain weight. Dietitians may recommend having high energy containing foods/ fortifying your diet with sugar based foods as strategies for adding extra energy in a concentrated food source. This is often the same with fat sources.

However, for many, the sugar content of the diet is something to watch out for. Excess sugar in the diet could mean excess energy (calories) intake. This may lead to weight gain. It is the weight gain (being overweight/obese) that puts us at risk of diet reacted diseases such as type 2 diabetes and heart disease.  People with diagnosis of diabetes may be advised to limit the amount of sugar in the diet or advised to “carbohydrate count” in order to adjust medications and insulin regimens.

How much sugar should we have according to healthy eating guidelines?

Recent guidelines published in July 2015 by SACN advise that the average intake of “free sugars” (previously known as non-milk extrinsic sugars ) should be no more than 5% total energy intake.  This is half of the previous recommendations for 10% total energy intake (³⁾.

5% of total energy intake (as calculated by Public Health England) means:

• no more than 19g/day of free sugars for children aged 4-6 year olds (³⁾

This equates to ~ 5 sugar cubes!

• no more than 24g/day for 7-10 year olds (³⁾

This equates to ~ 6 sugar cubes!

• no more than 30g/day 11+ year olds (including adults) (³⁾

This equates to ~ 7 sugar cubes!

The report highlighted that only 13% (1 in 8) of adults already achieve this 5% recommendation!

How to interpret sugar – label reading…

Sugar can be given a variety of names so the skill of label reading becomes important when analysing a food’s nutritional composition.

Labels on food packaging will state “Carbohydrates” and “Carbohydrates (of which sugars)”. “Carbohydrates” refer to the starchy carbohydrate content as well as the sugars and so should not be used as a sole interpretation of a food’s sugar content. The “Carbohydrates (of which sugars)” figure refers to the sugar content in the food – including naturally occurring sources found in milk or fruit as well as added sugar.

• High– over 22.5g of total sugars per 100g
• Low – 5g of total sugars or less per 100g

Be aware!  Sugar is not only present in “obvious” sweet tasting processed foods e.g. cakes/biscuits/ chocolates or sweets, but can be added sneakily to savoury snacks, salad dressings and pasta sauces etc.

Therefore, in order to work out whether a food contains lots of added sugar, you need to check the ingredients list.

Hopefully the list above has highlighted something important… just because “table”/ “caster”/ “granulated” SUGAR may not be listed, it doesn’t mean it’s sugar-free!  These are all sources of sugar (some are natural and found in less processed foods).

This is often where the confusion arises. Many glamorous recipes for batches of sumptuous “sugar-free” brownies will in fact contain plenty of sugar in the forms of honey/ maple syrup/ agarve syrup/ dates or some other dried fruit!

Perhaps these recipes should be renamed “wholefood” or “less processed” rather than “sugar-free”. There is no denying that these recipes contain superior nutritional profiles compared with refined, processed or manufactured versions, but that is often not what is being promoted.

Our hope is, that with a better understanding of the term “sugar”, you will be able to see past this marketing ploy and make an informed decision on how regularly this appears in your diet.

Key take home messages:

• Sugar has many definitions – watch out for the context of this term i.e. carbohydrates are different to refined sugars
• Many foods contain high sugar contents; just because it isn’t called “sugar” doesn’t mean it isn’t a source of it.
• We must consider the food’s overall nutrient profile – what other nutritional benefits does it provide?

For example orange juice vs a full sugar cola drink.

Orange juice though also high in sugar, if “not from concentrate” will contain vitamin C and 150mls will count as one of your 5 a day. Whereas a full sugar cola drink merely contains a sugar hit, caffeine and empty calories.

• Sugar can still form part of a healthy and balanced diet – it is the amount that we have in our diet which we need to consider.

References

(1): Lustig, R.H., Schmidt, L.A., Brindis, C.D. (2012) Public health: The toxic truth about sugar. Nature 482; 27-29.

(2): SACN (2015) The Scientific Advisory Committee on Nutrition’s recommendations on sugars. Available at https://www.nutrition.org.uk/attachments/article/872/sugars%20factsheet.pdf [last accessed 24/03/16]

Useful Links:

For further information make sure you check out some of these links!

• British Dietetic Association Food Fact Sheet – Sugar 
• British Nutrition Foundation – Let’s take another look at sugar
• British Nutrition Foundation – A Summary of the WHO Guidelines: Sugars intake for adults and children 
• Diabetes UK – Understanding food labels 

By Charlotte Foster BSc (Hons), MSc, RD

I recently returned from my honeymoon and it got me thinking about how challenging it can be to be mindful about eating healthily when on holiday or when travelling.

We were surrounded by SO much delicious food. The choice of several incredible restaurants to dine at, countless cocktails served with countless canapes was amazing,  but with so much delicious temptation everywhere, I actually found it quite overwhelming and difficult to maintain a balance! I never thought I would say this, but by the end of the trip, I really craved vegetables, bake beans and culinary simplicity!

Now, whilst I’m a firm believer in feasting on a feast day and enjoying all foods in moderation, indulging day in and day out took its toll!

However, there have also been trips where we have taken to the road with a more coin counting mentality! Being on a budget and with no means of refrigerating foods, (passing the time away with car karaoke!) eating anything other than highly processed snacks was a challenge.

Here are some of my top tips to navigate times of travel in the healthy eating arena!

Beware of the buffet!

Food glorious food! Buffets, serve yourself restaurants or all-inclusive holidays often encourage us to pile our plates to make the most of our money. The problem is this can encourage us to overeat and if done regularly will lead to us piling on the pounds as our bodies store the excess energy we consume.

Portion control!

When eating out at restaurants, it can be difficult to have control over the portion sizes of foods. Some countries/continents e.g. America are renowned for delivering larger plus size portions but more and more it is commonplace to order mammoth potions of food when eating out.  If you’re at a buffet and more in control be careful not to over fill your plate.  It can take up to 20 minutes for the feeling of satiety to kick in so take your time when dining!

For healthy eating, for a main meal the recommended portion sizes are:

• 1/3 plate starchy carbohydrate (e.g. pasta, rice, potato, cous cous)
• 1/3 plate protein (e.g. meat, fish, lentils, pulses etc)
• 1/3 vegetables

In weight loss, to achieve a calorie deficit try aiming for the following adjustment in portion sizes:

• ¼ plate starchy carbohydrate
• ¼ plate protein
• ½ plate vegetables

Eat your greens!

Get your 5 a day! As well as being nutritious, most fruits and veg don’t require refrigeration and make a fantastic  on the go snack if you’re travelling. Indulge in local/ seasonal produce to make sure you stock up on antioxidants, vitamins, minerals and fibre.

Avoid raiding the mini bar!

If you’re staying in a hotel equipped with a little treat filled fridge, try to limit / avoid opening it and devouring the tempting contents. As well as encouraging you to snack on potentially high sugar, salt and fat containing snacks, there tends to be a monetary mark up, meaning It will end up costing your wallet as well as your waist line!

Learn to be a food sharer!

An area my husband has grown massively in… food sharing. If faced with an abundance of rich and calorific foods or simply intrigued to sample a wide variety of local cuisine, having a more “open” and “sharing” approach to food can help satisfy your culinary curiosity whilst reducing your calorie intake.

Stay hydrated!

Most of us definitely don’t drink enough! If you’re in a hotter climate your demands for fluid will be greater. Although caffeine and alcohol may be fluids, they both act as “diuretics” which can increase your urine output and can exacerbate dehydration. So up the “hydrating fluids” (no surprises, water being the best!) and enjoy the caffeine and alcohol in moderation!

Watch the booze !

It is not uncommon that during times of rest, relaxation or celebration we may choose crack out our favourite tipple! As seen  below, alcohol is high in calories (especially compared with carbs and protein) and that’s without a sugary mixer added to it!

• One gram of alcohol =7 kcal
• One gram fat = 9 kcal
• Once gram carbohydrates = 4kcal
• One gram protein = 4 kcal

Not only is it energy dense, but alcohol can infact stimulate our appetites possibly making us even more ravenous for our favourite treats!

For more information about alcohol, click here for a fantastic fact sheet from the British Dietetic Association.

Get active!

Holidays and travelling is a time to switch off, rest, make new memories and experience new things. However, if you’re anything like me, I love to spend hours relaxing by a pool with a good book, doing NOTHING!

Again, there is absolutely nothing wrong with this from time to time – in fact, rest is very important for our bodies too, but it is important to remember that doing at least 30 minutes of moderate or greater intensity activity at least five days a week is important for maintaining good health.

Walking, swimming, shopping, exploring, cycling, sight seeing – it all counts (as long as you do it for 30 minutes and it gets your heart rate up!). So incorporate exercise into activities that you find enjoyable!

For more healthy eating tips on how to lose weight, make sure you check out our article on weight loss tips!

By Charlotte Foster BSc (Hons), MSc, RD.

Both natural and artificial, naturally existing in foods and manufactured into food products, sweeteners are everywhere!

But what effect do they have on our health? Are they healthier than sugar? Are they bad for our health?

We want to take a closer look.

To do this, it is important to examine the effect of them in relation to different disease states in order to weigh up what impact they have on our health.

Irritable Bowel Syndrome (IBS) – the effects on the gut

• Watch out for certain polyols (mannitol, sorbitol and xylitol)!
• Erithrytol and stevia, aspartame, saccharin should be better tolerated!

Some people with IBS may be advised to follow a specific diet (e.g. the low FODMAP) diet by a dietitian.

For some people with this condition, the consumption of a group of carbohydrates known as “polyols” or “sugar alcohols” can cause symptoms associated with IBS…

The problem is, many sweeteners  are in fact polyols! (e.g. sorbitol, xylitol, mannitol and erithrytol) (1).

For some people with IBS, when polyols are consumed (in amounts greater than can be tolerated) a laxative effect can occur resulting in symptoms e.g. diarrhoea (1).

It is the molecular size of the polyol which affects the absorption and it has been found that polyols with a six-carbon structure are poorly tolerated (mannitol, sorbitol, xylitol) (1).

However, erithrytol has a four-carbon structure and has been found to be better tolerated with IBS sufferers (1).

Other sweeteners that are not polyols should not cause any adverse gastrointestinal symptoms if consumed in small amounts.

Diabetes – effects on blood sugar levels

Sweeteners do not impact blood sugar levels, but it is unclear as to whether polyols should be taken into consideration by those who have diabetes and have been advised to “count carbohydrates” (2).

Polyols (sorbitol, xylitol, Erithrytol) are often added to food products marketed to those who have diabetes. Such food products are not advocated by Diabetes UK or the European Commission Regulations and are often high in calories and fat and when eaten in large amounts can lead to adverse gastrointestinal symptoms e.g. diarrhoea (2).

Dental health- effects to our oral health

Dental cavities can form when bacteria converts sugar into acid which erodes tooth enamel. The risk of tooth decay is reduced by good oral hygiene and not eating too much sugar which helps to reduce the amount of bacteria that produce acid that attacks the teeth (3).

So, surely as sweeteners are sugar-free, they should be better for our teeth?

Well, a study in 2011 published in the British Dental Journal highlighted that some polyol containing sugar-free foods/ drinks may help prevent the development of dental caries, but they have the potential to cause dental erosion. However, this could be due to the acidic flavourings/additives these foods contained (3).

All in all, further research is needed to determine the exact impact that sweeteners and sweetener- containing foods have on our dental health.

Cancer – will consuming sweeteners increase my risk of cancer?

In the 1980s there were claims that the artificial sweetener saccharin could cause bladder cancer in rats.  As a result, it was banned by the Canadian government and strong warnings were issued by the American government about the potential cancer causing risks. However, these claims came from rat studies, and have since been discredited.  In fact, the risk of developing bladder cancer  appears to be the same in those who have diabetes  and may use sweeteners more often (for blood sugar regulation) and the incidence of the disease did not appear to escalate in World War II when saccharin consumption was high (4).

Aspartame is another artificial sweetener that has had a lot of bad press regarding its link to cancer.  Concerns arose after research in rat studies showed possible increased risks of developing cancer (5&6).  However, the European Food Safety Authority (EFSA) has concluded that there is no evidence to suggest consumption of aspartame below the recommended level will cause an increased risk of cancer (7).

It appears that now there is a strong evidence base to suggest that artificial sweeteners are safe for human consumption (4).

Weight management – do sweeteners make you gain weight?

Sweeteners are often added to foods that are branded as “weight loss friendly” implying they are free from calories. However, it would appear that the evidence base is producing mixed messages, leaving many people confused as to whether sweeteners increase appetites, increase cravings for sugar- containing foods and lead to weight gain.

The problem is, there are a range of studies that have been published, but they all are comparing different types of sweeteners (e.g. artificial vs natural; or artificial vs artificial) and they all use different forms of sweeteners within the different studies (e.g. powders vs low-calorie sweetened drinks).

For example, an American review in 2010 in looked at the impact of different artificial sweeteners and concluded that they are ineffective for weight loss and there is a link between sweetener consumption and having an increased appetite with cravings for sugar (9).  Whereas, another study in 2010 comparing the effects of both artificial (aspartame) and natural sweeteners (stevia, and sucralose) concluded that the use of these sweeteners did not cause an increased calorie intake/ food consumption from participants (10).

There have been many other studies that support the use of sweeteners for weight management. A recent meta-analysis (review) conducted in America in 2014 looked at research from several randomised control trials. The author concluded that replacing full sugar drinks with low calorie sweetened versions can result in modest weight loss (8).

Summing it all up!

It would seem that the evidence shows that sweeteners may be useful to some people e.g. those with diabetes who are trying to control their blood sugar levels, whilst for others with gastrointestinal troubles relating to IBS they may aggravate the body. Despite accusations that sweeteners cause individuals to gain weight and increase the risk of cancer, these are currently unsupported by the evidence base.

Deciding whether to have sweeteners in the diet should be up to the individual, taking into account our own health issues.

Useful links :

• Sweeteners and diabetes
• Effects of sweeteners on dental health
• Artificial sweeteners and health 

References:

(1): Mäkinen., K.K.(1984) Effect of long-term, peroral administration of sugar alcohols on man.  Swedish Dental Journal 8(3); 113-124.

(2): Diabetes UK (2016) Sugar, Sweeteners and Diabetes. Available at https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Carbohydrates-and-diabetes/Sugar-sweeteners-and-diabetes [last accessed 21/3/16].

(3): Nadimi, H., Wesamaa, H., Janket, S.J, Bollu, P. and Meurman, J.H. (2011) Are sugar-free confections really beneficial for dental health? British Dental Journal 211; E15.

(4): Cancer Research UK  (2015) Food Controversies. Available at http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/food-controversies#food_controversies1 [last accessed 21/3/16].

(5):Soffrirri, M., Belpoggi, F., Degli Esposti, D., Lambertini, L., Tibaldi, E. and Rigano, A. (2006) See comment in PubMed Commons belowFirst experimental demonstration of the multipotential carcinogenic effects of aspartame administered in the feed to Sprague-Dawley rats. Environmental Health Perspectives 114 (3); 379-385.

(6): Soffrirri, M., Belpoggi, F., Tibaldi, E., Esposti, DD., Lauriola, M. (2007) See comment in PubMed Commons belowLife-span exposure to low doses of aspartame beginning during prenatal life increases cancer effects in rats. Environmental Health Perspectives 115 (9); 1293-1297.

(7): European Food Safety Authority (2009) Opinion on a request from the European Commission related to the 2nd ERF carcinogenicity study on aspartame. Available at http://www.efsa.europa.eu/en/efsajournal/pub/945 [last accessed 21/3/16].

(8): Miller, P.E. and Perez, V. (2014) Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. American Journal of Clinical Nutrition doi: 10.3945/ ajcn.082826.

(9): Yang, Q. (2010) Gain weight by “going diet” Artificial sweeteners and the neurobiology of sugar cravings. Yale Journal of Biology and Medicine. 83(2); 101–108.

(10): Anton, S.D., Martin, C.K., Han, H., Coulon, S., Cefalu, W.T, Geiselman, P. and Williamson, D.A. (2010) Effects of stevia, aspartame and sucralose on food intake, satiety and postprandial glucose and insulin levels. Appetite 55 (1); 37-43.

By Charlotte Foster BSc (Hons), MSc, RD.

The giving and receiving of eggs at Easter is a tradition spanning centuries. Traditionally, Easter eggs came from poultry not the confectionery aisle in the supermarket! Hen or duck eggs were decorated by hand and this tradition is still practised in some cultures and religions today.

Chocolate eggs first made an appearance in France and Germany in the 19th Century and have had us hooked ever since!

Like Christmas, Easter is a wonderful time of year, bringing people together. For many, where there are friends and family, there is an abundance of food!

Whilst the occasional “indulgent day” is more than inevitable and permissible, these times of year can make it difficult to maintain healthy eating.

Supermarkets certainly don’t make this easy with deals on chocolate and Easter related treats galore! Temptation is EVERYWHERE!

Here are some top tips on how to approach the weeks following Easter…

1. Be traditional! Before chocolate eggs, there were real eggs – high in protein, vitamins and minerals. Enjoy them poached, scrambled or boiled as a part nutritious meal.
2. See past the promotions! Supermarkets are out to sell and make a profit! It may appear to be a bargain with multi-buy offers on lots of tasty treats, but be mindful of the cost-benefit to your body/health.
3. Portion up! If you’ve been given lots of chocolate eggs this Easter, make sure you read the back of the labels to understand what a recommended portion is (you will most likely be surprised!) You may find it helpful to portion up bundles of little eggs to help with self-control!
4. Share to care for your body! If your cupboards are full of indulgent left overs, how about using this as an excuse to have friends over for a meal or taking chocolates/ Easter treats into the office. Not only will this help you to consume less, but creates an opportunity to socialise in community with others which is important for our social well-being.
5. Keep perspective – remember that indulging during special occasions is often inevitable. Every passing minute is a chance to change it all around! You can get back on the healthy eating bandwagon just as quickly as falling off it!

By Charlotte Foster BSc (Hons), MSc, RD.

When speaking to people with coeliac disease or those following a gluten-free diet, the reoccurring dissatisfaction relates to manufactured gluten-free bread and the disappointment with nationwide adored past-time of baking!

Here at DINE, we are passionate about getting people back into the kitchen and re-engaged with food! Following a gluten-free diet for coeliac disease patients can be an adjustment, so here are some top tips for approaching baking gluten-free!

You may be wondering why gluten-free baking is a challenge in the first place? So first thing’s first!

It’s important to understand why recipes list certain ingredients in order for the bakes to be a success! It’s not uncommon to think that  we can modify recipes by leaving out non gluten-free ingredients and then get frustrated when the bakes aren’t a success…. guilty as charged!!

To understand why the structure of these failed bakes aren’t working, we need to understand the role that the ingredients play…

A GREAT BRITISH BAKING EDUCATION….

What is the role of gluten in bread making and baking?

Gluten in its culinary context within wheat flours gives dough its elastic qualities and helps trap gas (produced by the addition of a raising agent e.g. yeast) within baked goods, to give rise to a desired airy crumb structure.

Without gluten, air pockets don’t form and the crumb structure is likely to become dense and dry. Therefore, replacing the gluten with ingredients that can replicate these qualities is essential.

Remember – ALWAYS READ THE LABELS!

Gluten can be found in many food products, even in ones you perhaps wouldn’t expect e.g. sauces and salad dressings!

So what gluten-free flours are there?

Gluten-free recipes will often refer to using “gluten-free flour blends”. These can be bought from supermarkets (often in the gluten-free aisle). However, they are not always as easy to get hold of compared with gluten-containing flours. Essentially, these pre-made blends contain a range of gluten-free flours mixed together mixed in with a binding agent (often xanthan gum). So why not have a go at making your own?

Gluten-free Flours

Top tips!

• Look at the recipes for the proportions of the different flours and don’t forget to add the binding agent e.g. xanthan gum!
• Different flours have different flavour profiles so pay attention to the quantities recommended in recipes!
• If you’re considering making your own gluten-free flours, refrigerating them will help keep them fresher for longer. Be sure to bring them to room temperature before baking with them.

Bringing it all together!

Eggs aren’t just a good source of protein! They are often a key feature in gluten-free baking, due to their ability to bind ingredients together and help create structure to foods.

However, there are 2 other ingredients that often feature in recipe lists – Guar gum and Xanthan gum (you can find these in the baking aisle of supermarkets). These are usually interchangeable and help to stabilise/ thicken gluten-free baked goods, so make sure you keep a pot of these in your cupboard!

Top tips when baking gluten-free…

• Make the most of foods that are naturally gluten-free… there are so many!!
• Try, test and invest in a recipe journal! Experiment with recipes, everyone will have a different taste! Journal the recipes that you like and that work well.
• Have realistic expectations! Gluten-free variations of well loved dishes and bakes will never be exactly the same… try and be open minded.
• Get the crunch! Steam baking will give your bread a lovely crust.
• Seal in the freshness! Gluten-free baked goods can go stale quickly, so make sure you wrap them in cling film/ store in an airtight container to prevent them drying out!

Tips to increase the nutrition of your gluten-free bakes

• Create your own nutritious gluten-free flour mixes by using a combination of gluten-free flours.
• Where possible, use whole grain or enriched, gluten-free flours (these will contain extra vitamins and minerals)

Tips to increase the moisture of your gluten-free bakes

• Adding flaxseeds/ linseeds to gluten-free flours will help absorb moisture to help for a tender crumb structure.
• Honey or agarve syrups can help retain moisture – be careful on how much you add as these are high in energy and sugar.

Tips to improve the structure of your gluten-free bakes

• Use a combination of gluten-free flours and mix together thoroughly before adding to other ingredients.
• Add dry milk solids or cottage cheese into recipe.
• Use evaporated milk in place of regular milk.
• To reduce grainy texture, mix rice flour or corn meal with liquid. Bring to a boil and cool before adding to recipe.
• Add extra egg or egg white if product is too crumbly.
• Do not over beat; kneading time is shorter since there is no gluten to develop.
• When using a bread machine, use only one kneading cycle.

Where is a good place to look for gluten free recipes and blogs?

There are 100s of gluten free recipe books available on the market as well as lots of great online blogs and sites.  Instagram and Pinterest are overflowing with gluten free recipes and advice too. 

Popular websites with recipes and blogs about the gluten free diet include:

BBC Good Food

The Gluten Free Blogger

My Gluten Free Guide

Deliciously Ella (not all recipes are gluten free)

Officially Gluten Free

Gluten Free Cuppa Tea 

Life After Wheat

Ambitious Kitchen (not all recipes are gluten free) 

Downshiftology (not all recipes are gluten free)

By Charlotte Foster BSc (Hons), MSc, RD.

There is research to suggest that what we eat may affect not just our physical health, but also our mental health and wellbeing too.  Whilst our thoughts and feelings can often influence our food choices, the nutrition we obtain from the foods we choose can then affect how our brains function and impact our mood and mental wellbeing. Below are our top tips on how to boost your mood with healthy food choices.

Regular eating -keep your blood sugars steady!

By eating regularly we can regulate our blood sugar levels better and provide our body with a steady supply of nutrition and calories to sustain us through the day.  Focus on having low glycaemic (low GI), slow releasing carbohydrates to help avoid sharp rises and falls in blood sugar levels.

The effects of low GI & high GI foods on blood glucose levels (1).

Don’t exclude food groups – all are important! Carbohydrates have had a lot of bad press in recent years, with many people advocating cutting out this food group altogether. The reality is, carbohydrates get broken down into glucose  which is the brain’s primary energy source.  Therefore, by not having enough carbohydrate in the diet, we can end up feeling fatigued and unable to concentrate.

So remember, to fuel your brain and nourish your body we need a combination of all food groups to obtain the nutrition we need. Try to have carbohydrates, fat and protein at every meal.

The  Eatwell Guide (2).

Get on board with good fats

Omega-3 and omega-6 are both polyunsaturated fatty acids which are both important for healthy brain function. Research has shown that low levels of omega-3 have been linked with a higher incidence of depression (3-5).

Omega-3 is essential for the production of  neurotrophic factors which regulate the growth of brain cells. It is also believed that omega-3  can affect gene expression.

There are two forms of omega-3 :

• ALA (alpha-linolenic acid) – found in mainly plant sources (mainly nuts and seeds) , it cannot be made in the body and so must be obtained in our diet.
• EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) – found primarily in fish, seafood and dairy sources, although  both can be synthesised from ALA can when necessary.

Good sources of where these essential fats can be found  include:

• Oily fish
• Poultry
• Nuts (especially walnuts and almonds)
• Olive and sunflower oils
• Seeds (such as sunflower, pumpkin and chia)
• Avocados
• Dairy foods – milk, yoghurt, cheese etc

For more information on omega-3, click here.

Pack in protein!

Protein is made up of amino acids, which make up the chemicals your brain needs to regulate your thoughts and feelings.

Good sources include:

• Lean meat
• Fish
• Eggs
• Cheese
• Legumes (peas, beans and lentils)
• Soya products
• Nuts and seeds

Fruit & Vegetables – Get your 5 a day!

• High in vitamins, minerals and fibre.
• Fresh, frozen, tinned, dried all count.
• Eat a range of colours to get a good range of nutrients – several portions of the same type of food won’t be so good for you.
• Tomatoes, mushrooms and bananas all contain high levels of potassium which is essential for your whole nervous system, including your brain.
• Think about cooking methods to preserve the nutrients – boiling/ cooking for too long can destroy some vitamins and minerals .

For more information on fruits and vegetables, click here.

The Sunshine Vitamin – Vitamin D

Vitamin D plays a vital role in preventing rickets in children and osteomalacia, promoting calcium absorption, bone growth and bone remodelling. It is involved in cell growth, genetic coding and functioning, neuromuscular functioning, immune functioning and reducing inflammation.

Some evidence which suggests an association between low vitamin D levels and osteoporosis, diabetes, cardiovascular disease, tuberculosis, multiple sclerosis, preeclampsia and cancer.

In July 2016,  Public Health England released updated guidelines on  the recommendations for vitamin D:

• Adults should aim for a daily dietary intake 10µg of vitamin D
• During autumn and winter months  a daily supplement containing 10µg of vitamin D should be considered.

Make sure you get your micronutrients!

Micronutrients (vitamins and minerals) all play an important role in the body. However, the following listed below are key to help ensure we have plenty of energy and maintain healthy brain function which together can help regulate our mood.

• Selenium – found in brazil nuts, seeds,  meat, fish and wholemeal bread.
• B vitamins-  found in wholegrain foods,  meat, fish, eggs and dairy products.
• Iron – found in red meat and offal, eggs and dark leafy greens.
•  Folate – found in green vegetables, citrus fruits, beans, liver  and fortified foods e.g. Marmite  or fortified cereals.

For more information, click here. 

Fill your glass with hydrating fluids!

Most of us don’t drink enough, which can massively impact our mood and ability to concentrate. Try to aim for ~ 1.5-2 L fluid everyday.

A lack of fluid can lead to :

• Alteration in  appetite
• Cause constipation
• Impact concentration and exacerbate fatigue

Try to limit caffeinated drinks and alcohol as these can enhance feelings of anxiety and depression and impact appetite.

References:

1: Glycaemic Index Foundation (2016). What is Glycaemic Index? Available at  http://www.gisymbol.com/about/glycemic-index/ [last accessed 22/11/16].

2: The Eatwell Guide (2016) Available at https://www.gov.uk/government/publications/the-eatwell-guide  [last accessed 11/1/17].

3: Su, K. et al.  (2014) “Omega-3 Fatty Acids in the Prevention of Interferon-Alpha-Induced Depression: Results from a Randomized, Controlled Trial” Biological Psychiatry , 76 (7); 559–566.

4: Freeman MP, Hibbeln JR, Wisner KL, et al. (2006) Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. Journal of Clinical  Psychiatry,  67 (12); 1954-1967.

5: Sarris J, Mischoulon D, Schweitzer I. (2003) Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. Journal of Clinical  Psychiatry, Epub ahead of print.

Useful Links:

• British Dietetic Association – Omega-3
• British Dietetic Association – Food & Mood 
• British Dietetic Association – Fruit & Vegetables 
• MIND – Food & Mood 

By Charlotte Foster BSc (Hons), MSc, RD.

How are you? Busy? Tired? Exhausted?

Many of us can relate to the rat race of early starts and late nights – we are busy, busy, busy and it can really take its toll!

Getting the balance of life’s demands during daylight hours can be a real challenge. Commuting long distances, juggling work/ friends/ family/ partners/gym/ exercise/sleep etc – life can be exhausting!

Sleep and exercise are definitely important, but is there anything we can do in our diets to help boost our energy levels?

Having recently returned from a 3 week break from work to get married, I am reflecting on my own lifestyle and the importance of implementing good dietary strategies to stave off fatigue…

Regular eating!

I hark on about this time and time again, because it is so easy to slip into bad habits and by eating regularly we can regulate our blood sugar levels better and provide our body with a regular steady supply of nutrition and calories to sustain us through the day.

Breakfast – break the fast!

By breaking the fast – breakfast (or the first meal of the day) helps to kick start our bodies, providing the “fuel” we need for the day ahead. The whole cheesy analogy of putting petrol into a car to get it going is a cliché for a reason…. there is some truth in it! For people in the UK, largely due to popular food choices, breakfast often provides an opportunity for obtaining a significant proportion of our fibre, calcium and iron intakes for the day ahead. Interestingly, evidence also suggests that breakfast skippers are more likely to gain weight, as summarised nicely by the National Obesity Observatory.

Fruits and Veg- the faithful friends!

How many portions are recommended by public health guidelines for good health? AT LEAST 5 portions, with some new evidence saying it should be nearer 7 portions a day (1).

But why? Because, they contain fibre, minerals, and a range of vitamins, many of which are antioxidants which are cardio protective (helpful for heart health) and have an anti-carcinogenic effect by stabilising “free radicals” (pollutants) which the body is exposed to.

Pumpin’ iron!

Iron is a vital mineral that the body needs for the production of red blood cells. Haemoglobin binds to oxygen and transports it around the body to. A lack of iron can lead to iron deficiency anaemia resulting in symptoms including:

• Fatigue / lethargy (feeling exhausted)
• Pale complexion
• Breathlessness
• Heart palpitations

Now, there are two forms of iron in the diet “haem” iron (found in red meat and other animal sources) and “non haem” (e.g. fortified breakfast cereals, dark leafy vegetables e.g. spinach or watercress; beans and pulses; nuts and seeds; tofu and certain dried fruits). Haem iron is absorbed easily in the small intestines whilst non haem iron is absorbed in line with our body’s demands (2).

Vitamin C is required to help increase the absorption of iron and phenolic compounds and phytates can inhibit iron absorption (2).

For more information check out  The British Nutrition Foundation’s fact sheet on iron and iron deficiency anaemia.

Boost the B vitamins!

There are a range of B vitamins, and they all have slightly different roles, but the majority of them play a part in helping with the energy metabolism of food.

The main B vitamins are:

• thiamin (vitamin B1)
• riboflavin (vitamin B2)
• niacin (vitamin B3)
• pantothenic acid
• vitamin B6
• biotin (vitamin B7)
• folic acid
• vitamin B12

Without adequate folate or vitamin B12, anaemias can develop. You cannot store B vitamins in the body (similarly) to vitamin C, as they are water soluble.

For more information about the role of each of the B vitamins and for sources and recommended intakes check out NHS Choices article.

The “sleep boosting” minerals – magnesium & calcium

There are some claims that magnesium and calcium can help with sleep disturbance and insomnia.

One study looked at a 500mg supplementation of magnesium on insomnia and found that there were statistically significant results for participants taking a supplement of magnesium in several subjective parameters including sleep efficiency, sleep time and sleep onset latency, early morning awakening. However, there was no significant difference between groups in regards to total sleep (3). Magnesium is also essential for energy release from food (4).

Good sources of magnesium include (4):

• green leafy vegetables  e.g. spinach
• nuts
• brown rice
• bread (especially wholegrain)
• fish
• meat
• dairy foods

Good sources of calcium include (5):

• Dairy foods e.g. milk, yoghurt, cheese.
• Dark leafy vegetables e.g. broccoli and cabbage
• Tofu
• Soya drinks fortified with calcium
• Nuts
• Foods made with fortified flour
• Sardines, white bait and pilchards (fish where you eat the bones)

Glycaemic index – choose slow releasing carbohydrates and watch the sugar!

Glycaemic index (GI) is a measure of the effect that certain foods have on the blood sugar levels. The higher the GI, the higher the blood sugar level will rise following consumption and digestion.

Most of us in the UK are eating far too much sugar. Sugar is an energy (calorie) dense source in the diet and can be useful to provide short and sharp bursts of energy in times of need. However, high sugar containing products will cause a sharp rise but also a sharp decline in blood sugar levels which can leave us feeling exhausted. Also, too much sugar has been linked to being overweight/obese.

For more information on sugar make sure you read DINE’s article here.

By choosing foods with a lower glycaemic index, will help sustain our energy levels for longer. As outlined in the diagram below, the carbohydrates with a lower GI will not cause such a dramatic rise and fall in blood sugar level, providing a gentle and slow release of energy to sustain you across the day.

For more information about glycaemic index click the British Dietetic Association fact sheet.

The effects of low GI & high GI foods on blood glucose levels (6).

Hydrate! Curb the caffeine and watch the alcohol!

When we are dehydrated we can often feel exhausted (7). Making sure you are drinking enough fluid is very important, and most of us don’t drink enough.

Caffeine is a stimulant and so can help boost energy levels during certain times, but too much caffeine can disturb sleep patterns and stop you switching off at bed time.  Herbal teas can provide a good alternative if you are craving a hot beverage and certain ones e.g. chamomile tea, are thought to evoke a calming, soothing and relaxing effect on the body.

Alcohol can also lead to a disturbed night by altering our sleep cycle and disrupting the deep sleep and REM sleep patterns and for some it can also make us snore! (8).

Both caffeine and alcohol can cause a diuretic effect, causing us to need the toilet more and can exacerbate dehydration.

What about supplements?

There are so many pills and supplements available on the market promising to “cure” our tiredness for good. Common supplements/ products that are often promoted as beneficial for boosting energy include:

• Tryptophan
• B vitamins
• Magnesium
• Iron
• Ginseng
• Energy drinks
• Glucose tablets
• Caffeine tablets

The reality is, we are designed to eat food! Supplements for some people are sometimes necessary, but for many of us we can obtain all the nutrition we need through food.

By making simple dietary changes e.g. boosting the fruit and vegetable contents of our diets, choosing complex carbohydrates and  reducing sugar, caffeine and alcohol, we can radically alter our body’s nutritional status and feel the energetic benefits of a healthy and balanced diet.

If your fatigue persists, it could be a symptom of a more chronic condition e.g. anaemia (iron of B vitamin related). If you have any concerns, be sure to book an appointment to see your GP.

Useful Links:

• NHS Choices – The Energy Diet 
• NHS Choices – Tiredness and fatigue 
• The British Dietetic Association- Iron & anaemia fact sheet
• NHS Choices – Vitamin B 
• British Dietetic Association – Glycaemic Index fact sheet
• Drink Aware – Alcohol & Sleep

References

1: Oyebode, O., Gordon-Dseagu, A., Mindell J.S. (2014) Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data. Journal of Epidemiology and Community Health ; published online.

2: The British Dietetic Association. Iron Food Factsheet. Available at https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html [last accessed 18/8/21]

3: Abbasi, B., Kimijagar, M., Saeghnijat, K., Shirazi, M.M., Hedayati, M. & Rashidkhani B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences 17(12);1161-1169.

4: NHS Choices (2015) Vitamins and minerals –Others. Available at http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Other-vitamins-minerals.aspx#magnesium [last accessed 22/11/16].

(5): NHS Choices (2015) Calcium. Available at http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Calcium.aspx [last accessed 22/11/16].

(6): Glycaemic Index Foundation (2016). What is Glycaemic Index? Available at  http://www.gisymbol.com/about/glycemic-index/ [last accessed 22/11/16].

(7):  NHS  Choices (2015) symptoms of dehydration. Available at http://www.nhs.uk/Conditions/Dehydration/Pages/Symptoms.aspx [last accessed 22/11/16].

(8): Drink Aware (2016) Alcohol and sleep. Available at https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-sleep [last accessed 22/11/16].

By Helen Dady, BSc (Hons), Msc, RD.

There’s no denying it, weight loss is a hot topic!  With so much information out there about what’s effective, it can be baffling to understand what could really work for you.  This article sets out some evidence based tips that provide a good basis for planning weight loss.

1.Awareness of Calories!

I’m not an advocate in calorie counting per se, however an awareness of calories in different foods and how calories affect weight management can be a vital tool!  Most effective weight loss plans involve reducing calorie intake so that intake is less than calories burned through physical activity.  The recommended deficit in calorie intake vs calories burned for achieving weight loss is 600 kcal per day (1).  Therefore if we are in weight maintenance, introducing changes that will add up to a reduction of 600 kcal calories consumed (or equivalent increase in calories burned), is likely to achieve the deficit needed.

2. Realistic Goals!

It can be helpful to have a small number of goals to follow as part of your weight loss plan (1).

Often weight loss programmes recommend a SMART goal approach; meaning the most effective goals are: specific, measurable, achievable, realistic and time framed (2).  For example, a SMART goal for physical activity could be: ‘I will walk in the park for 30 minutes three times a week’.  Using SMART goals has the advantage that we can easily monitor whether we have achieved them or not.  Also, they can be adjusted if new would like to increase the intensity of a goal, or if we find that a goal is unachievable/unrealistic. It is important to set goals that are realistic for you.  In addition, it’s worth setting say 3-4 goals that will add up to achieving the overall calorie deficit of 600 kcal per day, to achieve the energy balance required for weight loss.

3. Realistic Health Goals

It’s really important to have a realistic target weight loss in mind when planning to lose weight.  A realistic target can help to plan goals that are likely to achieve your aim, and avoid disappointment at not being able to achieve an unrealistic target.  The down side of having an unrealistic target, such as achieving dramatic weight loss quickly, is that achieving it tends to require drastic changes that are not sustainable in the long term; so once these changes are stopped, the weight goes back on.  Much better to introduce realistic, sustainable changes that are achievable and can be continued in the longer term.

Evidence suggests that, with a 600 kcal/day calorie deficit (see above), weight loss of 0.5 – 1.0 kg (1-2 lbs) per week and/or 5-10 % weight loss over 3-6 months, is realistic and achievable (3).

4. Portion size is key!

Even in a healthy, balanced diet, if our portion sizes are too big, this will still lead to excess calorie intake (4,5).  For healthy eating, for a main meal the recommended portion sizes are:

• 1/3 plate starchy carbohydrate (eg pasta, rice, potato, cous cous)
• 1/3 plate protein (eg meat, fish, lentils, pulses etc)
• 1/3 vegetables

In weight loss, to achieve a calorie deficit try aiming for the following adjustment in portion sizes:

• ¼ plate starchy carbohydrate
• ¼ plate protein
• ½ plate vegetables

The portion control approach has the bonus that we don’t have to deprive ourselves of any particular food group!   The calorie reduction comes from reducing the complex starch and protein portions, which are more calorie dense, and filling up on vegetables, which will also help to make us feel full after eating.

5. Exercise- feel the burn!

Building in regular physical activity, or increasing your current level, is a great way to manage your weight. Often those who include exercise in a weight loss plan find results come more easily.  Try to find something that you enjoy and can build into your lifestyle. This will be different for everyone, but examples include walking, an exercise or dance class, an online exercise video, cycling, gym, or gardening.  It is recommended for adults to do at least 30 minutes of moderate or greater intensity activity at least five days a week, which can be done in one session, or broken down into sessions of at least 10 minutes or more (1).

As well as burning fat and enhancing muscle tone, exercise is also known to increase the resting metabolic rate, which refers to the calories burned while not engaging in activity (6).  In addition, physical activity will have a direct impact upon controlling blood cholesterol, blood pressure and blood glucose (7,8), meaning that increasing exercise will independently reduce your long term risk of chronic diseases such as heart disease and diabetes, as well as manage your weight! (7,8).

6. Up the fruit and vegetables

Increasing your intake of fruit and vegetables is a great strategy in weight management. The fibrous structure  of these foods means that when we consume them in a meal with other foods, the overall amount of fat and sugar absorbed is reduced (9). It’s therefore worth consuming some with every meal.

Although fruit and vegetables are made of carbohydrates, because of their high water and fibre content, they generally weigh less per gram compared to other starchy carbohydrates (such as bread and pasta), so they are relatively low in calories. This means that we can fill up on them, which helps us to feel full without leading to excess calorie intake.

Aim for the recommended ‘5 a day’  as a minimum, but if it is realistic for you then increase this for enhanced benefits.

7. Eat regularly!

I can’t stress this highly enough!   Studies have found that a regular meal pattern, especially including breakfast, is associated with reduced levels of obesity and overweight (10, 11). The benefits of regular meals for weight control may occur due to improved appetite regulation (12, 13), as well as through beneficial effects on metabolism, for example leading to more efficient burning of calories throughout the day.  As a rough guide, it’s worth aiming for at least three meals per day including breakfast, and try not to leave gaps of more than four hours between meals.

Some people skip meals, even only eating once per day. This can lead to problems, as it may result in fewer calories burned during the day, as well and more intense hunger, making us more likely to consume high calorie snacks and larger meals.

8. Check out food labels!

Label reading  can be an excellent way to learn about choosing healthier foods that will help you to manage your intake of fat, sugar and calories, and therefore manage your weight.  Many foods now contain traffic light labels red on packaging, which are often thought to be the easiest to interpret.  Generally foods with red label colouring for fat and/or sugar will be high in these nutrients, therefore higher in calories. These are best to be cut down on. Labels with green or amber colours for fat/sugar are generally healthier choices and will help you to manage your weight better.

9. Cut down on sugary drinks!

Many of us focus on foods as our main source of calories, however it can be surprising how much sugar can be found in some popular soft drinks!  For example, did you know that a 500 ml  sports/energy drink  and can of cola contain nine teaspoons of sugar! These are just a couple of examples!  It is known that calories from sugary drinks (compared to solid foods) are less well detected by the body, and therefore can add to our calorie intake without the body registering them and adjusting appetite and further intake accordingly (14). It’s worth checking how much sugar is in a bottle/can of soft drinks when choosing by looking at the label (5 g = 1 teaspoon). Choosing ‘low sugar’, ‘no added sugar’ or ‘diet’ drinks can be a very effective way to reduce your calorie intake and manage your weight.

10. Try not to exclude certain food groups!

All of the food groups (eg fat, protein, carbohydrate, and dairy) are an important part of a healthy diet , and each has a role to play in maintaining our health.  Many studies have found that the key factor in achieving weight loss is calorie restriction, regardless of whether this is through restricting carbs, fat or a combination of both (15).  This means that balanced eating can be maintained in weight loss by focussing on reducing portion sizes, so that we can still include small amounts of ‘treats’ such as chocolate, biscuits, etc.  Avoiding food groups altogether (eg cutting out carbs ) can have adverse consequences.  These include the detrimental health impact of missing out on the nutrients in a food group (16) and increased cravings for certain foods, which means people can  find that it’s unsustainable to maintain such an unbalanced approach (17).

Balanced eating can be more achievable and effective in the long run!

11. Have long-term goals!

Maintaining a calorie deficit may not be sustainable in the long term and often people find that their weight reaches a plateau after a period of weight loss (18).  It is worth building in a longer term weight maintenance strategy to plan how you will sustain the weight loss you have achieved and avoid re-gaining weight when you stop weight loss strategies.  For example you may decide to aim for weight loss of 0.5 – 1 kg per week for 6 months, achieving 5-10 % weight loss, and then aim for weight maintenance for the next 6 months.  In weight maintenance, we aim to consume equal calories to what we burn off (19).  It may be necessary to continue some specific diet related goals to avoid going back to an eating pattern that leads to calorie intake exceeding expenditure. This could be achieved through a healthy eating approach. For example, weight maintenance strategies could include maintaining regular physical activity, following ‘healthy eating’ portion sizes, aiming for regular meals and continuing to avoid sugary drinks.

12.  Cut down on fat!

There has been much attention on added sugars in the media recently, however reducing your fat intake is a very effective method for losing weight (14).  This is because fat in food has more than twice the calories per gram (9 kcal/g) compared to the other macronutrients (carbohydrate and protein both contain 4 kcal/g). This means that even small amounts of fat will be relatively high in calories, therefore cutting down on this nutrient and avoiding excess fat intake can have a huge impact and is essential for weight control as part of a balanced diet.

Strategies for reducing your fat intake include:

• Reduce added fats: try to reduce the amount of fats such as butter, margarine and oils added in cooking and preparing food.  As a rule, aim for no more than 1 teaspoon of added fats per meal to avoid excess intake.
• Choose low fat dairy foods: a simple change such as replacing full fat dairy (milk, yoghurt, cheese) with lower fat products will help achieve a reduction in your calorie intake and assist with weight control. This change will also reduce intake of saturated fats  found in animal products, lowering blood cholesterol and therefore the risk of developing heart disease (7).
• Choose lean proteins such as lean meat, poultry without skin, fish, egg, lentils and pulses.
• Lentils and pulses  are lower in calories and fat than meat, and are high in fibre so make us feel full up. They are also a low GI food, which means that they can help to control blood glucose and reduce the risk of diabetes.  Try using lentils/pulses as a substitute for meat in casseroles and stews.

Useful Links:

• British Nutrition Foundation – Obesity and Weight Management
• British Dietetic Association: Weight Loss Food Facts Sheet
• NHS Choices: Healthy Eating
• Weight Concern: Losing weight

References:

(1): National Institute for Health and Clinical Excellence (2014) Obesity: identification, assessment and management: NICE guidelines [CG189]. Available at:  https://www.nice.org.uk/guidance/cg189/chapter/1-recommendations  [last accessed 21/5/16].

(2): Department of Health (2013) Developing a specification for lifestyle weight management services: best practice guidelines for tier 2 services. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/142723/Weight_Management_Service_Spec_FINAL_with_IRB.pdf  [last accessed 21/5/16].

(3): National Obesity Observatory (2010)  Treating adult obesity through lifestyle change interventions: A briefing paper for commissioners. Available at: http://www.noo.org.uk/uploads/doc/vid_5189_Adult_weight_management_Final_220210.pdf  [last accessed 21/5/16].

(4): Ello-Martin, J. A., Ledikwe, J. H. & Rolls, B. J. (2005) The influence of food portion size and energy density on energy intake: implications for weight management. The American Journal of Clinical Nutrition 82 (1); 2365-2415.

(5):  Rolls, B. J. (2014) What is the role of portion control in weight management?  International Journal of Obesity 38 (Suppl 1); S1-S8.

(6): Miles, L. (2007) Physical activity and health. Nutrition Bulletin 32; 314-363.

(7): Department of Health (2011) Start active, stay active: A report on physical activity for health from the four home countries’ Chief Medical Officers.  Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf  [last accessed 21/5/16].

(8): Joint British Societies 3 Board (2014) Joint British Societies’ consensus recommendations on the prevention and management of cardiovascular disease (JBS3). Heart 100; ii1-ii67.

(9): Threapleton, D. E. et al (2013) Dietary fibre intake and risk of cardiovascular disease: systematic review and meta analysis. British Medical Journal  347; f6879.

(10): Mela, D.J. (2001) Determinants of Food Choice: Relationships with Obesity and Weight Control. Obesity Research 9 (4); 249S-254S.

(11): Timlin, M.T. & Pereira, M.A. (2007) Breakfast frequency and quality in the etiology of adult obesity and chronic diseases. Nutrition Reviews 65; 268–281

(12): Farshchi, H.R., Taylor, M.A. & Macdonald, I.A. (2005)  Beneficial metabolic effects of regular meal frequency on dietary thermogenesis, insulin sensitivity, and fasting lipid profiles in healthy obese women. American Journal of Clinical Nutrition 81 (1); 16-24.

(13): Benelam, B. (2009) Satiation, satiety and their effects on eating behaviour. Nutrition Bulletin 34 (2); 126-173

(14): World Health Organisation (2003) Nutrition and the prevention of chronic diseases: Report of a joint FAO/WHO expert consultation. Available at: http://apps.who.int/iris/bitstream/10665/42665/1/WHO_TRS_916.pdf?ua=1 [last accessed 28/5/16].

(15): Astrup, A., Meinert Larson, T. & Harper, A. (2004) Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet  364 (9437); 897-9.

(16): Wilborn, C. et al. (2005) Obesity: Prevalence, Theories, Medical Consequences, Management, and Research Directions. Journal of the International Sociaety of Sports Nutrition 2(2); 4–31.

(17): Moyad, M.A. (2005) Fad diets and obesity–Part IV: Low-carbohydrate vs. low-fat diets. Urologic Nursing Journal 25 (1); 67-70.

(18): Thomas, D. M. et al (2014) Effect of dietary adherence on the body weight plateau: a mathematical model incorporating intermittent compliance with energy intake prescription. The American Journal of Clinical Nutrition 100 (3); 787-795.

(19): Moehlecke, M. et al. (2016)  Determinants of body weight regulation in humans. Archives of Endochrinology and Metabolism 60 (2); 152-162.

By Charlotte Foster BSc (Hons), MSc, RD.

Although we need food to provide us with nutrition, for many, food is at the heart of friendships and family. It creates a social outlet e.g. meeting for coffee/ going out for lunch/ having dinner.  Yet for some who have a food intolerance or allergy e.g. coeliac disease socialising around food can be a challenge.

With the level of intolerances and allergies on the rise, (and many people without complex dietary needs choosing to follow exclusion diets), the food industry have, and continue to respond, with booming ranges of food products which are gluten, dairy, egg and additive (to name a few) free.

Getting to grips with the management for coeliac disease (following the gluten-free diet and excluding wheat, rye, barley and possibly oats) can make the prospect of planning a meal/ entertaining seem a little overwhelming and a bit of a challenge.

Given this social relationship with food, it is essential that health professionals help those who have dietary-managed diseases not to feel excluded from food-orientated occasions. Here at DINE we want to help make it easier for friends and family of those who have coeliac disease, in order to make the “hassle” of cooking gluten-free a thing of the past.

Top tips for entertaining people with coeliac disease:

1. Get informed!

Make sure you read up on what coeliac disease is and what the gluten-free diet is .

2. Communication is key!

Be open and honest with your guest/ host. For people with coeliac disease, being sensitive to their dietary needs is essential. If you are cooking for people who have coeliac disease, don’t be afraid to ask questions and double check information.

3. Plan ahead & select a menu that is gluten-free but enjoyable for all!

There is such a variety of naturally gluten-free ingredients that cooking gluten-free is often easier than you think!

4. Read the labels!

Gluten is often found in unsuspecting food products such as marinades, salad dressings and many other ready-prepared food products. Make sure you read the food labels if in doubt.

5. Avoid cross-contamination!

This can often seem like a challenge as any food that comes into contact with the smallest amount of gluten will become contaminated. This poses a serious health risk for someone with coeliac disease. Therefore considering how you are going to cook the food is important.

• Prepare the gluten-free meal first if you are choosing to cook a separate dish for your guest who has coeliac disease.
• Wash up all kitchen utensils thoroughly in hot soapy water – you don’t need to buy new separate cooking utensils to cook a safe gluten-free meal.
• Clean all kitchen work surfaces and ensure that the cooking/ food preparation area is uncontaminated from gluten.
• Be diligent to ensure that the gluten-free meal is prepared safely – avoid using toasters/ appliances that are at high risk of gluten exposure.
• Wrap it up! Use foil and thoroughly cleaned tuppaware to store gluten-free foods and ingredients and keep these away from any gluten-containing foods that could lead to cross contamination.

Remember to watch out for:

1. Condiments: Knives/ utensils that have been used near gluten-containing foods which are “double dipped” into condiments pose a risk of gluten-contamination. Therefore, ensure you label condiments that are gluten-free and keep these stored separately.
2. Toasters: These pose a very big gluten cross-contamination hazard to coeliac disease     sufferers. Coeliac disease patients are advised to have their own toasters and to keep gluten-containing foods away from them.
3. Chopping Boards & Utensils:  Cooking equipment made from porous substances like wood e.g. wooden spoons can hold onto particles of gluten. To be on the safe side it may be advisable to use plastic/ steel (insulated) alternatives.

Grab a copy of our handout to give to friends and family on cooking for people with coeliac disease by clicking the link below

Entertaining Gluten-Free!

By Charlotte Foster BSc Hons, MSc, RD.

One common culinary conundrum surrounding the gluten-free diet is cost! At present, most gluten-free products tend to be more expensive than gluten containing equivalents (1&2).

Studies have been conducted to examine the barrier of cost and whether it influences compliance to the gluten-free diet, highlighting mixed results. One study reported that 51.3% of participants felt that the cost of gluten-free products was an important issue but 75.3% felt this did not make the gluten-free diet difficult to adhere to (3). However, another study demonstrated the opposite- that cost is an important factor affecting compliance to the diet (4).

So why are processed gluten-free foods usually more expensive?

There are several reasons for why gluten-free foods tend to be more expensive including:

• Growing consumer demands in what used to be a specialist “niche” market – the demand for an extensive product range has only been developed in recent years (5).

• Complex processing steps involved to ensure a satisfactory gluten-free equivalent food (5).

• Additional safety and quality checks to ensure that foods are meeting the standards for those with coeliac disease (5).

• Increased cost of ingredients and equipment to ensure no cross contamination (5).

Gluten-free on prescription

Those who have been formally diagnosed with coeliac disease may be eligible to receive certain gluten-free products on prescription which can be financially beneficial. However, due to budget cuts in the NHS certain areas may be exempt – speak to a GP or dietitian for further information.

Certain gluten-free foods that may be prescribed include:

• Cereals

• Crackers/Crisp breads

• Bread

• Pizza bases

• Flour

• Pasta

• Oats

Coeliac UK are currently campaigning to see the protection of prescriptions. Click here to find out more information. 

Other tips for keeping the cost down:

If getting gluten-free foods on prescription is not an option there are still some simple tips you can try to help close the financial gap!

• Keep gluten-free breads in the freezer and take slices out to use on an “as needs” basis.

• Base dishes around naturally gluten-free foods vs processed gluten-free alternatives.

• Batch cook and bulk out! Use beans, pulses, fruits and vegetables to make dishes nutritious and delicious, bulking them out last longer.

• Plan ahead and stick to your shopping list!

• Take advantage of offers and supermarket deals.

Coeliac UK have compiled a free and helpful fact sheet for following a gluten-free diet when on a budget. Click here to read more.

Further information:

• Coeliac UK Food and Drink Directory
• Coeliac UK gluten-free check list 

References:

(1):Stevens, L. and M. Rashid (2008) Gluten-free and regular foods: a cost comparison. Canadian Journal of Dietetic Practice and Research 69(3); 147-150.

(2):Lee, A.R., et al.,(2007) Economic burden of a gluten-free diet. Journal of Human Nutrition & Dietetics 20(5); 423-430.

(3):Leffler, D.A., et al., (2008) Factors that influence adherence to a gluten-free diet in adults with celiac disease. Digestive Diseases and Sciences 53(6); 1573-1581.

(4):Hall, N.J., G. Rubin, and A. Charnock (2009) Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology and Therapeutics, 30(4); 315-30.

(5):Coeliac UK (2016) Campaigning on the cost of gluten-free. Available at https://www.coeliac.org.uk/about-us/news/campaigning-on-the-cost-of-gluten-free/  [last accessed 25/4/16].

By Josie Townsend, MNutr, RD.

When it comes to people avoiding gluten and wheat, there are various conditions you might hear bandied around that sound pretty similar and it can get really confusing! It doesn’t help that many of the conditions (which may require the exclusion of gluten-containing and wheat-containing foods) share similar symptoms.

We hope to clarify and explain the differences between these conditions, to help explain why some people may be required to follow specific diets and eliminate certain foods.

Coeliac Disease

Coeliac disease is an autoimmune condition caused by the body’s immune system reacting to the protein “gluten” found in wheat, barley and rye. Oats contain a similar protein called “avenin” which can also trigger symptoms in some people.

The ingestion of gluten damages the lining of the small intestine, affecting nutrient absorption , leading to nutrient deficiencies and sometimes unpleasant gastrointestinal symptoms.  There is no cure for coeliac disease. However, symptoms and long-term complications, such as osteoporosis, can be prevented by strict adherence to a gluten-free diet.

Click here more information on coeliac disease and following a gluten free diet or watch DINE’s video to give an overview of the condition

Non-Coeliac Gluten Sensitivity (NCGS) and Wheat Intolerance

NCGS is a sensitivity to gluten or wheat, which results in similar gastrointestinal symptoms to coeliac disease but without the immune response or damage to the gut lining. It is therefore not associated with the same nutrient deficiencies or long-term complications as coeliac disease. However, to manage symptoms, the treatment is the same – avoiding gluten/wheat-containing foods. These may then be gradually reintroduced back into the diet following a period of elimination and according to an individual’s level of tolerance. It’s important to rule out coeliac disease before diagnosing gluten sensitivity or wheat intolerance.

It must be noted that those with a wheat intolerance may still experience symptoms with some gluten-free products. This is because only the in some processed gluten-free products the gluten protein has been washed out, leaving behind a non-gluten containing wheat based ingredient.

NCGS is poorly understood and an area for much needed research.

Wheat Allergy

An allergy is different to an intolerance. Whilst a food intolerance isn’t life threatening, an allergy can be. It occurs when there is an immune response to a particular protein, such as 1 of the 4 different proteins found in wheat, and this sets of a reaction normally fairly immediately but sometimes delayed for up to 24-48 hours. Symptoms often involve skin reactions, swelling and/or breathing difficulties, which is why a severe allergic reaction (known as anaphylaxis) should be treated as a medical emergency.

Treatment includes strict avoidance of the wheat-containing products, and the option to carry an auto-injector pen of adrenaline in case of accidental exposure to the allergen. Hospitalisation may also be required.

Irritable Bowel Syndrome (IBS)

IBS is a gastrointestinal condition , resulting in similar symptoms of coeliac disease and wheat/gluten intolerance . Therefore, it is important that the diagnosis of IBS is confirmed by a doctor ensuring that other conditions such e.g. coeliac disease and inflammatory bowel disease have been ruled out.

Symptoms of IBS can vary greatly between individuals and are generally characterised by the following (which are relieved on defaecation):

• abdominal pain/ discomfort

• bloating

• change in bowel habit (diarrhoea/ constipation/ fluctuation between diarrhoea and constipation).

These should be accompanied by at least two of the following four symptoms:

• altered stool passage (straining, urgency, incomplete evacuation)

• abdominal bloating

• distension, tension or hardness in stools

• symptoms exacerbated after food

•  passage of mucus.

Certain foods and drinks (not necessarily containing wheat or gluten) may trigger an individual’s IBS. Being overweight, increased stress and a lack of physical activity can also exacerbate symptoms.

Dietitians will provide dietary strategies and advice in order to help manage symptoms.

By Charlotte Foster BSc (Hons), MSc, RD.

I recently watched a documentary on Horizon with Dr. Gile Yeo which explored the popular clean eating movement, looking at the evidence surrounding some of the claims made by the famous faces behind  who advocate this way of eating.

I LOVED IT! I thought it was brilliantly filmed, with Dr. Giles Yeo doing an amazing job interviewing the likes of Ella Mills from ‘Deliciously Ella’ , and exploring the evidence behind claims from  The Helmsley sisters and Natasha Corrett’s promotion of the alkaline diet.

It was particularly harrowing to hear about how people promote the alkaline diet, claiming  that this diet can help cure diseases such as cancer. With my Specialist Dietitian hat on, I have seen first hand, and indeed continue to experience day in and day out, just how damaging, dangerous and unhelpful non-evidence based nutritional advice can be if given to people with a diagnosis of cancer.

Like many other dietitians and health professionals I am driven to see the best outcomes for my patients, with the privalidge of providing them advice as they face what can be very gruelling treatment (chemotherapy, radiotherapy, surgery or a combination). To do this effectively, we look at the latest research and studies and translate this into practical advice. Studies and new research is always being generated, but at present, until the evidence-base says otherwise, I will continue to advocate advice rooted in evidence to do the best for my patients.

But why do people buy into faddy diets and movements like clean eating? It got me thinking about peoples attitudes to food…

At one end of the spectrum we are eating an abundance of highly processed foods. These often present themselves as quick, cheap, convenient to prepare/cook and appealing (in terms of taste, texture and aesthetic appeal). The problem is, these foods are often not particularly nutrient-rich but instead provide the body with excess of energy derived from fats and refined sugars (simple sugars). By eating a diet high in energy-dense low-nutrient foods is it a surprise we begin to see a rise in weight gain (leading to being overweight/obese), malnutrition, cardiovascular disease (heart disease) type 2 diabetes and cancer?

At the other end of the spectrum there has been movement towards “clean eating”; eating like a caveman; going “sugar free”; following a gluten-free diet; or refusing to eat solid foods and only drinking fruit/vegetable juices or coconut water! We are convinced we need to buy an array of nutritional supplements in order to optimise our health and invest in expensive blenders and equipment, in a desperate attempt to lead a healthy lifestyle. Is this really necessary? In some cases, absolutely yes. For example, some people will be required to follow a specific diet for health reasons (e.g. a gluten free diet to manage coeliac disease) or prescribed nutritional supplements by their health professionals ( e.g. GP or Dietitian) in order to ensure that they are meeting their body’s nutritional requirements if they are unable to obtain all the nutrients from food.

But for many of us we are able to obtain all our body’s nutritional needs through our food! We can save a fortune and a lot of “brain space” by focussing on providing our bodies with a RANGE foods, following a healthy and balanced diet, allowing our bodies to naturally process and metabolise all nutrition it needs.

Interestingly, research has demonstrated that for healthy individuals having an excess of micronutrients (vitamins and minerals) found in supplements can actually have a negative impact on our health. To find out more read this position paper by Health Watch.

Reasons for why we adopt these attitudes are abundant and individual – working out why we choose the foods we do is a whole other issue in itself. I believe it is vital for us to identify our attitudes towards food as well as getting to know our bodies; we are all individuals after all.

It seems that the clichéd phrase of “everything in moderation” does not seem to register on our radar. Perhaps we aren’t satisfied with this or maybe we haven’t really understood what “moderation” actually means.

When we finally let that cheesy catchphrase become a mantra in our minds, we are able to lead a life where food is not just an essential source of metabolic fuel in order to help us live, but it quickly becomes an enjoyable interest, culinary pastime, a social activity drawing people together, and I believe is one of life’s great pleasures.

Useful Links:

• British Dietetic Association Food Fact Sheet – Healthy Eating
• Health Watch Position paper on Multivitamin Supplements

By Niamh O’ Sullivan BSc (Hons), MSc, RD .

Breakfast choices have hit the headlines with concerns surrounding the sugar contents of popular breakfast cereals and what children are choosing to eat as their first meal of the day.

In the last 10 years the breakfast market has been transformed from the traditional cereals served in a bowl eaten at the table into a handy, easy-to-grab packaged option eaten on-the-go. We have seen the rise of the breakfast biscuit and more recently the emergence of breakfast drinks. We all know time and money are precious commodities, but can we really afford to condense our breakfast?

We wanted to look at the breakfast drink market to evaluate some of the current products available and to see if there is any benefit in having a liquid breakfast.

But firstly, let’s ask a basic question…what are the benefits of eating breakfast?

Why bother with breakfast?

Breakfast is commonly labelled as “the most important meal of the day”, and although all meals are important, there is some evidence to suggest eating breakfast incurs nutritional benefits.

Up until recently dietary guidelines recommending the consumption of breakfast has been based largely on cross-sectional observational studies involving self-reported dietary intake (1,2). When looking at these studies, it is clear that breakfast brings positive impacts on our health, and has shown that those likely to skip breakfast are at an increased risk of adiposity (fat mass), diabetes and cardiovascular disease (3-7).

There has also been interesting research looking into the specific effects that eating breakfast regularly has on our health in lean and obese adults (8,9). Eating breakfast has shown to have positive effects on insulin sensitivity and blood sugar control and increased physical activity levels (8,9).  In obese adults, those who skipped breakfast were more likely to compensate by eating more food later in the day (9), with other research revealing that breakfast skippers are more likely to crave high calorie foods (10).

So it’s fair to say, breakfast is important! The evidence suggests that there are far more pros to kick starting the morning with a healthy breakfast to see us through the day ahead.

So what should breakfast provide?

When we think of what our first meal of the day should provide, we want it to be nutritious and satisfying (in terms of taste and creating a comfortable feeling of fullness). A healthy breakfast needs to provide our bodies with much needed energy and protein as well as vitamins and minerals such as the B vitamins, calcium, folate and iron.

For more information about healthy breakfast ideas click here.

Breakfast drinks – are they a morning meal contender?

We wanted to cast a critical eye at three of the most popular breakfast drinks available on the market (Weetabix ; Up & Go and Fuel 10K)  to see whether they really can provide a suitable candidate for a nutritious breakfast option?

The Results…

• Both Weetabix “On the Go” and Up & Go come in a volume of 250mls whilst Fuel 10k has a larger total volume of 330mls.
• Weetabix “On the Go” contained the most calories per 100ml (85kcal ) and per total product ( 213kcal in 250ml).
• Fuel 10k contained substantially less calories per 100ml, but due to coming in a bigger volume contained the second most calories per total product (330ml).

• The recommended daily intake of sugar per day for an adult is approximately 30g .
• All the breakfast drinks analysed  were exceptionally high in sugar, with Weetabix “On the Go” containing a staggering 20.1g sugar per total product.
• Up & Go contained the least amount of sugar per product (18.5g).

• Foods containing more than 5g saturated fat per 100g are deemed to be “high” in saturated fat. Whilst foods with 1.5g of saturates or less per 100g or 0.75g per 100ml are deemed to be “low” in saturated fat.
• Weetabix “On the Go” contained 15x more saturated fat compared with the other breakfast drinks per total product, whilst Fuel 10k and Up & Go can be categorised as low in saturated fat in line with dietary recommendations.

• 100ml semi-skimmed milk contains approximately 3.5-4 g protein.
• Fuel 10k was substantially higher in protein both per 100ml and per total product compared with the other breakfast drinks. Fuel 10k had nearly double the protein content of 100ml semi-skimmed milk.
• Weetabix “On the Go” contained the least amount of protein per 100g and per total product.

• It is recommended we try to have 30g fibre everyday for good health.   A portion of 2 weetabix (as in the breakfast cereal) provides approximately 3.8g fibre.
• Both Up & Go and Weetabix “On the Go” contained higher amounts of fibre per total product (>5.5g) compared with the high protein drink Fuel 10k.

Our verdict!

It is hard to identify one of the drinks as the “winner” in this analysis. Each of the breakfast drinks we analysed all had different superior nutritional features e.g. for high intakes of protein Fuel 10k was the best product, whilst for fibre, both Up & Go and Weetabix “On the Go” would be better choices.

When you break it down, and look at what the breakfast drinks contain compared with a bowl of cereal with milk, it can be difficult to justify them as a superior option.  All the breakfast drinks we analysed were very high in sugar, arguably no better than many breakfast cereals which have been under scrutiny.

Current labelling makes it hard to work out just how much of the total sugar come from free sugars opposed to naturally occurring milk sugars, but this can somewhat be deciphered from the order of ingredients listed on the products. For example, Up & Go lists “sugar” and “fructose”  as the fourth and fifth ingredient,  leading to the assumption they contribute to a large proportion of the overall sugar content.

It appears that Up & Go have reformulated their product since they originally first launched the product in the UK, by adding in extra fibre and protein and reducing the saturated fat and sugar contents as well as boosting the vitamin and mineral content.

Also, there is not much high quality research evaluating the question of whether drinking our breakfast in a liquid form is better than having it in a solid form.  Evidence has shown that solid foods appear to be more satiating than liquids (13-20). This is attributed to the physiological processes of chewing and the fact that solid foods are digested more slowly. Solid foods seems to slow down gastric emptying (rate at which food leaves the stomach) compared with liquids, leading us to feel fuller for longer.

Whilst breakfast drinks do provide a convenient option for those struggling to make time for breakfast, this convenience comes at a cost! On average each of the breakfast drinks were found to cost ~£1.50 per unit, but other brands can be as costly as £4+ per unit.

But what we do know is that having breakfast is better than not having breakfast. The food industry and restaurants are constantly developing and offering equally convenient breakfast options, many of which are more nutritious and the same or a cheaper price than that of a breakfast drink!

References

1. Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW, Bohan Brown MM, Durant N, Dutton G, Foster EM, Heymsfield SB, et al. Myths, presumptions, and facts about obesity. N Engl J Med 2013;368: 446–54.
2. Brown AW, Bohan Brown MM, Allison DB. Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence. Am J Clin Nutr 2013;98: 1298–08.
3. Fabry P, Hejl Z, Fodor J, Braun T, Zvolankova K. The frequency of meals. Its relation to overweight, hypercholesterolaemia, and decreased glucose-tolerance. Lancet 1964;2:614–5.
4. Barton BA, Eldridge AL, Thompson D, Affenito SG, Striegel-Moore RH, Franko DL, Albertson AM, Crockett SJ. The relationship of breakfast and cereal consumption to nutrient intake and body mass index: the National Heart, Lung, and Blood Institute Growth and Health Study. J Am Diet Assoc 2005;105:1383–9.
5. Kant AK, Schatzkin A, Graubard BI, Ballard-Barbash R. Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study. Int J Obes Relat Metab Disord 1995;19:468– 74.
6. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr 2010;92:1316–25.
7. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, Rimm EB. Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals. Circulation 2013;128:337–43.
8. Betts JA, Richardson JD, Chowdhury EA, Holman GD, Tsintzas K, Thompson D. The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. Am J Clin Nutr 2014;100:539–47.
9. Enhad A Chowdhury, Judith D Richardson, Geoffrey D Holman, Kostas Tsintzas, Dylan Thompson, James A Betts. The causal role of breakfast in energy balance and health: a randomized controlled trial in obese adults. Am J Clin Nutr. 2016; 103(3): 747–756.
10. Goldstone AP1, Prechtl de Hernandez CG, Beaver JD, Muhammed K, Croese C, Bell G, Durighel G, Hughes E, Waldman AD, Frost G, Bell JD. Fasting biases brain reward systems towards high-calorie foods. Eur J Neurosci.2009;30(8):1625-35
11. European Commission. Regulation (EC) No 1924/2006 of the European Parliament and of the Council of 20 December 2006 on nutrition and health claims made on foods.Available at: http://ec.europa.eu/food/safety/labelling_nutrition/claims/nutrition_claims_en (accessed 25 October 2016).

12. SACN(Scientific Advisory Committee on Nutrition). Carbohydrates and Health Report2015. Available at:https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report(accessed 23 October 2016).
13. Mattes RD, Campbell WW. Effects of food form and timing of ingestion on appetite and energy intake in lean young adults and in young adults with obesity. J Am Diet Assoc. 2009;109(3):430-437.
14. Cassady BA, Considine RV, Mattes RD. Beverage consumption, appetite, and energy intake: What did you expect? Am J Clin Nutr. 2012;95(3):587-593.
15. Zhu Y, Hsu WH, Hollis JH. The impact of food viscosity on eating rate, subjective appetite, glycemic response and gastric emptying rate. PLoS ONE. 2013;8(6):1-6.
16. Leidy HJ, Apolzan JW, Mattes RD, Campbell WW. Food form and portion size affect postprandial appetite sensations and hormonal responses in healthy, nonobese, older adults. Obesity (Silver Spring). 2010;18(2):293-299.
17. Houchins JA, Tan S, Campbell WW, Mattes RD. Effects of fruit and vegetable, consumed in solid vs beverage forms, on acute and chronic appetitive responses in lean and obese adults. Int J Obes (Lond). 2013;37(8):1109-1115.
18. Hogenkamp PS, Mars M, Stafleu A, de Graaf C. Repeated consumption of a large volume of liquid and semi-solid foods increases ad libitum intake, but does not change expected satiety. Appetite. 2012;59(2):419-424.
19. Hogenkamp PS, Stafleu A, Mars M, de Graaf C. Learning about the energy density of liquid and semi-solid foods. Int J Obes. 2012;36(9):1229-1235.
20. Zhu Y, Hsu WH, Hollis JH. The effect of food form on satiety. Int J Food Sci Nutr. 2013;64(4):385-391.

Check out these useful links and free fact sheets for more information to help you lose weight the healthy way!

Dietetic Information & Nutritional Evidence (DINE) 

• 12 Evidence-based tips to help you lose weight

The British Dietetic Association:

• Fad diets
• Weight loss

 The British Heart Foundation:

• Facts not fads – Your simple guide to weight loss 

British  Nutrition Foundation:

• Obesity and overweight

Living in a culture where a catch up over cake and a coffee is the norm, ample temptations dominate supermarket shelves and access to treats are cheap and easy, weight loss and weight maintenance can prove increasingly difficult.

In theory weight management is simple: Energy in (calorie intake) = Energy out (calories burned)

Therefore, to promote weight loss there needs to be a deficit in energy intake (generally 600 calories less than needed to maintain body body weight per day) or more energy needs to be burned through exercise, or ideally a combination of both to be most successful (3).

However, as most of us know it’s not quite so simple in practice, otherwise we wouldn’t be in the midst of the growing obesity epidemic!

Weight loss techniques:

Everyday calorie reduction

Make sure you check out our ‘12 Evidence-based tips to help to help you lose weight!’ for information on some effective and sustainable weight loss techniques.

Technology savvy! 

Modern technology can be an excellent resource for many. There are a variety of phone applications available to record daily food and drink intakes, calculate calorie consumption and set weight loss targets.

Weight management groups

Don’t underestimate the power of peer support! Education around healthy eating, regular weigh-ins and organised physical activities are often used to promote sustainable lifestyle changes.

• NHS, local council, or workplace programmes: Have a look at what’s available in your local area or provided by your employer. Some services may be free and some may be facilitated by trained healthcare professionals, such as Dietitians.

• Commercial weight loss groups: Likely to carry a cost, but they do work well for some people. Some programmes have been shown to be effective at 12 to 18 months (16) so do your research before joining! Just be mindful they are often run by those who have used the programme to lose weight themselves and are less likely to be facilitated by healthcare professionals, so may therefore not be as appropriate for people with more complex health issues.

Book an appointment to see a Dietitian!

Some people may prefer one-to-one support to explore current dietary patterns and identify any areas with potential for change. People after a more prescriptive approach, may be guided on specific diets including calorie controlled plans, the 5:2 diet or very low calorie diet. Dietitians are the only qualified nutrition experts to advise people with specific medical conditions, so they can assess what may or may not be appropriate for an individual.

 Avoid fad diets at all costs!

This includes the Atkins, cabbage soup, blood group, paleo, and the list continues…. Anything that advises the elimination of whole food groups could result in nutrient deficiencies, unpleasant side effects and are not sustainable. There are however a few diets that are backed by more positive scientific evidence, which can be of benefit if deemed safe by your healthcare team and with guidance from a Dietitian!

• 5:2 diet – this involves a significant calorie reduction on 2 days a week; 500 calories per day for women and 600 calories per day for men, which may or may not be consecutive days. On the other 5 days a healthy balanced diet is recommended but it is important not to undo all the good work by over indulging on non-fasting days. The 5:2 diet has been shown to be equally as effective as a standard daily calorie reduction for weight loss, in addition to other health benefits, as long as overall calorie reduction remains similar (17&18). However some people may find it easier to adhere to due to a more prescriptive approach and pre-planning if meals required.

• Very low calorie diet (VLCD) – this involves meal replacements with an extra allowance of non-starchy vegetables and calorie-free fluids (important to maintain hydration), generally totalling around 800 calories per day. A recent study which followed 30 participants on the VLCD for 8 weeks, demonstrated weight loss by more than 14 kg on average (19). The rapid weight loss may be desirable in some situations, as advised by a qualified healthcare professional, but the VLCD is not suitable or safe for everyone and should be done under close supervision. Normal foods should be gradually introduced after a period of no longer than 3 months as the restrictive diet is not nutritionally complete. Weight maintenance can be difficult when discontinuing the VLCD so individuals should be educated on the necessary knowledge and skills for sustainable weight loss.

Exercise regularly!

Weight management is most effective when healthy eating and an increased level of physical activity are combined. For those less mobile, have a look on the internet or seek support for more manageable chair or floor based activities.

Ensure you have good psychological support

Weight can be a complex issue that requires people to dedicate time and effort to gaining knowledge about nutrition and diet, skills in cooking healthy food and engaging with the psychological aspects of eating; being able to identify negative behaviours and find solutions.

Prochaska and DiClemente’s 1983 transtheoretical model of health behaviour change describes the way we progress, and potentially regress, through 5 stages of change as shown in the diagram below (21) .

Assessing motivation and readiness to change may be vital in identifying potential barriers to aid effective weight management (22)  and support you to help implement positive life-long changes.

Unfortunately, the availability of psychological support can be limited with long waiting lists. However, for some people seeking this support  may be essential to improve lifestyle behaviours for good. It is always worth asking your GP/ healthcare professional about what support is available and if you are eligible for a for a referral to local services.

Prevalence – How common is obesity?

Data from the 2014 Health Survey for England, found that around a quarter of adults living in England are now obese (9).

Between 1993 and 2014, the proportion of obese men increased from 13% to 24% and obese women increased from 16% to 27% (9).

41% of men and 31% of women are considered to be in the ‘overweight’ BMI category (9).

It is quite shocking that the number of men and women now considered to be of a ‘normal’ BMI are just 33% and 40% respectively (9).

Prevalence of childhood overweight and obesity is also unfortunately on the rise. The National Child Measurement Programme (NCMP) 2014/2015 figures showed that over a fifth of England’s children aged 4-5 and a third of those aged 10-11 were overweight and obese10. When looking specifically at the level of obesity, this comprised 9.1% 4-5 year olds and 19.1% of children aged 10-11 years old (10).

Worldwide prevalence of overweight and obesity was reported to be 39% (1.9 billion) and 13% (600 million) amongst the adult population (over 18 years of age) by the World Health Organisation in 201411. A recent study even found that there are now more obese people in the world than underweight people (12); a worrying statistic as it is estimated to reduce life expectancy by 3 years on average, or as much as 8-10 years in those who are morbidly obese (1). There are now more deaths worldwide due to overweight and obesity than underweight (11).

Complications of obesity

Overweight and obesity are associated with an increased risk of several health conditions (13):

• Raised cholesterol

• Hypertension (high blood pressure) – also a risk factor for renal failure and cardiovascular disease

• Cardiovascular disease – peripheral vascular disease, heart disease, heart attacks and stroke

• Type 2 diabetes mellitus

• Gestational diabetes – diabetes which develops in pregnancy

• Certain cancers, e.g. breast, colon and endometrial

• Sleep apnoea and asthma

• Non-alcoholic fatty liver disease (NAFLD)

• Reproductive issues – in woman: infertility, menstrual cycle abnormalities, PCOS (polycystic ovarian syndrome)

• Erectile dysfunction (in men)

• Gall stones

• Gastro-oesophageal reflux disease (GORD)

• Osteoarthritis

• Psychological and social issues e.g. depression and reduced self-esteem

• Irritable Bowel Syndrome (IBS) (14)

• Gout (15)

The terms ‘overweight’ and ‘obesity’ refer to the abnormal or excessive accumulation of fat which may impair health (2).

Here are a few common methods which may be used to establish if someone is overweight or obese:

1.Body Mass Index (BMI)

• This is a simple way of estimating if someone is a healthy weight for their height.
• It is calculated by using the equation: weight (kg) ÷ height 2 (metres) = BMI (kg/m2).
• BMI often needs to be interpreted with caution as it does not measure adiposity (fat distribution) directly, and is therefore a less reliable indicator of health in certain population groups. For example,  elite athletes may have a higher BMI as they carry more weight due to muscle bulk (which weighs more) than fat mass (3).

2.Waist circumference

• This measures abdominal fat including the level of fat deposits which surround the internal organs (4).
• Carrying excess fat around the middles (‘apple shape’) is a stronger predictor of cardiovascular disease and Type 2 diabetes than the storage of more fat around the bottom and thighs (‘pear shape’) (4).

3. Bioelectrical impedance

• This is an estimate of body composition, including body fat (4).
• Various forms of equipment are available and you may find stand-on scales in your local gym.
• Error in data entry, body position, hydration status and fluid balance, and variations in body shape and fat distribution may all affect the accuracy of measurements (4).
• NICE does not recommended it as a substitute for BMI (3).

WHO (2016) and NICE (2014) classification of adult overweight and obesity and risk of associated co-morbidities (3,5&6).

Exceptions:

Some ethnic groups are at increased risk of health complications at lower BMI levels than stated in the table above, which has led to the recommendation of different BMI classifications.

Example: South Asian population – a lower BMI threshold of 23kg/m2 or less is recommended (7&8).

Men from South Asian, Chinese and Japanese descent are advised to maintain a smaller waist circumference of less than 90cm (8).

Equally it may not be appropriate to apply the BMI thresholds in the table above to  older populations, where health risks associated with a lower BMI may be of more concern and therefore a higher cut off is accepted (3).

• Coeliac UK – what is coeliac disease?

• Coeliac UK – gluten-free diet 

• Coeliac UK  Food and Drink Directory

• Coeliac UK gluten-free checklist

• NHS – Coeliac Disease

• British Nutrition Foundation – Wheat Intolerance & Coeliac Disease

Due to intestinal mucosal damage, nutrient malabsorption is common in coeliac disease. Severe malabsorption and diarrhoea, may be associated with low sodium, potassium, magnesium and zinc levels. Iron absorption occurs in the proximal small bowel, therefore, iron-deficiency anaemia is one of the most common clinical presentations of coeliac disease. Anaemia, secondary to folate deficiency or vitamin B₁₂ deficiency, can also be more prevalent.

The prevalence of anaemia varies greatly (depending on the type) and has been found in 12%-69% of newly diagnosed coeliac disease patients (12). Calcium absorption can also be affected in people with coeliac disease. Therefore, low calcium and vitamin D may lead to osteopenia or osteoporosis (13).

Coeliac disease is also associated with an increased risk of other autoimmune diseases (e.g. type 1 diabetes) and malignancies (4).

The gluten-free diet  is the only treatment for coeliac diease (4). The diet involves the exclusion of gluten found in wheat, barley and rye.  Oats may also be implicated due to gluten contamination and different individual tolerance levels (2).

Good knowledge of gluten-containing foods is essential as they are not are always obvious (e.g. stock cubes, soups, processed meats and crisps). Coeliac UK produce a Food and Drink Directory which lists foods that are gluten-free. The directory can be ordered online via their website.

What does a gluten-free diet contain?

The diet promotes the consumption of foods that are naturally gluten-free (e.g. rice, potatoes, fruits, vegetables, meat, fish, cheese, eggs, beans and pulses) in combination with specially developed gluten-free food products (e.g. breads, pastas, cakes and biscuits). In order for these products to be labelled as “gluten-free”, legislation exists to ensure the gluten content is less than 20 parts per million, which is considered a safe level in coeliac disease (2).

How strict does the gluten-free diet have to be?

Strict adherence to a gluten-free diet is essential. When eliminated, symptoms usually resolve in a few weeks/months (6), alongside a reduction in the risk of coeliac disease complications and healing of the damaged intestinal mucosa (7).

The evidence behind strict adherence to the gluten-free diet…

A study demonstrated that when the gluten-free diet was followed strictly for 5 years there was a reduced risk of developing non-Hodgkins lymphoma, oesophageal cancer and oropharyngeal cancer. Whereas, in those that failed to follow the diet, the relative risk of developing cancer increased (8).

However, the increased risk of developing cancer could be due to other confounding factors other than poor adherence to the gluten-free diet.

When there is strict adherence to the gluten-free diet there appears to be improvement to bone mineral density (BMD), reducing the risk of bone health complications. This was demonstrated in a study of 25 coeliac disease patients assessed at baseline and at 37 months following a strict gluten-free diet. Improvements in BMD in the lumbar spine and total skeleton were demonstrated compared with baseline data (9).

How much gluten in the diet is required to cause intestinal damage?

According to one study the lowest amount of gluten thought to cause damage to the intestinal mucosa is 10-50 mg per day (10).  However, in a more recent Medscape review, one study reported more than half the participants consuming only 10mg gluten per day experienced increased intestinal damage (11).

To be diagnosed with coeliac disease, GPs will conduct a serological test (blood test) to detect antibodies (proteins in the blood that react against the body’s own cells/tissues) that may be generated in the bloodstream (for a person with the condition) when gluten is eaten. If a person has a positive antibody reading they will require a referral to a gastroenterologist (specialist) for an endoscopy and biopsy.

The initial serological tests will screen for anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Serological testing for coeliac disease should not be offered to  infants before gluten has been introduced into the diet (4).

Why are biopsies required?

Patients with IgA deficiency are at greater risk of presenting a false negative result if IgA-based serological tests are used diagnostically, which could result in under-diagnosis. In light of this, biopsies are required for a firm diagnosis (4). However, there are several limitations to biopsies e.g. potential poor orientation, fragmentation or inadequate sampling that could result in an incorrect diagnosis (5).

Through more sensitive serological tests, asymptomatic forms of the disease can also be detected. Research mainly from cohort studies in people with suspected coeliac disease has informed current NICE guidelines (4), providing recommendations (outlined below) to clinicians to recognise clinical symptoms and highlight when to offer serological tests in order to aid accurate diagnoses.

When to offer serological testing…

Offer testing for adults and children with any of the following (4):

• faltering growth

• unexpected weight loss

• persistent unexplained abdominal or gastrointestinal symptoms

• iron, vitamin B12 or folate deficiency

• prolonged fatigue

• severe or persistent mouth ulcers

• type 1 diabetes (when diagnosed)

• First-degree relatives of people with coeliac disease.

• autoimmune thyroid disease (when diagnosed)

• Adults with suspected irritable bowel syndrome

Consider testing for adults and children with any of the following (4):

• dental enamel defects

• unexplained neurological symptoms (e.g. peripheral neuropathy or ataxia)

• metabolic bone disorder (reduced bone mineral density or osteomalacia)

• unexplained sub-fertility or recurrent miscarriage

• Turner syndrome

• persistently raised liver enzymes with unknown cause

• Down’s syndrome

Prevalence

Previously considered a paediatric gastrointestinal disease affecting Caucasian populations, CD is now recognised to affect all ethnic populations (2), primarily those of north European ancestry.

It is thought to affect approximately 1% of the UK population, and onset can occur at any age, but the diagnosis appears to be increasingly common in adulthood versus childhood- a ratio of 9:1 as described (3).

Symptoms

Symptoms vary and can be gastrointestinal or as a result of nutrient malabsorption (e.g. decreased bone mineral density or iron deficiency anaemia). However, it is becoming more common for individuals to be asymptomatic and present with non-classical coeliac disease (4).

Gastrointestinal Symptoms include:

• Bloating/ Distension

• Abdominal pain

• Constipation

• Diarrhoea

• Steatorrhea (fatty, pale, oily stools as a result of fat malabsorption)

• Indigestion

• Nausea

Other symptom include:

• Fatigue

• Headache

• Mouth ulcers

• Weight loss

• Alopecia

• Dental enamel hypoplasia

• Ataxia

• Infertility and miscarriages

• Delayed puberty

• Delay of menstruation

• Bone disorders – osteoporosis and osteopenia

• Poor concentration

What is coeliac disease?

Coeliac disease is a common condition that can manifest itself during childhood or adulthood. It is associated with small bowel malabsorption occurring upon exposure to gluten in genetically predisposed individuals.

What is gluten?

Gluten refers to the storage proteins (prolamines) found in wheat (gliadin), barley (hordein) and rye (secalin) that can cause an immune response (reaction of the immune system) resulting in damange to the lining of the small intestine (mucosal inflammation, villous atrophy and crypt hyperplasia).

Oats contain the protein avenin which can also trigger symptoms in some patients. The fields and mills where oats are grown and manufactured may also produce wheat/ rye/barley, which could result in cross-contamination (1).

• Diabetes UK

• British Dietetic Association Food Fact Sheet – Type 1 Diabetes 

• British Dietetic Association Food Fact Sheet – Type 2 Diabetes 

• Statistics about diabetes

• Information of hypoglycaemia and how to avoid hypoglycaemic episodes

• Prevention of Diabetes

• Pre Diabetes

• Calculating your risk score for Type 2 diabetes 

• Information on Glycaemic Index 

• British Dietetic Association Food Fact Sheet – Glycaemic Index 

• Physical activity recommendations for 19-64 year olds

• Physical activity recommendations for 65+ year olds

Sweeteners

• NHS Choices (2014) The Truth about artificial sweeteners 

•  Sweeteners and diabetes

•  Effects of sweeteners on dental health

• Artificial sweeteners and health 

Carbohydrate counting is a method used to help improve accuracy with insulin doses whilst removing a restrictive dietary approach (e.g. rationing carbohydrate contents of meals / cutting out sugary foods) that was once promoted.

It involves adjusting insulin doses to match the grams of carbohydrate in foods/beverages that are consumed. Calculating how much carbohydrate is in foods is a skill! Looking at food labels/ using reference tables/ picture guides, or weighing foods can be helpful. Carbohydrate counting will only be appropriate if advised by a diabetes specialist who will provide education on the correct doses required.

There have been several benefits associated with carbohydrate counting including (24 & 25):

• tightening blood glucose control

• allowing ‘food freedom’ – more flexibility around what and when to eat

• no adverse effect on weight

• reducing the risk of hypoglycaemic events

• improving quality of life

Carbohydrate counting is particularly encouraged with people who have type 1 diabetes, but may also be useful for people with type 2 diabetes who are on basal bolus regimens of insulins.

If you are interested in carbohydrate counting, talk to your healthcare professional for a referral into a structured education programme or to see a Diabetes Specialist Dietitian and/or Diabetes Specialist Nurse for an individual appointment.

There have also been great developments in medication for people with diabetes over the years. There are many types available, all working in different ways and targeting different body processes. For this reason, treatment is very individual and although there are guidelines for first line treatment, it may be a bit of trial and error to optimise blood glucose control whilst balancing any issues with tolerance/safety. If treatment is started it is still important to maintain a healthy lifestyle to prevent/delay progression of diabetes and subsequent medications being added.

Overall aim of treatment = optimise blood glucose control to reduce the risk of short and long-term complications.

Maintain a healthy weight

Carrying excess weight (particularly around the middle) = insulin resistance.

Therefore, weight loss will help insulin to work better and be more efficient at lowering blood glucose. There are a number of ways we can tell if we need to lose weight (BMI, waist measurement, or simply clothes feeling a bit tighter). Research has shown clinical benefits with a modest weight loss of 5-10%, including a significant reduction in HbA1c, blood pressure, total cholesterol and a better balance between the ‘good’ and ‘bad’ components of cholesterol (15)  so it is reasonable to suggest this as a good starting point. Achieving small realistic goals tends to be more sustainable and motivating.

Optimise blood glucose control

This isn’t about avoiding all foods that affect blood glucose, i.e. carbohydrates. This is about ensuring an optimal balance and spread of foods across the day to improve blood glucose regulation.

Maintain a healthy heart

We know that diabetes increases the risk of cardiovascular disease so it is important to optimise diet to reduce all other risk factors, such as cholesterol and blood pressure.

Keep physically active

Physical activity helps to increase energy expenditure and is therefore beneficial for those trying to manage their weight. It also helps to reduce blood glucose, as the muscles become more insulin sensitive (16 &17).  Don’t forget all the additional benefits for heart health, mood, and muscle and bone strength for maintaining good mobility too!

Watch what you eat

Contrary to many people’s beliefs, there is no such thing as a “diet for diabetes”. Recommendations around what you should or shouldn’t eat are the same as for those without diabetes – following a healthy balanced diet.

• Avoid buying foods marketed for people with diabetes– Lots of people are tempted by the idea of eating these foods such as “sugar-free” chocolate/ confectionary. Unfortunately, they often come with the warning that excessive consumption may cause a laxative effect (due to containing sweeteners e.g. sorbitol/xylitol etc). Products tend to be expensive, higher in fat (to add flavour) and there is no evidence to support their use. Unless you really enjoy a diabetic product, you’re probably better off having a small amount of foods higher in sugar as an occasional treat.

• Eat regular meals – skipping meals often leads to overconsumption at a subsequent mealtime, as the body is craving energy. Eating a larger portion of food will result in a bigger spike in blood glucose compared with a few smaller meals spread out throughout the day. When the body is in starvation mode it will also crave the most concentrated sources of energy, so you are more likely to choose high fat, high sugar foods, which will provide extra calories.

• Eat a moderate portion of starchy carbohydrate with each meal–avoiding carbohydrates may be more detrimental to health. They are an important source of energy, fibre, vitamins and minerals, and wholegrain varieties have also been linked to a reduction in cholesterol levels (18). It is still important to watch the portion size, to prevent excessive spikes in blood glucose levels.

• Glycaemic index (GI) – this can be a complex but potentially helpful tool. GI relates to how quickly a particular carbohydrate-containing food affects blood glucose (see diagram below ). Low GI foods are slowly absorbed, causing a smaller and more gradual peak in blood glucose, whereas high GI foods are quickly absorbed, causing a larger and faster peak in blood glucose.

The effects of low GI & high GI foods on blood glucose levels (19).

• Fruit – many people with diabetes think they need to cut out certain fruit. No fruit is out of bounds! However, watching the portion size is important as fruit is a source of carbohydrate (natural sugar) and can raise blood glucose levels if consumed in large quantities. It is recommended to have no more than 1 portion at a time.

• Fats – fat is the most concentrated source of calories (1g =9 kcal). Extra calories results in weight gain which can increase risk of insulin resistance. It is therefore advisable to stick to a lower fat diet. The type of fat we eat is also important. Too much saturated fat (found in animal products; butter, cream, cheese, meat, baked products; also palm and coconut oil) is linked to increased cholesterol, and particularly LDL cholesterol, which contributes to the furring up of arteries (20). Replacing saturated fat in the diet with more unsaturated fat (fish and plant sources; vegetable/nut/olive oils, nuts & seeds, margarines/spreads) provides a protective effect for the heart by increasing HDL cholesterol which helps to “clear the arteries” (21 &22).

• Omega-3 – this healthy fat isn’t just good for your brain and joints, research has also shown the benefits for heart health (22). Rich sources include oily fish (salmon, mackerel, sardines, fresh but not tinned tuna, etc.); linseeds; flaxseeds; walnuts; rapeseed oil; soya; green leafy vegetables and milk. Current healthy eating guidelines recommend 1 portion of oily fish per week.

• Salt – too much salt in the diet is linked to high blood pressure (23). Unfortunately, it doesn’t matter what form it comes in, be it table/rock or sea salt! The fact is, we consume far too much salt than we need (the average person has more than 8g in the UK), thanks to taste preferences and convenience foods. Current recommendations are to consume no more than 6g per day (1tsp). Some manufacturers are taking steps to reduce salt in their products but the majority of us need to find ways to cut down our salt consumption by revising our cooking methods, flavouring food with other ingredients e.g. herbs and spices.

Diagnosing Diabetes

To be able to decide on the appropriate treatment options for people with elevated blood glucose levels, specific diagnostic criteria have been devised. These guidelines and recommendations produced by the World Health Organisation (WHO) (9&10) and supported by Diabetes UK (8) are summarised in the table below.

The guidelines for diagnosing gestational diabetes were recently reviewed and updated by NICE and the new diagnostic criteria can also be seen in the table below (11).

Complications

If diabetes control is not optimised there may be short-term and long-term complications.

Short-term complications:

Long-term complications:

The risk of certain micro- and macro-vascular complications (damage to small and large blood vessels) increases in those living with diabetes and with persistently high blood glucose levels (see table below). However, managing diabetes appropriately and optimising control can reduce the risk of these occurring and it is therefore important to maintain positivity and motivation to achieve the desired targets.

Targets

These are a general guide for adults with diabetes and may differ according to individual circumstances. You should always check with your healthcare team what you personal levels and targets are so you know what to aim for.

Capillary Blood Glucose

Not everyone will need to monitor their blood glucose on a daily basis, this is very individual and likely to depend on medical treatment. However, for those who do monitor, a good aim is:

• fasting (before meal) blood glucose level = 4-7 mmol/l (12&13)

• 2 hour post-meal blood glucose level = 5-9 mmol/l (12&13)

It is not expected that these blood glucose targets should be achieved 100% of the time, however if persistently out of target, a review of diet and medication is recommended.

HbA1c

• 48-53mmol/mol (12,13&14)

• <58mmol/mol if risk of severe hypoglycaemia (13)

Blood pressure

• <140/80 mm Hg(14)

• <130/80 mm Hg if kidney, eye, cerebrovascular damage  (14)

Cholesterol & Triglyceride levels

• Total Cholesterol  = <4mmol/l (13)

• LDL Cholesterol <2mmol/l (13)

• HDL cholesterol ≥1mmol/l (men),  ≥1.2mmol/l (women)   (13)

• Triglyceride = <1.7mmol/l (13)

Prevalence

The prevalence of diabetes in the UK, as well as many other countries, is rising and as of January 2016 it was reported tthat there are now over 4 million people living in the UK with the condition (8).

Just over half a million of these are thought to be undiagnosed Type 2 diabetes, which means they will not be receiving the treatment or the monitoring they need to reduce the risk of complications.

Type 2 diabetes is by far the most common type of diabetes, accounting for around 90% of cases, and the remaining 10% being Type 1 diabetes.

Symptoms

There are a few key symptoms that are often experienced in people with diabetes. Whilst symptoms tend to develop more quickly in Type 1 diabetes, people with Type 2 diabetes may go for several years before they are diagnosed due to such a gradual onset of symptoms.

• Polydypsia (excess thirst)

• Polyuria (excess urination)

• Fatigue

• Weight loss (may not be as common/ noticeable in people with type 2 diabetes)

• Delayed wound healing

• Infections

• Thrush/ genital itching

• Blurred vision

In a person without diabetes:

• Glucose is always present in the blood to give the body energy.

• The body will regulate the blood glucose level via a mechanism called “homeostasis” to ensure levels don’t rise or fall to dangerous levels.

• Excess glucose from food (carbohydrates) will be stored in the liver, ready to be released into the blood when levels drop.

• The pancreas produces a hormone called “insulin” which acts like a key, unlocking the body’s cells allowing them to take up the glucose out of the blood and use it for energy.

In a person with “pre-diabetes” or “Impaired Glucose Regulation” (IGR):

• This is where blood glucose levels are above normal but not high enough to be given a diagnosis of diabetes.

• It is unlikely that medication would be given at this point and risk can be reduced by nearly 60% through lifestyle changes (2, 3).

• More than 70% of people with IGR may eventually go on to develop Type 2 diabetes (4).

In a person with diabetes:

Type 1 diabetes:

• It is an autoimmune process where the body attacks its own insulin producing cells in the pancreas. The cause for this is unknown, but there are theories around certain triggers, such as viruses and trauma (5, 6).

• It is associated with other autoimmune conditions such as coeliac disease, rheumatoid arthritis, hypothyroidism, etc.

• There may be a genetic link in some cases, with first degree relatives having a 15 fold increased risk, although 85% of people with the condition will have no family history of the condition.

• In type 1 diabetes, the pancreas ceases to produce any insulin at all.

• The only treatment is to replace the insulin (most commonly via injections or insulin pumps). Inhalable insulins aren’t currently approved for use in the UK.

• It is usually diagnosed in children and young adults where it develops very quickly.

Type 2 diabetes:

• It tends to develop in people over the age of 40 but due to growing waistlines and sedentary lifestyles, we are seeing younger people and even children being diagnosed.

• Lifestyle factors, particularly carrying excess weight, can increase the risk of developing Type 2 diabetes.

• Too much fat (especially around the tummy) stops insulin doing its job properly, known as ‘insulin resistance’.

• A 1cm increase in waist circumference will increase the risk of type 2 diabetes by 3.5% (7).

• The pancreas tries to compensate by producing more insulin, but over time can exhaust itself so it also starts to produce less insulin.

• Treatment often starts with advice around lifestyle changes (losing weight if applicable, healthy eating and physical activity) with or without tablets and may progress onto other injectable medication and insulin.

• Type 2 diabetes is also a genetic condition and ethnicity also plays a role. Those from a South Asian, African-Caribbean, Black African, or Chinese background are at higher risk of developing Type 2 diabetes.

Gestational diabetes:

• Gestational diabetes develops in pregnancy, normally in the second or third trimester.

• It occurs due to changes in hormones, and usually disappears following birth of baby and placenta, unless there was undiagnosed pre-existing diabetes.

• It is more common in women who are overweight, have a family history of diabetes or who are from a certain ethnic background, or those who have had gestational diabetes before.

• It is important to achieve tight blood glucose control to prevent complications occurring during pregnancy and labour, such as baby growing too large, premature birth or baby’s blood sugar dropping too low after birth.

• Risks to mothers include high blood pressure and pre-eclampsia. Some women can control their blood glucose with dietary changes alone but further treatment is also often required in the form of tablets or insulin.

 Latent Autoimmune Diabetes in Adults (LADA):

• Characteristic of type 1 diabetes but tends to develop in older adults with a slightly slower progression and can therefore sometimes be misdiagnosed as type 2 diabetes.

• Treatment will still need to be insulin due to cessation of any pancreatic insulin production.

Secondary diabetes:

• Diabetes that develops due to another disorder, for example, pancreatitis, pancreatectomy (removal of the pancreas), cystic fibrosis, or medication (such as steroids).

Maturity Onset Diabetes of the Young (MODY):

• A genetic form of diabetes which is much rarer but runs strongly in families.

• There are multiple forms of MODY depending on the gene affected, which may be identified via genetic testing to determine the most appropriate treatment from lifestyle alone to tablets or Insulin.

‘Diabetes Mellitus’ literally means “siphon” “sweet like honey” (1) which describes one of the common symptoms of diabetes; sugary urine.  Historically, sweet urine was also a means of identifying the condition.

Diabetes is defined as having a high blood glucose level – you may hear this referred to as hyperglycaemia. It is a condition caused when either (or often a bit of both):

• the pancreas is unable to produce sufficient insulin (sometimes none at all)

• the insulin that is produced doesn’t work properly (known as insulin resistance)

Some useful terminology…

Glucose – one of the simplest forms of carbohydrate made up of one molecule, and therefore easily absorbed into the blood where it is then distributed around the body to be taken up by muscles and organs for use as fuel. All carbohydrates must be converted to glucose for use.

Insulin – a hormone produced by the pancreas that helps the body to store or use glucose for fuel.

Pancreas – a leaf-shaped organ that sits behind the stomach and produces hormones (such as Insulin), and digestive enzymes to break down food.

Carbohydrate – one of the major food groups which is known to be the most significant source of energy (glucose) and can be divided into the following subgroups:

• Sugar – generalised term for sweet, short-chain carbohydrates

• Starches – longer-chain carbohydrates

What is a Dietitian?

Knowing who to trust in the advice arena can be a challenge. Anyone is eligible to call themselves a Nutritionist/ Nutritional Therapist or “expert” in nutrition! However, unless having undertaken professional training, not everyone can call themselves Dietitians.

Dietitian

Registered Dietitians (who have the professional letters “RD” after their names) are the only qualified health professionals that have been trained to assess, diagnose and treat diet-related diseases in healthy and unwell individuals and at a population level. To ensure they work to the highest standard, dietitians are the only nutrition experts who are regulated by law and governed by an ethical code under the regulator the Health & Care Professions Council (HCPC).

Nutritionist

Nutritionists work in many areas including health policy, local and national government, Non-Governmental Organisations (NGOs), public health, education, research or in the private sector. Those that have studied courses in nutrition that meet accreditation by the Association for Nutrition (AfN) are eligible to register with the UK Voluntary Register of Nutritionists (UKVRN). Nutritionists work with people who are well and are qualified to provide information about food and healthy eating, but NOT about special diets for medical conditions. They SHOULD NOT work with people who are clinically unwell and require input from a dietitian.

Nutritional Therapists

Nutritional Therapists may have undergone informal training or via the Institute of Optimum Nutrition. They are not eligible to register with the UKVRN or the HCPC. Practice is not recognised by conventional medicine. Nutritional Therapists use treatments such as food-avoidance and detox or promote the intake of high dose vitamins, which are not NHS-approved. Their practice is not necessarily scientifically evidenced-based and advice is often based on personal opinion.

What is the Health & Care Professions Council (HCPC) that regulate dietitians?

The HCPC is a UK based health regulator established to protect the public. The HCPC outlines standards for dietitians which must be adhered to. Failure to do so results in the HCPC taking necessary action. Dietitians must be seen to be actively keeping up-to-date and refining their practice via “Contiuned Professional Development” (CPD).

What do dietitians do and where do they work?

Dietitians treat medical conditions using evidence-based practice. This means, they critically examine (appraise) the latest scientific evidence and research and subsequently translate it into practical advice to educate, advise and help people to make necessary food choices . They usually work in the NHS or in the private sector across many settings including:

1. Hospitals
2. The Community
3. Care homes
4. Rehab units
5. Food industry
6. Catering
7. Education
8. Public Health
9. Sport
10. Media

Further infomation

For more information about the profession of Dietetics visit The British Dietetic Association or Trust a Dietitian.