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Nutrition for PCOS

Polycystic Ovarian Syndrome (PCOS) is a hormonal condition that effects up to 20% of women.

An increasing number of women are developing PCOS due to weight gain during teen and adult years, increasing insulin levels which can cause cysts on the ovaries.

Why nutrition is important?

Women with PCOS often are insulin-resistant – meaning that the body can’t use insulin properly to help transfer sugars in the blood to the cells to be used for energy. Having high amounts of insulin leads to fat storage/weight gain. And long term, it is a risk factor for Type 2 Diabetes.

Eating high amounts of carbohydrates and carrying excess weight can increase your insulin levels and increase your body fat. Dietary management of PCOS requires a lower carbohydrate, low GI diet to prevent spikes in insulin levels and support weight loss.

Losing as little as 5% body weight can have huge health benefits. For example, if you weigh 90kg, losing 4.5kg is enough to decrease total body fat, visceral fat (the dangerous fat around your organs) and liver fat. Plus it can lower blood pressure, improve insulin sensitivity and all together this lowers the risk of developing type 2 diabetes.

Nutritional tips for managing PCOS

  1. Know what foods contain carbohydrate (breads, cereals grains, fruit, potato/sweet potato, dairy (except cheese), foods with added sugar)
  2. Remove processed carbohydrates – white bread, biscuits, cakes, sweets
  3. Portion control – small regular meals rather than big meals
  4. All fluids should be calorie free
  5. Meals should be built around a palm size piece of protein and non-starchy vegetables
  6. Follow a low carbohydrate diet (studies show limiting carbohydrates to 50g per day reduces fasting glucose, reduces body fat, and reduces risk of diabetes)

Day on a plate

Breakfast 1 slice of wholegrain toast with 2 eggs, gilled tomato and spinach

 

Lunch tuna ricotta and avocado salad – 60g reduced fat ricotta, 100g tin of tuna, 1 cup salad vegetables, 1/2 avocado
Dinner chicken and almond stir fry – 150g raw chicken breast, 2 cups mixed vegetables, basil, ginger, chilli, garlic, 2 tsp canola oil, 1/4 cup chopped almonds
Snacks 25g mixed nuts, 100g low fat yoghurt, coffee with 100ml skim milk

Dietitians are able to personalise your plans as no diet is ‘one size fits all’. Feel free to book in with one of the Accredited Practising Dietitians at Peninsula Physical Health and Nutrition (PPN).

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Protein for weight loss… how much do you need?

How much protein do you need to maintain performance and muscle mass during weight loss?

It is often necessary for athletes or those undertaking high levels of exercise or training to lose weight, whether that be for optimal body composition, aesthetics, requirements of the sport or weight gain over the off-season. It is also desirable to be able to maintain performance and training at optimal levels during weight loss, to maintain muscle mass and to prevent injury.

To do this we need to consider the amount of protein that will give us high quality weight loss while enabling the individual to continue to perform at their best. For health, we require 0.8g protein per kg per day, which for example means a 70kg person requires 56g of protein a day to meet general requirements. However, protein requirements during calorie restriction are much higher in this group of people. Studies show they need somewhere between 1.6-2.4g per kg body weight per day (1) – so the same 70kg person is looking at 112-168g protein per day.

Now, the total amount of protein is not the only consideration we need to make. Our bodies can only use 20-30g protein for muscle repair and synthesis every 3-4 hours. So, it is unhelpful to consume more than 100g of protein at once. Instead, it is best to spread protein intake evenly throughout the day, making sure each meal and snack contains 20-30g of high quality protein in order to meet their individual protein requirements. Another key time point to consume adequate protein is in the hour or two after training or exercise, particularly resistance exercise, when the rates of muscle protein synthesis are higher. This will ensure you are meeting your protein requirements necessary for good quality weight loss, or in other words body fat loss rather than muscle mass loss.

So, what does that look like in food? You can get 20-30g of high quality protein from:

  • 2-3 large eggs
  • 1 serving Whey Protein
  • 120g lean red meat or chicken
  • 120g fish
  • 1-2 tins of tuna or salmon
  • 250g (2 tubs) high protein yoghurt
  • 2 large glasses of milk
  • ½ tub cottage cheese

If you are unsure about how much protein you should be eating or would like further advice about weight loss, feel free to book in with one of the Accredited Practising Dietitians at Peninsula Physical Health and Nutrition (PPN).

  1. Hector, A.J., Phillips, S.M. (2018). Protein Recommendations fr Weight Loss in Elite Athletes: A Focus on Body Composition and Performance, Int J Sport Nutr Exerc Metab, 28, 2, 1701-77.
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What exactly is ‘energy availability’?

Energy Availability (EA) refers to the amounts of energy left over and available for your body’s functions after the energy expended for training is subtracted from the energy you consume from food.

Food energy intake – Exercise Energy Expenditure = Energy Available for your body systems

Low EA is when the energy available after exercise is insufficient to meet you baseline physiological needs. Basically, your body doesn’t not have enough energy to maintain normal, healthy functions which lead to hormonal and metabolic adaptions to reduce the amount of energy your body can function on.

As a result, low EA can lead to:

  • Impaired ability to use glucose effectively for energy
  • Increased fat stores
  • Slower metabolic rate
  • Increase cholesterol
  • Decreased production of growth hormone
  • Changes to menstrual cycle such as amenorrhea

This condition was traditionally thought only to affect athletes, adolescents and people suffering with eating disorders, however, people who exercise recreationally, of any body shape or size, are also at risk; especially in a society that pushes the message of eat less and move more. A study of 109 female recreational exercisers, published in the International Journal of Sports nutrition and Exercise Metabolism, showed that 45% were classified as at risk of Low EA.

Some signs to look for if you suspect you may have low energy availability:

  • Training hard, but not improving performance
  • Fatigue
  • Easily injured
  • Recurrent illness or infection
  • Decreased muscle strength
  • Altered menstrual cycle
  • Gastrointestinal problems
  • Low iron or anemia
  • Stress fractures

What to do to prevent it?

Now I am not suggesting that we move less as exercise has numerous benefits for physical and mental health, nor am I suggesting that everyone needs to eat more. Rather restricting your intake while pushing your body to the limits in the pursuit of weight loss, health or fitness as this approach will ultimately fail you, I’d suggest that it is about finding that balance between fueling your body and mind adequately for the amount of exercise that you are doing. Look out for the signs of low EA and seek support if you think this may be you.

Try to listen to your body, if you are hungry or low in energy, try a nutritious snack or meal; if you are tired, have a rest or try a lighter form of exercise that day. Eat regularly and nutritiously without depriving yourself of any particular food. Eat mindfully and learn about the foods and nutrients needed to fuel your body properly.

If you are still confused about how much or what you should be eating, or if you think that you may have low energy availability, it is worth seeking the support and advice of an Accredited Practising Dietitian (APD).

References:
Logue,D., Madigan, S.M, Delahunt, E., Heinen, M., McDonell, S., et al. (2018). Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance, Sports Medicine, 48,1,73-96.
Slater, J., McLay-Cooke, R., Brown, R., Black, K. (2016). Female Recreational Exercisers at Risk for Low Energy Availability, International Journal of Sport Nutrition and Exercise Metabolism, 26, 5, 421-427.
Fagerberg, P. (2017). Negative Consequences of Low Energy Availability in Natural Male Bodybuilding: A Review, International Journal of Sport Nutrition and Exercise Metabolism, 22, 1-31.
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Why do I need branched-chain amino acids?

Leucine, isoleucine and valine are the three branched-chain amino acids. These 3 BCAAs are also essential amino acids, meaning they cannot be made by the body and must be obtained from dietary sources. BCAAs are unique as they can be metabolised by the skeletal muscle, while the other essential amino acids are metabolised in the liver.

BCAAs have been commonly used in body building communities for years, but now they are gaining popularity with other athletes and the general active population.

BCAAs have been suggested to be beneficial by:

  • Stimulating muscle protein synthesis (through leucine)
  • Preventing muscle protein breakdown
  • Reducing markers of exercise induced muscle damage and so reducing muscle soreness
  • May have the potential of acting as a fuel source for muscles during exercise
  • May reduce fatigue by interfering with tryptophan transport to the brain and reducing serotonin.

However, studies have shown that they do not always correlate with improved performance and the evidence for the above benefits is only low to moderate at this stage.

The evidence is not conclusive whether BCAA supplementation is superior to whole protein supplementation or carbohydrate intake. Athletes with a tight energy budget may benefit as they may help to build muscle without a large kilojoule load.

For the best effect, BCAA supplementation should be used in amount to provide 2-3g leucine and so far, no negative or toxic effects have been found.

However, It is important to keep in mind that many protein sources contain BCAAs such as meat and eggs and those already consuming adequate protein may not need supplementation.

When considering any supplementation, it is important to consider what is right for you as an individual and consult an Accredited Sports Dietitian or Accredited Practising Dietitian if you’d like more information and guidance of safe and effective supplementation.

References
Foure, A., Bendahan, D. (2017). Is Branched-Chain Amino Acids Supplementation an Efficient Nutritional Strategy to Alleviate Skeletal Muscle Damage? A Systematic Review, Nutrients, 21, 9(10).
Cheng, I.S., Way, Y.W., Chen, I.F., Hsu, G.S., Hsueh C.F. et al. (2016) The Supplementation of Branched-Chain Amino Acids, Arginine, and Citrulline Improves Endurance Exercise Performance in Two Consecutive Days, Sport Sci Med, 5,15 (3), 509-515.
Ferreria, M.P., Li, R., Cooke, M., Kredier, R.B., Willoughby, D.S. (2014) Periexercise coingestion of branched-chain amino acids and carbohydrate in men does not preferentially augment resistance exercise-induced increases in phosphatidylinositol 3 kinase/protein kinase B-mammalian target of rapamycin pathway markers indicative of muscle protein synthesis. Nutr Res, 34 (3), 191-198.
Kephart, W.C., Mumford, P.W., McCloskey, A.E., Holland, A.M., Shake, J.J., et al. Post-exercise branched chain amino acid supplementation does not affect recovery markers following three consecutive high intensity resistance training bouts compared to carbohydrate supplementation, J Int Soc Sport Nutr, 26, 13, 30.
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Gut microbiome and obesity…

The microbiome is a collection of bacteria that lives in the digestive tract that is critical to health and well-being. A symbiotic relationship exists between gut bacteria and host, where they both benefit from one another.

Recently, there has been great interest in the role that gut bacteria plays in obesity and how we might be able to control our weight by manipulating or changing our gut microbiome through probiotics and prebiotics.

A link between gut microbiome and obesity was first recognized during mice experiments when gut bacteria from genetically engineered obese mice were put into germ free mice. These germ free mice experienced a 60% increase in body fat over a 2 week period, despite eating less food. This bacterium has been identified as firmicutes, which is efficient at extracting energy from the food we eat. From this, and other similar studies, it has been suggested that the composition of gut bacteria in obese individuals may have an increased capacity to harvest energy (calories) from food.

As a consequence, we are now looking at ways to manipulate or ‘improve’ our gut microbiome to assist with weight management. The ingestion of probiotics has been a key focus, however we have only just scraped the surface.

Probiotics are defined as the ‘good’ microorganisms expected to have a beneficial impact on our health and can come in different forms such as capsules (Inner Health Plus) or fermented foods and drinks (Kombucha). To date, there is no recommendations for adequate intake of probiotics.

While it is important to ensure that we have adequate ‘good’ gut bacteria in our digestive tract, it is just as important to make sure that we feed these bacteria adequately. This is done through the consumption of prebiotics, non-digestible carbohydrates that trigger the growth of good bacteria. Foods that are high in prebiotics include onion, garlic, leeks, artichokes, stone fruit, watermelon, dried fruit, barley, rye, wheat based products and legumes.

The role that our gut microbiome plays in obesity and our overall health is very complex and more research needs to be undertaken before we can make any conclusive recommendations. This is an exciting area so watch this space!

  1. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: Human gut microbes associated with obesity. Nature; 44. 1022-3.
  2. Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444-1027-31.
  3. Musso G, Gambino R, Cassader M. Interactions between gut and microbiota and host metabolism predisposing to obesity and diabetes. Annu Rev Med.
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What is ‘intermittent fasting’?

‘Intermittent fasting’ diets refer to any diet where you calorie restrict for a certain period of time, then eat ‘as normal’ for the rest of the week, with the aim of losing weight. 

The 5:2 diet popularised ‘intermittent fasting’, where a person fasts for 2 days per week, then eats normally for the remaining 5 days. The idea is that on fasting days the individual consumes approximately 25% of their requirements only, leading to overall weight loss over the course of a week. 

There is some talk around suggesting that intermittent fasting has greater benefits than just weight loss. That it can assist in reducing cholesterol and blood glucose levels, thus reducing risk of diabetes and cardiovascular disease. Dr Michael Mosley tested this theory himself in his recent BBC documentary ‘Horizon: Eat, Fast, Live longer’, and while he admits that the evidence is not solid yet, he did see positive changes in his own cholesterol and blood glucose levels after trialling the 5:2 diet for 5 weeks. 

Is it right for you: while the evidence shows that Intermittent Fasting is beneficial is achieving weight loss, so are many other types of diets. This diet can work well if you can stick to it and if it fits into your life, otherwise good old fashion ‘reduced calorie diets’ will work just as affectively. As for whether it reduces blood markers and disease risk – the jury is still out.  

Here is an example of a ‘fasting day’ diet (approximately 500 calories per day allowed)

Breakfast: 2 egg white omelette (30cal) + 1/2 cup spinach wilted (15cal)

Lunch: Tuna in olive oil (115cal) + 1 cup salad leaves (20 cal) + 8 cherry tomatoes (10cal) + 2 vita wheat crackers (45cal)

Dinner: 100g poached chicken breast (150cal) + 2 stalks broccolini (10cal) + 4 spears steamed asparagus (10cal) + 1/2 cup sautéed mushrooms with no added fat (25cal)

Snack: 6 carrot sticks + 1 tablespoon hummus dip (50cal)

Total: 485calories/2029kJ, 63g protein, 15g fat, 18g carbs, 12g fibre

Link to further readings: BBC News, The Power of Intermittent Fasting. http://www.bbc.com/news/health-19112549
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Eggs for muscle growth

Don’t separate your whites!

Post exercise, your muscles synthesis protein 40% more if you’ve consumes whole eggs, rather than consuming the equivalent grams of protein in egg whites only.

Many people have been throwing away the yolk thinking that they can get more protein from egg whites only, but in fact, the yolk contains valuable nutrients not found in the white, and these nutrients enhance the protein synthesis mechanism in the muscle. So don’t be afraid of the fat in egg yolk, it’s a powerhouse of essential nutrients for your muscles!

Why not scramble yourself a bowl of delicious egg after your next workout and watch those muscles grow?

Stephan van Vliet et al, Consumption of whole eggs promotes greater stimulation of postexercise muscle protein synthesis than consumption of isonitrogenous amounts of egg whites in young men, The American Journal of Clinical Nutrition (2017). DOI: 10.3945/ajcn.117.159855 
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The A-Z of fermented foods

Fermentation is the process in which microorganisms such as bacteria, yeast or fungi convert organic compounds – usually carbohydrates such as sugars and starch – into alcohol or acids.

The role of fermentation is varied, it was originally used to preserve foods, it makes food more digestible, changes the taste of foods and decreases cooking time. The bacteria involved in fermentation produce micronutrients, are a source of good bacteria’ for the gut and can reduce anti-nutrients.

Fermented foods such as kimchi, sauerkraut, kefir and kombucha have recently become popular in health conscious population due to their probiotic or ‘good bacteria’ content. These probiotics have been shown to improve intestinal tract health, enhance the immune system, reduce symptoms of lactose intolerance, potentially reduce prevalence of allergies and reduce risk of certain cancer. They may also play are role in improving our mental health.

So what are they and should I use them?

  • Kombucha is a drink traditionally made by fermenting sweetened tea with a symbiotic culture of bacteria and yeast, commonly referred to as a ‘scoby.’ Its lower sugar content makes it a good alternative to a sugary drink.
  • Kefir is a fermented milk drink made with kefir ‘grains’ – a fermentation starter made of yeast and bacteria. Traditionally, kefir was used to treat gastrointestinal problems, hypertension and allergies.
  • Kimchi is a traditional Korean side dish, made from salted and fermented vegetables, most commonly cabbage with a variety of seasonings.
  • Sauerkraut is finely cut cabbage that has been fermented by various lactic acid bacteria giving it a distinctive sour flavour.
  • Miso is a traditional Japanese seasoning, a thick paste used in sauces, spreads, picking and of course in miso soup,  produced by fermenting souybeans with salt and koji (a fungus) and sometimes other ingredients.

In the context of a healthy balanced diet, including some fermented foods for flavour, variety and the potential gut benefits would be a welcome addition. However, be careful not rely on these foods as a cure-all.

References
Parvez, S., Malika, M.A., Ah Kang, S., Kim, H.Y. (2006). Probiotics and their fermented food products are beneficial for health, J Appl Microbiol, 100(6), 1171-1185.
Vina, I., Semjonovs, P., Linde, R., Denina, I. (2014). Current evidence on physiological activity and expected health effects of kombucha fermented beverage, J Med Food, 17(2), 179-188.
Leite, A.M., Miguel, M.A., Peixoto, R.S., Rosado, A.S, et al. (2013). Microbiological, technological and therapeutic properties of kefir: a natural probiotic beverage, Braz J Microbiol, 44(2), 341-249.
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Can you sleep away a bad diet?

Wondering why you’re craving sugar so much when you’re tired? Feeling that afternoon slump?

A new study has found that sleeping a little longer each night could be the simple answer to cutting down your intake of sugary food. Many adults are not getting enough sleep each night, leaving them fatigued and craving sugary boosts.

A recent study looked at adults who slept less than seven hours per day, and their overall nutrient intake. They found that by extending sleep by an 1.5 hours, the participants ate 10g less free sugars, as well as less overall carbohydrates for the day.

This confirms what a lot of studies have already seen; that inadequate sleep is linked to poor food choices.

So put on your PJ’s a little earlier today and catch those zzz’s, then enjoy your healthy diet tomorrow!

Haya K Al Khatib  Wendy L Hall  Alice Creedon  Emily Ooi  Tala Masri  Laura McGowan  Scott V Harding Julia Darzi  Gerda K Pot , ”Sleep extension is a feasible lifestyle intervention in free-living adults who are habitually short sleepers: a potential strategy for decreasing intake of free sugars?” A randomized controlled pilot study . The American Journal of Clinical Nutrition, Volume 107, Issue 1, 1 January 2018, Pages 43–53, https://doi.org/10.1093/ajcn/nqx030
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Are there any health benefits of a vegan diet?

Yes, a vegan diet can be nutritious, but extra care needs to be taken. It is important that careful consideration and planning goes into a vegan diet to ensure that all nutrient bases are covered.

A vegan diet is one where only plant based foods are eaten, it excludes all animal products and animal derived ingredients (meat, poultry, fish, seafood, dairy products, eggs, honey and any other animal derived ingredients).

The benefits of a vegan diet on chronic health conditions:

A vegan diet can be beneficial in improving glycaemic control of individuals with type 2 diabetes, and reducing risk factors for cardiovascular disease. The American Diabetes Association looked into vegan diets and their affect on HbA1c, total blood lipid levels, cholesterol and body weight. All markers were significantly reduced after 22 weeks on a vegan diet – supplemented with B12 tablets to ensure nutrient adequacy.

A well balanced vegan diet may be one method of reducing weight, and improving glycaemic levels amongst T2DM sufferers and reducing risk of cardiovascular disease.1  

To ensure nutritional adequacy of a vegan diet, these nutrients need to be considered as they are mainly/only found in animal products:

  • Iron – the type of iron found in plant foods (non-haem iron) is not easily absorbed compared to animal sourced iron. It is important to pair your plant based iron (legumes, tofu, nuts, seeds, wholegrains, fried fruit, dark leafy greens) with Vitamin C rich foods to boost the absorption levels. Vitamin C rich foods include berries, citrus, tomatoes, broccoli.
  • B12 – is naturally occurring in animal products only. Vegans must include foods fortified with B12 or take a B12 supplement. Common foods fortified with B12 include vegetarian burgers/patties/sausages, some breakfast cereals, some soy milks)
  • Calcium – no dairy products are included in a vegan diet. Calcium must come from other calcium rich foods or fortified products. Tofu, calcium-fortified soy products, green leafy vegetables, tahini and almonds are good alternatives for dairy products.
  • Omega 3 fat’s – our body must ingest omega 3 fats as we cannot produce it ourselves. It is commonly found in oily fish, however a vegan diet could include linseeds, flaxseeds, walnuts, chia seeds, soy bean and canola oil as alternative omega 3 sources, but note that the type of omega-3 found in these plants differs from the marine omega 3 fat which is the more beneficial form. the body is able to convert a small amount of plant omega 3 fats to the marine type.

 

  1. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Neal D. Barnard, Joshua Cohen, David J.A. Jenkins, Gabrielle Turner-McGrievy, Lise Gloede, Brent Jaster, Kim Seidl, Amber A. Green, Stanley Talpers. Diabetes Care Aug 2006, 29 (8) 1777-1783; DOI: 10.2337/dc06-0606
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