What on earth are prebiotics?

Confused about PREbiotics and PRObiotics? Not sure if they are the same thing of different?

PREbiotics are in fact completely different to PRObiotics.

Prebiotics are non-digestible food ingredients that promote the growth of beneficial microorganisms in the intestines. In simpler terms…. they are the roughage in the gut that cannot be broken down and digested, so our gut bacteria thrives off it and grows, this is a good thing!

It is the healthy food for our good gut bugs, helping them to flourish and multiply. Having a good balance of good gut bacteria can improve IBS symptoms, reduce bloating and gas, improve bowel health, improve mood and immunity. Research is constantly showing us that there is a link between our gut microbiota and our health and disease status, so it’s important we feed our gut bugs with prebiotics to help them evolve.

So where do I find PREbiotics?

  • Vegetables
    • Garlic, onion, beetroot, fennel, Jerusalem artichoke, corn, cabbage
  • Legumes
    • Chickpeas, lentils, kidney beans, baked beans, soybeans
  • Fruit
    • Nectarines, peaches, watermelon, grapefruit, persimmon, fried fruits
  • Bread/cereals
    • Barley, rye, pasta, couscous, wheat bran, oats
  • Nuts/seeds
    • Cashews, pistachios

If you have IBS you may be looking at the above list and be thinking they are the foods you purposely avoid. A dietitian can provide guidance on how to manage your IBS, in the short term they may suggest you eliminate these foods, then with guidance, slowly re-introduce a range of prebiotics into your diet, to grow certain bacteria to help reduce your IBS symptoms in the long term.

Reference: Monash Uni Department of Gastroenterology
Read more

The effect of exercise on gut health

Most of us are well aware that exercising regularly is beneficial for weight management, can increase our feelings of happiness, strengthens our muscles and bones, enhances our energy levels and can motivate us in achieving our nutrition goals. Interestingly, recent evidence has emerged that suggests exercise can alter the bacterial composition of our gut microbiome.

Our gut microbiome contains over 100 trillion different bacterial species, and can be influenced by our diet, weight, medical history and the use of antibiotics. There is emerging research to suggest that the composition of gut is largely responsible for our overall health and wellbeing. Exercise has recently been proven to have a positive effect and increase the diversity of bacterial cells within the digestive system.

A recent study which looked at the effect of exercise on gut bacteria in rodents, found that regardless of their weight there was an altered bacterial state. Additionally, evidence also confirmed that irrespective of whether the mice was following a low-fat/high-fat diet, their gut bacteria was reformed after running (the degree of alteration was distance dependant).

Research is also proving results in humans, as well as rodents. A study recently looked at the bacterial composition of professional rugby players found that the variety of species was more diverse in these athletes, compared to non-athletes. It is important to recogniser that elite athletes are also likely to have greater metabolic and inflammatory markers, which may also effect their gut microbiome.

Aside from exercise and all the additional benefits we reap from keeping physically active, there are a range of other lifestyle practise that can be done to ensure maximal variety of bacterial cells within the gut microbiome:

  • Eat a wide variety of fibrous, plant-based foods
  • Include resistant starch and prebiotic containing foods daily (banana’s, potatoes, lentils, legumes, onion, garlic, asparagus)
  • Consider a probiotic supplement
  • Try a range of fermented foods (yoghurt, kimchi, kombucha and tempeh)
  • Include adequate wholegrains in your diet
  • Be mindful of antibiotic use
  • Control your stress levels: try meditation, yoga, going for a walk or catching up with a friend
  • Think about your fluids. Aim for water as your sole source of hydration, and remember that alcohol can have a negative effect on your gut health
  • Control your intake of processed and packaged foods
  • See an Accredited Practising Dietitian for individualised advice.
Read more

Ketogenics for managing Type 2 Diabetes

What are the benefits of low carbohydrate (ketogenic) diets in managing Type 2 Diabetes?

Ketogenic or very low carbohydrate diets are becoming increasingly popular due to their positive effects in weight reduction, improved lipidemia (fat in the blood) and glucose tolerance1. Because of this, low carbohydrate diets are being used in the management of diabetes, with outstanding results.

A systematic review, looking at the effects of using low carbohydrate diets (20-60g carbs/day) for >6mths in people with Type 2 diabetes, showed a significant 0.5% reduction in HbA1c, which was similar to that achieved by using medication2.

When compared again low fat and low GI diets, low carbohydrate diets resulted in superior weight loss, glycaemic control and lipid profile, with a 10% improvement in HDL ‘good’ cholesterol2.

A low caloric intake has also shown overwhelming results in the management of diabetes.

One study recruited 306 individuals with Type 2 diabetes and divided them into two groups. Group one was assigned to 825-853 calories per day for 3-5 months and group two was the control. Findings showed, that at 12 months, almost half (46%) of participants in group one had achieved remission to a non-diabetic state and required no diabetic medication3.


Nutritional ketosis vs diabetic ketoacidosis

When we restrict carbohydrates (<60g/day), our bodies start to utilise our stored carbohydrates (glycogen). Once our glycogen stores are depleted, this brings on a mild form of nutritional ketosis or ‘fat-burning’ where we start to break down fat (either dietary fat or stored body fat) to produce ketones for fuel (average range from 0.6-1.5mmol/L).

Alternatively, diabetic ketoacidosis (DKA) is a life threatening condition that occurs mostly in Type 1 diabetes but occasionally in Type 2 diabetes. Without enough insulin, the body’s cells cannot use carbohydrates (glucose) for energy. The body goes through a similar transition, switching from a ‘carbohydrate burning’ state to a ‘fat burning’ state, however this leads an accumulation of ketones in the blood at a dangerously high concentrations. Symptoms may include abdominal pain, vomiting and dehydration, requiring hospital admission4.

Effects of low calorie/low carbohydrate diets on diabetic medication

For some individuals with Type 2 diabetes, low calorie and low carbohydrate diets have resulted in the reduction/elimination of diabetic medication. This includes both oral hypoglycaemic medication and insulin5.

When commencing a low calorie/low carbohydrate diet, it is important to cease diabetic SGLT2 inhibitor medication such as Jardiance and Forxiga6-7.

These drugs assist in lowering blood sugar levels by causing the kidneys to remove sugar from the body through the urine. They also increase lipolysis and fat oxidation and enhanced ketogenesis. This can result in increased ketone production when following a ketogenic diet and therefore result in the development of DKA.

Although DKA is usually seen alongside high blood sugar levels (>14mmol/L), in a number of cases associated with SGLT2 inhibitors, individuals may present with only a moderately increased blood sugar level (<11mmol/L), which might delay diagnosis and treatment6-7.

It is important to note that SGLT2 inhibitors can continue to cause metabolic acidosis for several days after the cessation of the drug.

  1. Paoli A, Bosco G, Camporesi EM, Mangar D. Ketosis, ketogenic diet and food intake control: a complex relatopnship. Front Psychol. 2015 February; 6(27):1-9.
  2. Ajala O, English O, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97:505-16.
  3. Lean MEJ, Leslie WS, Barnes AC, Brosnanhan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet . 2018 February; 391(10120):541 – 551.
  4. Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014;7:255–264.
  5. WestmanEC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab. 2008;5:36.
  6. Ogawa, Sakaguchi. Euglycaemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. ‎J Diabetes Investig. 2016 March;7(2):135-138.
  7. Kohli J, Goldfarb S. Metabolic acidosis in a patient with type 2 diabetes. Am J Kidney Dis. 2017;69(6);11-13
Read more

Iron sources for vegans

Iron can be a tough mineral to get enough of, particularly for those who don’t eat a lot of red meat, or are pregnant, or follow a vegetarian or vegan diet.

Iron is a vital nutrient in the diet, it is essential for blood production, and for oxygen transportation throughout the body. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells.

Adult men need approximately 8mg/day, while the recommended daily intake for women is 18mg/day. Here are the best vegan iron sources to help you achieve your target:

  • Beans: 1 cup = 9.8mg
  • Lentils: 1 cup cooked = 6.6mg
  • Tofu: 100g = 6.5mg
  • Leafy greens: 1 cup cooked = 6.5mg
  • Quinoa: 1 cup cooked = 3mg
  • Tempeh: 1 cup = 4.5mg
  • Soy beans: 1 cup = 4mg
  • Chia seeds: 100g = 7.7mg (*you’re not likely to eat 100g of chia! 1 tablespoon is more realistic, therefore providing 1.5mg)

Non-animal sources of iron (non-haem iron) are not as readily absorbed by the body compared to haem iron (animal sources). This is way it’s extra important to follow the below tips to ‘boost’ absorption:

  • Add Vitamin C to your iron rich meal – think leafy green vegetables, tomatoes, capsiusm, citris fruit.
  • Avoid calcium rich foods within 30 minutes of having your iron. Calcium hinders iron absorption.
  • Avoid tea or coffee with your iron rich meal, the tannins also hinder iron absorption. Wait 30 minutes either side of your meal before enjoying a cuppa.
Read more

Does caffeine improve performance for everyone?

We know that caffeine is ergogenic, meaning that it has been shown to improve performance, particularly for endurance sports. It acts on the central nervous system  to reduce perception of fatigue and reduce rate of perceived exhaustion. The current guidelines recommend 3-9mg/kg body weight of caffeine 60 minutes before exercise. However, the difference in performance enhancement changes significantly between individuals ranging from highly effective to potentially worsening performance to no effect.

You may have noticed that some people can drink coffee all day, even before bed and have no issues with sleep or anxiety or over-stimulation, whereas others, if they touch coffee after midday, they’re awake all night.

It has now been shown that depending on how much and what type of CYPA12 enzyme you have will influence how you digest caffeine. This enzyme is needed to break down caffeine (much like lactase is needed to break down lactose) and some people have much more than others and difference variations of the gene exist.

This study showed that just under 50% of subjects were fast metabolisers of caffeine and in these people, a small amount of caffeine (2mg/kg body weight) reduced their cycling time trial time by 5% and a larger amount (4mg/kg body weight) reduced it by 7%.

A second subtype of this enzyme was found in 43% of participants and for them, caffeine had no effect on their time. It did not improve it or worsen it.

A third group, making up about 8% of the athletes, found that 4mg/kg body weight caffeine worsened their cycling time by 14%!

Of course, there are other factors that influence response to caffeine including habitual caffeine use, circadian rhythm, medication and expectancy of effect. However, this study highlights the need to take an individual approach to caffeine supplementation, especially for those 8% of people in which it could be doing more harm than good!

You can probably work out whether you respond well to caffeine or not if you are a regular coffee drink or caffeine user. However, if you are not sure or want some further guidance as to how best to use caffeine to improve your sports performance, book an appointment with an Accredited Sports Dietitian to get individualised advise on how, when and how much (if any!) you should be using for optimal results.

Pickering, C., Kiely, J. (2018). Are the Current Guidelines on Caffeine Use in Sport Optimal for Everyone? Inter-individual Variation in Caffeine Ergogenicity, and a Move Towards Personalised Sports Nutrition. Sports Med, 48(1), 7-16.
Read more

Understanding ulcerative colitis

Ulcerative colitis (US) is a chronic inflammation of the large intestine (colon). The colon is the part of the digestive system where water is removed from undigested material and the remaining waste material is stored. The rectum is the end of the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon can lead to symptoms of abdominal pain, diarrhoea, and rectal bleeding and mucous.

During an acute flare up, the capacity to absorb water is usually reduced, which can further worsen the symptoms of diarrhoea. Due to the fact that ulcerative colitis only affects the colon, it is less common to see nutritional deficiencies.

In ulcerative colitis, the inflammation may extend to varying degrees. When the entire colon is involved, the terms pancolitis or universal colitis are used.  There can also be some involvement of the terminal ileum.

The treatment of ulcerative colitis involves medications and/or surgery. Surgery may be used for treating severe conditions, individuals that don’t respond well to treatment, or to prevent the development of cancer. Almost always, the entire colon is removed during surgery since ulcerative colitis frequently involves the entire colon or can spread to unaffected parts of the colon after the diseased part is removed.

It is important to remember that there is no evidence to suggest that dietary factors are the cause of Irritable Bowel Disease (Ulcerative Colitis or Chron’s Disease). In addition, it is not possible to make your condition ‘go away’ permanently by adding or eliminating certain foods from your diet or by eating only particular types of food. In some cases, a particular food may aggravate symptoms and eliminating this food can make a positive difference.

However, for most people however the key to managing their condition is to eat a well-balanced diet that includes items from all major food groups. Good nutrition improves overall health status, supports the healing process and can enhance the response to medications.

A PPN Accredited Pracitising Dietitian can help you develop an eating plan that will reduce your GI symptoms, help identify trigger foods, prevent nutritional deficiencies and manage flare ups.

Read more

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).

Read more

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.
Read more

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).

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.
Read more

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.

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.
Read more