Metabolism changes in the context of ketosis

For an individual following a pattern of eating that contains an intake of more than 70g of carbohydrates per day, the body breaks down these carbohydrates into glucose and uses them as an energy source. Glucose is the bodies preferred source of energy, so if enough is available in the blood, it will be used as the primary fuel source to support metabolic functions.

When we significantly reduce our daily intake of carbohydrates between 50-70g, the body must find an alternative nutrient to use for energy. As we know, the body LOVES carbohydrates and will burn whatever it can find, so not only will it burn the glucose that is found in the blood, but it looks for stored glucose (also called glycogen) that is prominent in the muscles and the liver.

Once we have used up all of our carbohydrate stores, the body will start to break down fat. When the body breaks down fat, ketone bodies are produced which are then used as our primary energy source. The body is now in a state of ketosis. When the body goes from a fed to fasted state, the liver swaps from utilizing carbohydrates to producing ketones, which promotes a complete shift in metabolism. What we call the ‘FAT-ADAPT’!

Traditionally, ketogenic states occur when the body is starved or fasted. When our metabolism experiences a shift in fuel sources, we reap a range of benefits for our total health and well-being as a result of a complete ‘reset’. A lot of problems with our metabolism are related to a fat-storage hormone we call ‘Insulin’, which is secreted from the pancreas to move glucose from the blood into the cells for energy.

Lowering our daily intake of carbohydrates allows us to avoid constant spikes of insulin which may reduce our risk of a range of metabolic conditions such as insulin resistance, diabetes, fatty liver and high cholesterol.

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What is the low FODMAP diet?

You have probably heard the term FODMAP thrown around recently, but many people don’t know exactly what it means.

FODMAPs (aka Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are a collection of short-chain carbohydrates (sugars) which are not properly absorbed in the gut. This can trigger symptoms in people with IBS or food intolerances. FODMAPs are found naturally in numerous foods and food additives.

The low FODMAP diet was developed by researchers at Monash University and involves limiting the foods that contain FODMAPs that aggravate the gut and cause symptoms like bloating, gas and abdominal pain.

The low FODMAP diet is to be followed for 2-6 weeks until symptoms improve, followed by re-introduction challenges to determine which foods an individual is sensitive to. The ultimate goal is to have a wide and varied diet that only has to exclude or limit the foods that aggravate symptoms.

It is important to proceed through the re-introduction phase of the diet as such as restrictive diet in the long term can actually be worse for gut health as many high FODMAP foods are a great source of prebiotics. Long term restriction can worsen gut symptoms over time.

In addition, despite being named a ‘diet,’ the FODMAP diet is not a weight loss diet.

If you are suffering from IBS or any of the above gut symptoms and you think you’d benefit from trying a low FODMAP diet, it is best done under the guidance of an Accredited Practising Dietitian or health professional for optimal long term outcomes and symptoms relief.

Gibson P.R.1, Shepherd S.J. (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach, J Gastroenterol Hepatol ,25, 2, 252-8
Shepherd S.J., Parker F.C., Muir J.G., Gibson P.R. (2008). Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence, Clin Gastroenterol Hepatol, 6, 7, 765-71.
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Hemp: super food or unsafe?

Hemp products as food and supplements have exploded onto the market recently. In April 2017, the sale of low-THC Hemp products in Australia was approved. Until then, hemp has a bit of a bad reputation for its association with marijuana.

Hemp comes from the stem and the leaves of the marijuana plant which are generally low in tetrahydrocannabinol (THC), the psychoactive component. To be considered a food and safe to be sold in Australia, products need to be less than 0.5% THC.

Hemp is a good protein source, good fats and fibre. Although it is not a complete protein as it lacks lysine and leucine, it can contain up to 35% protein. It also has a high fat content with an optimal omega-6 to omega-3 ratio of 3:1, making hemp a great source of unsaturated, heart healthy fats. Hemp is sold as hemp seeds, hemp oil, hemp protein supplements and is added to other food products.

However there is currently not very strict regulations for testing the THC content of products and while most producers are careful, not all are testing their crop which could potentially results in a higher THC product being sold. For this reason, athletes that are undergoing drug testing by WADA or ASADA need to be careful when considering using these supplements. There is no need for the everyday consumer to be alarmed, the hemp products sold in Australia do not contain anywhere near the amount of THC known to alter one’s state of mind.

Hemp seeds can be used in a variety of ways. They are delicious sprinkled on top of yoghurt or muesli, soups and salads. Their texture makes for a creamy, nutty addition to a meal. While these products are no magic bullet for health or weight loss, they can make a delicious and nutritious addition to your diet.

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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
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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.
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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
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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.
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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.
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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.

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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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