THE KETOGENIC DIET: A REVIEW

Many of you have asked for my opinion on the ketogenic diet, here is my summary, based on current evidence.
What it is:
A very high fat, low carbohydrate diet, initially devised in the 1920’s to treat severe seizures in epilepsy.
Gained popularity for weight loss in recent years.

Breakdown: 70% fat, 10-20% protein, 5-10% carbohydrate. Looks like this:
Breakfast: 2 eggs, 1/3 avocado Lunch: salad with low carb veg, 100g meat, 1 boiled egg, 30g cheese, Dinner: 150g meat + low carb vegies, snacks: low carb protein bar, nuts, cheese, chopped veg, berries.
Studies show short-term improvements health markers
Benefits: fuller for longer due to fat content, ketones suppress appetite, fat loss instead of muscle
Disadvantages: sustainability, social occasions, restriction severe, satisfaction, expensive

What is ketosis?
Glucose is the main source of energy for the body, from carbohydrates. Brain uses 120g glucose per day
When the body is deprived, alternative fuel is produced =‘ketones’
During fasting – body removes glucose from the liver and breaks down muscle (glycogen) to release glucose
Once this depletes glucose stores, (3-4 days), insulin decreases and body uses fat as primary fuel.
Liver produces ketone bodies from fat.
Ketones accumulate in the blood = ketosis

Symptoms of ketosis: hunger, fatigue, low mood, irritability, constipation, headache, ‘brain fog’, nausea, vomiting, reduced exercise tolerance
Safety:
Unclear long-term risks, risk to heart health with high saturated fat diet (risk of high cholesterol)
Kidney stones, osteoporosis, uric acid (gout), nutrient deficiencies, gut health
Unsafe in certain medical conditions and times of growth: pregnancy, breastfeeding, children, adolescents

So what is the bottom line?

Option if difficulty losing weight other methods
If individual can stick to it and meet nutritional requirements
Consult GP and Dietitian before commencing
Dietitian can guide reintroduction of carbohydrates to enable long-term weight maintenance
Good option is a modified carbohydrate diet – easier to stick with in the long-term

– Weight regain a risk after following a restrictive diet

April 23, 2023

intermittent fasting

April 23, 2023

Intermittent Fasting: a summary of the evidence
April 4, 2019

What is Intermittent Fasting (IF)?

Cycles between brief fasting periods and unrestricted eating
Loss of fat, clinically significant improvement in blood pressure, cholesterol, blood glucose, possibly insulin sensitivity
Thought to reduce risks of CVD and Diabetes, however longest follow-up remains 12 months
Stops body from adapting to prolonged caloric restriction, preventing further weight loss

Different types of IF:

1.Alternate day fasting: (the most well-studied)

Is it easier to eat 500kcal 2 days a week, than 1200kcals every day on a traditional calorie-restricted diet?
What does 500kcals look like?

Breakfast: black coffee, small boiled egg, 3 asparagus
Lunch: bread, slice ham, lettuce
Snack: herbal tea/low kJ hot chocolate
Dinner: Small piece fish, 100g boiled potato, 100g boiled peas

25% energy intake more for heavier person or with higher activity levels

1.Time restricted feeding (16:8)

E.g. Meals 8am-3pm, fasting remainder of day

2.Whole-day fasting

1-2 days per week 0-25% calorie needs, no restriction other times

What does the literature say?
When IF and normal calorie restriction compared reduction in health parameters, studies show there is NO SIGNIFICANT DIFFERENCE BETWEEN:

Weight loss or body composition
Weight regain
Blood pressure, HR, glucose, insulin, cholesterol at 12 months’ follow-up
Studies have shown that followers generally do not overeat on non-fasting days when compared to other weight loss methods.
In women, there are anecdotal reports of changes to the menstrual cycle, therefore a modified approach may be required

There are benefits:

Weight loss and resultant improvement in health parameters
It’s simple to implement, no difficult rules or expensive products
More food may be eaten over a shorter time frame

There are disadvantages:

Difficult to sustain in the long term (consider social events, which many people struggle with moderating)
Lowered energy levels and productivity (reduced capacity to exercise, concentrate)
Risk of binge, constant thinking about food – not recommended for individuals who follow a binge-restrict pattern of eating.
No focus on QUALITY of diet only QUANTITY
Risk of nutrient inadequacy if not well considered
Risk of weight regain

There are disadvantages:

Difficult to sustain in the long term (consider social events, which many people struggle with moderating)
Lowered energy levels and productivity (reduced capacity to exercise, concentrate)
Risk of binge, constant thinking about food – not recommended for individuals who follow a binge-restrict pattern of eating.
No focus on QUALITY of diet only QUANTITY
Risk of nutrient inadequacy if not well considered
Risk of weight regain

It is unsafe in the following categories:

Eating disorders
Adolescents (active growth)
Pregnancy and breastfeeding
Specific medical conditions requiring medications (e.g. diabetes) – can be utilised in diabetes with medical management, including medication adjustment.
Food/dieting can cause adverse reactions, malnutrition
Refer to your resident NEST dietitian to assist with nutritional adequacy and safety

So the bottom line is:
Confirms evidence for caloric restriction
May be helpful in the short-term due to reduction in hunger hormone, grehlin

There is evidence that it can be a good alternative to usual caloric restriction for some individuals
It is unclear if it is superior to other methods weight loss: more high quality studies are needed with longer-term follow-up
Certain people who eat 1-2 meals per day may do better on this
More high quality studies, including RCT’s are needed, with follow-up greater than 12 months
Therefore cannot make strong recommendations
Difficult for person who eats every few hours
Risk overeating
Binge-restrict cycle
Fixation food
Impact on children who see parents skipping meals?
How long should diet be followed for benefit?

References

Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E, Varady KA. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med. 2017; 177(7):930-938.
Schübel R, Nattenmüller J, Sookthai D, Nonnenmacher T, Graf ME, Riedl L, Schlett CL, von Stackelberg O, Theron J, Nabers D. Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 wk: a randomized controlled trial. American J. Clin. Nutr. 2018; 108(5):933–945,
Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. Do intermittend diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol. 2015; 418:153-72

April 23, 2023

WHAT YOU NEED TO KNOW ABOUT SUGAR

April 23, 2023

WHAT YOU NEED TO KNOW ABOUT SUGAR

MYTH BUSTER #1: Shades of sugar

There is so much information about sugars, it is often confusing and misleading. Let’s clarify the information to help you make healthy decisions.
Sugar refers to simple chemical structures: glucose, fructose and galactose, all carbohydrates contain these building blocks in various forms. E.g. Sucrose (table sugar) = glucose + fructose, honey= fructose. There are more than 50+ alternatives for sugar, e.g. molasses, date syrup, coconut sugar, dextrose, honey, golden syrup, coconut sugar, barley malt, rice syrup, brown sugar, etc., and they are all nutritionally similar. The differences between the types is the source (e.g. plant, fruit or bees), and the type of processing to derive syrup or granules.

Manufacturers use alternative sugars for their health halo (e.g. coconut sugar), to trick consumers into thinking that they are making a healthy choice. A product with 4 different types of added sugar may falsely appear lower in sugar than it actually is. Check the label for all the different types; if any type of sugar appears within the first 3 ingredients, as well as further down the list, it’s a good indication that the product isn’t the best choice.

Honey is touted for its germ-fighting (antimicrobial) properties, but it is still uncertain how we would attain such benefits. Other sugars, e.g. date molasses contain antioxidants, though we would need to consume 500g for this benefit, which is obviously not recommended. Alternatively, a single cup of berries would provide the antioxidants along with myriad nutrients.

Fructose is another point of confusion. It is naturally found in fruit, and when we eat the whole fruit, we obtain the benefits from the fibre and multiple other nutrients in that food. Include two pieces of fruit per day as part of a healthy diet. This differs to free sugars, such as fructose syrup, added to foods in food processing.

The bottom line? When it comes to added sugar, no variety is a healthier choice than the other, our bodies absorb them in the same way. Overall keep any type of added sugars to a minimum by eating a range of fruit, veg, lean meats, legumes, fish, low fat dairy, whole grains and good fats.

Cake is cake, if made with raw vegan ingredients such as dates and coconut sugar, or old school white sugar, flour and eggs. My philosophy? Occasionally choose a small piece of the best quality cake you can afford and really want to eat…and savour it.

April 23, 2023

WHAT YOU NEED TO KNOW ABOUT SUGAR

MYTH BUSTER #1: Shades of sugar

April 23, 2023

Fruit: how much a day?

April 23, 2023

Fruit: how much a day?

Fruit contains vital nutrients including fibre, slow release carbohydrates, and myriad vitamins, minerals, plant nutrients & antioxidants (prevent damage to cells). The amount of fruit an individual needs depends on their age and stage. The type of sugar found in fruit is generally slow release energy and different to the free sugar added to processed foods, making it an excellent component of the daily diet. Leave the skin on for added fibre, to assist regular bowels and happy gut bacteria. Choose a variety of fresh, frozen or canned in juice. Watch out for products such as fruit straps, stringers & puffs as they tend to be high in fruit puree, concentrates & added ingredients, making them high sugar, low nutrient options.

What is a serve of fruit?

– 1 medium apple, banana, etc.

– 1 cup of canned fruit in juice

– 2 small stone fruit or kiwi

– 30g dried fruit = 4 dried apricots halves, 1 ½ tb of sultanas (include dried fruit occasionally, around once per week).

So how much does a child or adult need per day?

– 1-2 years: ½ serve = e.g. ½ medium apple, ½ cup canned fruit or 1 small apricot

– 2-3 years: 1 serve = e.g. 1 medium apple, 1 cup of canned fruit or 2 small apricots

– 4-8 years: 1 ½ serves = e.g. 1 apple & ½ cup strawberries,

– 9-18+ years: 2 = e.g. 2 medium apple/banana, etc. or 4 small apricots/kiwi/plums.

Aim to mix up the variety of fruit across the day and week. For example, a 4 year old may have 1 medium apple, and 1 small apricot to reach 1 ½ serves.

If your child loves fruit and is eating more than is recommended, it may mean they are missing out on other foods from the core food groups. Also, excessive fruit can lead to tummy upsets, due to the overload of fructose (this does not mean they are fructose intolerant). Try these alternative healthy snacks:

Vegetable sticks e.g. carrot, cucumber and celery with dips
Corn on the cob
Boiled eggs
Cheese on crackers
Yoghurt
Nuts (if older than 5 years)
Snack size canned chickpeas and edamame
Popcorn (if older than 5 years)

See our article on Healthy Lunchboxes for other healthy snack ideas: https://www.nicolebando.com/articles/a-healthy-lunchbox

References:
Eat for Health. Recommended number of serves for children adolescents and toddlers. 2015. Available at https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-children-adolescents-and

By Emma McShane, Dietitian, edited by Nicole Bando, APD

April 23, 2023

bliss balls: hit or miss?

April 23, 2023

bliss balls: hit or miss?

Thanks to Victoria Hobbs, Deakin University for data collection.

It’s time to examine a snack that has been trending for some time; the bliss ball. Are they actually a healthy snack and what sort of marketing tricks to the companies use to lure us in? I look at kilojoules/calories per serve, as well as fibre, sugar and protein per 100g. What are the top 3 ingredients – do they contain sugar, do they contribute nutrients? A good guideline for a snack is generally 300-600kJ, depending on your nutrition goals.
Let’s compare products:

Special K protein bliss bites: 420kJ/serve, moderate fibre, low sugar and a good source of protein (from milk). The fats and protein may improve satiety.
Carmen’s Bliss Balls : ~312kJ/serve (similar calories to an apple), 6-10g fibre/100g, high sugar 39-47g/100g across the range. A source of refined sugar, the primary ingredient is dates. Contain nuts, so a valuable source of protein. However, will 1 bliss ball fill you up? Consider how many you need in order to feel full and note if they take you through until the next meal.
Creative Gourmet Super Balls (fridge section): 525kJ/serve (equivalent to 1.5 apples), moderate fibre 6g/100g (2.1g per serve, an apple delivers up to 3-5g), high sugar 24.5g (mainly from dates as the first ingredient), good source of protein (whey), though also high in saturated fat from coconut cream.
I Quit Sugar’ Superfood protein ball mix:
This product is so directly misleading. Initially appears to be a good contender for a healthy snack: it is high in fibre, low in total sugars (<3g/100g) and 486kJ per serve. Its main claim to fame is being fructose free.
However, THIS DOES NOT INCLUDE the ingredients that must be added to the mixture to actually make the protein balls. Once the rice malt syrup, coconut oil and coconut are added, these protein balls lose the ‘no sugar’ kudos and increase to 640kJ/serve, refined sugars increase to ~25g/100g and they are a source of saturated fat from all of that coconut. This is marketing genius at its best. Not much better than a muesli bar and so very misleading.
Note: I have checked to see if I can locate this product and it is temporarily unavailable. Check other mixes such as these to see if the nutrition information panel reflects ALL ingredients, or dry portion only.
Bounce Peanut bliss balls:
A high energy snack with 880kJ/serve, they are low fibre, high sugar, despite being a good protein source – (derived from ~30% nuts). The second listed ingredient is brown rice syrup. This is OK as an occasional snack if you are very active, but may not fill you up for long and could contribute to weight gain over time.
Bounce Cacao raspberry balls:
High energy at 710kJ per ball, high sugar and moderate fibre. A better choice than the peanut ones, but not by much.
My verdict? Choose the top 2 products, stick to the serving size. Enjoy occasionally and observe if they fill you up enough to last until the next meal. They are similar in nutritional profile to muesli bars. Alternatives such as fruit, low fat dairy, nuts, seeds and grains provide more benefit nutritionally.

Why not make your own bliss balls at home to enjoy occasionally? This way you can reduce the serving size and choose the ingredients that will be healthiest. I like this recipe from shift nutrition:
https://shiftnutrition.com.au/recipe/chocolate-peanut-butter-bliss-balls/ (~300kJ/serve)

DISCLAIMER: I RECEIVE NO FINANCIAL BENEFIT FROM REVIEWING THESE PRODUCTS, THIS IS AN INDEPENDENT PRODUCT REVIEW BASED ON MY PROFESSIONAL OPINION. I HAVE REVIEWED A SMALL RANGE OF AVAILABLE SUPERMARKET PRODUCTS, THIS IS NOT AN EXHAUSTIVE COMPARISON.

April 23, 2023

netflix game changers: a review

April 23, 2023

netflix game changers: a review

By Nicole Bando, Dietitian & Lactation Consultant, November 2019

I’ll start by saying that I’m all for encouraging people to eat healthier food. There is absolute scientific consensus that we cannot sustain a future population of 10 billion people with our current diet and food production methods. An urgent, systematic review of how we produce, transport and eat food is required. Game Changers rightly touched on the global impact of current food production. However, should you obtain nutrition information from a Netflix documentary? I’d say no, and here is why:

Let’s talk ‘plant-based’:

The term ‘plant-based diet’ is new and what does it mean? Game Changers did not make this clear. If I took my dietitian hat off, the main message I received was to eat lots of vegetables and maybe some beans, absolutely no meat and I’d be good to go. But the reality is far more complex than that. It is true that a vegetarian or vegan diet confers many health benefits (lower risk of heart disease, stroke, diabetes, lower body weight). However, this diet must be carefully planned or serious deficiencies from lack of key nutrients such as iron, Vitamin B12, zinc, iodine and omega-3 fatty acids can develop.

The long-term consequences of deficiencies include anaemia, osteoporosis (brittle bones), loss of nerve function, depression and long-term cognitive impairment. At vital times such as pregnancy and breastfeeding, inadequate omega-3 fatty acids (found in fish, chia, flaxseeds, walnuts, microalgae) can impact a baby’s brain development. Serious stuff, no?

Athletes have far greater requirements than the general population, and risk inadequate iron, energy and protein intakes. This impairs recovery, increase injury risk and has long-term health consequences. The female athlete is risk of consequences including irregular periods, infertility, osteoporosis and a host of cardiovascular and mental health side effects.

None of these risks were mentioned, which is why it’s best to seek advice from a trained health professional, rather than Hollywood. I will give kudos to Game Changers for using some pretty good party tricks, such as finding the strongest man in the world who only eats plants to move some heavy stuff, measuring nocturnal erections of college students and centrifuging blood after a meat vs vegetarian meal. All very convincing, but a little lacking in scientific depth.

It’s a little extreme to compare the meat industry to the tobacco industry. Whilst the science does tell us that a diet heavy in processed meats can increase the risk of certain cancers, meat isn’t out to get us. I’m confused, aren’t we the ones hunting down the animals and putting them on our plates? My issue is the demonising of one food. Our health crisis is related to myriad factors, including added sugars, salt, overall saturated fat, caloric intake and lack of enough of the good stuff, mainly fruits, vegetables and whole grains. Even that is oversimplifying matters.

The bottom line?

If this documentary made you consider changing your diet to eat more plant foods and reduce meat, processed foods and sugar, awesome.
The Eat Lancet Commission gathered 37 of the world’s leading scientists produced a global document that addresses the environmental and health crisis we face as a planet, with food as the driver for change.
It is ok to keep some meat on your plate, try to reduce total to 300g per week. Include dairy, eggs and fish.
Base your diet on plant-based foods: nuts, legumes, fruit, vegetables, whole grains
Include good fats
Reduce added sugars
And please, seek advice from a university qualified nutrition professional if you are considering a vegetarian or vegan diet, especially if you are in a vulnerable category (pregnancy, breastfeeding, child, adolescent or athlete).
For some hard-hitting evidence-based information, explore this: www.eatforum.org
And a documentary that is right on the money? 2040 by Damon Gameau: www.whatsyour2040.com

April 23, 2023

netflix game changers: a review

By Nicole Bando, Dietitian & Lactation Consultant, November 2019

Let’s talk ‘plant-based’:

The bottom line?

If this documentary made you consider changing your diet to eat more plant foods and reduce meat, processed foods and sugar, awesome.
The Eat Lancet Commission gathered 37 of the world’s leading scientists produced a global document that addresses the environmental and health crisis we face as a planet, with food as the driver for change.
It is ok to keep some meat on your plate, try to reduce total to 300g per week. Include dairy, eggs and fish.
Base your diet on plant-based foods: nuts, legumes, fruit, vegetables, whole grains
Include good fats
Reduce added sugars
And please, seek advice from a university qualified nutrition professional if you are considering a vegetarian or vegan diet, especially if you are in a vulnerable category (pregnancy, breastfeeding, child, adolescent or athlete).
For some hard-hitting evidence-based information, explore this: www.eatforum.org
And a documentary that is right on the money? 2040 by Damon Gameau: www.whatsyour2040.com

April 23, 2023

compare the oats

April 23, 2023

compare the oats

Happy Winter everyone…with June 1st upon us, what do you need to know about oats – steel cut vs rolled vs instant or quick? All oats have the same nutritional profile, they are rich in fibre, beta-glucan (helps to keep cholesterol in check). They are often marketed to increase breast milk supply, however there is no evidence to support this claim, though oats are a great source of energy for breastfeeding women, therefore great to include as part of a balanced diet.

1. Steel cut oats are the least processed, they are unrolled then cut into pieces, they take the longest to cook; 20 minutes once simmering. Fashionable in recent years, there is negligible difference to rolled oats nutritionally, though they cost a lot more. They have a slightly lower glycaemic index than rolled oats.
2. Rolled oats have been steamed, rolled and dried. They take approximately 5 minutes to cook once bought to a simmer. They have a low glycaemic index, so will keep you full longer.
3. Quick oats have been rolled, steamed and ground into smaller pieces. They have just as much nutrition as their less processed relatives, but your digestive system doesn’t have to work as hard; so they may not keep you feeling as full for as long, meaning the glycaemic index is higher.
4. Instant oats: another step along the processing chain, these have been cut further and have additives, such as sugar, emulsifiers, milk products and sweeteners. They are lower in fibre and higher in sugar.

The bottom line? If choosing microwave oats, opt for a plain or high fibre option (e.g. Uncle Toby’s Original sachets, Carman’s Natural 5 Grain & Super Seed ). Steel oats are of negligible added benefit, so my advice is if you have time, choose plain rolled oats. Whichever oats you choose, add your own toppings such as fruit, yoghurt, nuts and seeds to sustain you for longer.

April 23, 2023

SIMPLE PACKAGED SNACK SWAPS

April 23, 2023

SIMPLE PACKAGED SNACK SWAPS

Emma McShane, Dietitian

References:

National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Breakfast Cereals. Australian Government: Department of Health, 2013. (Available from: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~breakfast-cereals, accessed September 3, 2021).
National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Savoury Snack Foods. Australian Government: Department of Health, 2013. (Available from:https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~savoury-snack-foods, accessed September 3, 2021).
Queensland Health. Sodium. The State of Queensland (Department of Health), 2021. (Available from: https://www.healthier.qld.gov.au/guide/sodium/, accessed September 3, 2021).
Coles. Food products. Coles Supermarket, 2021. (Available from: https://www.coles.com.au/, accessed August 22 – September 3, 2021).
Woolworths. Food products. Woolworths Supermarket, 2021. (Available from: https://www.woolworths.com.au/, accessed August 22- September 3, 2021).
Tong, T., Rangan, A., & Gemming, L. Evaluating the Nutritional Content of Children’s Breakfast Cereals in Australia. 2018. Children (Basel, Switzerland), 5(7), 84. https://doi.org/10.3390/children5070084

April 23, 2023

Fish, eggs & 5 a day: your questions answered

April 23, 2023

Fish, eggs & 5 a day: your questions answered

Eggs: how many is too many?

Eggs are a great source of nutrition, including protein, iron, choline, Vitamin D, B12, and selenium. Eggs contain heart healthy monounsaturated fats and also some saturated fat (which can increase cholesterol in excess). Include up to seven eggs a week, this won’t increase risk of heart disease. Those at increased risk of heart disease can eat up to six eggs per week.

How often should I eat fish?

Research supports including 2-3 portions of fish per week. Try to choose sustainably sourced fish and limit high mercury options, such as shark, swordfish, barramundi, orange roughy and ling. Low mercury fish include salmon, mackerel, tuna, sardines and shellfish.
Fish are a great source of omega-3 fatty acids (unsaturated fats – known as good fats!) which contributes to brain health and development and reduces risk of heart disease.
Protein, selenium, zinc, iodine, and vitamins A and D are other important nutrients in fish.

Vegetables: what’s 5 a day?

We may have all heard that adults need five serves of vegetables a day. To help figure this out, a serve of vegetables is ½ cup of cooked vegetables, canned or cooked legumes, or 1 cup of green leafy vegetables or chopped salad. To achieve this, aim to include half a plate of vegetables at lunch and dinner.

Did you know that toddlers need 2-3 serves per day, increasing to 5 serves by aged 9? A great way to increase vegetable intake, is to offer them 2-3 times per day, for important nutrients, including potassium, fibre, Vitamins C & A. Eat from the rainbow by choosing lots of different coloured vegetables. If 5 a day feels a bit tricky, start small and try to add some chopped carrot or cucumber to your morning snack. Frozen, canned and fresh are all great options.

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC), October 2022

Email: [email protected]

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THE KETOGENIC DIET: A REVIEW

intermittent fasting

WHAT YOU NEED TO KNOW ABOUT SUGAR

Fruit: how much a day?

bliss balls: hit or miss?

netflix game changers: a review

compare the oats

SIMPLE PACKAGED SNACK SWAPS

Fish, eggs & 5 a day: your questions answered

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