‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: Shut your pie hole or, in this case: Put less in your pie hole.

Thursday, June 15, 2017

The Critical Connection Between Gluten-Free and Eating Disorders

Since the gluten-free craze is still going strong and people are still really excited about it, I thought it was time for another gluten-related article. And yes, this one too is a spirit-crushing, shoulder shaking, face slap for those on the diet for an undiagnosed, non-medically necessary reason.

Let me preface this with the usual disclaimer that people who have been objectively biopsied and have true celiac disease should indeed follow a gluten-free diet. For the rest of you, and particularly other medical professionals, some interesting new research came across my desk recently about the association between celiac disease (CD) and anorexia nervosa (AN).

I know, right? Not what you were expecting. I'll do my best to lighten things up, but this article is on the serious side... Eating disorders aren't funny, but being on an unnecessary restrictive diet is a bit amusing.

Ok, so as it turns out, it appears there is a bidirectional association between celiac disease and anorexia nervosa. Well, what the heck does that mean?
  • A positive relationship between CD and AN, both before and after (bidirectional) CD diagnosis exists
    • Positive in this case ≠ a good thing, positive in this case means CD diagnosis and AN diagnosis increased together (this is a correlation)  
  • CD is associated with a significant two-to-threefold increase in diagnosis of AN and vice versa
    • Meaning having either CD or AN increases the chance of diagnosis with the other condition
Why might this be? The researchers offered several factors that could contribute to this relationship:
  1. Diseases that require dietary restrictions have been associated with AN (like food allergies and type 1 diabetes)
  2. Diseases or self-imposed "diets" can trigger obsessive eating patterns and/or diets with a long-term energy imbalance
  3. The positive association between CD and AN before and after CD diagnosis could be:
    • Because of a misdiagnosis with the other condition
    • Due to a genetic susceptibility - genomewide association studies of AN show genetic regions shared with type 1 diabetes and other autoimmune diseases
What's important here?
  • 1 in 5 Americans restricts gluten daily as a means to "eat healthier", the number is even higher in young females (who are already at a higher risk of eating disorders)
    • These people have no evidence (biopsy) to objectively evaluate the presence of true CD, meaning they are self-diagnosed, or just on the trendy bandwagon
  • Eating disorders often begin with well-meaning, self-imposed diets or attempts to eat healthy
    • This often includes banishing "bad" or "unhealthy" foods
    • Think about your social media channels... how many friends do you have posting about being on this diet, that "cleanse", or this "food challenge" (like no sugar for 30 days)?
      • Read more about these diets and make up your own mind here, here, and here
    • Orthorexia nervosa is the unhealthy obsession with eating healthy foods, see link below to read more
  • CD (or a medically-unnecessary gluten-free diet) requires dietary restriction that could easily become obsessive in susceptible individuals
  • Medical professionals would benefit to understand this association during screenings for patients with either AN or CD
For the rest of you on the gluten-free bandwagon without a medical diagnosis by a proper small intestinal biopsy (having followed the gluten-loading protocol) you might want to consider jumping ship and focus your efforts on just eating a healthier diet all around. Need some eating healthy help and resources? You can get some tips and info here, here, here, and here.

More on eating disorders here.
Read about orthorexia nervosa here.
Read more about gluten-free diets by yours truly:
- Gluten-free and microbiome health (or not)
-Gluten-free eating for the gluten-intolerant
-Why gluten-free doesn't = guilt-free

Wednesday, May 17, 2017

Born To Eat: A Book Review

Full disclaimer: Today's article is actually a book review (hence the title). If you're a Pie Hole devotee, you'll know this atypical. If you've landed on this page for the first time, welcome, you'll love it! This blog is all about the science of nutrition (written by a dietitian).

The book in question is "Born To Eat".

If you're friends with a new mum (or dad), married to a new mum (or dad), related to a new mum (or dad), or are a new mum (or dad)... You'll love this book. If you're a mum (or dad) with older young kids, this is still a worthwhile read.

Born To Eat is all about baby-led weaning, and how to feed your baby, your family, and yourself in a positive way that encourages body trust.

It's almost a self-help book that encourages eating all foods, banishing fears about certain "demonised" foods, and also explains many common nutrition myths. It points out which nutrients are important at different ages and why. But better, it's written by two dietitians and is based on nutrition science.

If you have no idea what I'm talking about, let me give you a snapshot of this book, and why it is brilliant.
Baby-led weaning is the idea that babies are capable of feeding themselves (toss the spoon-feeding image out of your mind). Mummies and daddies provide nutritious foods that they eat (goodbye "baby food") in a way that is safe for baby. Baby decides what of it, and how much to put in baby's pie hole. Basically, it's a book that embraces baby's capabilities, and takes the stress out of feeding.

Born To Eat fosters the beliefs that:
  • Babies are capable of feeding themselves
  • Babies are excellent self-regulators (meaning they will eat when they are hungry and stop when they're full - a very important skill to preserve for later in life to prevent over-eating and also dieting)
  • Parents benefit from allowing their babies to feed themselves and self-regulate
  • A healthy relationship with food begins when babies begin eating, and is something the whole family benefits from
  • A healthy diet includes all types of food
  • The best way to help your child have a healthy relationship with food is to see the family (especially the parents) having a healthy relationship with food
Any parent who's gone through introducing solids knows it can be quite nerve wracking. Will they choke? Will they hate the meal? Should I do purees? How soft should this potato be? Is my child still hungry? Is my child getting enough nutrients? And more. Wow, I'm feeling overwhelmed just thinking about it... And I've been there with my baby... I might know exactly what foods and nutrients are important, but I had lots to learn about textures and quantities, like all parents.

Born To Eat breaks down the stages of early eating, answers the above questions, and puts parent's minds at ease. This book is also on-point because it:
  • Explains and shows how to make foods safe (yes, there are illustrations!)
  • Gives sample meals/recipes/approximate serving sizes for different ages
  • Gives tips throughout the book (one of which is how to teach drinking from a straw, which was brilliant and the way my daughter learned that skill)
  • Written with nutrition science at the center
  • Non-judgemental!!! It encourages parents to adopt some or all of the baby-led weaning technique
Whether you want to go whole-hog with baby-led weaning, or only half, or quarter-hog, this book is a must-read. My daughter is now 13 months old and she's definitely a "Born to Eat" baby.

Disclosures: I received no compensation, sponsoring, financial incentive, or other inducements to write this article.

Wednesday, April 12, 2017

This Article About Metabolism Will Put You to Sleep

Remember your body clock? The one that tries to keep you in tune with your basic needs like sleep? Well, your clock is actually much more complex than that. Did you know it plays a role in your metabolism and metabolic health? Interested? Duh, of course you are (and if you're not, you're probably browsing the wrong part of the internet.)

Let's not rest on our laurels and get right stuck into it. Spoiler alert: Cutting your eating interval (period of time during the day where food/beverages are consumed) can improve sleep and translate to weight loss.

Here are 5+ things you need to know:

1.  Your body clock is more like body clocks. New research finds "peripheral" clocks in internal organs are involved in glucose metabolism. These organs are tucked away where the sun don't shine, so it's not like they can rely on light/dark stimuli from the environment. Instead, they use the timing of food and fasting for regulation. Changes in the time food is eaten, or poor sleep can throw off metabolism. Did I mention these clocks are responsible for the expression of thousands of genes that regulate the 24 hour circadian cycle? Remember this for later.

2.  Circadian gene expression impacts metabolic health and thus diseases like type 2 diabetes and obesity.

3.  Circadian gene expression also impacts the microbiome. This research shows the biome composition and activity are dynamic and demonstrate a diurnal (daily) pattern. The composition of the microbiome is known to play a role in disease pathogenesis, appetite control, feeding behaviour, and brain function and behaviour.

4.  Several mouse studies have demonstrated:
  • Mice with mutations in their "clock" gene become obese on their regular diet. They also:
    • Develop signs of metabolic syndrome (high cholesterol, high blood glucose, lack of insulin)
    • Sleep ~2 hours less than non-mutated mice
    • Have disturbed eating patters (regular mice eat during their active period at night, mutated mice ate both during the day and night) - the equivalent of a human waking up and raiding the fridge overnight
    • Had exacerbated weight gain when fed a high-fat diet
  • Mice fed a high fat diet during the day (when they usually sleep) gained more weight than mice fed the same diet but at night during their normal active period (which is 12 hours)
    • The research discovered that the central clock remained tuned to the 24 hour cycle, but the peripheral clocks in organs were out of sync (caused by eating at odd times and lack of sleep)
    • This lack of sync lead to deranged metabolism, weight gain, and glucose intolerance (the start of a series of unfortunate events where type 2 diabetes is concerned)
Shake a leg, Sleeping Beauty... Here's where it gets (even more) interesting.

5.  Keeping your eating interval to 10-12 hours can lead to weight loss, improved sleep, and improved energy levels.
A small pilot study took adults (with a BMI>25.0) whose eating interval exceeded 14 hours and had them limit their eating (including all non-water beverages) to a 10-12 hour period. The 16 week pilot intervention did not include suggestions of nutritional quality/quantity/calories. Results showed:
  • An average weight loss of 3.3kg (7.3lbs)
  • Participants reported significantly improved sleep satisfaction, hunger at bedtime, and energy levels
  • Participants voluntarily continued the restricted eating interval unsupervised. At 36 weeks (1 year after the beginning of the intervention) participants had maintained their weight loss, improved sleep, and energy levels
  • The shorter eating interval translated to an average calorie reduction of 20%
A few other fun facts:
  • Sleep in healthy people is disrupted by light pollution (from lights and devices) that emit the same wavelength as the sun
  • Lack of sleep impacts glucose metabolism in healthy people (including children)
  • This lack of sleep can decrease resting metabolism enough to cause weight gain of 12.5lbs in a year
  • You can reset your insulin responsiveness and depressed metabolic rate after 9 days of recovery sleep
The all-important take home messages, I'm going to keep it super short: You don't have to change everything in your life to become healthier. If you're committed to making 2 changes, do these:
  1. Think about your usual eating interval, if it's more than 12 hours, reduce it to 12 hours
  2. Add more vegetables to your diet, whether it's including veggies with your snacks, lunch, dinner, breakfast, or all of the above (I like the latter option). Prepare a stool sample and call me in the morning!