‘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.

Wednesday, April 24, 2013

Losing Your Mind? Can the Mediterranean Diet Help?

The Mediterranean Diet (MD) is one that is routinely in the news, frequently discussed by health professionals, commonly asked about by clients and often quite misunderstood. There are many health claims made about this nutty and fishy diet. This one is certainly no fad and has a fair bit of science behind it. Today we will focus on new research exploring the association between the MD and aging. Oil up and grab your nuts, this could get a little cheesy.

The MD is characterised by a high intake of vegetables, fruit, legumes, nuts, cereals and monounsaturated fats (eg: olive oil). Likewise, the MD comprises of low amounts of saturated fat (eg: processed/packaged goods, butter, etc) and a moderate intake of dairy, meat, poultry and fish. Alcohol (mostly red wine) is a regular but moderate feature with family meals. Lastly, the MD includes daily exercise activities. Countries in the Mediterranean region (Italy, Spain, etc) have eaten and lived this way for centuries.

What does the science say about the MD? Research shows associations between the MD and lowered risk of developing mild cognitive impairment (memory or thinking problems greater than normal for one's age and education). This encouragingly suggests that emulating the MD helps keep you from losing your marbles.

How does the MD have such a hold on your mind? The composition of the diet discussed above provides some highly desirable ingredients for health that reduces the risk of some cancers, diabetes, heart disease, memory problems/cognitive decline and more. The MD provides high amounts of:
  • Monounsaturated fats (found in nuts, avocado, vegetable/canola/olive/sunflower oils)
  • B vitamins (found in proteins like meat, poultry, fish, dairy, legumes, eggs and vegetables)
  • Antioxidants (substances, including vitamins, found in fruits, vegetables, nuts, legumes, fish and poultry that help protect cells from damage)
  • Vitamin C (found in citrus and other fruits and veggies like tomato, broccoli and watermelon)
  • Vitamin E (found in fats/oils like nuts, seeds, avocado, eggs, canola and olive oils)
  • Carotenoids (found in red, yellow, orange and dark green fruits and veggies)

These components have research linking them with better cognitive function and performance, reduced cognitive impairment and a reduced risk of Alzheimer's disease (1, 2, 3).

Another reason to lube up your pie hole with some olive oil and other aforementioned goodies is their role in reducing oxidative stress, which leads to inflammation. Oxidative stress is caused by regular body activities like breathing and metabolism that produce molecules called 'free radicals'. You can think of these molecules as hyperactive bouncy children that run around at a party knocking into things. These unpredictable and bouncy molecules bump into cells and cause damage (they contribute to heart disease, diabetes, asthma and some cancers). Antioxidants and vitamins provided by foods dominant in the MD help neutralise free radicals and prevent cell damage.

So what have we learned? Extend an olive branch to the MD by:
  • Adding some extra fruits and veggies to your meals and snacks
  • Taking it easy on the red meat, go fishy instead
  • Putting some olive oil, rather than butter, into your pie hole
  • Legumes now and legumes later help when you're an old fart

Further reading about the MD from other dietitians:

Wednesday, April 17, 2013

Dairy Products: To Fat or Not To Fat?

In the news recently, the dairy debate has re-emerged. Headlines proposing arguments for and against full fat vs low fat dairy and the reverse. So which is right? Is one better then the other? Today we will explore dairy fat and calcium in the weight loss context. Grab a chunk of cheese and glass of cow juice while we milk this topic for all it's worth.

Dairy products (milk, cheese, yoghurt, butter etc) come from mammal milk. Predominately, dairy in the western world comes from cows. Though there are cheeses and milks available that are made from sheep, goat, yak, camel, water buffalo, reindeer and horse milk.

What are the health benefits of dairy? There are quite a few! Dairy carries many nutrients that are beneficial to humans. Most people know dairy is rich in calcium, vitamin D and protein. It also contains riboflavin (vitamin B2; important in red blood cell production), phosphorus, vitamins A and B12 and pantothenic acid (vitamin B5; helps our bodies utilise carbohydrates, protein and fats). There is no shortage of benefits for putting dairy into our pie holes.

Even with all the vitamins and minerals provided by dairy, the dark side is that full fat dairy (FFD) also contains a fair bit of fat (in the form of saturated fat) and cholesterol. Both of these can lead to health problems if consumed in excess and not part of a balanced diet.

A recent study investigated how a group of overweight adults changed their dairy eating patterns following nutrition counseling from a dietitian. The dietitian recommended switching from FFD to low fat dairy (LFD).

The results uncovered interesting diet changes, and what's more is how these differed between males and females. Females tended to:
  • Replace full fat milk with low fat milk
  • Increase yoghurt consumption
  • Reduce intake of full fat cheese, but tended not to replace it with low fat cheese (they largely removed cheese from their diet)
In the female cohort, there was no significant decrease in energy/calories from dairy, likely because of the increase in yoghurt. Males on the other hand, decreased the amount of dairy they ate altogether. So it is no surprise their energy/calorie intake from dairy decreased.

What does this mean? A couple of things:
  • The decrease in dairy noted in males lead to a significant decrease in their calcium intake
  • Female calcium intake did not significantly change
Overall, the calcium and dairy intake pre and post dietitian intervention were well below the daily recommended amount. Based on this, the take home messages and best tips are:
  • Calcium is very important for maintaining strength and integrity of teeth and bones, which prevents the development of osteoporosis later in life
  • Dairy products contain many vitamins and minerals that are beneficial for health
  • Choosing reduced fat dairy products are preferable for day to day eating to prevent weight gain and unnecessarily high amounts of saturated fat and cholesterol
  • If you're one of the many people who can happily replace full fat yoghurt and milk with the low fat variants but can't stomach low fat cheese, eating a serve (Fig 1) of full fat cheese ~3 times per week is quite an acceptable compromise
  • Guidelines recommend choosing 3 serves (Fig 1) of reduced fat dairy daily
Dairy has good snack-ability because it is high in protein which will help keep you full - plus all the other aforementioned goodies. So really, swapping out the full fat stuff for the reduced fat stuff means you can continue enjoying dairy and all it benefits. It also gives you a couple of easy snacks to put in your pie hole each day.

One serve is: 1 cup milk, 200g or 3/4 cup of yoghurt, 2 slices or 40g of cheese.

Figure 1: Serves of dairy products, adapted from the 'Healthy Eating for Adults' brochure, National Health and Medical Research Council (NHMRC), Department of Health and Aging (DoHA), Australian Government


I love dairy! But I'm lactose intolerant so I mostly avoid it... :(
Hi Beckett, thanks for your comment.

Many people have trouble digesting lactose. Lactose intolerance (LI) is caused by the absence of the enzyme 'lactase' that breaks down the sugar 'lactose' (found in dairy) into glucose and galactose.

There are a few alternatives and tips for those with LI who do want to eat dairy:
- Lactose free milk, has the enzyme already added to the milk
- Harder cheeses; the harder the cheese the less lactose it has eg: Parmesan and aged cheeses
- Older (but not expired) yoghurt, eating yoghurt closer to the used by date means the bacteria in the yoghurt (that help our digestive system) have a chance to eat and break down the lactose before we eat it
- Lactase pills are available for purchase to take with dairy. They prevent LI symptoms like gas/bloating/diarrhea. Buying the generic pills are more cost effective compared with the name brands

Wednesday, April 10, 2013

The Skinny on How Diet Impacts Asthma

Back in the days before 32% of 2-18 year olds were overweight, obese or at risk of becoming so, no one thought anything of a little ‘baby fat’. That bubble is about to burst. With the rising numbers of childhood obesity, another illness is on the rise: asthma. Skeptical that the food you put in your pie hole has any influence on the air pipe just beyond it? Well, take a deep breath as we explore the evidence linking your diet and your lungs.

Both obesity and asthma have increased over the last 20 years. More obese kids have asthma compared with their healthy weight counterparts. Asthma is attributed to urbanisation: air pollution, tobacco smoke, less exposure to infectious agents, poor diet and poor lifestyle.

How is food affecting your lungs? Inflammation; This is a mechanical change linked to your diet. Having a higher body weight increases body inflammation and exacerbates lung and airway inflammation (see Figure 1). Diets that are high in calories, refined sugar, animal fats and low in plant products, combine to increase inflammation.
Figure 1: Pictorial representation of airway inflammation in people with asthma, during an asthma attack, compared to a normal airway. CDC, National Institutes of Health-National Heart, Lung, and Blood Institute, Asthma and Allergy Foundation of America, American Lung Association

A recent meta-analysis (combination and analysis of independent studies) of 48 studies demonstrates there is an association between body weight and asthma. Central obesity (around the chest and waist) increases asthma severity and decreases lung function (1, 2).

Evidence further linking airway problems and diet was demonstrated when adults with asthma ate a high fat meal and had increased airway inflammation following that meal. The same study found meals specifically high in trans fat had even more severe airway inflammation following the meal. In other words, fat makes it easy to be wheezy.

The good news is adults with asthma can improve their outcomes. Research shows asthma symptoms decreased in adults who lost weight.

Take a puff of your inhaler for this interesting morsel: babies who were breastfed for <2 months and were overweight, had increased incidence of asthma.

The take home points are:

  • There is a multitude of evidence supporting an association between high body weight and asthma in children 
  • Central obesity in children is linked with increased asthma severity and decreased lung function 
There’s nothing wrong with taking your child out to enjoy some ice cream or a burger every now and then. It comes down to ensuring that pint-sized pie holes are consistently eating a healthy diet to prevent ‘baby fat’ sticking around and affecting lung function.

Some practical tips:

  • When enjoying ice cream out of the house, get the 'kiddie' size 
  • If enjoying ice cream at home, use a small bowl and small spoon (it lasts longer) 
  • If you're out for dinner as a family and want to get dessert, get one dessert with a spoon for everyone and share it

Wednesday, April 3, 2013

Sport and Energy Drinks: Scientifically Formulated to Take Your Money

Our travels through the research behind sodas and soft drinks have set the tone to now discuss relatively new sugar sweetened beverages (SSBs) on the market. Sport and energy drinks. New research reveals interesting consumption patterns of these fun and fit workout companions. Join us, as we pop the lid on these performance-enhancing potions.

A recent study shows one in four US adults consume a sport or energy drink once per week. Additionally, one in nine adults consumes over three such drinks in a week. These numbers are rather astounding. Drinking three 20 oz bottles (one 20 oz bottle is 590ml, three 20 oz bottles is 1,770ml) of sport drink per week adds 477 calories to your diet. That’s almost the same as putting a McDonald’s double cheeseburger (450cal) in your pie hole. 
The study also discussed the demographics that tend to buy and swig these colourful concoctions. Contrary to SSBs like soda and fruit juice that are predominantly purchased and consumed among lower income and education groups, sport and energy drinks have higher consumption rates among higher income adults. Likely reasons for this include higher cost compared with other SSBs, and clever marketing (eg: endorsements by athletes).

Sport and energy drinks were most swigged by adults 18-24 years old, with 24% drinking three or more per week.

Drinking one or more of these specialised SSBs per week was significantly associated with drinking other beverages containing added sugar, like soda and fruit juice.  In addition to the calorie imbalance this can create, these beverages also contribute to high rates of pie hole erosion and dental caries.
An example of tooth erosion and dental caries. Patient history of
excessive daily consumption (5-6 bottles) of acidic carbonated beverages
Where energy drinks appear mostly consumed for the caffeine, sport drinks can actually have a place and benefit for some people. Sport drinks were originally designed for elite athletes as a way of simultaneously re-hydrating and providing fuel in the form of carbohydrates, and occasionally protein.

The ugly truth is, much of the research behind sport drinks and performance are financed by the companies trying to sell you their products: PepsiCo owns Gatorade; Lucozade is produced by GlaxoSmithKline and Coca-Cola Brands manufactures Powerade. Often these conflicts of interest are not declared or published. Additional problems with sponsored sport drink research includes:
  • Small sample sizes
  • Lack of 'blinding' (participants knowing that they are drinking a sport drink vs water. This invalidates findings because it doesn't take placebo effect into account)
  • Use of athletes as study participants (results are not representative of 'normal' people who workout a few times a week)
  • Manipulation of nutrition (many studies 'starve' participants the night prior and morning of the research study)
Unless you’re continuously training at a high intensity for 1-2.5hrs or >2.5-3hrs, the best beverage for your pie hole, and pocket book, is water.

Special acknowledgement to my friend and Doctor of Dental Surgery student Thomas W, for information about acidic beverages and impacts on dental health. www.buccal-aspect.com
Special thanks to Associate Professor in Nutrition and Dietetics at Deakin University, Tim Crowe, for insight and reference to further research. http://www.thinkingnutrition.com.au/