‘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, May 29, 2013

Don't Wait to Lose Weight and Ovulate

This week's article tackles a topic that is beyond the scope of a dietitian alone. I have enlisted the help of Reproductive Scientist, and great friend, Shannon Everett (Master of Reproductive Science). Polycystic Ovary Syndrome (PCOS): It's bit of a mouthful yes, but believe it or not, fertility is linked to your diet.

PCOS is one of the most common causes of female infertility. This syndrome prevents ovulation due to excessive production of sex hormones, called 'androgens'. Despite the name, not all women with PCOS have ovarian cysts; kind of like how not all vegetarians are healthier than omnivores.

The exact prevalence of PCOS is difficult to ascertain due to differing diagnostic criteria. If we had to put an approximate figure on it, it's somewhere between 6-21%.

'Normal' vs Polycystic Ovaries (Source: MedicineNet)

Presentation of PCOS is generally at least two of:
  • Menstrual dysfunction (infrequent, or lack of periods)
  • Increased acne/facial hair, and other signs of hyperandrogenism (increased production of sex hormones)
  • Polycystic ovaries (cysts identified on the ovaries via ultrasound)
Here's where diet and lifestyle factors come into play: over half of women with PCOS are obese (BMI > 30). Both obesity and PCOS increase the risk of health issues such as infertility, heart disease, insulin resistance and type II diabetes. When a woman falls into both categories, it's like spotting a kid playing with matches in the bush in the middle of summer: sirens are sounding.
The best way to improve PCOS symptoms and regain/improve menstrual function is pretty darn simple and supported by evidence in both dietetics and reproductive science... Weight loss!

A recent meta-analysis (combination and analysis of independent studies) investigated whether diet composition improved outcomes of PCOS. Diet compositions investigated were:
Results did not show one diet composition was superior over another. What is interesting, though, is positive body composition changes (decreased fat mass, waist circumference, waist to hip ratio and increased lean muscle mass) were observed independent of diet type. Menstrual regularity and ovulation improvements were also noted independent of diet composition.

If you were to liken the efficacy of your body to a car:
  • Change the spark plugs for more efficient petrol use (change from fast foods to whole foods and cook at home, you and your wallet will run more efficiently)
  • Use high quality, lower viscosity oil to reduce friction on the engine (whole grains increase the body's ability to efficiently produce energy from other high quality foods)
  • A clogged catalytic converter in the exhaust decreases efficiency (get that body moving to prevent human 'clogging')
  • Properly inflated tyres (tires) increases fuel efficiency, weight of the car has an impact (wear comfortable workout shoes, you're more likely to walk or workout longer if you're comfortable)
Take home messages:
  • PCOS is a serious condition affecting female fertility
  • A safe and sustainable diet, regardless of its specific composition, that results in weight loss has clinical benefits with regards to PCOS
  • The safest and most sustainable way to lose weight is through lifestyle modification:
  • Moderating portion sizes of meals destined for your pie hole
  • Physical activity
  • Eating plenty of unprocessed foods like fruits, vegetables and whole grains, with moderate amounts of lean meat and dairy

Big thank you to my wonderful friend and co-author, Shannon Everett (Master of Reproductive Science).
Also, thanks to the good folks at Come Racing for helping me liken a well oiled car to a well oiled body: http://www.comeracing.com/

For further reading, check out "Baby Making Nutrition" at http://pureformenyc.com/blog/baby-making-nutrition

Wednesday, May 22, 2013

Highfalutin Gluten (part II)

We are now all caught up on what gluten is, where it is found, and why people with diagnosed celiac disease (CD) must avoid ingesting it. The next part of the journey is evaluating the validity of the gluten free craze in the regular population as it reaches glutenous maximus.

We've all read it, heard it or talked about it: why not go gluten free? The worst answer out there is "it just makes sense". Actually, it doesn't "just make sense" at all.

The claim "we eat too much gluten in modern times" is thrown around pretty often. Many modern packaged foods contain gluten, and yes, people who eat them probably do consume more gluten than in times gone by. But this is still no reason to banish gluten completely from the diet.

People foolishly think that going gluten free means weight loss. It is true that people diagnosed with CD often lose weight after switching to the necessary gluten free diet. One major reason for this is because a gluten free diet is daunting and restrictive at first. Packaged, high calorie 'junk' foods and many staple foods like bread, cereal and pasta that contain gluten can't be eaten anymore. Fresh, low calorie foods like fruits and vegetables (naturally gluten free) are cheap and easy options. Ta-da! Cutting out the hamburgers, pies, Corn Flakes, cakes and cookies, coupled with increasing fruit and vegetables... Sounds like a solid weight loss recipe. It's gluttony rather than gluten that is to blame for weight problems.

Next up: packaging! On an excursion to my local supermarket, I perused the aisles and found some great visual aids.

First off, let's look at packages that state 'gluten free' without using it as a marketing tool:
These packages (canned tomatoes, tea, sausages) have a small tag showing they are gluten free and safe for those with CD. It is not a big part of the packaging or the marketing.

Now we move to the packages that attempt to confuse consumers into thinking they are great and healthy options by slapping on various phrases, including 'gluten free'.

This package uses the phrase "Nourishing kids in motion", basically saying "if your kid does a sporting activity, this product is good for them".

Next, it states "gluten free" between the phrases "real fruit rope" and "excellent source of vitamin C"... So I'll play captain obvious:
- It's a fruit flavoured rope, not to be confused with actual 'real' fruit
- An excellent source of vitamin C would be a real fruit
- Slapping "gluten free" in with the above phrases attempts to make this product seem healthier

This package epitomises using key words to sell an unhealthy product masquerading as a healthy one. The term "superfood" is not regulated. Would you buy a bucket of organic, gluten free lard if the manufacturer tagged on the word "superfood"? Just because they say it's super, doesn't mean it is. I can dress up my 92 year old grandfather in a superman costume... that doesn't mean he can fly.

Kale is a dark green leafy vegetable that is actually healthy. In it's raw form, 57g (2oz) of kale = 30 calories. This 57g (2oz) bag of glorified gluten free chips contains a whopping 320 calories. Super indeed.

Just to note, the nutrition panel states this bag is two serves...pfft.

Next up, we have a direct comparison between two 'like' products: pretzels. The gluten free variety (Glutino) is pictured above the regular variety (Snyder's). When looking at calories, total fat and salt (sodium) in a 30g (1oz) serve of each product, the gluten free version strikes out time and time again.
  • Calories:
    • Regular = 110
    • Gluten free = 120
  • Fat:
    • Regular = 0g
    • Gluten free = 3.5g
  • Sodium:
    • Regular = 250mg
    • Gluten free = 420mg (!!!)
Generally, gluten free packaged foods are higher in one or more of fat, sugar and salt to help compensate for the texture and taste difference when gluten is removed. This demonstrates how gluten free foods do not equal a healthier option (for those who don't need to avoid gluten).

Lastly, and my favourite finding from my stupendous supermarket excursion: gluten free sweets in the form of shortbread cookies.

Packaging claims...
  •  "Simply Natural" (top left) doesn't = healthy
    • Ricin, arsenic, lead, cyanide and anthrax are also 'simply natural'. Doesn't mean we should eat them
  • "Simply Balanced" and "Simply Nutritious" (center left and top right)
    • What does this even mean? This product's first two ingredients are butter and sugar... which of those sounds "balanced" or "nutritious"?
  • As a side note, the regular shortbread cookies (Walkers) had 4g of sugar per 28g (1oz) where the gluten free cookies were double that at 8g
At the dramatic conclusion of this gluten series, here's the take home recap:
  • Celiac Disease is an autoimmune disease requiring a lifelong gluten free diet to prevent chronic intestinal damage
  • Without diagnosed celiac disease, there is nothing wrong with gluten in your diet. It comes down to portion size and selecting wholegrain options (eg: bread and cereal)
  • Gluten free food does not automatically equal healthy
For further reading on gluten, gluten sensitivity and recipes, see:

Wednesday, May 15, 2013

Highfalutin Gluten

Gluten  free: A favourite claim in the food packaging world. Gluten free bread, gluten free cookies, gluten free pasta, gluten free water, gluten free gluten. The whole world has gone gluten free crazy. Journalists, quacks and randoms with a computer all have an opinion. It seems every man and his dog are preaching the benefits of gluten free diets, from promises of weight loss, to less bloating, to more energy. What does the science say? Fad, fiction, fact or downright foolish?

Gluten: It's a protein found in wheat, rye, barley and oats. It's the protein responsible for that lovely spongy, springy and fluffy texture in bread. It's commonly found in pasta, baked goods and cereals. In bread, for instance, gluten forms when flour is mixed with water. Gluten creates a complex structure which is enhanced by kneading. This structure traps the gas released by the yeast, thus allowing the bread to rise.

People with diagnosed Celiac Disease (CD), truly must avoid ingesting gluten.

What is CD? It is an autoimmune disease where the body reacts negatively to gluten.
What isn't CD? Ordering from the 'gluten free' menu at a restaurant because you want to feel special.
What else isn't CD? Feeling sick after you put too much in your pie hole.
What definitely isn't CD? Farting after you eat a sandwich (oh, it's not that crude, we all do it!)

CD is characterised by damage to the intestines caused by gluten. The damage is flattening and chronic inflammation of the 'villi' in the intestines, called 'villous atrophy' (see Fig 1). These 'villi' are finger-like projections lining your gut that increase surface area and allow your body to absorb food particles and nutrients.

Figure 1: Left image depicts healthy villi. Right image depicts celiac villi  (characterised by flattening)
Another way to think of this is opening your hand. Your fingers are like the long villi in your gut. Now if you make a fist, your fingers are gone and all that's left are your knuckles which are very flat in comparison (much less surface area and harder for your body to absorb nutrients).

Symptoms of CD range from various nutrient deficiencies, bloating, gas, nausea, abdominal pain, diarrhoea, weight loss and sometimes weight gain. The problem is, these are very common symptoms for many conditions, and plugging them into Dr. Google is meandering down the road to a wrong diagnosis.

Blood testing is the first step. Though blood screening alone is not enough to diagnose CD. Positive blood tests require follow up by a small bowel biopsy, which identifies villous atrophy. Genetic testing is useful only in some cases. Again, the gene test alone cannot diagnose CD as only 1 in 30 people carrying the genes associated with CD, will actually develop it.

But what if you just feel like cutting out gluten because you've had a few of these symptoms and you're sure you'll feel better once you go gluten free? You've heard you'll lose weight, gain energy and your bloating will disappear. All problems fixed by avoiding gluten for no other reason than "it just makes sense". We all know someone like this, and next week's article 'Highfalutin Gluten part II' will discuss the validity of these statements, get our hands on some food packaging and arm ourselves against the fictitious nonsense lurking about.

Wednesday, May 8, 2013

What Ails and Cures

Meat: What used to be a staple in most homes and enjoyed around the dinner table is now a controversial meat hole. There are the usual ethical and religious views as well as various types of vegetarian and vegan diets. Then there are media alarmist claims that eating meat is bad for your health. And the whiney list of reasons to break up with meat goes on and on, like a Taylor Swift song. Here we'll discuss all things meat-alicious. Jump on this juicy bandwagon as we flesh out the evidence behind this tasty topic.

Pie Hole devotees will recall that meat is an excellent and reliable source of nutrition. Plant killers like to argue that non-animal sources of iron, zinc, vitamin B12 and vitamin A (such as grains and dark green leafy vegetables) are just as good as meat. However, plant sources of these are not as bioavailable as animal sources. Bioavailability is the extent to which our body can absorb and use vitamins and minerals from food (for further explanation of the bioavailability concept, click here).

Vegetarian or omnivore? Studies show vegetarians have a lower risk of heart attacks and other lifestyle diseases like type 2 diabetes and heart disease. However, these studies show vegetarians make more conscious lifestyle choices beyond meat. For example, vegetarians are generally leaner, more active and smoke less compared to their omnivorous counterparts. These behavioural differences decrease risk of lifestyle diseases.

A recent study investigated meat consumption and risk of early death in a whopping 450,000 people. Results showed:
  • Males and females consuming the most red meat also consumed lower amounts of fruits and vegetables compared to those who ate less red meat
  • Males and females consuming the most red meat were also more likely to smoke and have lower education levels
  • Males (not females) who ate the most red meat, drank more alcohol than their low red meat eating peers

BUT... there's always a but. Neither red meat or poultry consumption was associated with increased risk of death. Processed meats on the other hand, were associated with higher risk of early death by cancer and heart disease. 

Processed meat includes sausages, salami and bacon. Not only are these meats higher in fat and cholesterol than fresh meat, they are treated by salting, curing or smoking. This often improves shelf life, colour and taste. Unfortunately, these processes also increase carcinogenic compounds in the meat... Thus what cures the meat, ails the eater.

One last meaty morsel in this tender tale is that the lowest risk of early death was seen in those who ate low to moderate amounts of red meat and poultry. Meat abstainers didn't exhibit the lowest risk of early death, as plant peddlers perpetuate.

Take home points and tips:
  • Small to moderate amounts of red meat and poultry in the diet is beneficial to health
  • Meat supplies protein and other nutrients that are highly bioavailable (zinc, vitamin B12, iron and essential fatty acids)
  • It's ok to have a special steak dinner every now and then, but for day to day practice, spread the meat around by buying meat you can cut up (e.g: chuck steak, beef strips, lamb steaks) and cook  in a curry or stew that includes your favourite veggies

Wednesday, May 1, 2013

We Don't Make This Stuff Up For Our Health...

Dietary Guidelines. All countries differ slightly in what and how much they recommend their population eat for optimal health. The food groups remain the same, portion sizes are similar and the breakdown of food groups making up the diet is comparable. Ever wondered about these guidelines? Today we discuss eating habits prescribed by dietary guidelines and how this affects aging in terms of quality of life (QOL). Grab your walking frame and tennis balls as we hobble up destiny lane.

Dietary guidelines and recommendations in the US and Australia similarly advocate high intakes of fruit and vegetables. They recommend a majority (~55%) of energy/calories come from whole grain cereals, breads, pasta, rice etc. Guidelines suggest moderate amount of dairy, meat, poultry, fish and small amounts of fats, oils and other 'sometimes' foods. Nothing new there, it's what we've heard our whole lives.

The burning question is: Does following the rules now help you later? To answer this question, we must tease apart the issue a bit more. A recent study followed a large cohort of adults (3,000) aged 45-60 years old for 12 years. They collected and analysed nutrition data, as well as evaluated both their mental and physical QOL.

Physical QOL looks at: a person's limitations caused by physical problems, bodily pain, and general health.
Mental QOL looks at: mental health, social functioning, and a person's limitations caused by emotional problems.

The study investigated compliance with both dietary and physical activity guidelines. Here's what they found:
  • Those who followed dietary guidelines had better physical QOL after the 12 years
  • Those who observed dietary guidelines had better initial mental QOL
  • Those who adhered to the physical activity guidelines had better initial physical and mental QOL

This summary brought to you by the Captain Obvious files:
Following a high quality diet combined with physical activity that aligns with prescribed guidelines does indeed translate to better aging, QOL and decreased cognitive impairment (similar to findings in last week's article: Losing Your Mind? Can the Mediterranean Diet Help?).

So train your pie hole, because healthy eating and activity behaviours now lead to better aging and QOL later.