‘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, October 30, 2013

Breakfast: Kick Start Your Ovaries

Pie hole devotees will recall a few months ago we discussed the most common cause of female infertility: Polycystic Ovary Syndrome (PCOS). The abridged digest of "Don't Wait to Lose Weight and Ovulate" is that weight loss, irrespective of diet composition (eg: high protein, low fat, low carb, etc) improved menstrual regularity and ovulation in women with PCOS. Oh, I almost forgot, the usual disclaimer for potentially blush-worthy words applies to this article: Words including ovulation, menstruation, sex hormones and ovaries will appear frequently. But stick around, today we're talking about improving fertility without weight loss.

A quick recap of PCOS: It prevents ovulation due to excessive production of sex hormones, called 'androgens'. Two major factors cause this overproduction of hormones: Insulin resistance and hyperinsulinaemia. Don't freak out! I'll explain: 
  • Insulin is the hormone that moves glucose (sugar) from your blood into your cells. Think of it as the ball boys at a tennis tournament who clear excess tennis balls from the court, allowing the game to continue
  • Insulin resistance means you require more ball boys to remove the same number of tennis balls as someone who is not insulin resistant
  • Hyperinsulinaemia is tied to insulin resistance as it refers to higher than expected levels of insulin (or ball boys) for a given amount of glucose (or balls... tennis balls that it)
PCOS affects 6-10% of reproductive aged women. Over half of women with PCOS are obese (BMI >30). Overweight and obese women can improve the above factors through diet and weight loss. But what about lean women with PCOS? Weight loss is not a viable option for them.

Previous research shows that timing of meals, hormones and nutrients can effect metabolism, fat metabolism and fat storage. A recent study looked at overweight and obese women with insulin resistance, and found that caloric distribution of meals impacted insulin levels. The group eating a high calorie breakfast and low calorie dinner had both improved weight loss and insulin sensitivity (fewer ball boys needed), compared to the low calorie breakfast and high calorie dinner group (lunch calories were identical).

Where it gets really interesting is with a new study that investigated lean women with PCOS (where weight loss is not an appropriate treatment option). One group had a high calorie breakfast and low calorie dinner (BF group), the other had a low calorie breakfast and high calorie dinner (D group). Both groups had the same number of calories for lunch. After 90 days the results showed:
  • Women in the BF group were significantly less insulin resistant (they needed fewer ball boys)
  • Women in the BF group had significantly lower levels of the sex hormones associated with irregular menstruation and ovulation
  • Almost 50% of women in the BF group had ovulated at least once during the study, compared to only 20% in the D group (these results were significant)
  • The D group did not show adverse insulin effects, their insulin resistance and other factors (like sex hormones) remained constant
This is exciting because it is a simple, safe way for lean women with PCOS to improve factors like sex hormone levels and insulin resistance without medication. These factors, in turn improve menstrual cyclicity and ovulation. 

So go on ladies, make breakfast really pack a nutritional and caloric punch to get those ovaries off to a great start!

Wednesday, October 23, 2013

High Tech Solutions to Weighty Problems... Pt II

We've discovered the health app and complimentary devices component of the smartphone and weight loss industry. However, I couldn't pass up the chance to write a follow up article based on some new research I stumbled upon. There's well and truly an app for everything, and there are some 10,000 apps specifically for diet and weight loss... Quite astronomical, really. So, how useful are they?

Some stats to start us off: 91% of adults in the US own a mobile phone. 61% own a smartphone. Half of smartphone users have used their phone to search health information. 60% of all downloaded health apps are related to weight loss and exercise. Perhaps more time walking and less time on our bums letting our fingers do the walking would help.

There are some studies that suggest the internet and mobile technologies are beneficial in delivering health behaviour interventions for lifestyle changes and weight management. It is, of course, traditional that these interventions are administered by trained healthcare experts whose strategies are based on evidence. This begs the question: How many health apps can boast evidence-based strategies?
Evidence-based strategies are those that have demonstrated efficacy through research. For example: Setting weight loss goals, education about food substitutions, portion control, time management and nutrition label reading are evidence-based behavioural strategies that aid weight loss. 

A majority of apps included weight loss goal setting and diet goals (90%). 87% of apps included calorie balance tracking (calories in vs calories out). The two highest scoring apps included 65% of behaviour strategies (MyNetDiary free and MyNetDiary Pro). The next highest scoring apps only included 25% of strategies (All-In Fitness and Noom Weight Loss). That's quite a quality difference.

Generally speaking, the free apps were just as good as the paid ones: Many of both featured a bar code scanner and allowed social media connection (providing social support). But the majority failed to feature much in the way evidence-based strategies for sustained weight loss.


In the end, evidence-based strategies are important, but so too is interface, user experience and the ability for people to engage and reengage with the app - which are imperative for long term behaviour change. Self monitoring and recording are associated with improved weight loss. So too is frequent and consistent monitoring of foods eaten which results in twice as much weight loss compared to infrequent monitoring.

The short recap:
  • Weight loss apps can be useful
  • Look out for ones that support your healthy lifestyle changes in the long term
  • It still takes drive and motivation... Just because you downloaded an app, doesn't mean the weight magically falls off

Wednesday, October 16, 2013

Should You Steer Clear of Beer?

Wine is often spruiked as 'heart healthy', 'artery unclogging', 'miracle juice'. There's almost a headline a week about how wine helps ward off cancer, gallstones, atherosclerosis (hardening of the arteries), cardiovascular (heart) disease, 'bad' cholesterol and more. But this begs the question: What about beer?

First, a bit of beneficial background about beer brewing. Beer is made from two plant sources: barley and hops. The act of 'brewing' allows the barley starch to morph into a sugary liquid called 'wort' (what an appetising name...). The 'wort' transforms into alcohol via fermentation by (brewer's) yeast.

A fun fact about beer colour: Dark beer doesn't equal higher alcohol content. Beer colour is determined by the type of malt. Alcohol content is determined by the amount of sugar in the wort.

Most beers use malted barley, although some beers use other grains, or combinations of grains including wheat, rice, oats and rye. 'Malted' simply means the grain germinates or sprouts before it is used. Hops, a flower from the hop vine, adds the bitter flavour and aroma typical of beer.
Some fun facts about hops:
  • It acts as a preservative (due to its acidity)
  • It has antibiotic properties that favour brewer's yeast above other microorganisms, this aids in 'head retention' (it sounds dirty, but it's the foam layer that sits atop your glass of beer)
As we said earlier, red wine is often promoted as 'heart healthy', but the truth is, it's the ethanol (alcohol) that provides benefits like increasing 'good' cholesterol, decreasing 'bad' cholesterol and reducing risk of blood clots.

There's a lot of talk about 'polyphenols', particularly regarding red wine. Polyphenols are potent antioxidants that have protective health effects like reducing risk of heart disease and blood clotting, and lowering 'bad' cholesterol. Both wine and beer contain polyphenols, but they originate from different sources. In wine they come from grapes and in beer they come from hops and malt. Basically, your yuppie, wine swilling neighbour isn't getting a better deal on polyphenols with his expensive bottle of wine.

A fun fact about polyphenols in wine: The red stuff contains about 10 fold more polyphenols than the white stuff.

How does beer measure up against wine nutritionally speaking? Per oz (~30ml):






Wine is higher in calories due to the higher alcohol content. A bit of context: 1 gram of alcohol contains 7 calories. Compare that to 1g of fat containing 9 calories and 1g of protein/carbohydrate containing 4 calories. Alcohol is pretty energy dense, booze hounds beware.

Beer and wine contain a slew of vitamins and minerals. Beer beats wine per ounce in niacin, pantothenic acid (vit B5), vit B12, folate, selenium and silicon. Wine beats beer in the calcium, iron magnesium, potassium, zinc, manganese and flouride departments.

Things to remember:
  • Beer and wine contain vitamins, minerals and antioxidants... In very small amounts
  • The health benefits of beer and wine are based on regular, moderate consumption
  • Health benefits of beer and wine are greater when combined with a healthy diet

Learn more about alcohol guidelines and 'standard drinks'

Wednesday, October 9, 2013

Fast Track Your Faeces

An action few can discuss without a giggle, a blush, or a joke... When my friend's husband, with a cheesy grin and red face, sheepishly broached the subject with me (right after dinner at a restaurant), my, perhaps too enthusiastic of a response was: "don't be shy, bowel dialogue with patients is mandatory, nothing you say can possibly perturb me on this subject". So there begun a discussion about fibre and faeces (yes, I'm spelling them the Australian way). If you're squirming already, or weak of stomach, hold your breath and strap yourself in coz there's more toilet humour ahead.

Fibre: It's the stuff found in plant cell walls that human bodies can't digest. It's the stuff that helps keep us regular (in the pooping department). And it's all around awesome stuff.

To answer my friend's first question: What is regular for me, might be different to what's regular for you. Some people's regular is once a day, some twice a day, some once every two days. That's fine. If you're going less than three times a week, your usual habits change, or it's painful to go, this could mean constipation (gosh darn, I said it and the sky didn't fall).

As for my friend's next question: If you want to put your faeces in the fast lane, a good place to start is with fibre. And I'm not talking about fibre supplements, I'm talking about the real stuff. Here are some foods that'll really get you in on the poop parade:
  • Fruits
  • Vegetables
  • Legumes
  • Whole grains
  • Nuts and seeds
A few important things to remember:
  • Increase the fibre in your diet slowly (gas and bloating can occur if you go from zero to hero too quickly, give your gut bacteria time to adjust)
  • Fibre slows stomach emptying which helps keep you feeling full for longer (two enthusiastic thumbs up)
  • The above foods are high in fibre whilst simultaneously high in vitamins, minerals, antioxidants and healthy fats
  • Fibre attracts water inside your gut. To ensure your excrement is expedited, drink plenty of water
  • Physical activity is another important aspect for convenient colon clearing (1, 2)
  • Fiber, fluid and physical activity together can help reduce constipation
What about packaged, manufactured products claiming they are high in fibre? So is a cardboard box... Do your due diligence and read the label. Adding extra vegetables and legumes to meals and soups, snacking on fruit, and buying whole grain products like bread, crackers, cereal, etc are economical ways to boost the fibre in your diet.

I do hope this has unclogged and cleared up a few everyday queries people may have about their bowels. Finally, I leave you with this hope: May the force not be with you.

Wednesday, October 2, 2013

High Tech Solutions to Weighty Problems

For those of us who can turn on a computer, check emails and acknowledge the internet isn't a passing fad, the world is online. It's about instant gratification and information. Want to pick a movie, listen to the radio, find a restaurant, share pictures of your baby or launch multicoloured birds into precariously built wooden structures? Well, there's an app for that. Along with these apps have emerged a breed of health apps, often connected to a device that monitors, well, you. How useful are they, really?

Research shows that keeping a food diary helps people lose weight. It makes us aware of our food habits, and makes us accountable for what we put in our pie holes. It's also a very handy tool to show your dietitian, who can help you assess meals, snacks, portion sizes and more (shameless plug).

The pitfall of food diaries is that they are time consuming to keep, which means they're not sustainable long term.

There are many fancy (and expensive) devices and apps that monitor one or many of your physical activity, heart rate, sleep patterns, food and beverage intake, mood, etc. More research is needed to fully assess their benefits, but so far it looks promising. Or you could just get a smart tooth implant to track your various pie hole habits - I presume the incentive to put that device in your mouth is that it's a 'chip'.

So here are my thoughts: I borrowed and trialed the Up band by Jawbone, which retails for $130. You can set goals like hours of sleep and number of steps. The nifty slumber function tracks info like how long it took to drop off, how many times you woke up and time spent in deep vs light sleep. You can also input your daily meals, snacks and beverages to track your calories.

Here's the summary download:
    • Sleep function:
      • How many times I'd woken up: The band often got it wrong
      • It often counted laying in bed as 'sleeping' (I wish they were the same thing)
    • The physical activity tracker: 
      • Only really useful for walking - cannot figure out activities like cycling, swimming, hockey, circus training, etc 
      • Doesn't monitor heart rate, so it can't distinguish between calories burned when walking up hill vs on flat terrain vs running 
      • It's on your wrist not your hip, so if you don't swing your arms (eg: hand in pocket, on the dog's leash, on the shopping trolly/cart) steps aren't logged
    • Food monitoring: 
      • It's time consuming! It takes several minutes to input, search and select each food item 
      • For combination meals made at home (like spaghetti bolognese, lasagne, curry) you either have to select pre-made versions or guesstimate the quantity you ate of each separate food item in the dish
      • What is really cool though, is in addition to displaying and tracking calories, it also tracks fiber, fat, carbohydrates, sugar, sodium, etc
      The inner workings of the Jawbone Up app in conjunction with the Up Band

      All these things impact accuracy. BUT for many people, these toys provide an incentive to go for a walk, or swap that chocolate bar for an apple.

      People already in the habit of exercising and who know how much food they need to maintain their weight, will find these devices redundant. But for people who are making big lifestyle changes, these tools could be the difference between a 'fad' change that lasts for a week, or a change that becomes a habit and lasts long term.

      The take home:
      • These devices can provide information to aid weight loss and an incentive to move more
      • They track progress and most importantly, bestow a sense of accountability
      • They are expensive, so perhaps a plain old food diary and cheap pedometer will do the job whilst simultaneously freeing up some cash to buy some nice produce