-
Eight tips to help you enjoy a dreamy dairy-free Christmas.
12th Dec 2011
Well Christmas is almost upon us once again and if you're anything like me it's always the final furlong which is the most stressful.
Each year I vow to be more organised but of course it never happens and this year like every other I'm still trying to find the perfect pressie for those tricky-to-buy-for-friends and relatives, wondering if I'm going to get my Christmas cards written in time to catch the last post, and planning the menu and getting organised for the big day itself.
And of course if you’re on a dairy free or indeed any sort of special diet then you have all that to think about as well so for my blog this month I’ve put together some tips which will hopefully help you to enjoy a diary free and stress free festive season.
- At this time of the year many of us are guilty of burning the candle at both ends and unfortunately this can weaken your immune system leaving you vulnerable to colds and infections. A healthy balanced diet, which contains plenty of fresh unprocessed foods, fruit and vegetables is the best way to keep your immune system up - so don’t neglect your diet.
- Christmas preparations can leave you feeling exhausted – so in the run up to make sure your fridge and freezer and are filled with healthy ready meals – so when time is short or energy levels are low you’ve got something healthy at hand.
- Start the day right – studies show that people who eat breakfast in the morning are less likely to suffer from colds and 'flu.
- Stress increases the requirement for several vitamins and minerals so at this time of the year your needs are likely to be greater than normal. Although supplements are never a substitute for a healthy balanced diet at this time of the year I always take a multivitamin and mineral supplement. If you decide to take a supplement choose an A-Z formula that provides no more than 100% of your Recommended Daily Amount. If you follow a gluten or dairy free diet ask the pharmacist to recommend a suitable brand.
- Stress can also deplete the number of pro-biotic 'friendly' bacteria living in your gut so I think it’s also a good idea to take a pro-biotic supplement - again a pharmacist will be able to help you to choose a suitable one.
- If you’re on a special diet eating out can be a bit of a nightmare. At parties stick to foods which you know are dairy free and if it doubt just say no. If you're going a party and you’re not sure if there will be anything suitable to eat have a snack before you leave home. If you're eating out in a restaurant phone ahead to let them know you are on a special diet or check to see if they have a menu online so you can work out which items on the menu are suitable for you.
- If you don't do it already why not do your Christmas food shopping on line this year. It's quick and easy, you can do it from the comfort of your own home and the best bit is you avoid the queues.
- Be as organised as possible for the big day itself. Write a list of what needs to be done and get as much preparation as possible done the day before. Don't try to do it all yourself of delegate simple tasks where you can and last but not least enjoy the day.
Finally a Happy Christmas to everyone reading this and best wishes
for 2012! -
A new approach to treating Irritable Bowel Syndrome.
14th Nov 2011
If you have clients who suffer from Irritable Bowel Syndrome (IBS), or maybe you are unlucky enough to suffer from the condition yourself, one of the first things you learn about the condition is that it is not easy to treat.
Last week at the Nutrition and Health Conference I listened to a very interesting presentation given by Heidi Staudacher, Research Dietitian at Guy's and St Thomas' NHS Foundation Trust on a new and exciting approach to treating IBS.
Although the FODMAPs diet is well known in Australia, it's only recently found its way over to the UK. The name is derived from the list of foods which need to be avoided in a diet - which are Fermentable, Oli, Di and Monosaccharide's and Polyols. The theory behind the diet is that FODMAPs are poorly digested by people with IBS which means they end up in the large bowel where they are osmotically active, which means they drawn fluid into the bowel, leading to diarrhoea. They are also fermented in the bowel producing gas that causes a range of symptoms including bloating, distension, abdominal pain and flatulence.
Trials that have used the FODMAPs diet for treating IBS have shown promising results with patients not only reporting an improvement in their symptoms but many also report improved energy levels. In the initial stages of the diet, patients are advised to cut out all oligosaccharides such as fructans (found in wheat, onion, garlic and pulses), lactose (found in milk and dairy products) monosaccharides (found in fruit) and polyols (such as sorbitol and sugar alcohols found in sugar free foods).
Tolerance to these foods does vary between patients so if the symptoms improve on the FODMAPs diet individual foods and food groups are gradually introduced back into the diet, one at a time, to check tolerance. The diet is complicated and restrictive so people should only undertake the diet with the guidance of a Registered Dietitian who can give support, advise on suitable products and monitor the nutritional adequacy of the diet.
Although the diet is complicated and restrictive, people that have tried the diet and found it helps say it is well worth the time and effort. If you are interesting in learning more about using the FODMAPs diet I would strongly recommend that you attend one of the training courses on the diet that Kings run – for more information go to kcl.ac.uk/fodmaps.
If you want to know more about the FODMAPs diet, click on the following link http://www.ncbi.nlm.nih.gov/pubmed/21615553.
-
More on lactose intolerance.
21st Oct 2011
In my last blog about lactose intolerance, I said that the first thing you should ask any of your clients who believe they may have a food allergy or intolerance (of any sort) to is to keep a food diary recording everything they eat and drink and the presence or absence symptoms such as bloating, diaorhea or wind for least 2 weeks.
In my last blog about lactose intolerance, I said that the first thing you should ask any of your clients who believe they may have a food allergy or intolerance (of any sort) to is to keep a food diary recording everything they eat and drink and the presence or absence symptoms such as bloating, diaorhea or wind for least 2 weeks.
In some cases once you review the food diary it becomes obvious what the trigger foods are. Unfortunately it’s not always that straightforward. Lactose intolerance can be hard to diagnose based on symptoms alone, because several other conditions including Irritable Bowel Syndrome, can cause similar symptoms. For this reason, it is always a good idea to confirm a diagnosis with a lactose tolerance test. There are two simple tests that can be used to measure the digestion of lactose:
Hydrogen breath test
As the name suggests, this measures the amount of hydrogen in the breath. Normally very little hydrogen is detectable, but if someone has lactose intolerance, undigested lactose in the colon is fermented by bacteria which produce hydrogen and other gasses. The hydrogen is absorbed from the intestine and carried in the blood to the lungs where it is exhaled.To carry out the test, patients are asked to fast overnight. Before the test begins a basal sample of breath is taken, then the patient is given a drink which contains 50g of lactose dissolved in 200 ml of water. Breath samples are recorded at 15 or 30 minute intervals for two hours. A positive test is indicated by a rise of 20 ppm of hydrogen above baseline. Smoking, certain foods, and certain drugs including antibiotics may affect the accuracy.
Stool acidity test
The stool acidity test is used for infants and young children to measure the amount of acid in the stool. Undigested lactose creates lactic acid and other fatty acids that can be detected in a stool sample. Glucose may also be present in the stool as a result of undigested lactose.Lactose intolerance is treated by avoiding or restricting lactose in the diet but it’s worth remembering that the amount of lactose people can tolerate varies and depends on their degree of lactase deficiency.
Milk and milk products are often added to processed foods, which means it turns up in foods which you wouldn’t necessary expect to contain milk. Anyone who is very sensitive to lactose will need to check the label of all manufactured products.
If any of the following words are listed on a food label, the product contains lactose:
milk
lactose
whey
curds
milk by-products
dry milk solids
non-fat dry milk powderIt's worth reminding your clients that lactose is also used in some prescription medicines and over-the-counter medicines like products to treat stomach acid and gas so they should check with the pharmacist.
While I was researching this topic I learnt 3 new and interesting facts, which may be helpful for people who can tolerate some lactose in their diet:
1. Consuming lactose containing foods as part of a meal or with foods that slow gastric emptying (high-fibre foods, high-fat foods or foods with a low glycaemic index) improves tolerance of lactose.
2. Cold milk may be better tolerated than warm
3. Chocolate milk may be better tolerated than regular milk -
Lactose intolerance.
30th Aug 2011
I guess there can’t be many people who haven’t felt uncomfortably bloated and embarrassingly windy at some point in their life but for some it’s a much more common and troublesome problem. One possible cause of bloating is lactose intolerance.
Lactase, the enzyme needed to break down the sugar that naturally occurs in cows’ milk, is a use-it-or-lose-it enzyme, which explains why an estimated two thirds of the world population are unable to digest large quantities of milk and dairy products. In Asian and African diets, milk isn’t traditionally a part of an adults diet and once a child is weaned lactase production is dramatically reduced.
The amount of lactase a person produces is also determined by genetics so it can be inherited or can be associated with other conditions such as Irritable bowel syndrome, Crohns Disease or coeliac disease. In the UK and other parts of Europe, the incidence of lactose intolerance is estimated to be between 5-15% of the adult population. It can occur at any time in life and it can be a permanent or temporary condition. For some people a gastrointestinal infection such as gastroenteritis or gastric ‘flu can trigger what’s called a secondary lactose intolerance.
Lactose intolerance can also be caused by some types of chemotherapy or after a long course of antibiotics. Without lactase to break it down, lactose passes unchanged into the large intestine where the bacteria, which naturally live there, metabolise it and in the process produce large amounts of gas. Symptoms of lactose intolerance include bloating, stomach cramps, diarrhoea and flatulence and usually occur between 30mins -2 hours after eating or drinking milk products.
One thing that sometimes makes it difficult for people to pin point milk as the cause of their bloating or stomach pain is the fact that people with low lactase levels can tolerate between 50-100mls of milk at one time without experiencing any symptoms – so it’s not always obviously what the problem is. The best way to identify any sort of food allergy or intolerance is to keep a food diary.
Contrary to popular belief low-fat and skimmed milk do not have less lactose but plant based milks like rice, oat or soya milk do not contain lactose so they are perfect solution for anyone suffering from lactose intolerance.
Lactose may occur in foods, like crisps, biscuits, breakfast cereals and some medicines, which you wouldn’t necessary expect to contain milk so people who are very sensitive to lactose will need to check the label of all manufactured products.
Different dairy foods contain different levels of lactose, hard cheeses such as cheddar and parmesan for instance are quite low in lactose; some people with lactose intolerance are able to eat yogurt or cheese without any repercussions.
For more information on the diagnosis and treatment of lactose intolerance go to www.nhs.uk/Conditions/lactose-intolerance
-
The importance of vitamin D during pregnancy.
18th Aug 2011
This week yet another study was published which confirms that when it comes to Vitamin D, we’ve under estimated its importance and have been somewhat complacent about how easy it is to get enough in our diet.
If you've read my previous blog article, you'll know that there's growing body evidence to show that vitamin D is important whatever your age and circumstance but for pregnant women, vitamin D is more important than ever.
It is essential for bone growth and development in the foetus and low levels at birth have been associated with lower birth weight and increase risk of rickets. Babies born with low levels of vitamin D have an increased risk of developing type 1 diabetes, asthma and low bone mass later in life. Low levels of Vitamin D may also increase risk of pre-eclampsia.
It's importance during pregnancy is confirmed by the fact that in addition to folic acid the Department of Health recommend that all pregnant women take a supplement of vitamin D (10 micrograms a day) throughout pregnancy and breast feeding. But a new study published last week by the Child & Family Research Institute in Vancouver suggests that even women taking supplements may not be getting enough vitamin D. Of the 336 pregnant women who took part in the study, 80% reported taking supplements containing vitamin D.
Despite taking a supplement, 65% of the women had a blood level of vitamin D below that recommended by the Canadian Paediatric Society for pregnant and breastfeeding women. Studies in the UK suggest that around one in 10 women are thought to be vitamin D deficient. During pregnancy the number rises to one in four during winter and spring. As well as pregnant and breast feeding women, other population groups recommended to take vitamin D supplements are children aged between 6 months and 5 years, anyone over the age of 65 and people who are housebound or cover up their skin for cultural reasons.
-
Why a little bit of sunshine isn't enough...
11th Aug 2011
When I was at college (I'll admit that was quite some time ago now), we were taught that most people could get all the vitamin D they need from having sunlight on their skin.
Many experts are now starting to question this theory, and last week I was shocked to read newspaper reports which revealed that doctors in Wales have diagnosed children suffering from rickets, a disease common in Victorian times when smog prevented children from getting enough sunlight.
In the last couple of years there has been a growing awareness of the importance of vitamin D for many aspects of our health. It is been known to be important for strong healthy bones for many years, without enough vitamin D bones do not harden and children develop the bowed legs characteristic of rickets. In adults it causes a condition called osteomalacia, where the bones and muscles bone soft and painful.
Recent studies suggest it is also important for heart health and that there may be a link between vitamin D status and colon cancer, multiple sclerosis, diabetes, rheumatoid arthritis and a healthy immune system. While it is true that vitamin D can be made by the action of sunlight on the skin, many children and teenagers are more likely to spend their day in front of a computer rather than playing outside. It's also worth noting that sunscreens with SPF15+ block 99% of the skins ability to make vitamin D.
When it comes to getting vitamin D from our diet the problem is that there are very few foods that naturally contain vitamin D, oil rich fish like salmon, mackerel, pilchards, sardines and herrings are a good source, liver and egg yolks provide useful amounts, by law margarine is fortified with vitamin D and some other foods like breakfast cereals, and yogurts have vitamin D added.
As the role of vitamin D in health becomes clearer, nutrition experts are looking for ways to boost levels. One option being considered is fortifying milk, something already done in some countries. Finland became the first country to add vitamin D to milk supplies in 2003. Fortification is carried out – but not mandatory – in Canada, Israel and Jordan. If you’re reading this blog the chances are that you don’t include milk in your diet anyway and even if you do it will probably be several years before experts agree whether or not milk should be fortified, but you may be interested to learn that Rice Dream + calcium and vitamins is already fortified with vitamin D as well as calcium and vitamin B 12 ( more about that in my future blog).
-
Tips for stronger bones.
2nd Aug 2011
Choose a bone friendly diet
A good calcium intake while bones are still growing will help to increase bone density; making bones stronger and helping to prevent fractures later in life.The more bone in the bank, the more you can afford to lose before problems occur. Calcium is found in a variety of foods including dairy products, beans and pulses, canned fish that are eaten along with their bones such as pilchards and sardines and some green vegetables and nuts. If you can't or don't eat dairy products make sure that you include a dairy free substitute which is fortified with calcium and vitamin D.
Get active
Active people have between 20-45% less risk of fracture. Exercise improves bone density. It also improves balance, which reduces the risk of falling. While exercise such as swimming and cycling may be good for overall fitness it is of no benefit to the bones. For strong bones you need to choose weight bearing exercise such as walking, jogging, tennis or aerobics.Don't smoke
Smoking damages the cells that make new bone.Cut back on salt
High salt intake can cause leeching of calcium from the bones.Stay within the safe guidelines for alcohol
Excessive intakes of alcohol can damage the cells that make new bone.Osteoporosis - The facts
- Osteoporosis literally means "porous bones". It occurs when calcium is lost from the bones, making them fragile, brittle and more susceptible to breaking.
- Every 3 minutes of the day someone somewhere in the UK has a fracture as a result of osteoporosis
- 30% of beds in orthopaedic wards are filled with patients with fractures resulting from osteoporosis
- Osteoporosis is not just a disease of the elderly, thousands of women in their 50's have and suffers painful and deforming fractures. Osteoporosis can occur in women in their 20's and 30's especially if they over exercise or are underweight with low body fat
Recommended intakes* for calcium
Women, 20-40 years -- 1000mg/day
Pregnant and nursing women -- 1200mg/day
Women, over 45 years -- 1500mg/day
Women, over 45 taking HRT -- 1000mg/day
Men, 20-60 years -- 1000mg/day
Men, over 60 years -- 1500mg/day* National Osteoporosis Society
Calcium content (mg)
100g Tofu -- 480mg
100g Sardines canned in tomato sauce -- 460mg
100g canned salmon (eaten with bones) -- 300mg
200ml skimmed milk -- 249mg
200ml semi-skimmed milk -- 248mg
200ml whole milk -- 237mg
200mls Rice dream (original plus calcium) -- 240mg
150g/small pot low fat yoghurt -- 225mg
30g Cheddar cheese -- 216mg
50g almonds -- 120mg
100g dried apricots -- 92mg
112g baked beans -- 59mg
85g steamed broccoli -- 34mg
1 orange -- 58mg
1 slice white bread -- 33mgFor more information on how to keep bones healthy www.nos.org.uk
-
Calcium - A recipe for stronger bones.
20th Jul 2011
Have you thought about the state of your bones recently? The answer probably depends on your age – if you’re 50 or older the answer is probably “yes” but if you’re a teenager or in your 20’s or 30’s the answer is most likely to be “no”.
The truth is that most of us take our bones for granted, unless of course we’re unlucky enough to break one! Osteoporosis ‘Brittle Bones’ is a staggeringly common problem in this country and affects 1 in 2 women and 1 in 5 men over the age of 50. Osteoporosis is a silent disease and for many people the first sign is when they fracture a bone.
The challenge for health educators is that the key window of opportunity for building strong bones is while bones are still growing. While most parents are aware of the importance of calcium for bone health, many people don’t realise that although bones stop growing in length around the age of 18 they continue to grow stronger and denser for a further 5 -10 years.
Unfortunately the health of their bones is probably the last thing on the mind of most young people. This is reflected by figures from the latest National Diet and Nutrition Survey which reveals that 6% of teenage boys and 11% of teenage girls have calcium intakes below the Lower Reference Nutrient Intake (LRNI) which is the amount considered to be the absolute minimum needed for health.
Other surveys have shown that women in their 20’s and 30’s are another group who are often falling short of the target for calcium. Pregnancy within this group is a concern as babies’ bones begin to calcify in the womb. If their mother’s diet doesn’t contain enough calcium to meet their needs, the body will take calcium from the mothers’ bones.
It is therefore key when talking to teenagers and young people about their health, to remind them now is the time to invest in their bone health for healthy, strong bones in the future.
-
Living with a food allergy or intolerance.
23rd May 2011
The phrase 'One man's meat is another man's poison' is so true when it comes to the subject of food allergy and intolerance.
Although some foods are more likely to cause problems than others; wheat, gluten, dairy, eggs, shellfish and peanuts being the most common, any food can cause an adverse reaction and different people with the same condition can react to different foods. Also, while some intolerances are lifelong others can come and go and are often related to what else is happening in your life (stress, poor diet or another illness can often prompt an intolerance). In some cases, and with some conditions like lactose intolerance, people can tolerate small amounts of milk and dairy in their diet while in other cases even a minute amount of a food can cause a problem. For people with Coeliac Disease for instance, even the tiny amount of gluten that you would get in a communion wafer would be enough to cause a problem.
Eliminating a major food group like wheat or diary from your diet is not easy – for one reason they are used as ingredients in so many other foods, so if you’ve just discovered you’ve got a food allergy or intolerance be prepared to do a lot of label checking when you next visit the supermarket. If you don’t do much cooking already now is the time to start – cooking can be a relaxing and pleasurable pastime and it’s the easiest way for you to control what food you are eating. If you haven’t done much cooking in the past don’t worry – I always say to people 'If you can read, you can cook' all you need is a good cookery book, one of the best books I’ve come across is Healthy Dairy Free Cooking by Tanya Carr and Mini C. Tanya Carr is a highly respected Registered Dietitian, so in addition to delicious recipes, this book provides a wealth of practical advice on how to cope with a dairy free diet. Of course, in addition to dairy free cookery books you will find lots of lovely recipes on this site and we’d love you to share some of your favourites with us.
Happy Cooking!
Healthy Dairy Free Cooking by Tanya Carr and Mini C, published Kyle Cathie
ISBN-13: 978-1856266222. -
New guidelines for assessment of food allergies in children and young people.
16th May 2011
One of the most common complaints that I hear from people who suspect they, or a family member have a food allergy or intolerance, is about the difficulty in getting advice from their GP and a referral to a specialist.
This probably explains why so many people turn elsewhere for advice – to the internet, health food shops and alternative practitioners. While each of these sources can be very helpful, particularly in terms of highlighting suitable products and practical advice such as meal plans, the quality of the advice can vary enormously. For this reason, I was delighted to learn that earlier this month, The National Institute for Clinical Excellence (NICE) published new guidelines for the diagnosis and assessment of food allergies in children and young people - http://guidance.nice.org.uk/CG116. These guidelines are an important step forward in improving consistency and quality of care provided by health care professionals. The document is available on-line and although it is intended for health professionals, I think anyone with an interest in food allergy or intolerance will find it an interesting read. If you’re in the mood for reading reports, the National Institutes of Health (NIH) Consensus Development has just published a report on the subject of lactose intolerance. You can read a summary of the report on www.consensus.nih.gov/2010/lactosestatement.htm.
One of the conclusions made in this document is that many people with lactose intolerance consume inadequate amounts of calcium and vitamin D which may predispose them to an increased risk of osteoporosis later in life. Our bones are something many of us tend to take for granted, however osteoporosis affects 1 in 2 women and 1 in 5 men over the age of 50 which is why in my next blog I’m going to talk more about what we can do to keep our bones healthy.
