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Eating fruits and vegetables can boost your gut health

Looking after your gut means looking after the health of the trillions of living microbes in your gut. A diverse gut microbiome has been linked to a lowered risk of many disease like heart disease, diabetes and depression.

Diversity in your diet can lead to a more diverse gut microbiome, which is a sign of good gut health. One way to add diversity into your diet is by eating a variety of plant-based foods. This means that eating more plants, like fruit and vegetables can help strengthen your gut microbiome and improve overall gut health.

This is the key message for National Nutrition week (#NNW2021) – Eat more Vegetables and Fruit every day. Not only are fruits and vegetables great for gut health, they can help against heart disease and help to reduce the risk for obesity, diabetes and certain cancers. They are rich in vitamins, minerals, fibre and dietary bioactive compounds important for good health.

Research has also shown that eating up to 30 or more different plants every week can be beneficial for our gut health. This includes fruits, vegetables, wholegrains, nuts, seeds or legumes each day. These foods can increase the beneficial bacteria in our gut like Bifidobacteria or prevent the growth of harmful bacteria. This helps look after the balance and health of our gut microbiome.  

Our South African Food based Dietary guidelines encourages eating plenty of vegetables and fruit every day and this can include 5 vegetables and fruit daily. We should aim for as many different varieties, types and colours to help boost the diversity of our gut microbiome.

Where to start? How much veg and fruit should I be eating?

It’s recommended we eat at least five portions of vegetables and fruit per day. 

1 portion = approximately 1 cup raw or ½ cup cooked, or 80g fresh and 30g dried. Don’t stress if you can’t get to five – every little bit helps!

5 ways to get your 5 a day

Eating more vegetables and fruit can help you manage your weight, help protect against disease and help you live longer! Try this:

  1. Aim for half a plate of vegetables with your main meals
  2. Include fruit at meals or as a snack between meals  
  3. Add cut fruit to cereal or low fat, unsweetened yoghurt
  4. Add chopped up vegetables, such as onions, tomatoes and spinach to eggs or to potatoes. 
  5. Replace starchy foods with vegetables, for example mashed gem squash or cauliflower instead of rice, potatoes and samp. Add cabbage and/or spinach or pumpkin to pap.

Start by making small changes to increase fruit and vegetables in your diet to benefit your gut and overall health.

Share this post and join us in celebrating #NNW2021. Visit www.nutritionweek.co.za to learn more.

#NationalNutritionWeek2021 #Nutrition #HealthyEating  #FruitandVeg #FruitandVegEveryday #NutritionTips #FiveADay

Is there a link between Covid-19 and gut health?

Research in recent years has certainly pointed heavily towards there being a link between immunity and gut health. It follows that a poor gut microbiome may increase susceptibility to a virus attack. Once a virus is resident does the quality of the gut microbiome protect you from the severity of the attack?

Covid -19 has been seen to affect the gastrointestinal tract in the form of diarrhoea, nausea and vomiting. Researchers have shown there seems to be a clear connection between altered gut microbiome and severe COVID-19. They have also indicated a dysbiotic gut microbiome composition in patients with Covid -19 persists long after the virus is gone.

Role of gut microbiota in immunity

Studies have suggest that SARS-CoV-2 infected patients first develop a fever, then respiratory symptoms, followed by GI tract symptoms. The virus spike protein interacts with cells in the epithelial lining of the organs especially the lungs, but also the GI tract via a molecular pathway of angiotensin-converting enzyme (ACE2) leading to a series of chemical reactions resulting in intestinal inflammation. This has been seen in the post mortem pathology of Covid -19 patients.

A growing body of studies have looked at the gut microbiome of the healthy vs the COVID-19 patient. It seems that those with underlying conditions including hypertension, diabetes and obesity as well as the elderly have a microbial dysbiosis and an inflamed gut lining resulting in a disrupted gut barrier integrity. This allows the virus to gain access to the enterocytes leading to the extensive organ damage seen in severe COVID-19.

Conversely a healthy GI tract with a high butyrate content and a subsequent increase in T cells results in the virus being contained in the GI tract and excreted in the faeces.

In a recent study it was shown that this gut dysbiosis extended up to 30 days post Covid and could be a contributor to the pathogenesis of ‘long-Covid’ and its on going health complications.

Which specific gut bacteria are we talking about?

In Covid -19 patients across the research there was a reduction in certain bacteria known to be beneficial. These are the Ruminococcaceae or Lachnospiraceae, a single species F. prausnitzii, and the class Clostridia .These are some of the major butyric acid-producing bacteria in the gut.

Butyric acid is a short-chain fatty acid (SCFA), which, along with propionic and acetic acids, is a fermentation product of the microbe and dietary fibre that plays a pivotal role in gut health. It aims to maintain gut barrier integrity by serving as an important energy source for colonocytes, allowing these cells to activate an anti-inflammatory and anti – allergic  response.

Depletion of certain butyric acid producers in the gut microbiota has been identified in a few chronic diseases, including allergies, inflammatory diseases, colorectal cancer, and Crohn’s disease.

Possible Interventions

Possible interventions to improve gut health and protect the gut in Covid -19 have been considered:

  • Faecal Microbiota transplant – an option that has been suggested for severe COVID -19  but not investigated.
  • Next generation probiotics with a focus on butyrate producers are also considered novel microbial therapeutics and still under scrutiny.
  • Increased dietary fibre intake – the simplest way to improve gut health , fibre being directly utilized by the butyrate producers amongst other beneficial bacteria.

Eating to boost your gut immunity

We know it is possible to increase the diversity of your microbiome by eating lots of plant-based foods.

The Mediterranean diet has been linked to improved gut diversity and reduced inflammation which may indeed protect from pathogens like the Covid-19 virus

The Mediterranean diet contains a diverse mix of fruit and vegetables , wholegrains, legumes, pulses, nuts and seeds. These contribute important vitamins and minerals for supporting immunity but also act as a fuel source for the gut microbiome.

Probiotic rich foods may also support the microbiome like yoghurt, cheeses and fermented foods.

This is just the start

We are starting to understand more about our complex microbiological world. The impact of the status of our gut health goes far beyond the Covid-19 pandemic . In the future we will  continue to deal with an ever increasing incidence of chronic diseases. The links between these and a damaged microbiome are becoming more and more prevalent. It seems that an improved diverse fibre rich diet is going to become more and more important in disease prevention.

Reference here

Nutrition in IBS should be individualised

The low FODMAP diet (fermentable oligo-, di-, and monosaccharides and polyols) has been shown to improve symptom management and quality of life in a number of patients with IBS.

But is this type of elimination diet suitable for everyone?

There is a small percentage of patients where eating disorder may be present and this can be associated with functional gut symptoms. There is also emerging research on the comorbidity of functional gut disorders and eating disorders.

Kate Scarlata, along with other authors have written from the dietitian’s perspective about how the Low FODMAP Diet (LFD) may not be suitable for some patients who are at risk for maladaptive eating, eating disorders or with mental health conditions.

The article encourages screening of individuals for eating disorder risk before prescribing an elimination diet, making nutritional approaches for IBS individualised.

Avoidant or restrictive food intake disorder (AFRID)

Avoidant or restrictive food intake disorder is a “diagnosis of eating or feeding disturbance due to lack of interest in eating, avoidance of sensory characteristics of food, or fear of adverse eating consequences (ie. digestive distress)” and was introduced in the DSM-5. (The DSM-5 is a revised Diagnostic and Statistical Manual of Mental Disorders handbook used by health care professionals as a guide to mental disorders assessment and diagnosis).

Feeding disorders like ARFID differs to other eating disorders and the research indicates that patients with IBS are meeting the criteria for ARFID. Prescribing of the LFD in this population needs to be carefully considered along with appropriate screening. Validated screening tools for ARFID in the IBS population need to be developed and with more research in this area is required. Registered dietitians and mental health providers with expertise in this area need to co-ordinate care to reduce risk to nutrient intake and mental health. More about this in our last article here.

Whether a LFD diet is prescribed or not, the overall recommendation is to reduce diet-related anxiety, stabilise or improve nutritional status, and enhance food-related quality of life, all while offering symptom benefit.

The FODMAP-gentle approach

If maladaptive eating is present and a full LFD is not indicated, a FODMAP-gentle approach may be considered. This allows for more flexibility with a reduction a few foods that are highly concentrated in FODMAPs from a patient’s diet.

Reference is made to the review paper by Emma Halmos & Peter Gibson in 2019, where the possible contraindications for diet therapy in IBS populations are discussed.  They describe the basis of a FODMAP-gentle diet, including the main high FODMAP foods to restrict.

A “top-down” approach has been described as a strategy for IBS diet treatment and includes a structured protocol of three phases, namely FODMAP restriction, reintroduction and personalisation involving a long-term plan of dietary manipulation. On the other hand, the FODMAP-gentle approach is a “bottom-up” method where there is mild FODMAP restriction, with a reduction of a few foods very high in FODMAPs and/or a reduction of a few targeted FODMAPs.

Thereafter there will be further restrictions only if required. The authors explain that the traditional published FODMAP protocol should be utilised in the majority of IBS sufferers unless there is indication to use the FODMAP-gentle approach. They note that with the FODMAP-gentle method, there may not be clarity of response which may be due to insufficient FODMAP restriction rather than wrong therapy.

Recognising the patients at risk.

Scarlata et al goes on to describe how to assess good candidates for the LFD diet. Factors to consider include diagnosis; diet and lifestyle history; and behavioural history.

An example of a poor candidate for a LFD would include a patient with current maladaptive eating avoidance. In order to evaluate for maladaptive food avoidance in IBS there are certain key factors that can be considered. These include the following: 

  • Body weight
  • Energy and nutrient intake  
  • Eating behaviours
  • Psychological distress
  • Patient beliefs/attitudes.

These factors can also be used for monitoring a patient during an elimination diet.

Take home messages:

  • Assess emotional and physical health to best select for LFD candidates.
  • Involve an experienced gastro-intestinal dietitian to assist in evaluating whether a patient is a good candidate for the LFD.
  • Encourage first line dietary advice for IBS as a starting point.
  • Refer on to a dietitian or behavioural health specialist with eating disorder expertise for supportive nutrition and psychological care if eating disorders or maladaptive eating are present.

Here is the article.

INTEGRATED CARE IS BEST FOR IBS

The world leaders in IBS research have come together and published a review paper on behavioural and diet therapies in integrated care for the IBS patient.

The diet therapy part of the study reviews the low FODMAP diet as a treatment option in an integrated care model, supporting its use as an evidence based dietary therapy. This summary will not delve into the LFD specifically as this has been done before but rather on the psychotherapy side of integrated care and what options exist for the IBS patient.

“Integrated care is becoming the rule not the exception” in IBS treatment

IBS is a chronic condition of diverse pathogenesis.

It is well known that IBS patients experience reduced quality of life. This arises from a combination of symptoms generated in the gastrointestinal tract but also centrally in the form of fatigue, insomnia, depression and anxiety to mention just a few.

The traditional Western management model which is not collaborative fails to deliver results and patient dissatisfaction is high

There is however now compelling research to support a team based collaborative care model where patients have access to dietitian and /or a behavioural therapist along with the clinician.

Most convincing research was an unblinded randomized study (MANTRA study) of 188 patients where a gastroenterologist led integrated, multidisciplinary care model showed significally improved clinical outcomes (84% in integrated care vs 57% in standard care) quality of life, psychological health and cost effectiveness.

Lets look at some of the behavioural therapies that work:

Behavioural Therapies

Research and efficacy data is limited but growing in this field.

The Gastrointestinal behavioural therapies available can be divided into 2 primary pathways:

Ascending Gut – Brain Pathway
This treatment focusses on reinterpreting benign sensations from the gut that could trigger maladaptive cognitive or affective process in the brain.
Various techniques exist with varying levels of evidence (Table 1 of the study, refence at end).

Mechanism

IBS patients have been shown to have heightened sympathetic nervous system arousal, lower heart rate variability and higher levels of circulating stress hormones – these can all lead to mechanical and chemical stimulation of the colon and activation of the emotional motor system. Under real or perceived stress these patients perceive normal gut signals as painful. IBS patients also have a reduced thickness of the prefrontal cortex. This limits their ability to ignore gut sensations, they are more susceptible to visceral hypersensitivity, attentional bias and hypervigilance.

The following therapies in various ways are able to reverse or decrease the effect of these mechanisms:

  • Gut directed hypnotherapy
  • Gastrointestinal CBT
  • Mindfullness based stress reduction programmes
  • Psychodynamic interpersonal psychotherapy – best for early trauma , personality characteristics (neuroticism and alexithymia – (inability to recognize or describe one’s own emotions)).

Descending Brain-Gut Pathway
Here gastrointestinal symptoms occur in response to cognitive and affective triggers that arise from fear of symptoms, lack of acceptance of disease or external environment stressors.

Mechanism
IBS patients demonstrate a reduced activity in the limbic system which is the emotional response network of the brain. This can result in ineffective down regulation of the gut signals and amplification of abdominal pain. Abnormalities of the emotional response system is common in depression and anxiety which often occurs alongside IBS.
There could also be reduced grey matter density and an altered resting state. This has been associated with cognitive errors in “pain catastrophizing” and “negative prediction overestimation” in some chronic conditions similar to IBS.

Good research exists for:

  • Gastrointestinal  Cognitive Behavioural Therapy , which includes acceptance based therapies that aim to focus on living a meaningful balanced life  in spite of chronic pain.
  • Gut directed hypnotherapy where the focus is on normalising the pain threshold.


It is important to stress that the success of behavioural therapy in IBS rests on the clinicians relationship with their patient and their ability to select the right patients for the right treatment routes.

WHO WOULD RESPOND BETTER TO BEHAVIOURAL THERAPY


GOOD CANDIDATES are those who:BAD CANDIDATES ae those who:
Understand the diagnosis and the gut -brain dysregulation and are open to brain-gut psychotherapies as treatmentAre fixated on a single cause or solution.
Refuse to accept their IBS diagnosis
Identify the impact symptoms have on Quality Of Life and functioningCannot perceive impact of IBS on their lives
Want to take control and responsibilityPlace responsibility for a solution on others
Have symptom – specific anxietyAre under significant psychological distress – may be better with traditional psychotherapy
Have somatic symptoms – poor sleep, non-gut painAre not able to maintain a collaborative therapeutic relationship
Realise stress is linked to gut symptomsAre in need of case management- social work
Are willing to commit the time and effortNot able to commit or prioritize behavioural treatment

Please read the full paper here:

https://doi.org/10.1053/j.gastro.2020.06.099

New & updated IBS management guidelines.

Hot off the press in April 2021, Gut journal has published the latest guidelines for the management of IBS, commissioned by the British Society of Gastroenterology (BSG). The last publication of these guidelines was in 2007 and this update has been much anticipated.

A diverse working group was involved in reviewing the guidelines, with the strength and quality of the evidence graded. We can use these updated guidelines to guide our clinical practice and to make sure the standards of care is the same for all with IBS.

A disorder of gut-brain interaction


First off to note is the re-classification of IBS, now being considered as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. The emphasis on the bidirectional link between the gut and the brain in IBS is now very much part in helping to diagnose this complex condition.

Foundations of IBS Treatment

As part of first line, emphasis is placed on:

  • Good communication
  • Simple lifestyle
  • Dietary advice

First Line Dietary Advice

Traditional dietary advice is considered first line and is based on National Institute for Health and Care Excellence and British Dietetic Association (BDA). See the link to the BDA Food Fact sheet here: https://www.bda.uk.com/resource/irritable-bowel-syndrome-diet.html

  • Healthy eating patterns
  • Regular meals
  • Adequate nutrition
  • Limiting alcohol
  • Caffeine intake
  • Adjusting fibre intake: Fibre was shown to have benefit in IBS, more specifically limited to soluble fibre, such as isphagula. Start with a low dose and build up gradually. Insoluble fibre, like wheat bran, may exacerbate abdominal pain and bloating.
  • Reducing consumption of fatty and spicy foods

Second Line Treatment

The low FODMAP diet is recommended as a second-line diet for IBS. These include short-chain fermentable carbohydrates found in variety of fruits, vegetables, dairy products, artificial sweeteners and wheat. New trials comparing a low FODMAP diet helped with a reduction in symptoms when compared to control interventions.

Another exciting development is that a response to a low FODMAP diet may be predicted. Preliminary data from faecal bacterial profiling and metabolomics activity could be used as a tool to identify those who may benefit.

To learn more about how the low FODMAP diet works and the EATFIT low FODMAP program, click here: http://www.eatfitsa.com/fodmap-diet/

What about Probiotics?

We all want to know whether to advise our patients to supplement with probiotics and if so, which strain would be beneficial.
It is now known that the faecal microbiome of patients with IBS may differ significantly from that of healthy individuals. New trial data showed significant effects on global symptoms or abdominal pain for combinations of probiotics but it was difficult to give specific recommendations on species or strain.

Patients who would like to try probiotics can take them for up to 12 weeks and discontinue if there is no improvement in symptoms.

Psychotherapy

With a growing interest in non-diet therapies for our patients with IBS, there is compelling evidence for cognitive behavioural therapy (CBT) and gut-directed hypnotherapy. Both are recommended by the NICE guidelines when symptoms have not improved after 12 months of drug treatment.

Cognitive Behavioural therapy:

Successes from two recent and large trials, using CBT developed specifically for IBS, show benefit for both mental health and gastrointestinal symptoms. IBS-specific CBT may be an efficacious treatment for global symptoms in IBS.
For more guidance on what CBT is exactly: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/

Gut-directed hypnotherapy:

This therapy aims to induce a deep state of relaxation and it may also be an efficacious treatment for global symptoms in IBS. The exact mechanisms in IBS are still uncertain primary aim of treatment is to lower the severity and impact of abdominal pain and to help regulate bowel habit.
If you would like more information on this type of therapy, check out this link: https://www.hypnotherapists.org.uk/hypnotherapy/hypnotherapy-for-ibs/

Other noteworthy recommendations

As part of first line drug therapy, peppermint oil could be of benefit in IBS. Peppermint oil could be effective for abdominal pain and global symptoms but gastro-oesphageal reflux is a possible side effect.

There was also no conclusive evidence for human gut microbiome profiling, the use of elimination diets based on IgG allergy testing and gluten free diets in IBS.

Finally, to be aware of those at high risk of overly restrictive eating behaviours and using simple screening tools if indicated before undertaking the low FODMAP diet.

Conclusion

All in all, a comprehensive review to guide our clinical practice to manage our IBS patients. Or course, the full article can be viewed here: https://gut.bmj.com/content/gutjnl/early/2021/05/24/gutjnl-2021-324598.full.pdf

IBS (Irritable Bowel Syndrome)

IBS

Irritable bowel syndrome (IBS) is a chronic condition of the digestive system.  Symptoms present are:  abdominal pain, stomach cramps, bloating, excessive wind, change in stool consistency or frequency (diarrhoea and/or constipation).ibs

For an IBS diagnosis IBS:
You should have recurrent abdominal pain on average at least 1 day a week in the last 3 months; along with two or more of the following:

  • Related to going to the toilet
  • Associated with a change in a frequency of stool
  • A change in form (consistency) of stool

Symptom type and severity may vary between individuals but the condition is often lifelong. Symptoms may also become more prevalent during times of stress or after eating certain foods.

IBS South Africa

There is very little data to tell us how many people suffer from Irritable Bowel Syndrome in South Africa. IBS is, however, a very common condition worldwide, affecting 1 in 5 people. It is thought to be a disease of urbanization and industrialization. Around twice as many women are affected as men. Irritable Bowel Syndrome affects all ages, even children and the elderly but is less common in those over 50 years of age.

Digestive problems and sensitive tummies

The exact cause of Irritable Bowel Syndrome  is unknown, but most experts think that one cause is digestive problems related to gut motility. Increased gut motility causes food to pass too quick through the digestive system and there is not enough tiirritable bowel syndromeme to absorb the water from your food and the end result is diarrhoea. If food moves too slowly, then too much water is absorbed and this can lead to constipation. These changes in motility may be due to disruptions in the signals travelling back and forward between the gut and the brain. Studies have also shown that people suffering from Irritable Bowel Syndrome also have oversensitive guts and feel pain more acutely than those without Irritable Bowel Syndrome.

Bile acid malabsorption (where bile produced by the liver builds up in the digestive system) may be responsible for some cases of IBS, where diarrhoea is the predominant symptom. Certain foods may also exacerbate IBS symptoms of bloating, wind, abdominal distension and diarrhoea.

IBS FODMAP

A new diet called the Low FODMAP diet has been shown to help Irritable Bowel Syndrome sufferers. Researchers have found that certain foods contain a group of fermentable carbohydrates.  These cause symptoms such as bloating, wind, abdominal pain, diarrhoea in Irritable Bowel Syndrome patients. The term FODMAP stands for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols. Examples of culprit foods includes onion, garlic, beans, pulses, honey and plums.

Bloating diet

The low FODMAP diet can be particularly helpful at beating the bloat! Bacteria in the large bowel readily ferment High FODMAP foods contributing to the production of gas.  However, there are other things that may be link with bloating – swallowing too much air when eating, chewing gum, drinking fizzy drinks or eating too fast. Constipation can also lead to bloating.

 Irritable Bowel Syndrome dietitian/dietician

Everyone is individual and so there’s no single dietary strategy for IBS. Before trialling the Low FODMAP diet it is important to get your diet and eating habits properly assessed by an Irritable Bowel Syndrome dietitian. They can advise on key initial changes needed to your diet before embarking on a lengthy elimination diet, such at the Low FODMAP Diet. The low FODMAP Diet is not suitable for everyone and there are nutritional and gut health risks by following the diet for long periods of time (especially if not done under the supervision of a FODMAP dietitian). Get in touch with us if you’re looking for assistance.

 

Irritable Bowel Syndrome

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal condition. It affects 1 in 5 of us on a daily basis. Abdominal pain, discomfort, wind, bloating, diarrhoea, constipation, rumbling noises, fatigue, backache, nausea, depression and anxiety are all symptoms.

irritable bowel syndrome

The medical definition of IBS is recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, associated with two or more of the following;hummus recipe

  • A change in frequency of stool
  • A change in appearance of stool
  • An improvement in symptoms after a bowel movement

Symptoms affect some people more severely than others and symptoms do vary between individuals. More women seem to be affected by IBS than men.

IBS can affect your quality of life as it is unpredictable. It can stop you going to work, socializing and eating the foods you enjoy. It is also often associated with low self-confidence or self esteem.

Triggers

Several factors may play a role – such as an increased sensitivity of the gut to pain, a change in bowel motility and problems digesting certain foods, but the exact cause of IBS is unknown. Other factors also linked with IBS symptoms are gastroenteritis or psychological factors like stress.

Diagnosis

Consult your doctor if you suspect you may have IBS. There are no tests for IBS, so a diagnosis may take time. To ensure nothing else might be causing your symptoms, like coeliac disease or bowel cancer, your doctor will need to follow a process of elimination. This might involve a gastroscopy, colonscopy and some blood tests. Your doctor can advise you on the next steps to take after he/she has diagnosed you with IBS.

Irritable Bowel Syndrome Treatment

IBS symptoms can be maibs south africanaged through medication, changes to your lifestyle and dietary therapy. The low FODMAP diet is a new diet designed to assist IBS sufferers. Fermentable carbohydrates are removed and reintroduced has been shown to help 3 out of 4 IBS sufferers. Please speak to your doctor about this diet. This diet should be done under careful supervision, so ask for a referral to a FODMAP trained dietitian. It is difficult to cut down on so many foods, and still eat a nutritionally balanced diet without specialist dietary advice. Help alleviate IBS symptoms by making other changes to your lifestyle such as exercise and managing stress.

Please contact EatFit Dietitians  for more information on IBS & FODMAP.

IBS – Some Facts

6 Facts about IBS

As we come to the end of IBS Awareness Month, we thought we would share some interesting facts about this common but little understood condition.

  1. Up to 1 in 5 people may have IBS
  2. There is no single test For IBS
  3. The exact cause of IBS is not known
  4. Treatments are available for IBS to help manage symptoms
  5. The Low FODMAP Diet may help
  6. IBS is a recognized disorder

Our key takeaway message is that you don’t need to suffer in silence with Irritable Bowel Syndrome. There are medical professionals that can help so get in touch with them.

 

 

April is IBS Awareness Month

Don’t Suffer Alone

April is Irritable Bowel Syndrome (IBS) Awareness Month. IBS is a fairly common digestive disorder that affects upto 20% of people. It causes symptoms such as abdominal pain, wind, bloating, diarrhoea, constipation and fatigue. Many people suffer in silence with IBS because they don’t realize that their symptoms are a medically recognized disorder nor that there is medical treatment that can help alleviate their symptoms. If you think you may have IBS, please see a doctor to get an accurate diagnosis.

Diagnosing and Treating IBS

There is no test for IBS so please see a doctor if you suspect you may have it. Your doctor may need to rule out other conditions such as coeliac disease or bowel cancer before you are given a diagnosis of IBS. You will then work together on a treatment plan that best fits your needs. There’s no single diet or medicine that works for all IBS sufferers. But symptoms can be managed through medication, changes to your lifestyle and diet. The exact cause of IBS is unknown but certain foods, food poisoning and stress are common triggers.

Dietary Management of IBS

A diet low in FODMAPs (“a Low FODMAP Diet”) has shown promising results in the research and is now internationally recognized as an effective dietary therapy for Irritable Bowel Syndrome. 50-80% of patients following the diet reporting an improvement in their symptoms.

FODMAPs are a group of fermentable carbohydrates found in a range of foods and researchers have discovered that these aggravate symptoms such as bloating, wind, abdominal pain, diarrhoea in individuals suffering from IBS. The term ‘FODMAP’ was coined by Australian researchers Susan Shepherd and Peter Gibson at Monash University in Australia and stands for;

  • Fermentable – they are fermented by the bacteria in your gut
  • Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of a few sugars joined together in a chain. Fructans are a type of oligosaccharide and is a type of fibre found in wheat, onions and garlic.
  • Di-saccharides – “di” means two so there are two sugars in this molecule. Lactose (the sugar found in milk) is a disaccharide.
  • Mono-saccharides – “mono” means single and so this is a single-sugar molecule. An example is fructose (a sugar commonly found in fruit and fruit juice)
  • And
  • Polyols – these are sugar alcohols commonly used as sweeteners in diet products but also found naturally in some fruits and vegetables e.g. Xylitol.

A Specialist IBS Diet

The low FODMAP Diet is not for the faint hearted and should only be done under the supervision of a dietitian with training in the Low FODMAP diet. It is difficult to cut down on so many foods, and still eat a nutritionally balanced diet without receiving support from a registered nutrition professional. A FODMAP dietitian can guide you through the full elimination and re-challenge process.

Take Away Message

If you think you may have IBS, be reassured that you are not alone and there are health professionals that can help you with the diagnosis and management of this condition.

 

How our microbes make us who we are

gut health

Gut Health

Interested in your gut health? Did you know that you are made up of more microbial cells than human cells? Scientists also believe your microbes play a central role in your overall health and there is growing evidence to show that diet can determine what your gut ‘microbiome’ or microbial population looks like and how healthy it is.

Want to learn more about Gut Health and how to eat for health? Take an Eatfit Course.

We have various programmes to suit your needs. Our programmes incorporate behavioral change techniques to help patients make changes easily. Here’s a breakdown of what we offer:

EatFit for IBS
This is a 4 session program. It’s a mix of group sessions and individual consultations to make it cot effective, does not compromise on FODMAP education and provides you with peer support.

We use an approach called “Eating For Intestinal Tolerance” that is based on the low FODMAP diet. This diet has been proven to be effective in reducing irritable bowel symptoms.

The programme explains the diet and offers advice how to exclude FODMAP foods. It also supports patients through the reintroduction stage. It includes meal plans, recipes, dietetic support for 16 weeks and up-to-date research based resources.

EatFit for Digestive Health
This programme is 1 session in a group that provides all the tools needed for a healthier, happier gut with an IBS Diet.

This programme will provide guidance on what to eat but also how to eat better. We will cover various topics, which include balancing your meals, types of fibre, plant power, prebiotics and probiotics.

Research has shown that gastrointestinal health is intricately linked with overall health. This means it is important to nurture your gut microbiome.

What Are Probiotics?

What Are Probiotics?

You may have heard the term ‘probiotics’ but most people are unclear of what this word means and why probiotics may be beneficial to your health.

what are probiotics

What Are Probiotics?
Probiotics are live bacteria and yeasts that are good for your health and gastrointestinal system. Probiotics are often referred to “good”, “helpful” or “friendly” bacteria because they have been linked with various health benefits. There are many types of bacteria and they appear to have different benefits, but two of the most common strains studied and used in commercial probiotics are;

Are probiotics and prebiotics the same thing?
It’s easy to get confused but probiotics are live bacteria and prebiotics are carbohydrates that our live gut bacteria like to feed on such as onions, garlic, and chicory.

probiotics south africa

Are there any health benefits taking probiotics?

Much more research is need in this area but it is thought that taking probiotics may help restore the natural balance of bacteria in your digestive system if it has been disrupted by an illness or treatment such as antibiotics. All of us have ‘good’ and ‘bad’ bacteria in our gut and a good balance can help our body function optimally in a number of ways;

    • Keep bad bacteria in check. By eating or drinking more ‘good’ bacteria, they help displace potentially harmful bacteria by competing for space and evicting them from our gut.
    • Improved immunity. oProbiotics are also believed to stimulate our own immune system and may lead to an improvement in immune function. However, more research is needed in this area.

There are some common conditions that probiotics may help treat are:

    • Antibiotic-related diarrhoea. Antibiotics wipe out ‘good’ and ‘bad’ bacteria resulting in diarrhoea. Taking probiotics while taking antibiotics may prevent diarrhoea.
    • Infectious diarrhoea.probiotics may help shorten an episode of diarrhoea related to a stomach bug.
    • Try to count the units of alcohol you are drinking. You will always be surprised and this can help you keep those units down.
    • Irritable bowel syndrome There is some evidence to show that taking probiotics may help with overall IBS symptoms and may reduce abdominal bloating and flatulence.
    • Lactose intolerancelactose intolerance is a common digestive problem where the body is unable to digest lactose (a type of sugar found mainly in milk and dairy products). Some studies have found that certain probiotics, such as Lactobacillus acidophilus, may help to reduce the symptoms of lactose intolerance, such as stomach cramps, flatulence and diarrhoea.

There is insufficient evidence to support health claims that taking probiotics will help boost the immune system, eczema, colic, inflammatory bowel disease or vaginal conditions.

prebiotics

Safety and other concerns
It does seem that for most people probiotics appear to be safe. If you wish to try them – assuming you have a healthy immune system – they shouldn’t cause any unpleasant side effects. However if you are acutely ill or have a compromised immune system you should be cautious about taking probiotics as more research is needed to guide us when probiotics should be avoided in relation to serious health conditions.

It’s also important to note that probiotics are not classed as medicines but rather as supplements. As such claims that they can cure, treat, or prevent disease are not allowed. In addition there is no regulation of the types of microbial strains used or even the amounts. Do your homework as only specific strains, in certain quantities, may help some conditions. Some manufacturers may not include the correct quantity of probiotics, which are measured in colony-forming units (CFUs), so the probiotic may not be as effective as the research indicated. Probiotics are also expensive so it is important to check that you are getting the correct product.

Which probiotics should you take?
Not all probiotics are created equal and different strains have been shown to have different functions. Different strains of the same species can vary and may not produce the same effects. A probiotic is defined by its genus (e.g. Lactobacillus), species (e.g. rhamnosus), and strain designation (often a combination of letters or numbers). In addition everyone has a different composition of bacteria in their gastrointestinal tract so it’s hard to make firm recommendations.

There are many commercial probiotics available and they may consist of a single type of bacteria, or a mixture. They are available in capsules, powders, yoghurts and fermented milks. Try to choose products that contain the same microbial strains and quantities as documented in the research and are in line with your health goals. A probiotic that helps against antibiotic associated diarrhoea may not help someone with Irritable Bowel Syndrome. Please speak to your doctor or dietitian if you would like some more guidance.

probiotics

How should you take probiotics?
Please read the manufacturer’s instructions for dose and timing as this does vary between probiotic brands. It is also recommended to not take your probiotic with a hot drink as this may kill the friendly bacteria. If you are on antibiotics, please take the probiotic 3 hours after the antibiotic.

How to boost your microbiota the natural way

    • Eat 30g cheese a day, a portion of unprocessed artisanal cheese the size of a matchbox contains a broad spectrum of microbiota.
    • Feed your bugs with natural fibre contained in fruit, vegetables, beans and pulses.
    • Polyphenols are chemicals found in tea, coffee, red wine citrus, garlic, onion and dark chocolate, which promote the growth of healthy bacteria.
    • Fermented food and drinks like yoghurt and kefir, kombucha and sauerkraut all contain healthy bacteria.
    • Avoid antibiotics unless necessary or advised by your doctor.

probiotic foods

Conclusion
The future around the use of probiotics in the management of health and illness is exciting and promising but the research still has a long way to go. It’s not an exact science as there are many microbial strains and their role may vary in relation to certain diseases. In addition, we all have different microbial fingerprints so there is no one solution that fits all

What Are Probiotics? Want to know more about improving your health? Get in touch with us.

The FODMAP Diet

Embarrassing digestive problems like bloating, wind, diarrhoea, abdominal pain and constipation are common symptoms if you have Irritable Bowel Syndrome (IBS). They affects as many as one in five of us on a daily basis. Learn about the FODMAP Diet or commonly mistaken as FOODMAP.

The Low FODMAP Diet

A diet called the Low FODMAP diet might be able to help you. Researchers have found that some foods contain a group of fermentable carbohydrates. These cause symptoms such as bloating, wind, abdominal pain, diarrhoea or nausea in IBS patients. The term FODMAP stands for;
diet fodmap

  • Fermentable
  • Oligo-saccharides
  • Di-saccharides
  • Mono-saccharides
  • And
  • Polyols

Examples of culprit foods include onion, garlic, beans, pulses, honey and plums.

A scientifically researched diet with good results

Research has shown that 3 out of 4 IBS sufferers benefit from following the Low FODMAP diet. The diet was developed by researchers at Monash University, Australia, and has since become available in the UK, Efodmap diet south africaurope, the United States and Asia. In the last 18 months FODMAP accredited dietitians have launched the concept in South Africa. The diet is not a fad diet and has been well researched over the last decade. It is fast becoming a key treatment strategy for anyone suffering from IBS.

 

FODMAP Diet: Not a diet for life

The diet involves a strict elimination of these fermentable carbohydrates for approximately 6 to 8 weeks. This is followed by a gradual reintroduction of key high FODMAP foods. Reintroduction is an essential part of the diet to work out what your key trigger foods are and how much of these you can consume without symptoms. Everyone is different and trigger foods do vary between individuals so it helps to do the reintroduction in a precise and thorough manner.

 

It’s best to seek guidance from a FODMAP dietitian

For the best results research has shown that the diet should be done under the supervision of a FODMAP trained dietitian. Unfortunately, much of the FODMAP information found on the internet is inaccurate. People who do not seek properly qualified FODMAP specialists or those who try to do it themselves often do not get the outcome they expect from the diet. The diet is also complex and nutritionally important foods are eliminated. A FODMAP specialist dietitian can tailor the diet to meet your individual nutritional needs, suggest suitable low FODMAP alternatives and provide the support needed to ensure the elimination and reintroduction phases are done correctly.

Please see a doctor if you have possible IBS

If you suspect you may have IBS, please visit a GP or gastroenterologist for a diagnosis. Many of the symptoms overlap with other gastrointestinal conditions such as coeliac disease so it is important that these conditions are excluded before you try the low FODMAP diet

For more information about the low FODMAP diet, please contact EatFit Dietitians.

The New IBS Diet – The low FODMAP Diet

Irritable Bowel Syndrome FODMAP

If you suffer from Irritable Bowel Syndrome (IBS) you may have stumbled across the term FODMAP or Low FODMAP Diet but don’t worry if you haven’t until now. This new IBS diet is relatively new to South Africa – but it’s backed by a decade of evidence from many international research centers. In this blog post we explain more about FODMAPs and the science behind this exciting elimination diet to help IBS sufferers.

FODMAP, FOODMAP…fodmapwhat are these things?

FODMAPs are a group of short chain carbohydrates and sugar alcohols found in foods and researchers have discovered that these worsen symptoms such as bloating, wind, abdominal pain, diarrhoea in individuals suffering from Irritable Bowel Syndrome.

What the term FODMAP stands for

  • Fermentable – they are fermented by the bacteria in your gut
  • Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of a few sugars joined together in a chain. Fructans are a type of oligosaccharide and is a type of fibre found in wheat, onions and garlic.
  • Di-saccharides – “di” means two so there are two sugars in this molecule. Lactose (the sugar found in milk) is a disaccharide.
  • Mono-saccharides – “mono” means single and so this is a single-sugar molecule. An example is fructose (a sugar commonly found in fruit and fruit juice)
  • And
  • Polyols – these are sugar alcohols commonly used as sweeteners in diet products.  Also found naturally in some fruits and vegetables e.g. Xylitol.

Australian researchers, Susan Shepherd and Peter Gibson at Monash University, coined the term.

The low FODMAP diet and IBS

An IBS FODMAP diet is fast becoming a key treatment strategy worldwide.  This diet has been scientifically proven as effective dietary therapy for Irritable Bowel Syndrome. 50-80% Of patients following the diet reporting an improvement in their symptoms. Excessive wind, abdominal pain, bloating, abdominal distension, nausea, diarrhea, constipation and fatigue ( all symptoms of IBS) were reduced.

How FODMAPs work to worsen IBS symptoms

After high FODMAP foods are eaten FODMAPs enter the small intestine where they are poorly absorbed and have an osmotic affect. There is a large movement of water across the intestinal wall into the lumen, increases the volume of fluid in your intestine, and this affects the speed at which your bowels move and expansion of your intestinal walls. When FODMAPs pass into the large bowel they are readily fermented by bacteria in the large bowel, contributing to the production of gas. These two processes trigger symptoms such as increased wind, abdominal bloating and distension, abdominal pain, constipation or diarrhoea, or a combination of both. The only way to reduce the effects of FODMAPs is reduce your consumption of them by following an elimination diet.

Seeing a Dietician

Elimination diets are difficult to follow. FODMAPs are found in a range of different foods which makes the low FODMAP diet complicated. The guidelines and research recommend that anyone wanting to do the Low FODMAP Diet does so with help from a specialized dietitian. A dietician can ensure that you have correctly eliminated all the fodmap dietFODMAPs from your diet but that your diet still remains balanced. Incorrectly following this diet has been shown to lead to certain nutritional deficiencies.  It can also negatively affect your digestive health by reducing some populations of good bacteria found in your large intestine. Please be careful following lists of high and low foods you find online as this are often incorrect.

Low FODMAP Diet in South Africa

Not many dietitians have been trained in the Low FODMAP Diet in South Africa. For the best results get in touch with EatFit so we can put you in touch with FODMAP dietitians or gut health dietitians. An Irritable Bowel Syndrome Dietitian can guide you through the full elimination and re-challenge process.

 

FODMAP South Africa: Cape Town, Johannesburg and Durban

EatFit can connect you with IBS dieticians in all of these areas of South Africa so please get in touch.

If you’re a dietitian, we also have programmes available to teach you how to assist your IBS suffering clients. Be sure to have a look!

Fact Vs Fiction: The Low FODMAP Diet

FODMAP FACT vs FICTION

Happy 2018! Ready to get on top of your health and digestive problems this year? Then the Low FODMAP diet may be for you. Everybody is talking about this revolutionary new diet for people suffering from Irritable Bowel Syndrome. Research has found that 3 out of 4 of patients see an improvement in their IBS symptoms if they are careful around eating certain high FODMAP foods. FODMAPs are fermentable carbohydrates that lead to your gut filling with fluid and gas which causes digestive symptoms.

THE WORD FODMAP STANDS FOR;

F ermentable
O ligo-saccharides
D isaccharides
M ono-saccharides
A nd
P olyols
The Low FODMAP Diet was specifically to manage IBS symptoms but has also been shown to be effective in other conditions. The diet can be very effective if followed correctly and used by the right person. Unfortunately, there are a lot of misconceptions about the diet flying round on the internet. We have developed an infographic to help dispel some common mistruths of the diet. Hope it helps you start your FODMAP journey safely and correctly.

fodmap-south-africa

 

 

Looking for a FODMAP Dietitian?

Over the last 5 years EatFit has been training dietitians across South Africa so they are up-to-date with the latest Low FODMAP Diet research. We are excited to announce that there are now many EatFit trained FODMAP Dietitians working in most parts of South Africa.
We support them and they support each other through the EatFit network so we are never working alone and always have another expert to confer with.

What is an EatFit Approved Dietitian?

All EatFit approved dietitians have followed an intense 15 hours training based on a similar course run by King’s College in London (the UK centre for excellence for the low FODMAP diet). That means all of the EatFit Approved Dietitians are evidence based and on top of the latest research in the area of FODMAPs. All the dietitians have a specialist interest in Irritable Bowel Syndrome, digestive concerns and gut health but they also cover a range of other health areas.

Why do you want to see a FODMAP Dietitian?

International guidelines advise that anyone considering following the Low FODMAP Diet does so under the supervision of a ‘FODMAP trained dietitian’. The low FODMAP diet is more complicated compared to some other elimination diets as FODMAPs are found across a lot of different foods. There is a risk that you might compromise your nutritional status and gut health if you follow the diet incorrectly.

Contact an EatFit Approved Dietitian in your area

Please complete our contact form and let us know what area you are in and we will put you in touch with your nearest EatFit Approved Dietitian.

Why You Can Trust a Dietitian

Looking for a Dietitian South Africa?

The nutrition sector may feel confusing with terms such as dietitian, nutritionist and nutritional therapist used interchangeably so we thought we would give you three reasons why it’s worth booking to see a dietitian.

 

1.‘Dietitian’ is a protected title

Not just anyone can call themselves a dietitian. Dietitians in South Africa are statutorily regulated,dietitian south africa with a protected title and governed by an ethical code, to ensure that they always work to the highest standard. The title ‘dietitian’ can only be used by those appropriately trained professionals who have registered with the Health Care Professions Council (HPCSA). Unfortunately, the title ‘nutritionist’ is not protected in most countries and anyone can say they are a nutritionist, even if they only completed a 2 week online course. In South Africa they can register with the HPCSA if they have done the appropriate training so please check if they are.

2. Dietitians have a university degree in nutrition

Always ask about your health practitioner’s qualifications so you know what you are getting. Dietitians have to complete a recognized nutrition qualification at degree or master’s level at specified universities. Most dietitians study the subject of nutrition for 3-4 years to ensure they use the most up-to-date and scientifically rigorous evidence to base their advice to patients. Dietitians also get training from hospital internships in managing a range of clinical conditions and are the only nutrition health care professionals working in hospitals.

3. Registered Dietitian South Africa are regulated by the HPCSA

Dietitians need to be registered to practice. They have to abide by the HPCSA Standards of Conduct, Performance and Ethics. This ensures they provide a high quality of service. They can be ‘struck off’ for not doing so. Nusouth africa dietitiantritional therapists are not eligible to register with the HPCSA and so are not regulated in South Africa. If you receive incorrect nutritional advice from a nutritional therapist there is no one you can report them to.

 

Takehome Messages

    • Everyone seems to be an expert in nutrition these days given the accessibility of information on the internet. However, if you would like advice backed by scientific evidence from a registered nutrition expert, please book to see a dietitian.
    • Always evaluate the qualifications of your health care professional
    • Please check if your health care professional is registered with the HPCSA

The Plant Based Diet

Fight Disease with Diet.

Eat a whole food and plant based diet

The regular consumption of an animal protein based diet may be associated with many negative health benefits including a shortened lifespan, weight gain, diabetes and heart disease.

Flexitarians are people who consciously choose to reduce their meat intake for health but still occasionally enjoy animal based foods. This growing trend is evident in the popularity of the Meatless Monday initiative, a food sustainability drive, and other similar such social media driven trends. More and more people are choosing to eat this way not only due to its well documented health benefits but also due to the ethical and environmental impact of eating less or no animal protein.

WHAT IS A WHOLE FOOD PLANT BASED DIET?

A whole food plant based diet is based on fruits, vegetables, tubers, whole grains, and legumes; it excludes or minimizes meat, chicken, fish, dairy products, and eggs, as well as highly refined foods like bleached flour, refined sugar, and oil. It is essentially a vegetarian diet with emphasis on unprocessed, whole foods but with some flexibility.

ETHICAL AND ENVIRONMENTAL IMPACT

Our population is becoming far more conscious of food stability, sustainability and the environmental impact of food production. Meat and dairy production require large amounts of fertilisers, pesticides, fuel, feed and water. By-products in the form of greenhouse gases, toxic manure and other pollutants contaminate our air and water. Much has been written and calculated about the climate saving actions of eating less animal based foods, for example, if a family of four has a meatless meal a week for a year, its environmental impact is similar to taking their car off the road for five full weeks. Many people also often choose to avoid animal protein for ethical reasons.

THE HEALTH BENEFITS OF PLANT POWER

An important motivator for plant based eating is its many health benefits. Vegetarian style eating patterns have long been associated with improved health, lower incidence of disease, reduction in chronic medications and reduced mortality. Many large clinical research projects have looked at the diets of thousands of people in Europe and America and the incidence of disease, with the following common conclusions:

  • Type 2 Diabetes has been linked to red meat consumption, further study has showed that when one serving was swopped for nuts everyday, the risk of developing type 2 diabetes was decreased by 21% and by substituting whole grains the risk was reduced by 23%
  • Heart Disease benefits are seen in several large studies due to decreased inflammation, oxidative stress, blood pressure and LDL – cholesterol levels. There was a 34% decrease in ischaemic heart disease in vegetarians over 5 studies including 76 000 subjects. The Harvard research tracked 110 000 volunteers for 14 years and found that those eating 8 plus servings of fruit and vegetables a day were 30% less likely to have a heart attack or stroke compared with those that had 1.5 servings.
  • Cancer – Vegetarians have a 12% lower overall rate of developing cancer. Specific cancers have been linked to an animal based diet such as oesophagus, stomach, pancreatic. The higher fibre plant foods may protect against cancers of the digestive tract.
  • Obesity – The EPIC European study (520,000 volunteers) found obesity was less common in pescatarians and vegans. The plant based diet tends to be richer in fibre and is therefore more filling which results in fewer calories consumed.
  • Living longer has been positively linked with those that closely adhere to a plant based diet.
  • Decreased inflammation and oxidative stress has repeatedly been seen in those that eat more fruit, vegetables, whole grains, olive oil, nuts and red wine in moderation. Increased levels of oxidative stress and inflammation are associated with the development of chronic disease.
  • Gut/ Immune system/ microbiome – a fibre rich plant based diet promotes healthy gut microbiota and has been linked to immune support and digestive health.
  • Alzheimers – Adherence to a plant based, Mediterranean diet has been linked to a 48% lower risk of the disease.
WHERE TO START

The newly released American Healthy Eating for Vegans infographic is a representation of the perfect plant based eating pattern. This is the ultimate goal but may be a little extreme and a more moderated approach more realistic for you. This is not an all or nothing diet it can be tailored to meet your individual needs.

Start slowly and gradually change your diet. Try this Step Wise Approach:

  1. RED MEAT – slowly reduce the amount of red meat you are eating, start with a Meatless Monday and then slowly expand this to more days in the week. Replace the animal protein with plant protein sources such as pulses, beans, soy and nuts. Start to experiment with different foods and new recipes.
  2. POULTRY AND FISH – now remove poultry and then fish, you are now a vegetarian!
  3. EGGS come next, reading labels becomes important as eggs are found in a lot of manufactured foods.
  4. DAIRY – Milk and cheese can be substituted with nut milks, soya milk and other plant milks. Dairy free cheeses are sometimes available through health food stores. At this stage you need to start to keep a careful eye on your micronutrient intake.
    Calcium – ensure that the substitutes you are choosing are fortified with calcium or perhaps you need a daily supplement.
    Vitamin B12 – all vegetarians should regularly be having a B12 supplement.
  5. WHOLE/ UNPROCESSED – finally your focus should be on eating more whole unprocessed foods and reducing refined carbohydrates. Aim to make everything from whole ingredients that you have sourced yourself. If you have to use manufactured foods then read labels carefully and aim for items with very short ingredient lists. Focus on the following foods.

Beans and Other Plant Proteins
Dried beans, lentils, chickpeas, kidney beans
Soya protein from soya beans (edamame), tofu, tempeh, soya milks and yoghurt.

Nuts and Seeds
Include almonds, almond milk, walnuts, flax seed, chia seeds.

Good Fats
Olive oil, canola oil, avocado, nuts

Green Leafy Vegetables
These provide calcium, iron and many vitamins
Spinach, Kale, broccoli, cabbages

Fruit and Other Vegetables
Aim for variety and lots of colour

Wholegrain Starchy Carbohydrates
Aim for the brown, whole, fibrous variety.
Brown rice, oats, millet, barley, potatoes, sweet potatoes, quinoa (also a protein)

10 TIPS TO HELP YOU ACHIEVE A WHOLE FOOD PLANT BASED DIET
1 Start the day right – have a veggie breakfast.
2 Plan your meal around the plants not the meat.
3 Join the Meatless Monday Bandwagon.
4 If you are eating meat, use it as a seasoning or flavouring and not as the main event.
5 Create a plant based pantry – beans, wholegrains, pulses.
6 Try 1 new vegetarian recipe a week.
7 Convert your favourite dishes from meat to plant.
8 Slow cooking works well.
9 Try plant based dairy alternatives.
10 Read labels and watch the fat. Stick to foods with short ingredient lists.
WHATS STOPPING YOU?

There are a few reasons why you may worry that this way of eating is not for you:

  • It requires more food preparation – yes and planning but what a small price to pay for longevity and better health. Start slowly and gradually it will become your way of life.
  • How do you get enough protein and micronutrients out of this diet?
    A badly planned plant based diet can cause micronutrient deficiencies. A broad spectrum vegan supplement will help you to cover this possibility. Be sure to include more of the following:
    Protein – we don’t need much, if a ¼ of your plate contains a plant protein source at every meal you will be getting enough. A well balanced plant protein diet can meet essential amino acid requirements.
    Iron – found in fortified cereals and wholegrain products, dried fruits, beans and lentils, leafy vegetables, nuts and sesame seeds. Take these with a vitamin rich food to aid the absorption of the iron.
    Calcium – try and use calcium fortified milk substitutes, include kale and pak-choy, sesame seeds, nuts and dried fruits. If you are at risk, then take a daily supplement.
    Vitamin D – found in fortified soya milks and yoghurts and in the sunshine.
    Vitamin B12 – is found in yeast extracts, soya products and some oat and rice milks. You may need to supplement this nutrient.
    Omega-3 fats – found in oily fish, replace this vital nutrient by including sea vegetable in your diet or an algae derived DHA supplement
  • You don’t know how to cook pulses, wholegrains, tofu etc. – a good vegetarian cookbook will provide you with wonderful ideas on how to prepare these ingredients in many delicious ways, so spoil yourself.
  • Foods are unfamiliar – yes and sometimes hard to come by, but once you have found your local supplier you will be on your way. Major supermarkets will always stock the store cupboard basics at very reasonable prices.
  • Your family will rebel – they might, but soon they will be tasting what you have prepared, start slowly and their tastes will change too.
MENU IDEAS TO GET YOU STARTED
  • Oats with flaxseeds, raw nuts, berries and cinnamon
  • Stir Fry – any vegetables include leafy greens/ any vegetarian proteins/spices- turmeric, tamarind, sesame oil, coconut oil etc
  • Scrambled crumbed tofu and vegetables
  • Quinoa vegetable chilli – combine any pulses and beans with vegetables, a grain and chilli flavours
  • Wholegrain pasta and vegetable/bean sauce and herbs
  • Vegetable rich salads with seeds , nuts and balsamic dressings
  • Smoothies – nut milks, berries, seeds, plant protein powders
DO IT NOW!

This diet requires some planning, label reading and discipline but the benefits far out-way the effort required when it comes to tackling chronic disease. Your effort or adherence to the diet is directly proportional to the results you will achieve. A dietitian can help tailor your plant-based diet to match your individual needs and help ensure no nutritional deficiencies. Be aware that your need for certain chronic medications could decrease or be eliminated all together when you change to this way of eating. We urge you to make a start for your health and for our world, however small to start to decrease your animal protein intake and move towards a healthier whole food, plant based diet.

Loose the Booze

IBS Alcohol – Loose the Booze

The festive season is here and drinking alcohol is common feature of most parties and get togethers. Drinking in moderation is fine but many people tend to drink well above the recommended safe limits. Here are some suggestions on how to lose the booze.

ibs alcohol

If you drink alcohol, drink sensibly
South African guidelines recommend that regular alcohol consumers should not exceed one drink per day (women) and two drinks per day (men). Whilst there is some evidence to show that one glass of red wine may help reduce cardiovascular disease, the benefits of drinking have been exaggerated in the media. There is far more research showing that alcohol consumption leads health problems such as weight gain, liver disease and cancers so it’s important to keep an eye on how much and how often you drink alcohol. Alcohol is a also a diuretic and stimulates urination. This leads to dehydration and contributes to your hangover.

ibs and drinking

Don’t let the drinks sneak up on you
Counting alcohol units is a good way to monitor your alcohol consumption. It is advised that women drink less than 14 units per week (two to three units per day) and at men drink at maximum of 21 units per week (four units per day). Unfortunately wine glasses are getting bigger so we inadvertently may be drinking more than we should. 2 large glasses of wine easily pushes us above the recommended daily unit intake. The alcohol content of wines has increased over time and South African wines tend to have higher alcohol content due to hotter climates. Alcohol content makes a big difference to the amount of units you may drink at any one time so read the labels on your wine or beer bottles to gauge the wine strength or ask your bartender for the alcohol content of the wine. It may be worth choosing lower alcohol versions or learning the alcohol content of your favourite brand to help you estimate how much you are drinking. A low alcohol beer should contain no more than 2.5% ABV.

For more information about units, have a look at the website Drink Aware

Top tips for sticking to the limits with IBS Alcohol

  • Never drink on an empty stomach. Eating before drinking will slow down your body’s absorption of the alcohol.
  • Alternate with glasses of water or soft drink with alcoholic drinks. Other options are a glass of mixer such as tonic. This will help you stretch out your unit quota and stayed hydrated at the same time.
  • Top up your drinks with ice. This will dilute the drink and reduce the amount of alcohol you can get into the glass. Even a glass of white wine can be diluted with a few cubes of ice.
  • Extend your drink by adding a low calorie mixer such as a shandy.
  • Try to count the units of alcohol you are drinking. You will always be surprised and this can help you keep those units down.
  • Savour your drink. Drink slowly, take small sips and pace yourself.
  • Avoid top ups as this makes it hard to monitor how much you are drinking and you may drink more than you think.
  • Give your body a break. Having at least two alcohol-free days every week will help your liver repair itself. You may even want to try an alcohol free month like October.

ibs drinking

What to drink – IBS Alcohol
Healthy drinks are an important part of a balanced diet and staying hydrated has many health benefits including regular bowel function, better energy levels and improved concentration. Aim to drink 2 litres of non alcoholic beverages a day. Water is the best and cheapest option followed by semi-skimmed or skimmed milk and diluted fruit juice. Keep carbonated drinks to a minimum (not more than 1 a day), as they are not good for your bone health, generally high in sugar, and additives.

Seasons Greetings from EatFit Dietitians. Have a happy and joyeous festive season.

 

Lactose Intolerance

Lactose Tolerance

Do you suffer from bloating, nausea, abdominal discomfort, cramps and diarrhoea? These are all symptoms of lactose intolerance, but could also be confused with Irritable Bowel Syndrome or other inflammatory conditions of the bowel.

Many people eliminate milk and milk products from their diet, before they have been properly investigated by a doctor, and this can be detrimental to their health. Always seek a proper medical diagnosis and professional dietary advice before you eliminate a whole food group from your diet to avoid nutritional deficiencies.

Cow’s milk allergy vs. Lactose Intolerance

Lactose intolerance is not the same thing as an allergy to cows’ milk. Cow’s milk allergy refers to an immune response to the protein in milk and milk products. This is an allergic reaction to milk and is more often seen in childhood. You may have a quick reaction to even a tiny amount of that food (although some allergic reactions may occur up to 72 hours after having cows’ milk). Symptoms may include swelling of the eyes, lips, tongue and roof of the mouth, itchiness in the mouth, ears or throat, a red rash or eczema.

Lactose intolerance refers to the inability to digest the sugar in the milk called lactose. It is critical to get the correct diagnosis and the management of the two conditions is very different. Most people with lactose intolerance can still consume small amounts of dairy containing lactose with no symptoms whereas someone with an allergy to cow’s milk needs to follow a very strict diet and cannot have any cow’s milk.

The science

Lactose intolerance is a digestive problem where the body is unable to digest the sugar commonly found in dairy products called lactose. Normally the enzyme lactase is responsible for breaking down lactose into smaller compounds so our bodies can absorb it. In the case of lactose intolerance, there is absence or deficiency of lactase, so the lactose is not absorbed by the small intestine and bacteria in the colon end up breaking down the lactose which produce gases that build up. This causes symptoms such as bloating, wind and abdominal pain.

Lactose intolerance is rare in children, affecting mostly adults. It mostly develops later in life although there a few people that may have it from birth. It is also more common in those from an Asian or African-Caribbean background. You may develop lactose intolerance if you have had a gastrointestinal illness but it is usually temporary.

Testing for lactose Intolerance

A GP will often advise to removing foods or drinks containing lactose from your diet for 4 – 6 weeks to see if there is an improvement. They will then reintroduce it to determine your tolerance.

A home lactose tolerance test involves drinking 300ml of milk in one sitting and recording your symptoms every 30 minutes for the next two hours. A more sophisticated version of this can be done in a laboratory where a blood sample is taken every 30 minutes to measure its glucose content, which indicated how well you absorbing it.

Dietary Treatment

The common treatment for lactose intolerance is to remove lactose from your diet. This commonly involves a restriction on dairy products and suitable milk alternatives may need to be consumed such as lactose free milk, nut milk, rice milk, coconut milk or oat milk. Most people with lactose intolerance are able to tolerate a small amount of lactose at one sitting. Certain cheeses are actually quite low in lactose and often tolerated. Avoiding lactose requires careful label reading as it is often added to foods and medicines.

The most obvious source or lactose will be milk. Replace this with lactose free milk or a non – dairy substitute such as nut milk, rice milk, coconut milk and oat milks.. Lactose is removed with the whey during the manufacture of cheese. This level of elimination should be sufficient, however in the rare case that it is not, you would need to avoid all hidden sources of lactose found in many manufactured foods.

Health Risks

It is important to get proper dietary advice from a registered dietitian to ensure your diet remains nutritionally adequate as dairy is a rich source of calcium. Calcium is essential in our diets for healthy bones and teeth. In order to meet our calcium requirements the average adult requires 2-3 portions of dairy rich foods per day, this will provide 600 – 1000mg of calcium. It can be a bit of a juggling act to get enough calcium whilst avoiding lactose. Please see the calcium and lactose list below for some guidance. More than 12g of lactose in a day would be considered high.

Vitamin D is essential for the absorption of calcium, get your levels checked even in our sunny country its easy to become deficient.

THE LACTOSE AND CALCIUM CONTENT OF VARIOUS FOODS
FOOD TYPE PORTION SIZE CALCIUM CONTENT (mg) LACTOSE CONTENT (g)
Cows milk, full fat 200ml 224 9,3
                  , skimmed 200ml 234 9,8
Lactose reduced cows milk 200ml 232 0,5
Goats milk 200ml 195 8,6
Sheeps milk 200ml 332 9,9
Soya milk 200ml 25 0
Butter 1 tsp / 6ml 1 trace
Low fat spread 1 tsp / 6ml 3 trace
Cheddar Cheese 1 slice / 30g 202 trace
Cottage cheese 2 Tblsp / 100ml 36 1
Goats milk cheese 1 slice / 30g 53 0,3
Cows milk yogurt, low fat 1 tub / 150g 300 7
Greek cows milk yogurt 1 tub / 150g 225 0,8
Ice cream, vanilla 2 scoop / 150ml 180 8,8
Eggs 100g 57 0
Tofu, soya bean 100g 510 0
Sardines 100g 550 0
Mussels 100g 200 0
Haddock 100g 100 0
Pilchards 100g 300 0
Baked beans 100g 53 0
Boiled cabbage 100g 33 0
Watercress 100g 170 0
Broccoli 100g 40 0
Sultanas 100g 64 0
White bread 100g 110 0
Wholemeal bread 100g 54 0
Mixed nuts 50g 100 0
Sesame seeds 25g 142 0
Sunflower seeds 25g 178 0
Enzyme supplements

It is possible to buy over the counter commercial enzyme supplements which can be taken with meals or added to milk to predigest the lactose. These are effective, however with the introduction of lactose free milks the need for them is diminishing.

A final word

It is important to know if you have an intolerance to lactose or if you are suffering from Irritable Bowel Syndrome. Before making assumptions and taking any steps to modify your diet on your own please seek professional help from your GP or gastroenterologist who will investigate you fully to get a proper diagnosis before referring you on for specialised dietary advice. Under the care of your health care practitioner, you will also get guidance on how intolerant you are and how much lactose you need avoid.

Erica Jankovich & Sasha Watkins
Registered Dietitians

Fad Diets

For many January is not just the start of the a new year but also the start of new diet. However, it is important to not get tempted by fad diets promising quick weight loss. Fad diets are restrictive eating plans which often cut out certain food groups or advise that you eat certain foods or food combinations.

fad diets

Why should we avoid fad diets?
Unfortunately many fad diets are based on poor scientific evidence and they may make you unwell. Cutting out whole food groups might make your diet nutritionally unbalanced and lead to poor long term health. For example, removing all carbohydrates from your diet will also remove fibre from your diet which is important for gastrointestinal health. Often fad diets are hard to stick to, so people end up putting the weight back on and begin a cycle of yo-yo dieting which is also bad for your health. You can lose weight without making dramatic changes to your diet and putting your health at risk.

How to spot a fad diet
Not all diets are equal so be wary of misleading weight loss claims and pseudoscience. Watch out for diets that;

  • Promise that you will lose more than 1 kg of weight a week. Crash diets may make you feel really unwell and unable to function.
  • Recommend that you eat a certain type of food as they have special fat-burning effects such as the grapefruit diet or because they fit best with your blood group. There is no evidence to support these types of diets.
  • Encourage the avoidance of a whole food group, such as carbohydrates, dairy products or a staple food such as wheat. Variety and balance are important tenets for good health and key to sticking to a weight loss diet.
  • Suggest you should substitute foods for large doses of vitamin and mineral supplements. Supplements are expensive and cannot replace the benefits of real food.
  • Recommend raw food on the basis that our body can digest it better. Cooking actually helps make some foods easier to digest and your body is well equipped with different enzymes and cellular processes to assist with the digestion and absorption of all foods.
  • Are endorsed by celebrities sharing personal success story. Just because someone is famous, it does not mean she/he understands nutritional science. One personal story does not make them an expert in weight loss and often celebrities use touched up photos and have a support team, such as a personal trainer, behind the scenes.
  • Suggest your weight is linked with a food allergy/intolerance or a yeast infection and that you must avoid certain foods. Speak to a doctor if you are worried that you have an allergy so you can get appropriate guidance.
  • Are fashionable and promoted by a book. Just because the book has been published does not mean it is supported by good research evidence. Authors often pick and choose the information that they want to include so you get a very subjective view.
  • Recommend you only drink fluids or juice to detox. Detox diets are based on the idea that toxins build up in the body and can be removed by eating, or not eating, certain things. However, there’s no evidence that toxins build up in our bodies and our liver deals well with the daily process of clearing the body of harmful by products.
  • Promote a ‘secret’ or ‘miracle’ ingredient that doctors do not know about yet. Everyone likes the idea of a magic bullet but if one was discovered, we would not be facing a global obesity crisis.
  • Suggest a diet will work for everyone. We are all different and there is no ‘one size fits all’ diet solution.
  • Are sensationalist. Claims that sound too good to be true, often are. Diets recommended by health care professionals may sound boring but that is because they are obligated by law to only give advice that is based on evidence and cannot make sensationalist claims.

diet

How to lose weight the healthy way
Weight gain is a slow process caused by us eating more calories than we burn through normal everyday activities and exercise. To lose weight we need to eat less and exercise more. Losing weight does not happen over night and can be challenging as our bodies are well equipped to defend against starvation. Fad diets may work in the beginning as they impose strict rules on how you eat or force you to rethink what you eat. However, they are hard to stick to for a long time and may adversely affect your health. The only way lose weight healthily for good is to make permanent changes to the way you eat and exercise. Below are some suggestions to guide you on how to change your diet for the better.

Aim for 5-10% weight loss as your initial goal
This amount of weight loss has been shown to improve your blood pressure, cholesterol and reduce your risk of developing diabetes. A healthy weight loss of 0.5 to 1kg a week translates into eating 500kcal less a day.

Re-evaluate what is on your plate.
Fill half of your plate with vegetables and reduce the carbohydrates to ¼ of your plate. Ensure any carbohydrates you are eating are wholegrains as these contain fibre and keep you fuller for longer. Also aim for 1 portion of lean protein and 1 portion of low fat dairy per meal to ensure you are getting all the nutrients your body need for good health. Remember you can still eat too much of a good thing. Eating healthy is one thing but we still need to keep an eye on those portion sizes.

diet dietitian

Have regular small meals through the day and don’t skip breakfast
Regular meals help you stave off hunger and resist those cravings when you tend to reach for unhealthy foods like biscuits and chips. Breakfast is a key meal of the day so please don’t miss it. When we sleep we fast for 8 to12 hours so our blood sugar is low first thing in the morning. This can leave you feeling tired, lethargic and more likely to choose unhealthy foods later in the day. Eating in the morning after a night’s sleep provides much needed glucose to your starved brain and should make you feel happier and more alert. Eating breakfast may also help you control your weight.

Think about how and where you eat
Eating behaviour can also determine how much you eat. Sit at a table, turn the TV off and try to eat slowly, dragging out your mealtime to 20 minutes. Savouring each mouthful, focusing on what you are eating can help you look out for the signs of satisfaction. Pause in the middle of the meal, think about how the food tastes and what is your current fullness level is. Aim to be satisfied and not full!

Get support
Eating healthier is much easier if you do it with help. This could be family, friends or even joining a weight loss group. If you would like some individualized weight loss advice, dietitians are well placed with their nutrition experience and training to help you.