Monday Myth Busting

(a weekly short post challenging myths and misconceptions regarding weight associated health conditions and their management). Originally posted to Facebook first.

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31.1.22

Going Against The Grain

The humble grain has been given a lot of bad press in the popular media lately, but like so much regarding healthy eating, the story is much more complex than just “good” food vs “bad” food.

1. Myth - Grain foods (rice, oats, wheat etc) are carbohydrates and all high carbohydrate diets are unhealthy.

• Highly processed, high simple sugar, high carbohydrate diets would be considered unhealthy (often the average Australian diet-eating pattern!).

2. Myth - There is no problem with cutting out all grains.

• Like any overly strict eating patterns there are some risks. Cutting out a whole food group, like grains risk micronutrient deficiency e.g. Two-thirds of our intake of vitamin B1 (Thiamin) comes from the food group that contains grains.

3. Myth – You need to follow a low carb diet to lose weight, so this means avoiding all grain foods.

• A low carbohydrate diet is one method to help some people lose excess weight as part of the management of health conditions associated with excess weight. There are ways to have a lower carbohydrate diet than is healthy. However, other people can achieve the same gaols with a high grain eating pattern too.

The confusing, conflicting advice regarding carbohydrates and grain food can seem overwhelming.

Who to believe?

Rather than follow generic advice in the popular media, why don’t you ask for individual assessment and management by one of the experienced expert health professionals at Lifestyle Metabolic.

7.2.22

Healthy Weight Range

I am heavier than the recommended “healthy weight range” for my height – that must mean I am unhealthy and will develop a health problem.?!??

Assessment of health is very complex.

When it comes to metabolic health -that is your risk of developing health conditions such as high blood pressure, diabetes, fatty liver, heart disease and stroke, your weight is only one marker of your risk, and a poor marker at that.

There are many ways to measure excessive body weight, but it is only excessive body fat that is a concern for metabolic health, and it's really only the excess body fat around the organs in your trunk that is a major health risk.

So what does this mean?

It means that any of the following measures: , body weight, body mass index (ie BMI), waist circumference, waist hip ratio and percent body fat, are all substitute markers or at least potential predictors of your risk of developing a health condition, but it is not the best predictor and should not be the sole focus when wondering about your health.

A full assessment of metabolic health risk includes some of these parameters, but also measurement of organ function, dietary quality, physical activity and mental health.

Full assessment may include additional blood tests, other investigations and other physical examinations.

Only an expert in metabolic health has the broad understanding of all the pros, cons and limitations of the many ways to measure weight/metabolic risk and its application to the assessment of the health of an individual.

At Lifestyle Metabolic we pride ourselves on keeping up-to-date with the latest research from a number of different disciplines, and integrated for the assessment and management for individual patients, with a focus on their goals, needs and quality of life.

14.2.22

Happy HEART Day

In a nod to Valentine’s day, today’s post is about heart health.

Healthy Heart Myths- 3 points to ponder

1. Myth : I don’t have high blood cholesterol, so I don’t need to worry about heart health.

Reality : High cholesterol is just one risk factor for heart disease. Other risk factors include smoking, high blood pressure and diabetes (plus more). These risk factors don’t just add up- they multiply.

2. Myth : Women don’t have to worried about heart disease, only men.

Reality : The number of females developing heart disease is increasing. The female hormone estrogen is protective against heart disease but after the menopause when estrogen levels dramatically drop (ie in the 5th decade of life) a woman’ s risk of a heart attack reaches that of men.

3. Myth : I don’t feel right but I don’t have chest pain- so this cant be a heart attack.

Reality : some heart attacks do not show classic central crushing chest pain – especially in women. Shoulder pain, nausea, dizziness, fatigue and short of breath can all be signs of a heart attack.

21.2.22

The Guts of Good Health

Gut health, dietary fibre, the microbiome and metabolic health.

1. Eating high fibre is all you need for good gut health.

a. Fibre is only one consideration in improving your gut’s microbiome ( the millions of gut bacteria that live inside our intestines ). Variety of food eaten as well as fermented foods are also important.

2. If you are following a lower carbohydrate eating plan, you can’t get enough fibre

a. Almost all sources of fibre also contain carbohydrates, in general, the fibre is not “counted’ as carbs – It may be harder for some people to eat enough fibre for good health on a lower carb eating plan but with careful consideration low carb can meet fibre requirements.

3. High fibre diets for everyone !

a. Some people may need to have partial gut rest after surgery, a bout of gastroenteritis or diverticulitis and thus a temporary decrease in food high in fibre is needed. Slow reintroduction of a higher fibre intake would be a good idea after such a change.

Did you know?

An abnormal microbiota is associated with the following conditions

• Diabetes

• Metabolic syndrome and obesity

• Allergies

• Inflammatory bowel disease

• Irritable bowel syndrome

• Auto-immune diseases

• Colon cancer

• Depression and anxiety

Although it is not clear if abnormal microbiota causes or is a consequence of these conditions.

An active area of research asks if microbiota can be improved leading to improved health.

The above “Did you know” information was taken from A resource prepared by the International Scientific Association for Probiotics and Prebiotics..(the creator and/or owner of the copyright of the materials).

https://isappscience.org/

28.2.22

Pregancy/ Parent / Baby -weight gain

Weight Changes and becoming a parent

- 3 points to ponder

Myth : If supermodel XX can have her pre-baby body back in time for the red carpet, than so should I.

Reality : For most women it will take quite some time to return to their preg-pregnancy weight. Think about how long it took to gain the weight, but also how much your life has changed since becoming a parent. Population studies suggest that most women lose most of their extra weight by 12 months post birth,….. all going well.

Myth : I am breastfeeding so all of my extra-weight should come off without any extra effort from me.

Reality : Breastfeeding is best for baby and mother but not all women are able to do this. Breastfeeding can help with losing unwanted pregnancy associated kilos, however evidence shows us that both nutrition and physical activity play an important role in the weight-loss process for anyone attempting to lose weight, and this includes following childbirth.

Myth : I am not going to bother trying to lose my 1st baby weight, I will just put it all back on again with my next pregnancies.

Reality : Weight loss in women who are overweight or obese prior to any pregnancy may reduce the epigenetic (sorry -very medical term !) increased risk of obesity and metabolic disease in their children and grandchildren.

If you are having difficulty with excess weight post becoming a parent, Lifestyle Metabolic maybe able to help you.

How can a Lifestyle Metabolic Dietitian help me?

Our specialist dietitians will work with you to

plan your dietary needs, compare how you are going with what is recommended for good health, and decrease your chance of not losing your ‘baby’ weight.

We will review your needs and interests, tailoring information to your lifestyle and preferences.

Dietitians are trained to take a key role in assisting women to maximise their nutrition during times of increase needs.

From breastfeeding to sleep-deprived, low energy days, dietitians are skilled in fitting your needs around your situation.

7.3.22

Weight Loss Medications

1. Weight control medications can only be used short term and have severe side-effects.

a. All medications have side effects . There are many different types of medications that are used to improve metabolic health and/or excess weight control.

In the last 20yrs, previous weight loss medications had such significant side effects, they were removed from the market.

We always need to be mindful of the risks of any intervention, both in regards to what we know now and what may come to light in the future.

Presently, there are many different types of medications that can be used to influence metabolic health, and if used in the lowest dose possible, with professional guidance, monitoring, and follow up, the risk of side effects are still present but are not necessarily severe.

b. How long a weight loss medication is taken, is determined by the reasons behind the recommendations for weight loss. Certain medications can be considered for long term use i.e., up to two years and for some conditions and individuals - lifelong.

2. Weight control medication causes dramatic weight loss.

a. In general, the research trials of weight control medication, show on average 10 percent weight loss, over a time period of 12 months. Newer medication(s) are showing better results.

3. The only type of weight control medication are appetite suppressants.

a. Reducing a person’s appetite usually leads to a reduction in total food and energy consumption and thus weight loss. However, we know that humans eat and drink for reasons other than hunger alone.

Non-hungry eating is part of the psychology in the complex influences of weight control. Some newer medications are looking at controlling some of the cravings and non-hungry eating needed as part of the intervention for successful long-term weight control.

At Lifestyle Metabolic (with the individual in mind), we do consider the option of weight control medication, as one of the many tools that can be added to the pillars of weight control theory :

• changes in eating pattern and food selection

• habits change in activity levels and exercise

• improvements in sleep, thought patterns, behaviour and stress management.

Only an expert in weight control and metabolic health has the broad understanding of all the pros, cons and limitations of the many ways to reduce weight and/ or metabolic risk and its application to the health of an individual.

At Lifestyle Metabolic we can use tools in addition to psychological, behavioural, eating and activity advice. If you have been struggling with lifestyle measures alone, a tool may be the missing ingredient.

14.3.22

Weight Loss Surgery

Bariatric (Weight loss) Surgery- part 1

1. Weight-loss surgery is a “cop out”, you should just be able to eat less and exercise more.

a. Research and many western countries are finally agreeing that obesity is a complex chronic disease. There are many body systems (genetic influences, hormones and neurotransmitters) that drive weight gain and prevent weight loss in susceptible individuals. For some, weight loss surgery is the only realistic intervention with significant, long-term success.

2. Weight loss surgery is a “quick fix”.

a. Weight loss surgery is not for the faint-hearted. I personally think it is hard. For example:

there is usually weeks of a very low calorie, meal replacement diet prior surgery,

post-surgery eating is significantly changed with low volume food and drink.

For some surgeries, it is recommended to have nutritional screening/ supplements for life

weight loss surgery has significant impacts psychologically- not always for the better

patients who have weight-loss surgery still need to make lifestyle changes.

3. Weight loss surgery is only for people who are “super or morbidly obese”(ie BMI >40 or >50)

a. Most developed countries have medical guidelines detailing which patients should be considered for weight-loss surgery.

As medical professionals gain greater understanding of both obesity as a disease and improved techniques in weight-loss surgery, the balance of pros and cons in weight loss surgery shifts. For some countries - weight loss surgery is recommended / should be considered for a BMI as low as 30 if they have type 2 diabetes and other factors.

At Lifestyle Metabolic we can discuss all the options available for the management of health conditions associated with excess body weight. In addition to psychological, behavioural, eating and activity advice, we can discuss the role of weight-loss/ metabolic medications and surgery .

If you have been struggling with lifestyle measures alone, an additional tool (such as medication or surgery) may be the missing ingredient.

21.3.22

Weight Loss Surgery

1. Weight loss surgery is just for people who want to look better – they should just learn to accept themselves.

Severe obesity is a chronic complex medical condition that negatively impacts health in many ways. Weight loss surgery for some people may be life-saving and recent research shows that weight loss surgery for the very high BMI -equates to an extra 10yrs of life expectancy.

2. Weight loss surgery is a guaranteed cure.

As obesity is a chronic complex disease, the major influences on a person’s weight condition (i.e., genetics, environment) do not change. As such, an individual is still at risk of weight gain. It is not uncommon for people who have had weight loss surgery to regain some weight, often after 12-18 months post-surgery. If someone is regaining weight after surgery, it is time for intervention and not necessarily a “failure” of the surgery……… or the person.

Different surgeries have different outcomes (i.e. % weight loss, improvements in diabetes etc) depending on the individual. If you have diabetes or reflux, a particular surgery may be recommended (due to particular risks or better metabolic outcome) and may impact/ reduce the expected weight loss compared to a person who doesn’t have some of these considerations.

3. You can only consider weight loss surgery if you have private health insurance.

Weight loss surgery is not routinely publicly funded in Queensland presently. This type of surgery is expensive. Some patients with Private Health Insurance may be financially covered for this type of surgery. For other people (without private health insurance) they may be able to access their superannuation for early release/ compassionate reasons, if medically recommended.

4. Weight loss surgery is really dangerous – you may not wake up.

There are many different types of weight loss surgery. Each type of operation has its own pros, cons, and risks. These days almost all weight loss surgery is performed laparoscopically (i.e., “key-hole” surgery) and some weight-loss interventions are via an endoscope (via a camera/tube through the mouth/gullet/stomach).

These techniques have reduced the immediate anaesthesia and perioperative risk, compared to a generation ago.

Weight loss surgery is major surgery but taken on average/comparatively has similar peri-operative risk complications to gall bladder surgery.

Only an expert in weight control and metabolic health has the broad understanding of all the pros, cons, and limitations of the many ways to reduce weight and/ or metabolic risk and its application to the health of an individual.

At Lifestyle Metabolic we can discuss all the options available for the management of health conditions associated with excess body weight.

In addition to psychological, behavioural, eating and activity advice, we can discuss the role of weight-loss/ metabolic medications and surgery.

If you have been struggling with lifestyle measures alone, an additional tool (such as medication or surgery) may be the missing ingredient.

Photo 72156080 / Surgery © Famveldman | Dreamstime.com

28.3.22

The Latest and Greatest Diet

Have you heard about the popular “diet XYZ”? It is based on new “science” and must be better than anything you have heard before, and we all should be following it.

I have been a practising clinical dietitian followed by a medical practitioner for almost 30yrs. As such, I have seen a lot of popular diets and dietary advice come and go.

I show my age when I ask does anyone else remember the “eat right for your body-type diet”, the “liver cleansing diet” and “the zone diet”?

I wrote a research-based critique on “the zone diet” in a dietitian’s textbook under my maiden name, so I remember that one in detail, it was very popular with athletes at the time. It has gone the way of the Tasmanian Tiger.

Some of these ever present but alternating popular diets promote weight loss, some promote health benefits. Almost all promote a quick fix. They are seductive and hence the popularity!

BUT…..

If an individual was to try and follow the top 10 google dietary rules currently, they would be running from pillar to post: for example

• Limits your calorie intake…….Don’t worry about counting calories just avoid carbohydrates

• Eggs are high in cholesterol and thus too many are bad for you………Eggs are a good source of protein and a high-protein diet is part of a Paleo/Hunter-gatherer diet

• Carbohydrates are a problem…..No just simple carbohydrates like sugars…grains are OK

Etcetera etcetera

My point is :

Popular diets come and go. Often, they are very strict with supposed new insights or understandings that don’t always hold up to rigorous scientific testing. The statements are not always false but often the claims are misleading for an individual. The claims can be lost in translation, confusing and very contradictory to prior advice.

If you were to ask me which diet/ eating pattern is the best, I couldn’t really say, as it depends on the individual and their specific health needs, priorities, and lifestyle. I do not believe one specific diet is better than another in general.

If a patient comes to me asking about a particular diet or health claim. I will look at the claim, the known evidence and break it down for an individual. I explain to them this part of it is true, or known, what may be controversial and when applied to their situation whether it may be helpful or relevant.

There is so much distorted health and dietary advice in the mainstream media. I believe it is becoming more of a problem, as people do not know where to turn. I believe that for quality medical condition health and dietary advice; individual assessment and targeted advice is essential.

Ultimately the best eating plan for an individual is one that meets their highest priority health needs, is nutritionally sound and can be followed for the rest of their life.

4.4.22

Body Image

Let’s talk body image

One person’s “fat pants” is another person’s “skinny jeans”.

Just take a moment to really think about that statement……Really think……

Body image is how you feel about yourself in relation to how your body looks/ appears to you… how you perceive it.

It is a distorted mirror. How you see yourself is not how others see you and it is not objective.

A negative body image can affect your health directly via reducing your social, emotional and mental health and indirectly your physical health.

As a society we value health but sometimes we fail to remember that health is not just physical health it is also mental health. Health is not just a lack of disease but also a joy of living.

Inappropriate pursuit of thinness in the misaligned belief that this equates to being healthier can worsen both mental and ultimately physical health.

How does this link to Lifestyle Metabolic….

A small amount of sustained weight loss (ie 5-10%) can bring significant health benefits to patients who have health conditions associated with excess body weight.

Such an achievement may bring health benefits but not necessarily the notional recommended ideal body weight and this can be challenging to their body image.

So..in summary:

The influences, issues and management options of health conditions associated with excess weight are complicated.

At Lifestyle Metabolic, the practitioners take a wholistic approach in their assessment, advice and management, which is client/patient-values focused. We explore potentially conflicting advice and ideals and discuss all options.

There are weight- neutral options.

You can get off the dieting / up and down body weight merry go round…You may not lose significant weight with such an approach, but you will gain health.

Lifestyle Metabolic’s dietitian Annika Buwalda has a special interest in weight-neutral nutrition and health advice. Annika is a HAES (Health At Every Size) trained practitioner.

Photo 138182519 / Body © calypsoArt | Dreamstime.com

11.4.22

Liver Health

Myth 1.

I don’t drink much alcohol so I’m sure my liver is okay.

Alcoholic Liver Disease is not the most common liver disease in 1st world countries. It is fatty liver disease (mafld- metabolic associated fatty liver disease) and 30% of Australians have it.

Most do not have any symptoms.

Fatty liver is associated with metabolic syndrome and raises cardiovascular risk.

Diagnosis is based on history and examination blood tests and ultrasound scans.

You may be at risk of mafld if you have diabetes or carry excess body weight around the middle.

Myth 2.

A liver detox regimen of fasting or juices or expensive supplements is the best way to look after, reset your liver and cleanse your body.

Fatty liver doesn’t respond to supplements. If your fatty liver is associated with excess body weight, a small weight loss of 5-10% can significantly help.

Myth 3.

Don’t tell me I have to lose weight for my fatty liver as well as everything else I’m trying to do!

Changes in what you eat, what activity you do, independent of your weight also can help reverse fatty liver.

It doesn’t have to be ridiculously hard with the right help.

Photo 116562537 © Anton Skavronskiy | Dreamstime.com

25.4.22

Diabetes Reversal

Part -1

Q. You can reverse diabetes?

A. Hmm,,,yes….well,….. maybe…but…it’s complicated

There are different types of diabetes. The most common is type 2 (T2D). This type of diabetes is associated with increased levels of the hormone insulin but the body is resistant to its action, causing blood glucose levels to be very high.

High blood glucose levels contribute to the symptoms and health complications of T2D.

Usually when you hear comments about people's diabetes being “cured”, it is only in relation to type 2 diabetes and I would like to point out some of the finer considerations to some of these claims.

Diabetes is a clinical diagnosis based on blood test results +/- classical symptoms (tired, blurred vision, increased urination, increased thirst etc). Blood glucose measures are the essential component of diagnosis and can be measured in more than one way.

When people talk about “curing diabetes”, I really think they are talking about remission.

Remission – is a concept where a disease (ie diabetes) is treated to the point where test results no longer meet the biochemical diagnostic criteria.….. a similar concept to some blood cancers where when undergoing intensive initial intervention, the ultimate goal is a cure but after the 1st round of treatment the doctors talk about the disease being in remission…. there is always a risk of relapse.

How is Diabetes Remission Possible?

The multiple causes that leads a person to a diagnosis of diabetes is varied and complex….. it can include :

• genetic vulnerability (family history of diabetes, personal history of gestational diabetes),

• increased weight around the middle,

• decreased physical activity (sedentary lifestyle) and

• certain eating patterns (think typical Australian diet!).

It is possible to change some of these causes/contributions, but for most people the vulnerability towards diabetes….. once discovered is likely to always be in the background.

Expert groups have defined diabetes remission as a HbA1c (a measure of long-term blood glucose levels) below 48mmol/mol or 6.5% for at least six months.

How do I put my diabetes into remission?

1. Remember some of the research talking about the success of intervention does include long term metformin.

2. Some interventions have remission as a definition without the need for any medication

3. Remission often involves significant changes to a person’s lifestyle either in regard to their eating patterns +/- activity / exercise.

4. Diabetes remission can be attempted with a focus on significant weight loss in patients with obesity or a focus on carbohydrate intake manipulation alone.

5. Diabetes remission is more likely to be achievable if attempted closer to first diagnosis than many years later

6. Diabetes remission interventions, can include bariatric surgery

PART 2 of this post- will explore the lifestyle options when trying to “reverse” a new diagnosis of diabetes....Stay tuned for next week's Monday Myth Busting

Photo 55158437 / Diabetes © Gustavo Frazao | Dreamstime.com

2.5.22

Diabetes Reversal

Part 2 - Type 2 Diabetes Remission

OK, so I want to try and put my type 2 diabetes into remission – What do I need to know?

Diabetes is a chronic, slowly worsening condition over many years. If we can slow diabetes progression, it will have huge health benefits now and in the future.

The potential for diabetes remission is greater if interventions occur within 5 to 10 years of first diagnosis. Type 2 diabetes is usually associated with excess body weight or at least excess fat tissue around the middle. Remission via weight loss is more likely in people who are very overweight.

There are two main methods used to try and reverse type 2 diabetes:

1. Weight loss

2. Carbohydrate intake modification – both total quantity of carbohydrate and type.

WEIGHT LOSS - Small amounts of weight loss ie 5% in people who are overweight or obese can significantly improve blood glucose control. It can also improve blood pressure and cholesterol levels. Small amounts of weight loss are more realistic and sustainable.

HOWEVER, it appears that at least 10% weight loss is needed for diabetes remission in people who have very high BMI (body mass index- a measure of excess body weight)

LOW CARBOHYDRATE eating - Diabetes can be considered an imbalance between the challenge of carbohydrate intake and the body’s reduced ability to process the resultant high blood glucose due to insulin resistance. A low carbohydrate diet means the body is no longer challenged where it is faulty.

For some people following a low carbohydrate eating plan is one intervention to help them lose weight but low carbohydrate eating is not the only way to help with weight control

NOTE: Diabetes remission is quite a controversial idea, and there is still active research in this area. At the moment, the consensus is that remission is possible, but patients remain at risk of relapse.

I believe weight loss is difficult but keeping the weight off is even harder.

For significant diabetes intervention aimed at remission the intervention needs to be sustainable.

This is where working with a qualified dietitian can be extremely helpful.

Dietitians understand the influences and basis of how you usually eat and help you tweak this into a healthier eating pattern. Dietitians consider your food preferences, your social and cultural influences and practicalities such as budget or the need to feed a family as well as time constraints.

A personally prescribed eating plan or advice is much more likely to be sustainable than following a radical generic diet that is very different from a person's usual or previous habitual eating.

TAKE-HOME MESSAGES

• Remission is more likely if you were diagnosed with a very high BMI

• Remission is more likely if you lose a substantial amount of weight ie > 15kgs

• Remission is more likely if you attempt to do so earlier in your diagnosis

Photo 40378523 / Diabetes © Convisum | Dreamstime.com

9.5.22

Low Carbohydrate Diets

The low-down on low carbohydrate eating.

Carbohydrates (CHO) are found in a variety of food : starchy vegetables (such as potatoes, sweet potato, beans, corn) as well as rice, oats and other grains and cereal, plus bread, biscuits, bakery foods, fruit and some dairy foods.

Low carbohydrate diets are very popular at the moment but can be controversial.

Firstly, I want to point out that health practitioners can quantify/ classify carbohydrate in total grams and/or percentage of total energy (calories) consumed from carbohydrates.

Secondly - there are different degrees of low carbohydrate eating, and they each have their own pros and cons.

Arbitrarily I'm going to divide the levels

Level 1 - Extreme low carb, otherwise known as a ketogenic diet.

This diet has less than 50 grams of Carbohydrate (CHO) consumed per day.

A ketogenic diet aims to put the body into ketosis - where it is breaking down muscle and fat to provide substitutes for glucose. These substitutes are known as ketone bodies, and they can impair hunger.

When ketosis is achieved, a person often feels less hungry, eats less and thus consumes less calories and aids in weight loss.

But beware: we humans eat for reasons other than hunger.

(https://www.lifestylemetabolic.com.au/.../controlling-non...)

The keto diet can have challenges when eating out or social events, ensuring your gut is getting enough fibre, certain micronutrients and variety of foods. More than a standard drink of wine can pull the body out of ketosis.

Certain health conditions and medications (eg diabetes) can have serious interactions and consequences if paired with a ketogenic diet.

Like all eating plans you can have a healthy or an unhealthy interpretation. For people that don't eat a lot of salads and non-starchy vegetables, I think this diet would be difficult and unhealthy in the long term.

Level 2 - Low Carbohydrate, Healthy Fat - LCHF – low carb (< 100g CHO).

This diet has significantly less carbohydrate than the typical Australian diet and focuses on healthy fats (think less animal fat and coconut oil and more olive oil, advocado). This low CHP version is easier to adhere to in the long term and has aspects that are similar to the Mediterranean style eating pattern.

Level 3 - Calorie Controlled – ie LED -low energy diet, low fat (1000-1200 kcal).

Just restricting energy consumption will reduce the total grams of carbohydrate eaten. In a typical Australian diet up to 60% of the energy intake is carbohydrate.

In the 2020 financial year, it was estimated that Australians consumed on average 236 grams of carbohydrate

If you restrict total food and energy consumption, this automatically reduces the typical carbohydrate grams eaten.

For example a low calorie diet of 1200kcal with 50% of the energy coming from CHO and 30% fat, equates to 150g CHO per day.

Research is conflicting in regard to certain aspects of health with a low carbohydrate diet (eg long term weight loss and cardiovascular health) and is a current area of further investigation.

Australian Dietary Guidelines currently reflect a 45-65% total energy intake from carbohydrate. However, over consumption of energy (calories) ie greater than what we expend will lead to weight gain no matter where they come from.

At Lifestyle Metabolic we believe the best “diet” is a long-term healthy eating pattern that can be habitual and lifelong. The best eating plan for an individual is unique and not a one size fits all.

Photo 15101117 / Carbohydrate © Evgenia82 | Dreamstime.com

16.5.22

Energy In vs Energy Out

You can't outrun or out-medicate a bad diet.

What I mean is, the energy you consume via food or drink, makes more of an impact on weight control then planned activity.

I see a lot of people almost punishing themselves at the gym or making themselves go for a run they dont enjoy because they feel they have overindulged the day before, but it doesn’t have to be that way.

Exercise and physical activity is extremely important for health and wellbeing, but in the context of weight loss, total energy intake (i.e. food and drink calories) are often the more important factor to modify.

You can get “more bang for your buck” making some changes to your habitual eating than pushing yourself with exercise that you don’t enjoy.

Let’s take an example:

One tim tam has 95 calories, this equates to an average female walking an extra 2850 steps.

A magnum has 260 calories and equates to 7770 steps.

For context – a sedentary worker would struggle to hit 5000 steps in a day without planned activity.

Now….the whole story is a little more complicated than that (it always is!), but my point is that people often overlook that fact that even if you are taking medication or increasing your activity for weight loss…..you can’t compensate for a eating pattern (i.e. “diet”) than is undermining your every move.

What is a bad diet?

I don't like using the word “bad” or “good” or even “diet”… but in this context where words are limited, I will use them as a shortcut !

For weight control, a “bad diet” is one where you are consuming more calories than you are burning.

A “good diet” for weight control/loss is one where you are eating less calories than you burn, is nutritionally adequate (ie getting all of the vitamins and minerals and protein that you need) and is something that fits into your life: where you can still be social, enjoy the foods you like and can maintain for the rest of your life.

This is why at Lifestyle Metabolic, your initial appointments are all about getting to know you and dietary history taking whether this is via questionnaire, a food diary or with one of our dietitians is an essential part of our holistic management options.

Photo 38523827 / Running © Flynt | Dreamstime.com

22.5.22

More Than Just Energy In vs Energy Out

Q. Weight control is just a matter of balancing energy intake with energy output – right? Move more and eat less? Why can’t everyone just do that.

A. This statement is only partially true.

The reason is because weight control and weight loss are so much more complicated than a simple equation.

There are many factors that influence the energy balance equation. Often these factors are so strong the balance towards weight gain is skewed.

What are these factors ?

Genetics is one of the most important. Your genes determine if you are “programmed” to gain weight easily, given the circumstances. The so called “thrifty-gene” hypothesis.

Yet the following also have a significance influence on why weight control is complex.

• Social changes

• Fast food and processed foods

• Less Activity through a multitude of energy saving devices

• Medical conditions

• Medications

• Sleep deprivation

• Stress

• Menopause

• Gut microbiota

• Environmental toxins eg Plastics Derived Endocrine Disruptors (BPA, etc)

We may not be able to change our genetics, but we can influence some of the other factors above.

A holistic comprehensive weight management strategy assesses all the factors and influences for an individual.

At Lifestyle Metabolic (with the individual in mind), we assess all the influences that is driving their energy balance equation.

Only an expert in weight control and metabolic health has the broad understanding of all the many factors influencing the weight and/ or metabolic risk of an individual.

6.6.22

Living Well With Type 2 Diabetes

Living Well with Type 2 diabetes

1. My doctor tells me that my diabetes control needs to be better…. But I don’t want to go on insulin.

The wonderful thing about science and medicine is that new ideas and improvements in the management of health conditions are cropping up all the time. Type 2 Diabetes management is going through a revolution at the moment.

There are new, better medications available now than there were 10 years ago. There is more choice for management. Trying to improve your diabetes control doesn’t always mean more pills, daily needles or insulin.

2. I also don’t want another pill to take… I have too many already!!

Trying to improve your diabetes doesn’t always mean adding another medication to the mix.

Combination medications (two medicines in one tablet) are more and more available now than ever before. A medication and/or lifestyle review with your doctor/diabetes team can help. For some patients it may reduce the number of tablets you are advised to swallow!

3. I’m over it! I tried hard when I was first diagnosed but with everything else going on it seems overwhelming.

Diabetes is a progressive disease…. It does get harder to manage as time ticks on. It is not your fault if you need additional management. Almost all people living with diabetes will, at some point in time.

Diabetes burnout is real. It takes its toll of “another thing” to think about. The recommendation of up to 3 monthly diabetes checks plus eye and foot reviews can seem a burden.

Yet small changes can yield huge improvements. In a UK study a 1% drop in HbA1c (the 3 monthly blood test measure used to monitor blood glucose) decreased some diabetes complications by 37%…. (think eye and kidney disease).

Please do NOT put off your regular diabetes health reviews due to concerns that you feel overwhelmed or like you are failing.

Lifestyle Metabolic understands the unique challenges of living with a chronic illness.

Only an expert in metabolic health has the broad understanding of all the pros, cons and options to improve the health of an individual living with type 2 diabetes.

13.6.22

Perimenopause

Are you between 40 and 55 years old ?

You could be “very peri” ie perimenopausal. ….and did you know that perimenopause is linked to your weight, heart, bone and mental health

What is the “perimenopause”?

Perimenopause is the transitional time around menopause ie when the usual monthly menstrual periods stop.

Hang on, I think I’m too young

Perimenopause can start and last 2 to 10 years before someone reaches their menopause (average age is 51)..... So, it’s really time to start thinking about this in your 40s!

What might I experience?

It’s more than just hot flushes and weight gain! Most of our body systems are affected by oestrogen in some way :

• our heart and blood vessels,

• our brain

• our adipose tissues (the way our body stores fat)

• our bones

Tell me more about weight gain and metabolic health.

Perimenopause weight gain is usually around the middle (even if this has never happen before!) and the reasons are via multiple systems in the body that are unique to the perimenopause.

This validates so many people’s experiences of “I’m not eating more but the weight is going on to my middle!”.

Is there anything I can do? And when should I start??

Current clinical guidelines do not recommend the use of menopausal hormone therapy (MHT, the new name for HRT) for preventive indications; it is indicated only for the treatment of menopausal symptoms present.

However,the perimenopause is an IDEAL time to

1. Assess your cardio-metabolic risk with your doctor,

2. Start (or change up) lifestyle behaviours, and

3. Increase careful monitoring of risk factors, including hypertension, cholesterol and diabetes markers.

Rather than follow generic advice in the popular media, why don’t you ask for individual assessment and management by one of the experienced expert health professionals at Lifestyle Metabolic.

For more details regarding the perimenopause go to Lifestyle Metabolic’s website blog page (https://www.lifestylemetabolic.com.au/blog)

20.6.22

Boost your metabolism.. Metabolic reset .. Is this a real thing ??

Q. Is there a pill or supplement that can increase my metabolism… and just burn off my extra weight?

A. There are no medications currently that can do this. It is something that researchers have been looking at, but a safe, effective product is not available.

Even the amphetamine-like weight loss pill currently on the market has its major effect via decreasing your appetite rather than burning extra energy at rest.

Q. What about foods? In the past foods such as chilli, cayenne, coffee and cinnamon have been spruiked as weight loss aids.

A. Nice in theory but the claims do not holdup under scrutiny and if any effect at all, it is very minor in the whole complex scheme of things that is weight control.

Remember all food consumption contributes to how much energy you burn…the “sciencey” name is called the TEF (Thermogenic Effect of Food).

This means all digestion requires the body to put effort (energy) into breaking food down and either using it as energy, storing it and/or removing as waste any by- products…. 10-15% of the total amount of energy burnt by an individual in a day is through the TEF.

Some foods require more processing than others (think high fibre and lean protein foods)…. But unfortunately, there isn’t a food which ultimately has negative calories ie takes more to process than it gives.

Q. My friend is slim yet can eat like a horse, however all I have to do is look at an extra slice of cake and it goes straight to my middle- does this mean they have a higher metabolism than me?

A. It doesn’t seem fair -does it? However the answer is a “probable yes” or that your friend is a lot more active than you.

Of note :

The amount of energy a person uses in a day is called TEE (Total Energy Expenditure). It is measured as calories or kilojoules.

Most of this (up to 70%) is from your BMR (Basal Metabolic Rate). BMR is the amount of energy you burn in a day at rest. 10-15% is the TEF (Thermogenic Effect of Food) as described above and the rest is your activity (planned exercise and incidental movement).

The biggest influences on BMR are things like whether you are female or male and your age.

In general metabolism decreases with aging, starting in mid-life. The best method to increase basal metabolic rate in the long term is ensure you are preserving your muscle mass as you hit mid-life…….think regular exercise and enough protein in your diet.

So,……… In SUMMARY

The devil is in the detail with a lot of the claims about metabolic / metabolism boosters. The partial truth is often lost in translation. Don’t believe the hype.

Rather than follow generic advice in the popular media, why don’t you ask for individual assessment and management by one of the experienced expert health professionals at Lifestyle Metabolic.

7.4.22

Are you “very peri”? Here are six dietary things you can do now to support your health at this time.

In this post we explore some of the ways you can nourish your body’s health during perimenopause.

Q. Is there really anything I can do to change my health risks at this time

A. Time for some good news – the answer is YES

Studies that have shown that starting lifestyle modification programs, incorporating dietary changes and being more physically active during perimenopause are extremely beneficial.

‘Food first’ is our mantra.

Eating a variety of food in the perimenopause is important. The main nutrients to focus on are: calcium and vitamin D, iron, fibre, omega-3 fatty acids, and low glycemic index carbs.

While it can be appealing quick fix to pop a multivitamin or other nutritional supplement, we never truly get the same benefits as we do when we eat a minimally processed, varied diet, for example : there are hundreds of plant chemicals (phytonutrients) that can’t be replicated in a pill.

Below, we’ve listed the six important nutritional decisions to prioritise to keep you feeling strong, healthy and happy for many years to come

1. Concentrate on calcium.

This bone-strengthening nutrient is found in dairy foods, fortified soy and other fortified nut milks, green leafy vegetables, nuts, seeds, canned fish with bones.

2. Don’t overlook Vitamin D.

Vitamin D helps calcium keep your bones and teeth healthy and strong. Vitamin D comes from the sun, supplements and a small amount from food. Most of the Vitamin D your body needs comes from the action of sun on your skin.

3. Include iron rich foods.

If you are or have been experiencing heavy periods it’s likely your iron is low. Iron is important in many vital body functions, including :

• carrying oxygen around your body,

• for general energy and focus,

• helping your immune system,

• and the regulation of body temperature.

Good food sources are red meat, fortified cereals, egg yolks, green leafy vegetables, legumes, nuts.

4. Fill up on fibre.

Fibre-containing foods are our best friends in perimenopause. We are all familiar with the health benefits of soluble and insoluble fibres for helping keep our bowels regular, but they also help reduce our cholesterol levels and regulate our blood glucose levels. Very important in helping lower our cardiometabolic risk.

In addition, resistant starch (technically NOT a fibre, but close enough) acts as a prebiotic. Prebiotics are a source of food for your gut's healthy bacteria. They're carbs your body can't digest. They move to your colon, where they act like food to help the healthy bacteria grow.

These bacteria influence our body’s immunity, inflammation, and regulate how we process and store the kilojoules we consume.

High fibre foods include : wholemeal and wholegrain breads and high fibre cereals, oats, vegetables and fruit with the skin on, as well as legumes, nuts and seeds.

5. Omega-3 fatty acids. Omega-3 fatty acids are found in both plant and marine foods, although it is the omega-3 fatty acids from marine sources that have the strongest evidence for health benefits (including reducing the risk of heart disease).

6. Love your low glycemic index carbs.

You may have heard of the glycemic index (or the GI) – this describes how different carbohydrate foods raise blood glucose levels.

Low GI carbohydrate foods raise blood glucose levels more slowly over a longer time, and in turn, insulin requirements are more uniform. This can help people who have impaired glucose tolerance. In addition, low GI foods help reduce appetite as they keep you fuller for longer and may assist people who are above their most comfortable or healthy weight.

Rather than follow generic advice in the popular media, why don’t you ask for individual assessment and management by one of the experienced expert health professionals at Lifestyle Metabolic.

A personally prescribed eating plan or advice is much more likely to be sustainable than following a radical generic diet that is very different from a person's usual or previous habitual eating.

This is where working with an Accredited Practising Dietitian can be extremely helpful. Dietitians understand the influences and basis of how you usually eat and help you tweak this into a healthier eating pattern.

Dietitians consider your food preferences, your social and cultural influences and practicalities such as budget or the need to feed a family as well as time constraints.

At Lifestyle Metabolic we pride ourselves on keeping up-to-date with the latest research from a number of diff

erent disciplines, and integrated for the assessment and management for individual patients, with a focus on their goals, needs and quality of life.