Parts 1 and 2 of the Understanding FODMAPs series gave a great explanation of what FODMAPs are, now in part 3 we will talk about when and how to use the low FODMAP diet, specifically for those with IBS. 


Irritable Bowel Syndrome (IBS)


IBS can be a poorly understood condition, even by the people who have it however despite a general lack of understanding about the condition it is becoming more common with one in seven New Zealanders having the condition. IBS is a chronic (meaning long term) functional bowel disorder that commonly presents with symptoms such as abdominal pain, bloating, diarrhea and constipation. However, these symptoms can flare up and change over time which can make it frustrating for people who have the condition. 


Now, the exact cause of IBS is unknown and is thought to be likely multifactorial. The best available evidence at the moment tells us there are a few things that could contribute to IBS: 

• The first of these is a previous gastrointestinal infection, sometimes referred to as post-infectious IBS. Essentially this when someone gets an infection in their stomach/intestine from a bug and once the bug has been cleared the symptoms described above persist.  
• Studies have also shown that there is a difference in the collection of gut bacteria in those with IBS vs those without IBS. However, whether this is the cause of the IBS in the first place or just a result of the IBS is not understood. 
• We also know there is a strong connection between our brain and the gut and it has been proposed that for some people increased stress and trauma can be a trigger for them developing IBS. We also see in people with IBS a phenomenon called visceral hypersensitivity. This essentially means they are more sensitive to changes in pressure in their intestines compared to someone without IBS.

Low FODMAP Diet in IBS


There is a range of therapies that have been proposed to treat IBS, ranging from probiotics and various supplements to changes in diet. One of the most effective therapies, helping around three out of every four people with IBS is the low FODMAP diet. 


Using the low FODMAP diet for IBS is done in three phases and you must complete all three phases/don’t stay in phase one of the diet. The way it works is by reducing the amount of FODMAPs you consume you also reduce the amount of pressure in your intestine as FODMAPs are great for producing gas and holding excess water in your gut.


Phase One - Strict Low FODMAP


As the name suggests, in this phase of the diet you are consuming only those foods that are classified as being low FODMAP. Now it is important to note that unlike an allergy where you need to avoid the allergen, in this phase of the diet you can have some FODMAP intake it just needs to be low. Here is an example of what I mean.


Take almonds as an example. They contain the FODMAP GOS (if you don’t know what that means, head to part 2). A serving of 10 almonds only contains a low amount of GOS and therefore is still okay to consume during phase one of the diet. However, 20 almonds contain a high amount of GOS and therefore would be too large of a serving size. The best currently available way to know whether a food is high or low FODMAP is to download the Monash University low FODMAP app. Monash University was the founder of the low FODMAP diet and hence (IMO) they have the best available resources when it comes to FODMAPs. 


You should follow phase one for 2-6 weeks, if you experience significant improvement in your symptoms then move to phase 2 of the diet. If you don’t experience an improvement then you must go over this with your dietitian who will reassess your diet. If you are still not experiencing any benefit from the low FODMAP diet then you must stop following the diet and try some of the other therapies available for IBS. This is also why I would recommend going through this whole process with a dietitian as it can be confusing as to whether you are following the diet correctly or not.


Phase Two - Reintroduction


During this part of the diet, you are trying to identify which FODMAPs, in particular, you react to and at what doses. The way you will do this is by keeping your base diet low in FODMAPs and then one at a time you will challenge each FODMAP group (refer to part 2 if you don’t know what the FODMAP groups are). 


These challenges work by you choosing a food high in just one FODMAP and having that food three days in a row, in increasing quantities to provide a moderate dose, high dose, and then your normal serving size of that food. After the first day you will assess whether there has been a flare-up in your symptoms or not, if there haven’t you will progress to the day 2 dose. If your symptoms are triggered by a dose then you can try that food in a smaller serving or stop that challenge completely. Once you have completed a challenge you should have a two to three-day washout period where you go back to eating low FODMAP before trying the next challenge. 


Here’s an example of a challenge for the FODMAP lactose:


Day 1: ¼ Cup of Cow’s milk
Day 2: ½ Cup of Cow’s milk
Day 3: 1 Cup of Cow’s milk 


Once you have gone through phase 2 you should have a list of your tolerance levels for each FODMAP and can then move to phase 3. 


Phase Three - Personalisation


In the final phase of the low FODMAP diet, you will take the results from your FODMAP challenge and create a new modified version of the low FODMAP diet that only restricts those FODMAPs/quantities of FODMAPs that you reacted to in phase 2. 


This is an important step as the strict version of the low FODMAP diet is NOT a healthy diet. Many foods high in healthy prebiotic fibre are also high in FODMAPs and are therefore missing from the diet in phase 1. Studies have also shown that following a strict low FODMAP diet can reduce the number of beneficial gut bacteria we have which further emphasizes the need to go through all three phases of the diet. The other consideration for going through all three phases is the toll going low FODMAP can have on the quality of your life. It can make cooking for yourself difficult enough let alone trying to socialize with other people or eating out. 


You can then continue to eat with your personalized low FODMAP diet. It is recommended that you try to rechallenge those FODMAPs you reacted to in the future as your tolerance to FODMAPs can change over time. 


Summary


IBS is a chronic functional bowel disorder that can affect anyone. Its cause is not fully understood however it is thought that those with IBS have a highly sensitive gut and so following a low FODMAP diet can be helpful in 70-80% of people with IBS as FODMAPs lead to increases in pressure in our intestines. If you do decide to follow the low FODMAP diet you should do this with a dietitian and you must not remain on phase one of the diet. 


Thanks for reading. 


Marco

A journalist from MediaWorks asked a great question during my talk there yesterday. I managed to give a brief (ish) answer then, but thought I would unpack the question "are different sweeteners like raw sugar actually any different/better than regular old table sugar?" Whilst writing I got a bit carried away so have written a blog post to provide a thorough answer so you can refer back to in the future.
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Is Sugar Bad?

The first thing to get clear, sugar is not inherently ”bad” or unhealthy. If I had no sugar in my blood I’d be dead (even in ketosis), sugar in fruit is fine because we know fruit is health promoting, but sugar does contain calories (4 per gram - remember that) and we can over-consume on sugar. An important question to ask is where is this sugar from and what am I getting with it? (more on this later).

Is Sugar from Table Sugar the Same as Honey and Coconut Sugar?

Whether I consume 10g of sugar from table sugar, or 10g from honey, or 10g of sugar from dates I’m still consuming 10g and thus 40 calories (remember 4 calories per gram). Therefore speaking purely about the grams of sugar, there would be no significant difference in calories consumed and thus weight gain/loss between the sweeteners you use (with everything else remaining the same). Now if I add 100g of table sugar vs 100g of honey or maple syrup there is a slight difference in energy content because not all sweeteners are 100% sugar. Table sugar is, yip you guessed it, 100% (pretty much) sugar. Raw sugar really isn't any different in this department sitting around 99.5% sugar. Coconut sugar is similar, around the 90-95% sugar mark. Honey is around 80%, maple/golden syrup around 70-75% and dates around 65% sugar. What this tells us is, if we add 100g of table sugar to our cooking, we are adding around 400 calories (4 x 100), if I add 100g of golden syrup though I have added around 290 calories (golden syrup is 72% sugar, 72 x 4 = 290).

Now in the real world, we don’t add things to our cooking based just on the number of grams of sugar they contain. Usually, we’re thinking about taste/sweetness. Therefore if you have a recipe, and you could sweeten it with honey instead of table sugar, and due to honey's taste, you add less honey than you would sugar then you have reduced the calorie content of your recipe. 

What About all the Other Things in Natural Sweeteners?

The next thing which people commonly bring up is what are we getting with our sugar? I mean this in terms of things like micronutrients and fibre. The short answer when looking at different sweeteners like the ones talked about already is, there isn't much of a difference at all. You will get a few extra micrograms of magnesium from using dates over table sugar, a small amount of iron from using honey and some calcium from golden syrup but they are really quite small amounts and you probably are not going to solve any nutrient deficiency by changing up your sweeteners.  Raw/brown sugar is pretty much the same as white/table sugar when talking about vitamins, minerals and calorie content. 

This question around fibre and micronutrients is better asked when we are talking about sugar naturally found in things like fruit and dairy products. In those situations, we might eat one banana, which contains around 15g of sugar, but with that we get significant amounts of some of our nutrients like potassium (~340mg). Getting sugar from table sugar is like me going to the supermarket, spending $20 and only getting a bag (a reusable one though) back. Whereas getting sugar from fruit is more like going to the supermarket, spending $5 and buying enough food to feed me for at least a meal. We get more bang for our buck eating fruit. 

So What's the Verdict?

The last point I want to make, and moving back to sweeteners, is the significance of this swap really depends on how much you are adding. If it's 100g in some baking that is going to be split between multiple people then if I'm completely honest it's really not worth the hassle, at all. If it's 1kg then the difference in calories might be more of a concern, but even then you'd assume that baking/cooking is being split between multiple people and so likely to have little effect. 

Summary

In summary:

• Sugar from table sugar and sugar from honey is all pretty much the same (technically different types of sugar but we'll cover that some other time) when talking about calories and when compared gram of sugar vs gram of sugar. 
• Different sweeteners have different sugar/calorie content depending on their make up. Most things with sugar in their name though (eg coconut sugar, raw sugar, white sugar) are pretty much the same. 
• There are slight differences in nutrient content between the sweeteners but they are very small and generally insignificant. 
• Therefore use the sweetener which you like the best!

Remember, sugar isn't inherently bad. Going to the supermarket and spending $20 and getting only a bag for it is pretty niggly though, but spending $5 and getting food for a meal is a win in my book.   

Thanks for reading. 

Marco

Fibre was discussed in part one, and micro and phytonutrients in part two. This is the final part talking about some extra considerations when turning our produce into drinks.  

Considerations

Drinking your food can be easier than eating your food. What I mean by that is most people could consume more food in liquid form than in solid form (Flood-Obbagy et al 2009). Therefore making a smoothie can be a super easy way to get some fruits and veggies in if you struggle to eat them or meet your 5+ a day. This could also be beneficial to those who are just struggling to eat enough in general. For example, some athletes with a heavy training schedule may struggle to get enough from eating food alone, so for them a smoothie could be one way to pack in some much need nutrients.   

Now because we can consume more by drinking our food we also run the risk of over consuming. For example, I could take my usual breakfast of oats, milk, peanut butter, and a banana, put it in a blender but with more of each ingredient plus other things and gulp it down. I’ve just eaten a lot more than I normally would for breakfast when I potentially didn’t need it, and may even still be hungry afterward. Doing this repeatedly could then lead to unwanted weight gain because I am now technically eating more. My recommendation here would be to ask yourself before making your drink, “Would I normally eat what I’m about to put in the blender?” If you are someone struggling to eat enough then still be mindful of what exactly you’re putting in your drink. Also, ask the question, "Does this satisfy me?", or are you going to go looking for something else to finish off breakfast. Something to note is sipping on your smoothie as opposed to gulping it down may also help make your smoothie a little more satisfying.   

There is also the train of thought that by blending a bunch of fruits together we create a drink that is acidic and potentially detrimental to health of our teeth (Ali et al 2014). The effect our drink has on our teeth is very dependent on what the ingredients actually are and how often we are sipping away. Drinking with a straw and not sipping on your smoothie over the day could be two easy ways to reduce any effect we may have on our teeth.  
​
Summary

The whole, unprocessed version of our fruits and vegetables should still be our first choice, but making our produce into drinks is an option to help get our 5+ a day. Different processing methods will affect different produce differently.  In general, a smoothie/blended whole produce is closer to its natural state, and probably the healthier option over a juice that's not as filling and lacking fibre. In smoothies, fibre is still retained but its structure and potentially function is altered because of it. We still get a lot of micro and phytonutrients from blended produce but we cannot definitively say doing so will “unlock” all the nutrients “trapped” in our fruits and vegetable, as some appliance manufacturers would claim. I would suggest making your own smoothie so you are aware of the ingredients too. Some drink manufacturers have gone with the notion of “more is best” in terms of ingredients, and there are plenty of commercially available smoothies that contain a lot more than is necessary. Keep in mind the ease of over-consuming while drinking our foods and remember to ask yourself, "Would I normally eat everything I am putting into the blender?" 

Thanks for reading. 

Marco 

There is a saying that we aren’t what we eat, but rather we are what we absorb. Therefore following on from the last blog post, this article will investigate what happens to the vitamins, minerals and phytochemicals/nutrients when we turn our produce into drinks. If you haven’t read part one looking at fibre then click here.


Micronutrients

Micronutrients sometimes referred to as micros include vitamins and minerals that are essential for our survival. They are needed in smaller amounts thus the name micro-nutrients and are important for helping our body produce everything it needs like hormones and enzymes. To read up on micros more click here. 

Phytochemicals/Phytonutrients

Phytochemicals are another group of chemicals that are produced by plants. These chemicals are thought to provide beneficial effects to human health such as antioxidant, anti-inflammatory, and antifungal properties. It should also be noted that some micronutrients also exhibit anti-oxidant effects as well as having other roles in the body like vitamin c and selenium. Some examples of groups of phytochemicals include polyphenols and carotenoids (you don't need to remember that right now). 

Claims

Some manufacturers of blenders, smoothie makers and juicers make claims that their machine will help unlock the trapped nutrients within fruits and vegetables making them more readily absorbed. Some will even claim these turn our ordinary foods into super-foods (sigh). 

Are These Claims True?

We know that food does require breaking down to release certain nutrients. Plants hold different nutrients in different compartments, and so as part of the eating process we need to break these plants down to help our bodies absorb these nutrients. This is normally the job of our mouth (chewing) as well as the mechanical and chemical breakdown in our stomach and GI tract.

Looking at the effects of blending there is some research to suggest that putting our produce through this process will make the nutrients found inside more accessible. A study done in 2012 found that the smaller the particle size of the food (i.e the more it had been blended) the more accessible the nutrients investigated were (Katlijin et al 2012). This study, however, used much more extensive processing methods to breakdown their produce than found in the average kitchen. They vacuum packed the produce, then heated them in a water bath followed by soaking them in deionized water. Then some of the produce was taken through high-pressure homogenization. Nobody is doing that with their morning smoothies. What they were left with was a puree made up of different sized particles. Similar to Goldilocks and the three bears they were left with big pieces, medium-sized pieces and tiny little pieces of puree. It was the tiny pieces they were the most accessible but most of the particles were still big pieces and so not as “accessible”. 

Looking at smoothies vs juices one study made drinks using with whole fruit or juices. It found that for some types of fruit, whole fruit smoothies lead to higher nutrient (vitamin c) content than those made with juice, but for other fruit, it was the opposite (Hee Pyo et al 2014).   

Now just because the nutrients may now be more accessible, that does not necessarily mean greater absorption. Different nutrients have their own way of being absorbed within our intestine. Some nutrients will compete for absorption with others and so if we have more iron, for example, we may have less calcium absorption. There is also the possibility that once these nutrients are “released” and more accessible they may interact with other things in our blender and form new compounds (Parada et al 2007). This may lead to greater or reduced absorption. Think of it like being in a relationship, and your parents don’t like your partner. You might break up with them making you more “accessible”. You could end up with a new partner your parents like (increased absorption) or one that was worse than the original (decreased absorption). 

What should also be noted is there are some phytochemicals thought to be bound to the fibre of our fruits and vegetables. Therefore with blending and juicing (which will remove/alter fibre content), there is also potentially the removal of the phytochemicals bound to the fibre (Bravo et al 1994)

Summary

What we need are well-conducted studies comparing the actual absorption of these nutrients in whole produce vs blended produce vs juiced produced. Unfortunately, we do not have this data. From what it looks like different nutrients and different plants will yield different results under different processing methods. There is no one rule, yet. So in short next time to read that blending your fruits and vegetables is going to help you absorb more of the nutrients found inside them, be skeptical. My interpretation and best advice would be the whole and less processed version should always be your first pick, because we know consumption of these is beneficial to our health and can significantly contribute to our nutrient intake . 

Look out for the last part of this series talking about some of the other considerations when making these drinks and what their role is in a healthy balanced eating pattern. 

Thanks for reading.

Marco

I can remember not so long ago, and they’re probably still floating around now, seeing ads on TV about the newest juicer or blender which would take your fruits and veggies and “extract vital nutrients from the plants cell wall and turn your produce into a super drink packed with nutrients”. Or something along similar lines. I had also heard as a kid that making smoothies would ruin the fibre from the ingredients and I was best to just eat my fruits and veggies whole. So, does blending destroy fibre? Is it better or worse for absorbing vitamins and minerals? This next series of articles will be unpacking what happens when we take our fruits and veggies and turn them into smoothies and juices. Here is a collection of some of the research and my interpretation.
 
Fibre
 
Fruits and vegetables can be a good source of fibre which is an important component of our diet. Fibre put simply is a type of carbohydrate that cannot be broken down in our gut. This allows it to pass through our small intestine which one, can help to keep us regular and two feeds our gut bacteria. Fibre also has other known benefits such as helping to reduce our cholesterol levels. Fibre is not just one compound/substance, think of it more of a group of different compounds that share the common theme of not being able to be broken down in the human gut. The difference between them is what happens as a result of them staying in our gut. For example, some act as a ‘bulking agent’, bulking up our stool (poop) whereas other types bind with water which can help us pass our stools more easily.
 
There is one train of thought that blending up our produce will destroy the fibre. Is this true? In the case of smoothie making we are not necessarily destroying the fibre but rather altering its composition. This is assuming we are adding whole fruit to our smoothies. When investigated it was found that when fruits where made into smoothies, they retained a significant amount of fibre (Saltaouras et al 2019) whereas juices generally have a much lower fibre content (potentially 10 times less) (Saltaouras et al 2019).   
 
Now the fibre that is still available in the smoothie does not necessarily have the same structure and function as whole fruit fibre. It has been shown in oat and wheat fibre, when blended their structure is altered leading to a change in function (Ann-Marie Cadden 1987). In a study looking at oat and wheat fibre the particles were both made smaller, but this resulted in different things for the two types. The wheat fibre had a decreased ability to hold onto water with the opposite occurring in the oat fibre after being blended.

Summary 

In short blending will not completely destroy the fibre per say, but rather alter its structure. Think of putting a log of wood through a wood chipper. You still have the wood but it’s now in a different form and so its function has been altered. We cannot make one generalised comment about what happens exactly to the function though. Blending will affect different fibres differently. There is still some fibre in-tact and so I would hypothesize we should still see some of its benefits like feeding our gut bacteria, but its effect on our bowel habits may be different depending on how it reacts with water. We do not however have conclusive evidence to say exactly what will happen to the fibre and how it will effect us.
 
Look out for the next post next week looking at what happens to the micronutrients followed by phytochemicals/antioxidants of fruits and vegetables when we turn them into drinks.
 
Thanks for reading.
 
Marco

With just a few days before Christmas I thought I'd put off finishing my Christmas shopping just a little longer a write a few thoughts about this time of year.

Everyone celebrates Christmas differently so these are just some of my opinions and thoughts on what I'll be thinking and doing during the day. To set the scene a little our family will celebrate by spending most of the day together opening presents in the morning and then a few different courses of food spread over the day.   


How I'll Decide What I'll Eat

It's quite a simple formula really. If I think I am going to enjoy eating something, I'll eat it. This is a day I will not be thinking about the healthy eating guidelines, a plate model or anything like that. I'll trust my gut and if I think consuming this is going to be pleasant, then down the hatch it'll go. Now I will still be mindful of what I am eating. As I said, if I think I am going to enjoy eating it I will; I will not be going on, nor do I recommend going on an uncontrolled binge. That will likely end with me feeling uncomfortably full, potentially a little sick, and most importantly without any room for dessert. I'm not missing my sisters Tiramisu! I think eating this way means I get to enjoy the foods I really love and helps me to enjoy the day by not feeling sick at the end of it.   


What I'll Be Thinking  
​
Christmas can be a stressful time. What I'll be thinking about to try to manage the stress is "not to let the little stuff ruin my day", particularly the stuff to do with food. Whether you're doing the big family get together or more of a low key celebration there might be a few little things throughout the day that don't go your way. The Christmas ham may not be how you like it, you might burn the chicken, forget to make such and such's favourite salad or someone might not like a gift you got them. In my mind anyway all of these things are really, when you think about it, very insignificant. At the time they may seem like the end of the world but in the scheme of things they don't really matter. Take a step back, smile and enjoy the day. I know there is going to come a time in my life when the consequences of a negative event are much more important than burning the Christmas cannelloni, so I should make the most of this day.

Over the years I've been made more aware of how lucky I am to spend this time with my family and have access to more than enough food. I now know Christmas can actually be a hard, lonely and overwhelming time for some and so I think it's important that I spend some time sparing a thought for others, and asking myself how can I make someones else's Christmas better? There are some awesome initiatives in place working to share the Christmas love both locally in New Zealand and internationally. Plunket for example does a tremendous job gathering food and other gifts for families struggling over Christmas time, delivering them in boxes in the lead up to Christmas. Making someone else's Christmas better in my mind could be as simple as looking out for someone locally in your community who might not expect a kind message, a present or even a little bit of your time.      

Have a wonderful Christmas and a happy New Year team!

Thanks for reading.

Marco

​This is the final part of the three-part series of lessons learned in my first year as a student dietitian. Click here for parts one and two.


The Amount of Misinformation Being Spread

Many years ago, as a teen trying to work out what the heck I was meant to be eating I was quick to trust the advice of people who I thought were trustworthy when it came to nutrition. I assumed being an author or because they had the letters “Dr” in front of their name their views on nutrition must be right and one I should hold in high regards. 

Nowadays some of the biggest frustrations for me are reading things presented as absolute truth but in reality, there is not a shred of evidence behind them (not evidenced based, remember the restaurant analogy) or even worse, we have great evidence they are completely wrong. Funnily enough, those saying these things are normally talking outside of their scope of practice (remember that means talking about stuff you don’t actually know about) and have just read something on someone’s blog, heard something on someone’s podcast or they’re being paid to endorse something. Now as I have mentioned previously, I have a particular scope of practice and so I don’t claim to know everything, but after being engrossed in the field of nutrition for four years I have picked up more than enough to see that many of those people who I perceived as being knowledgeable to actually just be sharing, for lack of a better word, bullshit.  

My best advice to you is, be skeptical of the nutrition information you read and hear from public figures. Ask the question, why should I listen to this person? Are they an expert in what they are talking about? While there are some good places to go for nutrition information on the internet or in books, a registered health professional like a dietitian or registered nutritionist is generally the safest place to go.  

The moral of the story for me this year though is listen to the experts in their respective fields, not the businessman dressed as an "everything related to health expert" or the wannabe “Jack of all trades” because they are the experts of none.


The More You Learn, The Less You Realize You Know

This was something that stuck with me after my first day as a student dietitian. The more you start to unravel a problem the more you understand just how complex it really is. With nutrition, it seems the more I learn, the more I see there is to learn. It can certainly feel like you’re trying to climb a mountain on a treadmill at times but at the same time is very exciting that there is always something new to discover. It reminds me of the importance of staying up to date and so makes me glad that I chose to do something that I have a genuine passion for, because I have my work cut out for me climbing that mountain.

While I think a trait of a true expert in their field is possessing the ability to simplify a complex topic, be skeptical of those who oversimplify things, because that may be a sign they themselves do not understand how complex that thing is. One common oversimplification is that sugar is bad. If you start sharing the message that sugar is bad people become confused or think they should stop eating everything with sugar in it, like fruits and dairy/dairy alternatives. In reality, these foods make up part of a healthy diet. You’re also more likely to make people feel guilty when they eat something with sugar in it. Now don’t get me wrong, products with large amounts of added sugar are not health promoting, but part of living a healthy, balanced and enjoyable life is enjoying a piece of your favourite dessert on occasion. Making people feel guilty about it ruins those times when they have cake. Cake tastes good. Please don’t ruin cake.
 
The main lesson here for me, don’t ever assume you know everything there is to know about anything. Chances are further you keep digging the more you’ll realise you have to learn. 
 

In Summary
 
With my first year as a student dietitian over I’ve had some time to re-evaluate what I’m trying to achieve with my blog. After much thinking not a lot has changed. My mission is still to educate the world about how what they put into their body’s effects them and make positive changes in the health of others. I will continue to provide education and answer questions within my scope. While I am certainly no chef, I will also continue to share relevant meal ideas and recipes trying to provide options that are a combination of health promoting, quick, easy and cost-effective. 

I hope I have managed to get across the significance of the past year for me. I think it's important I also show some appreciation to the dietetics teaching team at Otago uni as well as my amazing classmates who have been the source of much of my learning.  The sophistication of the brains and character of the people that make up both the teaching team and my class can't be well described in words (well a few short ones anyway). Look out for some waves to be made in the nutrition world in the coming years. 

Thanks for reading.  

Marco

​Picking up where I left off yesterday with more lessons I have learned in my first year as a student dietitian. If you have haven’t read part one you can find it here.
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Our Relationship with Food

How we think about food and our relationship with it perhaps does not get talked about enough. It wasn’t until this year I noticed how different our relationships with food can be. From using it as comfort, stressing and worrying about it, seeing certain foods as the enemy, understanding it can fuel performance, different people see food differently and so one major lesson for me is to be more mindful of how I talk about it. The impact that an individual with a respected opinion can have on another person’s thinking, by what they say, is much larger than I thought. Therefore for me to make sure I am working to reduce the wave of negative relationships and disordered eating I need to be mindful of how I talk about food. 

I have the belief that food should not be the enemy, a tax, a chore, or something we are working against. Food is nourishment, enjoyment, healing, and growth; it is a positive part of our life but for some, this is not the case. It is my opinion that one contributor is the way we talk about food and the culture this has created. So often as soon as I mention the words nutrition, healthy eating and food  people directly associate that with

• Dieting

• Restricting foods we like
• Willpower
• Being ‘good’ or ‘bad’

In reality, not only are these not the focus when it comes to healthy eating, I would argue they are the opposite. How about instead we use the words?

• Range of foods
• Balance 
• Listening to your body
• Not passing judgment on  yourself   

I see these as better qualities to associate with nutrition, food and healthy eating. I think it will require many different things for that to change but an important part of it is being mindful of how we, in particular those seen as the experts or leaders, talk about food.  

The mental aspect of food is one field of nutrition I have a lot to learn in and so I look forward to sharing that with you all over time. 


Evidenced-Based Practice

You know when you get asked for a suggestion? Like what should someone get when they go to your favourite restaurant for example, and you get a teeny bit nervous after telling them because they might not like what you recommended. Well previously one of the biggest worries for me when providing any sort of nutrition advice was giving advice that was not beneficial or worse yet, did more harm than good.

While reading and understanding research was part of my first degree it wasn’t until this year that I got to see what evidenced-based practice looked like. The name mostly gives it away and it ties into what a dietitian does. It is making decisions based on what research is available in conjunction with your professional expertise. As a healthcare professional, with a direct impact on people's health, it is crucial that the advice given is based on evidence. I know for me this provides confidence that what I say and do as an aspiring dietitian is not just sound but the best I can do, as well as minimising the risk of causing harm, putting some of my fears to rest.

Going back to our restaurant analogy, not working through evidenced-based practice would be like recommending something that you hadn't tried, but sounded good when you read its description on the menu. You have no evidence that dish tastes good, you're just basing it off what you think it might taste like. There are many nutrition "theories" that sound like they should promote your health because they do this to your metabolism or that to your cells. However, like in the restaurant, sounding good and tasting good are different things, or in the case of nutrition, sounding health promoting and actually promoting health are also different things. In a restaurant if you make the wrong choice or the dish comes out different to what you expected, like when they don't tell you there's coriander in the dish and you really don't like coriander, you might leave dinner a little dissatisfied but no real harm is done. When dealing with health if you start recommending things that sound good as a theory, but when tested don't work out how you thought they would; or you realise you didn't consider or know (surprise coriander) that it would actually lead to these other harmful things, you have much higher stakes than leaving a restaurant dissatisfied.      

Research does take time and money to conduct so not everything has been thoroughly investigated. This is where clinical judgment comes into things along with looking at what evidence we do have and how that relates to the situation. That is a basic and very rudimentary explanation of evidenced-based practice, I will do a separate post on what research looks like down the track but the crux is basing your actions and recommendations off evidence to make sure it works and that it is safe.
 
Tomorrow I will post my final lessons learned around the current pile of misinformation being spread and something that stuck with me from my first day. 

Thanks for reading. 
 
Marco