Category: family

Gluten Free – emerging evidence of intolerance

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Gluten is a protein found in wheat, rye and barley. A gluten free diet is the treatment for Coeliac Disease, however in recent years, gluten free diets have become popular with people who do not have Coeliac Disease. Celebrities such as Andy Murray, Bill Clinton and Gwyneth Paltrow give endorsement to the gluten free way of eating.

There is emerging medical evidence and a growing number of clinicians acknowledging that up to 10% of the population may have a gluten intolerance despite testing negative for coeliac disease. Allergy tests will also be negative (as it is an intolerance, not an allergy), negative in gut biopsies (where a sample of the gut is looked at under a microscope), and negative in endoscopies (tiny camera looks at your gut).

The medical term is Non-Coeliac Gluten Intolerance – here is an interesting article from the British Medical Journal, with the personal experience of a biochemist with gluten intolerance, followed by the opinion of a clinician.

Despite symptoms seriously affecting quality of life, a medical diagnosis of non-coeliac gluten intolerance can be difficult as although prevalent, it is under-recognised by doctors.

Gluten intolerance can manifest in many ways:

  • digestive system
  • skin
  • nervous system
  • muscles and joints
  • sleep
  • mood

During my practice, I have seen many patients with a variety of these gastrointestinal and non-gastrointestinal symptoms, in which coeliac disease has been tested for and excluded, but symptoms only respond to a gluten free diet.

Improvement in quality of life can be profound: the 7 year old autistic boy, who could stop wearing nappies as his ‘intractable’ diarrhoea resolved; the 74 year old almost housebound lady with chronic abdominal pain who can now happily get out and about; the 5 year old girl whose mother described her as being, not just emotional, but depressed, who within days emerged a ‘happy child’.

My story – why I have jumped on the gluten free bandwagon

I have suffered with spots since I was 15 years old. I’m now 36. Not just a few zits, but sometimes so many that I couldn’t even count them. Over the years, GPs and dermatologists have prescribed every pill and potion from the long list in their BNF (the medical profession’s prescribing manual, look for it on your GP’s desk). From the basic benzyl peroxide cream to Roaccutane. Side effects of Roaccutane include peeling lips, nose bleeds, liver damage (you have to have regular blood tests to monitor liver function), and deformed foetus if you become pregnant. The Roaccutane worked for about a year, but the spots returned.

Every medic told me diet and acne were not related. This outdated opinion comes from a 1969 study looking at the effect of chocolate on acne, in which the inappropriate conclusion was drawn that as chocolate did not appear to affect acne, neither did any dietary factor. However, there is a growing evidence of recent studies supporting the relationship between diet and acne, although there are none as yet specifically on gluten.

To cut a long story short, two years ago, aged 33, I jumped on the gluten free bandwagon. Why did it take me so long? Because there is no evidence of a relationship between gluten and acne, and I experience zero gastrointestinal symptoms, so I didn’t make the link.

The theory is that for intolerant individuals, gluten can affect hormone levels and provoke an inflammatory response, both triggers for acne. I was by no means confident that it would make any difference, in fact I was extremely skeptical, and it’s certainly not something I broadcasted to dietetic colleagues. However, after a few months, I was spot free. After about 8 months, I tested the gluten exclusion on holiday in Morocco, with the bread-tastic breakfasts. About 5 days later I had a major outbreak which took a couple of months to clear up. In June this year, on holiday in Ireland, each day I had the odd bit of scone and pastry (it would have been rude to turn down my husband’s Nan’s food!). Once again, I had a flair up a week later that took many weeks to clear. Surprisingly, a food challenge is the ‘gold standard’ for confirming diagnosis of food allergies and intolerances, rather than reliance on laboratory testing.

Thankfully, gluten free is much easier to do these days, than even five years ago. Most supermarkets have a great range of gluten free foods that are getting better and better when compared to standard products. That is why I am more at ease in suggesting clients trial a period of gluten free if more serious conditions eg. coeliac disease have been excluded by their GP. Some people see major improvements on eliminating the major sources of gluten eg. pasta, bread, cakes, biscuits, pastry. Some may need to be more vigilant about gluten containing foods by examining food labels.

If you are considering a gluten free diet because you may be suffering from any of the above symptoms, please get the all clear to do so by your GP. Serious health conditions should be eliminated first. A gluten free diet may not help you lose weight (especially when using gluten free products), and there is no need for those who do not have Coeliac Disease or Non-Coeliac Gluten Sensitivity to limit their diet unnecessarily.

The F word

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My gut reaction when my 3 year old used the F word was one of horror. I couldn’t believe my ears, but I guess this sort of thing is inevitable when they start going to nursery school.

“I was playing mummies and babies with x and y in the home corner, and x was making lunch, and we couldn’t have too much or it would make us FAT!”

My first response: my Mummy Poker Face. In my head I was tearing my hair out shouting “nooooooooo!”.  Second response: a light and breezy 1 minute chat about food making you strong.

My second reason for the horror was the thought that the teacher may assume that, as a dietitian, I was teaching my children this nonsense. Following 12 years as a dietitian, I have seen hundreds of people (children and adults) for advice on obesity. Issues around food commonly appear to come from childhood experiences, a parent’s relationship with food and how they relate this to their children. During my time as a paediatric dietitian in the NHS, one particular little girl sticks in my mind. She was about 5 years old and referred to me as she was overweight. The first thing she did when she came in to the clinic room, was to show me her Barbie. She asked if she would ever look like her. I told her nobody looks like Barbie.

Of course, every parent wants their child to eat well, have a diet of good nutritious foods, and be healthy in the long term. We come in all shapes and sizes, skinny does not necessarily mean healthy. Feeding yourself and your child wholesome food, not using food as an emotional crutch, and not feeling GUILTY about nourishing yourself are all crucial in achieving a balanced state of mind. But how do we convey this to our children, particularly our daughters? Is it appropriate to use the F word?  Here is what I have learnt from my time practising as a paediatric dietitian, and as a mum to 3 children:

  • Do not discuss your weight or ‘going on a diet’ within earshot of your children.  Do not discuss any body part that you dislike. Keep any food, body and weight insecurities to yourself.
  • Do not discuss their weight, shape or size in a negative way, even if you are trying to turn it in to a positive eg. “it’s ok if you’re chunky/have baby fat”.
  • Don’t ban any food. It’s ok to have crisps, chocolate, cake etc. as an occasional addition to a regular intake of the ‘healthier’ foods
  • Do not discuss calories, and burning off with exercise. This leads to negative associations between the two. Food should be enjoyed. And exercise should be enjoyed, not a chore or a punishment to ‘work off’ a ‘bad’ food choice.

What should you say?

  • Food provides nutrition to make our bodies strong, fit and healthy
  • Some foods have much more vitamins and minerals than others, it is important that we eat lots of these to give our bodies energy and to keep us well.
  • Bread, potatoes, rice, pasta give us lots of energy for running around, climbing, bouncing, having fun!
  • Veggies and fruit help us to stop getting sick, give us sparkly eyes, shiny hair, and help cuts and grazes to get better
  • Fat is not ‘bad’, some fat is important for our bodies to use the vitamins properly and to help our brains to work
  • Eating a mixture of food gives all the different things our body needs

Tell your children that our bodies are amazing………..talk about all the awesome things that they can do if they want to: climb a mountain, run a race, do a cartwheel, touch the sky with their feet on a swing.  Help them to love moving, because that is what we are designed for.  “We’ve got to go for a walk because we’ve eaten to much chocolate” is in no way healthy, helpful or positive.

Teach your child how to love fresh air

Teach your child to love movement and exploring new things

Teach your child how to bake a cake using butter, sugar and flour

Teach your child how to chop and cook veggies.

Tell them they are strong, tell them they look happy, tell them they are GLOWING!

Nutrition for Young Athletes

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Why a nutritious diet is needed:

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  • Normal growth and development
  • Healthy, strong body
  • Energy for everyday activities – school, gymnastics training
  • Repair of muscles following demands and stresses of training and competition

Main components of the diet:

Hydration:

bottled-water

  • as important as food
  • Overheating and dehydration can be dangerous (heat stroke)
  • Low levels of dehydration: reduced strength, stamina, concentration

Carbohydrate:

  • Supply energy for musclesSTARCHY
  • Immunity
  • Growth
  • Focus on wholegrain bread, pasta, rice, fruit, veg
  • Especially important before and after exercise for muscle energy

Protein:

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  • For muscular strength & power, muscle repair & maintenance
  • Focus on lean protein: chicken, fish, eggs,
  • dairy, beans, seeds, nuts

Healthy Fats:

  • Important for healthy heart, nervous system, hormones etc.
  • Focus on healthier fats from olive oil, oily fish eg. Salmon, avocado, peanut butter etc.

Vitamins & Minerals:

  • Calcium – strong bones
  • Iron – needed for blood cells to transport oxygen to muscles
  • Vitamin D – bone development, also implicated in long term health issues
  • B vitamins – energy production & protein metabolism
  • Omega 3 fats – oily fish, for brain development, heart health, vision etc.
  • Generally, supplements not needed if child has varied diet
  • Consider fish oil supplement (omega 3 fats) if intake of oily fish is less than once per week
  • Consider Vitamin D supplement if always wears sunscreen in summer

Pre – exercise fuelling:

  • Aim to have a meal or a substantial snack a few hours before:
    • Pitta/crumpets/toast with jam/honey/peanut butter + milk
    • Jacket potato + tuna/baked beansshutterstock_81803002
    • Baked beans on toast
    • Boiled egg and toast
    • Porridge, milk and raisins/berries
    • Breakfast cereal with milk
    • Bread roll with cheese/meat filling + banana
    • Pasta, rice or noodles with tomato sauce, lean meat eg. chicken, vegetables
  • Up to 1 hour before
    • Fluid for hydration: 200mls fruit juice/water/skimmed milk

 Early morning sessions: If training or competition is first thing in the morning, it is probably not possible to have a meal 3-4 hours before. In these circumstances, have a good meal the night before, then a snack and fluid 1-2 hours pre exercise eg. breakfast cereal and milk, fruit and yoghurt, smoothie or milkshake.

After exercise:

Ensure your child has a snack, or a meal following training. Carbohydrates replenish the muscles with glycogen for energy, while protein repairs and rebuilds muscle tissue. Sports protein shakes or supplements are unnecessary and not advised.

Post-exercise snack ideas (follow within a few hours with a meal):

  • Homemade shake – blend 200ml milk, tablespoon yoghurt, banana, tablespoon honey
  • Low fibre breakfast cereal  eg. Cornflakes/Rice Krispies and milk
  • banana and yoghurt/milk
  • Bread roll or sandwich with cheese/meat/fish filling

Rehydration

It is highly likely that your child will finish training with some degree of dehydration, therefore it is important to replace these fluids as soon as possible after the session. Aim for 200ml fluid with an hour of finishing.

Body image and Disordered Eating

In some sports there is pressure to ‘not get fat’/stay lean or to bulk up to enhance performance Eg. Gymnastics or rugby.

Any such pressure can have the opposite effect – unhealthy eating patterns, restrictive eating (anorexia), or bingeing (bulimia).

Poor nutrition, resulting in weight loss, can cause anaemia, reduction in muscle power and performance, weak bones, poor concentration and increased injury risk

Tips for parents:

  • Do not weigh your child (unless specifically asked to do so for medical reasons)
  • Do not discuss calories or fat, unless raised by your child.  Approach in a positive manner e.g. food gives us energy for exercising and being strong. Healthy fats are important for us to be healthy.
  • Talk about food being nutritious, for making us strong, repairing cuts in our skin, building our muscles, giving energy for running fast etc.

Written by Sarah Danaher, Registered Dietitian, Accredited Sports Dietitian

Registered Dietitians are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems.

If you have any concerns regarding your child’s or family’s diet, then please don’t hesitate to contact me:

danahersarah@yahoo.co.uk

www.sarahnutrition.com

07758 100727

Happy Carrots

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The name alone makes me love this. It’s also very easy to make which makes me happy.

Happy Carrots

Happy Carrots

Why it’s happy: protein from the quinoa and seeds; antioxidants from the carrots, mint and coriander; essential fatty acids from the pumpkin and sunflower seeds, and a little bit of sweetness from the sultanas.

Ingredients:

1 tablespoon sultanas (soak in hot water for 5 mins to plump up)

3 chopped spring onions

3 grated carrots

handful coriander leaves, chopped

small handful mint leaves, chopped

handful toasted pumpkin and sunflower seeds

a few tablespoons cooked quinoa/rice (optional)

dressing: 1 tablespoon lemon juice, 1 tablespoon olive oil, 1 chopped garlic cloves (or teaspoon of the garlic in a tube). Make more dressing, if you like it more dressingy.

Mix all the ingredients together in a bowl. Mix the dressing ingredients together and add when about to serve.

Fiery Noodles

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This recipe is adapted from Jaime Oliver’s 30 Minute Meals book. As you can see from the photo, this particular page is well used! This part of the recipe only takes about 10 minutes if you use the ready cooked noodles.image

 I use rice noodles instead of egg noodles (for a gluten free option), and leave out the faff of carmellising cashew nuts. If a recipe isn’t easy, or it has too many complicated ingredients or stages, then I don’t have the time or patience. Especially when our 1 year old is clutchingimage on to my leg while I’m trying to cook!

Ingredients: ready to use rice noodles, 1 red pepper, 1/2 red onion, chilli flakes, handful coriander, 2 tablespoons soy sauce, 1 lime, 1 teaspoon fish sauce, 1 teaspoon sesame oil.

  • Put the pepper, onion and coriander in a food processor and whizz up until chopped small. Or you can just chop everything up with a knife.
  • Make the dressing with the sesame oil, juice of the lime, soy sauce, fish sauce and chilli flakes (about 1/2 teaspoon, more or less depending on how fiery you like it!)
  • Mix dressing in to chopped pepper, onion and coriander.
  • Heat a frying pan, ideally non stick. If using a wok, add a little oil to imagestop noodles sticking.
  • Add the veg mixture to the pan.
  • Add the ready to use noodles.image
  • Heat through until noodles soft (about 3 minutes).
  • Eat immediately if you like it warm, or leave to cool for a cold salad.
  • Good served with chicken stir fried in a dash of soy sauce and honey. Or a salmon fillet flaked through it. Any other ideas welcomed!

Breakfast Omelette (sweet!)

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Most of us have become used to having something sweet in the mornings, rather than savoury. Think breakfast cereal, porridge with raisins, muesli, toast and jam, fruit and yoghurt etc. All perfectly great breakfasts.

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Omelettes usually fall in to the savoury category, so I thought I’d change ingredients to make it sweet. It sounds a bit odd, but bear with me, and give it a go. All you need are eggs, oats and some honey. Cinnamon if you are feeling adventurous!

Why this omelette is great!

Eggs:

  • contrary to popular belief, cholesterol in eggs does not raise blood cholesterol
  • nutrient dense superfood, choca-block with vitamin and minerals
  • high in choline (neurological benefits) and leucine (for muscle building – found in many sports protein drinks)
  • High protein – help you to feel full up for longer and for muscle building
  • cheap!

Oats:

  • low GI, for slow energy release
  • high soluble fibre and B vitamins
  • lowers cholesterol, prevents heart disease
  • also cheap!

Honey:

  • balance of fructose and glucose sugars (similar to sports carbohydrate gels, but without the additives)
  • easily absorbed by the body, increasing energy levels quickly

Here’s what you do:

1) whisk 2 eggs, add to hot non-stick omelette/frying pan

2) sprinkle in a small handful of oats, with cinnamon if you are using

3) give the pan a shake every so often and just a few times give a stir (stir too often and you’ll have scrambled eggs, equally delicious I’m sure)

4) drizzle some honey over the omelette

5) plate up! Add some extra honey if you wish.

Nutrition info: 320kcal, 16g protein, 30g carbohydrate

In the fridge today……

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Yesterday morning, a mum at the school gates dared me to post my fridge contents (she didn’t think I’d do it, so haha Ye Of Little Faith!) I promise that I’ve not removed or added anything. From the top…..

Photo on 2013-07-02 at 07.15

  • Boots Omega 3 Children’s supplement
  • Natural Yoghurt (full fat)
  • Kinetica Omega 3s – these ones for the grown ups
  • BBQ left overs (chicken, lamb)
  • Gatorade Ultimate Hydration (6% carbs, for exercise > 1hr)
  • Heinz Tomato Ketchup – lycopene & flavour!
  • Cherry Diet Coke – errrr, 2 bottles, a glass few times a week 😉
  • Butter – a little saturated fat ok
  • Bacon – processed meat 😦
  • Cheese – calcium
  • Left over Super Food Salad
  • Eggs – amazing nutrition powerhouses (don’t raise blood cholesterol)
  • Lavazza Coffee
  • Variety of veg: spring onions, broccoli, pepper, red cabbage, lettuce
  • Alpro Almond Milk – just for variety and to use in this and this
  • Kinetica High Protein Shake – used as quick snack or to bump up protein in these
  • Semi Skimmed Milk – good for protein, carbs, calcium – great post exercise refuelling.

Not a bad selection, plenty of nutritious things, some not so good. But like I always say, everything in moderation. Any comments gratefully received!