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Thursday, May 24, 2007

Elite level rugby: Is what they eat important?

There are key moments in any career that stand out above all others and this is one of mine; I clearly remember the moment when a former Wallaby great was sitting at my table at the annual Sydney University Grand Final Lunch. After asking what I did for a living, the player actually laughed, and said, “so they are still telling you what to eat” before he continued to make a complete joke about my profession, and rant about how he thought that dietitians working in rugby were a complete waste of time.

I did not say it was a fond memory……

So is what they eat important? Could they eat a steak and eggs and perform as well as they do today? Possibly; there will always be genetically gifted players who could eat whatever they like and still do well, but it is as well as they could have if they had eaten well? Surely, maintaining optimal levels of hydration to reduce the risk of cellular damage during contact sport, having more than enough fuel stored in the muscles for extra time, or aiding in the prevention muscle soreness on long flights by eating the right thing, are simple yet powerful things any athletes could do to make their bodies feel better under the huge impact of what they expect from them, training session after training session, season after season?

It seems to me that some of these things are pretty simple, and yet many players and administrations, at both junior and senior levels still do not think that sports nutrition is worth investing in. I will let you decide.

As sports drink containers fly across the field when the final siren sounds, it appears that teams have hydration down pat, but did we all forget that it was pre game hydration that was actually the most important thing? Significant injuries: knee and shoulder reconstructions, hamstring tears, broken bones can finish a player’s season and even their career. Surely it makes sense that a well hydrated body; one that has more fluid padding on every one of the millions and cells helps to reduce the risk of injury? And yet players are still routinely dehydrated. A study completed with a national rugby league team found that on the average training day, 60% of players were significantly dehydrated.

Remember, an elite level rugby player will lose 3-4 kilos of fluid a game! Intensive rehydration protocols utilizing supplementary drinks, electrolyte replacement technology and practical interventions in which water bottles are placed in player hands as opposed to be left lying across the field, will become increasing importantly as we expect more from the human body, travel more for international competitions and look for ways to gain competitive advantage.

The average person is exhausted after their daily gym workout so imagine your workout was tripled in time and intensity and then you may be slightly closer you how the body of an elite level rugby player feels, and that is before we consider the impact of injuries, travel and age related pains and niggles. Without aggressive supplementation post every single game and training session, elite level players muscular systems is constantly in breakdown mode – a negative physiological state that leaves players vulnerable to fatigue, injury, infection and illness. To say eat, is not enough, it is unfortunately not that simple. Rather, it needs to be eat this, in this quantity and this time for every meal, every day, is again the specificity required to not only allow for reasonable recovery for an athlete of this level and but again ensure that every aspect of a teams preparatory culture is optimal.

Pre Game Preparation
Most players at Super 14 and international level rugby are well organised. They basically know what to eat when they are training and in the gym but game day is a whole new ball game. Many will not feel like eating or travel and game logistics simply mean that the foods the players need are just not available but this is the most important time for optimal fuelling.

Ideally pre game preparation begins the day before a game; fluid loads, carbohydrate regimes with a training tapers and of course foods that digest well to prevent physical discomfort to ensure the player feels light and yet energized for the physically and emotionally game day. The exact carbohydrate types within any sports drink can be the difference between optimal fuelling and gastric comfort, again variables that are too important to be blasé about.

Players will rarely miss a gym session but they will readily miss the breakfast they need before the session and they will gladly skip the food they should be eating for a fantastic array of pills and potions that are guaranteed to make them stronger, fitter and faster than every before. Welcome to the world of supplementation. There is not doubt that elite level players do require some degree of supplementation to get the calories they require on day to day basis within the frantic world of international rugby but how they take these supplements is considered slightly less important. Players are shocked to hear that supplements will work better if they are consumed with food. Of course they will be, the human body is programmed to absorb complete nutrients and will always do so more efficiently when wholefoods are consumed. That is why supplement programs go hand in hand with food programs.

So, I think that what they eat is important. It is every bit as important as the weight programs they do in the gym, the training drills coaches spend hours formulating and the massages they rush to the tables post game to get. Food is the basis of the body, and rugby is about the strength, speed, the focus and physicality of the human body and yet it is still the one-thing coaches, administrators and apparently ex players are quick to downplay.

The funny thing is, that is always the true champions who are most respectful, who see the possible improvement in performance with small levels of intervention whether it be strength, conditioning or nutrition. Take Victor Matfield, arguably the worlds best line out forward, who sat quietly and respectfully in every one of the lectures I gave to his club on a recent trip to South Africa, even though he would have heard it all many times before. While junior players sniggered and carried on the way that young men in a group only can, Victor sat, listened and asked intelligent questions that inevitably has helped his team’s perforance in the recent Super 14 competition. These are the qualities of a true champion.

So, there can be ridicule, from ex players, coaching staff and even sometimes the players themselves, but every so often you work with a team in which you have been a part of a winning mentality, where all aspect of preparation including nutrition and have been second to none and the team outperforms itself. And that is what makes it all worth it.

My deepest congratulations to the Bulls for their standout season. I wish some of our teams here in Australia posessed your focus, commitment and vision which has so clearly paid off.

Monday, May 21, 2007

CSIRO for kids?

Last week the Federal government announced it would be funding CSIRO to formally evaluate "The CSIRO Total Well Being Diet" for children. Naturally this was met with both applause and resistance from health professionals. The health professionals who work with overweight children (including myself) are thrilled that we finally have an opportunity (and money) to formally evaluate the various dietary models we find work in clinical practice with these children. Others, who question CSIRO's funding background and the appropriateness of "diets" for kids once again find fault with any forward moving action.

At the end of the day, we have a lot of fat kids in Australia and any research we can get the government to fund to help evaluate management plans has to be a good thing.

Sunday, May 20, 2007

Another weight loss centre

It seems that yet another diet craze has hit the suburbs-the “Tony Ferguson Weight Loss Centre” is coming to a local shopping centre near you. This low carb craze will work, at least temporarily for many people but my concern is the people who have specific reasons for their weight problem; hormonal uses, psychological issues, for which, on the whole such centres rarely have the staff qualified to deal with such issues. So, you are thinking of trying it, or know someone who is, do your research and make sure it is the right program for you before you commit much time, energy and money to it. If it sounds too good to be true it probably is, low carb diets often only work in the short term and if there was an easy way to lose weight, I would tell you about it!

Thursday, May 17, 2007

Healthy or orthorexic? The new battle for teenage girls

Western societies obsession with everything thin and beautiful is frequently questioned in regards to the long-term effect this has on body image, self-esteem and the prevalence of eating disorders, particularly in the teenage population.

Teenage girls, for a myriad of reasons are a group of the population at particularly high risk in the high-pressured world in which they spend their adolescent years. Television, popular magazines and “My space” websites, are filled with stunning images of twelve going on thirty year old girls, pouting and posing with their lithe body’s wrapped in minute pieces of material, showing of the stunning physiques that bless us all during these brief few years.

While most will emerge from this period, strong and unscathed, for the vulnerable few who collapse under the pressure of this time, clinical disorders including depression and eating disorders become increasing common, potentially ruining young lives before they have even begun. The classification for clinical disorders is clearly defined in the DSM IV- the official manual used by the American Psychological Society to classify psychological disorders but as for any scientific definitions, there are outliers, and this is the case with an increasingly commonly seen condition in teenage girls – orthorexia.

Orthorexia was first described by an American doctor in the late 1990’s, who was seeing an increasing number of female patients who were exhibiting a number of eating disorder related symptoms including eating only an extremely limited food variety, and maintaining an extremely low body weight without satisfying the criteria for a clinical eating disorder. These girls were obsessed with only consuming foods that were “pure” and “healthy”, and as a result tended to consume only extremely low calorie, unprocessed foods, which in turn kept their body weight extremely low.

Unlike sufferers of a clinical eating disorder, these girls were not malnourished, as their diets were packed full of nutritious food choices, but in many cases their mood state was low either a result of a low food intake or a result of other stressors in their lives such as school issues caused by a clinical depression.

Orthorexia has been referred to less in the Australian scientific literature, with brief mentions in the lay media only but clinically over the past twelve months I have seen four teenage girls who too have presented in private practice with such symptoms. All cases have been teenagers between the ages of fourteen to sixteen, from middle class family backgrounds attending good schools. All girls have been classified as “very intelligent” but struggle socially with the pressures only teenage girls experience from peers - the lure of boys, the pressure to achieve at school and to look good. A trigger, either family distress or negative interaction at school appears to be a common link with all cases, leading to depressed mood and the desire to be in control of as many other variables in their life as they can, such as their food intake and the way they feel about their body.

From a clinician’s perspective, this is a challenging situation. The girls are underweight but not “unhealthy” and their eating patterns are disturbed, without being clinically disordered. Blood biochemistry can be checked for signs of physiological distress but in most causes, return within normal ranges as food or supplement intake, although minimal keeps the girls within normal biochemical ranges.

Maintaining an optimal baseline nutrient intake by ensuring adequate intake of core food groups including dairy, meat, oily fish and nuts is a positive initial step with these cases to ensure that the key nutrients; calcium, iron, zinc, protein and unsaturated fat are adequate.

Secondly, exploring the underlying emotional triggers such as stressors at home or at school that may be directly or indirectly related to the depressed mood and rigid eating patterns of these girls is an important part of the process to help empower them to be able to manage the various scenarios that arise in their day to day lives. There are a number of simple techniques including diarising all personal interactions with both friends and family that may be causing distress or anxiety is one way to help the girls learn to identify and manage their emotions, rather than using food and exercise as an escape from them.

Perhaps the most important step of all with this vulnerable patient group is developing a strong rapport and therapeutic alliance to help guide them and their family through this challenging period of their lives. Mums and dads are terrified as they see their baby girl struggle both physically and emotionally and need clinician support to empower them to help their teen through this intense period of their adolescent years.

While adolescents’ can be an extremely challenging group to work with, they can also be an enormously rewarding group to work with. I have now seen two of these girls work through their eating distress and are now well on their way into their final years of school, significantly happier and healthier than when I first saw them.

Unfortunately, the powerful media images of health and beauty are unlikely to disappear entirely and hence the incidence of conditions such as orthorexia is likely to increase. The key for health professionals and families affected is to know how to mange it before it is too late.

Wednesday, May 16, 2007

Helping Australia get healthy

People tend to have a number of pre-conceived ideas about what dietitians should and should not eat. It is as though once you become a fully qualified “diet Nazi” that you should never be seen consuming anything other than salad and day to day food traditions such as a sausage sandwich enjoyed at rugby training or a slice of cake with a cup of coffee need to be immediately abandoned. Such behaviours are greeted with total shock or disappointment by those who liked to view you as a dietary angel and who have since been bitterly disappointed.

This shock tends to be continued when dietitians are associated with food companies and their products, particularly if the company or the product are not what one may consider representative of a nutritionally ideal food choice.

Personally, while there are some products I would never feel comfortable endorsing, especially as the specialist obesity dietitian at one of Australia’s largest paediatric teaching hospitals, I still think it is important that dietitians play a significant role working with and for food companies to help them develop better food products for the average householder.

It is for this reason that I sit on the Coca Cola Nutrition Advisory Board. I do not do it because Coca Cola pay me huge amounts of money to tell the public that sugar sweetened beverages are good for you, I do it because if a company the size of Coca Cola is helped to improve the nutritional quality of their products, they have the potential to influence the health of a country, and that is pretty powerful stuff. A single dietitian can only educate and counsel so many people, but a large food company can influence the health of millions, directly by making better products or indirectly by improving the bad ones.

So, for this reason I congratulate companies like McDonalds and Coca Cola who are making an effort to improve their products rather than put their head in the sand and pretend that it is not their job to help their consumers in a quest to make healthier choices where possible.

But there is still much work to be done. There are many areas of the Australian packaged food supply that still require significant change. The major manufacturers of snack food, biscuits, cakes and breakfast cereal in Australia all need to look at ways in which they can improve the quality of fat and carbohydrate they are using with some of their products. No one is pointing the finger; there is not one food product that is making Australians’ fat but there is no doubt that there are a number of positive nutrition changes food companies could make to assist their customers with their weight battles.

And so, I challenge these food companies, the ones who have an enormous influence over what Australian children and adults buy and eat to start to think about how they can help Australians’ be healthier rather than bagging out other companies when they try. As is the case in elite sport, champion teams never spend time bagging out the opposition, instead they focus on building a competitive team that others want to be like. Why food companies waste time and money on advertising that bags out other products or legally trying to get new and innovative products off the market is beyond me. Can they instead spend this time and money on improving their own products and giving their consumers more healthy choices? Please tell me that some more of these powerful companies are up for the challenge?

Tuesday, May 15, 2007

Mixing good food with good health

Never has there been such interest in food. The number of food related magazine titles continues to increase and food lovers scour the pages as they sit in gourmet inner city delis, visualizing their next fabulous Sunday lunch. Celebrity chefs are as recognizable as rock stars in both Australia and internationally, with tickets to their special performances sell outs, at thousands of dollars per high profile, “who’s who of food” table.

Food preparation is considered an art; and failing to recognize a Picasso and his work by those who claim any form of food knowledge is the equivalent of food fraud. If you fail the test, you are sure never to be acknowledged in your career again.

And then there are the nutritionists; a tertiary educated bunch who are perceived to tell us all what we should and should not be eating; the food Picasso’s worst nightmare. As food stylists and directors dream of combining double thick cream with pork belly for a taste sensation never before experienced, the nutritionists tell the readers at the back of the publication that at least half of Australian adults are overweight or obese, and the double thick cream is not really such a good idea.

Why has this happened? Why is there such a division of “health” and “good” food? Why do the food magazines sit completely separate to the health magazines? Did Aristotle not say, “Let thy food be thy medicine”, not “let thy healthy food taste terrible”?

This apparent division only serves to fuel the perception for the humble foodies in suburbia that food that is considered nutritious for the body, the mind and ultimately the soul, cannot possibly taste good. You can eat your foie gras; but if you have high cholesterol suffer the consequences.

Health professionals who scream out the words, obesity, cholesterol, blood pressure, angina, insulin resistance and polycystic ovaries at every opportunity do need to take some responsibility for this view. For some time now, size 4, somewhat pasty looking dietitians lectured the more rounded amongst us about the risks of using butter on our thick white bread, almost forgetting that a jumbo sized bowl of pasta was perhaps not such a good idea either. If you do not simply adore food yourself, how could you possibly advise the average person how they can have their full fat cake and eat it too? Did they forget that low fat cheese, is actually not cheese. That once you remove the fat from it, the resultant plastic like mess, will not only refuse to melt hence failing to be useful in cooking at all, it also means that the consumer is not satiated after eating it and then tends to eats double the quantity of the low fat plastic stuff, which somewhat defeats the purpose.

The truth be known, if we all just simply ate a little less, of whatever it is we choose to eat; be it double thick cream, butter, bread; we would all be a lot better off and as a result, the cholesterol, insulin, glucose and blood pressure levels of thousands of people would all be improved.

Of all the scientific studies available that attempt to determine once and for all the optimal way to eat for health and longevity, the most convincing evidence comes from studies that have found we all simply need to eat less to live longer lives. Studies to date with both rats and primates have concluded that significant dietary restriction improves a number of the metabolic processes that are involved in aging including reducing free radical production (the nasty, cell damaging molecules) whilst improving immune function.

So where does this leave us, the consumer and our food loving Picasso’s? Perhaps it is as simple as promoting such a style of eating in the food print media. Focusing on small fillets of the leanest meat, a slice of pork belly, just a dollop of extra thick cream, or a sprinkle of rich Parmesan and opening telling the reader why. If the nutritionists and the food Picasso’s took a little time to talk, they would both realize they are all working toward a common goal and the public may be left a little less confused as to what constitutes healthy eating. The time to come together is now.

Monday, May 14, 2007

The first ever Australian nutrition blog

To the best of my knowledge, this is the first Australian nutrition blog! Having a blog on my site is a great way to continually update the nutrition info featured and to respond media reports straight away. It is my goal to add a little something to the site every day or two so stay tuned. Most importantly, it would also be great to get some of your feedback on topical issues as they arise.

It is now time for a champagne to celebrate the launch of the blog so until tomorrow!