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Tuesday, April 24, 2012

Butter or margarine?

The growing number of reality television shows that highlight home cooked meals as well as the use of copious amounts of butter and oil again bring up the question, “should we be using butter or margarine?” Indeed it is one of the most commonly asked questions when it comes to nutrition and as is the case with all areas of nutrition, the answer is not so simple.

If we take a step back and consider the role of any type of added fat in the diet, it is important to remember that the average adult will require just 40-60g of fat in total each day. If we then consider that a serve of nuts, some oil in cooking as well as some oily fish will provide at least 2/3 of this amount we are really just considering where we need to get just 10-15g of total fat, or 2-3 teaspoons each day. For those of you who are now considering how much butter or margarine you smear on your toast, or how much is added to the average recipe featured on television cooking shows, yes, you probably do need to cut back as we really do not need a lot of added fat in general.

So, of these 2-3 teaspoons which is best? Butter, while the spread of choice because of its more “natural” image is largely a saturated fat. A teaspoon of butter will give you almost 3g of saturated fat, the type of fat which we need to keep as low as possible in our diet as it is the type of fat most likely to store and clog our arteries. A teaspoon of margarine on the other hand; a formulated blend of different types of oils depending on the one you choose , will give <1g of saturated fat per serve.

The story then becomes a little more complicated when you then consider that many of the varieties of both butter and margarine are now blends of different oils, as food companies attempt to get rid of as much bad fat from both the butter and margarines they sell, while bumping up the good fats from monounsaturated and polyunsaturated sources. Light and extra light varieties of both butter and margarine mean that the total amounts of fat received from these sources can be as low as 2g of total fat per serve, which means that either used in moderation of just 1-2 serves each day can be incorporated into any nutritionally balanced eating plan.

Cholesterol lowering margarines offer another selling point to consumers, especially given there are also light varieties of such margarines which contain concentrated amounts of plant sterols which, when consumed in high enough volumes can significantly reduce blood cholesterol. What also needs to be considered though is that these spreads are very expensive, need to be used in the right amounts (3-4 serves a day) and the cholesterol lowering benefits are perhaps not as powerful as weight loss itself. Such formulated foods then suit individuals who do not need to lose weight, who eat a low fat diet in general and who still have elevated cholesterol levels.

So, have I answered the question about which is preferable? As a nutritionist, my focus is developing entire diet plans that tick a number of nutritional boxes. Dietary modeling will indicate that of all the types of fat in the average person’s diet, it is the long chain polyunsaturated fats that tend to be lacking in the diet. For this reason, when choosing spreads I generally suggest an extra light variety that offers a decent serve of polyunsaturated fat. As is the case with any added fat though, I would much prefer my clients get the fat in their diets from nuts, seeds, oily fish and good quality oil which means that there is really very little place for spreads in the diet in general.

Tuesday, April 10, 2012

Finding your motivation

“You can have anything if you want it desperately enough”

If I knew the secret to getting every single individual motivated I would be in a very powerful position indeed, but unfortunately, as is the case with many human attributes, motivation is a complex and changeable state. For many, motivation, particularly when it comes
to health and fitness routines in innate; we learnt to eat and behave in a certain way when were small and will continue to do so for the rest of our lives. For others, a health scare or realisation that you are 20kgs heavier than you should be gives us the kick we need to change our daily habits and turn our lives around. Then there are those individuals who just seem to never get it
and keep at it; they try one health and fitness craze after the other, never cementing a pattern of living that give their bodies and lives at better chance.

If you are reading this it is safe to say that on some level you are motivated. If you know that now you also need to cement your motivation it may be useful to clarify a few things. Some simple
questions that may help you to clarify the key reasons that you want to get your body fit and healthy and ultimately keep it that way include:

What are the benefits of keeping my body fit and healthy?
How would my life be better if I felt better about my body?
Am I the kind of healthy role model I would like to be for my children?
Can I physically do all the things I would like to with my body?
What am I really putting into my body each day?
If I was fit, healthy and happy what would I be eating and what training would I be doing each day?
If I knew I could keep my body disease free by eating well and moving, would I be more inclined to move more and eat less?
Who are the people in my life who would support me living like this?
What changes can I make to my lifestyle today that will help move me closer to my goal of living well and feeling healthy?

Having clear answers to some or all of these questions is not only useful in helping to remind you of the bigger picture reasons for wanting to get in shape and stay there but keeping the answers to such questions on hand can be very useful to refer back to when and if you do find yourself going off track.

The truth is that for behavioural change to be sustained, the desire for wanting it needs to come from within. It cannot be based on wanting to look good for a wedding, or to fit a certain dress, it
has to come from deep within to such an extent as it actually becomes part of you and you can no longer imagine life without it. As you embrace this new approach to weight loss and control, give yourself time to cement your new habits – you need 3 months. 3 months of regular training and eating well for these behaviours to become habits. And the longer the habit is with you, the harder it is to break.

Tuesday, April 3, 2012

Is your teen obsessed with being thin

A few years ago, I wrote a piece for Dolly magazine about an increasing common style of eating in which teenagers became somewhat obsessed with ‘healthy eating’. The girls typically presented with concerned parents who had noticed a change in eating habits and significant weight loss. These tall, lanky, lean girls did not satisfy the diagnostic criteria for a clinical eating disorder but refused to eat anything other than low calorie, low fat, unprocessed foods. Epitomizing all things natural’ and ‘healthy’, such a diet, solely consisting of fruits and vegetables, nuts, seeds and grains, while lacking in essential nutrients remained adequate (just) in calories so that followers become exceptionally thin, although not necessarily underweight.

Now whether it is becoming increasing common, or I just happen to see it in my clinic, again this week I have been referred two teenage girls with the same presentation - a presentation I am now treating as ‘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.

All cases I have seen in practice 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 a number of cases, return within normal ranges as food or supplement intake, although minimal keeps the girls within normal biochemical ranges.

For parents the scenario is exceptionally daunting. The rigid ‘all or nothing’ thinking that accompanies clinical eating disorders can be observed with this patient group, and we can be talking just a few kg shy of becoming clinically underweight. For this reason parents can be assured that the best thing they can do is to take control of the home food environment. Be strict with meal times, ensure family meals are enjoyed together and insist that your teen consumes the protein rich foods that they require for optimal growth and development in some form, whether it is in vegetarian protein rich options or via supplementary foods. Failure to comply with these basic eating rules needs to result in clear consequences such as removal of privileges or social media in the same way you would parent a toddler or small child. Most importantly, any link to weight loss and monitoring needs to be removed from the home, which means that the scales may need to be quickly thrown away.

Secondly, but most importantly 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. For teens that are exceptionally bright, keeping them busy and their minds active with scheduled exercise and/or sport, controlled social media usage and regular relaxation via pilates, yoga or meditation are other possible ways to shift their focus from food to life.

While adolescents’ can be an extremely challenging group to work with, they can also be an enormously rewarding client group. I have now seen a number of what I would describe as ‘orthorexic’ teens gradually 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 identify and manage this healthy food habit before it is too late.