Supplements and schoolboy athletes

Teenage boys love them, parents tend to be concerned about them and teachers try and ban them – supplements. The mix of white powders, special drinks and potions packaged in brightly coloured, extra-large containers with the words ‘huge’, ‘ripped’ and ‘massive’ plastered across the front in large bold writing via which school boys see the body of a Super 15 or NRL player suddenly within their reach.

So should we be concerned with teenage athletes turning to various supplements to boost their protein and nutritional intake to support weight gain? As is the case with all areas of nutritional science, there are two sides to the story. Of course parents should be concerned or at least aware of what their teenage athletes are consuming but the first thing to know is that we cannot group all supplements into the same category. There is a wide range of nutritional and performance supplements available, which all do very different things. Sure, some may warrant concern with various suspicious ingredients and stimulants, but many, as is the case with most ‘protein’ supplements are simply a mix of concentrated milk protein and some carbohydrates for energy.

Now while the most common question that comes from parents is, ‘can’t they just get their nutrition from their food and drink some extra milk?’ is warranted, here are some of the number to consider. A busy teenage athlete, competing in 2-3 different sports at a relatively high level will be burning and as a result require several thousand calories a day – and this is just to grow and develop normally. If the athlete then has considerably athletic ability identified and his sport will benefit from him gaining 5-10 extra kg, unless he is drinking a litre of milk in a sitting to get the equivalent 30-40g of protein he can get from a protein shake or eating large serves of lean meat or eggs at every meal and mid-meal, it is going to prove challenging for him to get the amounts of carbohydrates, calories and protein he will require for muscle growth and recovery on a daily basis. This is not to say that it cannot be done, just that it will require a lot of attention and eating – something which teenage boys are not necessarily good at, or have time for.

So for this reason, as long as the supplement schoolboy athletes are choosing is pure – that means contains just carbohydrates and proteins without growth additives such as creatine, which we do not know are safe for teenagers at this stage, and comes from a reputable Australian brand such as BSc, I do use protein supplements with school boy athletes. Naturally we stress that more is not better, and supplements will only work in conjunction with a strong baseline diet, but they are an option. And surely as parents it is better to know what they are having, where it comes from and make sure they are taking it the right way, as opposed to them purchasing a dodgy supplement from overseas and taking it on the sly, because this is what tends to happen deep in private school dorms late at night anyway.

 

 

Eating for HSC Success

With the exam period upon us and hundreds of thousands of high school students completing their final exams, stress levels within the family home are likely to be at an all time high. Getting your teen to eat well during this intense period may be more challenging than usual, but is crucial to ensure they are at their best mentally and physical throughout the entire exam period.

Breakfast is the most important meal of the day for all of us but is of utmost importance on the day of a big exam. Unfortunately nerves and stress are both likely to impact on appetite the morning of exams. It is absolutely imperative that some sort of breakfast is eaten on exam days. Skipping breakfast has been proven to reduce the ability to concentrate and remain focused throughout the morning and hence must be seen as a priority. Ideally a breakfast option that combines both low GI carbohydrates and lean proteins will sustain your teen throughout the morning. Good choices include eggs on wholegrain toast or oats or muesli with yoghurt and fruit. If solid food is not an option, try a liquid meal breakfast drink or protein shake. For worst case scenarios, a couple of dry crackers with spread or a muesli bar will be better than skipping breakfast altogether.

A second dietary factor to consider for busy students is whether they, particularly the girls are getting enough iron. Many teenage girls will cut back on red meat in their later high school years, but lean red meat is the best source of readily absorbable iron and ideally needs to be consumed in small amounts 3-4 times each week. If your teen appears abnormally tired, it may be worth having a blood test to check their iron levels and try and get them to eat red meat regularly throughout the exam period.

Finally, pay particular attention to how much caffeine and other stimulants your teen is consuming. Energy drinks, coffee and caffeine tablets may provide a short term energy burst but they can also result in increased heart rate and anxiety, insomnia and fluctuating blood glucose levels – all less than ideal symptoms for already stressed teens. Encourage your teen to drink water and herbal tea, limit their coffee intake to just 1 to 2 cups each day and encourage them to get plenty of rest during this time. Remember that small regular protein rich snacks of nut bars, protein drinks or dairy food will help to keep them alert and better able to concentrate and a good night sleep is sometimes the best thing for a tired and stressed out brain.

 

When a drink becomes a problem

A disclaimer before I begin this piece, I enjoy a drink. A glass of wine with a friend or a few vodkas on a big night out is a part of my life, as enjoying a few drinks each week is a part of many people’s lives. This column is not about a drink or two enjoyed occasionally and socially. It is not even about enjoying a glass or two of wine each night over dinner. This column is about drinking habits that are negatively impacting on your relationships, your health and ultimately your life. And unfortunately this is the type of drinking that we see far too often in Australia – ½ a case or a bottle or more on a daily basis that is not helping you to relax and unwind like you are telling yourself it is, it is serving as a crutch and escape from the real issue.

From a health perspective, excessive alcohol consumption causes two main issues – the first is that alcohol is relatively high in calories and hence it is easy to gain weight when we drink too much. Individuals who drink too much alcohol over many years often develop an alcohol fat apron around the abdominal area – for women this can make them appear pregnant, while for men a hard packed solid mass which is exceptionally hard to budge. The other issue, which is perhaps the worse of the two, is that excessive alcohol consumption results in disinhibit ion and lethargy -  you do and say things you should not, far less gets done, mood is impeding and basically you function at a much lower level than you could be at any point in time. Occasionally this is no issue but on a daily basis, this pattern of behaviour starts to destroy lives.

You know the stories – couples fighting after one partner have drunk too much again, someone passed out in front of the television at 9pm, the aggressive  and non-personable behaviours that can almost be 100% attributed to drinking too much. And alcohol and the perception of escaping pain and stress that it offers becomes a habit very, very quickly. What started as a twice a week habit is now a nightly one, in double the amounts that you once consumed. As you are used to now drinking this much it seems normal to you, once it starts to affect your health, your daily performance and your relationships, it is a problem and a problem that needs to be looked at more closely.

Signs that alcohol may be an issue in your life are as follows – if you cannot go a night without a drink, if you regularly pass out after a few drinks or if you cannot remember the night before, it is time to take action. One option that works for many is a complete break from alcohol – sometimes all that we need is a period without the substance whether it be a particular food or in this case alcohol to remind us of how much we are actually consuming and have become reliant on. If though the issue is bigger than this it is time to get professional help, as our lives and relationships are far too precious to be lost over beers or a cheap bottle of wine.

Why you should see a dietitian for weight loss and dietary advice

 

One of the most common questions that you get asked as a dietitian is ‘what is the difference between a dietitian and a nutritionist? Admittedly it is confusing – if anything the term nutritionist sounds far more user friendly compared to the term ‘dietitian’ which tends to conjure up images of a practitioner in a white coat dictating what you should and should not be eating. This is as opposed to nutritionist in which case we tend to imagine holistic health imagery filled with fresh fruit, vegetables and wellbeing.

While a dietitian is always also a nutritionist, this is not the case for a nutritionist. A dietitian is someone who has completed tertiary training, usually with a Master’s Degree at university in the area of nutrition and dietetics – the applied science of nutrition and its application to dietary change in people. To be called an Accredited Practising Dietitian (similar to an accredited accountant) you not only need to have completed this university training but annually complete a certain number of continuing education activities to ensure that your practice is current and up to date with the latest scientific research and its application to humans. The scientific training of a dietitian involves studying biochemistry, physiology, disease states, psychology, supervised nutritional counseling and statistical analysis. Such in depth training not only takes many years but teaches dietitians to be able to interpret scientific data and medical results in order to develop individual client dietary prescriptions based on scientifically proven data ad research. On the whole, the profession is highly regulated to ensure that best practice is ensured for our clients.

Nutritionists on the other hand are managed a little less rigidly – actually anyone can call themselves a nutritionist, and while some people may have studied nutrition at a tertiary level and earned various qualifications, others may simply have completed a course at a private college or via an online course. And for this reason, it is imperative that consumers check the credentials of the health professional that they are seeing. Recommending that those consumers wanting dietary advice or weight loss advice see a dietitian is given not because a nutritionist is not likely to improve the diet quality of any client that they see, but rather because dietary intervention can be a little more complicated.

To demonstrate this, a client story of mine that I will share with you;

A couple of years ago I saw a 32 year old female for weight loss. The female was roughly 90kg and had been feeling exceptionally tired. She has already seen a GP and an endocrinologist who had blamed the fatigue on a poor diet and her insulin resistance. Since these consults, my patient’s symptoms had not improved and she had also see a nutritionist at her gym who suggested she stop consuming wheat and dairy. Initially my client had felt better with this advice but she was still not losing weight and a month later she was still tired. When I first saw her, I simply changed her macronutrient ratios (her carb, protein and fat levels) slightly but had that practitioner sixth sense that all was not well with this girl. I have seen too many other women for weight loss, over many years to know when something is not right. My client appeared grey, low in energy and mood and even with insulin resistance her fatigue was extreme. When I went home I discussed the patient online with some dietitian colleagues – as a profession there is support available from other practitioners online when you are a dietitian. One of my colleagues suggested another endocrinologist simply as this one specialist had much experience with clients presenting with fatigue. While I continued to see the client and managed to help her lose 3kg, she finally got into the new specialist and was diagnosed with thyroid cancer. She has since had it removed and is in full remission.

Now I do not share this story to show off or claim glory but rather to show that simple dietary presentations whether they are fatigue, bloating, irritable bowel, bad skin or unexplained weight gain can be masking significant health issues, health issues which do need practitioners with a certain level of training to deal with. If I was not a dietitian I would not be in close contact with other medical professionals, nor would I have access to a 2000 other practitioners to reflect and discuss cases and refer on when necessary. Luckily in this case we were able to have a patient diagnosed with cancer thanks to these professional interactions and as a result ultimately saved her life. In my 12 years of practice I have seen 5 cancer diagnoses, numerous cases of insulin resistance and PCOS, more than 20 pregnancies and 12 coeliacs diagnosed – and I can guarantee that it was my training as a dietitian that resulted in these outcomes.

Telling someone to eat more fresh fruit and vegetables is unlikely to do any harm but it is always useful to be aware of ones limitations in this space, and when it comes to many dietary issues and weight loss, a dietitian is the best practitioner to manage these.

What is Zotrim and how can it help me lose weight?

As a dietitian you are constantly bombarded with the latest and greatest weight loss supplements and programs, and after more than ten years working in this field my response is generally lackluster to say the least. But I have to admit that late last year when Body Science presented me with the scientific evidence to support the herbal weight loss supplement Zotrim, I had to take it a little more seriously.

 Zotrim has been available in the UK for a few years now, and is a mix of three natural herbal extracts; Yerba Mate, Damiana and Guarana. The mix has been proven to help delay gastric emptying which appears to help keep users feel full and eat fewer calories as a result. Such a response appears to enhance weight loss attempts. For example, if you would usually get ½-1 kg off using a standard calorie controlled diet, in my experience Zotrim helps you to get 2 or 3kg. Users describe a constant feeling of fullness without the nasty stimulatory side effects of caffeine based supplements, and no other side effects.

As a nutritionist, my professional tendency is to always achieve sustainable weight loss results using what I know, and what is proven to work long term – calorie monitoring, high intensity exercise as well as regular movement. In the past I have generally not recommended weight loss supplements as there are none that I know are safe and /or proven to work. In the case of Zotrim, there is evidence to show that it can support weight loss. It does not change what you need to eat to lose weight, nor does it mean you do not have to exercise; it simply helps to control appetite and as a result caloric intake.

So is it for you? There are a few clients that I would support in using Zotrim. For anyone who battles with constant hunger and sugar cravings, using Zotrim in conjunction with a protein rich diet should help manage appetite. It should also be said here that if you need to lose more than 20-30kg, it may also be a good idea to have your insulin levels checked with your GP to ensure that an underlying insulin resistance is not acting to prevent weight loss. For those wanting to lose a little less, say 10-20kg, using Zotrim is likely to help you achieve better weight loss results initially, especially if you use it as part of a diet and exercise plan. If you can lose 2-3kg or even 5kg over a month using the supplement, chances are you are more likely to keep motivated compared to losing just 1-2kg with diet and exercise alone? Finally for those who simply want to lose a kg or two but struggle with portion control, Zotrim too may off you support with appetite, portion size and calorie control.

I have trialed Zotrim with a number of my clients with positive results. If you are looking for something to support your weight loss attempts, it may be worth trying Zotrim to see if you think it helps your attempts. And most importantly, make sure you let us know how you go.

Why I recommend meal replacement products for SOME clients

A few weeks back it was fructose, then gluten and now after posting a reference to a meal replacement product on Facebook there is lively debate on why a nutritionist would recommend a meal replacement product. So, here are my reasons given that a science degree and 10 years clinical experience working in weight loss does not seem to be enough.

For the record, a meal replacement is not a ‘protein shake’ – a meal replacement is a scientifically formulated product that contains similar macronutrients to that of a meal (20-30g total carbohydrate) as well as a full micronutrient profile with far fewer calories than that of a meal. Meal replacements were originally formulated and used with patients who were in need of rapid weight loss prior to surgery, when completely replacing all meals controlled calorie and carbohydrate intake to such an extent that the patient was put into ketosis and were able to lose weight rapidly.

While still used for this purpose, meal replacements are also commonly used on many ‘diet’ programs with the same goal, helping individuals to control calorie intake as well as being used as a meal option for meals which are commonly missed, such as breakfast.

Being trained as a dietitian, I was of course taught by academic types that as a nutritionist the focus should always be on fresh, healthy, natural food and using such products was really only a good option for those who were in desperate need of weight reduction under medical supervision ie as a dietitian always promote ‘real food’.

It was not until I began working at The Children’s Hospital almost 10 years ago solely with overweight and obese children and teens that I began experimenting with these products. In client cases in which I had an overweight teen that generally skipped breakfast, I began using these products as a breakfast alternative. The teens were often happy to ‘drink’ their high protein breakfast and almost to my disbelief we started to get positive weight loss results with these teens, even better than we got when we used standard breakfast options of cereal or eggs on toast.

It is was this observation that lead me to approach a supplier of meal replacement products in Australia to look at supplying product for a research trial and ultimately an endorsement of these products as I do get positive results using them in clinical practice for weight loss.

This is not to say that I recommend meal replacements for all of my clients but I do find that for breakfast skippers, busy executives who often miss meals and for those who need a weight loss kick-start after finding themselves on a tough weight loss plateau that meal replacement products can support weight loss.

To this day I still do not really know why these products work so well, but I do know that if I nutritionally model breakfast with a similar macronutrient ratio to than of a meal replacement that I do not get the same weight loss results and all I can put this down to is the calorie restriction even if it is only a 100 calorie difference between the standard breakfast option and a meal replacement product.

Then of course there is the ongoing aggression that arises whenever sugar is spied on a nutrition label. Meal replacements tend to be relatively high in sugars as a high protein drink will taste pretty ordinary without some sort of sweetener or sugar base to sweeten it up. This appears to have no negative outcome on insulin release or weight loss in these products simply as the high protein load of these products is likely to be buffering the sugar load, particularly as part of a tight calorie control.

Of course it would be amazing to have a randomized controlled trial that really investigates why and if these products really do work but I unfortunately do not have the 3 to 5 years an RCT takes to justify using these products, I need to get results with my weight loss clients now.

As is the case with every option in nutrition and life in general people can ultimately make their own decisions when it comes to the way they choose to go about weight control. It is not my job to tell everyone what they should do for weight loss. Nor is it to constantly defend why I choose different options working with clients towards sustainable weight loss – this is the art of my own clinical practice but if asked I can give my best scientifically informed opinion on what I find works well in practice and that is what I have done in the case of meal replacements. Whether or not you agree is up to you but there really is no need to get so nasty about it.

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.