Health Journal Online

Category: Nutrition

  • Hijacking Our Appetites 

    Hijacking Our Appetites 

    I debunk the myth of protein as the most satiating macronutrient.

    The importance of satiety is underscored by a rare genetic condition known as Prader-Willi syndrome. Children with the disorder are born with impaired signaling between their digestive system and their brain, so they don’t know when they’re full. “Because no sensation of satiety tells them to stop eating or alerts their body to throw up, they can accidentally consume enough in a single binge to fatally rupture their stomach.” Without satiety, food can be “a death sentence.”

    Protein is often described as the most satiating macronutrient. People tend to report feeling fuller after eating a protein-rich meal, compared to a carbohydrate- or fat-rich one. The question is: Does that feeling of fullness last? From a weight-loss standpoint, satiety ratings only matter if they end up cutting down on subsequent calorie intake, and even a review funded by the meat, dairy, and egg industries acknowledges that this does not seem to be the case for protein. Hours later, protein consumed earlier doesn’t tend to end up cutting calories later on.

    Fiber-rich foods, on the other hand, can suppress appetite and reduce subsequent meal intake more than ten hours after consumption—even the next day—because their site of action is 20 feet down in the lower intestine. Remember the ileal brake from my Evidence-Based Weight Loss lecture? When researchers secretly infused nutrients into the end of the small intestine, study participants spontaneously ate as many as hundreds fewer calories at a meal. Our brain gets the signal that we are full, from head to tail.

    We were built for gluttony. “It is a wonderful instinct, developed over millions of years, for times of scarcity.” Stumbling across a rare bounty, those who could fill themselves the most to build up the greatest reserves would be more likely to pass along their genes. So, we are hard-wired not just to eat until our stomach is full, but until our entire digestive tract is occupied. Only when our brain senses food all the way down at the end does our appetite fully dial down.

    Fiber-depleted foods get rapidly absorbed early on, though, so much of it never makes it down to the lower gut. As such, if our diet is low in fiber, no wonder we’re constantly hungry and overeating; our brain keeps waiting for the food that never arrives. That’s why people who even undergo stomach-stapling surgeries that leave them with a tiny two-tablespoon-sized stomach pouch can still eat enough to regain most of the weight they initially lost. Without sufficient fiber, transporting nutrients down our digestive tract, we may never be fully satiated. But, as I described in my last video, one of the most successful experimental weight-loss interventions ever reported in the medical literature involved no fiber at all, as you can see here and at 2:47 in my video Foods Designed to Hijack Our Appetites.

    At first glance, it might seem obvious that removing the pleasurable aspects of eating would cause people to eat less, but remember, that’s not what happened. The lean participants continued to eat the same amount, taking in thousands of calories a day of the bland goop. Only those who were obese went from eating thousands of calories a day down to hundreds, as shown below and at 3:22 in my video. And, again, this happened inadvertently without them apparently even feeling a difference. Only after eating was disconnected from the reward was the body able to start rapidly reining in the weight.

    We appear to have two separate appetite control systems: “the homeostatic and hedonic pathways.” The homeostatic pathway maintains our calorie balance by making us hungry when energy reserves are low and abolishes our appetite when energy reserves are high. “In contrast, hedonic or reward-based regulation can override the homeostatic pathway” in the face of highly palatable foods. This makes total sense from an evolutionary standpoint. In the rare situations in our ancestral history when we’d stumble across some calorie-dense food, like a cache of unguarded honey, it would make sense for our hedonic drive to jump into the driver’s seat to consume the scarce commodity. Even if we didn’t need the extra calories at the time, our body wouldn’t want us to pass up that rare opportunity. Such opportunities aren’t so rare anymore, though. With sugary, fatty foods around every corner, our hedonic drive may end up in perpetual control, overwhelming the intuitive wisdom of our bodies.

    So, what’s the answer? Never eat really tasty food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment.

    Ironically, some researchers have suggested a counterbalancing evolutionary strategy for combating the lure of artificially concentrated calories. Just as pleasure can overrule our appetite regulation, so can pain. “Conditioned food aversions” are when we avoid foods that made us sick in the past. That may just seem like common sense, but it is actually a deep-seated evolutionary drive that can defy rationality. Even if we know for a fact a particular food was not the cause of an episode of nausea and vomiting, our body can inextricably tie the two together. This happens, for example, with cancer patients undergoing chemotherapy. Consoling themselves with a favorite treat before treatment can lead to an aversion to their favorite food if their body tries to connect the dots. That’s why oncologists may advise the “scapegoat strategy” of only eating foods before treatment that you are okay with, never wanting to eat again.

    Researchers have experimented with inducing food aversions by having people taste something before spinning them in a rotating chair to cause motion sickness. Eureka! A group of psychologists suggested: “A possible strategy for encouraging people to eat less unhealthy food is to make them sick of the food, by making them sick from the food.” What about using disgust to promote eating more healthfully? Children as young as two-and-a-half years old will throw out a piece of previously preferred candy scooped out of the bottom of a clean toilet.

    Thankfully, there’s a way to exploit our instinctual drives without resorting to revulsion, aversion, or bland food, which we’ll explore next.



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  • What Is “Pine Mouth Syndrome”? 

    What Is “Pine Mouth Syndrome”? 

    Why do some pine nuts cause a bad taste in your mouth that can last for weeks?

    The reason I make pesto with walnuts instead of the more traditional pine nuts isn’t only because walnuts are probably healthier with 20 times more polyphenols, but also because of a mysterious phenomenon known as PMS. Not that PMS. Pine mouth syndrome is characterized by what has become my favorite word of the week: cacogeusia, meaning a bad taste in your mouth. You can get cacogeusia from heavy metal toxicity, seafood toxins, certain nutritional and neurologic disorders, or the wrong kind of pine nuts. “Termed ‘Pine Mouth’ by the public, cases present in a roughly similar fashion: a persistent metallic or bitter taste beginning 1–3 days following ingestion of pine nuts lasting for up to 2 weeks.”

    As I discuss in my video Pine Mouth Syndrome: Prolonged Bitter Taste from Certain Pine Nuts, thousands of cases have been reported, and it doesn’t seem to matter if the pine nuts are raw or cooked. Could the cause be an unidentified toxin present in some varieties of non-edible pine nuts? Indeed, “out of more than 100 species of the Pinus genus, [only] 30 are considered to be edible by the Food and Agriculture Organisation of the United Nations.”

    Researchers analyzed pine nut samples from consumers who had fallen ill and found that, indeed, they all contained nuts from Chinese white pine, which is not reported to be edible. That tree is typically used only for lumber. You can see photos of inedible and edible pine nuts below and at 1:36 in my video.

    More photos can be seen here and at 1:40.

    We don’t know it’s the Chinese white pine nuts, though, until we put it to the test. Researchers gave study participants six to eight Chinese white pine nuts. Most hadn’t ever heard of pine mouth syndrome, and they all developed symptoms. We still don’t know exactly what it is in those nuts that causes such a bizarre reaction. We know to stay away from those kinds of pine nuts.

    So, what kinds of pine nuts are on shelves in the United States? All kinds, apparently, “including those associated with pine mouth.” You can see more examples below and at 2:19 in my video.

    Unsurprisingly, hundreds of cases of PMS have been reported in the United States. Most of the implicated nuts “were predominantly reported to be labeled from or originating from Asia, and in most cases China,” as seen here and at 2:30 in my video.

    The European Union demanded that China stop sending them toxic nuts, which they did beginning in 2011. “This export restriction likely resulted in a global export restriction of these species to the US as well,” given the decline in cases going into 2012, as shown below and at 2:47. 

    Rare cases still occur, though, as evidenced by an active Facebook group entitled “Damn you, Pine Nuts.” The primary reason I made this video is to allay fears should this ever happen to you. “There are no proven therapies for PMS. The only treatment is to cease ingesting implicated nuts and to wait for symptoms to abate.” Thankfully, pine mouth syndrome appears to be benign and goes away on its own.



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  • Childhood obesity through a weight-inclusive lens

    Childhood obesity through a weight-inclusive lens


    In this episode, we’re joined by Dr Brooke Harcourt, an experienced paediatric dietitian and researcher, to explore how dietitians can support children living with overweight or obesity using a compassionate, evidence-based approach. Brooke unpacks the evolving landscape of paediatric obesity care, including the impact of weight stigma, the shift toward non-diet, weight-inclusive practice, and how to build trust with families. We also touch on the emerging use of GLP-1 medications in adolescents and when these rare, specialist-led cases may be considered. Tune in for practical strategies, language tips and real-world insights to support families with care.

    Hosted by Bec Sparrowhawk

    Biography

    Dr Brooke Harcourt is an approachable Accredited Practicing Dietitian and nutrition therapist with over a decade of experience in infant and child nutrition and metabolism conditions. She is nationally and internationally recognised for her medical research into endocrine conditions having completed research fellowships at the UQ Translational Research Institute, Baker Heart and Diabetes Institute, the Royal Children’s Hospital and Murdoch Childrens Research Institute. Brooke runs a large private practice, Family Dietetics, and a specialised ‘Therapy Kitchen’, where her and the team take a practical approach to attainable nutrition through feeding therapy and food learning programs in a real kitchen therapy environment. She also offers dietetics services at specialist paediatric centres, eating disorder services and the Victorian Department of Corrections and Youth Justice System. Brooke has a particular passion for helping infants and young people establish healthy growth curves, overcome eating disorders and traumatic feeding histories, and improving nutrition access for young people with disability, developmental and neurodevelopmental conditions.

     

    In this episode, we discuss how to:

    • Actively challenge weight stigma and create a safe space for families.
    • Communicate with confidence using language that empowers, not shames.
    • Prioritise validating families’ experiences and setting achievable, health-focused goals.
    • Understand the clinical context of GLP-1 use in adolescents

     

    DISCLAIMER:  In this episode, we’ll use clinical terms like ‘childhood obesity’ when needed to reflect current guidelines – but our focus is firmly on weight-inclusive, family-centred approaches that support health without stigma. This episode is targeted to dietitians with experience in paediatrics.

    Additional resources

    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.


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  • Lose 200 Lbs Without Feeling Hungry 

    Lose 200 Lbs Without Feeling Hungry 

    I dive into one of the most fascinating series of studies I’ve ever come across.

    Anyone can lose weight by eating less food. Anyone can be starved thin. Starvation diets are rarely sustainable, though, since hunger pangs drive us to eat. We feel unsatisfied and unsatiated on low-calorie diets. We do have some level of voluntary control, of course, but our deep-seated instinctual drives may win out in the end.

    For example, we can consciously hold our breath. Try it right now. How long can you go before your body’s self-preservation mechanisms take over and overwhelm your deliberate intent not to breathe? Our body has our best interests at heart and is too smart to allow us to suffocate ourselves—or starve ourselves, for that matter. If our body were really that smart, though, how could it let us become obese? Why doesn’t our body realize when we’re too heavy and allow us the leeway to slim down? Maybe our body is very aware and actively trying to help, but we’re somehow undermining those efforts. How could we test this theory to see if that’s true?

    So many variables go into choosing what we eat and how much. “The eating process involves an intricate mixture of physiologic, psychologic, cultural, and esthetic considerations.” To strip all that away and stick just to the physiologic variable, Columbia University researchers designed a series of famous experiments using a “food dispensing device.” The term “food” is used very loosely here. As you can see at 2:02 in my video 200-Pound Weight Loss Without Hunger, the researchers’ feeding machine was a tube hooked up to a pump that delivered a mouthful of bland liquid formula every time a button was pushed. Research participants were instructed to eat as much or as little as they wanted at any time. In this way, eating was reduced to just the rudimentary hunger drive. Without the usual trappings of “sociability,” meal ceremony, and the pleasures of the palate, how much would people be driven to eat? 
    Put a normal-weight person in this scenario, and something remarkable happens. Day after day, week after week, with nothing more than their hunger to guide them, they eat exactly as much as they need, perfectly maintaining their weight, as shown below and at 2:36 in my video.

    They needed about 3,000 calories a day, and that’s just how much they unknowingly gave themselves. Their body just intuitively seemed to know how many times to press that button, as seen here and at 2:48 in my video.

    Put a person with obesity in that same scenario, and something even more remarkable happens. Driven by hunger alone, with the enjoyment of eating stripped away, they wildly undershoot, giving themselves a mere 275 calories a day, total. They could eat as much as they wanted, but they just weren’t hungry. It’s as if their body knew how massively overweight they were, so it dialed down their natural hunger drive to almost nothing. One participant started the study at 400 pounds and steadily lost weight. After 252 days of sipping the bland liquid, he lost 200 pounds, as you can see here and at 3:35 in my video.

    This groundbreaking discovery was initially interpreted to mean that obesity is not caused by some sort of metabolic disturbance that drives people to overeat. In fact, the study suggested quite the opposite. Instead, overeating appeared to be a function of the meaning people attached to food, “aside from its use as fuel,” whether as a source of pleasure or perhaps as relief from boredom or stress. In this way, obesity seemed more psychological than physical. Subsequent experiments with the feeding machine, though, flipped such conceptions on their head once again.

    When researchers covertly doubled the calorie concentration of the formula given to lean study participants, they unconsciously cut their consumption in half to continue to perfectly maintain their weight, as seen here and at 4:24 in my video. Their body somehow detected the change in calorie load and sent signals to the brain to press the button half as often to compensate. Amazing!

    When the same was done with people with obesity, though, nothing changed. They continued to drastically undereat just as much as before. Their body seems incapable of detecting or reacting to the change in calorie load, suggesting a physiological inability to regulate intake, as shown below and at 4:40 in my video. 
    Might the brains of persons with obesity somehow be insensitive to internal satiety signals? We don’t know if it’s cause or effect. Maybe that’s why they’re obese in the first place, or maybe the body knows how obese it is and shuts down its hunger drive regardless of the calorie concentration. Indeed, the participants with obesity continued to steadily lose weight eating out of the machine, regardless of the calorie concentration and the food being dispensed, as you can see here and at 5:19 in my video. 
    It would be interesting to see if they regained the ability to respond to changing calorie intake once they reached their ideal weight. Regardless, what can we apply from these remarkable studies to facilitate weight loss out in the real world? We’ll explore just that question next.



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  • 体重无故下降 (Unintentional weight loss) | Dietitian Connection

    体重无故下降 (Unintentional weight loss) | Dietitian Connection

    What’s included:
    ✓     Simplified Chinese version of the patient resource ‘Unintentional weight loss’

    Translated by: Tracy Xiao (Australian APD)

     

    View the English version here

    The patient resources are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances.  The patient resources are for your information only, and we advise that you exercise your own judgment before deciding to use the information provided. Professional medical advice should be obtained before taking action.  Please see here for terms and conditions.

    Please note that all of our resources must be used in full and are unable to be personalised or customised.

     

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  • What is IBS? And can health coaches help clients with it?

    What is IBS? And can health coaches help clients with it?

    Many people with IBS would trade 10 to 15 years of life expectancy for an instant cure for their condition.

    This is according to the results of a study of nearly 2,000 people with irritable bowel syndrome (IBS).1

    In other research, people with IBS said they would take a medicine that carried a one percent risk of sudden death if it would cure their symptoms2—which can include urgent bouts of diarrhea, gas, or persistent constipation.

    Some people with IBS experience bouts of abdominal pain they describe as worse than childbirth. These flare-ups can siphon concentration, interrupt sleep, and destroy work productivity.3

    As a result, many people with IBS plan their lives around the availability of private, clean bathrooms. Fear of a sudden flare-up leads some to avoid restaurants, get-togethers, even exercising in public.

    This pervading worry has a name—gastrointestinal-specific anxiety—and it can affect everything from social relationships to overall well-being. It’s also the main reason people with IBS report worse quality of life than people with other chronic conditions, including heart disease, diabetes, and end-stage kidney disease.4

    If you or a client has IBS, there are ways to manage it.

    PN Super Coach Sarah Maughan, certified through Monash University—a global leader in understanding the link between food sensitivities and IBS—has witnessed how lifestyle changes can prevent flare-ups, calm GI anxiety, and allow people with IBS to live the lives they want.

    “My hope is for everyone with IBS to know they have options, whether that’s turning to a physician for medication and/or a health coach to learn about lifestyle changes and how to put them into action,” says Maughan.

    In this article, we’ll hear more from Maughan. You’ll also learn:

    • What IBS is, including why it happens and the different ways it can manifest
    • What your poo can tell you about the health of your digestive tract
    • Five evidence-based lifestyle changes that can improve IBS symptoms
    • The best way to determine which foods trigger your or your client’s IBS symptoms (and which foods are usually “safe” to eat)

    Plus, if you’re a health coach, you’ll learn how to support clients with IBS while safely staying within your scope of practice.

    So, what is IBS?

    Sometimes referred to as “spastic colon,” IBS is the most commonly diagnosed digestive disorder in the world, affecting about 14 percent percent of adults.5

    Unlike Crohn’s and other inflammatory bowel diseases (IBD), IBS doesn’t alter the architecture of the gut. When healthcare professionals use diagnostic imaging, they find no infections, inflammation, damage to the bowel wall, or other evidence of disease.

    Years ago, this lack of visible disease led many healthcare professionals to assume that IBS was purely psychological. More recently, however, this thinking has shifted.

    Experts now view IBS as a functional neuro-gastrointestinal disorder.

    That means the nerves between the GI tract and the brain don’t function optimally, causing the brain to deliver unnecessary pain signals and interfere with typical bowel function.

    What are the symptoms of IBS?

    IBS symptoms can come and go, with some people experiencing months or years of relief only to suffer a severe flare-up that can last hours to weeks.

    In addition, not everyone with IBS experiences the same set of symptoms, which can make the condition challenging to diagnose.

    The below illustration shows the range of IBS symptoms.

    Image illustrates various symptoms of IBS—abdominal pain; cramping; stool irregularities such as constipation, diarrhea, or both in alternation; excessive gas and bloating; mucus in stools; and/or incomplete bowel movements.

    What causes IBS?

    Researchers are still trying to understand why the gut functions differently in people with IBS. However, they do have a few theories.

    According to one hypothesis, the nerve endings in the GI tract may be overly sensitive in people with IBS. This can lead to two different sets of symptoms.

    ▶ Hypersensitive nerves communicate pain signals to the brain, causing people with IBS to notice digestive processes that other people wouldn’t feel. Tiny gas bubbles may be severely uncomfortable for someone with IBS, for example, but not bother someone without the disorder.

    ▶ Overreactive nerves can trigger GI muscles to contract with too much force, leading to gas, bloating, and diarrhea. If they underreact, the same muscles don’t contract forcefully enough, which slows the passage of food through the intestine and leads to constipation.

    Another theory blames disturbances on the gut microbiome, which helps to explain why some people develop IBS symptoms after first having a severe GI illness like the Norovirus.

    How is IBS diagnosed?

    If you or your client suspect IBS, see a credentialed health professional.

    The symptoms of IBS overlap with several other gastrointestinal diseases and health conditions that can require medication, surgery, or medically-supervised lifestyle changes. These include infections, inflammatory bowel diseases, celiac disease, cancer, and food allergies, among others.

    It’s especially important to see a medical professional if you or your client notice any of the following:

    • Rapid, unintentional weight loss
    • Rectal bleeding, blood in stools, or vomiting blood
    • Bouts of diarrhea that disturb sleep
    • Diarrhea with fever
    • Continuous abdominal pain
    • A sudden onset of GI symptoms after age 50

    IBS Types

    In addition to ruling out other GI conditions, a healthcare professional will also ask detailed questions about you or your client’s symptoms. This information allows them to pinpoint which IBS “type” you or your client might have:

    • IBS-D, which means someone predominantly has diarrhea
    • IBS-C, which is characterized by constipation
    • IBS-M, which means someone has alternating periods of diarrhea and constipation
    • IBS-U, which means someone’s symptoms don’t neatly fall into any of the above categories

    You or your client’s IBS type will inform what your healthcare professional recommends.

    A healthcare provider might suggest a short course of antibiotics and antidiarrheal medicine for IBS-D. On the other hand, for IBS-C, they might recommend a fiber supplement, non-habit-forming laxative, laxative-like medication, or other medicine that reduces the perception of pain and regulates bowel movements.

    How to prepare for a medical appointment: Your pre-appointment checklist

    In order to get the most out of the visit, you can help your client (or yourself) prepare for a healthcare appointment.

    A healthcare professional will likely ask the following questions, so consider the responses beforehand:

    • How long have you experienced these symptoms?
    • Did anything change around the time your symptoms began? (Stress levels? Dietary habits? Recent travels?)
    • Did you recently have food poisoning or gastroenteritis?
    • How much fiber do you consume?
    • How is your sleep quality? How many hours do you usually sleep at night?
    • How often do you exercise?

    Another way to prepare for your first appointment?

    Well, you might not like it, but it’s a good idea to…

    Look at your poo

    Consider keeping a poo diary for a couple of weeks before your appointment.

    In the diary, track the frequency of bowel movements and other symptoms. Use the Bristol Stool Chart (below) to take note of the quality of your poo. This information can help your healthcare professional assess whether you have IBS and which type.

    What does IBS poo look like? The following chart shows various types of stool and what they mean. For example, type 1 is small, hard and difficult to pass, which means poor quality. Type 2 is sausage shaped but lumpy, which is not great either. Type 3 is sausage shaped but cracked, which is so-so. Type 4 is sausage shaped, smooth, and soft, which means good quality. Type 5 is small and soft with defined edges, which is so-so. Type 6 is very small and mushy with ragged edges, which is also not great. And type 7 is watery, which is poor quality. People with IBS tend to struggle with type 1,2, 6, or 7—or a mix of all.

    (To learn more about the clues your poos can hide, read: 6 reasons you should care about your poop health)

    How to help IBS: 5 strategies to support bowel health and function

    In recent years, the U.S. Food and Drug Administration approved several new prescription medicines for IBS, along with a medical device that stimulates the cranial nerves behind the ear.

    In addition, thousands of research papers have looked at the interaction between IBS and various lifestyle habits, with many promising findings.

    Here are five evidence-based ways to reduce the symptoms of IBS (and bonus, many of them are great for enhancing overall health too).

    IBS relief strategy #1: Add exercise

    People with IBS who exercise regularly tend to experience fewer symptoms and flare-ups than people who don’t exercise.

    When researchers asked people with IBS to walk moderately for an hour three times a week, study participants experienced significant relief from bloating and abdominal pain within 12 weeks.6

    How exercise soothes IBS isn’t fully understood, though.

    According to other research, exercise may reduce stress and improve mental health, which, in turn, may help improve communication between the gut and the brain.7 8

    Another theory argues that exercise helps encourage the growth of health-promoting gut bacteria, which may help to break down food more efficiently and decrease inflammation.9

    IBS relief strategy #2: Work on stress management

    Anxiety, stress, and depression all activate stress hormones like norepinephrine (noradrenaline) and cortisol, which can:

    • Amplify gut-based pain signals
    • Alter the balance of bacteria in the gut (known as the gut microbiome)
    • Increase intestinal permeability—potentially allowing harmful substances into the bloodstream10 11 12

    Of course, stress doesn’t come with an on/off switch.

    Simply telling yourself, “Stop getting so stressed out!” won’t likely help—and may even paradoxically lead to more stress.

    That’s why Precision Nutrition-certified coaches like Maughan help clients learn to focus on what’s within their control—such as practicing self-compassion, or experimenting with nervous system regulators like yoga, breathing exercises, and gentle walking.

    As the image below illustrates, clients can control how they perceive, respond to, and anticipate stressors—but not always the stressors themselves.

    Image shows three nested circles. The outer-most circle is where you have no control, such as the weather or other people's thoughts and actions. The middle circle is where we have some control, such as your schedule and who you choose to include in your support team. The inner-most circle is where you have total control, such as your mindset and the level of effort you put in.

    Either way, when clients focus more on what they can control and less on what they can’t, they often feel calmer and more capable.

    (If you want to help a client figure out just what’s within their control—and what’s not—try out our free worksheet: Sphere of Control Worksheet)

    (Assess your current stress load by taking our free quiz: Do you have a Stress Bod?)

    IBS relief strategy #3: Slow your eating pace

    PN coaches have long appreciated and advocated slower, more relaxed eating.

    Yes, slow eating helps people fill up on fewer calories—but it also tends to help clients reduce or even eliminate GI woes like acid reflux, bloating, and pain.

    For one, slower eating often translates to more chewing. In addition to mechanically mashing food into a pulp, increased chewing also allows the mouth’s digestive enzymes to pre-digest food. As a result, the stomach and intestines have to work less hard.

    Plus, eating in a relaxed setting often lowers stress hormones like norepinephrine and cortisol, making it less likely that they will intensify GI pain signals.

    According to Maughan, this can be especially important for young parents, as it’s not always easy to eat undistracted and peacefully when tending to little ones.

    (Sounds simple, but slow eating is more challenging than people think—and a lot more impactful. Learn more: Try the slow-eating 30-day challenge.)

    IBS relief strategy #4: Troubleshoot sleep problems

    According to research, people with IBS experience more shallow, less restorative, and more interrupted sleep.13

    Because of poor sleep quality, many people with IBS sleep more hours overall than people without IBS—yet feel less rested.

    Fatigue can then set off a vicious cycle. When people don’t sleep restfully, stress hormone levels tend to be higher, which can exacerbate gut pain.14

    Unrested people also tend to feel hungrier during the day. Cravings for fats and sweets also intensify, driving people to reach for the very foods more likely to trigger IBS symptoms—and wolf them down too quickly.

    Stopping this cycle can be challenging.

    As with stress, you can’t simply will yourself to sleep more restfully.

    However, the first three strategies—exercise, stress management, and slower eating—can all help.

    Some PN clients have found that consuming a smaller dinner earlier in the evening gives their bodies more time to digest before bed. Other clients tell us that a relaxing pre-bedtime routine—a few minutes of foam rolling, a guided meditation, a bath, or some journalling—tends to help.

    (Find out the best practices for getting better sleep by checking out our infographic: The power of sleep)

    IBS relief strategy #5: Investigate your diet

    While there’s no one-size-fits-all IBS diet, experts have identified several food categories that are more likely to be problematic for many people. These include:

    ▶ Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs), which are a family of carbohydrate-rich foods that are poorly absorbed in the small intestine. Even in people without IBS, these foods tend to slow digestion and attract water. When gut bacteria ferment them, they produce gas, which can stretch the intestinal wall. For most, this slowed digestion and gas isn’t especially noticeable; In people with IBS, it can lead to intense pain. High-FODMAP foods include wheat, rye, barley, onions, garlic, beans, dairy, honey, cashews, some processed meats, and many fruits and vegetables. (More about FODMAPs in the next section.)

    ▶ Caffeinated beverages and foods, especially coffee, which trigger the release of stress hormones, stimulate the production of stomach acid, increase muscle contractions in the colon, and irritate the lining of the intestine.15

    ▶ Alcohol and spicy foods that irritate the gut.16 17

    ▶ High fructose corn syrup and sugar alcohols such sorbitol and mannitol, which have been linked to gas, bloating, and diarrhea in susceptible people.18 19

    ▶ Fatty, greasy foods, which can slow digestion and attract water, leading to loose stools, bloating, and gas.20 21

    If the idea of giving up all the foods and beverages on the above list has you in a cold sweat, know this…

    Not everyone with IBS is sensitive to the same foods and beverages.

    “Everyone can have different triggers,” says Maughan. “That’s why it’s so important to figure out what makes your body feel good and what doesn’t.”

    Some people struggle with apples but are okay with berries. Others can drink green tea but not black. One person might be able to consume five to eight ounces of beer but not 12. A gluten-free diet may work great for some but not others.

    Similarly, many people find relief by avoiding certain high-FODMAP foods. However, you may only be sensitive to some FODMAPs and not others. If so, eliminating all FODMAPs would be unnecessarily restrictive and difficult to follow consistently.

    For this reason, it can be helpful to try an elimination diet to see which foods and beverages are problematic—along with the quantities you can safely tolerate, says Maughan. You’ll learn more about elimination diets in the next section.

    (Want someone to walk you through exactly how to do an elimination diet? Read: How and why to do an elimination diet.)

    Scope of Practice: How to coach someone with IBS

    In our online coaching communities, we often see people asking some version of the following question:

    “My client just told me that she has IBS. Am I allowed to continue to coach this person?”

    The answer: Yes, you certainly can.

    As we mentioned, Maughan specializes in helping people with digestive problems. Coaching someone with IBS is no different than coaching a client with any other nutritional goal, she says.

    “Because IBS is often largely associated with what someone eats, it’s within a coach’s wheelhouse—with some caveats,” says Maughan. “You can’t diagnose your client with the condition, and you should make it clear that you’re not prescribing a diet for them. In addition, you should encourage clients to seek care from a medical professional, especially if you suspect something other than IBS is going on.”

    To stay within your scope of practice, follow these do’s and don’ts.

    DO DON’T
    Encourage clients with digestive issues to visit a healthcare professional so they can get a definitive diagnosis. Tell clients, “It sounds like you might have IBS.”
    Share information about potential lifestyle changes, including elimination diets. Help clients run experiments that allow them to gain insight about the connection between their lifestyle, diet, and their body. Pitch a rigid and restrictive diet as a treatment that will cure all of the client’s digestive problems.
    Offer to work with a client’s medical team. Help the client adopt and remain consistent with the lifestyle changes their team recommends. Contradict medical professionals by telling clients that the medical establishment always gets IBS wrong.
    Support clients with optional recipes and other tools that help them put what they learn about their body into practice. Create a prescriptive anti-IBS meal plan for a client to follow.
    Encourage clients to experiment with a multi-disciplinary approach to managing IBS so they can discover the right combination of approaches that works for them. Tell clients that you have all the answers or that they don’t need to seek medical advice or therapies.
    Ensure clients know they can choose to make any given lifestyle change—or not. Use force or fear to manipulate clients into following your advice.

    Elimination diets for IBS: How and when to try them

    Elimination diets do what the name suggests: They exclude certain foods for a short period—usually three weeks. Then, you slowly reintroduce specific foods and monitor your symptoms for possible reactions.

    Elimination diets work a lot like a science experiment that helps you identify problematic foods.

    The phrase “elimination diet” may sound scary and off-putting, as if you’ll be living for months on bland food you have to slurp through a straw.

    However, there are many different types of elimination diets, with some much less restrictive than others.

    Here are a few versions.

    Elimination diet “lite” for IBS

    This is an excellent option for people who suspect they already know which foods and beverages trigger symptoms.

    It goes like this: You eliminate up to four foods for several weeks. Then, slowly reintroduce them one at a time to see if your symptoms return.

    Let’s say, for example, from experience, you know you feel bad whenever you eat dairy. On the lite elimination diet, you’d eliminate just dairy for three weeks. Then you’d reintroduce it to see how you feel.

    Elimination Diet “medium” for IBS

    If you’re unsure of how food interacts with your GI tract—but aren’t ready for a super restrictive eating plan, our Precision Nutrition elimination diet is likely the way to go.

    Created by PN and approved by several registered dietitians, the plan removes many of the foods most likely to cause problems, while still including a variety of vegetables, fruits, starches, legumes, nuts, seeds, and meats, so you can continue to eat a well-balanced diet.

    To learn more, download our FREE Ultimate Guide to Elimination Diets. This ebook has everything you need to be successful, including an at-a-glance chart that helps you easily follow the diet, along with recipes, meal ideas, and tip sheets.

    The FODMAP diet for IBS

    Over several years, researchers at Monash University in Australia have developed and extensively studied a low-FODMAP elimination diet for people with IBS.22

    Unlike other types of elimination diets, the FODMAP diet is a highly specialized form of medical nutrition therapy. The FODMAP diet’s list of problematic foods (shown below) is anything but intuitive, and the reintroduction phase is more complex than other elimination diets.

    As a result, if you’ve been diagnosed with IBS and suspect you have a FODMAP issue, seek the expertise of a FODMAP-certified practitioner. You can also download Monash University’s FODMAP Diet app, which will help you navigate low-FODMAP eating.

    Food Group Low FODMAP High FODMAP
    Vegetables Green beans, bok choy, green bell peppers, carrots, cucumbers, lettuce, potatoes Artichoke, asparagus, mushrooms, onions, garlic, snowpeas, cauliflower, leeks
    Fruits Cantaloupe, kiwi, mandarin, orange, pineapple, firm bananas, blueberries Apples, cherries, mango, nectarines, peaches, pears, plums, watermelon, ripe bananas
    Dairy and Dairy Alternatives Almond milk, brie, feta, hard cheese, lactose-free milk & yogurt Cow’s milk and foods made from cow’s milk, soy milk
    Protein-Rich Foods Eggs, tofu, tempeh, most minimally-processed meats, poultry, seafood Most legumes, some marinated and processed meats
    Starches Foods made from oats, quinoa, rice, spelt, or corn Foods made from wheat, rye, and barley
    Sweeteners Dark chocolate, maple syrup, rice malt, table sugar High-fructose corn syrup, honey, sugar alcohols, agave
    Nuts and Seeds Peanuts, pumpkin seeds, almonds, macadamias, and walnuts Cashews, pistachios

    The power of health coaching

    In isolation, more knowledge doesn’t always lead to more power.

    For example, there’s a difference between knowing that dairy messes with your gut and doing something with that knowledge.

    Similarly, you might know that you feel better when you eat a small dinner earlier in the evening, but you may struggle to plan your life so an early dinner happens regularly.

    This is where a certified health coach can help.

    “Many of my clients already have an idea of the foods that tend to cause them problems,” says Maughan, “But they’re nervous to know for sure because they fear that the knowledge will make eating more challenging.”

    That’s why Maughan assures clients…

    Even if you do an elimination diet and you learn your favorite food is contributing to your IBS, you don’t have to do anything with that information.

    You can choose to continue to eat your favourite foods if you want, AND you can choose to avoid them when it’s really important for you not to experience IBS symptoms, she says.

    “With knowledge, you have choices,” says Maughan.

    References

    Click here to view the information sources referenced in this article.

    If you’re a coach, or you want to be…


    You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how.


    If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification. (You can enroll now at a big discount.)

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  • Are Raw Mushrooms Safe to Eat? 

    Are Raw Mushrooms Safe to Eat? 

    Microwaving is probably the most efficient way to reduce agaritine levels in fresh mushrooms.

    There is a toxin in plain white button mushrooms called agaritine, which may be carcinogenic. Plain white button mushrooms grow to be cremini (brown) mushrooms, and cremini mushrooms grow to be portobello mushrooms. They’re all the very same mushroom, similar to how green bell peppers are just unripe red bell peppers. The amount of agaritine in these mushrooms can be reduced through cooking: Frying, microwaving, boiling, and even just freezing and thawing lower the levels. “It is therefore recommended to process/cook Button Mushroom before consumption,” something I noted in a video that’s now more than a decade old.

    However, as shown below and at 0:51 in my video Is It Safe to Eat Raw Mushrooms?, if you look at the various cooking methods, the agaritine in these mushrooms isn’t completely destroyed. Take dry baking, for example: Baking for ten minutes at about 400° Fahrenheit (“a process similar to pizza baking”) only cuts the agaritine levels by about a quarter, so 77 percent still remains.

    Boiling looks better, appearing to wipe out more than half the toxin after just five minutes, but the agaritine isn’t actually eliminated. Instead, it’s just transferred to the cooking water. So, levels within the mushrooms drop by about half at five minutes and by 90 percent after an hour, but that’s mostly because the agartine is leaching into the broth. So, if you’re making soup, for instance, five minutes of boiling is no more effective than dry baking for ten minutes, and, even after an hour, about half still remains.

    Frying for five to ten minutes eliminates a lot of agartine, but microwaving is not only a more healthful way to cook, but it works even better, as you can see here and at 1:39 in my video. Researchers found that just one minute in the microwave “reduced the agaritine content of the mushrooms by 65%,” and only 30 seconds of microwaving eliminated more than 50 percent. So, microwaving is probably the easiest way to reduce agaritine levels in fresh mushrooms. 
    My technique is to add dried mushrooms into the pasta water when I’m making spaghetti. Between the reductions of 20 percent or so from the drying and 60 percent or so from boiling for ten minutes and straining, more than 90 percent of agaritine is eliminated.

    Should we be concerned about the residual agaritine? According to a review funded by the mushroom industry, not at all. “The available evidence to date suggests that agaritine from consumption of…mushrooms poses no known toxicological risk to healthy humans.” The researchers acknowledge agartine is considered a potential carcinogen in mice, but then that data needs to be extrapolated to human health outcomes.

    The Swiss Institute of Technology, for example, estimated that the average mushroom consumption in the country would be expected to cause about two cases of cancer per one hundred thousand people. That is similar to consumption in the United States, as seen below and at 3:00 in my video, so “one could theoretically expect about 20 cancer deaths per 1 x 106 [one million] lives from mushroom consumption.” In comparison, typically, with a new chemical, pesticide, or food additive, we’d like to see the cancer risk lower than one in a million. “By this approach, the average mushroom consumption of Switzerland is 20-fold too high to be acceptable. To remain under the limit”—and keep risk down to one in a million—“‘mushroom lovers’ would have to restrict their consumption of mushrooms to one 50-g serving every 250 days!” That’s about a half-cup serving once in just over eight months. To put that into perspective, even if you were eating a single serving every single day, the resulting additional cancer risk would only be about one in ten thousand. “Put another way, if 10,000 people consumed a mushroom meal daily for 70 years, then in addition to the 3000 cancer cases arising from other factors, one more case could be attributed to consuming mushrooms.” 
    But, again, this is all based “on the presumption that results in such mouse models are equally valid in humans.” Indeed, this is all just extrapolating from mice data. What we need is a huge prospective study to examine the association between mushroom consumption and cancer risk in humans, but there weren’t any such studies—until now.

    Researchers titled their paper: “Mushroom Consumption and Risk of Total and Site-Specific Cancer in Two Large U.S. [Harvard] Prospective Cohorts” and found “no association between mushroom consumption and total and site-specific cancers in U.S. women and men.”

    Eating raw or undercooked shiitake mushrooms can cause something else, though: shiitake mushroom flagellate dermatitis. Flagellate as in flagellation, whipping, flogging. Below and at 4:48 in my video, you can see a rash that makes it look as if you’ve been whipped.

    Here and at 4:58 in my video is another photo of the rash. It’s thought to be caused by a compound in shiitake mushrooms called lentinan, but because heat denatures it, it only seems to be a problem with raw or undercooked mushrooms.

    Now, it is rare. Only about 1 in 50 people are even susceptible, and it goes away on its own in a week or two. Interestingly, it can strike as many as ten days after eating shiitake mushrooms, which is why people may not make the connection. One unfortunate man suffered on and off for 16 years before a diagnosis. Hopefully, a lot of doctors will watch this video, and if they ever see a rash like this, they’ll tell their patients to cook their shiitakes.



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  • Why I Don’t Recommend Moringa Leaf Powder 

    Why I Don’t Recommend Moringa Leaf Powder 

    “Clearly, in spite of the widely held ‘belief’ in the health benefits of M. oleifera [moringa], the interest of the international biomedical community in the medicinal potential of this plant has been rather tepid.” In fact, it has been “spectacularly hesitant in exploring its nutritional and medicinal potential. This lukewarm attitude is curious, as other ‘superfoods’ such as garlic and green tea have enjoyed better reception,” but those have more scientific support. There are thousands of human studies on garlic and more than ten thousand on green tea, but only a few hundred on moringa.

    The most promising appears to be moringa’s effects on blood sugar control. Below and at 0:55 in my video The Efficacy and Side Effects of Moringa Leaf Powder, you can see the blood sugar spikes after study participants ate about five control cookies each (top line labeled “a”), compared with cookies containing about two teaspoons of moringa leaf powder into the batter (bottom line labeled “b”). Even with the same amount of sugar and carbohydrates as the control cookies, the moringa-containing cookies resulted in a dampening of the surge in blood sugar.

    Researchers found that drinking just one or two cups of moringa leaf tea before a sugar challenge “suppressed the elevation in blood glucose [sugar] in all cases compared to controls that did not receive the tea initially” and instead drank plain water. As you can see here and at 1:16 in my video, drinking moringa tea with sugar dampened blood sugar spikes after 30 minutes of consumption of the same amount of sugar without moringa tea. It’s no wonder that moringa is used in traditional medicine practice for diabetes, but we don’t really know if it can help until we put it to the test. 
    People with diabetes were given about three-quarters of a teaspoon of moringa leaf powder every day for 12 weeks and had significant improvements in measures of inflammation and long-term blood sugar control. The researchers called it a “quasi-experimental study” because there was no control group. They just took measurements before and after the study participants took moringa powder, and we know that simply being in a dietary study can lead some to eat more healthfully, whether consciously or unconsciously, so we don’t know what effect the moringa itself had. However, even in a moringa study with a control group, it’s not clear if the participants were randomly allocated. The researchers didn’t even specify how much moringa people were given—just that they took “two tablets daily with one tablet each after breakfast and dinner,” but what does “one tablet” mean? There was no significant improvement in this study, but perhaps the participants weren’t given enough moringa. Another study used a tablespoon a day and not only saw a significant drop in fasting blood sugars, but a significant drop in LDL cholesterol as well, as seen below and at 2:27 in my video. 

    Two teaspoons of moringa a day didn’t seem to help, but what about a third, making it a whole tablespoon? Apparently not, since, finally, a randomized, placebo-controlled study using one tablespoon of moringa a day failed to show any benefit on blood sugar control in people with type 2 diabetes.

    So, we’re left with a couple of studies showing potential, but most failing to show benefit. Why not just give moringa a try to see for yourself? That’s a legitimate course of action in the face of conflicting data when we’re talking about safe, simple, side–effect–free solutions, but is moringa safe? Probably not during pregnancy, as “about 80% of women folk” in some areas of the world use it to abort pregnancies, and its effectiveness for that purpose has been confirmed (at least in rats), though breastfeeding women may get a boost of about half a cup in milk production based on six randomized, blinded, placebo-controlled clinical trials.

    Just because moringa has “long been used in traditional medicine” does not in any way prove that the plant is safe to consume. A lot of horribly toxic substances, like mercury and lead, have been used in traditional medical systems the world over, but at least “no major harmful effects of M. oleifera [moringa]…have been reported by the scientific community.” More accurately, “no adverse effects were reported in any of the human studies that have been conducted to date.” In other words, no harmful effects had been reported until now. 

    Stevens-Johnson syndrome (SJS) is probably the most dreaded drug side effect, “a rare but potentially fatal condition characterized by…epidermal detachment and mucous membrane erosions.” In other words, your skin may fall off. Fourteen hours after consuming moringa, a man broke out in a rash. The same thing had happened three months earlier, the last time he had eaten moringa, causing him to suffer “extensive mucocutaneous lesions with blister formation over face, mouth, chest, abdomen, and genitalia.” “This case report suggests that consumption of Moringa leaf is better avoided by individuals who are at risk of developing SJS.” Although it can happen to anyone, HIV is a risk factor.

    My take on moringa is that the evidence of benefit isn’t compelling enough to justify shopping online for something special when you can get healthy vegetables in your local market, like broccoli, which has yet to be implicated in any genital blistering. 



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  • 老年人应重视的营养素 (Key nutrients for older adults)

    老年人应重视的营养素 (Key nutrients for older adults)

    What’s included:
    ✓     Simplified Chinese version of the patient resource ‘Key nutrients for older adults’

    Translated by: Tracy Xiao (Australian APD)

     

    View the English version here

    The patient resources are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances.  The patient resources are for your information only, and we advise that you exercise your own judgment before deciding to use the information provided. Professional medical advice should be obtained before taking action.  Please see here for terms and conditions.

    Please note that all of our resources must be used in full and are unable to be personalised or customised.

     

    Download resource

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  • Is Moringa the Most Nutritious Food? 

    Is Moringa the Most Nutritious Food? 

    Does the so-called miracle tree live up to the hype?

    Moringa (Moringa oleifera) is a plant commonly known as the “miracle” tree due to its purported healing powers across a spectrum of diseases. If “miracle” isn’t hyperbolic enough for you, “on the Internet,” it’s also known as “God’s Gift to Man.” Is moringa a miracle or just a mirage? “The enthusiasm for the health benefits of M. oleifera is in dire contrast with the scarcity of strong experimental and clinical evidence supporting them. Fortunately, the chasm is slowly being filled.” There has been a surge in scientific publications on moringa. In just the last ten years, the number of articles is closer to a thousand, as shown here and at 1:02 in my video The Benefits of Moringa: Is It the Most Nutritious Food?.

    What got my attention was the presence of glucosinolates, compounds that boost our liver’s detoxifying enzymes. I thought they were only found in cruciferous vegetables, such as cabbage, broccoli, kale, collards, and cauliflower. Still, it turns out they’re also present in the moringa family, with a potency comparable to broccoli. But rather than mail-ordering exotic moringa powder, why not just eat broccoli?Is there something special about moringa?

    “Moringa oleifera has been described as the most nutritious tree yet discovered,” but who eats trees? Moringa supposedly “contains higher amounts of elemental nutrients than most conventional vegetable sources,” such as featuring 10 times more vitamin A than carrots, 12 times more vitamin C than oranges, 17 times more calcium than milk, 15 times more potassium than bananas, 25 times more iron than spinach, and 9 times more protein than yogurt, as shown here and at 2:08 in my video. 
    Sounds impressive, but first of all, even if this were true, it is relevant for 100 grams of dry moringa leaf, which is about 14 tablespoons, almost a whole cup of leaf powder. Researchers have had trouble getting people to eat even 20 grams, so anything more would likely “result in excessively unpleasant taste, due to the bitterness of the leaves.”

    Secondly, the nutritional claims in these papers are “adapted from Fuglie,” which is evidently a lay publication. If you go to the nutrient database of the U.S. Department of Agriculture, and enter a more reasonable dose, such as the amount that might be in a smoothie, about a tablespoon, for instance, a serving of moringa powder has as much vitamin A as a quarter of one baby carrot and as much vitamin C as one one-hundredth of an orange. So, an orange has as much vitamin C as a hundred tablespoons of moringa. A serving of moringa powder has the calcium of half a cup of milk, the potassium of not fifteen bananas but a quarter of one banana, the iron of a quarter cup of spinach, and the protein of a third of a container of yogurt, as seen below and at 3:15 in my video. So, it may be nutritious, but not off the charts and certainly not what’s commonly touted. So, again, why not just eat broccoli?

    Moringa does seem to have anticancer activity—in a petri dish—against cell lines of breast cancer, lung cancer, skin cancer, and fibrosarcoma, while tending to leave normal cells relatively alone, but there haven’t been any clinical studies. What’s the point in finding out that “Moringa oleifera extract enhances sexual performance in stressed rats,” as one study was titled?

    Studies like “Effect of supplementation of drumstick (Moringa oleifera) and amaranth (Amaranthus tricolor) leaves powder on antioxidant profile and oxidative status among postmenopausal women” started to make things a little interesting. When researchers were testing the effects of a tablespoon of moringa leaf powder once a day for three months on antioxidant status, they saw a drop in oxidative stress, as one might expect from eating any healthy plant food. However, they also saw a drop in fasting blood sugars from prediabetic levels exceeding 100 to more normal levels. Now, that’s interesting. Should we start recommending a daily tablespoon of moringa powder to people with diabetes, or was it just a fluke? I’ll discuss the study “Moringa oleifera and glycemic [blood sugar] control: A review of the current evidence” next.



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