Tag Archive for: sugar

Sweet tooth, sick heart

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By Tamzyn Murphy, RD, MSc (Dist.)

 

Guard your heart this Valentine’s day. Say NO to SUGAR… Sugar may be sweet on the tooth but it’s no sweetheart. In fact it may be the most damaging thing to your heart that you can put in your mouth. 

 

High blood pressure puts stress on your heart by making it have to do much more work to push your blood around your body. Just a 2-mmHg reduction of systolic blood pressure could lower death from stroke by 10% and from ischemic heart disease (i.e. heart disease caused by blockages of blood) by 7% in people with normal blood pressure [1]. So protecting your heart means maintaining a healthy blood pressure.

 

Sugar in general and it’s most dangerous component, fructose specifically, appear to play a pivotal role in the development of obesity, which in turn raises blood pressure [1]. But sugar, especially in the form of liquid sugar or sugar-sweetened beverages, may raise blood pressure independently of increases in body weight. In other words, even if sugar doesn’t make you fat it can still raise your blood pressure, thereby putting undue strain on your heart. 

 

Did you know…

    • 1 or more sugar sweetened beverages per day makes you 22% more likely to have high blood pressure than nonconsumers (The Framingham study) [2,3]. 
    • > 4 sugar-sweetened beverages per day could increase your chances of having high blood pressure by 28-44%, compared with infrequent consumers (The Nurses’ Health Study I and II ) [2,3].
    • The fewer sugar-sweetened beverages you drink the lower your blood pressure [4].

 

How sugar’s fructose component raises blood pressure:

  1. It increases blood uric acid concentrations. Uric acid raises blood pressure [1,5,6] by reducing the production of a potent blood vessel-dilator, called nitric oxide [1].
  2. It raises fats in the blood thereby potentially raising blood pressure [3].
  3. It stimulates the sympathetic nervous system, thereby reducing urinary sodium (salt) excretion and increasing sodium (salt) absorption in the gut [1].

 

So a sweet heart, isn’t so sweet after all. Take stress off your heart this Valentine’s Day. Say NO to SUGAR.

Can kids ‘Bant’?

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By Tamzyn Murphy

BSc Med(Hons) Human Nutrition and Dietetics, RD

 

We await the verdict of Prof Tim Noakes’ HPCSA trial over a tweet in which he “advised” a mother to wean her child onto LCHF food. In the meantime let’s take a closer look at the evidence regarding Banting and kids…

 

Today’s children are the first generation expected to live shorter lives than their parents [1]. We are seeing more overweight children and adolescents than ever before [2, 3]. And we know that overweight children are likely to grow up into overweight adults, with associated health risks (e.g. heart disease and diabetes) [4]. It is clear that the way most children are eating is not doing their health any favours.

 

If we always do what we’ve always done, we’ll always get what we’ve always got

 

Sickly sweet South African kids

Eating too much sugar is associated with dental caries and increased obesity risk [3]. Both of which are prevalent health concerns amongst South African children.

 

We know that children and adolescents in South Africa, and across the globe, eat more sugar than adults. In fact one study reported that South African children eat about 50g (12.5 teaspoons) of sugar each day, while South African adolescents consume as much as 100g (25 teaspoons) per day [3]. This represents 10-20% of daily calorie consumption [3]. South African adults on the other hand, are thought to be eating approximately 38-51g (9-13 teaspoons) of sugar each day, contributing 10-15% of their calories [3].  The World Health Organisation’s guidelines recommend a maximum of 5% of daily calories from sugar – that’s no more than 7 teaspoons daily from all sources. Reducing or even eliminating our children’s added sugar consumption can only be good for their health.

 

Most medical practitioners and scientists will agree that drastically reducing or even cutting out children’s sources of added sugar can only be good for them. But the question remains, can children safely following a low carbohydrate, high fat (LCHF) diet (popularly known as Banting in South Africa), that’s devoid of starches and wholegrains as well as sugar?

 

Evidence: very LCHF diets in children

Although, very little research has been done on LCHF eating in children, a few studies have shown that overweight  kids and teens (6-18 years of age) who followed a LCHF, containing less than 60g of carbs each day, successfully lost weight, without negatively affecting the levels of fat and cholesterol in their blood [5, 6]. The authors suggest that reducing dietary carbohydrate may be a possible treatment for insulin resistance in children and adolescents.

 

Of note, a very low carbohydrate, ketogenic diet has been successfully used to treat childhood epilepsy for almost a century [7]. A modified version of the Atkin’s diet, also very low in carbohydrates (it only contains 10g), but easier to follow than the ketogenic diet (as, unlike the ketogenic diet it doesn’t also limit calories and protein), has been used successfully for the same purpose for over a decade. Unlike protein and certain fats, dietary carbohydrates are not essential nutrients – our bodies can make them from scratch to use as fuel. So it’s not surprising that both the ketogenic and modified Atkin’s (probably more so than the ketogenic diet, which also limits protein and calories) diets are considered safe when used in conjunction with multivitamin and calcium supplementation [8, 9].

 

“Banting” for children needn’t be very low carb

It’s important to bear in mind that most children who follow a LCHF don’t need to drastically restrict carbohydrates to the ketogenic levels (<60g per day) investigated in the studies discussed above (A LCHF diet typically provides 20-120g of carbohydrate daily or 5-30% of total energy intake). So, while added sugar, starches and grains will be eliminated from their diets, other wholefood sources of carbohydrates won’t be excluded (e.g. dairy, starchy vegetables, nuts, seeds, fruit and even properly prepared legumes).  I recommend that children only restrict their carbohydrates to below 60g under the supervision of a dietitian or knowledgeable medical doctor.

 

Provided that a child consumes the recommended 3 portions of dairy daily and eats enough vegetables, supplementation shouldn’t be any more necessary on this diet than with any other. While I don’t suggest being too restrictive about children’s starchy vegetable, fruit and nut consumption, excluding starches (in the form of grains) and added sugar from children’s diets shouldn’t pose any health risk and will likely come with a host of benefits. Especially considering that these restrictions are done in the context of a diet that emphasises avoiding processed food, while eating REAL, nutrient dense foods.

 

“Banting” for kids simplified

  • Eat real food. Avoid processed food.
  • Eat freely: Avocados, olives, other vegetables, dairy, fish, poultry, meat (including organ meats), eggs, butter, olive oil, coconut oil
  • Eat moderate amounts: Fruit, nuts, seeds, properly prepared legumes (beans, peas, lentils)
  • Exclude: Added sugar (in all its forms), processed food, grains (although it’s likely fine to include limited amounts of the less irritating grains such as oats or quinoa)

 

References 

[1] Olshsky SJ, Passaro DJ, Hershow RC, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. N Engl J Med 2005; 352:1138-1145 

[2] Gupta N, Goel K, Shah P, Misra A. Childhood Obesity in Developing Countries: Epidemiology, Determinants, and Prevention. Endocrine Reviews. Jan 2012;33(1) 

[3] Steyn N, Temple NJ et al. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health. 2012;12:502

[4] Singh AS, Mulder C, Twisk JWR, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews. Sep 2008;9(5):474-88 

[5] Gow ML, Ho M, Burrows TL, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obesechildren and adolescents: a systematic review. Nutr Rev. 2014 Jul;72(7):453-70. 

[6] Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253-8. 

[7] NICUS. The Ketogenic Diet…Fa(c)t or fiction? 2007

[8] Tonekaboni SH, Mostaghimi P, Mirmiran P, et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med. 2010 Nov;13(6):492-7. 

[9] Suo C, Liao J, Lu X, et al. Efficacy and safety of the ketogenic diet in Chinese children. Seizure. 2013 Apr;22(3):174-8. 

Best first food for baby: Meat vs cereal

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By Tamzyn Murphy

BSc Med(Hons) Human Nutrition and Dietetics, RD

 

South African personality, sports scientist and Emeritus UCT Professor Tim Noakes is making news headlines again as the second and last day of the closing arguments of his “Baby Banting” trial before the Health Professions Council of South Africa (HPCSA) commences. The council is investigating Noakes for giving unconventional and un professional advice. The complaint laid by Association for Dietetics (ADSA) president, Claire Julsing-Strydom, is over ‘advice’ that Noakes tweeted in response to a mother’s query regarding the best food to introduce to her baby. Noakes advised the mother to introduce low carbohydrate, high fat (LCHF), Banting-friendly foods (which include meat and vegetables) to her baby from 6-month of age.

While the HPCSA will determine whether babies should or shouldn’t Bant, it is clear that Noakes is right about at least one thing: meat is far superior to cereal as babies’ first food. Health authorities’ recommendations that meat, meat alternatives (like eggs) and iron-fortified cereal are the best first food for babies imply that these are options are nutritional equals [1]. They are not. Here’s why meat beats cereal hands down.

 

Meating babies’ nutritional needs

Iron deficiency is very common in children in South Africa [2,3], and across the globe [4]. Many infants also don’t eat enough iron [2]. Infants with iron deficiency have impaired growth, mental development and problem solving ability [4]. Iron deficient babies score worse for mental and motor functioning when they’re older too [4]. By 6 months of age babies run out of iron stores [4]. Meat, fish and poultry are rich sources of the most readily absorbed heme form of iron. The iron contained in iron fortified cereal on the other hand, is in a non-haem form that is very poorly absorbed [4].

Meat, liver, poultry and fish – given as babies’ first foods in many traditional societies [1] – were the obvious iron-rich first foods to be introduced to babies before iron-fortified cereals were available. Since iron-fortified cereal was introduced it has replaced meat as the first food of choice for babies [4]. Not only is it a poor replacement as a source of bioavailable iron, but it also contains anti-nutrient phytates, which interfere with iron absorption, thereby reducing its bioavailability even further [2]. Therefore, cereal, even if it’s fortified with iron, may not be able to provide the iron that 6 month olds so desperately need.

Interestingly, zinc deficiency is also very common in babies and children. Meat is an excellent source of zinc. Introduction of meat as opposed to cereal as an early complementary food for exclusively breastfed infants is associated with improved zinc, iron and protein intake.  Babies fed meat instead of cereal have a higher head circumference and possibly also improved psychomotor development [5].

 

A weighty issue

Dietitian text books recommend that sugar and salt are not added to babies foods. Yet in the same breath they say that fortified infant cereal – usually packed with added sugar – is the first food to be introduced to babies [4].

Dietary sugar is linked to dental caries and the development of obesity and other lifestyle-related diseases. Even if parents do find baby cereal options that don’t include added sugar, they are still very refined (processed) and incredibly high in fast-release (high GI) carbohydrates.

Introducing cereals and fruit as babies’ first solid food is linked to the development obesity later in life [6]. Meat contains no carbohydrate and is high in fat and protein. A high fat intake during babies’ complementary feeding period doesn’t appear to increase their risk of becoming obese later [7]. There has been concern that high protein intake during infancy promotes weight and fat gain. However, a recent study indicates that this only holds true for high levels of protein from cow’s milk in formula fed infants. Breastfed babies who were fed meat instead of cereal, gained more weight and grew taller than those fed cereal, but they didn’t get fatter [8]. This indicates that higher protein levels from meat may not be linked to fatness after all.

Parents and health professionals await the outcome of Noakes’ HPCSA trial with bated breath. For now though, at least one aspect is clear: introducing ‘Banting-friendly’ meat to babies is a far better option than introducing cereal. From 6 months of age, babies should be offered pureed meat, liver, poultry, fish and eggs, progressing to the introduction of a variety of foods from family meals, such as vegetables mixed with pasture-fed butter, olive oil or breastmilk. Breastmilk continues to be the main source of nutrition throughout the first year. Breastfeeding is recommended for at least one year whenever possible, and preferably for up to two years or beyond.

 

References

[1] Health Canada. Nutrition for health term infants: Recommendations from six to 24 months. 24 Mar 2014

[2] Faber M, Wenhold F. Nutrition in contemporary South Africa. AJOL. 2007;33(3):393-400

[3] Visser J, Herselman M. Anaemia in South Africa: the past, the present and the future. S Afr J Clin Nutr. 2013;26(4):166-167

[4] Mahan LK, Escott-Stump S. Krause’s Food & Nutrition Therapy. International Edition 12. Saunders Elsevier. 2008

[5] Krebs NF, JE Wescott, N Butler, et al. Meat as a First Complementary Food for Breastfed Infants: Feasibility and Impact on Zinc Intake and Status. J Pediatr Gastroenterol Nutr. Feb 2006;42(2)

[6] Caroli M, Mele RM, Tomaselli MA, et al. Complementary feeding patterns in Europe with a special focus on Italy. Nutr Metab Cardiovasc Dis. Oct 2012;22(10):813-8

[7] Michaelsen KF, Larnkjaer A, Molgaard C. Early diet, insulin-like growth factor-1, growth and later obesity. World Rev Nutr Diet. 2013;106:113-8

[8] Tang M, Krebs NF. High protein intake from meat as complementary food increases growth but not adiposity in breastfed infants: a randomized trial. Am J Clin Nutr. Oct 2014;ajcn.088807

Inflammatory food

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Excess inflammation leads to autoimmune, inflammatory and age-related diseases as well as aging, but changing the way you eat can help

By Tamzyn Murphy Campbell
BSc, BSc Med(Hons) Human Nutrition and Dietetics, RD

Excess inflammation leads to autoimmune, inflammatory and age-related diseases as well as aging, but changing the way you eat can help

By Tamzyn Murphy Campbell
BSc, BSc Med(Hons) Human Nutrition and Dietetics, RD

To most of us “inflammation” – characterised by redness, heat, pain and swelling – is a dreaded word associated with a variety of ailments: joint pain, backache, arthritis, inflammatory bowel disease and psoriasis (skin condition). But inflammation actually has an essential role to play. It’s our body’s first form of attack against infection or other foreign bodies. The wellknown inflammation related problems set in when inflammation spirals out of control and starts to attack the body’s own tissues – autoimmune disease – or when it goes on too long – thought to be one of the processes responsible for aging and related diseases. So, although inflammation is an important indicator of something being wrong, keeping it in check and preventing it from going overboard is fundamental to health – and what you eat can help.

BEAT THE BELLY

Belly fat releases inflammatory molecules which scientists blame for obesity-associated inflammatory diseases: insulin resistance, diabetes and heart disease risk factors (high blood pressure and imbalanced blood fat and cholesterol levels). It’s also linked to lower levels of the hormone adiponectin, which may play a role in increased inflammation, heart disease risk and insulin resistance. Research indicates that women with a belly have more signs of inflammation than their male counterparts. Scientists have found that using diet to keep weight in check reduces inflammation and the markers of its associated diseases. So find a diet and exercise program that works for you, and stick to it to drop the kilos and keep inflammation free. Reducing stress and getting adequate sleep can also help keep the belly at bay.

INFLAMMATORY FOOD

Researchers have found that certain food promotes inflammation, while other food reduces it. Avoid the following to reduce inflammation:

  • Trans fats – found in processed baked goods (biscuits) and fast food fried in reused oil – raise inflammation-boosting molecules and heart disease risk
  • Refined carbohydrates and sugar increase inflammation, probably due to the combination of their low fibre, vitamin, mineral, phytonutrient and essential fatty acid content, as well as their penchant for swinging blood sugar and insulin levels. This boosts blood fat and free radicals, causing inflammatory molecule production, which in turn results in inflammation
  • Processed food is high in trans fats and refined carbohydrates and sugar. So they’re definitely a no-no
  • Excess omega-6 fats Most of us get too much inflammation-promoting omega-6 in our diet, from processed food and cooking oils, like sunflower oil. The omega-6 fat, linoleic acid (LA) is converted into arachidonic acid (AA), which is the major building block for making inflammation-promoting molecules (eicosanoids).

ANTI-INFLAMMATORY FOOD

This food helps reduce inflammation throughout the body and therefore also age-related inflammatory diseases (e.g. osteoarthritis) and the activation of aging genes

  • Unsaturated fats Monounsaturated fats from nuts, seeds, avocado, olive and canola oils improve your blood fat profile to reduce inflammatory molecules and heart disease risk
  • Omega-3 fats found in oily fish (Norwegian salmon, snoek, sardines, anchovies), activate anti-inflammation genes. They’re also a building block for the production of anti-inflammatory molecules. And higher levels of omega-3 fats inhibit the production of inflammatory molecules made from omega-6 fats. Eat fatty fish at least three times per week or supplement with fish, or krill oil
  • Moderate alcohol has been linked to lower blood levels of inflammation-promoting molecules and reduced heart disease risk. Wine (1-2 glasses daily) is particularly anti-inflammatory, but beer and liquor have also been found to be beneficial
  • Antioxidants found in fruit and vegetables (especially brightly coloured ones), certain herbs and spices (cloves, oregano, rosemary, tumeric), green and rooibos tea, dark chocolate and red wine reduce free radical damage and inflammatory molecule production
  • Fibre exerts its anti-inflammatory effects by helping control blood sugar, insulin, fat and cholesterol levels, increasing adiponectin levels and reducing inflammatory molecule production. Fibre’s found in vegetables, fruit, beans, lentils, nuts and seeds.

References include

  1. Chung HY, Lee EK, et al. Molecular Inflammation as an Underlying Mechanism of the Aging Process and Age-related Diseases. JDR. Jul 2011;90(7):830-40
  2. Pou KM, Massaro JM, et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress. The Framingham Heart Study. Circulation. 2007;116:1234-41
  3. Giugliano D, Ceriello A, et al. The effects of diet on inflammation. Journal of the American College of Cardiology. 2006;48(4):677-85
  4. Lihn AS, Pedersen SB, Richelsen B. Adiponectin: action, regulation and association to insulin sensitivity. Obes Rev. Feb 2005;6(1):13-21
  5. Tajik N, Keshavarz SA, et al. Effect of diet-induced weight loss on inflammatory cytokines in obese women. J Endocrinol Invest. Jun 2012: Published online
  6. Calder PC. n−3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. Jun 2006;83(6):S1505-19
  7. ORAC Values. www.oracvalues.com. Jul 2012