Tuesday 31 May 2016

Dining out with PCOS



Life will always present opportunities to derail best intentions, including eating healthily.  Often, when we are busy during the week with work, we can remain organised and focused with our meals; but what happens when someone brings morning tea to work to celebrate a birthday, or we are invited out to dinner, or to a party?  Having a few strategies up your sleeve for these times will help you enjoy yourself without feeling stressed about choosing the healthiest food options.  This blog will hopefully prepare you for those times so you can stay on track and eat foods that are best for you. 



Office celebrations



This can be tricky because you don’t want to offend the person who provided the treat, nor do you want to miss out on all the fun, but at the same time, you don’t want overeat or eat foods laden with unhealthy fats or sugars.  My go-to tips include the following.  If you have others than work for you, let me know and I’ll include them in the list to help others in a similar situation.



  • ·         Have snacks in your desk drawer just for these times; try a sweet protein bar (my favourite is Quest Bars) that you can cut up and put on a plate or napkin and nibble on.  They last forever, don’t need refrigeration and they actually taste great!

  • ·         Slowly sip a hot drink, such as a herbal tea of your choice.  This technique keeps your hands busy but you can still take part in the festivities.

  • ·         Eat before you go.  You are less likely to want to snack on foods on offer if you aren’t hungry and it’s easy to keep your resolve when your tummy is full.




Restaurant Dining

Dining out doesn’t have to be awkward or avoided.  Sometimes it just takes a little forward planning so you can arrive at the restaurant feeling relaxed and ready to enjoy yourself.


  • ·         If you know which restaurant you’ll be going to, look at their menu online and see what they offer.  Most restaurants cater for special dietary requirements and will state this in their menu.

  • ·         If you can’t find something suitable online or they don’t supply an online menu, give the restaurant a quick call.  I’ve often called ahead of arrival and asked if they can make a few changes to meals, and they are always more than accommodating. 

  • ·         Order a starter for your main meal.  A smaller meal is still going to be enough for dinner and it will help you remain within your energy requirements.

  • ·         Is that dessert menu screaming your name?  Ask someone to share with you.  That way you get to savour the flavours without eating too much and sending your blood sugars skyward!  Or, order a sweet tea or coffee to sip on if others are still eating.



Parties

Parties are a time of celebration and, as I say to all my clients, I don’t want you to feel like you’re missing out, or just a party-pooper for not devouring everything in front of you. 


  • ·         Offer to bring a plate.  Again, you can then be in charge of some of the food on offer and eat knowing you are still looking after yourself and your health.

  • ·         Like I said earlier, eat before you arrive.  It doesn’t have to be too substantial, just enough to take the edge off your hunger so you don’t feel the urge to hang around the buffet table.  Try snacking on a couple of boiled eggs, or even a cruskit cracker or two topped with a can of flavoured tuna (don’t forget the breath mint!).

  • ·         Summon support.  Let your friends know you have a nutrition goal you are aiming to achieve and ask them to help you stay on track.  We all do better when we have a cheer squad cheering us on.



These are just a few ideas to get you started.  Remember, your good health is your most important goal, and it should be bigger than a single event.  Eating is a part of life and can’t be avoided.  We are always going to be tempted by the abundance of foods available in the 21st century, and navigating through these choices is just a matter of having a few of the above strategies available for you to use.

Cheers for now

Annie 

PCOS: What to eat to optimise thyroid function

The thyroid gland lies at the base of the throat, with each of its two lobes sitting either side of the wind pipe.  The thyroid gland looks after heart and muscle function and bone health, as well as being a major regulator of your metabolism.  It does this by taking iodine from your blood and using it to make two hormones, thyroxine (T4) and triiodothyronine (T3).  These two hormones are used by every other cell in your body to turn the food you eat into energy to burn to fuel your body.  Optimising the function of the thyroid gland can help you optimise your metabolism.

Iodine
In Australia, about half the population is thought to have an iodine deficiency.  Iodine can be found in some foods we eat; seafood such as tinned salmon and fresh oysters, iodised salt, and bread that has been fortified with iodised salt, trace amounts in dairy and trace amounts in fruits and vegetables, depending on the soil they’re grown in and the types of fertilisers used.  Before modern farming practices, soils were rested between plantings and had time to replenish valuable nutrients.  Also, dairies were previously cleaned using iodine as a sanitiser and iodine was found in milk and other dairy products.  Now, soils are depleted of nutrients, such as iodine, and other sanitisers have replaced iodine, and dairy products are no longer a reliable source of iodine.  The WHO recommended the fortification of salt as far back as the 1920’s to reduce global iodine deficiency but more and more people are cutting back on their salt intake because of its link to high blood pressure.  Since 2009, all breads, except organic bread, are produced using salt that has been fortified with iodine.  What if you don’t eat bread?  Optimise your uptake of iodine to increase hormone production by eating iodine-rich foods at different times to eating brassica vegetables (eg. cabbage, Brussels sprouts and broccoli), sweet potato or corn because these veggies can stop your body from absorbing all the available iodine.  Adding small amounts of iodised salt (about ½ teaspoon per day) to your meals can help ensure you are having your recommended iodine intake of 150µg/day.  Don’t confuse adding iodised salt on your meals at home with salt found in commercially produced food as non-iodised salt is more commonly used.  Found out more about iodine from the Australian Government's Nutrient Reference Values for iodine. 

Selenium

Selenium is a trace element found in some foods and soils and it is not produced by the human body.   While iodine is required to make our metabolism hormones, T3 and T4, selenium is required to manage those hormones by turning the inactive T4 thyroid hormone into the active T3 hormone.  Selenium also supports the body’s immune function.  The largest stores of selenium are found in the thyroid gland as well as the liver and kidneys, and its role in metabolism is so important, the body will drag selenium from other areas of the body to use in the thyroid glands if your selenium levels are too low.  Natural food sources of selenium can be found in seafood such as cod, prawns and salmon, in eggs and in Brazil nuts.  In fact, just two Brazil nuts contain about 150µg of selenium while a single hard-boiled egg contains around 15µg.  This page from the National Institutes of Health provides a table with many more foods that contain selenium.  The jury is still out on what an optimal intake per day of selenium should be, currently, in Australia, it is recommended adult women have 55µg/day with an upper limit of 400µg/day.  Recent studies are revealing benefits of increasing selenium intake include an improved immune response, a reduction of total cholesterol against HDL cholesterol and even reducing the risks of developing some cancers.  You can find out more about the role of selenium in thyroid function here. 

Zinc, Iron, and Copper

Zinc is required for the manufacture of the thyroid hormones, T3 and T4, and the conversion of T3 to its active form.  Also, these thyroid hormones are required for the absorption of zinc which can cause a cycle of deficiency of both zinc and T3 and T4 hormones.   Zinc is also required for proper immune function, wound healing and helps us with our senses of taste and smell.  We aren’t able to store zinc so we need to regularly consume foods containing zinc.  The best food sources of zinc are oysters, beef, chicken and fortified breakfast cereals. Find more sources on this zinc factsheet.

Iron and copper also play a role in optimising the thyroid function.  Animal-based (haem iron) is readily absorbed and good sources include liver, beef, kangaroo and lamb.  Vegetarian (non-haem) sources aren’t well absorbed but the best sources include fortified breakfast cereals, legumes such as kidney beans and chickpeas, spinach and cashew nuts. You can increase the absorption of non-haem iron by including some vitamin C, such as from strawberries or citrus fruit, with the meal.  Nutrition Australia provides a more comprehensive list. Great food sources of copper include shellfish, whole grains, beans, nuts and organ meats.  You can find other food sources of copper from this document from The National Institutes of Health.  

If you think you might not have adequate levels of the nutrients I've mentioned above, your GP should confirm this with simple lab tests before you take any over-the-counter supplements. 



Reference List
Andersson, M., Karumbunathan, V., Zimmermann, M. B. (2012).  Global iodine status in 2011 and trends over the past decade.  The Journal of Nutrition, p 1. doi: 0.3945/jn.111.149393 

Australian Government. (2007). The prevalence and severity of iodine deficiency in Australia. Australian     Health Ministers Advisory Committee.Retrieved from https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&ved=0CEIQFjAF&url=http%3A%2F%2Fwww.foodstandards.gov.au%2Fcode%2Fproposals%2Fdocuments%2FThe%2520prevalence%2520and%2520severit      y%2520of%2520iodine%2520deficiency%2520in%2520Australia%252013%2520Dec%25202007.pdf&ei=MW1qVe_5O4W48gWG8oCoAw&usg=AFQjCNFYqxtewZQtjzPYFq9GPx5lDj4_w&sig2=_vl4UrvEHAzHJXOo_BT2Jg&bvm=bv.94455598,d.dGc   

Australian Government. (2014). Feature Article: Iodine.  Australian Bureau of Statistics.  Retrieved from  http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.006Chapter1202011-12  

Australian Government. (n.d.). Iodine. National Health and Medical Research Council.  Retrieved from https://www.nrv.gov.au/nutrients/iodine

Kapil, U. (2007). Health Consequences of Iodine Deficiency. Sultan Qaboos University Medical Journal, 7(3), 267-272.  Retrieved from  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074887/  
Li, M. & Eastman, C. J. (2012). The changing epidemiology of iodine deficiency. Nature Reviews Endocrinology 8. doi: 10.1038/nrendo.2012.43 

Monday 30 May 2016

Welcome to my PCOS blog



Whenever people find out I'm a dietitian and a personal trainer, I get asked this question; how can I lose weight?  People commonly tell me they exercise enough but their weight remains the same.  What are they doing wrong?  After more than twenty years as a personal trainer and rehab trainer, I’ve found many of my clients (I only train females) have Poly-cystic Ovarian Syndrome (PCOS).  Observed signs of PCOS can include: 

  • overweight or obesity, especially with excess weight carried around the middle
  •  acne
  • excess facial hair and even male-pattern balding or thinning of hair
  • skin tags, especially around the neck and shoulders

This is due to an excess of the male hormone testosterone and another hormone which promotes fat storage called insulin.  Levels of the appetite regulating hormones have been shown to be impaired in women with PCOS too, making it much harder to lose excess body weight. 

There is so much conflicting evidence available it's hard to know what the truth is and what the hype is.  The basic rule of thumb to lose body fat  comes down to about 20% planned exercise, 10% incidental exercise (such as walking to the bus stop, mopping the floors, mowing the lawn etc) and a whopping 70% of fat loss comes by eating properly.  By eating properly, I don't just mean getting your five serves of veg and two serves of fruit per day either.  Also, there are plenty of "quick fixes" out there but they are often hard to sustain or they require eating special meals or expensive drinks, and once you stop the quick fix, the weight piles back on again. If you have PCOS, you might find you have insulin resistance and have trouble metabolising carbohydrate-rich foods; this is the same issue people with Type II diabetes have.  The CSIRO, Australia’s largest research body, have recently completed a three year study on the effects of consuming a very low carbohydrate diet.  The majority of participants have had incredible successes, so much so, the CSIRO are now recommending people with insulin resistance follow a very low carbohydrate diet, and they are now developing a diet plan for this growing population.

I've been helping women achieve their fitness and weight loss goals for nearly two decades and I supply them with the tools to keep the weight off.  By educating my girls on how their body metabolises different food groups and how their bodies are different to a man's body, they can learn to eat in a way that not only nourishes them and provides energy for their busy days, but to lose excess body fat and keep it off; even when they no longer need me to guide them.  What is my ultimate goal and why have I decided to start blogging?  I want to pass on what I have learnt so that everyone can achieve their personal goals, no matter what barriers they face or where they are starting from.  I hope you will find my page can help you become healthier by providing evidence-based nutritional knowledge.

Annie

Recipes

 All of my recipes have no added sugar, are gluten-free (I have coeliac disease so I'm never going to cook with wheat), and have reduced carbohydrate content to decrease an insulin response in your body.  Keep coming back to this page as I continue to add more recipes so you can enjoy your sweet treats without feeling guilty.

 

Low-carb Peanut Butter Cookie

Ingredients
(18 serves approx)
1 cup of 100% peanut butter
2/3 cup of Splenda (or other spoon for spoon sugar alternative)
1 egg
1/2 teaspoon baking powder
1/4 teaspoon salt

Method
Preheat oven to 160 deg Celsius (fan forced) and line two oven trays with baking paper.
Mix all ingredients in a large bowl until thoroughly combined.
Roll tablespoons of mixture into balls and place on trays with enough room to spread. Press down lightly on each one.
Bake until slightly golden for about 12-15 mins. Cool on trays before removing and storing.
Each cookie is about 100 calories with 30% protein and 5% carbs


Coconut Chocolate Mousse with Chia Seeds

chiamousseIngredients

450ml coconut cream
2/3 cup raw cacao or cocoa powder (compare sugar content between brands)
2/3 cup chia seeds
4 tablespoons stevia granules (or to taste)

Method
Place all ingredients into a medium-sized bowl and whisk together until combined.
Pour equally between four serving bowls (each serve is about 1/2 a cup).
Chill in the fridge until set.
Serves four




Coconut Flour Red Velvet Cupcakes

 Ingredients
redvelvet1/2 cup coconut flour
2 Tablespoons cocoa powder
1/4 teaspoon salt
1/4 teaspoon baking powder
4 eggs
2 Tablespoons coconut oil
1/2 cup rice malt syrup (or liquid stevia to reduce carbs)
1 Tablespoon red food colouring

Method
Preheat oven to 160 degrees Celsius, fan forced.
Line 10-12 muffin cups with paper liners.
In a large bowl, whisk together coconut flour, cocoa powder, salt and baking powder.
In a separate bowl, combine eggs, oil, sweetener and food colouring; whisk vigorously until well mixed.
Add wet ingredients to dry ingredients; use electric mixer to combine.
Spoon batter into each prepared muffin cup.
Bake 18 to 22 minutes, or until toothpick inserted in the centre of a cupcake comes out clean.
Let cupcakes cool, then remove from pan and top with icing using a mixture of 200g softened cream cheese, 3/4 cup cream, a little food colouring and powdered stevia.
Alternatively, ice with mock cream made from butter beaten with powdered stevia, food colouring and a little vanilla until light and fluffy.

These cupcakes are not low in calories but they are gluten free and much lower in carbs than traditional cupcakes so will not spike your blood sugar levels.

 

What is PCOS and can I improve my symptoms with diet?


What is PCOS and can I improve my symptoms with diet?



Doctors aren’t sure why some women are susceptible to Poly-cystic Ovarian Syndrome (PCOS), but they do know it’s because these women have elevated levels of the male hormone, testosterone, and one of the hormones which regulates blood sugar levels, called insulin.   Having too much testosterone can cause lots of unpleasant side effects such as having trouble losing weight, excessive facial hair, acne, and male-pattern baldness.  You might find you become irritable or depressed more easily, and have irregular periods or no periods at all, which can cause reduced fertility.  We need to try and reduce the symptoms associated with PCOS because having it can also cause insulin resistance, which may lead to type II diabetes mellitus (T2DM).  It can also cause high blood pressure, high cholesterol, and heart disease.  About 18% of women, who are in the reproductive age range, have PCOS, and managing your dietary intake is just one part of treatment. So, where do we begin?  Firstly, how about we set some goals?  You’ll have an improvement in symptoms with as little as 5-10% weight loss. 



People tend to put on weight when they eat more than their body needs.  It isn’t hard to do that in today’s busy world, but I have a few simple suggestions you can use to avoid that.  Because PCOS causes you to have high levels of insulin in your body, you need to start incorporating foods into your diet that are carbohydrate-rich, but take a long time to break down in your body.  These kinds of foods are often called complex carbohydrates; they’re typically made from whole grains and don’t go through too much processing.   Complex carbohydrates don’t cause your body to release a lot of insulin and keep your blood sugar levels more even. 



 On the other hand, carbohydrate-rich foods, which are more processed and very easy for the body to convert to energy, are called simple carbohydrates.   You see, if you don’t use all that energy in your cells before you eat again, the cells stay full and your body sends that excess, unneeded, energy, glucose, to be stored in your fat cells, for when times are tough.  But, if you eat foods that take a lot longer to break down, this gives your cells more time to use up its energy, and so less will be sent to your fat cells.  Not only that, if you are overweight, we want a little bit of a deficit so you aren’t eating enough to fuel your cells properly through your diet, and so some of that stored energy in your fat cells can be used instead.  

Your diet should include foods that are high in nutrients, but not so high in kilojoules.  Nutrient-rich foods are those that aren't too processed, like fresh meats, whole grains, dairy, fruits, and vegetables.  Processed foods are those that are often packaged and contain lots of ingredients on the labels.  They're often full fats and sugars, which can add lots of extra kilojoules, and can be high in salt too, which is associated with high blood pressure and heart disease but they don't contain much of the good stuff our bodies need like vitamins, minerals and fibre.  You should find, by eating nutrient-dense foods instead of energy-dense foods, you won't get hungry as quickly, will naturally start to eat less, and you will have that energy deficit we talked about earlier. 

This is just a brief overview.  You will find lots more information in my coming posts, such as What to eat to optimise thyroid function, and Is low-carb eating better for women with PCOS?

Cheers for now

Annie