Spotlight on Exercise, Part 3: Creating An Exercise Habit

Spotlight on Exercise, Part 3: Creating an exercise habit

Please do take a look at Part 1, The health benefits of exercise & Part 2, The potential risks of over-exercising of this series before reading the following. It will help to give some more perspective and context.

Moving our body throughout the day, regularly getting out of breath and incorporating some strength and resistance training into our week are all fantastic ways to maintain health and prevent future disease. However, increasing this to multiple hours of strenuous exercise on a regular basis does not necessarily magnify these benefits. More is not always better.

If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Here are some ideas and tips that may help you to find your ‘happy medium’ of exercise intensity and frequency.

Whilst I don’t purport to have all the answers (who does?! I am not a fitness professional and am still on my own fitness journey), these are some of the things that help Richard’s and my own clients:

  • Have at least one complete rest day every week, but also give yourself the permission to take a longer break if you feel you need too.
  • Try not to be too rigid with your training programme, and work on both emotional and mental flexibility with your plan. Remember the importance of the whole tripod of exercise, diet and rest. You need all three to be equally balanced.
  • Become aware of the messages your body uses to let you know if you are pushing yourself a little too much. Listen to them and adapt what you are doing accordingly. What works best for you will be constantly changing and evolving over time.
  • If you are suffering with stress or anxiety and feel overwhelmed by exercise instead of relieved, some periods of hyper-relaxation can be really helpful. Try guided meditations, breathing exercises, yoga, or other mindfulness-based activities. Even having a long, hot bath or just sitting in nature for 10 minutes can be so beneficial.
  • Make time for energy-boosting situations; spend time with friends and family, watch a comedy, go to the cinema. Remember that being healthy certainly isn’t all about training and nutrition plans.
  • Think outside of the box. Movement doesn’t have to mean formal exercise – walking the dogs, doing chores around the house, even going shopping (!), gardening, walking a few stops instead of sitting on the bus or tube can all contribute.
  • If you sit at a desk all day, consider switching from a normal desk chair to more active sitting (there are all sorts of options available online), or a standing desk. Things like moving your bin away from arms reach, always making your coffee on another floor and moving your printer to the opposite side of the room will prompt you to stand up more frequently throughout the day – small movements which really add up over the course of a year.
  • Give yourself enough time to adequately recuperate after illness or injury – your body needs rest to heal and build muscle.
  • Sleep is essential – the amount required varies from person to person, but in general, you need to get enough sleep to feel generally alert and wakeful for the duration of the day
  • Mix up your training to avoid over-stressing particular muscles and joints, but also to stop it getting boring or too repetitive
  • Be aware that other life stressors can add to the stress of physical training. Don’t be afraid to ease off training a bit during those periods. Sometimes the best thing you can do for yourself is just to have a week or two off.
  • Eat to fuel your body properly – and that doesn’t just mean getting enough calories, carbohydrates or protein, but also making sure that you are getting all the essential micronutrients (vitamins, minerals and essential fatty acids) too.
  • Consider working with a fitness professional to help you plan an appropriately staged and periodised training programme, if you are a high performance athlete or enjoy training for a significant number of hours per week. Try using the FITT principles to guide your training plan; Frequency, Intensity, Time and Type.
  • Likewise, consider working alongside a functional physiotherapist to help prevent injury as well as treat it – particularly if you are more of a ‘weekend warrior’.

. . . . . . .

Handy resources:

For more information on recommendations for exercise, do take a look at the NHS choices website:

nhs.uk/physical-activity-guidelines-for-adults

For some simple, 10-minute workouts you can do at home:

nhs.uk/Livewell/loseweight

Advice on exercising in pregnancy:

nhs.uk/conditions/pregnancy-and-baby


Spotlight on Exercise, Part 2: The potential risks of over-exercising

Spotlight on Exercise, Part 2: The potential risks of over-exercising

If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Please do take a look at Part 1, The health benefits of exercise.

It is common for practitioners to skirt around the tricky topic of over-exercising. But in clinic, this is something I often see.

We do need to move, of course, for all the health-giving reasons I highlighted in Part 1 (The health benefits of exercise), and I completely understand that everyone’s abilities and hobbies differ. But pushing ourselves excessively (and that is definitely the key word here) with endless hours of classes, training sessions, long runs, gym time and so on may not necessarily be the best idea for overall health. I sometimes see clients who are so exhausted and stressed and just need to focus on getting some good quality sleep and rest in order to establish a better overall life balance. It can be hard to encourage them to consider meditation or yoga instead of their daily HITT class.

Whilst no single definition of ‘over-exercising’ exists, I tend to think of it as the point at which your body is starting to struggle with the amount of training stress you are asking it to handle, i.e., where the downsides are starting to outweigh the positives.

This tipping point will vary widely between people and their life circumstances. Someone who is happy, stress-free, fit and healthy can potentially handle a higher training load than someone who is under enormous personal pressure, less fit than they used to be and suffering from a chronic disease. Therefore, there cannot be an absolute level at which you can definitively say “this is over-exercise” and “this is not”. It will all depend on the individual.

Having said that, there are a couple of questions that I might ask my clients, to help them to identify for themselves if they might be over-doing it. Whilst this is not a validated test, it may help to prompt a discussion about ways that we could potentially modify (not necessarily stop) an exercise programme if desired:


1. How do you feel emotionally during and after your workout?

– Do you feel excitement and joy during and immediately after your session, followed by a sense of contentment and ease a little while later?
– Or do you feel more panic, anger or anxiety during and immediately after your session, followed by a sense of overwhelm, exhaustion and despair?

2. Do you look forwards to training or dread it?

3. Do you find yourself getting lots of infections or back-to-back injuries?

4. Are you always tired, particularly upon waking?


If you find that your answers to these questions are weighted more towards the negative, then this may be an indication your balance is tipping in the wrong direction and perhaps it’s time to ease off a little.

Effective training can be thought of as a tripod made up of exercise, diet and rest. If all three are not equally addressed, the tripod will tumble and so will your training goals’ – Richard Hannam

When it comes to exercise, I therefore think of it as a bit of a goldilocks phenomenon; not too little, not too much, but just the right amount for you at each point in time is the best bet for optimising health.

The reasons why people over-exercise are, of course, varied. For some, it is simply what is necessary to enable them to compete at a high level. But, perhaps more commonly in my clinic, it is as a result of trying to manage either weight or body image, or a belief that it is somehow necessary to really go hard with the training to be healthy – a conviction that seems to be increasingly fueled by social media and fitness gurus.

Although it is certainly true that a combination of exercise and diet together is the best way to maintain a healthy weight in the long run, we may be more likely to maintain good habits if we are exercising for enjoyment and pleasure, rather than simply as compensation for calories. Remember – exercise should never be considered penance for eating. We need to eat, and we need to move. Neither needs be contingent on the other!

Here are a few potential consequences of over-exercise on health and/or sports performance

  • Dampened immune function, and potentially increased risk of common infections (such as coughs and colds) (Smith, 2003).
  • Gut inflammation and potential increase in intestinal permeability after prolonged periods of intensive exercise (Costa et al., 2017).
  • Irregular menstrual cycles
  • Female infertility (Olive, 2010), particularly if underweight (Rich-Edwards et al., 2002).*
  • Excessive weight loss
  • Excessive fatigue (Meussen et al., 2013)
  • Increased stress, reduced sleep
  • Increased risk of injury, especially if you are more of a ‘weekend warrior’ (Psoinos et al., 2012)
  • Over-training syndrome; where you are continuing to train vigorously, but your performance starts to deteriorate over the long term (Meussen et al., 2013).

*However, in women with a BMI > 25 who undertake vigorous exercise of for <60 minutes per day, there is actually a reduced risk of infertility (Hakimi and Cameron, 2016). So, as with so much of health and nutrition, individual context clearly matters.

. . . . . . .

For more information:

The UK register of Exercise Professionals is a good place to start your search for a new fitness instructor to help and support you: exerciseregister.org/members/members-directory-listing

. . . . . . .

 

Next: Part 3, Creating an exercise habit

References & Bibliography:

Barrack, M., Ackerman, K. and Gibbs, J. (2013). Update on the female athlete triad. Current Reviews in Musculoskeletal Medicine, 6(2), pp.195-204.

Costa, R., Snipe, R., Kitic, C. and Gibson, P. (2017). Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Alimentary Pharmacology & Therapeutics.

Griffiths, M., Szabo, A. and Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), pp.e30-e30.

Hakimi, O. and Cameron, L. (2016). Effect of Exercise on Ovulation: A Systematic Review. Sports Medicine.

Lakier Smith, L. (2003). Overtraining, Excessive Exercise, and Altered Immunity. Sports Medicine, 33(5), pp.347-364.

Lee, I., Sesso, H., Oguma, Y. and Paffenbarger, R. (2004). The “Weekend Warrior” and Risk of Mortality. American Journal of Epidemiology, 160(7), pp.636-641.

NICE (2013). Physical activity: brief advice for adults in primary care | Guidance and guidelines | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ph44/chapter/1-Recommendations [Accessed 9 Jun. 2017].

O’Donovan, G., Lee, I., Hamer, M. and Stamatakis, E. (2017). Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Internal Medicine, 177(3), p.335.

O’Keefe, J., Lavie, C. and Guazzi, M. (2015). Part 1: Potential Dangers of Extreme Endurance Exercise: How Much Is Too Much? Part 2: Screening of School-Age Athletes. Progress in Cardiovascular Diseases, 57(4), pp.396-405.

O’Keefe, J., Patil, H., Lavie, C., Magalski, A., Vogel, R. and McCullough, P. (2012). Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise. Mayo Clinic Proceedings, 87(6), pp.587-595.

Olive, D. (2010). Exercise and fertility: an update. Current Opinion in Obstetrics and Gynecology, 22(4), pp.259-263.

Psoinos, C., Emhoff, T., Sweeney, W., Tseng, J. and Santry, H. (2012). The dangers of being a “weekend warrior”. Journal of Trauma and Acute Care Surgery, 73(2), pp.469-473.

Rich-Edwards, J., Spiegelman, D., Garland, M., Hertzmark, E., Hunter, D., Colditz, G. and et al. (2002). Physical Activity, Body Mass Index, and Ovulatory Disorder Infertility. Epidemiology, 13(2), pp.184-190.

Roberts, D., Ouellet, J., McBeth, P., Kirkpatrick, A., Dixon, E. and Ball, C. (2014). The “weekend warrior”: Fact or fiction for major trauma?. Canadian Journal of Surgery, 57(3), pp.E62-E68.

Stranahan, A., Lee, K. and Mattson, M. (2008). Central Mechanisms of HPA Axis Regulation by Voluntary Exercise. NeuroMolecular Medicine, 10(2), pp.118-127.

Walsh, N. and Oliver, S. (2015). Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Immunology and Cell Biology, 94(2), pp.132-139

 


Spotlight on Exercise, Part 1: The health benefits of exercise

Spotlight on Exercise, Part 1: The health benefits of exercise

What part should exercise play?

It’s hard to argue with the fact that regular movement is good for our health. As well as playing an important role in helping to prevent heart disease, type 2 diabetes, stroke, some cancers and musculoskeletal problems, exercise can also boost our mood and cognitive function (NICE, 2014) (Kramer and Erickson, 2007). Plus for many people, it can also be a source of great enjoyment, a bit of headspace, a way to unwind and de-stress or an excuse to catch up with mates.

I do also know that this isn’t the case for everyone and many dread doing exercise. Personally, I have to force myself to do it and many of my clients feel the same way. So seeking out ways to enjoy it are key. For me this is being outdoors, with my dogs or with friends rather than being in a gym or class, but each to their own.

I am not a fitness professional. However, I do understand the importance of movement for a healthy mind and body. This 3-part series has been written in collaboration with Richard Hannam, an experienced health and wellbeing physiologist and personal trainer, who has kindly shared his wealth of expertise and knowledge throughout this feature. If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Whether you love it or hate it, exercise is important, but it is easy to get confused about what we are aiming for and why we are doing it. Social media can make it seem a very off putting and daunting task (only for those with perfect bodies!) and fitness websites can sometimes make it seem that unless you are training everyday, top-to-toe clad in tight fitting Lycra, then it’s not for you. And don’t get me started on how tight and uncomfortable most exercise clothing is, seemingly made for those who are slim and fit and not for those with “normal” bodies. Almost everyone I know and work with wants realistic and enjoyable ways to exercise that isn’t going to cost them a fortune and make them feel bad about themselves.

So I thought I would start by sharing what the UK general recommendations for exercise are, and hopefully show that it isn’t as difficult to achieve / scary / unrealistic as we might think. And, happily, there is no need to join an expensive gym, spend hours lifting weights, or bedeck yourself with fancy fitness gear to achieve these suggestions.

The current UK movement recommendations for healthy adults are as follows (NICE, 2013)

  • Try to be active in some way daily – anything is better than nothing. Even if that’s just 5 minutes a day to start with.
  • Over a week, this could add up to at least 150 minutes of moderate activity (you can choose how you divide those minutes up)
  • Or, comparable benefits can be achieved through at least 75 minutes of vigorous activity spread across the week
  • Or a combination of the two.
  • Try to incorporate some resistance (muscle strength) and balance training twice a week – this is important for bone health and health preservation (such as pilates, yoga and body weight exercises).
  • Everyday movement (walking up stairs, walking to the shops, doing the housework, pottering around etc.) is just as important as formalised ‘exercise’.
  • Many workplaces are now starting to offer the option of standing desks to help minimise the amount of time you spend sitting, or if this isn’t an option, I have found that putting a Sissel SitFit on my desk chair has made a big difference to back aches and pains, and I also find that I just move about a lot more whilst I am working away – I honestly love it (and it’s a bit less cumbersome than an exercise ball).

How to get the right intensity

Working to a ‘perceived intensity’ helps you tailor the activity you are doing to your current level of fitness. Richard uses this simple guide with his clients, called the ‘sing’ test:

Moderate intensity:
Faster breathing, increased heart rate and feeling warmer. In other words, you could still talk, but you couldn’t sing whilst you are moving.

Vigorous intensity:
Hard breathing, rapid heart rate and shortness of breath. In other words, you can neither talk nor sing whilst you are moving.

This is how it could look in real life:

Monday:  Rest day – just pottering about at home or work
Tuesday:  Walk to work and home again (60 minutes moderate cardio)
Wednesday:  Pilates class (strength & balance training)
Thursday:  Spinning, dance or circuits class (45 minutes vigorous cardio)
Friday:  Quick body weight workout at home (strength & balance training)
Saturday:  Bike ride and play in park with kids (60 minutes moderate cardio)
Sunday:  Gardening or general housework (30 minutes moderate cardio)

Exercise doesn’t always need to mean pounding the treadmill hard, or sweating it out in class. Sometimes it can just mean gentle movement therapy. Find a green space and walk around it, do some gentle stretches, swim in the sea, play with your children, potter about the garden. It is all valuable and valid movement”

Handy resources:

For more information on recommendations for exercise, do take a look at the NHS choices website:

nhs.uk/physical-activity-guidelines-for-adults

For some simple, 10-minute workouts you can do at home:

nhs.uk/Livewell/loseweight

Advice on exercising in pregnancy:

nhs.uk/conditions/pregnancy-and-baby

. . . . . . .

References:

Kramer, A. and Erickson, K. (2007). Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends in Cognitive Sciences, 11(8), pp.342-348.

NICE (2014). Physical activity: exercise referral schemes | Guidance and guidelines | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ph54/chapter/what-is-this-guideline-about#benefits-of-physical-activity [Accessed 9 Jun. 2017].


Gut Health, Part 3: 10 Ways to Help Support Gut Health

Gut Health, Part 3: 10 Ways To Help Support Gut Health

This is the third part of my series on gut health. Do check out The Basics of Gut Health and Probiotics and Prebiotics in Gut Health for further information on this popular topic.

How to eat more fibre

  1. Start with the basics

Whenever I am asked to consider ways to support individual organ systems or processes (such as brain health, skin health, immunity etc.), I always start by saying that we can’t isolate just one part of the body and focus only on that.

We exist as an intricately connected whole system. What affects one area of our body will also affect everywhere else, to a greater or lesser extent. This concept applies to our gut health. So while there are certain strategies that may specifically benefit our microbiota or digestive health, we must consider their wider effects, too.

Likewise, many aspects of our lifestyle beyond just diet can also influence our gut – from lack of sleep, to stress, to being consistently sedentary. Therefore, perhaps the most important first step to nourishing our gut is actually to nourish our whole body and mind. To establish those fundamental basics of health: restorative sleep, moderate alcohol intake, regular movement, a balanced and nourishing diet, active stress management and social connection.

Often, we may find that when these basics are in place, consistently (not perfectly – that’s not a realistic goal), much of the rest takes care of itself.

  1. Take time to eat, sit down & chew properly

Our digestion needs time to work properly, so sit down to eat, and try to give yourself at least 10 minutes for each meal, ideally undistracted. The more relaxed we are when eating, the more we activate the ‘rest and digest’ state of our nervous system. Which, as the name suggests, is very helpful to support efficient digestion.

Chew your food well and give your digestion a break between meals (I suggest at least 4-5 hours). These two simple factors can do an awful lot of good when it comes to gut health, especially bloating, without changing a single thing in your diet.

If you’d like more information on how to practice mindful eating (including a mindful exercise) as well as more on digestive health and nutrition, I suggest taking a look at my online course  which explores many of these topics in detail.

  1. Drink enough water

Your body maintains a finely tuned fluid balance by absorbing more water from your gut if you are getting a little dehydrated. This hardens the contents of your bowels, and so dehydration is a common cause of slow gut transit time and constipation.

Good hydration enables good elimination! For gut health, it is suggested that we aim for around 30-25ml fluids per kg of body weight per day (although this will vary according to the temperature and amount of exercise you are doing too, so as always, please listen to your body).

  1. Include healthy fats in your diet

For simplicity’s sake when it comes to healthy fats, I generally recommend using plain olive oil for cooking, and your fancy extra-virgin olive oils for salad dressings and drizzling. Other healthy fats, such as avocados, oily fish and nuts & seeds, are also very gut friendly.

There is a lot more information on how to build a healthy diet, including which healthy fats to go for in my third book, Nourish & Glow: The 10 Day Plan.

  1. Focus on fibre

A fibre-rich diet is associated with an increased diversity of the gut microbiota (and, in general, the greater the diversity the better), as well as helping to reduce constipation and other bowel-related problems. It may potentially even help to reduce the risk of heart disease and stroke (Wald, 2013) (Gobson and Shepher, 2010) (De Filippo et al., 2010).

Plus, fibre is filling and low in available calories, so great for those who are watching their weight. Aim for at least 30g/day, which you can get from lots of fresh vegetables, beans and pulses, and unrefined, whole-grain carbohydrates (oats, millet, quinoa, amaranth etc.).

See my article ‘Eat More Fibre’  for lots more on this topic.

  1. Eat a colourful diet rich in polyphenols

Plant polyphenols are important naturally occurring compounds that are found in a range of plants, fruits and vegetables which are thought to have all sorts of beneficial effects for both your gut and your body as a whole (Puupponen-Pimia et al., 2002).

Good sources of polyphenols include:

  • Citrus fruits (whole fruits though, not just the juice!).
  • Dark green leafy vegetables (spinach, chard, cabbage, kale etc)
  • Green Tea
  • Red and purple berries (I often recommend a portion a day for gut health – frozen ones are fine when fresh are out of season)
  • Nuts and seeds. Linseeds (also known as flax seeds) and chia seeds are a good example, although I would recommend soaking them for a few hours or overnight in water before eating them for maximum nutrient absorption. I would suggest trying to have a moderate portion of nuts, seeds or nut butter every day (assuming you tolerate them well and have no allergies)
  • Cacao – yep, that means chocolate! Either go for raw cacao or organic cocoa powder, or look out for organic chocolate with a cocoa content of > 85%. 10-25g per day is a sensible amount (that’s about 1-2 large squares).

For more information on polyphenols, take a look at my article Why ‘eating the rainbow’ is not just a cliched phrase – also contains lots and lots of colourful recipe inspiration.

  1. Include some probiotic & prebiotic foods

Probiotic foods include organic fermented dairy products such as bio live plain yoghurt, sour cream, aged cheese or kefir (if you tolerate casein protein and lactose). Alternatively, kimchi, kombucha, miso, natto, sauerkraut and tempeh are fermented too. Do make sure that these contain ‘active, live cultures though’ – if they have been pasteurized or heat-treated after fermentation then they will no longer have significant probiotic function.

Prebiotic foods include things like asparagus, under-ripe banana, aubergine, endive, garlic and onions, Jerusalem artichokes, leeks, pulses (such as beans, peas and lentils) and chicory. Unrefined wholegrains may also have some prebiotic function.

Please note: It’s recommended that you always start to include these foods very gradually into your diet. Adding a lot of probiotics and prebiotics at once can potentially lead to a significant exacerbation in gut symptoms. Sometimes I recommend just a teaspoon every other day to begin with (although others may be fine adding more). Listen to your own body, as always.

  1. Consider possible food allergies & intolerances

If you have a specific food allergy or intolerance, this food may need to be eliminated for a while (or indeed, indefinitely in some instances), to allow your gut and symptoms to heal.

It’s always best to speak to a Registered Nutritionist, Nutritional Therapist or Dietitian to advise you on this (head over to my FAQs page for info). As far as possible, eating a widely varied diet is important to ensure we don’t inadvertently develop nutrient insufficiencies, and to minimise the stress and anxiety we might feel around eating.

Please be wary of any online company that offers at-home tests to find if you have any allergies or intolerances – most of these are not proven to be effective, and may result in you restricting your diet unnecessarily.

  1. Reduce ultra-processed foods

It’s a good idea, both for our overall health as well as for our gut health, to cut down on the amount of heavily processed and/or junk food we consume, especially processed meats and high-sugar, high saturated fat foods. Although all foods do have their rightful place in a balanced diet, moderation is important when it comes to these sorts of foods. It’s best to base the majority of our meals on whole foods, such as fruits, vegetables, high-quality proteins, pulses, wholegrains and nuts & seeds, cooked simply.

  1. Actively manage stress

Stress can be a big factor in both our gut health and our overall health. Our brain, microbiota and gastrointestinal tract are all intricately connected, and can all affect each other. This book explains that connection really well.

Although we all feel stress, and a bit of it can actually be beneficial to us, too much is definitely unhelpful. Actively managing stress can take many forms. Some people find exercise incredibly helpful, others self care and others still seek social connection in times of challenge.

It’s less about what you do than actually doing it consistently. This book, offers a great deal of ideas, tips and suggestions if you’re not sure where to begin when it comes to reducing your own stress levels.

SHOP THE EDIT

Eat Yourself Happy | Dr Megan Rossi

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Be Good To Your Gut | Eve Kalinik

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The Joy of Healthy Eating | Amelia Freer

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Nourish & Glow: The 10 day plan | Amelia Freer

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Green Tea | Clipper Tea

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The Stress Solution | Dr Rangan Chatterjee

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Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.

References & Bibliography:

Bjarnason, I., Williams, P., Smethurst, P., Peters, T.J. and Levi, A.J. (1986) ‘Effect of non-steroidal anti-inflammatory drugs and prostaglandins on the permeability of the human small intestine’, Gut, 27(11), pp. 1292–1297. doi: 10.1136/gut.27.11.1292.

De Filippo, C., Cavalieri, D., Di Paola, M., Ramazzotti, M., Poullet, J.B. and Massart, S. (2010) ‘Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa’, Proceedings of the National Academy of Sciences, 107(33), pp. 14691–14696. doi: 10.1073/pnas.1005963107.

De-Souza, D.A. and Greene, L.J. (2005) ‘Intestinal permeability and systemic infections in critically ill patients: Effect of glutamine*’, Critical Care Medicine, 33(5), pp. 1125–1135. doi: 10.1097/01.ccm.0000162680.52397.97.

Dethlefsen, L. and Relman, D.A. (2010) ‘Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation’, Proceedings of the National Academy of Sciences, 108(Supplement_1), pp. 4554–4561. doi: 10.1073/pnas.1000087107.

Gibson, P.R. and Shepherd, S.J. (2010) ‘Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach’, Journal of Gastroenterology and Hepatology, 25(2), pp. 252–258.

Lambert, G., Boylan, M., Laventure, J.., Bull, A. and Lanspa, S. (2007) ‘Effect of aspirin and ibuprofen on GI Permeability during exercise’, International Journal of Sports Medicine, 28(9), pp. 722–726. doi: 10.1055/s-2007-964891.

Puupponen-Pimiä, R., Aura, A.., Oksman-Caldentey, K.., Myllärinen, P., Saarela, M., Mattila-Sandholm, T. and Poutanen, K. (2002) ‘Development of functional ingredients for gut health’, Trends in Food Science & Technology, 13(1), pp. 3–11. doi: 10.1016/s0924-2244(02)00020-1.

Wald, A. (2013) Patient information: High-fiber diet (Beyond the Basics. Available at: UpToDate (Accessed: 1 December 2015).

Photos by Jen Rich and Darryl Leja


Gut Health, Part 2: Probiotics and Prebiotics in gut health

Gut Health, Part 2:  Probiotics & Prebiotics in Gut Health

What are probiotics?

Probiotics are “live micro-organisms, which when consumed in adequate amounts, confer a health effect on the host”. Use of probiotic foods is an ancient tradition – even as far back as the time of Genghis Khan, fermented milk was being drunk as an elixir of strength and health.

In the second part of this gut health series, we are going to look at the role of probiotics and prebiotics in gut health – possibly one of the most exciting new topics to emerge in nutrition in the last few years. If you missed Part 1: The basics of gut health  take a look at it first to give you a little more background.

Most often, probiotic foods or supplements contain strains of either Lactobacillus or Bifidobacterium bacteria, usually from fermented dairy products. However, before starting to act, they have to survive the hazardous journey to reach our gut:

  1. They need to first get through manufacturing, transportation and storage processes, to reach our fridge or kitchen cupboards alive and in good condition.
  2. Then they must make it through the acidic environment of our stomach (designed precisely to kill off any wayward bacteria) and through the swamp of potent digestive juices and enzymes secreted by the gallbladder and pancreas.
  3. Finally, if they succeed in reaching their destination, the large bowel, they then actually need do some good for the host rather than just going along for a free ride, or even possibly doing some untoward harm.

Because of these difficulties with getting the right probiotics to the right place, it is important to point out that the benefits which are seen in clinical trials may not all be possible to achieve with the yoghurts, tablets or other supplements available over-the-counter.

Despite all these challenges, however, good quality strains of probiotics have been associated with beneficial effects in some disease processes, such as reducing antibiotic-associated diarrhoea.  Researchers are also examining a huge range of other conditions that may benefit from probiotics (Tuohy et al., 2003) (NHS Choices, 2015). Further research is very much ongoing.

Limitations

Most of the clinical research that has been carried out on prebiotics has been in unwell populations, and even then they are not yet in widespread use. We do not yet know much about the impact that taking probiotics might have in generally healthy people (Puupponen-Pimia et al., 2002). Anecdotally, I have found them to be of tremendous benefit for myself and some of my clients. However, anecdote is not a strong form of evidence, and I am always cautious about recommending any supplements on this sort of platform, so please do speak to your doctor or an appropriately qualified nutrition professional prior to commencing any supplements.

Furthermore, probiotics, even as tablets, are also still regarded as foods. Therefore they do not have to undergo the same rigorous testing as medicines do, so it is difficult to know if they actually contain the bacteria they claim, alive, in an adequate dose, and are able to give you a tangible benefit (NHS choices, 2015). The European Food Safety Authority has even gone so far as to ban the probiotic food industry from certain advertising claims, such as that they ‘boost the immune system’, because there is insufficient evidence to back such claims up at the moment. A healthy dose of skepticism is often helpful in nutritional science!

As Dr Alessio Fasano so neatly puts it, we can compare our current knowledge of the microbiota to our knowledge of space. We know the universe exists (our microbiota), and we are getting to grips with the fact the Milky Way is there (the major strains of bacteria), but we are far off knowing where London is! In other words, there is a lot of detail still to understand before we are able to fully utilize probiotics for health.

What about prebiotics – are they the same thing?

No. Prebiotics are a class of nutrients called ‘oligosaccharides’ (a type of fibre) which pass through the upper portion of the gut undigested, to feed and stimulate the growth of microbes further down. I think about it as nectar for gut bugs!

Types of prebiotic that are thought to influence the microbiota include (Tuohy et al., 2003);)

  • Inulin & Fructooligosaccharides – found in foods such as Jerusalem artichoke, asparagus, leeks, green bananas, chicory and onions (Sabater-Molina et al., 2009)
  • Lactulose
  • Galactooligosaccharides – found naturally in breast milk to help feed the microbiota of new born babies.

In general, a dose of more than 20g a day of all of these combined, may lead to unwanted side effects such as flatulence and bloating (Tuohy et al., 2003). I would therefore suggest it is a sensible idea to always ‘start low and go slow’ when introducing these to your diet.

As an added benefit, when our gut microbes break down these prebiotic fibres, especially inulin, they release a compound called butyric acid (Scott et al., 2013). This may be particularly important in gut health, as not only is it thought to be anti-inflammatory, but it also helps build up the gut defence barrier and decreases oxidative stress. Plus it might even help to signal to our brain that we are full and satisfied at the end of a meal (Hamer et al., 2007).

My pragmatic approach, if you are generally well, and would like to boost your probiotic and prebiotic intake, is to use foods first as much as possible.

In part 3 of this series,10 Ways to Help Support Gut Health, we will explore lots of practical ideas on how to do this.

SHOP THE EDIT

Gut | Giulia Enders

SHOP

The Joy of Healthy Eating | Amelia Freer

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Eat Yourself Happy | Dr Megan Rossi

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Be Good To Your Gut | Eve Kalinik

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Smoky Pink Kraut | Eaten Alive

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Organic Kefir | BioKef

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Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.

References & Bibliography:

Hamer, H.M., Jonkers, D., Venema, K., Vanhoutvin, S., Troost, F.J. and Brummer, R.. (2007) ‘Review article: The role of butyrate on colonic function’, Alimentary Pharmacology & Therapeutics, 27(2), pp. 104–119. doi: 10.1111/j.1365-2036.2007.03562.x.

NHS Choices (2015) Probiotics – NHS choices. Available at: http://www.nhs.uk/Conditions/probiotics/Pages/Introduction.aspx (Accessed: 11 December 2015).

Puupponen-Pimiä, R., Aura, A.., Oksman-Caldentey, K.., Myllärinen, P., Saarela, M., Mattila-Sandholm, T. and Poutanen, K. (2002) ‘Development of functional ingredients for gut health’, Trends in Food Science & Technology, 13(1), pp. 3–11. doi: 10.1016/s0924-2244(02)00020-1.

Sabater-Molina, M., Larqué, E., Torrella, F. and Zamora, S. (2009) ‘Dietary fructooligosaccharides and potential benefits on health’, Journal of Physiology and Biochemistry, 65(3), pp. 315–328. doi: 10.1007/bf03180584.

Scott, K.P., Martin, J.C., Duncan, S.H. and Flint, H.J. (2013) ‘Prebiotic stimulation of human colonic butyrate-producing bacteria and bifidobacteria, in vitro’, FEMS Microbiology Ecology, 87(1), pp. 30–40. doi: 10.1111/1574-6941.12186.

Tuohy, K.M., Probert, H.M., Smejkal, C.W. and Gibson, G.R. (2003) ‘Using probiotics and prebiotics to improve gut health’, Drug Discovery Today, 8(15), pp. 692–700. doi: 10.1016/s1359-6446(03)02746-6.

Photos by Darryl Leja


Gut Health, Part 1: The Basics of Gut Health

Gut Health, Part 1: The Basics of Gut Health

In the Autumn of 2020, I asked my lovely newsletter subscribers what they would like to see more of from me in the future. The overwhelming response was ‘gut health’.

So, in response I have given this gut health mini-series (originally written a few years ago) a real overhaul, updated it to meet my current practice and philosophy, and linked in all sorts of useful and relevant articles to expand on various topics. I’ve also added some of my favourite products and gut health books at the end of each section, in case you’d like a few of my personal recommendations.  I hope you find it helpful.

What do we mean by the ‘gut’?

The gut is a collection of organs, running from the mouth to the bowels, with help from the stomach, liver, pancreas and gallbladder along the way. All of these structures work together to extract the greatest amount of nutrition from whatever we choose to eat.

Alongside our digestive organs, we increasingly understand the powerful impact that our gut microbiota has on health. The microbiota consists of trillions of microbes (bacteria, yeast, funghi and viruses), which live inside our bowels, interacting not only with the food we eat, but also with each other and with us. Each microbiota is unique to each person.

When in harmonious balance, these microbes helpfully aid our digestion, make vitamins and other nutrients, break down dietary toxins, strengthen the body’s internal barrier against the contents of gut, prevent overgrowth of bacteria which can make us unwell, and can even influence our immune system and mood (Butel, 2014). But when out of balance, these microbes may also have the potential to negatively impact our health, too. I therefore now see the ‘gut’ not only as an organ system, but as an ecosystem too.

All sorts of factors may affect the composition and function of our microbiota, and therefore our gut health, including:

Hippocrates reportedly said that ‘all disease starts in the gut’. Clearly this isn’t true all of the time (take genetic disorders, for example), but a significant proportion of chronic diseases may indeed be linked to gut health. It has just taken medical science a few thousand years to catch up!

What is a healthy gut?

There is actually no specific definition of what makes a ‘healthy’ gut, because that depends so much on the individual.

But in general, I personally would consider a healthy gut to:

  1. Be free from persistent digestive symptoms (such as bloating, abdominal pain or disrupted bowel habits). We all get the odd mild symptom from time to time though, but when things change, are persistent, or show any worrying signs (see below) this should be flagged to your healthcare provider promptly.
  2. Eliminate regular, formed (but easily passed) stools*
  3. Allow complete digestion and absorption of nutrition. The average time for the entire process of digestion / absorption is 24 hours, although this does vary a lot between individuals.

* This little step, which wraps around your loo, helps your body adopt a physiological squatting position when opening your bowels which some people find beneficial with constipation.

What is an unhealthy gut?

There are certain unhealthy gut symptoms that are known as ‘red flags’. These are important warning signs that should be discussed with a doctor as soon as possible. Although some of them may represent a harmless condition that will settle itself, it is important if you have any of these symptoms to seek a medical opinion promptly.

These signs may include (note that this is absolutely not an exhaustive list – please speak to your GP if you have any concerns whatsoever about your gut health);

  • A sudden, persistent change your bowel habits
  • Any bleeding, or black, tarry stools
  • Persistent bloating
  • Increasing heartburn, indigestion or stomach pains
  • Abdominal pain
  • Losing weight unintentionally
  • Any difficulty or pain on swallowing

Within the scope of my nutritional practice, I would also look at all sorts of other symptoms (even if they are not necessarily directly related to the gut), such as skin, mood, energy, weight and more. There’s an old phrase in Nutritional Therapy that states ‘what happens in the gut doesn’t stay in the gut’, and so I do look beyond just digestive symptoms when talking with my clients.

How might gut health affect weight?

We know that our gut needs to be functioning effectively to be able to digest and absorb the nutrition that we are eating. If this function becomes impaired, it could potentially lead to both weight loss, and perhaps even weight gain.

Perhaps the most important question to ask is firstly whether there could be an underlying medical problem that is driving poor digestion? The best way to work out if this is a possibility is to speak to your doctor or other healthcare provider. Problems with maldigestion or malabsorption may lead to an unintended decrease in weight (although not always).

Once any medical concerns have been ruled out (if necessary), the next step would be a more comprehensive look at overall digestion, and to see whether there are any signs and symptoms gut inflammation or irritation. This is often highly variable between people, so again, I would suggest that you find a well-qualified Nutritional Therapist, Dietitian or Registered Nutritionist (see FAQs for more info) to help. There simply isn’t a one-size-fits-all approach to gut health, so this individualised support is very important.

There is also a lot of interest at the moment around the potential role of the gut microbiota in the development of obesity, and obesity-related diseases. Lots of this revolves around how certain microbes may potentially alter appetite, metabolic function and energy absorption by the body.

Unfortunately, we do not know enough about this topic yet to know which types of microbe could potentially help us to lose weight (or indeed, help us to gain weight). However, there are some promising studies emerging and research is certainly ongoing (Abenavoli et al.l, 2019, Kadooka et al., 2010)

Please click the links below for further related information;

Gut Health Part 2: Probiotics & Prebiotics in Gut Health

Gut Health Part 3: Ways to Support Gut Health

Eat More Fibre

SHOP THE EDIT

Gut | Giulia Enders

SHOP

The Joy of Healthy Eating | Amelia Freer

SHOP

Eat Yourself Happy | Dr Megan Rossi

SHOP

Be Good To Your Gut | Eve Kalinik

SHOP

The Mind-Gut Connection | Emeran Mayer

SHOP

Step Stool

SHOP

Please note, this website uses some carefully selected affiliate links. If you buy through these links, we may earn an affiliate commission, at no additional cost to you. This helps to keep all of our online content free for everyone to access. Thank you.

Please note: This article is for information only and in no way replaces medical or personal nutrition advice. You should always speak to your healthcare provider in the first instance if you have any concerns whatsoever about your digestive or gut health. Please do not disregard or delay treatment based on anything you read on this website. I am not a doctor, nor am I your Nutritional Therapist. The information I share is very general and may not be relevant or appropriate for you as an individual.

References

Kadooka, Y., Sato, M., Imaizumi, K., Ogawa, A., Ikuyama, K., Akai, Y., Okano, M., Kagoshima, M. and Tsuchida, T. (2010) ‘Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial’, European Journal of Clinical Nutrition, 64(6), pp. 636–643. doi: 10.1038/ejcn.2010.19.

Krajmalnik-Brown, R., Ilhan, Z.., Kang, D.. and DiBaise, J.K. (2012) ‘Effects of gut microbes on nutrient absorption and energy regulation’, Nutrition in Clinical Practice, 27(2), pp. 201–214. doi: 10.1177/0884533611436116.

Abenavoli, L.; Scarpellini, E.; Colica, C.; Boccuto, L.; Salehi, B.; Sharifi-Rad, J; Aiello, V.; Romano, B.; De Lorenzo, A.; Izzo, A.A.; Capasso,R. Gut Microbiota and Obesity: A Role for Probiotics. Nutrients 2019, 11, 2690.

Credit – top image:  Darryl Leya, National Institutes of Health (NIH)


Life as a Nutritional Therapist, Amelia Freer

Life as a Nutritional Therapist

life as a nutritional therapist

Life as a Nutritional Therapist, Amelia Freer

life as a nutritional therapist

One of the wonderful things about my profile as a nutritional therapist is that I get lots of budding nutritional therapists asking for advice. And of course I believe that there is plenty of room for more well-trained and enthusiastic nutritionists to help support a population which is suffering from an increasing number of diet-related diseases.

I receive many requests asking where to study, how to get started or those with an interest who are considering a new professional path. Regrettably I am unable to answer each individual request, so I have tried to answer all of the queries and share all that I think is necessary to consider and give you a little more insight into the reality of the vocation and lifestyle of nutritional professionals.

1: Get properly qualified

An online, or weekend course does not properly qualify you for this profession. Nutritional Therapy is a challenging profession that requires a huge amount of time and dedication. Working with an individual’s health, advising and supporting them appropriately needs to be managed responsibly. This is very different to running a glamorous blog! This is an industry that is now starting to achieve better recognition and hence regulation. Ensure that your course is recognised by The British Association for Applied Nutrition and Nutritional Therapy (BANT) (BANT.org.uk) which is the professional body for Registered Nutritional Therapists. Its primary function is to assist its members in attaining the highest standards of integrity, knowledge, competence and professional practice, in order to protect the client’s interests, nutritional therapy and the Registered Nutritional Therapist. BANT offers a wide range of benefits to students and full members and has its finger on the pulse for any changes or new developments within this dynamic profession.

I studied at The Institute for Optimum Nutrition (ion.ac.uk) and absolutely loved it. I have continued my education with The Institute for Optimum Nutrition (functionalmedicine.org). I am not familiar with the other courses available having not done them and suggest you really research each one that is recognised by BANT in order to choose which one feels right for you and your professional goals.

2: Your qualification is just the beginning

The moment you complete your studies is the moment you really start learning as a nutritionist. You have the foundations to practice safely, but you will still need to learn on the job, make mistakes and gain in wisdom, experience and confidence. What works with one client won’t work with another. Gradually you will build up a set of skills, phrases and knowledge which will become your own personal toolbox.

3: Work with the mind as well as the body

You may have a million and one scientific facts up your sleeve about the dangers of eating sugar, but you also need the skills and ability to help support someone who is bingeing on ice cream every evening because they are depressed. The mind and the body are inextricably linked, and food is almost always attached to a great deal of emotion. Understand where your role lies here – it is not your job to ‘fix’ people – you are only part of the process. And be aware when and where is the right time to seek help from colleagues who may be more able to support your client (psychologists, counsellors, GP etc.) to resolve these issues. I have built my own “toolbox” of appropriate practitioners to refer my clients to so that they can get the help they need.

4: It’s not all about looks!

I would say that the majority of clients that seek out a nutritional therapist are not just looking to lose a few pounds. They often have complicated medical histories, multiple symptoms, exhaustion, allergies, take a cocktail of medicines or behavioural problems around food, and need careful and safe support to help them move towards a healthier place. If in doubt, ask for advice from a mentor or specialist, and don’t be afraid to work closely with the other health professionals involved in your clients care. The wider impact of your actions and advice always need to be carefully considered. The best thing about helping these types of clients however, is the hugely positive impact that nutritional changes can have – and the weight loss is just a lovely side effect!

5: Keep developing

Science keeps on moving forwards, and you need to keep up to date with the most relevant changes. Attending regular professional development seminars, workshops or lectures is vital to keep your knowledge current. There are lots of networks and associations for nutritional professionals that provide information about lectures, seminars and events. You can’t stop learning once you have your qualification, even if it has felt like a mammoth mountain to climb!

6: You will often be changing your mind

Following on from the last point, you may find that as your knowledge progresses over time, your views and opinions also change. For example, I used to advise my clients to snack regularly. Now I encourage them to just have three proper meals everyday. Don’t be afraid to hold your hands up every now and again and say ‘Hey, I want to change my mind!’. Be open minded to new developments. You could not have known what was not yet discovered. Don’t adopt a “my way or the highway” approach. Everyone is individual.

7: Be aware that you might need to ‘unlearn’ a few things

Of course, by this I don’t mean go and throw all your textbooks away, but what you need to know is far, far more detailed than what your client needs to know about nutrition. In fact, most clients are not really interested in the science or the facts – they want practical action steps. Bombarding them with all of your passionate knowledge can be overwhelmingly confusing and not attending to their needs. Learning how to make things simple, even when they’re complicated and hard, is a vital skill for a great nutritional therapist. Think about it like an iceberg – just give them the curated tip of your knowledge.

8: Balance

This is a hard one, because so many nutritional therapists are passionate about what they do, and so many clients become rather reliant on their nutritional therapists. But you need to create boundaries you are happy with right from the beginning. I assure you that you will have happier clients as a result! I leave work behind at 6pm and do not answer work emails at the weekends. I explain all of this at the beginning of my partnership with a client, so everyone is clear from the start. Have a think about what you’d like your boundaries to be and don’t be afraid to state them clearly to any new client.

9: Money…

This is a tricky one to tackle, but I think it is important. Nutritional therapy is not a lucrative business, and many friends and colleagues I know have really struggled to make ends meet. The successful and glamorous side of the field is very rare, and although there are opportunities (such as book deals, sponsorship, meal delivery services etc.) to make a good profit, it is hard from seeing clients alone. It is definitely more a vocation, something you do because you love doing it, than a profession to make a fortune in! However, it is still an important profession and it’s reputation must be protected and so you need to be professional and run your business efficiently, charging appropriately for your time. Free advice and free consultations puts the client in an awkward position.

10: Sometimes you’ll need to defend yourself

Often I have met people socially who (for some unknown reason), feel obliged to tell me that they think my job is ridiculous. That nutrition is just calories in vs. calories out and people just need to stop being lazy. Where are their manners?! I used to get cross with this, but now I don’t rise to it. Their ignorance is a shame, but it doesn’t need to upset me. The best tip here is just to let it go – for every rude dinner party bully, there are a hundred other people who are on board with your message.

Although, as with every job, nutritional therapy has its challenges, it is also a wonderful, exhilarating and very rewarding job. There is no greater feeling than helping someone win an inner battle they’ve been fighting and become a healthier, happier person. The field is rapidly expanding and becoming a more dynamic and exciting place to work and learn. And so enjoy the journey and ride the wave of knowledge as it sweeps and expands throughout the health care of the future.

Wishing you the very best of luck for your future career!

 

amelia freer

FdSc, Dip ION


Portrait of Amelia Freer holding kale

Why Clean Eating Needs a Side Order of Common Sense

This article was written in 2016 following the media backlash around clean eating. Although the situation is rather a lot calmer now, many of my thoughts on this topic still stand.

Portrait of Amelia Freer holding kale

Why Clean Eating Needs a Side Order of Common Sense

Just like fashion, trends in dieting come and go. I’ve been an interested observer of these for well over a decade now, watching each new idea peak in popularity before fading away in readiness for the Next Big Thing. So the enormous rise and subsequent criticism against clean eating comes as no surprise to me.

However, despite the fact I’ve not specifically promoted the clean eating trend, as a fully-qualified nutritional therapist and author in the public eye, I find myself increasingly included in the opinion pieces surrounding its backlash. While this is an inevitable (albeit unwelcome) part of my job, I feel the storm around the topic of clean eating is becoming increasingly unhelpful for both sides of the argument.

This is especially true as we gear up for celebrations and events such as Christmas – what with all the indulgent foods and drinks that go with it, it’s tempting to pour scorn on clean eating and write it off as joyless. However, neither extreme – the indulgences of December nor the January detox – is good for us. So I feel compelled to respond, not to state whether clean eating is right or wrong, but rather to pour a healthy dose of common sense and calm onto the stormy waters.

The clean eating trend was originally born out of a desire to reduce the amount of junk or processed foods we consume, and increase our intake of unprocessed, whole foods. There’s nothing particularly groundbreaking about that – indeed, it’s the same advice given to us by public health bodies.

However, this simple message has subsequently turned out to be both its blessing and its curse. Rather than being able to reject clean eating as a fad and carry on, nutritional professionals, like myself, have found that this one has rather muddied the waters. Because what may have started out as sensible, healthy advice, also has the potential to morph into a far less beneficial, sometimes even dangerous, message.

If we take clean eating back to basics, strip away the marketing hype, remove the shame-inducing labels and ignore its unrealistically glamorous portrayal, we’re fundamentally left with a diet that matches almost exactly what I’ve been encouraging my clients to follow for years: fresh fruit and vegetables, quality protein, healthy fats, plus some complex and unrefined carbohydrates. These ingredients need not be expensive. Nor difficult to find and cook. And they are a big step up, health-wise, from the refined, high-sugar and high-salt foods we have come to consume in abundance.

Perhaps amongst the hype, however, we’ve forgotten that the clean eating ‘trend’ is nothing new. It’s simply the way our grandparents ate. So to my mind, it shouldn’t be about limiting important food groups, nor about a strict adherence to a set of rules and letting nothing else pass your lips. Instead, it should be about flexibility, moderation and enjoyment – with space for an occasional treat when you fancy it.

For those who embrace clean eating in such a balanced way, the results can be transformational after years of perhaps being stuck in a dietary rut, and such achievements shouldn’t be belittled or judged.

The rise of in popularity of clean eating has also resulted in more readily available healthy ingredients, inspirational cooking resources and wonderful grass-roots movements encouraging young people into the kitchen. In restaurants, cafes, supermarkets and even fast food chains, the choice of healthy options is now better than ever.

This simply wasn’t the case when I started out in practice. And having spent the past fifteen years trying to encourage people to eat more healthily, these changes have helped enormously. And frankly, I have to applaud a movement that’s elevated kale (traditionally a cattle feed) to almost cult-like status. Making everyday vegetables sexy is the holy grail of nutritional practice and clean eating has managed it in bucket loads.

 

Salmon Soba Noodle Salad by Amelia Freer

However, the clean eating trend is not without its problems. But I wonder whether these problems lie more in the delivery of the message, rather than in the actual message itself?

Successful trends attract businesses, and people, ready to jump onto a commercial bandwagon with little regard for the core values of the trend. However much marketing dust is sprinkled on it, a cake labeled ‘clean’ is still a cake. The same goes for expensive green juices, and all-singing-all-dancing superfood powders. They may be nice (and I do enjoy them myself occasionally), but they’re not necessary for good health, despite what the marketers tell you.

Most worrying of all though, is the rise of disordered eating as a result of this trend. Warped clean eating messages promoting strict food rules or shame-inducing body images are on the rise, and are now able to reach us 24/7 through social media and the internet.

Although the development of disordered eating is multi-factorial, I never underestimate the power of such messages. The pressure to be ‘picture perfect’ at all times was something I’m grateful I didn’t experience growing up, but I can see how vulnerable this could make anyone feel. And such feelings are certainly not confined only to adolescents.

And of course, many people giving advice on clean eating aren’t necessarily qualified to do so. I’ve read a lot in the press about the lack of regulation in nutrition which is a problem that needs addressing and is certainly adding fuel to the fire. Practicing nutrition absolutely requires appropriate, validated training, so I’m very much in favour of regulation. However, we must also be conscious that many of the articles slamming clean eating aren’t written by nutrition professionals either.

It’s important to remember that no food trend should justify eliminating vital nutrition from our diets. Nor should it become the catalyst to ignore the physical cues to eat. We must eat well to survive and prevent disease. Food, after all, cannot be ‘clean’ or ‘unclean’. It is just food. And good food is not only important for physical health, but also for our emotional and social health too.

So why not start afresh and take clean eating back to being healthy eating again? Remove the restrictive rules, the excessive promises, the inflated prices, the hidden sugars…and even the name. For many, the term ‘clean’ has come to imply a moral high ground or value judgment that is, at best, simplistic, and at worst, manipulative.

Because what started out as a positive move towards a whole-foods based diet now feels like it’s slipping dangerously close to a divisive, commercially-driven fad, encouraging the most vulnerable to feel dangerously inadequate.

One final thought. Even once we’ve brought a little common sense to the clean eating debate, it might be helpful to zoom out to the even bigger picture. In these troubled times we find the world in, I try to remind myself how incredibly lucky I am to be living in a democracy where most people have a choice about what to eat and how to live their lives. There are many millions who do not have this privilege. So although it’s easy to get caught up in the detail, let’s try to stay grateful for simply having food on our table.

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Should I Be Taking Supplements?

should I take supplements

should I take supplements

This is a question that I am asked almost daily. The idea certainly seems appealing, that by taking these little pills, you can almost ‘insure’ yourself against perhaps a less-than-perfect lifestyle. On the opposite side of the argument, we are told that we don’t need to supplement as long as we eat a well-balanced diet. So what’s going on?

Firstly, it is really important to emphasise that every individual is unique, and therefore the decision whether or not you need a supplement is not something that you can work out from a blog post. The most I can do here is to give you some information to help you decide (alongside your healthcare professional if needed), where you stand on this matter.


Nutritional depletion

Unfortunately, in today’s frantic world where meals are often grabbed on-the-go, it can be pretty challenging to make sure that you are getting enough of all of your nutrients over the course of a day or week. There are lots of reasons for this,

  • You really need to be eating a very well balanced and thoughtfully considered diet to have a good chance of including all the micronutrients you require. This is by no means impossible, but it does mean a diet jam-packed full of high nutrient density foods: things like fresh fruit & vegetables, nuts, seeds, good fats, legumes, oily fish, organic eggs and other high-quality proteins. There really isn’t much space in terms of energy consumption left for less nutrient dense foods (sugar, processed foods, alcohol) (1). See my article on Positive Nutrition for more on this.
  • We no longer eat food fresh from the ground. As hunter-gatherers, or even as farmers, we would be eating food very soon after it was picked. It is thought that the longer fresh food is stored, the more depleted of certain phytonutrients and vitamins it may become. Food picked weeks ago and transported halfway across the world may still look fresh, but may also have a different nutrient profile to something picked and eaten the same day.
  • Food production and animal and plant breeding methods make commercially grown food vastly different to the diet we evolved to eat – which was predominantly wild food. Although I do not sign up to the Paleo ideal as such, the principle that we haven’t ‘caught up’ yet to the environment that we now live in is likely true. Wild plants for example have a tougher life – they are not cosseted with herbicides to fight off competition, pesticides to fight off predators or fertilisers to make growing easy. In essence, they have to work harder to exist, and therefore may akso have a higher phytonutrient profile (natural compounds that protect a plant as it grows). Animals which would originally have eaten a grass-based diet, including many other meadow plants, are now kept in barns and given grains (which potentially changes their fat profile) (3). Even fish haven’t escaped intensive farming practices (causing some farmed ‘oily’ fish to have minimal beneficial omega-3 content) (4). The animals and plants we now eat can therefore have fewer. or at least different, nutrients than were available to our ancestors.
  • Cooking (especially boiling), can leach vitamins and phytonutrients out, depleting their nutritional profile.
  • Intensive food processing can severely deplete nutrients, yet still create foods dense in energy. This energy: nutrition ratio is an important point to make. We want to optimise out body’s access to a wide range of essential nutrients, while at the same time maintaining a healthy energy balance. Therefore, overly relying on heavily processed foods to form the bulk of our diets runs the risk of us inadvertently developing nutrient deficiencies, yet still having a diet high (perhaps even too high) in simple energy. The bottom line? Minimally processed whole foods are a great way of optimising this balance (of course, allowing for the odd treat from time-to-time).

Given all of this, it seems like it might be quite difficult to get enough of the right nutrition into our bodies, so perhaps you’re thinking a multivitamin would be a good idea?

There is a but, however  . . .


More is not always more

Unfortunately, it is not so simple as just adding a couple of multivitamins into your diet and job done. I know the message you’re getting here is a bit confusing then, which reflects the confusion in the media too. For example, one day vitamin D is a panacea for all ill-health, the next it causes some worrying disease. The problem is that nutrition research is very difficult to do reliably, and researchers often look at nutrient supplements individually as if they were drugs. It is hard to measure the effect of nutrients working together as a ‘team’. For example, spinach is a brilliantly health food, but if all you ate was spinach, you would get poorly and die. You need to eat a balanced amount of all the nutrients to maintain optimum health.

A word of warning. Research has also shown that in certain circumstances, nutritional supplements can, in fact, be dangerous. Of course, preventing or treating a serious deficiency is very important, but if someone has a less severe deficiency (a “subclinical” deficiency), there is really not much known about how this should be treated, Taking supplements, particularly at high doses, can cause immediate side effects (such as tummy upsets) (5), but more worrying are the long-term effects. These can range from kidney stones (6) to worsening pre-existing medical problems (5), even potentially increasing the risk of cancer (8), infections (9) or death (10), amongst many more reported effects. So, without wanting to cause alarm, the message is that there needs to be a degree of caution when taking supplements, particularly single supplements at high doses. More is definitely not always better, especially if you are already getting plenty in your diet. Other factors to consider before taking a supplement include;

  • Although we have a pretty good idea about how much of each nutrient we need to prevent a serious deficiency, we do not know enough yet about what ‘optimal’ levels of nutrients are, so therefore how can we know what optimal supplement doses are? Even the recommended nutrient intake values published by the government are often based on educated best guesses.
  • Everybody needs and metabolises different amounts of each nutrient. Therefore a one-size-fits-all multivitamin is unlikely to be optimum for anyone.
  • We are not sure of the ideal ratios of nutrients to take together. For example, taking zinc can make you copper deficient, so should you take them together, and at what doses? There needs to be more research to make this information available.
  • We are now starting to understand the very important role that genetic variation has on how we absorb, use and excrete individual nutrients (11). Whereas current recommendations target the majority of the population to prevent nutritional deficiencies, using a more personalized approach based on an individual’s genome (their unique DNA code) would allow much more targeted recommendations. This is still a pretty novel concept, but we may find that it becomes increasingly more mainstream in the future.


Regulation

When you go to the doctor and get a prescription, you know that the pill you take is what it says it is. This is because medicines are a heavily regulated product, and undergo years of testing before they are released to patients. Unfortunately, supplements do not have the same level of controls applied to them, so it is very difficult to know exactly what you are buying. These are some of the possibilities when you buy supplements over-the-counter;

  • The form that the nutrient is prepared in may mean that it is absorbed poorly by the body.
  • The dose on the label may not match the dose in the pill
  • The raw materials (such as fish oil supplements, or herbs) may not be tested or processed to remove contaminants (such as mercury, PCBs, or lead)
  • The pill may contain other ingredients than those listed on the packaging
  • The manufacturing process may have poor quality control processes, leading to unreliable quality between batches.
  • Be cautious about too-good-to-be-true marketing claims! They most probably are…

So, whilst I do not endorse or condemn any supplement manufacturers, I would urge you to be cautious if you chose to buy and take supplements. As with the food you eat, try to get supplements from a reputable firm that is happy to tell you about its quality control procedures. Guidance from a healthcare practitioner can be useful to help you navigate which product may be best for you.

 


Special circumstances

Sometimes, you will be diagnosed with a specific nutrient deficiency, or be at risk of one, such as anaemia. In this instance, it would be important both to try to understand the root cause of the deficiency (in partnership with a health professional), as well as working towards improving it through careful nutritional changes and/or supplements.

Likewise, if you are trying to have a baby, or are pregnant, it is recommended that you should be regularly taking at least a folate and vitamin D supplement. Take a look at this page for further information;

nhs.uk/conditions/pregnancy-and-baby/

 

The bottom line?

  1. Consider seeking assessment from a qualified nutrition or healthcare professional before taking a supplement, to work out whether you really need one. It is almost always better to be targeted, and only take what your body requires. Be wary of single nutrient, high dose supplements, particularly if you are taking them for a prolonged time.
  2. Getting a widely varied, great quality diet should be your primary focus. This is the best way to get all the nutrients your body needs, in forms that it can recognise and use, alongside lots of beneficial phytonutrients too. Sometimes it’s thought that it could be these phytonutrients which give more health benefit than the vitamins themselves! It is also very difficult to ‘overdose’ yourself with nutrients from food.
  3. You could try using a food diary app that calculates your nutrient consumption as well as your total calories, to give you an idea of where you might want to make some tweaks.
  4. Eating your food as fresh, minimally processed and lightly cooked as possible to boost nutrient content without adding any extra calories.
  5. Consider growing your own to make sure that you can cut down the time to consumption as much as possible – this can be a great money saver on organic veggies too.
  6. If you are considering becoming, or already are pregnant, do make sure that you check out the information on antenatal supplements.
  7. When choosing supplements, go for the highest quality you can find. Ask for advice if you are unsure about which brands to trust.

The most important thing to take away is that choosing to take, or not take, supplements is very much an individual, personal choice. I hope that after reading this article you feel armed with a little bit more information to take away, to help you make your own decisions, in collaboration with a healthcare or nutritional practitioner if you want some more support.

References

(1) NDL/FNIC food composition database home page (2011) Available at: http://ndb.nal.usda.gov (Accessed: 2 December 2015).

(2) Davis, D.R. (2009) ‘Declining fruit and vegetable nutrient composition: What is the evidence?’, HortScience, 44(1), pp. 15–19.

(3) Średnicka-Tober, D., Barański, M., Seal, C., Sanderson, R., Benbrook, C. and Steinshamn, H. (2016) ‘Composition differences between organic and conventional meat: A systematic literature review and meta-analysis’, British Journal of Nutrition, 115(06), pp. 994–1011.

(4) Weaver, K.L., Ivester, P., Chilton, J.A., Wilson, M.D., Pandey, P. and Chilton, F.H. (2008) ‘The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish’, Journal of the American Dietetic Association, 108(7), pp. 1178–1185.

(5) Pazirandeh, S., Burns, D. and Lo, C. (2014) Overview of water-soluble vitamins, UpToDate. Available at: http://www.uptodate.com.oala-proxy.surrey.ac.uk/contents/overview-of-water-soluble-vitamins?source=machineLearning&search=vitamin+c&selectedTitle=5%7E150&sectionRank=1&anchor=H54#H54 (Accessed: 14 October 2015).

(6) Nasr, S.H., Kashtanova, Y., Levchuk, V. and Markowitz, G.S. (2006) ‘Secondary oxalosis due to excess vitamin C intake’, Kidney International, 70(10), pp. 1672–1672.

(8) Lippman, S.M., Klein, E.A., Goodman, P.J., Lucia, M.S., Thompson, I.M. and Ford, L.G. (2009) ‘Effect of Selenium and vitamin E on risk of prostate cancer and other cancers’, JAMA, 301(1), p. 39.

(9) Graat, J.M., Schouten, E.G. and Kok, F.J. (2002) ‘Effect of Daily Vitamin E and Multivitamin-Mineral Supplementation on Acute Respiratory Tract Infections in Elderly Persons’, JAMA, 288(6), p. 715.

(10) Miller, E.R., Pastor-Barriuso, R., Dalal, D., Riemersma, R., Appel, L. and Guallar, E. (2005) ‘Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality’, Annals of Internal Medicine, 142(1), p. 37. doi: 10.7326/0003-4819-142-1-200501040-00110.

 (11) Stover, P. (2006) ‘xInfluence of human genetic variation on nutritional requirements’, Am J Clin Nutr, 83(2), pp. 4365–4425.


Buying Meat: The Questions to Ask

Buying Meat:
Questions to ask

We each approach life with a vastly different set of ideas, beliefs, concerns and expectations which guide our decisions. Respecting such differences in opinion is important in all walks of life, but I think it’s especially important when it comes to nutrition.

What is right for one person may be wholly wrong for another. I am, therefore, a strong advocate and supporter of personal choice – and this is especially true when it comes to considering the choice between whether or not you eat meat or other animal products.

There are many reasons why you may decide that you’d prefer to stick to a pescatarian, vegetarian or even vegan diet – and with careful planning, it is certainly possible to eat a well-balanced diet without any animal protein. If, however, like me you dochoose to eat meat, I think it is well worth spending a little time considering how you buy it, where it comes from and what the conditions were like for the animals involved. By doing so, you will not only help to bring mindfulness to your own nutrition, but you will also be able to make more conscious consumer choices – both for animal welfare and sustainability reasons (hopefully encouraging retailers to follow suit). It’s a win-win situation.

The tidily packaged meat we buy in supermarkets now is so far removed from its origin, it is easy to forget that it came from a living being at all. Picking up a packet of chicken breasts is no more challenging than picking up a bag of apples. This disconnect from the reality of meat production can lull us into a false sense of security, where we are not prompted to ask the questions that challenge unkind or unsustainable production methods. Retailers have made it easy to be unaware of the truth behind the meat we buy.

It is not all bad news though: there are some great initiatives afoot to lobby retailers and policy makers to mandate higher meat production standards, and at-a-glance logos on packaging (such as The Soil Association Organic or ‘Freedom Food’ / ‘RSPCA approved’ logos) to help us make quick and easy choices. Finding a brand or retailer you trust is key here. Few of us have the time to investigate every meat purchase in detail, but if you know your local farm shop or butchers only stocks high-quality meat, then the decisions become simpler. Yes, it may be a little more expensive, but in most cases, I sincerely believe that this higher price just reflects the true cost of ethical meat production. Cheap meat is, sadly, often cheap for a reason.

The questions I ask myself when sourcing and buying meat

1. Firstly, I ask myself – do I feel like eating meat today? Personally, I elect to eat red meat only once or twice a week (for cost, health and sustainability reasons), so I’ll often choose chicken or fish instead, or I’lI substitute these for good quality plant or dairy protein sources (I’m a great supporter of Meat-Free Monday). In all aspects of food sourcing and shopping, I aim to be a mindful, conscious consumer, so when buying fish, l’ll take a look at the Marine Stewardship Council to check the sustainability of my fish purchases.

2, I buy my meat from the local farm shop or butcher in favour of the supermarkets whenever possible. Quality really does matter, especially with meat: ‘buy less, buy better’ is my motto! Buy the best you can afford and be confident of good welfare conditions. Naturally, if you are able to buy organic meat, then more’s the better: organic farms don’t use fertilisers, pesticides or routine antibiotics and they ensure high levels of animal welfare. However, I do know this can sometimes be difficult as organic meat is not always readily available or its higher cost can present an added challenge to household budgets (especially if feeding a family), so if this is the case, try at least to look for higher-welfare, RSPCA-assured (‘Freedom Foods’), free-range / grass-fed meat where possible and consider using less familiar (less costly) cuts. I ask my supplier if I am not sure.

3. Keep in mind that processed, salted or cured meats are OK to enjoy occasionally, but I generally recommend sticking to unprocessed meat or fish for the most part.

If you’d like some more information on any of the topics discussed above, please take a look at the following websites:

I’m incredibly proud to be supporting the FARMS NOT FACTORIES campaign #TurnYourNoseUp

Farms Not Factories is a non-profit organisation working through film-making and campaigning to support the ‘food sovereignty’ movement by exposing the true costs of cheap meat from animal factories in order to inspire people to only buy meat from local, healthy, high welfare farms. Their long term vision is a world without animal factories and they work collaboratively with other groups who focus on other important areas of work – such as policy change, supporting producers and campaigning locally to provide content, support their work and spread a shared message through film.

Find out how you can get involved here: farmsnotfactories.org/

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