Access Allied Health

Food Intolerances and FODMAPs

Access Allied Health - Tuesday, May 19, 2015

Irritable Bowel Syndrome and the low FODMAP diet

Irritable bowel Syndrome or IBS isn't really a dinner table topic of conversation but it affects around one in five people at some time.  IBS is a long term condition that has a long list of symptoms including abdominal pain and distention, bloating, excess wind, nausea, changes in bowel habits (diarrhoea, constipation or a combination of both) and other gastrointestinal symptoms.  The cause is unknown but there are some known triggers such as change in routine, emotional stress, infection and diet. Unfortunately IBS cannot be cured with medication.  The good news is that research by Dr Sue Shepherd from Monash University in Melbourne has proven that there is a very effective dietary therapy for IBS.  It's the low FODMAP diet.

 food map

FODMAPs are found in the foods we eat.  FODMAP is an acronym (abbreviation) of certain molecule collections found in food that are poorly absorbed by some people.  These molecules shoot through to the large intestine (rather than being absorbed by the body) and become a food source for the bacteria that live there naturally.  The symptoms experienced by those with IBS are the outcome of the complex molecules (FODMAPs) being digested or fermented by the bacteria.

 

The low FODMAP diet has two phases.  The first phase involves eliminating high FODMAP foods for a period of 6 - 8 weeks.  The second phase involves gradually testing these high FODMAP foods to see which ones can be reintroduced and are suitable for each individual.   Obviously each low FODMAP diet is going to look different for each individual.  Tim Black our principal dietitian has completed two training courses at Monash University in Melbourne on the low FODMAP diet and has excellent success helping his clients find relief from the symptoms of IBS.   






Malnutrition in Aged Care Facilities

Access Allied Health - Thursday, March 07, 2013

Would you believe that, in Queensland alone, half of all aged care residents are classified as malnourished?[1].  Well, perhaps a little shockingly, this is what current research shows.  However, what’s even more concerning is that further Australian based research shows that malnutrition is not being recognised in these residents and they are therefore not receiving the correct nutrition intervention[2].

Now this is not at all a reflection on the hard working clinical and support staff working in the aged care sector, but rather brings nutrition into the limelight as an area of aged care needing increased attention.

What is Malnutrition?

Malnutrition may be defined as a state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients cause measurable adverse effects on tissue (shape, size, composition), function and clinical outcome.  The predominant form of malnutrition in aged care is Protein Energy Malnutrition (PEM) which simply means that there are inadequate levels of protein and/or energy to maintain good health.

What does malnutrition look like?

A person with malnutrition may have one or more of the following presentations:

  • Reduced body weight
  • Muscle wasting and decreased strength
  • Reduced respiratory and cardiac muscular capacity
  • Thinning skin and loss of skin integrity
  • Decreased metabolic rate
  • Fatigue
  • Oedema and immunodeficiency

These presentations can compound and have a significant health impact such as:

  • delay in recovery from injury or illness,
  • poor wound healing,
  • increased occurrence of complications,
  • reduced quality of life which can lead to depression and
  • increased risk of falls.

As you can see, malnutrition is linked with poorer health, leading to an increased burden on health resources.

What can be done about malnutrition in the aged care setting?

Prevention is the best remedy for this costly and debilitating condition.  There are some simple but very effective strategies that aged care facilities can adopt to combat malnutrition in their residents.

  • Screening all residents for malnutrition on a regular basis
  • Implementing a protocol for malnutrition including both the screening of residents and an action plan when a resident is identified as having malnutrition
  • Seeking assistance from an accredited practicing dietitian when a resident is identified as having malnutrition

To discuss, assess, review or change the nutrition management procedures at your aged care facility, please speak to an accredited practicing dietitian who can assist you in this process.



[1] Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics.  2007: 64:172-178

[2] Gaskill, D., Black, L. J., Isenring, E. A., Hassall, S., Sanders, F. and Bauer, J. D. (2008), Malnutrition prevalence and nutrition issues in residential aged care facilities. Australasian Journal on Ageing, 27: 189–194.

Image retrieved from www.agedcarenursing.net.au

Weight Loss - Diet vs Exercise

Access Allied Health - Thursday, February 28, 2013

In the minds of many a weight loss aspirant, the quest to find the silver bullet often pits diet and exercise against each another in a showdown with all the intensity of a boxing showpiece.  “In the left corner, backed by a multi-million dollar weight loss industry and weighing in less-than-it-did-last-week: DIET! (Cheer) And in the right corner, wearing the not-so-flattering bike shorts and carrying the hopes of personal trainers everywhere: EX-“no pain, no gain”-ERCISE. (Cheer).  And now ladies and gentleman, we are about to see the end of decades of speculation and crown the victor of this bout with the one-size-fits-all title of weight loss king of the world! So let the battle begin!” (And the crowd goes wild).

Now, in my profession, I come across those steadfastly camped in either corner of the ring ready to defend their champion and point out the flaws of the opposing force.  “Diets don’t work” some will say, while in response others will look to point out the unsustainable demands of rigorous exercise both on our knee caps and our time.  So what’s the answer – who wins the fight – who is the champion between these two formidable opponents?

Well, perhaps not surprisingly, I am one of those with both feet planted firmly in the diet camp, rubbing the shoulders and singing the praises of the champ to be (metaphorically speaking).  But my support of food (or less of it) as the superior weight loss process is not just a biased opinion, but rather a position steeped in scientific studies and research.

Now, don’t get me wrong, one of my favourite quotes is from WM Bortz of the American College of Sports Medicine who said, ‘There is no drug in current or prospective use that holds as much promise for sustained health as a lifetime of physical exercise” – well said Mr Bortz!  However, when it comes to weight loss, exercise not only can’t hold its own against diet, but is actually fairly useless.  What?  Useless?  Yes that’s what I said and yes I realise that this is going against the most commonly held assumption going around today (i.e. If you exercise you will lose weight).  So let me explain.

A few years ago, Dr Wayne Miller and his colleagues reviewed 493 weight loss studies to determine whether adding exercise to a restricted calorie diet would accelerate weight loss[1].  25 years of research showed that exercise provided only a marginal weight loss benefit when compared to diet.  That is, from all the studies reviewed, dietary restriction alone resulted in an average weight loss of 7.8kg over a 15 week period. Adding exercise to dietary restriction merely added another 1.2kg giving a total of 9.0kg loss (while 1.2kg is nothing to sneeze at, I know who’s side I’d rather be on in a fight).

Further to this, in their published research[2], Dr Timothy Church’s team described a principle of compensation.  That is, those who exercised more in his study, ate more or compensated in another way (like moving less when they got home from the gym) which resulted in a less-than-expected weight loss.

While I don’t expect the two above mentioned studies to end the discussion once and for all, they are just the tip of the iceberg when it comes to seeing inconsistent (at best) weight loss from exercise.  I do however hope this helps to answer that frustrating question “How come I’m not losing weight?”  Well, it’s probably got less to do with the gym workout you missed and more to do with the muffin you had with your coffee this afternoon.

Again, please don’t get me wrong – exercise has many amazing benefits for our health – so please keep incorporating it into your lifestyle.  However, simply find something you enjoy and if you’d like to lose weight, speak to an accredited practicing dietitian.


[1] Miller WC, et al. (1997) A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention, International Journal of Obesity, vol. 21, pp. 941 - 947

[2] Church TS, et al. (2009) Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women. PLoS ONE 4(2): e4515. doi:10.1371/journal.pone.0004515

Image from: www.goodhealthyadvice.com.au

Fast or slow weight loss - which is better?

Access Allied Health - Thursday, January 24, 2013

”Is it better to lose weight slowly?” I get asked this question all the time and the short answer is ‘no’.

I’m not sure where it came from, but there seems to be this idea that losing weight slowly is somehow much more meritorious and honourable than losing it quickly.  And I, for one, don’t buy into it.

Be it fast or slow, weight loss is one of the most effective health improvement strategies for anyone carrying a few too many kilos.  But motivated new-years resolutioner’s beware.  Losing weight will only improve your health if your lost weight stays lost.  In fact, should you pile on the pounds after losing weight you end up unhealthier than if you’d never lost weight in the first place!

Given that reported statistics tell us only five per cent of weight losers are successful in keeping their tummies trim, a maintenance strategy is something that needs to be incorporated into any weight loss plan.

I guess this is one advantage of a slower weight reduction, as it does suggest that some moderate lifestyle changes have been made and stuck to over time.  This, in turn, may make maintaining that loss easier.  Now this doesn’t at all invalidate faster weight loss.  But should it be fast or slow, improvements to your health will only be seen if you keep the weight off long term.

So before you head down to the chemist to pick up a month’s supply of meal replacements, spend some time considering the day-to-day changes you’ll need to make once the replacements run out.

For help with a weight maintenance plan, see the experts – an accredited practicing dietitian.