tag:theconversation.com,2011:/columns/clare-collins-7316Eating Science – The Conversation2017-10-31T05:20:39Ztag:theconversation.com,2011:article/865192017-10-31T05:20:39Z2017-10-31T05:20:39ZDo vitamin supplements prevent macular degeneration?<figure><img src="https://images.theconversation.com/files/192570/original/file-20171031-18686-1bg19e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's evidence vitamins can slow the progression of existing macular degeneration. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Vitamin and mineral supplements <a href="https://www.ncbi.nlm.nih.gov/pubmed/28756617">won’t prevent the development of age-related macular degeneration</a>. But there is some evidence taking supplements containing vitamin C, vitamin E and zinc may <a href="https://www.ncbi.nlm.nih.gov/pubmed/28756618">slow the progression of age-related macular degeneration</a> in those who already have it. This evidence comes from two major systematic reviews published this year, conducted by the <a href="http://www.cochranelibrary.com/">Cochrane collaboration</a>. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-age-related-macular-degeneration-59889">Explainer: what is age-related macular degeneration?</a>
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<p>The reason researchers thought about testing dietary supplements for eye disease relates to <a href="https://www.nkcf.org/about-keratoconus/how-the-human-eye-works/">how the eyes convert light into sight</a>. Light gets absorbed into pigments in the retina at the back of the eye. This process produces byproducts called free radicals. <a href="https://www.livescience.com/54901-free-radicals.html">Free radicals are oxygen atoms that have unpaired electrons</a>, which makes them highly reactive and unstable. As these atoms hunt around to find another electron so they can become more stable, they trigger damage to other molecules, the walls of cells and to DNA. In the eyes, this contributes to gradual loss of vision.</p>
<p><a href="https://www.betterhealth.vic.gov.au/health/healthyliving/antioxidants">Anti-oxidants are nutrients that absorb free radicals</a> and include vitamin A, C and E, the minerals zinc and selenium, and many phytonutrients found in edible plants including vegetables and fruit. Theoretically if more anti-oxidant nutrients were present in the eye, less damage should be done to the eye. Lets look at what the scientific evidence says.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/28756618">first review</a> looked at people who already had age-related macular degeneration and includes research published up until March 2017. They found 19 trials in adults who already had early or moderate macular degeneration. Nine studies compared people taking vitamin supplements to those either not taking them or being given a placebo (dummy) capsule for periods of time from nine months to six years. </p>
<p>They found the vitamin supplements were associated with 28% lower odds of progressing to late stage macular degeneration. The studies that compared zinc supplements to a placebo found a 17% lower risk of progressing to late stage macular degeneration. </p>
<p>The authors final conclusion cautiously suggested use of antioxidant vitamin and mineral supplements may help delay disease progression in people with existing age-related macular degeneration, with a reminder that while vitamin supplements are generally safe they can have harmful effects in some, <a href="https://www.ncbi.nlm.nih.gov/pubmed/18429004">such as smokers</a>.</p>
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Read more:
<a href="https://theconversation.com/mondays-medical-myth-take-a-vitamin-a-day-for-better-health-8482">Monday’s medical myth: take a vitamin a day for better health</a>
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<p>The second review looked at <a href="https://www.ncbi.nlm.nih.gov/pubmed/28756617">prevention of age-related macular degeneration</a>. There were four trials that compared taking Vitamin E to a placebo which found vitamin E had no effect on prevention of age-related macular degeneration. And one trial found a side-effect of an increase in risk of haemorrhagic stroke in those taking vitamin E.</p>
<p>Two studies used beta-carotene (an organic compound found in plants that the body converts into Vitamin A) and found no reduction in risk of new onset macular degeneration with one study confirming <a href="https://www.ncbi.nlm.nih.gov/pubmed/8127329">an increased risk of lung cancer in the smokers</a>. </p>
<p>One study in men compared vitamin C or multivitamins with a placebo and found no effect for vitamin C and a slightly higher risk for age-related macular degeneration in the group taking the multivitamins. There was no evidence related to other antioxidants such as lutein or zeaxanthin.</p>
<p>Loss of vision due to age-related macular degeneration is associated with a loss of ability to do the things that help to improve your nutrition related health and well-being as you age. Compared to adults of a similar age and sex who did not have age-related macular degeneration, those with it have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28665868">higher risk of death from heart disease and all other causes</a>.</p>
<p>It’s wise to trying and boost your <a href="https://www.ncbi.nlm.nih.gov/pubmed/19335941">diet quality for a host of reasons</a>, by eating more healthily as you age and trying to <a href="http://www.quitnow.gov.au/">quit smoking</a>. You can use our free <a href="http://healthyeatingquiz.com.au/">Healthy Eating Quiz</a> to check your score.</p>
<p>Meanwhile, try to increase you intake of foods rich in phytonutrients. Oysters, meat, eggs, seafood, nuts, tofu, legumes, wheat germ and wholegrain foods contain zinc. Oranges, mandarins, lemons, limes, strawberries, kiwifruits, tomato, capsicum, spinach, broccoli, cabbage and green vegetables contain vitamin C. Nuts, seeds, wheatgerm and eggs contain vitamin E. Egg yolk, corn, spinach, pumpkin, cucumber, kiwifruit, red grapes, zucchini, capsicum, oranges and mangoes contain the antioxidants lutein and zeaxanthin. </p>
<p>If you’ve been told you have age-related macular degeneration then you should discuss the risks and benefits of supplementation with your doctor. Keep in mind vitamin supplements that include beta-carotene are not recommended if you are a smoker. Remember to talk to your GP about your eye health as you age.</p><img src="https://counter.theconversation.com/content/86519/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She was a team member conducting the systematic reviews to inform the 2013 revision of the Australian Dietary Guidelines and the 2017 evidence review on dietary patterns and heart disease for the Heart Foundation.</span></em></p>Vitamin and mineral supplements won’t prevent the development of age-related macular degeneration. But there is some evidence taking supplements containing vitamin C, vitamin E and zinc may slow the progression…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/845952017-09-27T01:06:11Z2017-09-27T01:06:11ZSix common questions about eating carbs during pregnancy answered<figure><img src="https://images.theconversation.com/files/187699/original/file-20170927-19342-8ewt1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's a big difference between carbohydrates in wholegrains and lollies. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>During pregnancy women get bombarded with food and nutrition information. Eat this, don’t eat that! It gets very confusing. Recent debates about <a href="https://theconversation.com/new-study-finding-fat-isnt-as-bad-as-carbs-misses-the-point-83217">the role of carbohydrates</a> have cranked the confusion up a notch. In pregnancy, women need nutrient-rich sources of carbohydrate, in the right amounts. </p>
<h2>1. What are carbohydrates?</h2>
<p><a href="https://www.nrv.gov.au/nutrients/carbohydrate">Carbohydrate</a> is a macronutrient that your body uses as a source of fuel for muscles and organs like the heart, lungs and brain. Out of the three major <a href="https://www.nrv.gov.au/chronic-disease/macronutrient-balance">macronutrients</a> found in food (protein, fat and carbohydrate), carbohydrates have the biggest impact on short-term blood glucose levels. </p>
<p>When foods containing <a href="https://en.wikipedia.org/wiki/Carbohydrate_digestion">carbohydrates are eaten, they are broken down</a> into smaller units in the small intestine using enzymes found in saliva, the small intestine and the pancreas. Next, the hormone <a href="https://www.diabetesaustralia.com.au/insulin">insulin</a> is released into the bloodstream to help move glucose from the blood into our cells, causing blood glucose (or blood sugar) levels to rise. </p>
<p>Foods contain varying amounts of carbohydrate. Rich sources include starchy vegetables (potatoes, sweet potatoes, corn), bread, pasta, rice and fruit. Foods containing carbohydrate in smaller amounts include milk, yoghurt and legumes such as kidney beans. These foods all include nutrients that are important for everyday health, such as <a href="https://www.nrv.gov.au/nutrients/dietary-fibre">dietary fibre</a> and <a href="https://en.wikipedia.org/wiki/B_vitamins">B vitamins</a>. </p>
<p>Foods that are high in refined carbohydrates, particularly added sugars are called energy-dense, nutrient-poor, non-core or <a href="https://www.eatforhealth.gov.au/food-essentials/discretionary-food-and-drink-choices">discretionary foods</a>. These include soft drink, ice cream, lollies, cakes, biscuits and pastries. Ideally, these should only be eaten occasionally, meaning once a week to once a month or less often. </p>
<p>Alarmingly, in the 2011-2012 Australian Health Survey <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007%7E2011-12%7EMain%20Features%7EDiscretionary%20foods%7E700">35% of Australian’s total daily energy</a> was found to come from discretionary foods and beverages. </p>
<h2>2. Why are carbohydrates important during pregnancy?</h2>
<p>During pregnancy, metabolic adaptations occur that allow the mother to meet her own nutritional needs, as well as those of the developing baby. These normal adaptations, as well as weight gain during pregnancy, <a href="https://www.ncbi.nlm.nih.gov/pubmed/1960041">impact on maternal glucose and insulin metabolism</a>. </p>
<p>These changes mean a pregnant woman is more likely to have high blood glucose levels (hyperglycemia) and more likely to have impaired regulation of blood glucose levels, which could lead to the development of <a href="https://www.diabetesaustralia.com.au/gestational-diabetes">gestational diabetes mellitus</a>. </p>
<h2>3. What are the consequences of high blood glucose levels during pregnancy?</h2>
<p>High blood glucose levels during pregnancy are associated with an increased risk of the mother developing <a href="https://www.diabetesaustralia.com.au/gestational-diabetes">gestational diabetes during pregnancy and then type 2 diabetes</a> in the future. It also <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa0707943#t=article">increases the risk of pregnancy and birth complications</a> for both the mother and baby, such as primary caesarean delivery and infant hypoglycaemia (low blood glucose levels) immediately post-birth, as well as premature delivery, <a href="https://en.wikipedia.org/wiki/Shoulder_dystocia">shoulder dystocia</a> and <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-pre-eclampsia">pre-eclampsia</a>.</p>
<p>High blood glucose levels in pregnancy are most commonly linked to gestational diabetes. However, blood glucose levels that are slightly elevated, although not high enough to be diagnosed as having gestational diabetes are associated with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26056493">higher risk of some, but not all</a> adverse health outcomes. </p>
<p>Blood glucose levels within the diagnostic gestational diabetes range have been found to be independently associated with the <a href="http://care.diabetesjournals.org/content/early/2017/03/09/dc16-2397">offspring’s risk of abnormal glucose tolerance</a>, obesity and higher blood pressure at seven years of age. Therefore avoiding excessive high blood glucose levels in pregnancy has the potential to optimise the baby’s health in later life. </p>
<h2>4. Should I avoid carbohydrates during pregnancy?</h2>
<p>No! Carbohydrates should definitely not be avoided during pregnancy. Other nutrients important for pregnancy that are limited in the Australian food supply, folate and iodine, are added to bread-making flour. Both of these nutrients are needed more <a href="https://theconversation.com/five-ways-to-boost-your-nutrition-before-pregnancy-76352">during pregnancy</a>. <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet">Folate helps protect again neural tube defects in the developing foetus and iodine</a> is needed for the production of the thyroid hormone, which plays an important role in growth and development. </p>
<p>Following the mandatory fortification of bread with folate and iodine in Australia in 2009, there has been a significant <a href="https://www.aihw.gov.au/news-media/media-releases/2016/2016-jun/decrease-in-neural-tube-defects-since-folic-acid-a">overall decrease (14.4%) in the rate of neural tube defects</a>. Folate is also found in a range of other foods including vegetables (asparagus, spinach, broccoli), chick peas and bran flakes and iodine is found in seafood, eggs, meat and dairy products.
The key thing to consider when choosing foods that <a href="https://www.heartfoundation.org.au/healthy-eating/food-and-nutrition/carbohydrates-and-sugars">contain carbohydrates is the quality</a> and the quantity eaten. </p>
<h2>5. Are all carbs of equal value?</h2>
<p>No! Carbohydrates are present in a wide variety of foods and <a href="https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/nourishing-nutrients/carbohydrates-what-you-need-to-know/">these vary greatly in nutritional quality</a>. High-nutritional quality carbohydrate containing foods are generally nutrient-dense “core” foods that belong to the basic food groups within the <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">Australian Guide to Healthy Eating</a>. This includes grains/cereal, vegetable, fruit and dairy food groups.</p>
<p>Examples of high-nutritional quality carbohydrate foods include wholegrain breads, sweet potato, kidney beans, fresh fruit and yoghurt. Low-quality carbohydrate foods are generally in the discretionary foods list. Examples of low-quality carbohydrate containing foods include cakes, biscuits and lollies. </p>
<p>If you’re eating mainly high-quality carbohydrates and limiting your intake of low-quality carbohydrates, then you have taken the first step to managing your blood sugar levels and boosting your fibre and nutrient intakes, as well as your overall health. </p>
<h2>6. If I eat the ‘right’ type of carbohydrate, can I eat as much as I like?</h2>
<p>No! Carbohydrates have a direct impact on blood glucose levels and the portion size, which is the amount eaten in one meal or snack, has a big impact on your blood glucose. Spreading your intake of carbohydrate foods throughout the day and consuming appropriate portion sizes is important in managing blood glucose levels.</p>
<p>The Australian Guide to Healthy Eating can help you to identify <a href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/what-serve">what one standard serve size of various carbohydrate containing foods looks</a> like in order to better manage your portion sizes. </p>
<p>Carbohydrate foods are also digested at different rates; some slower and some faster than others. The <a href="http://www.gisymbol.com/about/glycemic-index/">Glycaemic Index (GI)</a> is a relative ranking of carbohydrate foods according to how quickly your blood sugar rises after eating a standard amount. Lower GI foods (a GI value of 55 or less) are digested more slowly and therefore result in a slower rise in blood glucose levels compared to foods with a higher GI value. Low GI foods include grain and seed breads, legumes and reduced fat milk. High GI foods include white bread and short-grain white rice. </p>
<p>Carbohydrates are not something to be feared during pregnancy. Include a <a href="https://www.eatforhealth.gov.au/eating-well/healthy-eating-throughout-all-life/healthy-eating-when-you%E2%80%99re-pregnant-or-breastfeeding">range of healthy core foods</a>, including nutrient rich sources of carbohydrate, but be mindful of the types of carbohydrate foods and the portions size eaten. </p>
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<p><em>If you are pregnant and would like to learn more about healthy eating and carbohydrate intake in pregnancy, take part in our Australia-wide <a href="https://tinyurl.com/uonpregnancy-conversation">nutrition study</a>.</em></p><img src="https://counter.theconversation.com/content/84595/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She was a team member conducting the systematic reviews to inform the 2013 revision of the Australian Dietary Guidelines and the 2017 evidence review on dietary patterns and heart disease for the Heart Foundation.</span></em></p><p class="fine-print"><em><span>
Hannah May Brown is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle (UoN), NSW. She is a PhD candidate and research assistant and is a member of the Dietitian’s Association of Australia. Hannah’s PhD is supported by a Post-Graduate Research Scholarship from the University of Newcastle and The Neville Eric Sansom Scholarship.</span></em></p><p class="fine-print"><em><span>Megan Rollo has received research funding from a number of bodies including Diabetes Australia, Hunter Medical Research Institute, New South Wales Government (TechVoucher) and Novo Nordisk, and consulted to the Sax Institute and Quality Bakers Australia Pty Limited. She is affiliated with the Priority Research Centre in Physical Activity and Nutrition at the University of Newcastle and a member of professional organisations including the Dietitians Association of Australia.</span></em></p><p class="fine-print"><em><span>Tamara Bucher is affiliated with the Priority Research Center for Physical Activity and Nutrition, the University of Newcastle Australia, NSW and the Consumer Behavior Research Group at ETH Zürich, Switzerland. She has received a range of research grants including the Swiss National Science Foundation (SNSF) and the Swiss Foundation of Nutrition Research (SFEFS) and the European Union (Horizon 2020).</span></em></p>During pregnancy women get bombarded with food and nutrition information. Eat this, don’t eat that! It gets very confusing. Recent debates about the role of carbohydrates have cranked the confusion up…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleHannah Brown, PhD Candidate Nutrition and Dietetics, University of NewcastleMegan Rollo, Postdoctoral Research Fellow, Nutrition & Dietetics, University of NewcastleTamara Bucher, Senior Researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/818102017-09-14T22:54:36Z2017-09-14T22:54:36ZDo ketogenic diets help you lose weight?<figure><img src="https://images.theconversation.com/files/185804/original/file-20170913-20570-kpfikx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ketogenic diets involve eating mostly fats. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/510665620?src=S8Nl-qn_aii9LUjs-DcW-w-1-0&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Is a ketogenic diet effective for weight loss? The answer depends on whether it achieves a reduction in total kilojoule intake or not.</p>
<h2>What is a ketogenic diet?</h2>
<p>A classical ketogenic diet follows a strict ratio for total grams of fat to combined <a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">grams of carbohydrate and protein</a> and typically has <a href="https://www.ncbi.nlm.nih.gov/pubmed/28754198">80-90% of total kilojoules coming from fat</a>, which is very high fat. Carbohydrate intake varies from 20 to 50 grams a day, or 5-10% of total energy, while protein intakes are moderate. </p>
<p>The difference between a strict ketogenic diet and diets that are described as low-carb is that ketogenic diets specifically aim to achieve elevated blood levels of <a href="https://en.wikipedia.org/wiki/Ketone_bodies">ketone bodies</a> which are chemicals produced as a consequence of your body burning fat. Hence general low-carb diets are not as high in fat as classical ketogenic diets.</p>
<p>Research on the use of <a href="https://theconversation.com/what-are-ketogenic-diets-can-they-treat-epilepsy-and-brain-cancer-83401">classical ketogenic diets</a> for weight loss is limited. But there are many studies that compare lower-carb diets to other approaches. </p>
<p>These show that aiming for a <a href="https://www.ncbi.nlm.nih.gov/pubmed/12761364">carbohydrate</a> restriction of 20-30 grams a day, without setting a daily kilojoule target, leads to 2-4 kilograms greater weight loss compared to a low kilojoule diet, in studies up to six months. </p>
<p>In longer studies with follow-up <a href="https://www.ncbi.nlm.nih.gov/pubmed/15148064">between one</a> to <a href="https://www.ncbi.nlm.nih.gov/pubmed/15250842">five years</a> there is no difference in weight loss. A review of weight loss diets with <a href="https://www.ncbi.nlm.nih.gov/pubmed/23035144">a moderate carbohydrate restriction</a> (45% or less of total energy intake) compared to low fat diets (under 30% fat) found they were equally effective in reducing body weight in studies from six months to two years. </p>
<h2>How much carbohydrate do we eat?</h2>
<p>In Australia, current carbohydrate intakes range from approximately <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007%7E2011-12%7EMain%20Features%7EMacronutrients%7E703">210 to 260 grams a day</a>, or about 45% of total energy intake. More than a third of what Australians currently eat comes from discretionary, or <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0.55.007Main+Features12011-12">“junk” foods</a>. It is definitely a good idea to cut down on <a href="https://www.eatforhealth.gov.au/food-essentials/discretionary-food-and-drink-choices">discretionary foods</a>. These are commonly <a href="http://www.leeds.ac.uk/yawya/science-and-nutrition/Ultra%20processed%20food.html">ultra-processed</a> and contain refined carbohydrates and include burgers, chips, pizza, crumbed foods, biscuits, cake, pastry, lollies, cordial, sugar sweetened juices and soft drink. </p>
<p>The problem is most people do not eat enough minimally processed, nutrient rich foods that contain carbohydrate, like legumes, wholegrain breads, cereals and other grains, vegetables, fruit, nuts, milk and yoghurt. These foods contain important nutrients, from dietary fibre, to B vitamins, and minerals and trace elements like iron, zinc, magnesium, calcium, selenium and iodine.</p>
<p>Your body needs these nutrients for digestion, metabolism, growth and repair of cells and to help protect the brain, heart, muscles and nerves. </p>
<h2>What happens when you go on a ketogenic diet to lose weight?</h2>
<p>If you severely limit all foods that contain carbohydrate, such as during a ketogenic diet, you end up cutting out many foods. This means you <a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">eat less total kilojoules and therefore lose weight</a>. </p>
<p>Whether you follow a classical ketogenic diet or a very low energy diet you may end up producing “<a href="https://en.wikipedia.org/wiki/Ketone_bodies">ketone bodies</a>”, which may help with weight loss, particularly fat mass. </p>
<p>Carbohydrate is used in the body as the major source of fuel, like petrol is used to fuel a car. Your body has a store of carbohydrate in the liver and muscles called <a href="https://www.ncbi.nlm.nih.gov/books/NBK21190/">glycogen</a>. When glycogen stores are low your body switches to burning fat, which leads to production of ketone bodies. </p>
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<a href="https://theconversation.com/what-are-ketogenic-diets-can-they-treat-epilepsy-and-brain-cancer-83401">What are ketogenic diets? Can they treat epilepsy and brain cancer?</a>
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<p>Glycogen becomes limited when your total energy intake is very low, such as during a strict weight loss diet, a fast, or when you do not eat foods containing carbohydrate. This means your body burns the fat you eat, as well as body fat, leading to a loss of stored body fat. You still produce small amounts of glucose through a process called <a href="https://en.wikipedia.org/wiki/Gluconeogenesis">gluconeogenesis</a> by breaking down protein and some fat. </p>
<h2>Ketogenic diets and appetite</h2>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/25402637">systematic review</a> evaluated how people perceived their appetite before and during a very low energy diet that contained less than 3,300 kilojoules a day or a ketogenic low carbohydrate diet containing less than 10% energy from carbohydrate (50 grams or less per day). Those following the very low energy diet reported less hunger and greater fullness and satiety during weight loss, while those following the ketogenic diet reported feeling less hunger and having less desire to eat. The authors concluded that although the absolute change in subjective appetite ratings were small, they were important in terms of helping people stick to a weight loss diet. </p>
<p>One research study followed 18 obese men during eight weeks of a ketogenic very low energy diet of 2300-2700 kilojoules per day, followed by four weeks of weight maintenance. They measured <a href="https://www.ncbi.nlm.nih.gov/pubmed/28439092">changes in appetite</a> and blood concentrations of appetite hormones and ketones.</p>
<p>While hunger increased significantly by day three and up until the men lost 5% of their starting body weight, it <em>did not get worse</em> after that while they were dieting. Once they increased their food intake during maintenance, they had an increase in hunger. The good news was that while they were producing ketones, they appeared to be able to tolerate feeling hungry.</p>
<h2>Ketogenic diets and weight loss</h2>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pubmed/27623967">randomised controlled trial randomly allocated 45 obese adults</a> to either a ketogenic low energy diet of 2500-300 kilojoules per day for about two months or a low kilojoule diet where total daily energy intake was reduced by 10%. </p>
<p>As you would expect, those in the low energy group lost significantly more weight after one year. After two years, and accounting for those who dropped out, both groups lost weight (low energy 7kg versus 5.3kg low kilojoule). Of note was that a greater number in the low energy group lost 5% or more of their initial body weight at 12 months.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28750216">systematic review </a> of nine studies in adults with type 2 diabetes following lower-carb diets (less than 130 grams a day or less than 25% energy from carbohydrate) compared to control weight loss diets found weight loss was greater up to one year in the lower-carb groups. </p>
<p>While there was no long-term difference in weight loss between dietary approaches, blood triglyceride concentrations were significantly lower and HDL (good) cholesterol concentrations were higher, but there was no reduction in total or LDL (bad) cholesterol.</p>
<h2>Should you or shouldn’t you?</h2>
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<a href="https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185805/original/file-20170913-23126-jnd0d2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If you are risk of colon cancer, give ketogenic diets for weight loss a miss.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/599666765?src=KGFnhgsqF1X-H53jaWWSog-1-1&size=huge_jpg">from www.shutterstock.com</a></span>
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<p>If you have a family history of bowel cancer then don’t follow a ketogenic weight loss diet. The World Cancer Research Fund has shown <a href="http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/continuous-update-project-cup-matrix">convincing evidence for a higher risk of colorectal cancer</a> in association with low fibre and <a href="https://theconversation.com/health-check-does-processed-meat-cause-bowel-cancer-15294">higher red and processed meat intakes</a>. </p>
<p><a href="http://www.wcrf.org/int/research-we-fund/our-cancer-prevention-recommendations">Prevention guidelines recommend</a> having greater variety, and higher intakes, of legumes, wholegrains, non-starchy vegetables and fruit.</p>
<p>When it comes to weight management, reduce your carbohydrate intake by reducing energy-dense, nutrient-poor foods. Increase minimally processed foods high in fibre and phytonutrients, including vegetables, legumes/pulses and wholegrains and only use classical ketogenic diets under supervision of your health care team. </p>
<p>Read this for more tips on <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">how to lose weight without fad diets</a>.</p><img src="https://counter.theconversation.com/content/81810/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She was a team member conducting the systematic reviews to inform the 2013 revision of the Australian Dietary Guidelines and the 2017 evidence review on dietary patterns and heart disease for the Heart Foundation.</span></em></p><p class="fine-print"><em><span>Rebecca Williams is affiliated with the Priority Research Centre for Physical Activity and Nutrition at the University of Newcastle. She is a post-doctoral researcher within the PRC for Physical Activity and Nutrition and the School of Health Sciences, University of Newcastle. </span></em></p>Is a ketogenic diet effective for weight loss? The answer depends on whether it achieves a reduction in total kilojoule intake or not. What is a ketogenic diet? A classical ketogenic diet follows a strict…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleRebecca Williams, Postdoctoral Researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/834012017-09-05T01:43:45Z2017-09-05T01:43:45ZWhat are ketogenic diets? Can they treat epilepsy and brain cancer?<figure><img src="https://images.theconversation.com/files/184461/original/file-20170904-8541-1vt54hj.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Here's the evidence on ketogenic diets. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Ketogenic diets are <a href="http://www.huffingtonpost.com.au/2017/08/14/what-is-a-ketogenic-diet_a_23076347/">back in the news</a> with claims they are a “cure-all”. Research shows that in <a href="https://www.epilepsyqueensland.com.au/about-epilepsy-1">epilepsy</a> not controlled by current treatment, around 50% of <a href="https://www.ncbi.nlm.nih.gov/pubmed/26859528">children</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25628734">adults</a> following ketogenic diets have a reduction in seizures. For brain cancer, most research has been in animals. A number of human <a href="https://www.ncbi.nlm.nih.gov/pubmed/28325264">trials are underway</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/28353094">testing safety</a>, tolerance, interactions with other treatments, side-effects and the impact on cancer progression, quality of life and survival.</p>
<h2>So what are ketones?</h2>
<p>Although the main source of energy for the body is usually carbohydrate, which gets converted to blood glucose during digestion and metabolism, the body can also burn fat for energy. <a href="https://en.wikipedia.org/wiki/Ketone_bodies">Ketone bodies</a>, or ketones for short, are molecules produced by the liver when fat is metabolised.</p>
<p>Ketones are used as the fuel source to produce energy for the body when glucose is not available. The three ketone bodies resulting from fat metabolism are <a href="https://en.wikipedia.org/wiki/Acetoacetic_acid">acetoacetate</a>, <a href="https://en.wikipedia.org/wiki/Beta-Hydroxybutyric_acid">β-Hydroxybutyrate</a> and <a href="https://en.wikipedia.org/wiki/Acetone">acetone</a>. Acetoacetate spontaneously converts to acetone, which is easily vaporised. Acetone crosses lung membranes and gets expired on your breath. That’s why people who are <a href="https://en.wikipedia.org/wiki/Ketosis">ketotic</a>, meaning ketones are their primary fuel source, often have a “nail polish” odour. </p>
<p>As blood levels of ketones rise, acetoacetate and β-Hydroxybutyrate cross the blood-brain barrier to become the main source of fuel for the brain. Ketones also appear in urine. Their presence is tested for using <a href="https://en.wikipedia.org/wiki/Urine_test_strip#Ketone_test">“keto” strips that change colour</a> from buff to pink to maroon, depending on the concentration. It’s thought the metabolic changes associated with being “ketotic”, in combination with lower blood levels of glucose, are the important issues in epilepsy and cancer. </p>
<h2>What is a ketogenic diet?</h2>
<p>Ketogenic diets should only be used as part of <a href="https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/">medical nutrition therapy</a>, where diet is used to specifically treat a medical condition, and advice is provided by qualified health professionals, such as accredited practising dietitians. Ketogenic diets aim to drastically reduce carbohydrate and replace it with fat so the liver produces <a href="https://en.wikipedia.org/wiki/Ketone_bodies">ketone bodies</a>. They <a href="https://www.ncbi.nlm.nih.gov/pubmed/28754198">require supplementation with specific vitamins and minerals</a> because the severe restriction of food types and amounts means they don’t meet a range of vitamin and mineral requirements. Individuals on ketogenic diets also need to be monitored for side-effects, including poor growth in children. </p>
<p>Any diet that leads to the body metabolising mainly fat, rather than glucose, is technically a ketogenic diet. This includes when following a high fat, very low carbohydrate diet, during fasting, starvation or prolonged low to moderate intensity exercise. </p>
<p>The <a href="https://www.epilepsyqueensland.com.au/ketogenic-diet">classical ketogenic diets</a> calculate set ratios of fat to the combined total intake of carbohydrate plus protein. The most restrictive ketogenic diet is the 4:1 (four grams of fat to one gram of carbohydrate plus protein), followed by the 3:1 and 2:1 diets. These diets require carefully planned meals with specific amounts of foods so that the liver keeps making a steady supply of ketones and the body uses these ketones as a primary fuel source. This is referred to as being in a state of ketosis or being ketotic. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28754198">Other regimes include</a> the <a href="https://en.wikipedia.org/wiki/Medium-chain_triglyceride">Medium Chain Triglyceride</a> diet or <a href="https://www.epilepsyqueensland.com.au/modified-atkins-diet">Modified Atkins</a>. In epilepsy these diets are monitored relative to symptoms, with the goal to improve seizures, while minimising side-effects.</p>
<p>A typical ketogenic diet <a href="https://daa.asn.au/voice-of-daa/hot-topics/">limits total carbohydrate to between 20 and 50 grams a day</a>. This is not much. One cup of milk contains about 15 grams of carbohydrate, a medium apple has 20 grams and a regular slice of bread about 15 grams. A well-planned ketogenic diet could include either smaller quantities of these foods or foods much lower in carbohydrate such as vegetables (onion, spinach, cabbage, broccoli) or almond or flax-meal. The amount of fat in a ketogenic diet can be more than 150 grams per day. One teaspoon of butter or margarine contains four grams of fat, a cheese slice has seven grams and a fried egg has about 12 grams.</p>
<p>In Australia current <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007%7E2011-12%7EMain%20Features%7EFat%7E707">fat intakes </a> are around 70-90 grams per day and <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007%7E2011-12%7EMain%20Features%7EMacronutrients%7E703">carbohydrate intakes</a> 210 to 260 grams per day. By severely limiting foods that contain carbohydrate, you end up not getting enough dietary fibre and other nutrients including folate, B vitamins, calcium and trace elements. This is why ketogenic diets need ongoing monitoring and regular review of dietary supplements based on results of the dietary assessment.</p>
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<span class="caption">Cutting out carbohydrates means you also miss out on other things - such as fibre.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28754198">sample daily eating plan</a> could include scrambled eggs with mushroom, spinach and a grapefruit; a green salad with avocado, cheese, meat, egg and oil dressing; pesto chicken with zucchini. The <a href="https://www.charliefoundation.org/">Charlie Foundation website</a> and <a href="https://www.epilepsyqueensland.com.au/about-epilepsy-1">state epilepsy organisations</a> offer practical advice on epilepsy and for those following ketogenic diets for medical conditions.</p>
<h2>Ketogenic diets for epilepsy</h2>
<p>In 400 BC medical teachings from <a href="https://en.wikipedia.org/wiki/Hippocrates">Hipprocrates</a> challenged the notion that epilepsy was of supernatural origin and proposed dietary treatment. But <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.01821.x/full">it took until the 1920s</a> before “<a href="https://en.wikipedia.org/wiki/Ketogenic_diet">ketogenic diets</a>” were used as treatment for epilepsy. </p>
<p>A systematic <a href="https://www.ncbi.nlm.nih.gov/pubmed/26859528">review of seven trials in children</a> found that among those following a 4:1 ketogenic diet, 50% were seizure free and 85% had a reduction in seizure number after three months. Following the less restrictive Modified Atkins diet led to 10% being seizure free and 60% having fewer seizures after six months. </p>
<p>While the 4:1 ketogenic diet was more effective than less restrictive approaches, it was associated with more adverse side-effects, including diarrhoea, constipation and vomiting. These adverse effects were the reason most people stopped the trials, followed by not liking the diets or the diets not working. </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/25628734">systematic review of 12 studies</a> established using meta-analysis that the proportion of the 270 adults who achieved at least a 50% reduction in seizures was 52% for classical ketogenic diets and 34% for the Modified Atkins Diet. Similar to the child studies, the compliance rate was lower for classical ketogenic diets at 38%, compared to 56% for the Modified Atkins Diet. </p>
<h2>Ketogenic diets for brain cancer</h2>
<p>Interest in ketogenic diets as part of cancer treatment increased when it was <a href="https://www.ncbi.nlm.nih.gov/pubmed/23837760">recognised cancer cells need a steady supply of glucose</a> to grow and they can’t metabolise ketones. This means it’s theoretically possible to selectively starve cancer cells and make them more susceptible to the effects of radiotherapy and chemotherapy. But there is a major challenge in ensuring any dietary restrictions do not trigger <a href="https://www.ncbi.nlm.nih.gov/pubmed/28825869">malnutrition, and worsen cancer prognosis</a>. </p>
<p>In malignant <a href="http://www.webmd.com/cancer/brain-cancer/malignant-gliomas#1">glioma</a>, a type of brain cancer, pre-clinical studies in animal models suggest ketogenic diets can lower the incidence or progression of cancer in animals. This doesn’t mean, however, <a href="https://theconversation.com/of-mice-and-men-why-animal-trial-results-dont-always-translate-to-humans-73354">they will have the same effects in humans</a>. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28325264">number of human trials are underway</a> which suggest that ketogenic diets can be safe and feasible, with two of six studies indicating possible clinical benefits and the remaining were inconclusive. </p>
<p>While trials are currently ongoing, at this stage <a href="https://www.ncbi.nlm.nih.gov/pubmed/28353094">clinical evidence is limited,</a> but research is seeking to identify what ketogenic approaches may be useful, potential synergistic effects with other cancer treatments, ethical issues and the impact on quality of life for those living with cancer. </p>
<p>While it’s always a good idea to cut down on energy-dense, highly processed foods that contain lots of refined sugars, fats and salt, strict ketogenic diets should only be followed under medical supervision.</p><img src="https://counter.theconversation.com/content/83401/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She was a team member conducting the systematic reviews to inform the 2013 revision of the Australian Dietary Guidelines and the 2017 evidence review on dietary patterns and heart disease for the Heart Foundation.</span></em></p><p class="fine-print"><em><span>Rebecca Williams is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is a current post-doctoral researcher within the School of Health Sciences, Faculty of Health and Medicine at the University of Newcastle.</span></em></p>Ketogenic diets are back in the news with claims they are a “cure-all”. Research shows that in epilepsy not controlled by current treatment, around 50% of children and adults following ketogenic diets…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleRebecca Williams, Postdoctoral Researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/832172017-08-30T04:50:31Z2017-08-30T04:50:31ZNew study finding fat isn’t as bad as carbs misses the point<figure><img src="https://images.theconversation.com/files/183913/original/file-20170830-5668-31rv9i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's more important to examine is whether the fat and carbs come from fruits and vegetables or doughnuts and candy. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext">A new study</a> has added weight to the debate as to whether fat is better or worse for you than carbohydrates, in terms of risk of heart disease and early death. Unfortunately based on this study the jury’s still out, but it does highlight that we should focus on what foods people are eating, rather than just looking at components such as fat and carbohydrates. </p>
<p>Researchers looked at intakes of fat, carbohydrates and protein in more than 135,000 people from 18 low income countries (Bangladesh, India, Pakistan, and Zimbabwe), middle income countries (Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, occupied Palestinian territory, Poland, South Africa, Turkey) and high income countries (Canada, Sweden, United Arab Emirates). </p>
<p>They assessed dietary intakes based on questionnaires, and compared the results with death rates from heart disease and from all other causes. </p>
<p>Over 7.4 years of follow-up, 5,796 people died and 4,784 had major cardiovascular disease events, such as a heart attack or stroke. Interestingly, they found those with the highest intakes of total fat and sub-types of fat (saturated, unsaturated) compared to those with the lowest intakes, had a <em>lower risk</em> of dying from all causes. </p>
<p>There was a 21% <em>lower</em> risk of stroke among those with the <em>highest</em> saturated fat intakes compared to the lowest. However, when it came to the risk of having a heart attack or dying from heart disease, fats had no relationship with risk. </p>
<p>Interestingly, those consuming the highest percentage of total energy from carbohydrates had a 28% higher risk of early death, but no higher risk of having heart disease or dying from heart disease. </p>
<p>Although it hasn’t received as much attention, they also found a higher percentage energy intake from protein was associated with a 23% lower risk of early death and 15% lower risk of dying from causes other than heart disease. Animal protein intake was also associated with a lower risk of dying, but there was no significant association between plant protein and risk of early death.</p>
<h2>So what does this all mean?</h2>
<p>This study highlights that both carbohydrates and fat are important, but which foods you eat that contain fat or carbohydrate is even more important when it comes to how long you live. </p>
<p>The researchers found some differences between results for those living in Asian countries compared to other regions. For example there was no statistically significant difference in early death from all causes between those with the highest, compared to the lowest percentage of energy from carbohydrate for those living in Asian regions. But there was among those from non-Asian countries. </p>
<p>The analysis adds more weight to the global call to go beyond macro-nutrients (protein, fat and carbohydrate which are the major constituents of food) and to look carefully at actual food and drinks consumed. It matters whether your carbohydrates come from an apple, lentils or carrots compared to soft drink, doughnuts or pancakes. </p>
<p>The types of foods actually consumed could inform how changes in the food supply within lower and middle income countries relate to changes in death rates. They could also inform nutrition policies for countries experiencing a nutrition transition as they become more wealthy.</p>
<p>Overall, this study is very important, and a timely reminder of the need to continually update the evidence on diet disease relationships and to factor in what part of the world the individuals under study are from. But it’s not time to throw out the pasta, rice and bread and start guzzling tubs of fat. </p>
<p>It is time to pay more attention to nutrition and to focus on optimal eating patterns within each country. We need to stem the tide of <a href="https://en.wikipedia.org/wiki/Ultra-processed_products">ultra-processed</a> foods that disrupt healthier eating patterns. Studies from around <a href="https://www.ncbi.nlm.nih.gov/pubmed/28714425">the world show</a> that getting the ratio of ultra-processed to minimally processed foods <a href="https://www.ncbi.nlm.nih.gov/pubmed/27825941">back in balance</a> is key to <a href="https://www.ncbi.nlm.nih.gov/pubmed/28193285">improving the nutritional quality</a> of our overall diets.</p>
<h2>Dietary patterns and heart disease</h2>
<p>We recently reviewed the <a href="https://www.saxinstitute.org.au/publications/evidence-check-library/dietary-patterns-cardiovascular-disease-outcomes/">evidence on dietary patterns and heart disease</a>, where most research has been done in high income countries. </p>
<p><a href="https://www.saxinstitute.org.au/publications/evidence-check-library/dietary-patterns-cardiovascular-disease-outcomes/">Our report</a> highlighted that a number of dietary patterns that vary in fat and carbohydrate type and quality are associated with lower heart disease risk. What they have in common is that they are all high in vegetables, fruit, wholegrains and most includes legumes.</p>
<p>This new study provides support for a focus on improving the nutritional quality of macronutrients. In other words, it matters what foods you eat that contain high amounts of carbohydrates and fats. For example is the major source of carbohydrate coming from fruit and vegetables or is it added sugars and highly processed foods?</p>
<p>Close examination of the barriers and facilitators of consuming a healthy diet is warranted. In an earlier analysis of data from this new study, the team reported <a href="https://www.ncbi.nlm.nih.gov/pubmed/27567348">very low intakes of vegetables and fruit</a> with a mean combined intake of 3·8 servings a day. This varied from 2.1 servings of vegetables and fruit per day in low income countries up to 5.4 servings per day in high income countries. They found that the cost of fruits and vegetables relative to household income was high. </p>
<p>This highlights that to improve dietary patterns globally, we need people to eat more vegetables and fruit. To achieve that we must develop nutrition polices that support affordability of healthy food for all and stop arguing about whether fat is better than carbs. That just adds to the current confusion.</p><img src="https://counter.theconversation.com/content/83217/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She was a team member for the systematic review conducted to inform the 2013 revision of the Australian Dietary Guidelines and the 2017 evidence review on dietary patterns and heart disease for the Heart Foundation.</span></em></p>Arguing about whether carbohydrates or fats are better misses the main point. To improve global health we need reduce intakes of ultra-processed foods and eat more minimally processed foods.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/814192017-07-25T04:19:50Z2017-07-25T04:19:50ZWant to be happier, healthier, save money? It’s time to get cooking<figure><img src="https://images.theconversation.com/files/179551/original/file-20170725-29149-e444p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who cook more at home have healthier diets. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Research shows people who cook more have healthier eating patterns, spend less money on take away foods and have indicators of better health. </p>
<h2>Cooking makes you happy</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/21613564">A study in 160 adults</a> examined whether eating healthy foods prepared at home affects your emotions. Researchers found people who cooked more reported more intense positive feelings and worried less compared to those who had more meals away from home. They were also more likely to then choose healthier foods at their next meal compared to people who ate more food away from home.</p>
<p>A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28526477">randomised controlled trial in 141 Irish mothers</a> found learning to cook lasagna, either by following recipe cards or by video increased their confidence and enjoyment of cooking. Being taught how to cook reduced how difficult they perceived cooking the meal from scratch to be and increased their intention to cook it again.</p>
<p>It is not only cooking, but sharing meals with others, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25946941">that is associated with greater feelings of happiness</a> as found in an eight-year follow-up of 39,000 people in a cohort from Thailand.</p>
<h2>Cooking saves money</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28689608">In the US Cooking Matters six-week program</a>, low income adults were taught how to shop for and prepare healthy meals within a tight budget using hands-on meal preparation techniques. Six months after the program was completed individuals still showed significant improvements in confidence about being able to maximise their food dollars and food management techniques associated with choosing healthy foods. They were also less worried about running out of food before they had money to buy more.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28256283">A survey of 437 adults in the US</a> looked at the relationship between frequency of home-cooked dinners or eating out with overall diet quality and money spent on food. As you could guess, cooking at home more frequently was associated with higher diet quality and spending less per person on food away-from-home ($65 per person per month) and on food overall ($273 per person per month), while eating out more often was associated with lower diet quality and spending more per person on take-away ($133 per person per month) and food overall ($330 per person per month). Importantly the frequent and infrequent home cookers spent about the same on food prepared at-home ($193 compared to $196).</p>
<h2>People who cook more have healthier eating habits</h2>
<p>Ultra-processed foods tend to be higher in total kilojoules, salt, sugar and saturated fat. In a 2008 <a href="https://www.ncbi.nlm.nih.gov/pubmed/28535769">survey of 509 adults in the</a> UK, the average percentage of energy from ultra-processed foods was 51%. Those who were more confident with cooking or who cooked a main meal at least five days a week consumed 3–4% less total daily energy from ultra-processed foods. </p>
<p>This is equivalent to a difference of around 240–330 fewer kilojoules per day (57-75 Calories) coming from ultra-processed foods. It may not sound like much, but over a week it makes a difference to your intake of nutrients such as fibre, vitamins and minerals. For example 2,300 kilojoules is equivalent to about a 100g bar of chocolate or 2kg of broccoli.</p>
<h2>Cooking is associated with a lower risk for type 2 diabetes</h2>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pubmed/27379673">a US study</a>, over 58,000 women and 41,000 men were followed for 25 years. Every four years they were asked how many of their lunch and dinner meals were usually prepared at home. Among those having five to seven home prepared evening meals there was a 15% lower risk of developing type 2 diabetes compared to those having two or less, while among those who had five to seven midday meals at home there was a 9% lower risk. </p>
<p>This higher risk was partly attributed to those eating more meals at home experiencing significantly less weight gain. For those consuming 11–14 meals per week prepared at home, women gained 3.02kg and men gained 2.62kg during follow-up. This was significantly less than the weight gained by those having zero to six meals a week prepared at home, which was 3.36kg for women and 3.85kg for men.</p>
<h2>Cooking interventions help</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24703245">In studies where people</a> actively sought to cook more they improved nutrient intakes, diversity of food groups, and ate better foods. </p>
<p>Across all the studies of this type there were some positive impacts on health outcomes such as blood cholesterol, blood pressure, markers of rheumatoid arthritis, chronic kidney disease and quality of life for patients with prostate cancer. The reviewers highlighted though that well-designed studies with rigorous evaluations were needed because many studies had weak study designs.</p>
<h2>Who teaches you to cook?</h2>
<p>A 2015 survey found about one in five <a href="http://healthyweightweek.com.au/wp-content/uploads/2014/11/Cooking-at-home-prescription-for-good-health-FINAL.pdf">Australians wanted to cook more at home</a>. In an <a href="https://www.ncbi.nlm.nih.gov/pubmed/27842556">Irish survey</a>, over 1,000 adults were asked about their cooking skills, including cooking measures such as chopping, food skills like budgeting, cooking practices including food safety, cooking attitudes, diet quality and health. They were also asked when they learnt to cook and who taught them. </p>
<p>Results showed adults who had learnt to cook as children or teenagers were significantly more confident, had a greater number of cooking skills and practices and mostly had better overall diet quality and health. Mothers had been the main person who taught them how to cook. Learning to cook from an early age is important. This means the health of the whole family could potentially be improved by helping the main carers to improve their cooking skills.</p>
<hr>
<p><em>At the University of Newcastle we’re conducting a nation-wide online survey that will compare the cooking and food preparation skills of Australians with people from European countries. You can take our survey by clicking <a href="https://prcpan.au1.qualtrics.com/jfe/form/SV_01iV242k9UmL3lH">here</a>.</em></p><img src="https://counter.theconversation.com/content/81419/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p><p class="fine-print"><em><span>Tamara Bucher is affiliated with the Priority Research Center for Physical Activity and Nutrition, the University of Newcastle Australia, NSW and the Consumer Behavior Research Group at ETH Zürich, Switzerland. She has received a range of research grants including the Swiss National Science Foundation (SNSF) and the Swiss Foundation of Nutrition Research (SFEFS) and the European Union (Horizon 2020).</span></em></p>Research shows people who cook more have healthier eating patterns, spend less money on take away foods and have indicators of better health.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleTamara Bucher, Senior Researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808382017-07-14T02:41:51Z2017-07-14T02:41:51ZGot pre-diabetes? Here’s five things to eat or avoid to prevent type 2 diabetes<figure><img src="https://images.theconversation.com/files/178206/original/file-20170714-14267-ntnndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lifestyle changes can prevent full-blown type 2 diabetes. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><a href="https://www.diabetesaustralia.com.au/pre-diabetes">Pre-diabetes</a> is diagnosed when your blood sugar levels are higher than normal, but not high enough to be classified as having <a href="https://www.diabetesaustralia.com.au/type-2-diabetes">type 2 diabetes</a>. Pre-diabetes is an early alert that your diabetes risk is now very high. It is ten to 20 times greater compared to the risk for those with normal blood sugars. What you choose to eat, or avoid, influences this risk.</p>
<h2>Diabetes Prevention Programs</h2>
<p>Studies around the world, including Finland, China and the US have shown diabetes prevention programs prevent or delay progression to type 2 diabetes. When people <a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">eat more healthily</a>, <a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">drop their body weight by 5-10%</a> and walk for 30 minutes a day, five days a week, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22020084">they lower the risk</a> of developing type 2 diabetes by about 58% over two years.</p>
<p>We recently gave 101 men with pre-diabetes <a href="https://www.ncbi.nlm.nih.gov/pubmed/28423969">a self-directed diabetes prevention program over six months</a>. We found they were able to reduce their portion size of potato and meat and improve their variety of health foods. They were able to reduce the proportion of energy coming from junk food by 7.6% more than the group who didn’t change their diet and got a four-point increase in their scores from the <a href="http://healthyeatingquiz.com.au/">Healthy Eating Quiz</a>. These improved eating patterns were associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/26526160">an average weight loss of 5.5kg and better blood sugar regulation</a>. </p>
<p>This is great news for the <a href="https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html">318 million adults around the world</a>, including two million Australians, who have pre-diabetes.</p>
<p>The original diabetes prevention studies started in the 1980s. Back then the advice was to reduce your total kilojoule intake by <a href="https://theconversation.com/mondays-medical-myth-low-fat-diets-are-better-for-weight-loss-11586">eating less fat</a>, especially from take-away, processed and fried foods and to eat more foods rich in carbohydrate, such as vegetables, fruit and wholegrains. That advice worked because the world <a href="https://www.ncbi.nlm.nih.gov/pubmed/24102801">did not have the huge numbers of ultra-processed foods and drinks</a>, many of which claim to be healthy but are actually high in kilojoules. </p>
<h2>What do people in diabetes prevention programs eat?</h2>
<p>Drilling down to exactly what you should or shouldn’t eat to beat type 2 diabetes is confusing. Less fat? More protein? Less carbs? More wholegrains? Here is what the research suggests.</p>
<p><strong>1. More vegetables and fruit</strong></p>
<p>In a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22854878">meta-analysis of observational studies that included over 179,000</a> people there was a lower risk of developing type 2 diabetes in those who had the highest intakes of vegetables and fruit compared to the lowest. Drilling down to specific fruit and vegetables identified that high intakes of green leafy vegetables like spinach, silverbeet, cabbage, kale, Asian greens, lettuce, rocket, broccoli and watercress had the strongest relationship. </p>
<p><strong>2. Ditch the softdrinks</strong></p>
<p>A review of 17 population studies from the US and UK looked at the prospective associations between <a href="https://www.ncbi.nlm.nih.gov/pubmed/27044603">drinking sugar-sweetened beverages</a> and developing diabetes. Over ten years, more than 38,000 people developed type 2 diabetes. After adjusting for weight status, every extra sugar sweetened drink per day was associated with a 13% increase in the incidence of type 2 diabetes. </p>
<p><strong>3. Plant based diets</strong></p>
<p>A study of about <a href="https://www.ncbi.nlm.nih.gov/pubmed/27299701">200,000 adults in the Nurses and Health Professionals study in the US</a> looked at plant food intake and diabetes risk over 20 years. People who had a high intake of plant foods and low intake of animal foods had a 20% lower risk of diabetes, while those with the highest intakes of the most healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) had a 34% lower risk of developing type 2 diabetes, even after adjusting for body weight. Among those with high intakes of less healthy plant foods (refined grains, potatoes, sweets, fruit juice, sugar-sweetened beverages) there was a 16% higher risk of diabetes.</p>
<p><strong>4. Glycaemic Index</strong></p>
<p>Food with a high <a href="https://en.wikipedia.org/wiki/Glycemic_index">glycaemic index</a> (GI) are digested more rapidly leading to a greater increase in blood sugars after eating. The GI value is out of 100 and less than 55 is considered low. In a review of 21 studies there was a small but significant 8% increase in the risk of developing type 2 diabetes for every five unit increase in GI. You can find information on the <a href="http://www.gisymbol.com/resources-consumers/">GI value of foods here</a>.</p>
<p><strong>5. Drink more coffee</strong></p>
<p>Coffee, whether caffeinated or decaffeinated, contains bioactive molecules that help regulate blood sugar levels. <a href="https://en.wikipedia.org/wiki/Chlorogenic_acid">Chlorogenic acid</a> improves glucose metabolism and insulin sensitivity, while <a href="https://en.wikipedia.org/wiki/Caffeic_acid">caffeic acid</a> boosts the rate muscles use up glucose. This helps explain why <a href="https://www.ncbi.nlm.nih.gov/pubmed/24150256">across 28 studies and over one million adults</a>, coffee drinkers have a lower risk of type 2 diabetes. For those who drank three or more cups of coffee a day, there was a 21% lower risk compared to those who never or rarely drank it. For those drinking decaffeinated coffee, there was a 6% lower risk for each cup. </p>
<h2>What about low carb diets?</h2>
<p>In a review of <a href="https://www.ncbi.nlm.nih.gov/pubmed/28679144">four studies with over 85,000 people where 8,000 cases of diabetes</a> developed in the following 20 years, there was a small but significantly greater risk of developing type 2 diabetes in those who had the lowest carbohydrate intakes. It’s a good idea to ditch highly processed carbohydrates and refined sugars like molasses, white, brown and raw sugar and other types of <a href="https://www.heartfoundation.org.au/healthy-eating/food-labels">sugar listed on food labels</a> including sucrose, high fructose corn syrup and other refined sugars. However, complex carbohydrates provide fibre, B vitamins and are often fortified with folate and iodine to prevent conditions like neural tube birth defects and goitre. So ditching all carbs could be inviting disaster and needs careful evaluation.</p>
<h2>Check your diabetes risk</h2>
<p>Meanwhile, use the <a href="https://www.diabetesaustralia.com.au/risk-calculator">Diabetes Australia Risk Calculator</a> to check whether you are at risk of pre-diabetes and type 2 diabetes, or talk to your GP.</p><img src="https://counter.theconversation.com/content/80838/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p><p class="fine-print"><em><span>Megan Rollo has received research funding from a number of bodies including Diabetes Australia, Hunter Medical Research Institute, New South Wales Government (TechVoucher) and Novo Nordisk, and consulted to the Sax Institute and Quality Bakers Australia Pty Limited. She is affiliated with the Priority Research Centre in Physical Activity and Nutrition at the University of Newcastle and a member of professional organisations including the Dietitians Association of Australia.</span></em></p>Knowing exactly what to eat and avoid to beat type 2 diabetes can be confusing. More protein? Less carbs? More wholegrains?Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleMegan Rollo, Postdoctoral Research Fellow, Nutrition & Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/766112017-06-26T03:49:50Z2017-06-26T03:49:50ZGet headaches? Here’s five things to eat or avoid<figure><img src="https://images.theconversation.com/files/175523/original/file-20170626-4492-mqyzj3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drinking more water can help with headaches. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Last week I had a headache. Two hours in a traffic jam, hot day, no water, plans thrown into chaos. That day I was one of the <a href="http://headacheaustralia.org.au/our-story/">five million Australians affected by headache or migraine</a>. Over a year one person in two will experience a headache. </p>
<p>Mine was a “<a href="http://headacheaustralia.org.au/headachetypes/tension-type-headache/">tension-type</a>” headache, the most common category. <a href="http://headacheaustralia.org.au/headachetypes/migraine/">Migraines</a> are less common but about one person in eight will experience one in any given year. </p>
<p>Headaches are really common, so here are five things the research evidence indicates are worth trying to help manage or avoid them.</p>
<h2>1. Water</h2>
<p>A study was conducted in people who got at least <a href="https://www.ncbi.nlm.nih.gov/pubmed/22113647">two moderately intense or more than five mild headaches a month</a>. The participants received a stress management and sleep quality intervention with or without increasing their water intake by an extra 1.5 litres a day. </p>
<p>The water intervention group got a significant improvement in migraine-specific quality of life scores over the three months, with 47% reporting their headaches were much improved, compared to 25% of the control group. </p>
<p>However, it did not reduce the number or duration of headaches. Drinking more water is worth a try. Take a water bottle everywhere you go and refill it regularly to remind you to drink more water.</p>
<h2>2. Caffeine</h2>
<p>Caffeine can have opposing effects. It can help relieve some headaches due to analgesic effects but also contribute to them, due to caffeine withdrawal. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/15448977">review of caffeine withdrawal studies</a> confirmed that getting a headache was the number one symptom of withdrawal, followed by fatigue, reduced energy and alertness, drowsiness, depressed mood, difficulty concentrating, fuzzy head and others. </p>
<p>When people were experimentally put though controlled caffeine withdrawal, 50% got a headache, with withdrawal symptoms occurring within 12-24 hours, peaking between 20-51 hours and lasting from two to nine days. Caffeine withdrawal can happen from a usual daily dose as low as 100 mg/day. One cup of brewed coffee contains 100-150mg caffeine, instant coffee has 50-100 mg depending on how strong you make it and a cup of tea can vary from 10-90mg. It appears that maintaining usual caffeine consumption may subconsciously relate to avoidance of withdrawal symptoms.</p>
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<a href="https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175483/original/file-20170625-13456-1j9tzw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Caffeine can lessen or worsen headaches.</span>
<span class="attribution"><span class="source">Jonathan Thursfiled/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Caffeine can dampen down pain. in a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25502052">systematic review that included five headache studies</a> with 1,503 participants with migraine or tension-type headache, 33% of participants achieved pain relief of at least 50% of the maximum possible after receiving 100 mg or more caffeine plus analgesic pain medication (ibuprofen or paracetamol) compared to 25% for the analgesic group alone.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/19308315">study in over 50,000 Norwegians,</a> who have high caffeine intakes (more than 400 milligrams a day), examined the relationship with headaches. Those with the highest caffeine intakes (more than 540mg/day) were 10% more likely to get headaches, including migraine. </p>
<p>But when headache frequency was examined, high caffeine consumers were more likely to experience non-migraine headaches infrequently (less than seven per month) compared to those considered low caffeine consumers (less than 240mg a day). This was attributed to potential “reverse causation” where high caffeine consumers use caffeine to damp down headache pain. They found those with the lowest caffeine intakes (125mg a day) were more likely to report more than 14 headaches per month, which may have been due to greater sensitivity and avoidance of caffeine. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/23832130">Hypnic headaches</a> are a rare type that occurs in association with sleep. They typically last 15-180 minutes and are more common in the elderly. Hypnic headaches are treated by giving caffeine in roughly the amount found in a cup of strong coffee.</p>
<h2>3. Fasting</h2>
<p>Some people get a <a href="https://www.ncbi.nlm.nih.gov/pubmed/20490742">headache after fasting for about 16 hours</a>, which equates to not eating between 6pm and 10am the next day. A study in Denmark found one person in 25 has been affected by a fasting headache. These headaches are most likely to occur when fasting for a blood test or medical procedure or if you are following a <a href="https://theconversation.com/what-are-fasting-diets-and-do-they-help-you-lose-weight-76644">“fasting” weight loss diet</a> or a <a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">very low energy meal replacement diet</a>. </p>
<p>Fasting headaches are likely to be confounded by caffeine withdrawal. Check the test procedure instructions to see what fluids, such as tea, coffee and water are allowed and drink within those recommendations.</p>
<p>In a study <a href="https://www.ncbi.nlm.nih.gov/pubmed/24417796">34 people with new-onset migraine</a> who kept a headache diary for about a month, those who ate a night-time snack were 40% less likely to experience a headache compared to those who didn’t snack. For susceptible individuals this may prevent fasting headaches. Try a slice or wholegrain toast with a topping like cheese and tomato or avocado and tuna, with a cuppa.</p>
<h2>4. Alcohol</h2>
<p>Headache is the classic feature of alcohol induced <a href="https://en.wikipedia.org/wiki/Hangover">hangovers</a>. The amount of alcohol needed to trigger a hangover varies widely between individuals, from one drink to many. A number of factors mash up to produce a throbbing post alcohol headache. Increased urination and vomiting both increase risk of dehydration which leads to changes in blood and oxygen flowing to the brain. </p>
<p><a href="https://en.wikipedia.org/wiki/Congener_(alcohol)">Congeners</a>, a group of chemicals produced in small amounts during fermentation, give alcoholic drinks their taste, smell and colour. Metabolites of alcohol breakdown in the liver can cross the blood-brain barrier contributing to hangover. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27114660">Alcohol can trigger</a> tension-type headaches, <a href="http://headacheaustralia.org.au/headachetypes/cluster-headache/">cluster headaches</a> and migraine. People with <a href="https://www.ncbi.nlm.nih.gov/pubmed/21336550">migraines have been shown to have lower alcohol intakes </a> compared to others.
The wise advice is to drink responsibly, boost your water intake and don’t drink on an empty stomach. If you are sensitive to alcohol, avoidance is your best option.</p>
<h2>5. Boost your intake of folate-rich foods</h2>
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<span class="caption">More folate in your diet helps migraines.</span>
<span class="attribution"><span class="source">ahmadpi/flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Some migraineurs are <a href="https://www.ncbi.nlm.nih.gov/pubmed/22644176">diet-sensitive. Triggers</a> include cheese, chocolate, alcohol or other specific foods. A recent study found women with <a href="https://www.ncbi.nlm.nih.gov/pubmed/25598270">low dietary folate intakes had more frequent migraines</a>. However a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27339806">daily folic acid (1mg) supplement made no difference</a>. </p>
<p>Boost your intake of foods rich in folate such as green leafy vegetables, legumes, seeds, chicken, eggs and citrus fruits. Use our <a href="http://healthyeatingquiz.com.au/">Healthy Eating Quiz</a> to check your nutrition, diet quality and variety. Keep a <a href="http://headacheaustralia.org.au/headache-management/headache-migraine-diaries/">headache diary</a> to identify triggers and then discuss it with your GP.</p><img src="https://counter.theconversation.com/content/76611/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p>Watching what you eat and drink could help manage your headaches.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/766442017-05-08T03:39:18Z2017-05-08T03:39:18ZWhat are ‘fasting’ diets and do they help you lose weight?<figure><img src="https://images.theconversation.com/files/168260/original/file-20170508-7677-175jv54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are many types of "fasting" diets. But are they any better than restricting your energy intake the old fashioned way?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/344331644?src=OA2xswyElecJxS-y2G-M6w-1-26&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Trying to lose weight is hard work. You need to plan meals and snacks, and make a big effort to <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">avoid situations that trigger more eating and drinking</a> than you’d planned. Dieting can also be very antisocial. But what if you could speed up weight loss, spend less time “dieting”, with the “promise” of better results? This is where “fasting” diets come in.</p>
<h2>What is a ‘fasting’ diet?</h2>
<p>Intermittent fasting is the broad name for diets when you fast to some degree on some, but not all, days of the week; you eat normally on the other days. </p>
<p>On “fast” days, the kilojoule (energy) restriction is severe, at about 25% of what you would normally eat. This is only 2,000 to 3,000 kilojoules a day. An average person needs around <a href="http://www.8700.com.au/">8,700 kilojoules</a> a day (depending on body size and activity level) to maintain their current body weight. </p>
<p>To lose between one quarter and half a kilogram a week you would need to <a href="https://theconversation.com/health-check-ten-ways-to-save-2-000-kilojoules-and-drop-a-clothes-size-37039">reduce your energy intake by 2,000 kilojoules a day</a>. Over a whole week, this is equivalent to cutting back total energy intake by 14,000 kilojoules. Fasting diets compress this 14,000 kilojoule reduction into fewer days of dieting. In practical terms, this means that you reduce your intake by so much on a couple of days, you do not to be so strict on the other days.</p>
<p>Depending on the type of “fasting” diet, you focus all your weight loss efforts into sticking to the severe restriction for either two days a week (as in the <a href="https://en.wikipedia.org/wiki/5:2_diet">5:2 diet</a>) or every second day (for three to four days days a week), as in <a href="https://en.wikipedia.org/wiki/Intermittent_fasting">alternate-day fasting</a>. Another variation is the 16-hour overnight fast where eating is restricted <em>every day</em> to an eight-hour window, such as 11am to 7pm. Across all types of intermittent energy restrictions diets, we don’t know the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28106818">longer-term benefits or harms</a>. </p>
<p>Any intermittent fasting approach will work if you can tolerate the hunger pains and stick to it. Sounds easy, but it is a very hard thing to do and for many it is not realistic. When you are fasting, your body thinks there is a <a href="https://theconversation.com/health-check-why-diets-fail-20066">famine and will try to get you to eat</a>. The idea is that by including non-fasting periods, when you eat what you want, you may feel less like you are on a “diet”, and <em>that</em> makes it easier to stick to.</p>
<p>Even though “fasting” dieters are told to eat what they feel like on non-fast days, most <a href="https://www.ncbi.nlm.nih.gov/pubmed/27062219">do not get a compensatory increase in appetite</a>. In other words, they do not over-eat, but just eat normally on non-fast days. So they reduce their total kilojoule intake over the whole week.</p>
<h2>How about very low energy diets?</h2>
<p>A specific type of continuous (every day) fasting diet is called a protein sparing modified fast or a very low energy diet. These limit you to 1,800 to 2,500 kilojoules a day, every day. They use products called <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1747-0080.2012.01628.x/full">formulated meal replacements</a>, in the form of milkshakes or snack bars to replace most meals and snacks. These are supplemented with vitamins and minerals to meet the body’s nutrient needs. </p>
<p>Such very low energy programs usually include one small meal that contains a couple of cups of vegetables (to boost fibre and nutrient intakes), a small amount of oil (to keep the gall bladder working) and sometimes a fibre supplement (to manage constipation). These are reserved for when you need to lose weight urgently for health reasons or ahead of surgery.</p>
<p>Continuous fasting using these very low energy diets is associated with a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25402637">reduction in hunger</a>. This is thought to be due to the production of molecules called <a href="http://www.webmd.com/diabetes/ketones-14241#1">ketones</a> that cross the <a href="https://theconversation.com/explainer-what-is-the-blood-brain-barrier-and-how-can-we-overcome-it-75454">blood-brain barrier</a> (from the brain’s bloodstream into its tissues) and reduce appetite.</p>
<h2>Do ‘fasting’ diets work?</h2>
<p>Intermittent fasting diets that last for at least six months <a href="https://www.ncbi.nlm.nih.gov/pubmed/27338458">help people lose weight</a>. However, they are no more effective than other dietary approaches that restrict your kilojoule intake every day, but not so severely as a “fast”.</p>
<p>Consistent with this result, a study published last week <a href="https://www.ncbi.nlm.nih.gov/pubmed/28459931">randomised 100 adults </a> to either alternate-day fasting, a continuous energy restriction diet, or to no intervention, for six months. They were followed for another six months after that. There was no difference in weight loss between the diet groups after a year.</p>
<p>And <a href="https://www.ncbi.nlm.nih.gov/pubmed/26775902">a review</a> that compared behavioural interventions for weight management to those that also included very low energy diets found very low energy approaches achieved slightly greater weight loss for up to two years.</p>
<h2>Who should not try a fasting diet?</h2>
<p>Fasting diets are not for everyone. People with major medical problems, or taking a range of medications including insulin, should not go on them, unless under medical supervision; they are not suitable for children, in pregnancy or for people with eating disorders; and they may exacerbate some mental health conditions. </p>
<p>Fasting diets can also have side-effects. The more days you spend “fasting”, the more likely you are to have them. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26775902">Side-effects can include</a> constipation, headaches, bad breath, <a href="https://theconversation.com/got-gallstones-heres-what-to-eat-and-avoid-53229">gall bladder</a> disease, <a href="https://theconversation.com/got-gout-heres-what-to-eat-and-avoid-50239">gout</a> and liver inflammation. </p>
<p>So, before starting a weight loss diet, see your doctor for a check-up. When you need more support to improve your eating habits, or the diet you were following stops working, you need to try another approach. That is a good time to also get advice from an <a href="https://daa.asn.au/find-an-apd/">Accredited Practising Dietitian</a>. </p>
<h2>What is the best diet for weight loss?</h2>
<p><a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">The best diet</a> to help you achieve a healthy weight is one you can stick with. It should also help you feel better and be healthier. </p>
<p>By making improvements to your usual eating habits, that you can live with permanently, you will drop some weight. It might <a href="https://theconversation.com/you-dont-have-to-be-the-biggest-loser-to-achieve-weight-loss-success-11587">not be your dream weight</a>, but it is likely to be realistic. It might not sound sexy, but it’s true.</p><img src="https://counter.theconversation.com/content/76644/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p>Fasting diets aim to make it easier to stick to a weight loss program, but they are not for everyone.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/769812017-05-02T22:01:37Z2017-05-02T22:01:37ZFeeling worn out? You could have iron overload<figure><img src="https://images.theconversation.com/files/167448/original/file-20170502-26313-zixla5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No, not that type of iron overload – haemochromatosis, when your body absorbs too much iron.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/442118806?src=_STvjoIZMwVdZZezu0Copw-1-5&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Feeling a bit tired and worn out? Vague symptoms like these are common in iron deficiency and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaemia">anaemia</a>. But before you reach for the iron supplements or chow down on steak, these symptoms are common in another condition related to iron. This time the trouble is <em>too much</em> iron, not too little, because of the iron overload disorder called <a href="http://haemochromatosis.org.au/explanation/">haemochromatosis</a>.</p>
<h2>What is haemochromatosis?</h2>
<p>Haemochromatosis is the most common iron storage disease in Australia, the US and most European countries and occurs in about <a href="https://www.ncbi.nlm.nih.gov/pubmed/9138148">one person in 200</a>. It is <a href="https://www.ncbi.nlm.nih.gov/pubmed/23577916">rare in people of Asian descent</a>. </p>
<p>It is a recessive genetic condition, meaning you have to <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">inherited two copies of the haemochromatosis gene</a> (one from each parent). The defect is in the gene that regulates how much iron you absorb from food and supplements. This means that more iron gets into your system than you <a href="https://en.wikipedia.org/wiki/Human_iron_metabolism">need to make red blood cells or to perform other functions</a>. The excess iron ends up in your organs and <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">can damage your heart, liver, pancreas, joint and glands that make hormones</a>. If left untreated, you are at a higher <a href="http://haemochromatosis.org.au/">risk of heart and liver disease, diabetes and arthritis</a>. </p>
<h2>Signs and symptoms</h2>
<p>Symptoms commonly appear in men aged 40-60 years, but appear later in women due to blood loss from menstruation and childbirth.</p>
<p>The most common symptoms are fatigue and joint pain. More advanced symptoms include osteoarthritis, hormonal changes with loss of libido, skin that has a bronze or slate grey colour, heart problems, diabetes (including <a href="http://www.diabetes.co.uk/hemochromatotis-bronze-diabetes.html">bronze diabetes</a>) and liver diseases such as cirrhosis and liver cancer.</p>
<p>It seems confusing that absorbing <em>more iron</em> could lead to fatigue. Iron is needed to make red blood cells that carry oxygen around the body. However, <em>too much</em> iron is toxic. <a href="http://www.mayoclinic.org/diseases-conditions/hemochromatosis/symptoms-causes/dxc-20167290">Excess iron gets deposited in your organs, and this then interferes with normal body functions</a>, as well as the production of hormones that regulate your metabolism and sex drive. Not surprisingly, you don’t feel well. </p>
<h2>Diagnosis and treatment</h2>
<p>Your GP can order a simple blood test to check your iron status. This includes <a href="https://en.wikipedia.org/wiki/Transferrin_saturation">transferrin saturation</a> and <a href="https://en.wikipedia.org/wiki/Ferritin">serum ferritin</a>. If these suggest you could have an iron overload disorder then a gene test will confirm the diagnosis. Once diagnosed, close relatives would also need to be checked for the condition. </p>
<p>The good news is that treatment for haemochromatosis is straight forward and effective. The <a href="https://en.wikipedia.org/wiki/Venipuncture">venipuncture</a> process (similar to becoming a regular blood donor) removes excess iron from the body.</p>
<h2>What do I need to avoid eating and drinking?</h2>
<p>Avoiding eating meat, chicken and fish or becoming a <a href="https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/vegetarian-diets-the-basics/">vegetarian</a> will help reduce the amount of iron you eat and can therefore potentially reduce what your body absorbs.</p>
<p>Other things to avoid are vitamin C supplements and juices high in, or supplemented with, vitamin C. Vitamin C converts the iron from legumes, eggs, nuts, seeds, grains and breakfast cereals into a form that is more easily absorbed, increasing your iron load.</p>
<p>There are many reasons why you could feel fatigued. If you have a lethargy that just won’t lift, see your GP for a check up.</p><img src="https://counter.theconversation.com/content/76981/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p>Feeling tired and out of energy? Talk to your GP about checking your iron level.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.