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healthy &HEARTWISE TRUSTED FOR HEALTH

Shelley Craft Making room to laugh

The cholesterol controversy Exercise after a cardiac event

16

RECIPES

with fresh seasonal ingredients

AUTUMN | WINTER 2014 VOL 54

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COLD COMFORT FOOD avoid winter weight gain

BREAST CANCER

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Editorial advisory panel DR ALISTAIR BEGG MBBS, FRACP, FCSANZ, DDU Alistair has had 15 years of private practice experience in Sydney and Adelaide, and worked as a cardiologist at Flinders Medical Centre before joining SA Heart, Ashford, Adelaide in 2007. He has a particular interest in patients with chest pain, heart failure or significant risk factors, and is actively involved in cardiac rehabilitation. Alistair is Publisher of Healthy & Heartwise, author of What should I eat for my heart? and producer of preventive and rehabilitation educational resources: www.whatswrongwithmyheart.com

DR GINNI MANSBERG BMed, Grad Dip Journalism Ginni is Channel Seven’s Sunrise and Morning Show GP, and appears regularly on numerous radio programs around Australia. She writes for several magazines, such as Women’s Health and Practical Parenting, and is author of three books: How to Handle Your Hormones, How to Get Your Mojo Back and Why Am I So Tired? Ginni practises as a family doctor in Sydney and has three children while running a popular blog, www.drginni.com

CHRIS TZAR AEP, MSc (Ex Rehab), BSc (HMS) Chris is an accredited exercise physiologist with extensive experience in providing exercise therapy and lifestyle programs for people with diabetes, cardiovascular disease, musculoskeletal disorders, HIV/AIDS and cancer. Chris is Director of the Lifestyle Clinic in the Faculty of Medicine at the University of NSW, a Board Director of Eastern Sydney Medicare Local, Chair of Exercise is Medicine (Australia), and a National Board Director of Exercise & Sports Science Australia.

MILENA KATZ BSc (Nutr), BTeach, APD, AN Milena is an Accredited Practising Dietitian and founder of Ahead In Health, a Sydney-based private practice and nutrition consultancy. Milena works part-time within the Multicultural Health Service of NSW Health and has wideranging experience in clinical nutrition and education of healthcare professionals. Milena is particularly passionate about the nutrition status of older adults, especially residents in aged care facilities.

PROFESSOR TRISHA DUNNING AM PhD, RN, Med, FRCNA, CDE Professor Dunning is Chair in Nursing and Director of the Centre for Nursing and Allied Health Research at Deakin University and Barwon Health in Geelong, Victoria.

She is a member of the Board of Diabetes Australia – Victoria and a Credentialed Diabetes Educator. Trisha is widely published in many peer-reviewed journals, sits on the Editorial Advisory Panel of Conquest and has written several books and book chapters.

From the

EDITOR

W

elcome back to Healthy & Heartwise – Australia’s oldest preventive health magazine has returned after a two-year hiatus.

Since 1998, HHW has been circulated every quarter to general practices, pharmacy chains and pathology collection centres across the nation and, until it became commercially so difficult in the magazine world, sold through newsstands and to a growing list of subscribers.

Thanks to Adelaide cardiologist Dr Alistair Begg, HHW now breathes again, and comes to you biannually through a cardiac rehab or pathology centre if not a newsagent, online or via an app.

In its own way, the magazine had its near-death event, surgical intervention and, like many of its readers, is now embarked on a rehab program to face the world with renewed focus and changed perspective.

Heartwise is your companion through your recovery, your witness to lifestyle change and a guide to a long and healthier life. It alerts you to what you can do for your cardiovascular care in all its dimensions: body, mind and spirit.

Risk factors such as hypertension and conditions commonly shadowing heart disease – obesity, depression and stress – are also within our remit, not to mention the array of metabolic problems that can result in the global and wholly preventable pandemic of our age, type 2 diabetes.

Hence Dealing with Diabetes retains the reverse side of the magazine, with news, features and regular sections dedicated to preventing the many complications that can arise from the country’s fastestgrowing chronic disease.

Recipes, the most beloved section of the old HHW, is reformatted and now features contemporary, seasonal and innovative meals from national food, health and culinary icons. As before, we analyse and rate recipes for nutrient levels so you get an idea of how to modify them according to your own health needs.

Enjoy reading and look out in October for our Spring/Summer issue.

STEVEN CHONG

Autumn | Winter 2014 • Heathy & Heartwise

3

6

We hear you – letters page

7

Health alert – hot news briefs

42

Health on the shelf

43

Well read & watched – media reviews

EDITOR Steven Chong steven@healthpublishingaust.com.au

ON THE COVER 14

PUBLISHER Alistair Begg

EDITORIAL COORDINATOR Emily Rundle emily@healthpublishingaust.com.au

HEALTHY REHAB 16

How you feel after a heart attack or surgery is about more than just your physical state, and it will change

20

Movement is key to a safe and sustained recovery from a heart event

ADVERTISING Michael Sant msant@healthpublishingaust.com.au P (02) 9439 1599

CREATIVE Wetdog Design steve@wetdog.com.au ISSN 1833-8798

REAL LIFE HEALTH STORY 18

The Biggest Loser Retreat was just the space to help Christine Cole jump out of the rut she'd been in

66

At first Glenn Cotter thought it was depression but later realised he had diabetes

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EDITORIAL CORRESPONDENCE Health Publishing Australia AMA House Suite 207, 2nd Floor 69 Christie St, St. Leonards, NSW 2065 P +61 2 9439 1599 F + 61 2 9439 1688 E hhm@goodhealthpublications.com W www.heartwise.com.au www.facebook.com/healthyandheartwise

22

24

Bariatric surgery is an increasingly realisitic option for more people – but how will it affect your diet?

30

How to get through the cold season without gaining weight around your middle

32

Meal replacement programs can be effective for weight loss and healthy eating

advice or instruction. No action should be taken based on the contents of this magazine, instead, appropriate health professionals should be consulted. The circulation of this

Prostate and other problems can make incontinence the bane of men's lives

HEALTHY WEIGHT

expressed by authors do not necessarily reflect the policy information only, and may not be construed as medical

14

HEALTHY MEN

Contributions are welcome. Copyright © 2014. The opinions of the Publisher. All material in this magazine is provided

Shelley Craft – she's been around The Block enough times to tell us a thing or two about smiling through stress

magazine is 50,000 CAB audit pending.

HEALTHY LIVING

4

Heathy & Heartwise • Autumn | Winter 2014

26

The practice and pitfalls of screening for breast cancer

27

It may feel like a heart attack but it could be heartburn, and it's much easier to fix

28

contents HEALTHY EATING 28

46 50

Beans, pulses and legumes are made for winter – time to dust off the pack or tin in the cupboard and get cooking Chef's chats with Lee Holmes and Janni Kyritsis 14 winter breakfast, salad, dinner, snack, soup and dessert recipes – with expert nutritional analysis

46

ASK THE EXPERTS 34

73

Angina and post-op recovery explained by Ashford cardiac rehab specialists Gluten sensitivity and type 2 diabetes symptoms

38

HEALTHY SUPPLEMENTS 36

Pharmacist Gerald Quigley answers your questions

HEALTHY EXERCISE 38

If you've lost strength in your legs or have other balance problems, here's how you can prevent spills and falls

HEALTHY WOMEN 40

Could your symptoms be polycystic ovarian syndrome?

DEALING WITH DIABETES 61

69

62

64 65 67 69

20

70 74 77 78

Changes in how your feet feel could indicate nerve damage How to make sure that diabetes during pregnancy stays temporary Driving safely with diabetes Dental care is about more than a quick brush and gargle How high glucose levels can threaten your sight Restless legs – the complication that robs sleep Deciphering food labels Why chocolate really is good Blood glucose monitors Diabetes news

Autumn | Winter 2014 • Heathy & Heartwise

5

letters Have your say about

WE HEAR YOU!

healthy &HEARTWISE

GALLING GALLSTONES

CAN I DRIVE WITH DIABETES OR NOT? I read Healthy & Heartwise and am interested in the Dealing with Diabetes section.

The purpose of this email is to ask if you could do an article on driving.

As it stands we have an annual Roads and Traffic Authority (RTA) medical and, depending on one’s medication, should not drive if the blood glucose level (BGL) is below 5.4 mmol/L. The saying seems to be,“If at five don’t drive”.

I have read that as I do not have type 2 diabetes and NOT on medication, I could drive when my BGL is as low as 3.4 mmol/L, but I cannot remember the source.

However because this is a grey area, consolidation of facts would be great help because advice seems to covers a large spectrum.

TIM C SALISBURY

via email • EDITOR’S NOTE: See page 64!

LET US KNOW 6

I have a good one for you: a couple of years ago I had gallstones stuck in duct and ended up with jaundice. They were removed, followed a few months later by the gallbladder because the doctors said that they would recur otherwise.

Gradually I recovered from that ordeal but lately I’ve not been feeling my usual self and with the same symptoms that I had with gallstones. The doctor arranged blood tests that revealed my liver enzyme levels were raised, so I was sent to hospital. Further scans and tests found a stone in the little bit of duct remaining.

“How can you get gallstones with no gallbladder?!” I wondered but I could apparently and did, so

returned to hospital to have the rest removed.

The doctors have told me it is not uncommon for it to happen, but not a routine thing.

I now feel better that the first procedure, which is a good sign.

It would be nice for some recipes to show potassium count in them because kidney disease sometimes requires a lowprotein, low-potassium diet. Many products you buy do not show the level of potassium in them and the US National Kidney Foundation are trying to get manufacturers to disclose it on their products’ lists of ingredients. I saw a dietitian to find out what and how much I can eat.

see page 34!

food

the cholesterol lowering and fat burning

Lisa Wilkinson

men:

The art of the early start

relate to your prostate!

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Healthy & Heartwise Suite 207 AMA House 69 Christie St ST LEONARDS NSW 2065

5/09/11 5:54 PM

I was given a copy of Healthy and Heartwise (Spring 2011, Vol 51) by a friend. I had never read it before, but I was instantly impressed! I especially appreciated the tips on how to choose different types of milk, what’s important and what I can ignore when selecting a brand. Thank you, and keep up the good articles.

I’ll be sure to read them!

MAY HARTLEY

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Heathy & Heartwise • Autumn | Winter 2014

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healthalert

OECD glances at our figures, sees too much fat & medication WITH 28.3% of Australian adults obese, we are the fourth fattest country after the US, Mexico and New Zealand within the Organisation for Economic Co-operation and Development (OECD).

The OECD’s Health at a Glance 2013 report released in November compared its 34 member countries on 75 indicators of health from data current at 2011.

In the decade until then, our increase in obesity among adults was the third highest – nearly 10% more became obese in that year.

Over that period, prescriptions of cholesterollowering medication almost tripled, making us the highest consumers of statins in the OECD.

Health at a Glance 2013 OECD INDICATORS

Health at a Glance 2013 OECD INDICATORS

ABOVE: The OECD praised Australia’s health system as consistently among the top five countries for cardiac and cancer care, but warned that our obesity rates were the fourth highest http://dx.doiorg/10.1787/ health_glance-2013enhealth_glance-2013-en

However, blood pressure medications were much less popular with consumption below the OECD average, while we are the second-most prescribed antidepressants – a rate that has doubled in the past decade.

In the past two decades, cardiovascular healthcare has come a long way in Australia, with CVD deaths reduced by 64% and strokerelated deaths reduced by 55%. Only five per cent of Australians admitted to a hospital with a heart attack in 2011 died within 30 days, which was half the rate of 2001. This could be due to the greatly increased of coronary angioplasty as a proportion of heart surgery over that time.

vital statistics

COPING POSTHEART ATTACK ABOUT HALF of Australians who survive a heart attack do not attend a rehabilitation program and have ‘misperceptions’ as to its cause, a national survey of cardiac patients and carers has found.

The Baker IDI Heart and Diabetes Institute released the findings in its Two Hearts, One Future report July last year.

Both carers and patients too often thought stress to be the underlying trigger to heart attacks, said lead investigator Prof Simon Stewart, however the ‘overemphasis’ was not corrected by attending a rehab program.

Attendance was associated with more positive attitudes to healthy lifestyles plan, although all recognised its importance.

Men generally reported better quality of life than women, indicating a stronger recovery, said Prof Stewart, with the notable exception of emotional status.

However, female subjects and carers had better recognition of warning signs and symptoms of a repeat heart attack.

Autumn | Winter 2014 • Heathy & Heartwise

7

healthalert

#1 KILLER: heart disease

CANCER

CANCER HAS OVERTAKEN heart disease as the biggest killer in Australia and globally but after Denmark and France, we have the thirdhighest rate of diagnoses, says the World Health Organization (WHO).

The World Cancer Report 2014, the WHO’s first worldwide review of cancer since 2008, revealed 14 million new cases are diagnosed each year, which is expected to rise to a ‘tidal wave’ of 22 million annually within the next 20 years.

Cancer deaths overtook those from heart disease in 2011, and will rise from 8.2 million to 13 million per year until 2025. However, Heart Foundation national director Dr Robert Grenfell said CVD remains the biggest national killer because we include strokes as well as coronary heart disease in our figures, and 45,622 Australians died from CVD that year compared to 43,622 deaths from cancer.

Costs of treatment are estimated to be US$1.16 trillion, or two per cent of global GDP. In 2012, 40,000 Australians died from cancer and although death rates are decreasing overall, the increasing incidence is thought to be due to longer lives in which to be diagnosed, plus early detection from screening programs such as for cervical and breast cancer, says Terry Slevin from Cancer Council Australia.

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ABOVE: World Cancer Day 2014 ‘Debunk the myths’ campaign seeks to reduce stigma and dismiss misconceptions about the disease

LD CA

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Australians and New Zealanders are twice as likely to be diagnosed with melanoma than anywhere else in the world, while prostate cancer is the most commonly diagnosed form in Australia, with 21,800 diagnoses in 2009, according to the Cancer Council.

The WHO said that half of the predicted cases are preventable by curbing obesity, smoking and alcohol consumption.

“Governments must show political commitment to progressively step up the implementation of high-quality screening and early-detection programs, which are an investment rather than a cost,” said Dr Bernard Stewart, co-author of the Report and Conjoint Professor with the School of Women’s & Children’s Health at the University of NSW. Cancer Australia launched an education program on World Cancer Day in February to debunk the myth that ‘We don’t need to talk about cancer’, and expects about 128,000 Australians to be diagnosed this year. www.iarc.fr, www.abc.net.au, canceraustralia.gov.au

Women die most from a broken heart CARDIOVASCULAR DISEASE (CVD) remains the leading killer of Australian women, claiming three times as many as breast cancer yet receiving almost none of the attention, heart experts said in Sydney in March.

Launching a global program aimed at preventing the recurrence of heart attack or stroke in people with CVD, Prof Simon Stewart of the Baker IDI Heart and Diabetes Institute presented his recent research [see page 7].

Prof Stewart’s national survey of 536 men and women post-heart attack found 83% of women found it challenging to adhere to treatment and lifestyle change compared to 73% of men.

“A worrying number of patients find it difficult to change their diet or physical activity

8

Heathy & Heartwise • Autumn | Winter 2014

levels after having a heart attack. We also know that women in particular often don’t undergo the required treatment or therapy, often because of potential side effects and costs associated,” said Prof Stewart.

“Nearly half of female heart attack patients also fail to follow doctors’ instructions, and about a third occasionally forget to take critical medication,” he added.

Women are usually gatekeepers for their family’s health, yet men were more likely to follow their doctors’advice, so Prof Stewart was surprised that “Women are falling behind men when it comes to taking steps to save their own lives.” www.goredforwomen.org.au

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healthalert Cholesterol: con, conspiracy or just complicated?

Great big

fat spat The ‘healthy’ debate shows that dietary prevention of CVD to be a dynamic, evolving field with a complexity that defies easy answers

THe ABC Catalyst documentary ‘Heart of the Matter’ broadcast in October ignited furious public, health and media debate about the causes of cardiovascular disease (CVD), its prevention with cholesterol-lowering medications (statins) and the role of diet.

However, the show – criticised as sensational, ill-founded or potentially dangerous by health authorities and the ABC’s own Dr Norman Swann and Media Watch – coincided with the British Medical Journal (BMJ) publishing a high-profile critique about the ‘myth’ blaming saturated fat for CVD. Research published before and since the Catalyst broadcast reveals strong dispute among biomedical and nutrition communities, with potential implications for public health, treatment and lifestyle and dietary guidance.

The ‘healthy’ debate shows that prevention of CVD – both before and after a cardiac event – to be a dynamic and evolving field of a complexity that defies simplification and easy ‘one size fits all’ answers.

One certainty is that CVD, the person with it, their healthcare professionals and their treatment are each unique and that the most effective prevention, management and rehabilitation is individualised.

10 Heathy & Heartwise • Autumn | Winter 2014

Catalyst questioned the long-standing emphasis on raised total cholesterol levels as a risk factor. CEO of the Heart Foundation Dr Lyn Roberts expressed shock at the ‘disregard’ of the evidence: “High cholesterol remains a major risk factor for heart attack, stroke and peripheral vascular disease and having multiple risk factors places you at higher risk.”

The Foundation and medical guidelines maintain that an individual’s absolute CVD risk is a combination of factors:“It’s important to remember that it’s just one risk factor and all other risks need to be considered to work out a person’s overall risk of heart attack,”said the Foundation’s Chief Medical Adviser Prof James Tatoulis.

In terms of the number of lives that elevated cholesterol alone takes, it does appear the weakest risk factor. According to WHO, World Heart Federation and World Stroke Organization, high blood pressure is responsible for 13% of global deaths, followed by tobacco use (9%), raised blood glucose and physical inactivity (both 6%), overweight and obesity (5%), with cholesterol at 4.5%.

Raised total cholesterol levels is projected to result in 2.6 million deaths globally in 2015, which is less than a tenth of the 21.3 million who will die from CVD and four per cent of total deaths.

A review of the evidence by Cambridge University published in March said that saturated fat raised HDL as well as a benign subtype of ‘fluffy’ LDL, while a denser form of LDL was more dangerous and tends to be present with high triglycerides and low levels of HDL. The very dense LDL particles are increased not by saturated fat, but by sugary foods and an excess of carbohydrates, said lead reviewer Rajiv Chowdhury. “It’s the high carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said. “If anything is driving your LDLs in a more adverse way, it’s carbohydrates.”

Statin the too obvious?

Although cholesterol-lowering medications (statins) have been shown to reduce deaths in patients with established CVD, Catalyst questioned whether they were overprescribed in the general population, or for people with risk factors who could lower cholesterol through dietary and lifestyle change.

In addition, Aseem Malhotra, interventional cardiology specialist registrar at Croydon University Hospital in London, wrote in the BMJ that obsession with levels of total

healthalert

Autumn–Winter

cholesterol “has led to the over-medication of millions of people with statins and has diverted our attention from the more egregious risk factor of atherogenic dyslipidaemia” (an unhealthy ratio of blood fats).

Adopting a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin, wrote Dr Malhotra. “Doctors need to embrace prevention as well as treatment.”

The Heart Foundation’s Chief Medical Adviser Professor James Tatoulis responded that after a heart attack, treatment with a statin is standard evidence-based management.

Prof Richard Lindley, Chair of Stroke Foundation Clinical Council, warned “If you’ve never had a stroke in the past or never had a heart attack, there are still people who would really benefit from a statin… If you’ve had a stroke and you stop taking a statin, you will be at higher risk of having a stroke in the future.”

health calendar

28 April – 4 May MAY 4–10 6 8 10 12 12–18 12–19 17 20 20–26 22 25–31 26–31 28 31

Saturated in dietary advice Ongoing research into different forms of dietary fats, their individual fatty acids and their effects on subtypes of cholesterol has divided experts over the current understanding of CVD. In his original BMJ critique, Dr Aseem Malhotra said the data from population studies “have not supported any significant association between saturated fat intake and risk of CVD.” Instead, saturated fat has been found to be protective and Dr Malhotra added that “It is time to bust the myth of the role of saturated fat in heart disease and wind back the harms of dietary advice that has contributed to obesity.”

US cardiovascular research scientist and pharmacy PhD Dr James DiNicolantonio agreed, writing in Open Heart that dietary guidelines should be “urgently reviewed and the vilification of saturated fats stopped to save lives”.

Most guidelines, including those for people with CVD or diabetes [see page 45], recommend replacing saturated with polyunsaturated fat from nuts and vegetable oils, but Dr DiNicolantonio said recent trials showed that without a matching rise in omega–3s, this could increase the risk of death from CVD. The Cambridge meta-analysis of more than 70 studies involving half a million people assessed diet but also blood and tissue samples, and found a link with trans fats but no evidence of danger from saturated fat. There were weak links between blood levels of palmitic and stearic acids (mainly in palm oil and animal fats, respectively) and CVD, but levels of the dairy fat margaric acid seemed to significantly reduce risk.

JUNE 9–15 14 23–29 27 29

JULY 13–19 21–27 28 AUGUST 3–10 4–11 11–17

www.abc.net.au/ catalyst, British Medical Journal – 22.10.14, www. heartfoundation. org.au, www.worldheart-federation. org , Annals of Internal Medicine – 18.3.14, www. strokefoundation. com.au, Open Heart – 5.3.14

22 24–30 27 SEPTEMBER 1–5 1–7 8–14 10 11 15–21 21 29–5 October

Pneumonia awareness Week neurofibromatosis awareness Month Kiss Goodbye to MS Month Motor neurone disease Week World asthma day World Ovarian cancer day World lupus day International Me/chronic Fatigue Syndrome day national Volunteer Week Multiple chemical Sensitivity Week Food allergy awareness Week World hypotension day World autoimmune arthritis day Spinal health Week australia’s Biggest Morning tea Macular degeneration awareness Week Kidney health Week exercise Physiology awareness Week World MS day World no tobacco day lipoedema awareness Month Bowel cancer awareness Month Men’s health Week World Blood donor day World continence Week red nose day World Scleroderma day Stay in Bed day eye health awareness Month national diabetes Week national Pain Week World hepatitis day

healthy Bones action Week dental health Week Brain Injury awareness Week haemochromatosis awareness Week daffodil day hearing awareness Week national Meals on Wheels day International Prostate cancer awareness Month Blue September Jean hailes Women’s health Week national asthma awareness Week Parkinson’s awareness Week national Stroke Week eczema awareness Week World Suicide Prevention day r U OK? day headache and Migraine Week World alzheimer’s day Sleep awareness Week

Autumn | Winter 2014 • Heathy & Heartwise

11

healthalert

Fish oils prevent second heart events

What ate the chocolate?

Microbes are responsible for consuming chocolate in our intestinal tract, claims a study presented at a meeting of the American Chemical Society in March – and the bacteria turn the confection into anti-inflammatory compounds that create its unique health profile [see pp 74–5].

The Society rigged up a model digestive tract from modified test tubes and fed three types of cocoa powder through it, which then underwent anaerobic fermentation using human facecal bacteria.

Fibre and antioxidant compounds in cocoa were poorly digested and absorbed until they reached the colon.

“The fibre is [then] fermented and the large polyphenolic polymers are metabolised to smaller molecules, which are more easily absorbed. These smaller polymers exhibit anti-inflammatory activity,” said lead investigator Dr Finley.

Combining fibre in cocoa with prebiotics – carbohydrate-based‘food’for probiotic bacteria – was“likely to improve a person’s overall health and help convert polyphenolics in the stomach into anti-inflammatory compounds,”he added.

“When you ingest prebiotics, the beneficial gut microbial population increases and outcompetes any undesirable microbes, like those that cause stomach problems.”

Dark chocolate could be even healthier if combined with fruits also high in polyphenols, such as pomegranate and açai, added Dr Finley. www.acs.org

Above: Probiotic bacteria in the colon break down chocolate and help convert its polyphenols into anti-inflammatory compounds

tAken in HigH doses and long term, supplementing with omega–3 fatty acids – such as from marine oils from oily fish or krill – does protect against sudden or cardiac death or a heart attack if you already have cardiovascular disease (CVD), according to an analysis of high-quality trials.

Italian researchers reviewed 11 randomised controlled trials that tested omega–3 supplements of daily dosages of 1–6 g against a placebo in people with a history of CVD for at least one year.

Risk of death from any cause and risk of stroke were not affected by omega–3 supplementation, but risk of: • cardiac death was reduced by 32% • sudden death was reduced by 33% • heart attack was reduced by 25%.

Studies of omega–3 supplements that had shown no effect in these outcomes could be the result of cardioprotective medications such as statins being used concurrently, said the researchers, who added that further trials should account for them.

Atherosclerosis Supplements – August 2013

Omega–3s with statins lower triglycerides A recent US–South Australian trial of high-dose omega–3s in high-risk CVD patients with high triglyceride levels treated with statins backed the cardioprotective effects of the fatty acids.

The double-blind trial of 647 people with triglyceride levels of 200–500 mg/dL used a novel omega–3 formulation in free fatty acid form which can have four times the bioavailability of conventional omega–3 supplements.

While remaining on statin therapy, the patients were given daily placebo capsules of olive oil or 2 g or 4 g of the supplement for six weeks, then had fasting serum blood samples taken.

The 2 g dose lowered triglyceride levels 14.6% and the 4 g dose lowered them 20.6%, while the placebo only lowered it 5.9%. Total and VLDL cholesterol concentrations were reduced with either dosage and the ratio between total and HDL cholesterol was significantly decreased with the higher dosage, as were lipoprotein CVD markers.

Clinical Therapeutics – September 2013

12 Heathy & Heartwise • Autumn | Winter 2014

coverstory

As a TV host and presenter fronting everything from home videos to travel and reality shows on two networks since the mid-90s, Shelley Craft makes joy and enthusiasm seem effortless.

She has described happiness as key to her technique and success so Heartwise finds out what’s making her happy.

hww Hosting The Block meant

commuting to Melbourne from Byron Bay for several weeks. With two young daughters and you and your husband working, how do you make your schedule flexible and adaptable?

Shelley Flexibility and adaptability are the absolute key and something that Christian and I both learnt in our years of working in TV. It is a rare day in TV if things actually go to plan or by the rundown. It’s a great skill to have and one that I believe only a few personality types can actually work with.

Luckily for us, it seems that both the girls are as easygoing as we are and can move and change with ease. About the only thing we can plan for is what time to get up in the morning and from there, just take it as it comes.

Shelley Craft

hww Recently you contributed a

recipe to the Byron Bay Cookbook.

What was it and when did you get into cooking?

Shelley It’s actually a berry brekkie smoothie recipe so I don’t know if that counts as cooking! But, it is a great way to make sure we all get enough

14 Heathy & Heartwise • Autumn | Winter 2014

coverstory of everything in the morning to get us through the day. Lots of fresh berries (antioxidants), muesli, yoghurt, banana, kale, honey and soy milk. hww You must see a lot of innovative

kitchen designs, appliances and kitchenware working on renovation shows – what’s stood out for you in terms of making a healthy diet as easy as possible?

Shelley We’ve just moved houses ourselves and I am missing my gas stovetop terribly. So at this point, I would say that. We keep our diet very simple: low carbohydrates with loads of protein and legumes with every meal.

Shelley’s favourite • Travel destination from The Great Outdoors – Antarctica

hww Skiing and horse riding are

passions but can you indulge them in Byron Bay and with life so busy? Have you turned to any other sports or exercise?

Shelley I wish I had more time for my passions. We are beach goers now, more so than the mountains. Chasing two girls around is the most consistent exercise I do and I have recently given paddle boarding a go and loved it, so when I have some‘me’ time, that’s what I might take up next.

• Restaurant – FISHHEADS Byron Bay • Smartphone app (other than your own!) – Pinterest • Ski run – Summit Falls Creek • Jetlag remedy – Don’t sleep at your destination until at least 9pm

hww How do you protect your

family’s skin in all that sun?

Shelley Banana Boat 50+ on the girls at all times as well as hats and protective clothing.

I do believe in the need for vitamin D, so I try to make sure we have a bit of outdoor time uncovered before 10am, so we can all get the much-needed vitamin D.

hww What got you involved in promoting campaigns for Planet Ark and Lifeline?

Shelley I was approached by both of them to promote particular campaigns that they run through the year. Planet Ark National Tree Day is making a massively positive impact on our environment and teaching our kids the importance of looking after our country.

Lifeline’s Stress Down Day is tackling an issue that I am sure affects all families.

I believe laughter is the best medicine and to let go of stress is one of the

• Memory from 80s Brisbane – EXPO 88 • Funniest Home Video clip/ moment – “Jinny Barnes”

We keep our diet very simple: low carbohydrates with loads of protein and legumes with every meal kindest things we can do for ourselves.

Stress is a major factor affecting our mental and physical health so it’s great to help raise not only awareness but also funds for the 24-hour crisis line. hww You’re now promoting the Swisse

range of supplements. How did that come about and which formulas do you use?

Shelley I started using Swisse Pregnancy Ultivite when I was planning my first pregnancy. Through that I was introduced to other Swisse products and now I wash my hair with it, bathe in it and drink it! I rely on it for helping maintain a good balance. It’s a terrific Aussie brand that helps support my

busy lifestyle and makes me confident that I am giving myself the best chance at a long and healthy life. hww From your experience on The Block,

what can people do about health and safety on worksites? There are many acute hazards and risks but also longterm, less apparent ones like asbestos.

Shelley NEVER touch or remove asbestos — that is the only rule.

ALWAYS use experts for any of the ‘real’ jobs on a renovation. Leave plumbing to the plumbers, electrical to the electricians and structural to the engineers. It will save you money in the long run and possibly your life. ♥

Autumn | Winter 2014 • Heathy & Heartwise

15

healthyrehab

Life after heart surgery:

how do you feel?

A cardiac event is an emotional experience, not just a physical one. Rehab psychologist DR ROSEMARY HIGGINS explains what people go through and what helps.

A

heart attack or other cardiac event can come as a huge shock. People may pass through a range of emotions including shock and disbelief, fear and anxiety, guilt, anger, sadness and even relief as they adjust to a life-changing event.

This period of adjustment can range from a few weeks to many months.

For some, it can take quite some time to adjust to lifestyle and physical changes that arise in response to the cardiovascular problem. While this adjustment will differ depending on your own circumstances, there are some commonalities.

The emotional range

This emotional adjustment happens at the same time that patients are asked to make major changes in their lifestyle.

The list of lifestyle changes can be long for some, including dietary change, increasing some forms of physical activity and reducing others, cutting

16

down on alcohol consumption, quitting smoking and taking medication daily.

It is small wonder that patients feel overwhelmed when recovering from a cardiac event.

reassurance to help reduce this vigilance to a more helpful level.

Other patients need to learn to‘trust their body again’after feeling as though their heart has‘let them down’.

SHOCK AND DISBELIEF are common early on, with the whole experience described as being ‘surreal’. This disbelief is stronger for patients who had little or no warning time before undergoing coronary artery bypass surgery, having a stent or some other cardiac surgery. Patients may need to retell the story of what happened to them numerous times as they come to terms with what has happened.

EXISTENTIAL CRISES – Many patients, particularly the young ones, report a heightened awareness of their own mortality after a cardiac event. They realise that life is both precious and short. While we all know logically that we won’t live forever, becoming aware of this at an emotional level can feel like a heavy burden to carry. This is a natural reaction to a serious health event.

Over time, this fear and anxiety reduce as patients recover and return to the distractions of normal life.

FEAR AND ANXIETY are also common in the early days after a cardiac event.

Patients may become‘hyper-vigilant’to any bodily sensations, fearing that this may signal another event.

Cardiac rehabilitation can provide muchneeded education and appropriate

Heathy & Heartwise • Autumn | Winter 2014

SOME PATIENTS MAY FEEL GUILTY, particularly if they believe that the event could have been avoided “If only …” Some can feel guilty about what they have put their family through,

healthyrehab

The place of rehab People who have a heart event need time to recover emotionally as well as physically. Cardiac rehabilitation helps in your emotional recovery by: • letting you know that you are not alone

• helping you to understand your condition

• helping you plan for a new and healthier future • building your confidence that you will recover

• giving you feedback about improvements in fitness.

Some patients find themselves being more irritable or angry after a cardiac event, feeling much more ‘tightly wound up’ and tending to snap at those around them. others for not responding to the first symptoms that something was wrong.

Some parents even feel guilty about passing down ‘bad genes’ to their children. Some patients can feel guilty for not being able to do the things that they normally do, such as grocery shopping, driving or taking out the rubbish. Others may feel guilty about their lifestyle before or after the cardiac event. Cardiac rehabilitation can be useful for helping patients to focus on the future rather than the past and to understand what they can do to look after themselves.

SOME PATIENTS FEEL MORE IRRITABLE OR ANGRY after a cardiac event, feeling much more ‘tightly wound up’ and tending to snap at those around them. Others feel frustrated at not being able to do the things that they want to do or with being dependent on others for help. Over time, these feelings pass as you recover

physically. Anger and frustration may signal that you need to go a bit easier on yourself and on those around you.

PATIENTS CAN ALSO GET DEPRESSED post-cardiac event. Some report feeling that ‘it is all too hard’ and ‘the future is bleak’. Having a cardiac event can initially overwhelm our coping resources, leaving us flat and miserable.

For most patients, ‘the cardiac blues’ tend to pass over time. Rehabilitation can be helpful but for some patients, unfortunately these feelings of sadness do not pass, or even get worse over time. This is serious — people tend not to take good care of their health when they feel down or depressed. Patients with depression are less likely to take their heart medications, less likely to stop smoking and less likely to change other aspects of their lifestyle. If this is you, it is important that you talk to your general practitioner to get some help right now.

PEOPLE CAN ALSO FEEL RELIEF after a heart attack, surgery or stroke; relief that their life was saved, that they finally know what was wrong or that good treatments are available for their heart problems.

Some people can feel a renewed connection to those around them and feel lucky to have people who care about them. ♥

ROSEMARY HARRIS, DPsych (Health), BBSc, GradDipBehHlthCare, AMPS, is a Senior Research Fellow at the Heart Research Centre: heartresearchcentre.org

Autumn | Winter 2014 • Heathy & Heartwise

17

♥ reallifestory

How retreat leads to

TRIUMPH At her lowest ebb, Christine Cole booked three months at The Biggest Loser Retreat in Queensland to begin a life-changing transformation.

I

was devastated in 2005 when I lost my 24-year-old son and my sister. Three months after, I fell into a deep depression that consumed the next eight years.

Earlier this year, my depression culminated in a nervous breakdown where I was unable to get out of bed or interact with my four daughters and

seven grandchildren (who I adore).

My husband said,“You’ve got to do something … you can’t live like this.”

It was at this point when I discovered The Biggest Loser Retreat by Golden Door, a new retreat in the Gold Coast Hinterland that combines the Golden Door Health Retreats’wellness philosophy with a dedicated weight-loss program. It would allow me to take some time out for myself, help me to learn a healthier lifestyle and shift some of the 30 kg I had gained during the past eight years.

Retreat beats being blue And it was the best thing I have ever done for myself. I lost 18 kg during my stay and have gained a newfound strength in mind, body and spirit.

With most of the training outdoors amongst the Retreat’s stunning scenery and with a real focus on fun, surprisingly, my favourite activities were the workouts that were individually tailored around my pre-existing

injuries and fitness level. I also loved the afternoon holistic activities such as yoga, mediation and Feldenkrais … and the food was amazing. Who would have thought nutritious, perfectly balanced meals could be so delicious?

My stay at The Biggest Loser Retreat has completely uplifted me and I’m no longer controlled by depression. Since returning home, I have lost a further five kilograms by applying my eating plan, exercise program, and essential knowledge learnt at The Biggest Loser Retreat to my everyday life.

We spend thousands of dollars on our homes, cars and holidays, when we really should be investing in our health.

I urge everyone reading my story to look into The Biggest Loser Retreat and invest in themselves. ♥ ■ CHRISTINE COLE is a mother of four

NEW YEAR, NEW YOU! Create a ‘new you’ with a complete health boost at The Biggest Loser Retreat

by Golden Door and lose an average 2 kg of fat (and years of bad habits) in just a seven-day program.

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To enter, email guestservices@biggestloserretreat.com.au in 25 words or less why you’d like to win a seven-day fitness and weight-loss program at The Biggest Loser Retreat. The email subject must be ‘Healthy & Heartwise Competition’ and entries close 31 August 2013.

Are you ready to change your life? www.biggestloserretreat.com.au

DER A E R ER! F F O

18 Heathy & Heartwise • Autumn | Winter 2014

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healthyrehab

Moving to mend Recovery from a heart event no longer demands rest and relaxation but physical activity, even aerobic or weightbearing exercise.

Craig Cheetham explains why.

F

ollowing a heart event, procedure or assessment, the thought of performing regular physical activity can be intimidating and, in many cases, the last thing on your mind. However, research strongly supports this prioritisation should be the complete opposite, with evidence showing significant benefit regardless of your age or type of heart condition.

Benefit of regular exercise Despite the common belief that we only need to exercise to lose weight,

20 Heathy & Heartwise • Autumn | Winter 2014

the benefit extends far broader and in ways that no medication or medical procedure can mimic.

Regular exercise will benefit cardiovascular health by: • lowering LDL (’bad’) cholesterol and increasing HDL (‘good’) cholesterol • lowering blood pressure • assisting the reduction of body fat while importantly maintaining muscle mass • improving blood sugar control – Exercise is the best tool available to stop or slow down the onset of diabetes

healthyrehab

Exercise is the best tool available to stop or slow down the onset of diabetes lining of blood vessels • improving emotional wellbeing which influences exercise, eating and sleeping habits, as well as improving quality of life.

Which level is right for you?

If your doctors have encouraged you to resume normal daily activities, even with the advice to “take it a little easy”, it is appropriate to commence regular physical activity or exercise. However, if your doctor specifically requests that you do not exercise or participate in physically activities, it is important to follow this advice.

The key considerations when initiating exercise is: • Start small. Begin with small, lowintensity (gentle) bouts of exercise and gradually build the duration before thinking about making it more vigorous. The exercise intensity will place load on your heart by increasing both your heart rate and blood pressure. This is a normal physical response to exercise and partly why we derive some benefit from it.

• More is not necessarily better.

There is no clear evidence that exercising harder or more vigorously gains any additional benefit.

Which type of exercise?

– Exercise will increase insulin sensitivity, making the body more responsive to insulin and assisting the reduction of blood glucose levels (BGLs). This is very important in pre-diabetes and diabetes – Physical activity utilises the sugars circulating in the bloodstream – Lowering body weight also plays an independent role in improving blood glucose control • improving the reactivity of blood vessels and the release of beneficial substances associated with cardiovascular health from the

There is no evidence that one type of exercise gains better outcomes than another. Therefore the best type of exercise for you is the one you enjoy the most — but please consider the intensity of the exercise (how vigorous, or how ‘out of breath’ it leaves you) and the load this can place on the heart.

Common modes of exercise include: Aerobic exercise – e.g. walking, cycling, swimming, etc. which prolong rhythmic

activity. It is relatively easy, little or no equipment is needed, and it can be performed most times/places.

Light resistance exercise – excellent for joint/muscle health, promotes strength to support activities of daily living. Excellent for those with existing joint/muscle complaints and can be performed indoors so is ideal during unfavourable weather.

How much is enough?

Consider every bout of exercise as a ‘dose’ similar to taking a dose of a medication, only one where the more frequently it is delivered to the body, the greater the health benefits. Ideally exercising on most days of the week (five out of seven) for approximately 30 minutes will see you gain most of the health benefit. There is evidence that suggests three bouts of 10 minutes are almost as beneficial.

However, attempt to sustain each bout for as long as you can. If 30 minutes of exercise is comfortable, you can continue for longer periods.

However, if exercise is challenging and you may not be able to achieve 10 minutes, any duration you can achieve is nonetheless beneficial.

And you will improve. ♥

CRAIG CHEETHAM is Director of Cardiovascular Care WA; Adjunct Lecturer at the School of Sports Science, Exercise & health at University of Western Australia; and President of the WA Cardiovascular Health and Rehabilitation Association.

Autumn | Winter 2014 • Heathy & Heartwise

21

♥ healthymen

Holding it in I

ncontinence affects one in four people older than 15, or about 4.8 million Australians.Women are more likely to have urinary incontinence than men, with pregnancy and menopause major contributing factors [see HHW 50, page 40], however prostate swelling, bladder weakness following prostate surgery and‘after dribble’keeps the male prevalence as high as 13%.

And almost twice as many Australian men experience faecal incontinence compared to women: some 20% as opposed to 12.9%.

Although this problem is one of the three major reasons for admittance to a nursing home, it exists at large in the community without medical help or awareness.It is estimated that 30% of men who visit the GP are affected by incontinence, but only one-third of these will discuss the issue.Loss of control over one’s most personal of bodily functions is one of the last conditions to lose its stigma – most people living with bladder and bowel problems are reluctant to seek help, despite research showing 60–70% of cases can be cured or better managed.

5 SELFHELP TIPS

1

Eat well Eat a healthy diet rich in

dietary fibre to avoid constipation.

You need at least 30 g of fibre daily, which you’ll likely clock up from the recommended daily intake of twoto-three serves of fruit, five serves of

vegetables and five serves of cereals and breads. It’s important to get the balance right because just adding fibre to your diet without enough fluids can cause constipation or make it worse.

2

Drink well Drink 1.5–2 litres

of fluid each day to prevent bladder irritation and constipation, unless otherwise advised by your doctor.

For up to one in three men, getting through the day depends on knowing where the closest toilet is.

Steven Chong raises the continence issue most are too embarrassed to mention.

3

Exercise regularly

4

Tone your pelvic floor muscles

Try to exercise for 30 minutes most days.

Walking is great exercise – walk to work at least part of the way and go for a stroll with a mate instead of the usual pub catch-up.

Pelvic floor muscles give you control over your bladder and bowel and, like any muscle, are kept strong with regular exercise. Practise squeezing your pelvic floor muscles to control the urge to go to the toilet. A continence physiotherapist can guide you and determine the best frequency of pelvic floor exercises for you.

5

Practise good toilet habits

Go to the toilet when your bladder feels full or when you get the urge to open your bowels – don’t get into the habit of going ‘just in case’.

Take the time to completely empty your bladder and bowel. How you sit on the toilet is just as important: sit with your elbows on knees, lean forward and ensure your feet are flat on the floor (support your feet on a footstool if necessary). ♥

For assistance, phone the National Continence Helpline on 1800 330 066 between 8am to 8pm AEST Monday to Friday. The Helpline, an Australian Government initiative managed by the Continence Foundation of Australia, is a free service staffed by continence nurse advisors who can provide advice, resources and referrals to local continence clinics: www.continence.org.au

■ STEVEN CHONG, BA (Comm), is the Editor of HHW

22 Heathy & Heartwise • Autumn | Winter 2014

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healthyweight

Taking the knife to fat Gastric banding, sleeve and bypass surgery is becoming more acceptable, if not recommended, for some overweight or obese people. Melanie McGrice looks behind five myths that have emerged so you can decide if it’s the cut for you.

24 Heathy & Heartwise • Autumn | Winter 2014

H

ave you ever considered weight-loss surgery?

Unfortunately, most media tends to either show the best stories where people lose 100 kg, start running marathons, get a promotion at work and meet the partner of their dreams; or the worst cases where people get terrible complications, end up in the Intensive Care Unit for a month, then spend the rest of their lives eating baby food and vomiting after every meal.

In reality, these types of scenarios occur in very few cases. However, the misinformation has led to many myths, a handful of which follow.

healthyweight

To make weight-loss surgery worthwhile, you need to commit to regular education sessions with your bariatric team to learn how to get the best results from your procedure. not a ‘set and forget’ operation, either.

You will need to continue to work on choosing a nutritious diet and optimising your physical activity.

2. Weight-loss surgery will cause you to get down to your‘ideal body weight’ The average weight loss after surgery is 50% of your excess body weight. So, if you weigh 140 kg and your ‘ideal body weight’ (BMI 25) is 80 kg, your excess weight is 60 kg (140 – 80). You should expect to lose about half of this: about 30 kg. If you weigh 80 kg and your ideal weight is 60 kg, you carry 20 kg excess, so you should lose about 10 kg.

Weight-loss surgery is a tool and the better you learn to use it, and the more time and effort you invest in your health, the more weight you will lose, surgery or not. The type of surgery you choose will also have an impact on how much weight you lose, e.g. you are would probably lose more weight with a gastric bypass than a band, but the biggest determinant of your weight loss post-surgery is your eating and exercise habits.

5 common myths: 1.Weight-loss surgery is a‘last resort’ Research shows that losing and keeping off over 10% of your weight can significantly reduce your risk of heart attack or stroke. Weight-loss surgery can be a great tool for helping you to improve your health. People who have a BMI over 40, and those who struggle to exercise due to injury or have significant weight-related medical conditions should consider weight-loss surgery sooner rather than later. But it is

3. Everyone will know you’ve had it done Unless you tell people, they don’t have to know. Contrary to some myths, you do not have to eat mashed food for the rest of your life. In fact, you’ll get better results eating more solid foods.

Vomiting occurs after eating too quickly or taking large mouthfuls, so if you learn to eat slowly and cut up your food properly, you shouldn’t vomit at all.

4. It’s too expensive If you are currently spending a lot of money on medications and specialists’ appointments, then you may find that

weight-loss surgery pays for itself quite quickly. Do the maths. However, I always recommend private health insurance because if something does go wrong and you end up in hospital for longer than expected, it can become a very expensive experience without it.

5. It’s ‘cheating’ Many people feel guilty about undertaking weight-loss surgery but choosing it does not make you a ‘failure’; for some it can instead be a smart choice. And it does not make weight loss easy, just easier.

I’ve seen many people who, after surgery, still eat ‘treat’ foods daily.

Obviously if you’re eating chocolate every day, you won’t lose much weight.

To make weight-loss surgery worthwhile, you need to commit to regular education sessions with your bariatric team to learn how to get the best results from your procedure. It’s a good investment to spend six months optimising your eating and exercise habits before having your surgery done. Developing good habits, such as learning to eat slowly, will make the transition post-surgery much easier.

Don’t consider weight-loss surgery if you’re not ready to make significant changes to your lifestyle and diet.

Taking it further If you’re wondering if bariatric surgery is right for you, book a consultation with your local Accredited Practising Dietitian found through www.daa.asn.au.

They will make an initial assessment and consider your goals, medical conditions, medications, physical activity, body composition and lifestyle, and assess whether it is going to be the best option to suit your needs. ♥

MELANIE MCGRICE, AdvAPD, MNutr, is an Accredited Practising Dietitian with a blog at www.melaniemcgrice.com.au Autumn | Winter 2014 • Heathy & Heartwise

25

♥healthy living

Breast changes to look for

Breast cancer Fourteen thousand women and 100 men are diagnosed with breast cancer every year.

However, diagnosis is not perfect and Prof John Boyages warns of some of the traps.

A

s women age, it’s important for them to be aware of changes in their breasts, particularly if their family has a history of breast cancer. If you notice a change that is unusual for you, see your doctor. To conduct a selfexamination, make sure it is several days after a period, as fluctuating hormone levels can cause harmless lumps and thickening in the breast.

A diagnosis of breast cancer involves the triple test of: 1. Medical history and clinical breast examination 2. Imaging tests that may include a mammogram and ultrasound 3. Taking a biopsy using a thin/fine needle or slightly thicker (core biopsy) needle.

Used together, mammography and ultrasound will detect about 95% of breast cancers. An opinion from a breast specialist may be crucial to determine whether further testing such as a biopsy is needed despite normal imaging

findings. A failed triple test means referral to a doctor. The test can fail because: • you have a lump but the mammogram and ultrasound show a ‘benign’ or no abnormal finding. If a lump persists, you need a biopsy to doublecheck that the mammogram result is not a ‘false negative’ • if a mammogram shows worrying calcifications and a biopsy is organised that has a ‘negative’ result, it is worth a breast cancer specialist doing a clinical exam over the abnormal area and correlating your X–rays and the final pathology result • if you have a nipple rash that won’t go away and your X–rays are normal, a breast MRI (magnetic resonance imaging) scan is a good next step but can be expensive • if your doctor says your lump is okay

26 Heathy & Heartwise • Autumn | Winter 2014

• New lump/s or lumpiness, especially if only in one breast and does not go away after your period has finished • Change in the size, shape or contour of your breast.

For example a flattening in your normal curve in one area or the curvature pointing outwards • Change to your nipple such as crusting, itch, an ulcer that doesn’t heal, or if it becomes inverted • Nipple discharge that occurs without squeezing, particularly if it’s from one area • Change in the skin of the breast, such as redness or dimpling, particularly when you raise your arms above your head • Unusual pain that doesn’t resolve Remember most lumps are not breast cancer and several benign conditions may cause symptoms.

The important thing is to see your doctor even if you don’t have a family history of breast cancer. but it’s not going away, don’t leave it too long before you have it checked again or ask to be referred to a dedicated breast assessment clinic.

Should I get screened?

If you are over 50, BreastScreen Australia offers free mammograms every two years that you can access by calling 132 050. About one in 200 screening mammograms will diagnose a cancer. If you have a family history of breast cancer, start at age 40 or 10 years before your closest relative had breast cancer. ♥

Prof John Boyages, MD, PhD, is the Director of the Macquarie University Cancer Institute and author of Breast Cancer: Taking Control. See www.breastcancertakingcontrol.com.au

healthyliving ♥

Heartburn The burning facTs

S

ometimes you can feel it start, behind and just below the sternum – a muscle seems to relax but discomfort follows; a slow burn radiates up the oesophagus until it’s at the back of the throat and, unlike wind or nausea, no amount or coughing, burping or retching seems to stop it. In fact, bending, lying down or straining can make it worse, resulting in a bitter, acidic taste in your mouth and pain across your chest, back and neck.

It’s heartburn or, as it’s more accurately known because as a form of indigestion it has nothing to do with the heart although its symptoms can mirror those of a heart attack, gastrooesophageal reflux. It is very common, with about one in five Australians experiencing it at least once a week and usually managing it with antacid tablets, but about half of those have it more often, when it becomes a disease that needs medical attention.

“Persistent burning or rising pain can be symptoms of a disease called gastric reflux or GORD and only your doctor can diagnose the condition,”says HHW’s GP editor Dr Ginni Mansberg, who urges people not to ignore symptoms at www.heartburn.com.au.

Left untreated, GORD may progress to oesophagitis (destruction of the lining of the oesophagus), other complications and occasionally oespohagaeal cancer.

It’s important therefore to see a doctor if you experience any of the following more than twice a week: • Heartburn • Excessive burping • Regurgitation (when fluid or food returns to the mouth) • Sudden filling of the mouth with saliva • Difficulty swallowing • Sore throat • Persistent dry cough • Chest pain – seek immediate medical attention

Self-help tipS • Avoid known trigger foods (e.g. chocolate, peppermint, coffee, cola, onions, citrus fruit, tomatoes, spicy/fatty food) • Avoid tight-fitting clothes • Avoid large or late meals and remain upright for two hours after meals • Eat smaller meals • Lose weight • Stop smoking • Reduce alcohol consumption • If symptoms are worse at night and disrupt your sleep, try raising the head of your bed • Ask a pharmacist to review your medications

How heartburn happens The sphincter at the end of your oesophagus normally keeps swallowed food down but sometimes spasms open, allowing food and stomach acid to move back up (reflux) the oesophagus,causing damage and pain.

Some medical and lifestyle factors can predispose you to this sphincter dysfunction, such as a hernia, obesity, pregnancy, smoking and alcohol and medications, such as for hypertension, depression or asthma.

Relief for reflux Most people reach for quick-acting antacid tablets and liquids for occasional heartburn,which coat the oesophagus with a protective emulsion or form a barrier that covers the refluxed acid.

There are also lifestyle steps you can take to prevent reflux [see‘Self-help tips’box].

Other classes of medications are available from pharmacies over the counter for people with more troublesome reflux or GORD, which reduce the amount of stomach acid produced for up to a day at a time. Some, however, become less effective the longer they are used, or can cause side effects such as inhibit absorption of other medicines or foods, so ask a pharmacist for advice as to which is most appropriate for you. ♥

n Steven CHong, Ba (comm), is the editor of hhW Autumn | Winter 2014 • Heathy & Heartwise

27

healthyeating

Long live legumes!

They’re undeniably healthy but less than one in four of us eat them even once a week.

Claire Hewat explains how and why we should love our legumes.

L

egumes (also known as pulses) include beans, peas, soy foods — and even peanuts. They can be found dried, canned or frozen.

Popular varieties in Australia include chickpeas, red kidney beans, split peas, cannellini beans and soy beans (found in soy-based products). Legumes are a good source of B vitamins, iron, zinc, fibre and antioxidants. They are also high in fibre and low GI, making them a healthy choice for people with health conditions such as diabetes, heart disease, obesity and constipation.

Source: 2010 Nuttab database

Nature’s all-rounder Australia’s national dietary guidelines recommend eating a variety of foods from the five core food groups every day in order to reduce the risk of disease. Legumes appear in two of these core food groups: 1. Fruit 2. Vegetables and legumes/beans 3. Grain (cereal) foods 4. Lean meat and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans 5. Milk, yoghurt, cheese and/or alternatives.

Legumes are in a league of their own as they fit the bill as a meat alternative and a vegetable. They contain protein

and contain many of the same nutrients as foods of animal origin: meats, poultry, fish and eggs. But being plant-based, legumes are also high in fibre and contain many vitamins, minerals and antioxidants.

Low GI for blood glucose control Legumes are a low-GI source of carbohydrate, making them a great choice for people with diabetes or at high risk of diabetes. The slow digestion and absorption of the carbohydrate in legumes prevents a sharp rise in BGLs after a meal but also helps with satiety — ideal if you’re watching your weight.

While both high- and low-GI foods

What’s in a legume?

Legume

Energy (KJ) Protein (g) per 100 g per 100 g

Fat (g) per 100 g

Fibre (g) per 100 g

Chickpea

449

6.3

2.1

4.7

Haricot bean

447

8.2

0.7

8.8

Butter bean

338

6.4

0.3

5.3

Red kidney bean

426

6.6

0.6

6.5

Lentil

323

6.8

0.4

3.7

Soy beans

597

13.5

7.7

7.2

Peanuts (raw with skin)

2376

24.7

47.1

8.2

Snow peas

151

2.9

0.2

2.6

Green beans

122

2.4

0.2

3.1

28 Heathy & Heartwise • Autumn | Winter 2014

healthyeating ADDING LEGUMES TO YOUR LIFE: • Red kidney beans to burritos • Tofu to a vegetable stir-fry • Lentils to a soup • Baked beans to a cooked breakfast • Chickpeas to an Indian curry • Hummus as a dip • Lentils to rice, cous cous or quinoa • Mixed beans to a salad

can be included in a healthy diet, it’s important to include a low-GI food at each meal to help keep BGLs in check.

Fibre for bowel health Insoluble fibre found in legumes absorbs water and gives stools bulk.

This bulk gives a sense of fullness and helps to keep bowel movements regular. Research shows that most Australians are not getting enough fibre. Many health problems such as diverticular disease, haemorrhoids and constipation could be reduced, or even prevented, through a high-fibre diet.

A diet high in fibre can also help reduce the risk of chronic diseases such diabetes, and cancers such as bowel cancer. Just one cup of cooked legumes can provide more than a third of an adult’s daily fibre needs.

Two points for vegetarians • Vitamin B12 comes from animal foods, although it is present in nuts and legumes in insignificant amounts.

A vegetarian can run the risk of pernicious anaemia from vitamin B12 deficiency, so consult an Accredited Practising Dietitian for individual advice • Non-haem iron in legumes can be better absorbed when eaten with meat, fish or poultry. Including foods with vitamin C (such as broccoli or strawberries) can also help increase the iron absorption.

Tips for tummy troubles One of the top three reasons for Australians avoiding legumes is worry around bloating, wind and flatulence.

But you can reduce any abdominal symptoms with some steps: • When soaking legumes, add salt and change the water once or twice while they soak and rinse before cooking.

• Rinse canned legumes before cooking.

• Increase the fibre (including legumes) in your diet slowly.

Sudden increases in fibre from any food can cause short-term bloating or flatulence.

It can take a short time for your body to adjust to an increase in dietary fibre. If you have irritable bowel syndrome, an Accredited Practising Dietitian (APD) can develop a meal plan that suits your individual needs and take into account any potential food intolerances.

Dried vs. tinned Soaking dried legumes is important for good digestion. If you’re stuck for time, canned legumes are a great choice as they don’t need soaking – just rinse them before use to get rid of the salt water.

Three* steps to cooking dried legumes: 1. Rinse in water 2. Cover with water and soak overnight (6–8 hours) 3. Change the water and gently boil legumes until they are cooked to your liking. ♥ * Split peas and lentils don’t need soaking overnight.

WHERE TO GO FOR MORE HELP • An Accredited Practising Dietitian (APD) can provide tailored expert advice to help you eat well and stay healthy. To find an APD in your area, visit the Dietitians Association of Australia website www.daa.asn.au and look under ‘Find an Accredited Practising Dietitian’. Visit the Smart Eating for You section of the DAA website for some great recipe ideas and more nutrition information.

• Grains and Legumes Nutrition Council: www.glnc.org.au • Eat for Health: www.eatforhealth.gov.au

CLARE HEWAT is the CEO of the Dietitians Association of Australia

Autumn | Winter 2014 • Heathy & Heartwise

29

♥ healthyweight to trim the fat from meat and remove the skin from chicken.

• Lighten up. Swap your full-cream milk for a reduced-fat version for use in hot drinks, such as coffees, hot chocolates and chai lattés.

Mindful munching

Avoiding the

winter belt

You may feel like hibernating but know that you’ll end winter feeling as bulky as a bear. Claire Hewat shows how to avoid winter weight gain.

A

s the cooler weather arrives, it’s tempting to reach for comfort foods and stay rugged up indoors. These changes in lifestyle can make it easy to put on a kilogram (or several) over winter. But by developing some healthy strategies you can avoid winter weight gain.

The smart start to the day It’s tempting to stay in bed on a chilly morning, but people who regularly eat breakfast are better able to maintain their weight compared with those who skip it. To keep hunger at bay, aim for a breakfast that is high in fibre, low GI and packs a protein punch. Some healthy winter warmers include: • Rolled oats cooked with dried fruit and reduced-fat milk • Wholegrain toast with poached eggs and grilled tomatoes • Omelette with tomato, mushrooms and baby spinach on some wholegrain toast.

Kitchen creativity When food is metabolised by the body, it releases heat. It’s normal to crave foods to warm our bodies up but many traditional winter foods, such as pies and puddings, are high in energy and unhealthy fats that can harm our heart and our waistlines.You don’t have to cut out all of comfort foods in winter, just make some smart swaps! For example:

Paying attention to what you eat is important all year round. Listen to internal cues about appetite and satiety (feeling ‘full’) to help prevent overeating. Try these techniques: • Savour each mouthful – appreciating smell, taste and texture • Remove distractions – eat main meals at a table and switch off the TV or move away from your computer • Rate your hunger – before reaching for a second helping, pause and ask yourself if you are that hungry. Register your hunger and satiety on a scale from one to 10.

Keeping active Cold weather and shorter daylight hours can become easy excuses to relax your usual exercise routine, so consider a list of ‘plan B’ options that you can fit into your day. For example, taking a 30-minute walk during your lunchtime break (even if it’s in a shopping mall) or exercising with a fitness DVD at home.

Your expert diet coach See an Accredited Practising Dietitian (APD) who can tailor an eating plan to help motivate and support you to eat better to look and feel healthier. To

Paying attention to what you eat is important all year round.

• Bulk up. Ditch reliance on takeaway foods by cooking in bulk. Freeze dishes in individual portions, ready to be used as a quick go-to meal. Hearty winter meals like soups, casseroles and curries are great for freezing.

• Lean up. Switch to leaner cuts of meat and poultry when cooking casseroles and curries. Remember

30 Heathy & Heartwise • Autumn | Winter 2014

find an APD in your area, visit the DAA website www.daa.asn.au and look under ‘Find an APD’. ♥

■ Claire Hewat, AdvAPD, is CEO of the Dietitians Association of Australia

♥ healthyweight

W

e all know that being physically active, buying fresh ingredients and cooking healthy homemade foods is the best route to long-term weight loss and maintenance. But despite our best efforts, we can’t always prepare our own meals, or sometimes we really do need to lose weight fast. Are there any real healthy alternatives?

The answer is a qualified yes. Very low-energy diets (VLEDs) are a special kind of meal replacement that can be used under certain circumstances for short periods to help you lose weight rapidly. Alternatively, meal replacement programs can provide healthy kilojoulecontrolled prepared meals that will help you to lose weight safely and effectively, but at a slower rate than VLEDs.

Very low-energy diets A VLED can help people lose more weight than regular healthy diets in the short-to-medium term (less than 12 months). This can be useful if you need to lose weight rapidly for surgery, or to help alleviate another acute health problem e.g. severe joint pain. There is little evidence that they are healthy for long-term (1–5 years) weight management, however.

VLEDs are defined as diets providing fewer than 3300 KJ/day. They are designed to produce rapid weight loss while preserving lean body mass (muscles and organs). This is achieved by providing high proportions of protein, typically 70–100 g a day.

not starved Can a high-protein meal replacement program deliver prompt weight loss? Dr Alan Barclay explains how it can.

32 Heathy & Heartwise • Autumn | Winter 2014

healthyweight ♥ The protein is usually from milk (whey), soy or egg-based powders that are mixed with water or skim milk and consumed as a ‘shake’.

Typical VLEDs provide 45–90 g of carbohydrate and 2–20 g of fat each day, and most provide 100% of the recommended daily allowance for most vitamins and minerals. In addition, you need to drink two litres of non-caloric fluids (e.g. water, black tea/coffee, diet soft drinks, etc.) and preferably two cups of non-starchy vegetables (e.g. most vegetables except potatoes, sweet potatoes, yams, pumpkin, sweet corn, peas, carrots, beetroot and parsnip).

VLEDs are generally only recommended for people who have a body mass index (BMI) greater than 30 kg/m2.

If you take diabetes medications/insulin, the dosage may need to be reduced to prevent hypos because VLEDs can be relatively low in carbohydrate. Also, the high-protein content of VLEDs may put a strain on your kidneys, which can be serious if you have kidney/renal disease. It is therefore very important that you discuss using a VLED with your doctor and dietitian before commencing it.

Depending on the formula and where you get it, goodquality VLEDs cost at least $45 per week for one person. Typically a VLED is used exclusively for a three-month period, then progressively less over a few weeks or months until replaced with regular healthy meals.

and 6300 KJ/day, are nutritionally complete (provide enough protein, fat, carbohydrate, vitamins and minerals for the typical adult) and consist of main meals, soups and desserts. Due to their higher kilojoule content, they do not promote as rapid weight loss in the short term as VLEDs (9.7% vs. 16.1% decrease in weight over an average of 12.7 weeks).

However, the evidence suggests that they are as effective as VLEDs in the long term (5% vs. 6.3% decrease in weight over an average of 1.9 years).

As the programs may contain different amounts of carbohydrate and protein to your regular meals, it is also wise to consult your doctor and dietitian before commencing a meal replacement program.

Prices for one person’s weekly supply of food from quality suppliers start from $105.

Many people with diabetes can use VLEDs or meal replacement programs to safely lose weight in the short term.

Meal replacement programs Designed for people who don’t like ‘shakes’ or similar meal replacement formulas, most meal replacement programs provide between 4200

The potential downside

Neither VLEDs nor meal replacement programs teach you how to buy and prepare healthy and appetising meals.

They are designed for individuals – not families – and if you are the main grocery buyer/cook in your household, you will most likely have to continue to prepare meals for your family or housemates while you only consume the shakes or meal replacements. This may not only be inconvenient, but could create tension within the home.

The bottom line Many people with diabetes can use VLEDs or meal replacement programs to safely lose weight in the short term.

If you need to lose weight rapidly for sound medical reasons, discuss with your doctor and dietitian whether either option is suitable for you. ♥

■ ALAN BARCLAY, PhD, Bsc, GradDip, is Chief Scientific Officer of the Glycemic Index Foundation and Head of Research at the Australian Diabetes Council Autumn | Winter 2014 • Heathy & Heartwise

33

asktheexperts

Cardio rehab specialists from Ashford answer patients’ FAQs.

All about angina What is it?

AlistAir Begg, MBBS, FRACP, FCANZ, DDU is a cardiologist and Publisher of HHW.

Angina is chest discomfort or pain, usually from either a narrowing or blockage of the coronary artery supplying blood to the heart muscle.It is rarely due to a spasm of the artery but there may be a blockage in the other arteries around the heart.It is often seen in people with diabetes and may be associated with a slow blood flow into the muscle through the smaller arteries.

What are the symptoms?

Faintness, sweating or a shortness of breath may be the only symptoms or can come with pressurelike, dull or heavy chest pain that radiates into the jaw and down the arm(s), typically the left arm and possibly through to your back.The pain may resemble indigestion or heartburn [see page 27] but more rarely, it is described as sharp or piercing.

Angina typically occurs on exertion but may occur at rest and can be worse after food.

How do I know it’s not a heart attack?

Angina occurs when the heart is deprived of oxygen but unlike in a heart attack, there is no

death of any actual heart muscle. While pain from angina may be prolonged, in a heart attack it may not be. Generally, however, any suspicious chest pain should be investigated by specialists to assess the extent of any narrowings or blockages in coronary circulation.

How is angina treated?

Apart from lifestyle options such as losing weight and pursuing regular exercise, medications include low-dose aspirin or a similar blood-thinning medicine, with a cholesterol-lowering medication called a statin. Sometimes a combination of drugs that lower blood pressure and open arteries is needed. In more severe cases, there may be the need for coronary artery ballooning (angioplasty) and stenting, or even bypass surgery.

What if I have an angina attack?

Stop and rest immediately. If that doesn’t help rapidly, take your angina medicine. If angina is not relieved in five minutes, take another dose. If there is not complete relief within 10 minutes of onset, or is severe or worsens quickly, call an ambulance.

Post-heart surgery recovery

liBBy Birchmore, BN, MNP, MRCNA, is a consultant cardiac nurse practitioner.

WItH Any HeArt problem, but particularly heart surgery, your mortality has almost hit you in the face.

The family tends to wrap you in cotton wool, you’ve experienced pain, sleep deprivation and separation from your family, which make you think,“What is my life going to be like now?” And we need to put those pieces back together in cardiac rehabilitation.

We like to see patients within two-to-four weeks post-surgery depending on the issue.

Some of the research shows that those who get quick follow-up after a cardiac event are less likely to present back at hospital.

34 Heathy & Heartwise • Autumn | Winter 2014

Bronte Ayres, MBBS, FRACP, is a clinical cardiologist.

It Is reAsonAble to expect to be home on day 6 after surgery, although you may be there for 10 days if you have diabetes, respiratory issues, or need blood thinning.

Many patients are itching to get home by day 7 and should have somebody there for them upon discharge. ♥

healthysupplements

Radio’s most knowledgeable pharmacist Gerald Quigley answers common questions about vitamin, mineral and herbal supplements.

Ask

Gerald

Gerald QuiGley BPharm, is a community pharmacist and Master Herbalist and a presenter on radio 3AW, 6PR, 4BC and 2CC

Research has shown that a vitamin B complex, supported by magnesium, can reduce the effects of stress by up to 20 per cent.

Q

i hear the word “stress” all the time. i think i’m stressed but i’m not sure.

How can i tell?

Control meCHanisms in our body are geared toward counteracting the everyday stresses of living. Most often, the stress response is so mild that the body’s work goes entirely unnoticed. However, if stress is extreme, unusual or long-lasting, these control mechanisms can be overwhelmed and stress can have harmful results, such as insomnia, depression, fatigue, headache, upset stomach digestive disturbances and irritability.

There are three stages of stress: the alarm ‘fight or flight’ response is usually short-lived but the following ‘resistance’ stage allows our body to continue fighting a stressor long after the effects of flight or fight have worn off. It initiates the changes required for meeting emotional crises, performing strenuous tasks and fighting infection.

If this resistance stage of stress is prolonged, it raises the risk of chronic diseases such as diabetes,

36 Heathy & Heartwise • Autumn | Winter 2014

hypertension and cancer.The last stage of stress is exhaustion, caused by extensive loss of potassium ions and depletion of adrenal hormones.

Effective stress management needs: 1. mental techniques to calm the mind and promote a positive attitude 2. a healthful diet designed to nourish the body and support physiological processes 3. exercise 4. supplementation to support the whole body but especially the adrenal glands – research has shown that a vitamin B complex, supported by magnesium, can reduce the effects of stress by up to 20 per cent.

A simple pill won’t make the world seem a rosier place but the right stress management techniques can help reinforce your ability to meet the trials and tribulations of living.

healthysupplements

Q

You mentioned the energy-lifting nutrient coenzyme Q10 previously [HHW 52, page 32].There are so many brands and dosages.

How much do I need to give me energy?

As A generAl rule, 150 mg of coenzyme Q10 is a sensible level at which you can gauge its energy-lifting ability. Remember, however, that just popping a pill isn’t the solution to everything. If you are taking a statin medication to help lower cholesterol [see HHW 52, page 41], coenzyme Q10 levels also will be lowered, so replacing the depleted nutrient with a supplement makes sense.

Otherwise, look at the how and why of your low energy. Are you making sensible food choices? Are you eating plenty of protein?

Do you make time for breakfast? Do you have your dinner too late in the evening then have

Q

your sleep disturbed while it is digested?

Coenzyme Q10 is a very important aspect of energy.We make it in our own body but levels do fall as we get older. It’s available in small amounts in offal and oily fish, so a supplement can be helpful.

My nails have become brittle — they chip easily then break off. Yesterday my hairdresser mentioned that I have lots of split ends in my hair. Am I lacking something?

BrITTle nAIls, lack-lustre hair and dry skin are the three most common ways we show the results of stress.Others include mouth ulcers, cold sores and poor wound healing.Generally speaking, these signs show a poor immune response to the everyday challenges and pace of life.

As well as looking generally at your lifestyle, silica is the specific nutrient deficiency that tends to result in your problems. Some soil scientists claim that Australian soils are becoming deficient in many of the minerals, such as silica, that we

need for our enzyme systems to function efficiently for growth and healing.

Silica contributes to the architecture and resilience of connective tissue, and plays a fundamental role in the crosslinking mechanisms in body tissue generally.It is intimately involved in the development, growth and integrity of hair, nails and skin and, as a bonus, in mucous membranes, arteries, bones, cartilage and all connective tissue.

There are many silica supplements available but with all of them remember you won’t get an instant result — nails and hair grow slowly, so be patient!

Q

I have indigestion and reflux, so take medicines to reduce my acid levels.

But I’m confused now because I’ve heard I need acid to help digest my calcium supplements. Is there anything else I might consider?

MAnY AspecTs of our health involve balancing what we need to support nutrition and what we need medically to help uncomfortable problems like indigestion or heartburn.We need acid to digest food but too much in the wrong places can be a problem, and on the other hand we need calcium – as well as vitamin D – for healthy bones.

Why not look at lifting your intake of calciumrich foods? These include dairy and almonds, broccoli, egg yolk, green leafy vegetables, sardines and turnips.

Eating more of these foods means that the calcium supplement becomes a ‘top up’.

You can then take a liquid calcium supplement in a lower dose; it is easier to digest and at night it will also help sleep.

To help with your indigestion and reduce your need for acid-lowering medicine, ensure that you: • eat more slowly and chew each mouthful really well • seek advice on weight management if overweight is a concern — even reducing meal portion size eases the pressure on your digestive system • skip suspect beverages or foods that tend to trigger your symptoms • stick to small meals and eat at least two or three hours before lying down • raise the head of your bed about 10–15 cm • avoid tight clothing and exercises that might increase abdominal pressure, such as sit-ups. ♥

Stick to small meals and eat at least two or three hours before lying down

Autumn | Winter 2014 • Heathy & Heartwise

37

healthyexercise

M

ost falls happen from slips or trips rather than from a ladder or height but they can be just as devastating.

Although we mainly associate falls with older people, they can happen to anyone and may be the only time the importance of balance is appreciated!

Without balance, we’d have trouble standing up or even sitting, let alone walking, jogging or lifting weights.

Loss of balance isn’t usually noticed until we have a fall or just before one, when we might step down from a curb quickly or move out of someone’s way.

We don’t seem to realise we’ve lost strength until we attempt to move, lift or open something we usually find easy but then find it’s beyond us.

Building balance

Falls are the everyday enemy of an ageing population but loss of balance can begin much younger and is preventable. Christine Armarego explains some simple exercises to help train and strengthen our sixth sense.

38 Heathy & Heartwise • Autumn | Winter 2014

healthyexercise The 4 pillars of balance

1. The vestibular system is a small sensory organ in our inner ear that senses where we are in space and relays information to our eyes and the muscles that keep us upright. It tells us if we are leaning to the left or if we upside down. This sense (proprioception) is often what we often need to train.

2.Vision is key because we use visual data to orient ourselves and indicate whether we are standing still and upright. When we close our eyes, we rely on the vestibular system and proprioception to guide us as to whether we are upright.

3. Nerves in the soles of our feet evaluate the ground surface beneath. If the surface is soft or slippery, our brain makes small corrections to our balance to keep us upright. If the nerves are damaged, then they send less information to the brain, increasing our risk of falls.

4. Muscles need to be strong enough to react quickly to avoid a fall. And just as resistance training improves our muscular strength, regular performance of specific exercises will improve our balance muscles and vestibular system.

Standing exercises To work on your static balance, it’s important to have a table or rail nearby in case you lose your balance unexpectedly. Place your feet in the position indicated and hold out your arms. If you can hold that position comfortably for 30 seconds, try closing your eyes. If you feel like you are losing your balance, open your eyes and reach for the table or rail.

BEGINNER – STANDING BALANCE 1. Stand with your feet together and close your eyes.

2. Stand with your feet one in front of the other (like walking a tightrope).

Vision is key because we use visual data to orient ourselves and indicate whether we are standing still and upright.

HEEL–TOE WALKING

INTERMEDIATE – SINGLE-LEG STEP TAP 1. Standing on one leg, tap one foot on the top of a step and then return to the floor.

2. Repeat keeping your weight on your stance leg.

3. If you can do this easily, try it with your eyes closed.

ADVANCED – SINGLE-LEG STANCE 1. Stand on one leg and try to hold the position as long as you can.

2. If you can do this easily, try closing your eyes.

3. Try standing on a soft surface such as a pillow (but with your eyes open at first!). If this is easy, try closing your eyes as well.

Dynamic balance exercises HEEL–TOE WALKING 1. With your arms held out, walk forward with the heel of your foot meeting the toe of the foot already on the ground – as if you are walking on a tightrope.

2. If you can do this well, bring your arms into your body. If that’s easy, try it on a soft surface or with your eyes closed.

SINGLE LEG SQUATS

3. Both at the same time is very advanced.

CROSS-LEG WALKING 1. With your arms held out, walk sideways by crossing your leg in front of the other and placing its foot as close as you can to the other.

2. Cross the next leg to the back, bringing its foot to be as close as possible to the other.

3. Repeat this crossing forward and backward. If you can do this easily, bring your arms in. If this is still easy, try on a soft surface or with your eyes closed. Both is also very advanced so stick to one challenge at a time!

SINGLE LEG SQUATS This is like standing on one leg, but is much more intense so best to be done after you have mastered all the others!

1. Stand on one leg, then bend the knee of that leg until you are in a partial squat, then stand up tall again.

2. Move to a soft surface if this is manageable and then try closing your eyes for a big challenge to your balance! ♥

CHRISTINE ARMAREGO, ESSAM, MAppSci (Ergonomics), MAppSci (Ex Rehab), is an accredited exercise physiologist and manager of The Glucose Club Autumn | Winter 2014 • Heathy & Heartwise

39

healthywomen

When

hormones go wrong

As many as a fifth of women may have PCOS and not even know it. If you don’t know what PCOS stands for and experience facial hair, irregular periods, weight gain and mood swings, read what RHonda GaRad says.

40 Heathy & Heartwise • Autumn | Winter 2014

healthywomen DIAGNOSIS REQUIRES TWO OF THE FOLLOWING THREE CRITERIA: 1. Anovulation (no egg is released during the cycle) and irregular menstruation (no or few periods to frequent and heavy periods) 2. Increased levels of androgens (male-type hormones) on blood testing, which contribute to acne, hirsutism and male-pattern baldness 3. The appearance of cyst-like structures on the ovaries on ultrasound.

an accurate diagnosis of PCOS. However, Australian guidelines for health professionals’ assessment and management of PCOS have been published in 2011 and 2012, which has increased our understanding of the condition and of effective treatment.

Signs, symptoms and diagnosis PCOS is thought to have both a genetic link and to be highly influenced by lifestyle factors such as diet and activity levels. Women with PCOS experience physical and psychological symptoms that vary between individuals, including: • increased body hair on areas such as the face, chest, back and stomach (hirsutism) metabolic complications such as abdominal obesity, insulin resistance or diabetes • increased risk factors for heart disease e.g. high blood pressure • emotional and mental health problems.

How it happens

P

(PCOS) is a common but poorly understood hormonal condition that affects up to one in five women of child-bearing age. Although discovered as far back as the 1930s, PCOS has been underrecognised in the community — up to 70% of women may have the condition without realising.

If not treated, however, PCOS can cause real damage to a woman’s wellbeing and quality of life, both on an everyday and long-term level. It is the leading cause of anovulatory infertility — where no egg is released during the menstrual cycle — and increases the risk of endometrial cancer.

Currently it can take up to 10 years for women to receive

A common feature of women with PCOS is weight gain, with the key cause being decreased insulin sensitivity, or insulin resistance (IR). The main role of the hormone insulin is to keep the blood glucose levels constant (between 4 and 7 mmol/L) by transporting glucose into cells as a form of energy.

However, in the case of IR, the cells do not respond to insulin and therefore the glucose and insulin remain circulating in the bloodstream. Glucose will then be stored as fat, leading to weight gain.

Commonly, IR will manifest as tiredness and increased weight, cholesterol levels and blood glucose levels. IR leads to the development of chronic metabolic conditions such as diabetes, obesity and increases risk for heart disease.

The emotional toll The emotional impact of PCOS is extensive. Women with it have higher rates of depression and anxiety, poor body image, eating disorders, higher rates of suicide attempts and social phobia. The prevalence of depression in women with PCOS is higher (28– 64%) than for women in the general population (7.1–8%). About 34–57% of women with PCOS have anxiety disorders, compared to only 18% of women in the general population.

The reasons for higher prevalence and severity of mood disorders in women with PCOS are complex, with hormonal, metabolic and reproductive features likely to contribute.

The long-term, complex and often frustrating nature of PCOS may further significantly contribute to the mental health burden. Assessment for emotional wellbeing in women with PCOS is vital because recognition and treatment improves quality of life.

Treatment Management of PCOS needs to be highly individualised but research indicates that the most effective treatment is focused on lifestyle change. Increased physical activity levels (150 minutes each week of moderate to intensive), caloriecontrolled diet, education and emotional support are the main therapeutic interventions.

Women with PCOS who work with a multidisciplinary health team that may include a GP, endocrinologist, dietitian, exercise physiologist and counsellors/ psychologists also seem to have better longer-term health improvements.

Other treatments include use of the oral contraceptive pill, metformin and anti-androgenic medications.

Specialist PCOS clinics that provide intensive education and provide access to a multidisciplinary heath team are important to ensure that women with PCOS receive the best possible care. ♥

RHONDA GARAD RN is a nurse educator with Jean Hailes

Autumn | Winter 2014 • Heathy & Heartwise

41

♥ healthy living

Health on the

Shelf Our choice of the best health buys

Optislim’s meal replacement range Over 19 years, Optislim has become an Australian-made market leader of very lowcalorie diet (VLCD) programs. Optislim offers individual flexibility with an unrivalled range of products designed to help you lose weight, improve your health and regain your life –from a 48-hour Detox program to kickstart your diet, re-energise and boost your metabolism through to nutritionally balanced and satisfying VLCD total meal replacements in shakes, soups and bars for weight loss.

There’s also formulated LCD (low-calorie diet) meal replacements in shakes and soups made with natural colours and flavours, great-tasting 100-calorie snacks and low-fat, low-calorie Healthy Option three-minute ready meals.

Visit www.optislim.com.au, call 1800 882 408 toll-free, or speak to your healthcare professional and get on top of weight loss faster.

FAB IRON tablets and capsules Are you getting enough iron in your diet?

FAB IRON® is an easy-to-absorb iron formulation with essential energy-boosting B-group vitamins ... to iron out that tired feeling.

FAB IRON® contains an organic chelated form of iron that is gentle on the stomach and digestive system.

Available from pharmacies nationally.

RRP $18.95 for 60 tablets and 60 capsules, $12.95 for 30 tablets. www.fabiron.com.au

FABFOL – the pregnancy multivitamin FABFOL® provides daily nutritional support before, during and after pregnancy.

Specially formulated with the essential nutrients of folic acid, iodine, iron and energy-boosting B-group vitamins to help give your baby a good start in life and assist you maintain energy and vitality.

Available from pharmacies nationally.

RRP: $24.95 for 56 tablets. www.fabfol.com.au CHC52394-05/12 Vitamin should not replace a balanced diet.

CHC52385-05/12 Vitamins should not replace a balanced diet.

Blooms high-potency magnesium formula

MoliCare Mobile

Great-tasting, easily absorbed Blooms Magnesium Complex Powder contains 400 mg elemental magnesium with important cofactors to help relieve muscular cramps and spasms.

MoliCare Mobile is pH-balanced and tested dermatologically, making it the ultimate skin-friendly continence product that looks and feels like normal underwear. The unique DryPlus nonwoven layer locks liquid away rapidly and super-absorbent materials in the core guarantee fast fluid absorption. Soft, water-repellent inner cuffs offer additional leakage protection around the legs, giving the wearer optimal comfort and confidence.

Suitable for moderate to severe incontinence and available in pharmacies nationally.

42 Heathy & Heartwise • Autumn | Winter 2014

www.bloomshealth.com.au 1800 181 323 CHC53096-11/13 Always read the label, use only as directed.

If symptoms persist, see your healthcare professional.

Deliciously Australian!

Get back your Aussie spark with Blooms Organic Iron Plus, the great-tasting Australian-made liquid iron formula with iron, B vitamins, folic acid, vitamin C and herbal extracts to support energy metabolism.

Available in 300 and 500 ml. www.bloomshealth.com.au 1800 181 323 CHC52622-11/12 Always read the label, use only as directed.

mediareviews

well read & watched

ow been produced to try on a successful model addresses multiple issues diac conditions, risk factors, process. d chapters it can be viewed ed to each individual, and rdiac rehabilitation and

COMMON QUESTIONS, lesser-known facts and quick lists punctuate this follow-up volume to Dr Begg’s debut text What’s Wrong With My Heart?, which gives guidance on everyday lifestyle and dietary management of heart disease.

Structured around major risk factors with additional chapters on nutrition and exercise, it features a sample meal plan and food labels.

ASHFORD AND SA HEART, $59.98 LOOKING FOR A FITNESS

The DVD has been extensively reviewed and includes input from leading cardiologists, a cardiac surgeon, physiotherapist, cardiac nursing specialists, dietitian, and pharmacist.

The DVD comes as a 2 disc set. The first disc has a mix of patient vignettes and expert commentary on various cardiac conditions, risk factors, device and surgical therapies, heart failure, heart rhythm disturbances, and coping strategies.

lowering therapies.

This resource will be broadly available and will help to fill a gap in the traditional model of delivery of cardiac care. It will also assist to reinforce the important existing services and health care systems.

s as a 2 disc set. The first disc has a ignettes and expert commentary on www.whatswrongwithmyheart.com conditions, risk factors, device and ne cardiac rehabilitation resource at //heartrehab.litmos.com/online-courses pies, heart failure, heart rhythm nd coping strategies.

indepth interviews with a dietitian ,with extensive detail on the major particular warfarin and cholesterol ies.

ill be broadly available and will help he traditional model of delivery of t will also assist to reinforce the ng services and health care systems.

ithmyheart.com

ce at

EBOOK BY VIVID PUBLISHING, 2014, US$9.99

www.whatswrongwithmyheart.com

en extensively reviewed and includes ing cardiologists, a cardiac surgeon, The second has indepth interviews with a dietitian and pharmacist,with extensive detail on the major cardiac nursing specialists, dietitian, cardiac drugs in particular warfarin and cholesterol

tals in Australia to perform hford Hospital has a long tions. The team at Ashford ve patient education DVD.

By Dr Alistair Begg

What’s Wrong With My Heart?

UR RISK

mes have been shown to diac events but are only hose individuals at risk. his including access, cost, s, and recognition of the tions of the community.

What Should I Eat for My Heart?

nline-courses

ROUTINE

TWO DVDS educate about prevention, DESIGNED FOR HEART PATIENTS? nutrition,WANT medication and what’ s involved TO KNOW HOW TO EXERCISE SAFELY A CARDIAC EVENT OR HEART PROBLEM? in treatmentAFTER of heart disease. Adelaidebased NOT cardiologists, SURE HOWrehab HARDcoordinators, TO EXERCISE AFTER A CARDIAC EVENT? a cardiac surgeon, nurse practitioner, NOT A GYM PERSON BUT pharmacist and dietitian give expert, NEED SOME PROFESSIONAL HELP WITH EXERCISE? specialist but also everyday insights into WANT TO KNOW WHAT TYPES OF EXERCISE ARE SUITABLE IF YOUmanagement HAVE A HEART PROBLEM? lifestyle and medical from their experience in a busy clinic.

NOW THERE IS AN EXERCISE DVD PROGRAMME THAT YOU CAN USE IN THE PRIVACY AND

Low GI DietCOMFORT Shopper’s OF YOUR OWN HOME...

Guide 2014 60minBrand-Miller, DVD includes: Kaye FosterBy ProfThis Jennie WARM UP PROCEDURE Powell, Fiona Atkinson SAFE EXERCISE LEVELS -WHAT IS SAFE

By Tanya Curran Brown LOVE & WRITE PUBLISHING, RRP $24.99

WHEN A 45-YEAR-OLD NSW hairdresser and mother is diagnosed with aggressive breast cancer, she meets it head-on with wit, honesty and a resolve to get through for her 10-year-old daughter. With flashbacks to key life memories, a glossary and photos, high-grade mammary gland carcinoma and a double mastectomy have never been so funny, nor as human.

Exercise DVD

BENEFITS - WHY EXERCISE,WHAT ARE THE BENEFITS

www.whatswrongwithmyheart.com

HACHETTE AUSTRALIA, RRP $14.95 WHAT ARE SAFE STRETCHES

ASHFORD AND SA HEART $29.99

WHAT TYPES OF EXERCISE ARE SAFE FOR HEART PATIENTS HOW HARD SHOULD I EXERCISE?

A Tale of Two Titties

THE LONG-RUNNING bestselling bible for people concerned about carbs’ Glycemic Index (GI) now features over 1000 foods and readymade meals available on the Australian market, shopping and cooking tips, glutenfree eating, facts about sweeteners and how to eat out and keepTO lowPURCHASE GI. The authors fromDVD GO TO: THIS www.whatswrongwithmyheart.com Sydney University’s GI Foundation are global This programme can also be accessed via the membership site http://heartrehab.litmos.com/online-courses authorities in the field.

HOW MUCH SHOULD I EXERCISE?

ALTERNATIVE FORMS OF EXERCISE AND SPECIFIC BENEFITS CORRECT EXERCISE TECHNIQUE

CAN BE DONE AT HOME WITH MINIMAL EQUIPMENT SUCH AS A CHAIR WITH ARMS

HOW TO EXERCISE WITH OTHER MEDICAL COMPLAINTS SUCH AS ARTHRITIS HOW TO MEASURE THE HEART RATE AND WHAT HEART RATE IS BEST FOR EXERCISE IN HEART DISEASE

HOW TO PROMOTE STRENGTH AND CONDITIONING AFTER A CARDIAC EVENT WHAT ARE THE WARNING SIGNS WHEN EXERCISING CORRECT COOL DOWN PROCEDURE

The Anger Fallacy

By Steven Laurent and Ross G Menzies AUSTRALIAN ACADEMIC PRESS, RRP $24.95

DUSTIN WILLISS, exercise physiologist and Cardiac Rehab Coordinator for SA Heart in Ashford, Adelaide, gives an hour-long demonstration with a model on safe and easy-to-learn exercises and physical activities suitable post-cardiac surgery. This is an excellent resource to help your body recover within the space of a living room and without specialised equipment.

The Baker IDI Blood Pressure Diet & Lifestyle Plan PENGUIN GROUP, RRP $35

IT’S THE TRAFFIC, it’s work, it’s your partner, kids, government, parents, life – it’s anger.

Ever-present and infinitely flexible, anger fits into any situation and manifests in manifold ways in everyday life, from road rage to teen and domestic violence. Anger is almost validated by coaches, lawyers, politicians, shock jocks and celebrity chefs who channel it for results, but the authors contend that its destructive hold can be overcome.

MELBOURNE’S BAKER IDI Heart and Diabetes Institute lends its imprimatur to this volume coauthored by Professor Peter Clifton of the bestselling CSIRO Total Wellbeing Diet, whose format it follows. Chapters about the ‘silent killer’, weekly kilojoule-controlled menu plans and recipes covering vegetarian, budget dinners and posh nosh make a comprehensive must-have for the hypertensive.

Autumn | Winter 2014 • Heathy & Heartwise

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recipeguide

healthy &HEARTWISE

REcIpES explained...

Heartwise recipes now come to you from eminent and renowned chefs with an interest in health, and feature the seasonal produce and cooking methods they recommend.

Heartwise recipes have been analysed for their energy (kilojoules) and nutrient levels, which are then rated against the 2006 Nutritional Reference Values for Australian and New Zealand Suggested Dietary Targets to reduce chronic disease risk.

The Targets suggest that to prevent heart disease, obesity and diabetes, the daily intake of energy of 8700 KJ should comprise: • 15–25% from protein

Analysed for nutritional content by Accredited Practising Dietitian MIlEnA KAtz, you can learn about the latest novel or rediscovered dishes, handy techniques and wholesome ingredients you might have heard about, seen on TV or tried at a restaurant – but never thought you could cook.

• 20–35% from fat: ≤10% from saturated (and trans) fats 4–10% from omega–6 fats 0.4–1% from omega–3 plant ALA fats • 40–65% from carbohydrate – primarily low-GI Sodium : 1600 mg – for the general population the limit is 2300 mg; but 4700 mg potassium (from fruit and vegetables) can blunt the effect of sodium on blood pressure Fibre: 38 g men, 28 g women Omega–3 610 mg men (marine EPA, DHA fats) 430 mg women

Heartwise rEcIPE rAtInGS Nutrient

Recipe

Star rating

Sodium

Main meal

≤450 mg

Snack, dessert or side dish

≤150 mg

Baked goods*

≤250 mg

Main meal

≤18 g OR ≤25 g if saturated fat ≤ 6 g

Snack, dessert or side dish

≤7 g OR ≤10 g if saturated fat ≤2 g

Main meal

≤6 g

Snack, dessert or side dish

≤2 g

Main meal

≥5 g

Snack, dessert or side dish

≥2 g

Fat Saturated fat Fibre

carbohydrate Main meal

≤60 g

Snack, dessert or side dish ≤30 g * A higher sodium level has been applied to baked goods such as cakes and muffins because of the use of self-raising flour

Dietitian Milena Katz has added tips highlighted in gold to the recipes to make healthier meals according to the 2013 Australian Dietary Guidelines. If a recipe’s carbohydrate, fat, saturated fat, fibre or sodium level fits the ranges in the table below based on the Targets, it is bolded in gold. If all these nutrient levels meet the following ranges, it is a

★ gold STAR ReCiPe IF yOu HAvE HEArt DISEASE The Heart Foundation’s 2012 Expert guide to clinical practice for secondary prevention of heart disease includes daily nutrition goals to prevent another heart event for people who have had a cardiovascular event: • <7% of energy from saturated fat, with <1% from trans fats • 1 g omega–3 marine EPA + DHA fats • >2 g omega–3 plant AlA fats • 1550 mg sodium • 25–30 g fibre • two standard alcoholic drinks, or one for women with hypertension or taking blood pressure medication.

IF yOu HAvE DIAbEtES Diabetes Australia’s 2012/13 Diabetes Management in General Practice guidelines advise that daily energy intake consist of: • ≤50% from carbohydrates, primarily low-GI • ≤30% from fat, preferably unsaturated omega–3, 6 and 9 fats; lean meat; low-fat dairy and light margarines with sterols • 10–20% from protein • low-salt and ‘no added salt’ products • ≤2 standard alcoholic drinks • sugar in moderation and sweeteners except sugar alcohols (e.g. sorbitol) are acceptable. ♥

Autumn | Winter 2014 • Heathy & Heartwise

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chef’schat

Holmes-some health & beauty The emphasis in Lee Holmes’ cooking philosophy is on fresh local, seasonal whole foods as both preventive medicine and beauty therapy. She talks with Heartwise about supercharging our diets.

HHW: A diagnosis of fibromyalgia in 2006 led you to explore diet and nutrition. It is a chronic, painful disease that medicine still struggles to define and treat but what did it mean for you?

It meant a period of six months where I literally couldn’t get out of bed. I was experiencing widespread muscular and soft-tissue pain and had chronic fatigue but I couldn’t understand what was happening. I was used to being really active and not being able to operate as normal frightened me, especially when it came to caring for my daughter and holding down a full-time job. It also had a long-term impact on my lifestyle, which now I see as a positive that took me on an adventure including the scenic route as opposed to the narrow road I had been travelling.

HHW:The Institute of Integrative Nutrition (IIN) in New York seems central to the ideas and philosophy behind Eat Yourself Beautiful. Is such training is available in Australia?

I enjoyed studying to be a holistic health coach at the IIN — I felt I had found a school whose students and lecturers were likeminded, especially when it came to using food as medicine. It’s an integrative and holistic approach to health so it’s not just about eating a lowcalorie, low-fat, artificially sugar-laden diet and laws of the universe, such as energy in equals energy out. From my experience, I don’t believe that nutrition is black and white – there are many shades of grey and everyone is different so what works for me may not work for others. It is an online course so you can study it from anywhere but there are also opportunities in Australia at local colleges where nutrition is taught.

HHW: You argue that ‘fat free’ and ‘low fat’ are not necessarily health claims but signs of higher sugar content, and that the saturated fats in coconut oil and butter are actually healthy. Dietitians contradict this so do you agree with the recent Catalyst documentary that mainstream healthy eating advice is wrong?

I originally ate a low-fat diet but because I was experiencing ill health I wanted to experiment with a new way of eating, so

46 Heathy & Heartwise • Autumn | Winter 2014

chef’schat

I swapped to a diet that included good fats and was high in anti-inflammatory foods. I noticed that my symptoms were retreating – my hair started to grow back, my skin was looking clearer and my muscle aches had gone.

Fats in coconut oil are good for balancing out good and bad cholesterol levels and I believe that sugar, as an inflammatory agent in the body, is one of the leading factors of long-term conditions, particularly autoimmune diseases and those affected by the health of the gut and its microbes.

HHW: While we know about the effect of sugar consumption on insulin levels, you also mention leptin, an appetite hormone. How does sugar interact with leptin and why is fructose bad – it occurs naturally in fruit so should we avoid fruit?

A key driver of longevity is normalising levels of insulin and leptin. Consuming sugar decreases receptor sensitivity of these hormones and can lead to premature ageing and chronic diseases such as heart disease and diabetes.

That’s why cutting down on table sugar (sucrose); fructose; low-quality carbohydrates in pies, biscuits and sweets; and complex carbohydrates such as bread and pasta, which convert to glucose in your body, is beneficial.

I don’t think it’s good to completely cut out a food group unless it is for medical reasons, e.g. gluten if you have coeliac disease. I follow the 80/20 rule: eat well 80% of the time and indulge the other 20% otherwise life is too boring and rigid and you don’t want to enter eating disorder territory.

Regarding fruit, I like berries because they are a wonderful source of vitamins and anti-oxidants but I wouldn’t juice a lot of other fruits because it is a big sudden hit of fructose. For people with digestive and fructose malabsorption issues, fruit can cause digestive distress.

If you consume too much fructose, fat accumulates in your liver and muscle, leading to insulin resistance. The metabolism of fructose by your liver creates waste products and toxins, including substantial uric acid, which switches on your fat lever, resulting in weight gain. Too much sugar can also feed the bad bacteria in your gut.

HHW: Garlic is in your top 10 of supercharged foods and appears in many recipes. What about the breath and repeating issues?

I generally eat a bit of parsley after eating garlic. Foods that contain polyphenols, such as apples, spinach and green tea, can also help neutralise garlic breath, as can mint, anise seeds, cardamom, cloves and fennel.I wouldn’t recommend eating mints or chewing gum — it’s better to have bad breath than all those artificial sugars circulating around your body!

Water can help with it repeating on you.

HHW: Why is flaxseed important?

Flaxseeds are an abundant natural source of alpha-linolenic acid, a primary omega–3 fatty acid vital to decrease inflammation. Flaxseeds contain insoluble dietary fibre, help promote more regular bowel movements and remove wastes from the body. It is best to opt for flaxseed oil or add ground flaxseed for digestibility.

HHW:Tell us about your campaign to improve hospital food.

I believe fresh and nutritious hospital food is vital to improving patient health, particularly after medical procedures.

Research by the UK Soil Association shows that improving hospital food is achievable, and a recent UK review by Deloitte found that local and seasonal food did not generally cost more but could cost less. As a result of my petition, an improved menu is being trialled in selected NSW hospitals so I am very happy about that. ♥

I don’t believe that nutrition is black and white – there are many shades of grey and everyone is different

Recipe and images from Supercharged Food: Eat Yourself Beautiful by Lee Holmes, Murdoch Books, RRP $35, photographer Alan Benson

Lee’s cleansing turmeric & ginger tea SERVES: 1 PREPARATION TIME: 5 MINUTES 250 ml almond or rice milk 2 tsp ground turmeric 1 tsp freshly grated ginger Stevia liquid, to taste 1. Add the almond milk to a small saucepan and heat gently.

2. Add the turmeric and ginger to a mug. Pour a small amount of warm milk into the mug and stir to create a liquid paste, ensuring there are no lumps. Add the remaining milk and sweeten with a few drops of stevia.

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chef’schat HHW: You grew up in Greece – which part and did it influence your later culinary career?

I grew up in Kavala, a city in northern Greece, in the 50s and 60s when the diet was fairly traditional and healthy – not because we wanted it that way but because of circumstance. We ate a lot of local veges, fish and olive oil because meat and butter was too expensive for more than a once or twice a week.

I had trained and worked as an electrician by the time I settled in Melbourne in 1970 as a 23-year-old.

I met my partner David, who was an interior designer but had an instinctive interest in food and diets. I’d cook for him daily and made me conscious about balancing a meal, with say a salad or dessert, and fruit in the morning.

HHW: Initially you trained with Stephanie Alexander – how did the opportunity come about and what were the best lessons learnt?

I had read cookbooks by Margaret Fulton, Elizabeth David and Julia Child by the time I went to train with Stephanie Alexander, through a friend who worked there. She took on a 30-year-old electrician as a second chef and from her I learnt about balance, which not many chefs know. However, she also had the foresight to be adventurous and take risks with food.

HHW: You were part of Australia’s food revolution at the legendary Berowra Waters Inn, then Sydney Opera House before opening MG Garage in 1997. It was quite radical at the time – what gave you the idea to eat among cars?

After about five years at Stephanie’s Restaurant, I moved to Sydney as head chef with Gay Bilson at Berowra Waters Inn. For the next 12 years, David and I lived here in Potts Point Monday to Thursday and weekends I would spend in Berowra. When Gay sold the restaurant in 1995, I went to the Bennelong Restaurant at the Opera House as head chef for two years.

I was 50 when I started MG Garage with Trivett Classic in 1997, so maybe it was my midlife crisis that made me

I jumped at the idea of a book because I realised you don’t have to have a boring diet with diabetes

Janni Kyritsis: as it is!

The food icon behind Australia’s gastronomic revolution has more than one Chef’s Hat for every year he’s lived here, type 2 diabetes and a cookbook full of new ideas to manage the condition with a who’s who of contemporary chefs. Janni Kyritsis talks to Heartwise.

48 Heathy & Heartwise • Autumn | Winter 2014

Janni with fellow Sydney food legend Lucio Galletto OAM

chef’schat open my own restaurant full of sports cars! Before then, I had no real interest in vehicles but got inspired from our dining experiences around the world, such as Paris. I retired early, in 2002, and it was the best thing I ever did – to leave while at the top with a three-Hat restaurant, making a total of 50 Hats across my career.

HHW: Your diagnosis of type 2 diabetes in 2009 you call a shock and a wake-up call.Were there any warning signs?

I was 63 and there were no real symptoms that I was aware of. I was at Stephanie Alexander’s Christmas party and started drinking a lot of water because I felt so thirsty. I collapsed the next morning and went to St Vincent’s Hospital where they confirmed that I didn’t have a heart attack but had diabetes! They warned me that I’d be on insulin injections within a year unless I lost some weight.

HHW: How did you adapt to life with diabetes?

I had some knowledge about nutrition so cut out desserts and rich sauces, included a slice of bread as an absolute minimum with meals, and a reasonable amount of protein. Importantly, I phased out picking at food and made sure I ate three regular meals and no snacks.

I didn’t have too many problems changing my diet – just got on to more protein, such as fish or sashimi – but am glad it happened after I retired because it would have been harder to stop the picking habit while cooking!

I started exercising and within a year I lost 20 kilos and went from six tablets to one to control my BGLs, which I monitored every day until they stabilised. Walking is amazing and I can notice how my BGLs go down quickly when I walk regularly – now I feel better than ever and can walk 15 km – say from Manly to the Spit, or home to Circular Quay, and back.

HHW: What gave you the idea for your cookbook At My Table for people with diabetes?

Eileen Anastas, the fundraising coordinator at St Vincent’s Diabetes Centre, had the idea. I jumped at it

Recipe and cover from At My Table, published by Allen & Unwin (Sydney, 2013); images courtesy of Janni Kyritsis

Janni’s dark chocolate mousse with orange SErVES: 6 PrEPArATIon TIME: 10 minutes CookInG TIME: 15 minutes + 2 hours chilling 125 g dark chocolate (70% cocoa solids), in pieces Zest of 1 orange, finely grated 2 tbsp orange juice 4 extra-large eggs, separated 1. Combine chocolate with orange zest and juice in a heatproof bowl. Place bowl on top of saucepan of simmering water and turn off heat. Let chocolate melt about 10 minutes.

2. Whisk egg whites to very soft peaks. In a separate bowl, whisk egg yolks briefly and fold into chocolate and orange mixture.

Fold egg whites into mixture and stop folding as soon as egg white is incorporated.

3. Place in six glasses or cups and refrigerate a couple of hours until cold.

Crossing Sydney Harbour Bridge as part of a marathon

because I realised you don’t have to have a boring diet with diabetes.

Amanda Bilson, who had type 1 diabetes since her teens and also went to the Centre, joined as editor because we wanted to give ordinary people with diabetes a chance not to feel deprived of nice recipes. So we rounded up the chefs we knew, such as Stephanie Alexander, Sean and Matt Moran, kylie kwong, Luke Mangan and Maggie Beer, to provide recipes and had them analysed nutritionally by a dietitian.

I contributed more to desserts as I knew lots about reducing sugar and using sweeteners that the dietitians told me were okay.I wanted easy desserts for household cooks, so sourced accessible and affordable ingredients from supermarkets and grocers.

HHW: What does the future hold?

I do charity work and teach cooking to friends but don’t do much consulting to other chefs because I prefer to be hands on. But I will never stop cooking! ♥

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recipesbreakfast Rainy day hot milk & barley porridge Michael Moore From Blood Sugar The Family, New Holland Publishing P/L, 2013

COOKING TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1150 KJ – 13.2% DAILY INTAKE, FAT 11.4 g, SATURATED FAT 2.8 g, CARBOHYDRATE 31.5 g, PROTEIN 10.6 g, FIBRE 5.5 g, SODIUM 319 mg Excellent for slow release of energy and high in protein 475 ml milk (2% fat) 2 tbsp agave nectar 1 cinnamon quill 1 vanilla bean or tsp vanilla essence 1 tbsp sultanas 80 g rolled barley flakes 2 tbsp sunflower seeds 2 tbsp pumpkin seeds 2 tbsp flaked almonds Pinch ground nutmeg 1. In a medium-sized saucepan, heat 350 ml of milk with agave nectar, cinnamon quill and the split vanilla bean or essence. Stir in sultanas and barley flakes and cook over low heat for 10 minutes, stirring until thick and barley is soft.

Quinoa brekkie

2. Meanwhile, in a preheated, non-stick frying pan, cook together sunflower, pumpkin seeds and flaked almonds until toasted light brown. Allow to cool then add to the porridge.

NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1650 KJ –18.9% DAILY INTAKE, FAT 7.2 g, SATURATED FAT 1.4 g, CARBOHYDRATE 72 g, PROTEIN 12 g, FIBRE 6.3 g, SODIUM 117 mg

3. Bring the remaining milk to the boil, whisking to maximise froth. Spoon porridge into serving bowls, then top with froth and dust with nutmeg.

Anna Gare PREPARATION TIME: 5 MINUTES COOKING TIME: 25 MINUTES

Recipe and image from eat in!, Murdoch Books, RRP $39.99

★ GOLD STAR RECIPE Quinoa is a great gluten -free option for breakfast, and to reduce the carbohydrates in this recipe you can skip the honey and sultanas!

200 g (1 cup) white quinoa 500 ml (2 cups) water 85 g (½ cup) sultanas Pinch of ground cinnamon 200 g (¾ cup) plain yoghurt, plus extra to serve

2 apples, grated 1 heaped tbsp honey, plus extra for drizzling Fresh berries, to serve (optional) 2 tbsp pistachio nut kernels, to serve (optional)

1. Wash and strain quinoa before use, then put in a medium saucepan with water. Bring to the boil over medium–high heat.

2. Reduce heat to low and simmer uncovered for 10 minutes, then add sultanas and cinnamon, cover and simmer for 5 minutes.Turn off heat and allow to cool.

3. Fold yoghurt, apple and honey through the cooled quinoa.

4. Serve in bowls, topped with an extra dollop of yoghurt, the berries and pistachios (if using). Drizzle with extra honey.

breakfastrecipes Baked chilli eggs with chickpeas, spinach & shaved ham Michael Moore PREPARATION AND COOKING TIME: 40 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1515 KJ – 17.4% DAILY INTAKE, FAT 26 g, SATURATED FAT 4 g, CARBOHYDRATE 22 g, PROTEIN 26 g, FIBRE 7 g, SODIUM 1050 mg Leave out the salt to make a low-sodium version. The chickpeas make the breakfast high in fibre!

From Blood Sugar The Family, New Holland Publishing P/L, 2013

2 tbsp olive oil 1 medium onion, finely diced 1 clove garlic Pinch smoked paprika ½ tsp dried chilli flakes 4 ripe tomatoes, chopped 300 g can organic chickpeas Sea salt and pepper 2 cups fresh spinach leaves 8 large eggs 175 g finely shaved smoked ham Grainy bread, toasted, optional to serve 1. Preheat oven to 180°C. In a medium-sized non-stick frying pan, heat 1 tbsp olive oil and fry together the onion and garlic until light brown.

2. Add a pinch of paprika, chilli flakes and the chopped tomatoes. Cook on a low heat for 15 minutes until a rich sauce has formed.

3. Add the chickpeas and cook a further 20 minutes.

Season with sea salt and fresh pepper, and add more chilli to taste.

4. In 4 small ovenproof dishes or ramekins, divide the spinach leaves and spoon over the hot tomato chickpea mix. Using the back of a serving spoon, make a well on the top. Crack two eggs into each well. If you like your eggs really spicy, sprinkle some chilli flakes or fresh chilli on the eggs.

5. Drizzle the top with a few drops of olive oil and bake for about 12 minutes until the eggs are cooked to your liking. Place shaved ham on the top and serve with some hot grainy bread, toasted.

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recipessnacks&soups Sardines with avocado Lee Holmes PREPARATION TIME: 5 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 1) ENERGY 1900 KJ – 21.8% DAILY INTAKE, FAT 17.2 g, SATURATED FAT 4.9 g, CARBOHYDRATE 20.8 g PROTEIN 26 g, FIBRE 4.4 g, SODIUM 822 mg Sardines are high in calcium when you eat the bones. This recipe is packed full of healthy fats Recipe and images from Supercharged Food: Eat Yourself Beautiful by Lee Holmes, Murdoch Books, RRP $35, photographer Alan Benson

½ avocado, peeled and stone removed 1 tbsp lime juice, freshly squeezed 1 tsp chopped red chilli (optional) Pinch of Celtic sea salt Freshly ground black pepper 1–2 slices gluten-free bread 1 small handful of rocket leaves 120 g tin sardines, smashed Extra-virgin olive oil, for drizzling

Spinach soup Janelle Bloom COOKING AND PREPARATION TIME: 45 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1608 KJ – 30% DAILY INTAKE, FAT 21.7 g, SATURATED FAT 9.5 g, CARBOHYDRATE 38.3 g, PROTEIN 8.7 g, FIBRE 2.7 g, SODIUM 1819 mg Use salt-reduced stock to lower the sodium content, which is more than the daily NRV. A great starter for BBQ meat like grilled chicken

From My Favourite Food for All Seasons, Ebury Press, 2011

2. Toast one or two slices of your favourite gluten-free bread.

2 tbsp olive oil 2 brown onions, halved, thinly sliced 1 garlic clove, crushed ¼ (about 250 g) cauliflower, trimmed, chopped 4–5 cups chicken or vegetable stock 30 g butter

3. Spread the avocado mixture over the toast and top with the rocket and smashed sardines.

1. Heat the olive oil in a large saucepan over a medium-low heat. Add onions and garlic and cook slowly, stirring occasionally for 10 minutes or until soft (but not coloured).

Add the cauliflower and cook a further 5 minutes or until it starts to soften.

4. Drizzle with olive oil and serve with the lime wedges on the side.

2. Pour in 4 cups of stock, increase heat to medium and simmer gently, uncovered, for about 10 minutes or until the cauliflower is tender.

1. Place avocado, lime juice, chilli (if using), salt and pepper in a bowl and mash together with a fork.

2 bunches English spinach leaves, washed, shredded ¼ tsp freshly grated nutmeg 1 lemon, rind finely grated, juiced 4 tbsp thickened cream, optional Toasted sourdough, to serve

3. Meanwhile, melt the butter in a deep large frying pan over medium heat.

Add spinach and sauté for 2–3 minutes or until it just starts to wilt. Add the nutmeg and lemon rind and toss to combine. Add sautéed spinach to the cauliflower mixture, remove from heat and allow to cool a little before blending.

4. Blend or purée soup in batches until smooth. Return to the saucepan. Add 2 tbsp lemon juice and season to taste with salt and freshly ground black pepper.

Bring soup back to a simmer, adding more stock to reach desired consistency.

Swirl through cream if using and serve with toasted sourdough.

5. Alternatively replace cauliflower with 3 medium sebago potatoes, peeled and chopped, or a 400 g can drained and rinsed cannellini beans.

52

snacks&soupsrecipes Vegetable minestrone with ricotta pesto Kevin Donovan MAKES 2 LITRES COOKING TIME: 60 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 8) ENERGY 960 KJ –11% DAILY INTAKE , FAT 10.3 g, SATURATED FAT 1.8 g, CARBOHYDRATE 30.2 g, PROTEIN 5.3 g, FIBRE 3.8 g, SODIUM 1381 mg A great vegetarian option that is low in saturated fat. It has almost the daily limit of sodium, however, so use reduced-salt stock and don't add the sea salt if you have high blood pressure

1–2 tbsp olive oil 3 onions, finely diced 2 celery stalks, finely diced 1 handful flat-leaf (Italian) parsley leaves 6 cups (1.5 L) vegetable stock 2 potatoes, cut into 1 cm cubes 8 roma tomatoes, peeled, deseeded and diced ½–1 zucchini, cut into 1 cm cubes 1 /3 cup (50 g) fresh peas 50 g green beans, cut into 2 cm lengths 50 g tinned borlotti beans, drained

4 silverbeet leaves, chopped and stalks removed 1 cup (175 g) cooked rigatoni Sea salt and freshly ground pepper ricotta cheese RICOTTA PESTO 1 garlic clove 2 tsp pine nuts 1 tbsp freshly grated parmesan cheese 50 g ricotta cheese 2½ tbsp olive oil 2 cups basil leaves

1. Heat olive oil in a large saucepan over medium heat. Add onion, celery and parsley and cook until soft but without colour.

2. Add vegetable stock, potato and tomato and bring to the boil, then simmer for 20 minutes until soft.

3. Add zucchini, peas and green beans and cook soup for a further 15 minutes until vegetables are soft but retain their shape.

Recipe and image from At My Table by Amanda Bilson and Janni Kyritsis, Allen & Unwin, RRP $39.99

4. Remove from heat and strain into another large saucepan, reserving vegetables.

Return half the cooked vegetables to the soup and purée with a hand-held blender. Return remaining vegetables to soup. Return pan to heat and add borlotti beans, silverbeet and rigatoni. Simmer for 5 minutes.

5. For ricotta pesto, blend all ingredients except basil in a food processor until smooth. Add basil and blend until smooth.

6. To serve, stir 4 tbsp pesto into soup. Add salt and pepper to taste and ladle into warm bowls. Garnish with crumbled ricotta.

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recipessides&salads

Rare tuna & kale salad with soy, beans & red quinoa Michael Moore PREPARATION TIME: 15 MINUTES COOKING TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1270 KJ –14.6% DAILY INTAKE, FAT 14.4 g, SATURATED FAT 1 g, CARBOHYDRATE 22.2 g, PROTEIN 19.8 g, FIBRE 5.1 g, SODIUM 656 mg Low carbohydrate and high in fibre – this saladis a winner!

From Blood Sugar: Quinoa & Healthy Eating, New Holland, 2013

Pinch black sesame seeds Pinch white sesame seeds ½ tsp Sansho or Szhechuan pepper Pinch ground ginger Pinch sweet paprika Sea salt flakes 240 g fresh tuna fillet ½ tsp sesame oil 2 heads fresh green kale 120 g fine green beans 80 g red quinoa DRESSING 1 small piece of red chilli, crushed Juice and zest of 1 lemon 1 small knob of fresh ginger, grated 1 small piece of lemongrass 1 tbsp dark soy sauce 2 tbsp light olive oil

1. In a small bowl, mix together the sesame seeds and Sansho pepper with the ginger, paprika and a pinch of sea salt.

2. Cut the tuna into two even-sized pieces. Season with the paprika and some sea salt. Roll tuna in the Sansho pepper mixture, pressing as much as possible of it onto the tuna.

3. Preheat a small non-stick frying pan over medium heat. Pour in sesame oil and sear the tuna on each side for only 30 seconds. Remove it from the pan and allow it to cool slightly, then roll in plastic wrap and reserve until required.

4. Wash the kale leaves and trim them into small florets, removing the stalks.

Trim the green beans and cut into small batons about 5 cm long.

5. Prepare a large bowl of iced water and bring a large pot of salted water to the boil. Cook the kale and reserve the liquid. Refresh in iced water. Then cook the green beans in the same water for 3 minutes, as desired.

6. In a small saucepan cook the quinoa in lightly salted water until fully absorbed and plump.

7. Place all ingredients for dressing in a small jar and shake well. Pour the dressing over the quinoa then dry the kale in a tea-towel as best as possible. Slice the tuna as thinly as you can and mix it with the beans and the kale. Dress and serve.

54 Heathy & Heartwise • Autumn | Winter 2014

sides&saladsrecipes Winter salad of prawns and fennel Jeremy Strode PrePArAtion & cooking time: 15 minutes nutritional information per serve (serves 4) energy 1375 kJ –15.8% Daily intake, fat 27.3 g, Saturated fat 0.2 g, Carbohydrate 14.3 g, protein 9.3 g, fibre 3.1 g, Sodium 106 mg Packed full of vitamin C, this is a lowcarbohydrate salad so if you are having it as a main meal you may want to served it with a slice of grainy bread

1 large fennel bulb, trimmed 1 tsp olive oil Sea salt and freshly ground white pepper 1 handful rocket leaves 1 handful flat-leaf parsley leaves 1 handful watercress sprigs 12 cooked medium prawns, peeled and deveined

12 orange segments, membrane removed Dressing Juice of ½ orange 1 tbsp sherry vinegar 1 tsp fennel seeds, roasted and ground ½ garlic clove, crushed Large pinch of sea salt ½ tsp freshly ground white pepper 100 ml extra virgin olive oil

1. Preheat oven to 170°c.

2. cut fennel in half lengthways. cut one half into 8 even wedges, reserve other half.

Place fennel wedges on a baking tray, drizzle with olive oil, season and place in oven. roast for 8–10 minutes until golden brown and softened.

3. Divide fennel wedges between four serving bowls.

4. in another bowl, whisk together dressing ingredients.

5. Finely shave reserved fennel half on a mandoline and divide evenly between bowls containing roast fennel. Add even amounts of rocket, parsley, watercress, prawns and orange to each bowl. Dress each salad, toss and serve.

Recipe and image from At My Table

by Amanda Bilson and Janni Kyritsis, published by Allen & Unwin, RRP $39.99

Autumn | Winter 2014 | Heathy & Heartwise

55

recipesdinner Slow-cooked lamb shanks with Italian vegetables & sage Michael Moore PREPARATION TIME: 15 MINUTES • COOKING TIME: 1 HOUR 45 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2762 KJ – 31.7% DAILY INTAKE, FAT 36.3 g, SATURATED FAT 7.1 g, CARBOHYDRATE 28.2 g, PROTEIN 69.5 g, FIBRE 8 g, SODIUM 1139 mg Lamb is an excellent source of iron and zinc – enjoy this healthy dish on a Sunday instead of roast!

From Blood Sugar: The Family, New Holland, 2013

4 x 300 g French trimmed lamb shanks Sea salt and pepper 2 tbsp of olive oil 1 medium onion, finely chopped 1 clove fresh garlic 1 glass of red wine 1 sprig of fresh rosemary 1 punnet of cherry tomatoes 1 medium can crushed tomatoes 1 medium-sized green zucchini, thinly sliced 175 g buckwheat, cooked in boiling salted water 12 large green olives 1 bunch fresh sage Selection of seasonal green vegetables 1. Preheat oven to 180°C and heat a large earthenware casserole dish on the stovetop.

2. Season the lamb shanks with sea salt and pepper. Add the olive oil to the dish and sear the lamb shanks for 3 minutes on all sides.

3. Remove the lamb shanks and add the chopped onion and the garlic.

4. Cook for 2–3 minutes until softened then add the red wine and the sprig of rosemary. Reduce wine by half, add cherry tomatoes and crushed tomatoes. Return the shanks to the pan and bring to the boil.

5. Cover dish with some foil and a lid and place in a medium oven (180°C) for 1 hour and 30 minutes.

6. Remove from oven. Test with a small knife that the meat is cooked through and falling off the bone.

Depending on shank size, they may need up to another 30 minutes.

7. Carefully remove the shanks from the sauce and set aside. Add the sliced green zucchini, buckwheat and green olives to the sauce and stir through, adjust seasoning with sea salt and pepper.

8. Spoon the sauce over the shanks and garnish with the fresh sage leaves. Serve with steamed seasonal vegetables.

56 Heathy & Heartwise • Autumn | Winter 2014

dinnerrecipes 1. Preheat the oven to 130°C. Combine the flour, cumin, coriander, paprika, turmeric and salt and pepper in a large snap-lock bag. Add the beef and shake the bag to coat the beef.

2. Heat an 8–10-cup capacity ovenproof, stovetop casserole dish over medium-high heat until hot.

Add 1 tbsp of the oil and half the beef and cook, stirring occasionally, for 5 minutes until browned all over.Transfer the beef to a bowl.

Repeat with oil and remaining beef, adding any remaining flour and spice mixture.

3. Reduce the heat to medium-low, add remaining oil and bacon to the hot pan and stir for 3 minutes until the bacon starts to colour. Add onion, carrots, celery and bay leaves then cook 5 minutes until onion softens.

Add tomatoes and stock, return the beef and any juices in the bowl, then bring to a gentle simmer. Press a piece of baking paper directly onto the beef’s surface to keep it submerged, and cover the dish tightly with a lid or foil. Place into the oven and cook for 3½ hours until tender.

Beef hotpot Janelle Bloom PREPARATION TIME: 20 MINUTES COOKING TIME: 4 HOURS NUTRITIONAL INFORMATION PER SERVE (SERVES 6) ENERGY 3150 KJ –36.2% DAILY INTAKE, FAT 40.2 g, SATURATED FAT 9.9 g , CARBOHYDRATE 52.9 g, PROTEIN 52.4 g, FIBRE 4.4 g, SODIUM 912 mg Enjoy this recipe with steamed green vegetables or a garden salad!

From My Favourite Food for All Seasons, Ebury Press, 2011

2 tbsp plain flour 3 tsp ground cumin 3 tsp ground coriander 1 tsp smoked paprika 1 tsp ground turmeric 1 kg beef (blade, chuck or gravy beef), trimmed, cubed ¼ cup olive oil 4 rashers bacon, chopped 1 large brown onion, finely chopped 2 carrots, peeled, diced 2 stalks celery, diced 2 fresh (or 1 dried) bay leaves 400 g can diced tomatoes 1½ cups beef stock ½ cup fresh or frozen peas POTATO DUMPLINGS 350 g Desiree or Red Rascal potatoes 50 g butter, chopped ²⁄3 cup milk 1¼ cups self-raising flour, sifted 1¼ cups grated tasty cheese ¼ cup flatleaf parsley, chopped

4. With 30 minutes to go, prepare the potato dumplings. Peel and cut the potatoes into large pieces. Place into a shallow microwave-safe dish.

Cover with damp paper towel and microwave for 6–7 minutes on high/100% until tender. Drain and transfer the potato to a large mixing bowl. Add the butter and use a potato masher to roughly mash. Add the milk and stir with a wooden spoon until smooth. Add flour, cheese and parsley and stir until well combined. Season with salt and pepper.

5. Remove the hotpot from the oven.

Increase the oven temperature to 200°C fan-forced/220°C no fan.

Remove the lid, discard the baking paper and bay leaves and stir the peas into the hotpot. Divide the dumpling mixture into 12 portions and roll into balls. Drop the dumplings evenly over the hotpot. Bake, uncovered, for 25–30 minutes or until the dumplings are golden and cooked through.

Serve.

Autumn | Winter 2014 • Heathy & Heartwise

57

recipesdesserts

From Indulge: 100 Sweet and Savoury Recipes, Harper Collins, 2011

Lemon and ricotta cheesecake Rowie Dillon PrePArAtion time: 15 minutes + refrigeration Cooking time: 50 minutes nutritional information per serve (10–12) energy 1171 kJ – 13.4% daily intake, fat 13.6 g, Saturated Fat 0.5 g, Carbohydrate 27.1 g, protein 13.1 g, fibre 1.1 g, Sodium 30.7 mg

Mandarin jelly

Serve this delicious low-sodium, high-protein cheesecake with berries!

Janni Kyritsis

100 g golden rice flakes 1 kg ricotta 3 eggs 2 egg whites Zest and juice of 2 lemons 50 g (1/3 cup) gluten-free cornflour 125 g honey

nutritional information per serve (serves 4) energy 281 kJ, Fat 0.2 g, Saturated Fat 0 g, Carbohydrate 11.3 g, protein 5.7 g, fibre 0 g, Sodium 11.5 mg

1. Preheat the oven to 180°C. grease and line a 20 cm springform cake tin.

Spread the rice flakes on a baking tray and bake for 5 minutes or until crisp.

Set aside to cool. reduce the oven temperature to 140°C. 2. Place ricotta, eggs, egg whites, lemon zest and juice, cornflour and honey in a food processor and blend until smooth.

3. Crush the rice flakes with a rolling pin and spread a thin layer in the base of the prepared tin. Spoon the ricotta mixture, smooth the top and back for 35–45 minutes or until golden and set.

4. Allow to cool. Chill in the fridge for 2 hours or overnight.

PrePArAtion time: 15 minutes + refrigeration

a low-carbohydrate, high-vitamin C option when you want something sweet but healthy 2 tbsp hot water 1 tbsp Equal 1 tsp finely grated mandarin zest 2 cups (500 mL) strained mandarin juice 3 tsp powdered gelatine

Recipe and image from At My Table by Amanda Bilson and Janni Kyritsis, Allen & Unwin, RRP $39.99

1. in a bowl, mix hot water with equal and mandarin zest and leave to steep for 5 minutes.

2. in a saucepan put ½ cup (125 ml) mandarin juice, sprinkle the gelatine on top and leave to soften for 5 minutes. Add zest mixture to pan and heat it through just enough so that gelatine melts (do not let it simmer). Stir in remaining mandarin juice.

3. rinse and drain four ½ -cup moulds (tea cups or dariole moulds are suitable); this makes it easier to unmould jelly. Strain jelly into moulds and refrigerate until set.

4. Unmould each jelly in centre of each serving plate and serve with fruit of your choice or with spiced orange salad. note: if mandarins aren’t available, use oranges, blood oranges, ruby grapefruit or another citrus fruit.

58 Heathy & Heartwise • Autumn | Winter 2014

dessertsrecipes Cinnamon apple upside-down pudding Michael Moore PREPARATION TIME: 20 MINUTES COOKING TIME: 55 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2233 KJ – 25.7% DAILY INTAKE, FAT 35.1 g, SATURATED FAT 15.9 g, CARBOHYDRATE 49.7 g, PROTEIN 10.8 g, FIBRE 4.6 g, SODIUM 410 mg A substantial stand-alone snack – enjoy it as an afternoon tea

From The Cook’s Garden, New Holland, 2011

4 red apples 60 g butter 1 tsp ground cinnamon Pinch ground cloves Pinch ground nutmeg 3 tbsp agave nectar PUDDING MIXTURE 120 g fresh ricotta ½ tsp vanilla essence 120 ml milk (2% fat) 60 g butter 2 eggs, separated 1 tsp caster/superfine sugar 2 tbsp ground almonds 2 tbsp self-raising/bakers flour, sifted 2 tbsp flaked almonds

1. Preheat oven to 160°C. Peel, core and cut each apple into 8 wedges.

2. Melt 60 g butter in a small pan with the spices and 2 tbsp agave nectar.

Coat the apple wedges in this and place wedges onto a non-stick baking tray. Bake in oven for 20 minutes until soft and caramelised.

3. Remove from the oven and while hot, place apple wedges into a deep ovenproof baking dish (preferably glass).

4. Warm the milk and vanilla with the remaining 1 tbsp of agave nectar and 60 g butter, melt together and then allow it to cool.

5. In a mixer beat the ricotta for 3 minutes until smooth and creamy, add the egg yolks and the milk mixture. Then mix in the ground almonds and flour combine together.

6. In a separate bowl, whisk the egg whites to a stiff peak with the caster sugar. Fold these egg whites into the mixture and pour mixture over the caramelised apples, sprinkle the top with the flaked almonds.

Pumpkin scones Sheridan Rogers PREPARATION TIME: 20 MINUTES COOKING TIME: 20 MINUTES NUTRITIONAL INFORMATION PER SERVE (12) ENERGY 643 KJ – 7.3% DAILY INTAKE, FAT 4 g, SATURATED FAT 0.9 g, CARBOHYDRATE 31.3 g, PROTEIN 4 g, FIBRE 1.1 g, SODIUM 109 mg A great breakfast option if you add a protein-rich filling, such as scrambled egg 15 g butter, softened 125 g sugar Grated zest of ½ orange 200 g mashed steamed pumpkin, cold 1 egg, well beaten 375 g self-raising flour ½ tsp nutmeg (optional) ½ tsp mixed spice (optional) Milk, if necessary

7. Bake in oven for 30 minutes until golden and firm to touch. Serve warm.

1. Preheat oven to 220°C.

From Blood Sugar The Family, New Holland Publishing P/L, 2013

2. Cream together the butter, sugar and zest. Stir in the pumpkin and egg.

Sift dry ingredients together and stir into the pumpkin mixture. Add a little milk if mixture is too dry.

3.Turn out onto a lightly floured bench or board and pat mixture out to 3–4 cm thickness. Cut them out with a glass or round cutter dipped in flour and arrange close together on a greased tray or tin.

Cook for about 20 minutes or until golden.

4.Try them with apricot jam and cream if your diet allows.

Autumn | Winter 2014 • Heathy & Heartwise

59

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diabetes&feet

Keeping your nerve

We tend to take our prime means of transport for granted until something goes wrong but that may be too late with diabetic neuropathy, warns endocrinologist Dr Pat Phillips.

A

s we get older, our hair greys, our skin wrinkles and we lose some brain cells. Our nervous system ages too – we lose individual nerve cells and nerve fibres.

By age 80, we have a lot less fibres in the nerves than at age 20.

Diabetes speeds up this process, especially if blood glucose levels (BGLs) are high. If you have had diabetes since the age of 50, your nerves at age 65 might be like those of someone without diabetes at age 80.

When nerves are damaged, signals of sensation going to your muscles no longer reach their usual destination.

The sensations you feel may be altered or lost and your muscles may become weaker and smaller.

Because the nerves going to your feet are furthest away from the spinal cord, they are most affected and the abnormal or loss of sensation and loss of muscle power starts there.

Nerve problems become progressively worse. After 20 years of living with diabetes, about 50% of people have some damage and about 20% have severe damage that can cause major problems. With time, the same problems that affect the lower limbs can begin happening in the hands and arms.

Signs of nerve damage ABNORMAL SENSATION – In the early stages, the signals from your feet to your brain can be a bit ‘scrambled’ and you feel spontaneous sensations that haven’t been triggered by anything. These sensations can be quite disturbing but generally they go away with time.

LOSS OF SENSATION – As the damage progresses, nerves stop carrying signals.

The symptoms are less distressing than the abnormal sensations but they indicate that you can easily damage your feet without realising it and you’ll need to take extra care of them.

GOING OFF AUTOMATIC – Much of your nervous system continuously monitors and controls the internal processes that run your body’s ‘machinery’. This is the autonomic nervous system, which is affected quite early in the process of nerve damage because, like the sensory system, its nerve fibres are very fine. Because the autonomic nervous system supplies every part of your body, problems can occur from the top of your head to the tips of your toes – particularly your skin and mucous membranes, bladder, sexual organs and intestinal tract.

LOSING POWER – Muscles supplied by nerves thicker than those in the sensory and autonomic systems are less easily damaged and problems occur later.Your hands’ muscles can be affected, weakening your grip, or the loss of muscle power can allow your toes to become fixed in a curve, like a fork. As with the nervous system, strength diminishes first in the feet and leg, then in hands and arms. ▲ THE ABOVE can be associated with diabetes-related nerve damage (neuropathy) but there can be other causes. Your doctor will assess the sensation in your feet as part of regular diabetes care but you may have symptoms before your feet are checked, so look after them – with a daily routine of footcare, appropriate footwear [see HHW 53, page 73, 77], and noting and reporting any changes in sensation. ♥

61 Heathy & Heartwise • Autumn | Winter 2014

DR PAT PHILLIPS, MBBS, MA, FRACP, MRACMA, is Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service This article from Conquest Winter 2014

dealingwithdiabetes

Gestational diabetes Terri Berenguer explains a common complication of pregnancy that can be a harbinger of later developing type 2 diabetes.

G

estational diabetes mellitus (GDM) is glucose intolerance of variable severity with onset or diagnosis during pregnancy and that lasts the term of the pregnancy.

Between five and eight per cent of pregnant Australian women will develop GDM. While most will have their blood glucose levels (BGLs) normalise after their baby is born, their risk of later developing diabetes or abnormal BGL increases.

The age of onset of type 2 diabetes is decreasing and the trend of women to delay having children has also increased the number of women at risk of GDM. In 2005–6, 4.6% of Australian women aged between 15 and 49 who gave birth in hospital were diagnosed with GDM, an increase of more than 20% since 2000–1.

The PCOS process spelt out Gestational diabetes usually occurs during the 24th to 28th week of pregnancy due to gestational hormones causing a decrease in the ability of the mother’s cells to respond to insulin, i.e. increased insulin resistance. Women who develop GDM cannot produce sufficient extra insulin to overcome this resistance, causing BGLs to rise.

GDM can have health implications for both mother and baby. The

children of GDM mothers have an increased long-term risk of obesity and diabetes and the outcomes in GDM pregnancies are significantly worse than in non-GDM pregnancies.

There are higher rates of complications such as pre-eclampsia and Caesarean section. Infants are often large for their age prebirth and at higher risk of prematurity and birth trauma.

mother and baby.

Public health strategies to optimise family planning and directing efforts to reduce the prevalence of obesity in general and towards preventing unnecessary weight gain in pregnancy are vital.The risk of being diagnosed with GDM increases with age — from 1% among

Lifestyle interventions addressing diet and exercise have convincingly reduced diabetes risk and, importantly, seem to have a sustained effect.

Treatment Lifestyle and dietary change and, when necessary, insulin will assist in managing BGLs within the advised normal target ranges, provide adequate nutrition for mother and baby and maintain appropriate weight during the pregnancy.

Spreading carbohydrate intake over three small meals with two-tothree snacks each day, and choosing carbohydrate foods with lower GI is recommended. Referral following a diagnosis of GDM to healthcare with the appropriate level of diabetes education is important to promote and improve health outcomes for both

63 Heathy & Heartwise • Autumn | Winter 2014

15–19-year-old women to 13% among women aged 44–49 years. Lifestyle interventions addressing diet and exercise have convincingly reduced diabetes risk and, importantly, seem to have a sustained effect.

Research suggests that most women enter pregnancy unprepared and only seek medical care upon realising they are pregnant but they and their healthcare provider need to be aware of the risks related to GDM.

What you can do Type 2 diabetes is frequently without symptoms at onset and

dealingwithdiabetes

ARE YOU AT INCREASED RISK? • Over 30 years of age • A family history of type 2 diabetes • Overweight or obese • Aboriginal or Torres Strait Islander, Vietnamese, Chinese, Middle Eastern, Polynesian or Melanesian background • GDM during previous pregnancies

follow-up healthcare to prevent and target interventions to postpone or prevent its development is imperative. To reduce your risk or delay the development of type 2 diabetes, keep in mind the following: • Maintain or achieve a healthy weight – balancing food intake with activity levels is the best way to maintain or reduce any excess body weight • Eat healthily – limit saturated fat, choose lean meat, skinless chicken and low-fat dairy foods.

Limit processed and fried foods. Eat plenty of vegetables, legumes, fruits,

wholegrain breads and cereals.

• Be physically active – aim to include at least 30 minutes of moderateintensity physical activity on most days. You should discuss your physical activity plans with your doctor before starting any exercise regime.

• Check BGL – have your BGL tested every one-to-two years. Discuss this with your doctor.

The National Gestational Diabetes Register, established in July 2011 by the National Diabetes Service Scheme (NDSS) — an initiative of the Australian Government and

administered by Diabetes Australia — enables women diagnosed with GDM to receive annual reminders for follow-up diabetes screening; lifestyle information to minimise the risk of developing type 2 diabetes; and access to subsidised NDSS products.

Aimed to help women manage their health into the future, the Register also sends a reminder letter to a nominated family doctor. Women are eligible if they reside in Australia and hold a Medicare card. To apply, complete the NDDS registration form available by calling 1300 136 588 or visiting www.ndss.com.au/GD ♥

Autumn | Winter 2014 • Heathy & Heartwise

62

livingwithdiabetes

Driving and diabetes Plunging or soaring blood glucose levels, complications and medication all put drivers with diabetes at greater risk of fatigue.

But good blood glucose control and knowing what to look out for will help get you from A to B safely, says Steven Chong.

I

t’s every driver’s deepest worry, pushed far to the back of mind when alert and stimulated but creeping forward with lulling attention and fatigue: falling asleep at the wheel.

Even microsleeps – three to five seconds where just a part of your brain naps – are enough to wreak havoc but the more we press on ‘just another 10 k’ or ‘until the next town’, the more we invite them.

Hypos – not just a hunger game While sleep deprivation is behind most driver fatigue, people with diabetes or insulin resistance are especially at risk when their blood glucose levels (BGLs) are too low or high.

Hypoglycaemia or a ‘hypo’ is when BGLs fall below 4 mmol/L, although the exact figure can vary, with some people feeling the common symptoms of light-headedness, weakness, trembling, sweating or poor concentration at higher levels.

Other drivers, particularly those who’ve had diabetes long term, experience no hypo symptoms whatsoever but still can end up confused or lose consciousness without warning – a condition called lack of hypo awareness.

The causes of hypoglycaemia are numerous and not unique to diabetes: missed, late or unbalanced

meals; drinking on an empty stomach; unplanned physical activity or unusually strenuous exercise.

However, too much insulin or diabetes medication can also cause a hypo, and people with diabetes are more likely to have complications that affect driving, such as vision problems (see page 67), nerve damage (neuropathy, see page 61), heart disease and of course sleep apnoea.

On top of that, hyperglycaemia, where BGLs rise too high – say after too much cake, pasta or soft drink – can cause blurred vision, fatigue and decreased concentration; the ‘3pm slump’ of drowsiness people without diabetes complain of an hour or two after lunch.

What’s your fitness to drive?

The primary concern of most road authorities is hypoglycaemia and the use of insulin, and it is your legal responsibility to advise the licence

authority in your state or territory of your diabetes and if you take any glucose-lowering medications. If you are treated with diet and exercise only, notification requirements vary across jurisdictions and you should check with your local authority or doctor. However, failure to notify the authorities when it is required can result in being charged with driving offences if you have an accident.

Normally, your health professional advises you about your ability to drive and supplies a letter or report to take to your licensing authority, which then makes the final decision.They may make place conditions on your licence or seek further advice from an endocrinologist to ensure you are fit to drive.

Notifying your motor vehicle insurer is sensible as well, as you may have problems with insurance claims if your diabetes is not disclosed. ♥

ROAD SAFETY CHECKLIST ✔ Test your BGL and ensure it is above 5 mmol/L before driving ✔ Ensure your BGL is above 5 every 2 hours during driving ✔ Always carry a fast-acting/high-GI carbohydrate snack/drink and blood glucose meter with you and in the vehicle ✔ If you feel hypo symptoms while driving, pull over safely, eat something sweet (about 15 g glucose) then some lower-GI carb.

Test that your BGL rises above 5, wait at least 30 minutes before testing again. If it’s still above 5, you’re OK to drive Autumn | Winter 2014 • Heathy & Heartwise

64

livingwithdiabetes extractions may have affected the alignment of the teeth adjacent.

Uneven teeth make it difficult to keep the exposed tooth surfaces clean.

• Salivary flow – Diabetes and some medications can reduce salivary flow, promoting the growth of bacteria, bacterial plaque and the rapid progression of caries. Salivary flow may be stimulated by chewing gum (sugar-free) or a specialised mouthwash from a pharmacy.

• Diet – The bacteria that cause caries require carbohydrate to form acid. Frequent consumption of high-carbohydrate foods and drinks — such as soft drinks or juices, confectionery, sweet pastries and/ or starchy snack foods that coat and stick to the teeth — are the major culprits. Generally, the healthy foods recommended for all of us — low glycemic index (GI), high fibre, low energy density — are much less problematic for teeth.

• Oral hygiene – Complete dental care includes flossing, picking and brushing.

Minding your mouth!

No one wants gaps in their teeth, a dry mouth or bad breath but dental problems are more common with diabetes and they can affect its management. Dr Pat Phillips and Prof Mark Bartold explain.

W

e all have an automatic cleaning system in our mouths – saliva washes the teeth clear of debris and bacteria.

The processes of ageing and diabetes affect the nerves controlling the system and high blood glucose levels (BGLs) cause a dry mouth.

The resulting dry mouth and teeth are uncomfortable, particularly for those with dentures, but a dry mouth also makes it easier for bacteria to damage the teeth (causing caries) and the gums (causing periodontal disease).

High BGLs affect the immune system and further accelerate damage to your teeth and gums. After age 40, people become more likely to develop diabetes at the same time as the fine vessels supplying the teeth start narrowing or blocking. Diabetes greatly

accelerates vascular disease in the teeth and gums, and in the rest of the body.

Dental caries A healthy tooth in a healthy gum and healthy mouth is pretty secure.

The roots are firmly embedded in bone and the gum firmly encases the tooth, leaving only the resistant enamel exposed to any remaining debris and bacteria that the saliva has not flushed away. Many factors can cause caries including: • Anatomy – You may have been born with uneven teeth or tooth

65 Heathy & Heartwise • Autumn | Winter 2014

Proper care takes time Unfortunately many Australians, with or without diabetes, give their teeth ‘a lick and promise’ but not the full care they need. Fortunately, caries and the potential of serious complications are largely preventable by routine dental care and regular visits to dental health professionals. The inflammation associated with gum disease may adversely affect diabetes control so it is very important to have your gums checked and cleaned regularly.

In order to avoid problems such as dental caries, bacteria-causing bad breath, tooth loss and deep tissue infections, it’s important to make flossing, picking and brushing part of your daily routine. You can also ask your doctor to refer you to a diabetes health professional who is subsidised by the Commonwealth (the Medicare Plus Schedule). ♥

DR PAT PHILLIPS is Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service; PROF MARK BARTOLD is the director of Colgate Australian Clinical Dental Research Centre.

This article adapted from Conquest Winter 2012

diabetesreallifestory

Depression At 54, Glenn Cotter was in the age range when most people are diagnosed with type 2 diabetes. For him, it was brought on by years in a stressful trucking job and a nasty turn in his wife’s health. But 18 months later he’s in better shape with the right help.

A

t first I thought I had depression. For years I had worked as a truck driver, commonly covering 650 km over a 12 or 13-hour day, and it was hard to stop and fit in exercise or healthy eating. I struggled with my weight, had constant mood swings, low energy and motivation, and poor sleep.

Then my wife was diagnosed with breast cancer, so with no kids left at home, I had to take a second job parttime to keep things going on top of handling the stress of her situation.

We live in Marulan near the NSW– Victorian border, so my wife was sent to hospital in Canberra for a week of intense radiotherapy, where she was put in isolation because she was quite weak and vulnerable to infection. Naturally she was scared and anxious, so I travelled there every chance I could to be by her side. I would finish one job at 4.30pm, start my second at 5.30pm until 11pm, then wake up early to drive up and

“The half-empty glass is now half full”

have breakfast with her.

I felt burnt out, had severe mood swings and knew I wasn’t well. But being a typical bloke, I just shrugged it off and ignored it. One day, though, I was at work and everything was fine and happy and then suddenly I burst into tears.

Diabetes diagnosed I went to my local doctor, who diagnosed me with type 2 diabetes, put me on some medicines to lower my blood pressure and cholesterol, and recommended some dietary and lifestyle changes to get my weight down.

I thought,“Okay, I will start eating healthily and that will fix all the problems I have.” I followed the basic ‘high-carb, low fat’ dietary guidelines, but it was making my condition worse.

Blood glucose tests showed big spikes after my meals, even if it ate something relatively healthy like rice or wholegrain toast, and then big drops when I would struggle to stay alert.

My GP referred me to a dietitian and I just had to tell her a few of my symptoms before she immediately understood what was wrong.

She explained how the food I was eating was affecting me in many ways, from my mood swings to fatigue.

She gave me a higher-protein eating plan that I could fit in my life and within nine weeks, I’d dropped seven kilos.

Instead of just toast for breakfast, now I’ll also have scrambled eggs and walk for 15–20 minutes every day or so.

Over four months, I’ve lost 12 kg and my life is completely turned around with no mood swings — the half-empty glass is now half full. My blood pressure and cholesterol is now normal, and so are my sugar levels. At my last visit the doctor said I wasn’t yet free of diabetes but to keep doing what I’m doing because it seems to be working! ♥ ■ GLENN COTTER took early retirement and is now a full-time carer for his wife

Autumn | Winter 2014 • Heathy & Heartwise

66

diabetes&eyes

Saving

your sight Having diabetes means regular eye checks.

Even if you experience no symptoms, by the time you’re seeing things, diabetic retinopathy is already well advanced, Steven Chong warns.

D

iabetic retinopathy accounts for 10% of all blindness in Australia and is its most common cause in people younger than 60. People with diabetes are 25 times more likely to suffer this common complication – about a quarter of Australians with diabetes have some form of it.

Almost everyone with type 1 diabetes and, within 20 years of diagnosis, almost two-thirds of people with type 2 diabetes will have diabetic retinopathy but about 17% will go undetected.

This could be because according to the Centre for Eye Research Australia, up to half of people with diabetes do not have their eyes checked every two years as per national guidelines.

However, if treated early, 98% of severe vision loss can be prevented.

Questions and answers

How do I know if I have it?

There are no visual symptoms in its early stages so eye tests at least every two years or as directed by a health professional are crucial to detection and early effective treatment.

And if I don’t treat it?

Once advanced,‘clouds’ appear to float across your vision and, if the blood vessels around the retina’s centre are affected, you struggle to read standard print, watch TV or see people’s faces. You will experience increased sensitivity to glare and difficulty seeing at night.

Is there anything I can do?

You can reduce your own risk by managing blood sugar, blood pressure and cholesterol levels well. A GP can refer you to an ophthamologist or

What is retinopathy? A complication of diabetes where the eye’s small blood vessels leak fluid or grow on the surface of the retina.

67 Heathy & Heartwise • Autumn | Winter 2014

help you find an optometrist in your area to test for retinopathy.

Are the tests painful?

Eye professionals will check your vision but also look for cataracts, check fluid pressure within your eyes to detect glaucoma, and indentify signs of retinopathy. It is all pain-free and done within 10 minutes.

Diagnosis and treatment A full eye examination is performed to check for diabetic neuropathy. Drops are put in the eyes to enlarge the pupils and an ophthalmoscope’s bright light is used to observe the retina.

Fluid pressure inside the eye is checked and images of the retina may be taken with a special camera. In some cases, a fluorescein angiography may be needed where a special yellow dye is injected and, when it passes through blood vessels in the retina, photos are taken to detect whether dye has leaked.

If signs of advanced retinopathy or macular fluid retention are found, laser treatment may be recommended. If detected early, lasers can seal or destroy leaking blood vessels and restore vision.

A relatively new treatment option for diabetic eye disease involves the injection of medications directly into the vitreous of the eye (intravitreal injection). Surgery may be required to treat advanced diabetic retinopathy. ♥

STEVEN CHONG is the Editor of HHW www.cera.org.au

diabetescomplications

Restless legs It isn’t the travel bug but an uncontrollable urge to move your legs that can frustrate sleep and may be linked with diabetes. Jayne Lehmann explains.

R

estless Legs Syndrome (RLS) causes an overwhelming desire to move the legs when sitting or lying down and affects young and old, with half of cases also affected in their arm(s). This common movement and sleep disorder affects women twice as much as it does men and is more common in people with diabetes.

Mild RLS is found in about 10% of Australians, with another 3% experiencing more severe symptoms more than twice a week that often start earlier in the day. Many people with the milder form go undiagnosed and may experience symptoms only overnight.

Could you have it?

Diagnosis of RLS relies on identifying the following symptoms that run the gamut from being mild to very debilitating to quality of life: • An unpleasant feeling deep in the muscle or bones of the legs at rest that may be described as a‘creeping crawling’sensation, cramps, itching, burning, searing or tugging • An overwhelming desire to move the legs when sitting or lying down • Difficulty falling asleep due to the desire to move • Symptoms worsen and may only be experienced overnight in the milder form – often between midnight and 2am • Feeling tired during the day due to disturbed sleep patterns

• 80% of cases have involuntary jerking or twitching of limbs usually more than five times overnight.

RLS often runs in families — about 40% of people with RLS have family members with the condition — and symptoms usually progress slowly, appearing more frequently with age.

What causes RLS? You can’t test for RLS. It is diagnosed by the doctor based on a person’s symptoms and medical history and is either diagnosed on its own (primary) or due to another condition (secondary).

If a primary diagnosis, the cause is generally unknown but may be due to low levels of certain neurochemicals, especially dopamine, which helps regulate movement. Symptoms usually begin before age 45 and progress slowly.

Secondary causes include: • low iron levels e.g. iron deficiency anaemia • diabetes • renal failure • poly-neuropathies e.g. peripheral neuropathy [see page 61] • coeliac disease • pregnancy (about one in five experience RLS) • Parkinson’s disease

69 Heathy & Heartwise • Autumn | Winter 2014

• underactive thyroid • multiple sclerosis • some medications for depression, psychiatric disorders, nausea, blood pressure, epilepsy • inflammation.

Rest for the restless It is important for RLS to be diagnosed and treated early to limit its impact on health.

Currently there is no cure and treatment initially focuses on the relief of symptoms and maintaining general health.This is especially so in people with diabetes.

Mild RLS symptoms improve in the short term when the affected limb is moved or stretched.Walking in the afternoon can also help, as can magnesium and iron (if less than 50 mcg/L) supplementation. Stopping smoking and limiting alcohol and caffeine intake will prevent overstimulation of the nervous system, which can worsen symptoms.

Poor sleep has a negative impact on diabetes and CVD risk factors, so a sleep study can determine whether RLS is causing it.If symptoms are experienced overnight three times or more a week, medication that corrects low dopamine is usually recommended.Sedatives can improve sleep, while seizure or pain medication can address symptoms.♥

JAYNE LEHMANN, BN(Ed), DipAppSc(Nsg), FRCNA, RN, CDE, is a Credentialled Diabetes Educator with EdHealth Australia: www.edhealthaustralia.com

eatingwithdiabetes

Read the label

Learning to decipher the marketing claims and ingredient lists on food and beverage products is essential for healthy eating. Dietitian Milena Katz reveals what’s really beneath the packaging.

W

hat we see on food packaging and on menus in restaurants and fast-food outlets has changed over the past decade.

Manufacturers make health claims on food packets announcing how little sugar, fat or salt there is inside.

But it is often not the highlighted information that is important to us consumers but the small print, which shows where the product was made, its actual ingredients and the Nutrition Information Panel (NIP).

NIP bad choices in the bud The NIP — a small list or table of figures — gives good insight into whether the product is worth buying and of value to our health and wellbeing.It indicates the

average amount per serve and per 100 g/ml of the food or liquid of energy (in kilojoules and/or kilocalories), protein, fat (total and saturated), sugars, carbohydrate and sodium (a salt constituent).

A NIP also shows any other nutrients for which a nutritional claim is being made, e.g. a “Good source of fibre and calcium” claim means the amount of fibre and calcium in the food must be shown in the NIP. Companies cannot make a nutrition claim such as “low fat” without a NIP. Some items do not require a NIP, such as tea and coffee, mineral

water, herbs and spices, foods sold unpackaged or made at the point of sale. Interestingly, foods with a packaging surface area less than 100 cm2 are not required to display a NIP.

Listed ingredients An ingredient list is usually found next to or underneath a NIP. The ingredient list must be listed in descending order (by weight). For example, if sugar is listed near the start of the product list then the product has a higher proportion of this ingredient.

Manufacturers are required to declare all foods, ingredients or parts of an ingredient made from the following allergens that can cause severe reactions in some people: • Peanuts and other nuts • Seafood • Fish • Milk • Eggs • Wheat/gluten • Soybeans.

Additives such as colours, flavours and preservatives must also be listed.

Some items do not require a NIP, such as tea and coffee...

71 Heathy & Heartwise • Autumn | Winter 2014

eatingwithdiabetes Other names for fat, sugar and salt

Label terms expLAined

FAT

SUGAR

SALT

beef fat* coconut* coconut oil* copha* cream* dripping* lard* mayonnaise* sour cream* nuts oil** oven fried/baked palm oil* toasted**

brown sugar corn syrup dextrose disaccharides fructose glucose golden syrup honey lactose malt maltose mannitol maple syrup molasses monosaccharides raw sugar sorbitol sucrose xylitol

baking powder booster celery salt garlic salt meat/yeast extract onion salt monosodium glutamate MSG rock salt sea salt sodium sodium bicarbonate sodium metabisulphite sodium nitrate/nitrite stock cubes

Use by – should not be consumed after this date for health and safety reasons.

Best before – a shelf life of less than two years. It may be safe to eat after this date but have less quality and nutritional value.

No added sugar – no sugars added but may contain other sugars e.g. fructose, lactose.

Low fat – fat should be less than 3 g/100 g.

Reduced fat – not necessarily low fat but lower in fat than the normal product.

Lite/Light – may describe the taste, texture, fat, salt or sugar content rather than energy.

Toasted/oven-baked – likely to be high in fat.

All natural – sugar, oil, fat and cream are all natural but not healthy in large amounts.

Low salt – sodium should be less than 120 mg/100 g food.

* high in saturated fat ** may be high in saturated fat if it’s toasted with coconut, palm or hydrogenated vegetable oil

Salt-reduced – less salt than usual product but may still be high in salt.

SeRviNg Size: The food manufacturer determines the quantity, which may not be the same amount you’d eat Amount of kilojoules or calories of eNeRgy released when food is metabolised by the body.

1 calorie = 4.2 kilojoules ToTAL fAT amount is shown plus a separate line entry must indicate the amount of SATURATed fAT A simple carbohydrate listed separately. Includes naturally occurring SUgAR (e.g. fructose in fruit) and added sugars.

Products with a ‘no added sugar’ nutrition claim still contain high levels of natural sugars.

Look for products with less than 5 g sugar per 100 g.

NUTRITION INFORMATION Servings per package: 36 Serving size: 33 g (2 biscuits) (Wheat cereal)

Per 200 g serve

Per 100 g

Energy

447 kJ

1490 kJ

Protein

3.7 g

12.4 g

– Total

0.4 g

1.4 g

– Saturated

0.1 g

0.3 g

– Total

20.1 g

67 g

Sugar

1.0 g

3.3 g

87 mg

290 mg

Fibre

3.3 g

11g

Iron

3 mg

10 mg

Fat

Carbohydrate

Sodium

Look for products that have lower SodiUm content because it has been linked to higher blood pressure

QUANTiTy peR 100 g/mL: Think of as a percentage, 30 g fat means the product contains 30% fat If you have a chronic condition such as diabetes it is best to weigh or measure the portion size that you are about to eat and compare it with the 100 g nutrient profile. pRoTeiN is essential for health and is particularly important for satiety, i.e. feeling ‘full’. Animal sources of protein include eggs, dairy products, fish, meat and poultry. The major vegetable sources of protein include lentils, nuts, dried peas and beans. cARBohydRATe: Important for people with diabetes, blood glucose control issues (e.g.

Syndrome X) or requiring insulin medication. Includes starches found in high amounts in white, wholemeal and wholegrain cereal, breads, rice and pasta, plus root veges and legumes.

Milena Katz, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney For more inFormation, visit www.foodstandards.gov.au

Autumn | Winter 2014 • Heathy & Heartwise

70

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Asktheexpert

diabetes

& Qa

Prof Trisha Dunning answers common questions arising from her extensive career in diabetes management.

Thirst, toilet trips with type 2

Q

Professor Trisha Dunning, AM, PhD, RN, MEd, FRCNA, is the Chair of Nursing at Deakin University and Barwon Health, and VicePresident of the International Diabetes Federation These questions from Conquest Autumn 2014, Summer 2012

Ask Trisha

Email your queries about diabetes to hhm@goodhealthpublications.com.au with ‘Ask TrishA’ in the subject field

I was diagnosed in 2003 with type 2 diabetes. I have been having a problem that I only reported to my doctor recently.

I experience uncontrolled thirst and many trips to the toilet after going to bed.

My doctor found a slight irregularity with my kidneys only. I am desperate to have a good night’s sleep and do not drink much fluid because I am up even more if I do.

a

i can hear your distress and that the lack of sleep makes coping more difficult.

You mention your doctor said you had ‘a slight irregularity with your kidneys.’ i would ask him what that actually means. it often helps if you write down your questions and take them with you to the appointment so you can ask them. kidney problems are one of the complications of diabetes but they do not necessarily cause the symptoms you describe. Your thirst seems to have been present for some time and possible causes need to be considered, including: • High blood glucose levels (BGLs), which is also associated with the need to pass urine frequently, including at night. if your BGLs are consistently high, your diabetes medicines or dosages may need to be changed. This is the most likely cause of your problem and might be from an infection.

• Urinary tract infections and foot infections can lead to urinary frequency and cause BGLs to go high, which contributes to thirst.

• Eating a lot of salty foods.

• Very high blood calcium levels.

• Diuretics (water tablets) can contribute to the urinary frequency.

• An uncommon cause of excessive urination and extreme thirst is Diabetes Insipidus (Di). it is very different to diabetes and sometimes runs in families, occurring when the kidneys cannot conserve water.

Di can be caused by head injury, severe infections and emotional distress.

Although unlikely to be behind your problem, if the common causes are ruled out then it should be considered.

73 Heathy & Heartwise • Autumn | Winter 2014

Gluten sensitivity

Q

I have type 2 diabetes but not coeliac disease and am a nosey old nurse.

My daughter is not coeliac either but is sensitive to wheat. She has told me that because glucose comes from wheat, she cannot tolerate it.

Would the advice to have glucose handy for hypos therefore be contraindicated in people with coeliac disease?

a

Glucose should not cause problems for people with wheat sensitivity or coeliac disease. Foods that contain gluten, such as wheat-based bread and cereals, are broken down to release nutrients including glucose, but glucose does not initiate the reaction in the intestines associated with gluten.

Glucose in glucose gel, sweets and soft drinks can be used to treat hypoglycaemia because they do not usually contain gluten.

Glucose is a sugar, not a protein like gluten.

Thus, people with wheat sensitivity or coeliac disease do not react adversely to glucose, which is the appropriate treatment for hypoglycaemia. if necessary, the glucose can be followed up with a longer-acting carbohydrate that does not contain gluten, such as potatoes, buckwheat or gluten-free bread. i suggest you discuss the problem with a gastroenterologist or Accredited Practising Dietitian who specialises in coeliac disease. ♥

eatingwithdiabetes

Yes you can – even if you have diabetes or heart disease, or both! With choices proliferating as South America’s ‘food of the gods’ conquers the world, you just need a few pointers from Dr Alan Barclay to be a discerning and healthy cocoa connoisseur.

Choosing chocolate C

hocolate was considered a health food until early last century, with a range of potential benefits. It was used thousands of years ago by the ancient Mayans and Aztecs, then by Europeans between the 16th and 19th centuries, as an ingredient in cures for many illnesses, including fevers, liver disease, kidney disorders, dysentery, constipation, and to foster needed weight gain.

Perhaps underlying its current role on Valentine’s Day, the original chocolate drink was used by the Aztecs as an aphrodisiac and some European doctors in the 1700 and 1800s said chocolate made people amiable and “incited consumers to ... lovemaking”.

There is increasing scientific evidence that a little bit of chocolate each day may do you good. But as you may already know, when it comes to your health, all chocolates were not created equal.

Nutritional properties It is relatively simple to compare your favourite kind of chocolate by looking at the Nutrition Information Panel found on nearly

all foods [see pages 70–1. The table lists the nutrient composition of the more common varieties in a 25 g serve, which is equivalent to half of one row of a large block (350 g) of chocolate, or half a small bar.

As the table opposite indicates, all chocolates are relatively high in energy (kilojoules), mainly because of their fat content. Most are also a good source of carbohydrates, primarily because added sugars help mask chocolate’s naturally bitter flavour. The exception is the new stevia-based chocolate bars that use polydextrose instead of carbohydrate to provide texture and bulk.

What about weight gain?

Most chocolates are what we call energy dense, with lots of kilojoules in a relatively small volume. This is good if you are trying to gain weight, travel long distances with limited storage space, or participate in an endurance sport where it is advantageous to carry around a concentrated and highly palatable source of carbohydrate and energy.

However, high energy density is obviously

75 Heathy & Heartwise • Autumn | Winter 2014

ALAN BARCLAY, PhD, BSsc, GradDip, is Chief Scientific Officer of the Glycemic Index Foundation and Head of Research at the Australian Diabetes Council This article adapted from Conquest Winter 2014

eatingwithdiabetes Product name

Energy

Fat

Saturated fat

Carbohydrate

Sugars

Fibre

Chocolate bar, milk, with nuts

544

7.4

3.6

13.3

11.2

1.2

Chocolate bar, milk

539

6.9

4.2

15.5

13.9

0.2

Chocolate, dark

540

7.1

4.3

15.7

13.0

0.3

Chocolate, milk, with nuts & fruit

545

7.4

3.6

13.3

11.2

1.2

Chocolate, milk, caramel filled

498

6.2

3.8

15.4

13.4

0.1

Chocolate, dark, fondant-filled

434

4.0

2.8

17.0

16.8

0.5

Chocolate, liqueur-Filled

418

3.9

3.6

15.0

14.7

0.7

Chocolate, carbohydrate-modified, plain, non-nutritively sweetened

402

7.0

4.3

15.5

1.4

0.2

Chocolate, dark, stevia sweetened with polydextrose

496

10.8

6.6

1.4

0.1

6.5

not good if you are trying to lose weight.

In contrast, most non-starchy vegetables provide less than a quarter and most fresh fruits provide less than half of the energy per serve as chocolate, and they are much higher in water and fibre so they tend to be more filling.

Cholesterol and fats Chocolate is high in total and saturated fats.

In high-quality chocolates, cocoa butter is the main source of fat. Cocoa butter is high in stearic acid, which of all the saturated fats raises the ‘bad’ LDL cholesterol the least and raises the ‘good’ HDL cholesterol more, so the net effect on your total blood cholesterol level is not bad at all.

However, the amount of cocoa butter used in chocolate varies, as does the amount of the stearic acid, and this information isn’t usually provided clearly on the packaging. As a rough guide, the better-quality and, as a result, more expensive varieties generally have more cocoa butter, so are usually a better choice.

Effect on blood glucose Despite the relatively high carbohydrate (sugar) content of most chocolates, they don’t have as large an impact on blood glucose levels (BGLs) as expected, unless of course you overindulge. Chocolate contains around 15 g of carbohydrate per 25 g serve (with the exception of the new stevia/polydextrose-based chocolate bars that have less than 2 g per serve), which is within the recommended range (15–30 g of carbohydrate) for a snack or dessert.

Also, the glycemic index (GI) of chocolate is low, with an average value of 45 for most local brands. This is because of the high fat content, which slows the rate that the sugars are released from the stomach into the intestine and absorbed into the blood. So overall, the glycemic load [see HHW 51, page

71] is less than 10 (low) for a typical serve of most common varieties.

So provided they don’t overindulge, people with diabetes do not have to eat low/ reduced-sugar chocolates to avoid high BGLs. But while the low-carbohydrate stevia/ polydextrose varieties will have the least effect on BGLs, they are relatively high in fat and consequently have nearly the same amount of kilojoules as regular varieties, so are not much better if you are trying to lose weight. Other kinds of alternatively sweetened chocolates usually provide less kilojoules — although they are usually more expensive and often not as tasty as sugarsweetened chocolate.

There is a good argument that you should have a little bit of what you enjoy, or, “If you really like chocolate and don’t wish to over consume the product, always choose your favourite!”

Oh, and the antioxidants!

Along with green and black tea, red wine, certain fruits (e.g. berries, black grapes, plums, apples) and vegetables (e.g. artichoke, asparagus, cabbage, russet and sweet potatoes), chocolate is one of the richest sources of a powerful group of antioxidants known as flavonoids. Flavonoids are thought to possess several properties that may benefit people with diabetes or pre-diabetes, including helping to prevent cholesterol accumulating on artery walls, relaxing major blood vessels and thus decreasing blood pressure, and maybe even reducing the ability of the blood to form too many clots. Half a row (25 g) of dark chocolate provides about the same amount of these antioxidants as half a cup of black tea or a glass of red wine. But please note: milk chocolate contains only one third as many antioxidants as dark chocolate, and white chocolate contains none at all. ♥ Autumn | Winter 2014 • Heathy & Heartwise

74

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diabetestests

What’s the BUZZ...

blood glucose meters?

Jayne Lehmann reviews the current market and glimpses what’s just over the horizon of self-monitoring.

B

lood glucose meters support people with diabetes to be actively involved in their diabetes care.They provide ‘insider information’ on blood glucose levels (BGLs) to help evaluate the impact of diet, exercise and stress as well as any diabetes medication.

The abundance of portable meters available can make it hard to decide the best suited to your diabetes and lifestyle, so the table below summarises some on the Australian market.

Jayne Lehmann, RN, is a Credentialled Diabetes Educator with EdHealth Australia: www.edhealthaustralia.com

Meters by feature Meter groups

Feature summary

Examples

Basic

Easy to use, accurate results with basic functions

AccuChek Performa II BG Star Nipro True Result SensoCard

Mini

Smaller version of the basic meter

Accu-Chek FreeStyle Freedom Lite Nipro True Result Twist

Can be attached to the strip container

Strip free

Strip-free: 50 blood glucose checks in one disposable cartridge

Accu-Chek Mobile

Subsidised use in type 1 diabetes only via NDSS

Blood and ketone testing

A meter that can check both BGLs and ketone levels using separate test strips

FreeStyle Optium

Usually only people with type 1 diabetes check their blood or urine for ketones

iPod/iPad 4 compatible

A meter that utilises the iPod/iPad 4 to display BGL results.

iBG Star

Version 5 iPod/iPads require an adapter to connect

Advanced

Supports BGL checking, advanced analysis of results and uses an algorithm to support multiple daily insulin dosing for carbohydrate consumption

Accu-Chek Aviva Expert Bayer Contour Link FreeStyle InsuLinx OneTouch Verio IQ

Designed for individuals using insulin – education session with a CDE/DE* strongly recommended before using

Talking meter

A meter with audio that prompts during the BGL check and announces result

SensoCard Plus

Useful for individuals with visual impairment or confusion

Before buying a new meter • Work out what you want your meter to do before looking at new meters • Talk to a CDE/DE about the features and meters best suited to your needs • Look for reviews of meters by other people with diabetes on the Internet • Talk to your friends with diabetes – what meter do they use and what do they like/don’t like about it?

The future of mobile monitoring Meters are being developed that let you upload and forward diabetes care information to health professionals.

The longer term will see a smart contact lens that includes a blood glucose meter and a nano-sensor inserted under the skin to record BGLs. To help choose and make the most of a BGL meter, see a Credentialled Diabetes Educator: www.adea.com.au

Special considerations

Blood glucose meters/sensors are available from Credentialled Diabetes Educators/ Diabetes Educators, diabetes consumer organisations, the local pharmacy or providers of quality health products

77 Heathy & Heartwise • Autumn | Winter 2014

diabetesnews

Fat at the cutting edge

Yoghurt curdles type 2 risk eAting About 80 g of low-fat yoghurt every day could cut the risk of developing type 2 diabetes by about 25%, a study from Cambridge University has reported.

Other low-fat fermented dairy products, such as fromage frais (a.k.a. fruche or quark) and cottage cheese, showed the same beneficial association but higher-fat dairy did not — but nor did it increase risk.

Compared to people who ate no yoghurt, people who ate the most yoghurt reduced their risk of getting type 2 diabetes by 28%, even when accounting for body weight.

Substituting yoghurt for snacks such as crisps was associated with a reduction in risk of 47%.

The Norfolk-based study compared a daily record of all the food and drink consumed over a week among 753 people aged over 40 who developed type 2 diabetes over 11 years of follow-up with 2502 randomly selected participants.

The weekly food diaries were completed in advance rather than with hindsight as in most population studies, which are criticised for overreliance on subjects’ memory.

“While this type of study cannot prove that eating dairy products causes the reduced diabetes risk, [they] do contain beneficial constituents such as vitamin D, calcium and magnesium. In addition, fermented dairy products may exert beneficial effects against diabetes through probiotic bacteria and a special form of vitamin K associated with fermentation,” added the University.

Diabetologia – online 8.2.14

Above: Add culture and set – regular consumption of fermented dairy products is associated with lowered risk of developing type 2 diabetes

FAts witHin beta cells that determine how much insulin the pancreas produces may hold the key to future diabetes treatments, say scientists at Sydney’s Garvan Institute of Medical Research.

Lysosomes inside the beta cells act as recycling units that break down unwanted fats and proteins so they can be re-used. However, when PhD student Gemma Pearson and Prof Trevor Biden of the Garvan’s Diabetes Cell Signalling Lab stopped lysosomes from breaking down fat, beta cells secreted more insulin – a crucial potential benefit for people with diabetes whose insulin production has slowed down.

“When you shift fats from the lysosome, you store them in other parts of the cell, and they become available to participate in various signalling pathways. One of these pathways clearly increases insulin secretion,” Ms Pearson explained.

“The good thing about this particular pathway is that it is only stimulated by glucose. That limits the beta cell to producing excess insulin only to deal with food, rather than around the clock.

Too much insulin circulating in the blood, or hyperinsulinaemia, can be very detrimental to health in many respects,” Ms Pearson added. www.garvan.org.au – 29.10.13, Diabetologica – 1.1.14

Dementia and blood glucose AltHougH diAbetes is a recognised risk factor for dementia, even high BGLs without a diagnosis of diabetes may increase dementia risk.

The US ACT study has been following 2067 randomly selected senior Washington citizens since the mid-1990s, with their glucose or HbA1c levels and cognitive function assessed every two years.

After an average of about seven years, dementia developed in a quarter of the group, including 450 of the 1724 participants who did not have diabetes and 74 of 343 people who did.

When BGLs for the previous five years were analysed for people without diabetes, the risk of dementia was found to strengthen with increasing BGLs. An average BGL of 6.4 mmol/L had an 18% greater risk of dementia compared to an average of 5.5 mmol/L. For people who did have diabetes, an average BGL of 10.5 mmol/L meant a 40% higher risk of dementia than an average of 8.9 mmol/L. The correlation may be due to acute and long-term hyperglycaemia and insulin resistance, and increased disease in the tiny blood vessels of the central nervous system, said the researchers.

New England Journal of Medicine 8.8.13

79 Heathy & Heartwise • Autumn | Winter 2014

diabetesnews

Blueberries best fruit to fight risk Eating morE whole fruits, particularly blueberries, grapes and apples, is associated with a lower risk of type 2 diabetes, but too much fruit juice increases the risk, suggests a long-term study of US health professionals’dietary data.

The population study of 187,382 people included more than three million years of follow-up and 12,198 of them developed diabetes over the 20 years or so that the US studies ran – an overall risk of 6.5%.

Three servings per week of blueberries, grapes and raisins, apples and pears significantly reduced risk of diabetes, and substitution of fruit juice with whole fruits other than strawberries and melons reduced risk by 7%. See the ‘Diabetes risk jackpot’ infographic for risk change if juice consumption three times a week was replaced with:

Diabetes risk jackpot 3 x blueberries

% risk change 33  19 

2 x grapes + 1 raisins

18  3 x prunes

14  2 x apples + 1 pear

13  3 x bananas

12  3 x grapefruit

11  peach, plum, apricot

8



3 x oranges 3 x melons

British Medical Journal – 29.8.13

10 

A spoonful of vinegar makes the blood glucose go down below: Acetic acid in vinegar is believed to suppress carbohydrate absorption, blunting BGL spikes

a tablEspoon of acetic acid – common table vinegar – twice daily at mealtimes reduced blood glucose levels (BGLs) in adults at risk of type 2 diabetes, a study from Arizona State University has found.

Fourteen people with diagnosed prediabetes or fasting BGL >5.5. mmol/L were given a vinegar drink containing 750 mg acetic acid or a control pill of 40 mg acetic acid twice at daily meals, and their BGLs measured before and two hours after eating.

After 12 weeks, the average fasting BGL in the vinegar group decreased 0.91 mmol/L compared to 0.26 in the control group, while hydrogen in the breath was 19% higher in the vinegar group, suggesting an increase in fermentation in the colon.

The HbA1c and two-hour BGLs were not significantly different between groups, possibly because a BGL reading 30 minutes might have been a better indicator of glycaemic control in people without diabetes, said the researchers, or it could depend on the type and amount of carbohydrate in the meal.

However, the fasting reductions were greater than those achieved by daily metformin or rosiglitazone use, which in other trials have been 0.22 and 0.50 mmol/L respectively.

Even the slight reduction in the control group’s BGLs may have been due to the trace amount of acetic acid in the vinegar pill, the authors speculated.

Acetic acid is believed to suppress carbohydrate digestion, and “Elevations in colonic fermentation as evidenced by breath hydrogen and methane measurements suggests that antigylcaemic effect of vinegar is related in part to carbohydrate maldigestion,” concluded the researchers.

Journal of Functional Foods – October 2013 Autumn | Winter 2014 • Heathy & Heartwise

78

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diabetesnews

Melbourne the centre of global diabetes action RIGHT: Melbourne Convention & Exhibition Centre

MORE THAN 10,000 local and overseas diabetes patients, educators, policy makers and health professionals from the International Diabetes Federation (IDF) met in Melbourne December last year for the largest medical congress ever held in Australia.

With more than 400 speakers and 275 hours of innovative and interactive scientific sessions, the World Diabetes Congress is the only global event dedicated to the disease, described by IDF

Diabetes direct from Mum INSULIN RESISTANCE may be ‘imprinted’ on our metabolism by our mothers between conception and birth, suggests a German study among pregnant women.

Thirteen healthy women in the last trimester of pregnancy had their blood samples assessed for insulin sensitivity one and two hours after a 75 g glucose tolerance test. Meanwhile, ultrasound observed how quickly their foetuses reacted to audio signals.

In women who were insulin resistant, foetuses took longer to respond to the auditory stimuli than in women with higher insulin sensitivity.

The researchers warned of the consequences of this ‘foetal programming’ on later life, as shown in other studies: “Compared with newborns of non-diabetic women, children of diabetic mothers with poorly controlled glycaemia show neurophysiological impairment and have a higher risk for metabolic syndrome, obesity and type 2 diabetes.”

ABOVE: Ultrasound observed foetal response to audio tones before and after mothers were given an oral glucose tolerance test

Diabetologica – online 25.3.14

81 Heathy & Heartwise • Autumn | Winter 2014

President Sir Michael Hirst as a pandemic with the Western Pacific region as its epicentre.

“It has more people with diabetes than any other region in the world, so it’s a diabetes hotspot, and the economic growth in the developing countries here means that those populations of workers have got to stay healthy,” Sir Hirst said.

Highlights from the Congress include: • The Federal Government committed to pursuing a new National Diabetes Strategy, the first since 2005. Minister for Health Peter Dutton announced the establishment of a high-level taskforce to develop the Strategy, with prevention, early detection and management key priorities.

• The Melbourne Declaration by members of more than 50 parliaments to tackle the global diabetes epidemic. The signatories have committed themselves to working across parliaments to ensure that diabetes is high on the political agenda in every country.

• An Indigenous Stream focused on the high rates of diabetes in Australian and other countries’ indigenous communities, and innovative programs designed to meet the challenge. Chair of the Indigenous Stream Prof Alex Brown said that more than half of Australian Aborigines older than 50 had type 2 diabetes, and the 15–30% overall prevalence was similar to indigenous populations across the Pacific, New Zealand, Canada and the US. • A new guideline for managing type 2 diabetes in older people was launched by IDF Vice-President and HHW diabetes expert Prof Trisha Dunning. It will support health professionals to make age- and functionappropriate care decisions for the 134 million people worldwide aged 60–79 with diabetes.

• A 10-year partnership with the Fred Hollows Foundation to tackle diabetic retinopathy [see page 67], a leading cause of blindness in people with diabetes. The partnership will pursue advocacy, health workforce development, research, technological development and community awareness. www.idf.org

diabetesnews

The figures: 1,000,000 and counting…

The Australian Bureau of Statistics (ABS) is releasing numerous reports as part of its Australian Health Survey, the largest and most comprehensive survey ever conducted nationally, which reveal fascinating detail on the challenges the community faces from diabetes: www.abs.gov.au.

The biomedical component of the Survey includes the National Health Measures Survey in which 11,000 respondents aged five or older gave blood and/or urine samples that were tested for fasting blood glucose levels and HbA1c.

Key facts during Australia 2011–12:

5.1%of adults had diabetes

But only 4.2% were diagnosed – 0.9% had blood-test results indicating diabetes, so 1 in 5 don’t even know they have it!

HALF

Almost as many more men than women are likely to have diabetes

15% 2.3% 7.5% 3.1%

Diabetes prevalence increases to 15% for 65 to 74-year-olds

of blood test results indicated they were at high risk or pre-diabetic

of people aged 55 to 74 had the highest rates of newly diagnosed cases

11.2% of obese people had diabetes compared to

4.1%

Pre-diabetes climbs with age, with 7.5% aged 75 and older most at risk

54% of people with diabetes and

39.9%

of overweight people and

who had pre-diabetes had a close relative with the condition

1.6%

of normal or underweight people

22.5%

3.1%

22.5% of people with diabetes had albuminuria, an early sign of kidney disease, compared to only 3.1% of the general population

48.6%

21.7%

31.5%

12.5%

22.5%

People with diabetes were more than twice as likely as those without diabetes to have abnormal levels of HDL 'good' cholesterol (48.6% compared with 21.7%) and high levels of triglycerides (31.5% compared with 12.5%). People who were at high risk of diabetes were also more likely than those without diabetes to have abnormal HDL cholesterol and triglyceride levels.

Autumn | Winter 2014 • Heathy & Heartwise

82

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