09Feb
Bulimia Nervosa
Rowinda DimechAdult, Children, Diets, Health

Eating Disorders – Bulimia Nervosa

Do you feel out of control around food?

Do you tend to go out of bed to binge during the night?

Do you feel uncomfortable in your body size and lack of self confidence?

 

This month we’ll continue to have a look at Eating disorders. The first blog was on anorexia nervosa and today we shall focus on bulimia nervosa. Eating disorders are affecting a lot of people worldwide. In fact, it’s are on the rise as we are living in an era where everyone became conscience about food and what they are eating. There are three main eating disorders which are anorexia nervosa, bulimia nervosa and binge eating disorders. Bulimia nervosa is especially common among adolescents and women. Boys and men tend to suffer less but unfortunately it is also on the increase.

What is the bulimia nervosa?

Bulimia nervosa is a type of eating disorder, potentially life-threatening if not taken care of. A person suffering from bulimia nervosa has binge eating episodes. A binge is when a person over-eats massive amount of food in a short period of time, usually 1 or 2 hours. Then, fear and anxiety drive the person to restrict his diet in order to prevent weight gain. In addition, a person with bulimia nervosa may resort to self-induced vomiting after eating, perform excessive exercise and use diuretics or laxatives in order to sooth his anxiety.

There are some official diagnostic criteria for bulimia nervosa, in Diagnostic and Statistical Manual of Mental Disorders V (DSM-5). These are as following:

  • Consuming an amount of food that is definitely larger than most people would eat within an 1 hour and usually in hiding
  • A sense of losing control over eating during the binge episode
  • Remittent unbecoming compensatory behaviour in order to prevent weight gain, such as vomiting, laxatives or diuretics, restricting food or excessive exercise
  • Bingeing and purging both occur, averagely, at least once a week in three months’ time period
  • Self-esteem is overly affected by physique

Unfortunately, the cause of eating disorders is still unknown but there is strong evidence that it may be caused by various factors such as family history, personality traits and environmental factors. In fact, it is well known that a person may be more prone to develop bulimia when:

  • Family members are obese or have an eating disorder.
  • Have a perfectionistic personality trait.
  • You have a job or do a sport that emphasizes body size, such as bodybuilding, modelling, ballet, swimming or gymnastics.
  • Continuously dieting or exercising in order to lose weight or change your physique.
  • Have a distorted body image or think that your body should be looking like someone else’s body.

 

Signs and Symptoms

 

Someone who suffer from bulimia nervosa may have appropriate weight for his height and age. Unfortunately, the person may still perceive himself as being too heavy and therefore wants to lose weight. Patients suffering from bulimia often display the following symptoms:

 

  • Being obsessed with body shape and weight
  • Bingeing and feeling a lack of control or inability to stop eating
  • Compulsively and excessive exercising
  • Using laxatives or diuretics
  • Self induced vomit after eating
  • Restricting calories, fasting or avoiding certain foods for periods of time

Treatment should be comprehensive and include several types of therapy. The most effective way to treat bulimia is to get a team approach which includes a doctor specialized in mental health, registered dietitian and even your relatives. There are several treatment options which are recommended which are psychotherapy, medications such as fluoxetine and nutritional management.

 

Nutrition management

 

Individuals suffering from bulimia nervosa have the tendency to be rigid, controlling, obsessive-compulsive, impulsive and extreme perfectionist. By extension they should be discouraged from sticking to rigid meal plans and rigorous exercise routines. It should be emphasized to make the meals regular and maintain satiety throughout the day to stop binging. This can be accomplished through composing a healthy, well-balanced and flexible eating plan.

Many patients may request weight-reduction meal plan, which is not recommended as further restrictions may be triggering the disease. It can contribute to the onset of binge-purge cycle. Diet should consist of breakfast, 2 main courses and 2 – 3 snacks throughout the day. The meal plan should have clear and planned structure. Patients should be thought to eat their meals regardless of feeling hunger and not to skip the meals.

 

Eating disorders such as bulimia nervosa are serious conditions which should be dealt holistically in a professional way from specialised healthcare professionals in this topic. If you think you might have this condition seek professional help immediately. If, you are concerned about your child or a friend that might be suffering from bulimia nervosa encourage them to seek help.

07Jan
Anorexia Nervosa dietitian nutritionist Malta
Rowinda DimechAdult, Children, Diets, Health

Eating Disorders – Anorexia Nervosa

Are you or your child experiencing intense fear near food?

Has eating become stressful?

Is diet hindering you from going out to meals with your friends or loved ones?

 

If, you answered one of these questions, yes, I encourage you to read this blog. This blog is dedicated to all those women and adolescents who are suffering in silence due to an eating disorder. This subject has become very special for me after 3 years working with clients suffering from this illness.

 

What are eating disorders?

Eating disorders are serious mental health illness associated with a person’s eating behaviors. This involves obsessive thinking about weight and food. This obsessive thinking may lead to the most common types of eating disorders which are anorexia nervosa, bulimia nervosa and binge eating disorders.

These conditions can have consequences such as medical issues, anxiety, depression, suicidal thoughts, growth and development problems in children. It is known that every 62 minutes a person dies from an eating disorder.

 

What is anorexia nervosa?

Anorexia nervosa is a type of eating disorder. It’s characterized by an intense fear of gaining weight and distorted perception of body image. People suffering from anorexia nervosa try to maintain their weight at the lowest possible point, by reducing food intake and/or exercising a lot. These actions contribute to a starvation mode in the body which can lead to serious medical conditions, as mentioned above.

According to the diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (DSM-V) are as follows:

  1. Restriction of energy intake relative to requirement, leading to a significantly low body weight
  2. Fear of gaining weight, becoming fat or persistent behaviour that interferes with weight gain, despite significant low weight.
  3. Disturbance in a way in which a person perceive his body weight and shape or persistent lack of recognition of the current low body weight.

 

What is the cause of anorexia nervosa?

 

The exact cause of anorexia is not known. People diagnosed with anorexia may have a bad body image and have the drive to be focused on being, ‘perfect’. They may also have the tendency to look for ways to control their lives. Unfortunately, the onset of anorexia is a combination of biology, psychology and environment aspects.

Even though it’s not yet clear which genes are responsible, there may be genetic sequences in the DNA that make some people more prone to develop anorexia nervosa. Many individuals may have a genetic tendency toward perfectionism, sensitivity and perseverance which are all features associated with this illness. On the other hand, some patients diagnosed with anorexia may have obsessive-compulsive personality features which helps to stick with such strict and restrictive diets and deny eating despite the feeling of hunger. Unfortunately, the environment also plays a role. Nowadays there is the trend to emphasize and promote thinness. Triumph and self-esteem are often equated with being thin. False body images from media like television or print media can significantly influence young people, especially teenage girls and promote the desire for thinness.

 

Symptoms and signs

 

The primary sign is apparent weight loss or very low body weight. It should be emphasized that not everyone will demonstrate the same symptoms. Appropriate early diagnosis and immediate treatment increase the chance of a positive outcome as severe malnutrition may lead to numerous physical signs and symptoms such as the following:

 

  • Extreme weight loss
  • Noticeable thinness
  • Cold intolerance
  • Low body temperature with cold limbs
  • Irregular heart rhythm
  • Fragile hair and nails
  • Amenorrhea
  • Abdominal pain and constipation
  • Dizziness or fatigue
  • Facial hair

 

Tips for anorexia nervosa

As a registered dietitian working with clients suffering from anorexia nervosa and specializing in mental health, I have a few tips that you or your child can try. Here we go:

  • Set a structured meal plan throughout the day
  • Plan your meals ahead
  • Think quality instead of quantity
  •  No food discrimination
  • Keep a food diary

If you are a parent or know someone with anorexia nervosa you can still help him out. Let’s see the do’s and don’ts.

DOs

  • Do speak and ask the person how they are feeling
  • Do encourage them to seek help from a doctor
  • Do be available for them

DON’Ts

  • Don’t discuss the subject  of food and eating around that person
  • Don’t mention anything about the way they look – not positive neither negative
  • Don’t try to insult and shame the person for his/her new eating habits

 

Anorexia nervosa is quite a challenging illness and requires professional help. If you think that you might be suffering from this illness seek help immediately. On the other hand, if you notice that your own child or friend is suffering from this disorder speak to them immediately and offer help. The early, the better. If you have any queries please contact us.

15Dec
Inflammatory bowel disease IBD
Rowinda DimechAdult, Children, Diets, Health

Inflammatory Bowel Disease

Do you feel bloating and gastro intestinal discomfort? 

Does your diet affect these symptoms?

Do you suffer from an intestinal disorders?

 

Intestinal disorders

Intestinal disorders are becoming more common worldwide such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) both in adults and children. The most common factors which may affect these conditions are stress, viral infections, alcohol consumption and poor diet. IBS might be mixed with inflammatory bowel disease, IBD, as they show quite the same type of symptoms. It is important to note that IBS is different from IBD as IBD includes chronic diseases such as Chron’s and Ulcerative Colitis.

 

What is Inflammatory bowel disease?

IBD refers to a group of bowel diseases mainly Crohn’s disease and Ulcerative colitis that cause inflammation in the various areas of the digestive tract. The cause of IBD remains unknown. It is believed that diet and stress aggravate the symptoms but are not the cause therefore it is more likely that genetics and malfunctioning of the immune system is the cause of IBD.

Crohn’s Disease

Crohn’s disease causes inflammation of the digestive tract which can be from the mouth to the anus. Usually, the inflammation part appears in patches next to other healthy tissues. This leads to various symptoms including abdominal pain, diarrhea, fatigue, reduced appetite, weight loss, malnutrition and blood in your stools according to where the inflammatory patch is in your digestive tract. Other signs and symptoms which are not so common are inflammation of the skin, eyes and joints, kidney stones, anemia, and delayed growth and sexual development in children. Crohn’s symptoms also overlaps with diverticulitis. It is also believed that Crohn’s is a secondary reaction of diverticulitis, although more research is still needed.

Ulcerative Colitis (UC)

On the other hand, UC contributes to ulcer formation in the tissues of your digestive tract mainly the large intestines, rectum, and anus. In UC the damaged areas are continuous so if the inflammation starts in the large intestine it continues till the anus. The symptoms are quite similar to Crohn’s disease. These include abdominal pain, fatigue, diarrhea, blood in stools and weight loss. Symptoms usually develop over time and sometimes can be life- threatening.

Inflammatory bowel disease complications

IBD can lead to severe consequences such as malnutrition, colon cancer and blood clots if left untreated and can become life-threatening. Unfortunately, there is no cure for IBD but current medication such as corticosteroids along with diet changes can greatly reduce the symptoms of the disease. Severe IBD may require surgical procedures to remove the damaged parts of the gastrointestinal tract. There are different surgical procedures for Crohn’s and Ulcerative colitis since they affect different parts of the gastrointestinal tract.

IBD may take a long time to diagnose. It can be diagnosed by using a combination of procedures such as endoscopy for Crohn’s and colonoscopy for Ulcerative colitis. Your doctor may also check your stool samples in order to make sure that it is not caused by an infection. In such cases, antibiotics may be prescribed. In addition, probiotics may also be recommended as they can improve symptoms although there is no concrete evidence about this till now.

Appropriate diet

Fortunately, both Crohn’s and Ulcerative Colitis can be improved by adopting the right type of diet. There are various diets which are recommended such as low FODMAP diet, Plant based diet, High fiber diet, Low residue diet, lactose- free diet and gluten-free diet. The recommended diet would be chosen based on the symptoms being experienced by the individual.

As you can see from this blog and other blogs on gastroenterology, there are various intestinal disorders. It is important that if you or your child suspects of any intestinal disorders you contact your doctor and a registered dietitian. In all intestinal disorders, food plays a role in improving symptoms and quality of life!

04Nov
Irritable Bowel Syndrome IBS
Rowinda DimechAdult, Children, Health

Irritable Bowel Syndrome

Do you suffer from bloating?

Or nausea and vomiting?

Did you change your diet to reduce these uncomfortable symptoms?

 

Intestinal disorders

Intestinal disorders are becoming more common worldwide affecting 3 out of 10 people. Irritable bowel syndrome is not a life-threatening condition and it usually affects more women than men. There are numerous factors which may cause this condition. The most common factors are stress, viral infections, alcohol consumption and poor diet. Intestinal disorders can affect both children and adults.

What is Irritable Bowel Syndrome, IBS?

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestines. This may cause bloating, cramps, diarrhea and constipation. If you have IBS you may experience only 1 symptom such as diarrhea or constipation, every 2 weeks in adults. In children, they might experience IBS symptoms during the exam period only. On the other hand, some people may have diarrhea followed by constipation on a daily basis. Dealing with IBS symptoms everyday may have a big impact on your life and in fact it can cause anxiety. Fortunately, only a small number of people suffering from IBS have severe symptoms. IBS might be mixed with inflammatory bowel disease, IBD, as they show quite the same symptoms. It is important to note that IBS is different from IBD as IBD includes chronic diseases such as Crohn’s and Ulcerative colitis.

IBS can be diagnosed after there are least 3 months period during which you experience either diarrhea, diarrhea followed by constipation, or chronic constipation. Usually, patients affected by IBS show no structural signs in the large intestines and usually have correct medical check-up results including blood test.

 

Coping with IBS

IBS is a chronic condition that you’ll need to cope with it long term, possibly a lifetime. Fortunately, mild symptoms can be prevented or treated by dietary changes, lifestyle changes and minimizing stress as much as possible. While severe symptoms can be managed with medication along with diet and counselling sessions.

The first dietary recommendation for IBS is a lactose free diet along with a low fiber diet. These types of diet are recommended during symptoms of diarrhea. If, the symptoms persist a Low FODMAP diet may be recommended by a dietitian. The word ‘FODMAP’ stands for Fermentable Oligo- Di- and Monosaccharides and Polyols. This diet minimizes the food intake containing short chain carbohydrates which are badly absorbed in the small intestine and may lead to bloating, increased gas production and also have a laxative effect.

High FODMAP products include fresh and dried fruits, fruit juices, fructose as sweetener, high fructose corn syrup, sweeteners like: sorbitol, mannitol, honey, coconut, cruciferous veggies, beans and sprouts. In addition, it’s worth considering writing a food diary including emotions, activities and environment. In certain circumstances, probiotics may also play a role in improving symptoms although there is no concrete research about this till now.

A diet for IBS can be considered quite challenging as it may be time- consuming. In addition, certain foods preferred by the person may have to be eliminated from the diet causing a psychological effect. It is always recommended that any diet changes are first discussed with a registered dietitian, especially in children as they are still growing up. Despite this challenging diet, a diet appropriate for IBS may improve quality of life by reducing intestinal symptoms, so I think it’s definitely worth to try it.

18Sep
Lactose Intolerance
Rowinda DimechAdult, Children

Lactose Intolerance

Do you suffer from bloating?

Did you every think of an intolerance?

Is lactose intolerance different in adults and children?

 

lactose intolerance

 

Lactose intolerance is a digestive disorder. It happens when the small intestines in your body is unable to digest lactose. Lactose is a type of carbohydrate which is found mainly in cow’s milk, dairy products and any food derived from cow’s milk. This lactose is broken down by an enzyme called lactase which is produced in the small intestines only. Therefore, if not enough lactase is produced you may develop lactose intolerance.

There are different severity of lactose intolerance. Some people who suffer from lactose intolerance may not tolerate any lactose in their diet completely. On the other hand some may tolerate small amounts of lactose such as from cheese.

The severity of symptoms are influenced by various factors such as lactase activity, colonic mucosal absorptive capacity, faecal bacterial metabolites, gastric emptying time and intestinal transit time. When lactose remains in the gut for a prolonged time it is fermented by the gut bacteria. This results in the production of gas leading to bloating. The most common symptoms of lactose intolerance include abdominal pain, nausea, vomiting, cramps, bloating and diarrhoea.

A clinical diagnosis of lactose intolerance can be confirmed by a dietetic assessment, lactose tolerance tests and hydrogen breath tests. Therefore, this intolerance can be identified by a registered dietitian or a doctor. The diagnosis can be done based on your symptoms and your body’s response to a reduction of dairy food products in your diet. I strongly recommend from my daily experience in this field that if you are suffering from any mentioned symptoms you don’t make a self diagnosis as the mentioned symptoms are very similar to other intolerances such as gluten intolerance, diseases such as inflammatory bowel disease, Irritable bowel syndrome and milk allergy.

Lactose- free diet

 

Till now there’s no cure for lactose intolerance. If you have lactose intolerance you can control your symptoms by making dietary changes. Lactose is found mainly in cow’s milk and dairy products such as butter, cheese, cream and yogurts. Although these are the main sources of lactose unfortunately it is also found in other foods such as powdered soups, party dips, milk chocolate, biscuits, cakes and ice- cream. These foods should be avoided according to your lactose intolerance severity. It is very important that you always check the food label before you consume food. In the food label you should check that ‘milk’ is not listed in the ingredients section. In addition, in the section ‘may contain’ or ‘contain’ section of the food label, it is good to note if milk is listed there. As a dietitian, I strongly recommend to continue eating lactose containing foods which you can tolerate so for example hard cheese such as grana contains very little lactose which a lot of people who are lactose intolerance can still tolerate and enjoy eating.

Lactose control without diet changes

Besides the dietary changes, you may also make use of lactase tablets, liquid drops or capsules that contain lactase. These replace the lactase which is unable to be produced by the small intestine. Therefore they can reduce symptoms by helping your body digest lactose found in your meals more easily. I would recommend that these lactase replacement are not used on a daily basis. But I would strongly recommend to be used for social events such as weddings so that you can still have fun and enjoy the ‘special wedding’ foods without having to make up to it later at night 😉

It is important to distinguish between lactose intolerance and milk allergy. Milk allergy is different than lactose intolerant because it is an immune response by the immune system. The symptoms experienced by a milk allergy are different than those experienced that lactose intolerance. Some symptoms of milk allergy are wheezing, itching, swelling of the lips and tongue, runny nose, loose stools and colic in babies.

This type of intolerance works the same for both adults and children. So if you or your child suffers from lactose intolerance a balanced diet including 3 portions of calcium should still be consumed. If, you are in doubt I recommend to contact us to provide you with a meal plan specifically for you, especially if you or your child suffers from other medical conditions as well.

 

 

 

28Jul
Coeliac Disease in children and adults
Rowinda DimechAdult, Children

Coeliac Disease in children and adults

What is coeliac disease (CD)?

Coeliac disease can affect both children and adults gut health. It is an autoimmune disease meaning that the immune system starts to attack healthy body tissue, in this case the small intestines. As a result, there is a chronic inflammation of the small intestinal mucosa. Patients suffering from coeliac disease have an immunologic reaction to a specific protein, known as gluten. In coeliac disease the immune system mixes gluten as a dangerous substance for the body and therefore it tries to eliminate it. When a person with coeliac disease consumes foods containing gluten the intestinal villa flattens which leads to malabsorption of nutrients.

The factors that causes coeliac disease is not entirely clear, but it seems that there is an association between genetics and environmental factors.  Coeliac disease can have the onset at any age after an individual consumes foods or even medicines that contain gluten. When left untreated, the disease can contribute to serious health problems such as iron deficiency anemia, folate deficiency, osteoporosis, malnutrition, lactose intolerance and cancer.

The most common symptoms are diarrhea, bloating, abdominal cramps, malabsorption and weight loss. Children who suffer from coeliac disease may also experience growth failure, delayed puberty and chronic fatigue. Patients affected by coeliac disease may not experience all the symptoms mentioned in fact a lot of people only experience one or two symptoms. Another disease linked with coeliac disease is Duhring’s disease. This is characterized by an extremely itchy bumps and blisters scattered mainly on forearms near the elbows, on the knees and buttocks. This happens when immunological residue that eliminated gluten from the small intestines resides under the skin causing the itchy bumps and blisters.

 

What is the diagnosis and treatment for CD?

 

If you or your child are experiencing symptoms or have a family history of disease you should speak with a healthcare professional to test for Coeliac. The test for coeliac disease is done taking a blood test, first. If, you have a positive result for gluten then a biopsy need to be carried out in order to confirm the diagnosis. It is important that if you are being tested for coeliac disease you are on gluten containing foods otherwise you will have a negative result and a misdiagnosis for coeliac disease. This method described works for both adults and children although recently in September 2019 ESPGHAN recommended that a no-biopsy diagnosis can be offered to children with coeliac who are asymptomatic.

 

If you or your child are diagnosed with coeliac disease you should change to a gluten-free diet. Sticking to a lifelong gluten-free diet reduces the prevalence of abdominal discomfort like diarrhea, constipation, gas, bloating, nausea or vomiting, gastroparesis and prolonged transit time. This diet excludes all foods containing rye, wheat, barley and any products derived from them. Alternative foods such as rice, corn, quinoa, millet, buckwheat, potato, soy, legumes and nuts are allowed on a gluten-free diet. Below are some examples of foods containing gluten which should be avoided.

Gluten containing Foods
Contain gluten May contain gluten
Cereals and flours Wheat, rye, barley, bulgar wheat, durum wheat, spelt, triticale, wheat flour, wheat bran, oat bran, semolina, couscous, malt and malted barley

 

 Oats
Bread, cakes and biscuits Bread, croissants, brioche, naan bread, pitta bread, ordinary biscuits, crackers, ordinary cakes, muffins, pizza, pastry, croutons, pancake, Yorkshire pudding

 
Pasta Fresh, dried or canned pasta and noodles

 

 Rice noodles
Breakfast cereals Wheat based breakfast cereals, muesli

 

 Cornflakes, rice cereals, porridge oats and oatmeal
Fruit and vegetables Fruit and vegetable coated with breadcrumbs or butter or flour

 

 Processed chips, mashed potatoes, canned fruit
Pulses and nuts Canned baked beans, dry roasted nuts

 
Milk and dairy products Milk with added fibre, yogurt containing cereals Coffee, tea, artificial cream, whiteners, yogurts and fromage fraise

 
Meat and meat products Meat pies and puddings , sausages, faggots

 

 Beef burgers, canned meat products, meat pastes
Fish and shellfish Fish cakes, fish fingers

 

 Fish in sauce, fish pates
Eggs Scotch eggs Egg substitutes
Desserts and puddings Macaroni milk puddings, trifle, sponge and suet puddings

 

 Ice cream, instant desserts and mousses
Fats and oils Suet
Soups, sauces and seasonings Soy sauce, mixed seasonings and spices (check label) Canned and packet soups, sauces, ketchup, stock cubes, mustard, mayonnaise, salad cream. Salad dressings, pickles and chutneys Tamari (Japanese soy sauce)

 
Savoury snacks Pretzels, snacks containing wheat, rye or barley Flavoured crisps
Preserves and spreads Mincemeat, lemon curds, chocolate, sweet spreads

 
Confectionery Sweet, iced lollies, chewing gum, toffee, chocolate

 
Beverages Vending machine chocolate drinks, Barley waters, fizzy drinks, malted milk drinks, beer, lager, ale, stout and low alcohol beers

 

 Herbal teas, cloudy fizzy drinks, chocolate powders, milk shakes and mixes sport and health drinks
Miscellaneous Ice-cream cones, wafers, communion wafers and Quorn

 

Baking powder

 

Till now a lifelong gluten free diet is the only medical treatment for Coeliac disease. A gluten-free diet manages to heal the small intestines mucosal injuries and therefore gluten induced symptoms and signs disappears. Fortunately, for future generations scientist are working on a vaccine development which induce tolerance towards gluten for both children and adults.

12May
Malnutrition Over and Under nutrition Dietitian Malta
Rowinda DimechAdult, Diets

Malnutrition Under and Over nutrition

Does malnutrition exits in Malta?

It is rare to think of malnutrition in Malta, being a developed country. Usually, when we speak of malnutrition we are more likely to think about third world countries such as Somalia and Sudan. Most probably we picture extremely underweight children with a big belly who we see on national television during a charity show. Unfortunately, malnutrition is more common than we think so let’s in more depth about this topic and check if you can relate.

What is malnutrition?

Malnutrition refers to poor nutrition due to under/over nutrition and micro-nutrient deficiencies. Undernutrition is when a person is not eating enough and might lead to stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiency. On the contrary, over-nutrition is when a person over eats which might lead to overweight, obesity and diet – related diseases such as heart diseases, diabetes and kidney problems. Individuals who are over-nourished can still have micro-deficiencies in fact around 30% of women in their reproductive age from developed countries are affected by iron-deficiency anemia.

There are various medical conditions that can lead to malnutrition. Some of which are chronic diarrhea, chronic nausea, depression, Chron’s disease, dementia and eating disorders. These conditions all lead to either poor oral intake or poor nutrient uptake. Nowadays, new studies  are also showing that people who are malnourish are also at a higher risk of getting coronavirus. Malnutrition has various signs and symptoms.

Signs and symptoms of malnutrition

 

  • Unintentional weight loss
  • Lack of appetite
  • Reduced interest in food
  • Feeling tired all the time
  • Feeling weak
  • Getting ill often and taking a long time to recover
  • Poor concentration
  • Low mood or depression
Importance of a good diet

A varied and balanced diet is essential to keep you healthy and reduces the risk of chronic diseases. A proper diet refer to adequate carbs, protein, fats, fruit and vegetables. If, you suffer from any medical conditions get in touch for a tailored made diet in order to control the medical condition. A good diet for a specific medical condition may vary a lot from that recommended to the general public. In cases such as chronic nausea it may be suggested to decrease protein intake, increase carbs and fat intake and eat frequent snacks. This example illustrates the importance of an individualized diet/ meal plan done specifically for you.

I think that malnutrition is important to treat in order to prevent illness and complications of medical conditions. In other words, having adequate macronutrients and micronutrients in the diet will make you feel much better. A good diet will also affect your mental health reducing moods swings and anxiety throughout the day. A good diet is much more than simply how you look. It will affect your relationship with yourself, your family, friends and colleagues.

19Mar
Polycystic ovary syndrome PCOS
Rowinda DimechAdult, Diets, Health

Polycystic Ovary Syndrome (PCOS)

Do you suffer from Polycystic ovary syndrome (PCOS) and you were advised to cut carbohydrates?

Are you on a keto diet because of PCOS?

What is the right diet for PCOS?

What is PCOS?

 

Polycystic ovary syndrome, known as PCOS is a hormonal condition in women involving an unbalance production of androgens, insulin and progesterone. The cause of PCOS is still unknown but it could be genetic. In our body, each hormone is responsible for a specific function. If you have PCOS your body will produce more insulin which is important to regulate blood sugars levels. In turn this will cause your ovaries to react and produce the male hormones in high levels. One of these hormones is androgen hormone which is often low in women but if you have PCOS due to the increased insulin production your androgens will be high. This may cause excessive facial and body hair. In addition, high insulin will also affect progesterone to be produced in lower amounts than needed. Low levels of progesterone may lead to irregular periods or to miss your periods for a long time.

 

What are the symptoms?

 

PCOS is associated with various symptoms due to the hormonal imbalance. Apart from the symptoms of excess hair, irregular periods and missing periods mentioned above, it also includes having acne, a lot of small cysts in the ovaries and difficulty in losing weight.

It is important to recognize the symptoms of PCOS as it can put your health at risk for insulin resistance syndrome. In other words, the metabolic syndrome. This syndrome includes risk of obesity leading to Type 2 diabetes, high cholesterol levels and high blood pressure. It also leads to a higher risk of abnormal growth of the lining of the uterus and endometrial cancer.

How is PCOS treated?

Currently, there is no cure for PCOS but it can be managed by diet and lifestyle. Maintaining a healthy weight is the main factor to control PCOS as much as possible. This can be achieved by exercise and a balanced diet. Studies show that women with PCOS benefit from 30 minutes of exercise 5 times a week as there is a strong positive correlation with cardio – metabolic outcomes.

 

What diet is recommended for PCOS?

Currently, the trend for PCOS is a low or a no carb diet. As, I previously explained in my blog about carbohydrates , carbs offer various health benefits such as energy, protects against diseases and a rich source of vitamins & minerals. So the question for a women with PCOS is: should I eliminate carbs?

The evidence suggests that a diet for PCOS should contain a low glycemic index (GI). A low GI diet is rich in fiber, a type of carbohydrate which slows digestion, proteins and healthy fats. This diet rich in fiber causes a gradual increase in blood sugar levels rather than a spike, as shown in the graph below:

 

Some examples of high fiber foods are

  • Wholegrain bread
  • Wholegrain pasta and rice
  • Wholegrain cereals such as oats
  • Fruit
  • Vegetables

Studies  show that women with PCOS had an improved menstrual regularity when they followed a low GI diet as less blood sugar spikes improved insulin sensitivity. It is important to highlight that a low GI diet does not mean a low carb diet. It still means that 50% of your calorie intake should come from carbohydrates for proper metabolic and brain function.

In conclusion, the recommendation for a PCOS diet is high fiber carbs, lean proteins and healthy fats. So the good news is that you can still enjoy plenty of tasty carbs but choose high fiber ones. In addition, exercise can also moderate insulin levels. The minimum daily exercise recommendation is 30 minutes of any type of exercise which you love to do.

20Jan
Milk and breast cancer
Rowinda DimechAdult, Diets, Health, Nutritonist

Milk and Breast Cancer

Does dairy cause breast cancer?

Should we eliminate dairy from our diet, especially women?

Is it better to use alternative milks like soya milk?

 

What is the evidence about milk and breast cancer

I encounter lots of women who have a ‘phobia’ for dairy and dairy products. I can understandably empathies with all women who worry about this issue. This reason being because the internet is full of misinformation about milk. Apart from the misinformation on the web, there are also published studies that drinking dairy milk is associated with cancer. One particular study  was published in the International Journal of Epidemiology that concluded that drinking dairy milk is associated with a greater risk of breast cancer by 30%. In this study, dairy products as such cheese and yogurt don’t appear to have any effect on breast cancer.

This type of research is known as an observation study. This describe and potentially identify a correlation between milk intake and the rate of breast cancer occurrence in women. The problem with observation studies is that they don’t identify a cause and effect. Therefore, its aim is to direct scientists to ask the right questions and conduct proper studies. Observational studies are not intended to be used to inform clinical decisions for dietitians. In other words these studies cannot guide us on what to eat or not to prevent cancer. In nutrition studies, researchers use food frequency questionnaires and diet recall methods to find out what subjects are eating. This is because a person who drinks soya milk could have been eating more fruit and vegetables. While people who consumed dairy milk could also consume junk food on a regular basis. Therefore, their diet wasn’t measured in terms of quantity and quality.

 

What is the evidence about soya milk and breast cancer?

In addition, I frequently hear women say that they consume soya milk as it is ‘healthier’ than dairy milk. Evidence on the relationship of soya and breast cancer are very limited. In other words, more research is needed for conclusive evidence whether soya increases or decreases the risk of breast cancer.

In both cases, the research is inconclusive but there is a lot of strong evidence about other foods which prevent the risk of having cancer such as fruits and vegetables. In addition, milk is important for its calcium intake for strong bones, teeth and Vitamin D synthesis.

Recommendations

Till now, from the thousands of studies assessing the relationship between dairy milk and breast cancer we cannot conclude that there is a relationship. Some studies found that there might be an increase in risk, some found no relationship at all.  Other studies suggested that dairy milk is protective against breast cancer. This means that more research studies need to be carried out as it is concluded in a systematic review  published in The American Journal of Clinical Nutrition.

In conclusion, I would strongly suggest to stick with the current evidence based recommendations of having 3 portions of dairy products per day. These could be 1 glass of milk or alternative milk such as soya, yogurt and cheese. In addition, always try to include fruit and vegetables for their anti-oxidant properties. Also, don’t forget to exercise and keep fit for maximum immune system function and well-being.

05Nov
Kidney stones prevention dietitian nutritionist Malta
Rowinda DimechAdult, Diets, Health, Nutritonist

Kidney Stones Prevention

A healthy diet can directly reduce your risk for kidney stones. There is plenty of information on the web that is incorrect and not scientifically proven. This has led to misinformation and confusion about what a healthy kidney stone prevention diet should be.

What are kidney stones?

Kidney stones forms from a high concentration of calcium and oxalate in the urine which combines to form calcium oxalate. In other words, these two substances binds together to form kidney stones. Urine that is too acidic increases the risk of calcium oxalate kidney stones. Calcium and oxalate are more likely to bind in acidic environments. So, the kidney stone diet aims to increase urine pH to reduce the risk that calcium and oxalate will bind.

 

7 nutrition tips for kidney stones prevention
  1. Drink lots of fluids

The first diet goal for kidney stones prevention is to drink more fluids. The more urine you pee, the less concentrated calcium and oxalate there will be. As a result, it is less likely that a kidney stone will form. It is recommended to drink about 3L of fluid per day. Your daily fluid requirement may be different based on your body size, environment, gastrointestinal health and exercise schedule. Always seek advice form a dietitian about what is your fluid requirement. Drinking too much fluids can also lead to other health problems such as oedema. The best beverage choice is water and drinking 3L of tasteless fluid can be challenging for some people. Making water more “exciting” can help quite a bit. This can be done by infusing fruits or herbs with water in order to add a very lovely flavour without adding many calories or sugar.

  1. Limit Salt (Na)

Eating lots of salty foods will increase urine calcium and the risk for kidney stones. The extra calcium in the urine due to a high salt diet comes from our bones, putting them at risk of osteopenia. In addition, a high sodium diet is associated with increased blood pressure, which increases the risk of all sorts of health problems like kidney disease, heart disease, stroke and dementia. It is important to note that the majority of the salt we eat is already hidden in food. So, simply avoiding salt will not reduce sodium to our goal for most people. The key to a low sodium diet is to choose foods that are low in sodium in the first place. In other words, this means cooking with fresh, non-processed ingredients. Restaurants, commercially prepared and to-go foods are usually high in salt.

 

  1. Moderate amount of protein

A high protein diet will increase the urine calcium. In addition, high protein diets produce acid during metabolism. This acid is eventually excreted in our urine, which lowers urine pH and increases the risk of kidney stones. Similar to sodium, the extra calcium in urine from a high protein diet is taken from bone, putting the bones at risk of osteopenia.

  1. Eat enough Calcium

Calcium is a critically important piece of the kidney stones prevention diet. Previously, doctors told people with kidney stones to reduce calcium and dairy. This seemed to make sense since one of our goals is to reduce urine calcium.

However, we now know about the importance of calcium in stopping oxalate absorption in the intestines. Similar to how oxalate loves to bind with calcium in our kidneys and make kidney stones, they love to bind in our intestines as well. So, if calcium binds with oxalate before it is absorbed, the oxalate is excreted in our feces, instead in our urine. Studies have shown nearly a 50% reduction in kidney stones by adding dairy to the diet along with the low sodium and moderate protein considerations. It is important to note that for the latter to happen, we need to eat calcium when we eat oxalate so make sure to eat dairy with meals.

In addition, a diet high in calcium is critical for bone health. People who have a history of calcium kidney stones are more likely to experience bone fractures and weak bones. This makes sense, as all of that extra calcium in your urine comes primarily from breaking down bone.

 

  1. Reduce added sugars

Too much sugars in your diet will increase urine calcium. Therefore, sugar will increase the risk of kidney stones. In addition, high sugar intake is associated with an increased risk of heart disease and diabetes. Make sure to check the nutrition facts label for added sugar, as well as sodium. Try to find products with as little added sugar as possible. And, save sweet desserts for special occasions. Swap out ice cream after dinner for a lower sugar frozen yogurt or fruit.

  1. Reduce food containing oxalate

Reducing oxalate in the diet is perhaps the trickiest part of the kidney stone diet. Firstly, oxalate information found online is often conflicting, which results in frustration for people trying to follow a low oxalate diet. Foods which are high in oxalate include spinach, almonds, bran, rhubarb, raspberries and potato with skin.

  1. Eat fruit & vegetables

The final nutrition tip is to eat plenty of fruits and vegetables. How many? Aim for at least 2 servings of fruit and 3 servings of vegetables per day. Eating fruits and vegetables is associated with reduced risk of hypertension, heart disease, stroke, cancer and gastrointestinal conditions. For kidney stones specifically, they help make our acid less acidic in urine. Therefore, it is less likely to form calcium oxalate from an acid urine.

Putting all the pieces of a healthy kidney stone diet can be overwhelming so always seek the help of a dietitian. A dietitian will guide you step by step for a kidney stone diet so that it becomes relatively easy and healthy for you. Lastly remember that this diet will reduce your risk for kidney stones and further medical complications.

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