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autumn 2015 vol 56

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3 night s resort at Cypress la , hu ke see p nter valley s age 1 2 night 1! s at Ga i a Retrea & SpA, t t w see p eed shire! age 6 4!

The 2015

flu why you

Maggie Beer cooking up an

need your shot now

appetite for life Fermented, SOAKED & smoked foods

do they ‘activate’ health or leave it in a pickle?

recipes

a harvest of seasonal produce from Teresa Cutter, Matthew Evans and more best-selling chefs

Will superfood supplements save you? All about ➤ interval training $7.95

Why everything’s coming up coconuts How technology is changing health www.heartwise.com.au 3 FREE

Autumn 2012

30-day trial of our app! see page 13

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 chris beer MBBS, BBioMedSci, FRACGP, MACNEM, Cert IV Fitness As a GP who practises nutritional and integrative medicine, Cris has developed expertise in not just treating illness but helping her patients achieve optimum health. Preventive health and lifestyle medicine, hormone balance, weight loss, fatigue and sleep disorders, digestive and women’s health are among Cris’s interests. She is also qualified in personal fitness training, acted as health consultant for The Biggest Loser Retreat and currently practises on the Gold Coast at The Medical Sanctuary: www.drcris.com.au

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

his issue of Heartwise comes to you in deep, double-faced mid-autumn – alternating between savage gales that dump rain for days and chilled, still air so powder-dry that leaves curl and eyes smart with rediscovered dryness – our new GP Dr Chris Beer [see left; and no relation to the marvellous Maggie on our cover and interviewed on pages 14–15] has some tips to counter this on page 28. Yes, it was only weeks ago that we were sweating and complaining about humidity, and in a few weeks it will seem that we never felt anything but cold and accustomed to the comfort of indoors, layers and soups. I've already had my cold, I keep telling myself between spasms of expectoration, acquired over Easter when the weather was similarly wild. And it can't have been flu because there was no leaden ache and lethargy, and ‘it isn’t time yet’ – the flu vaccine has only just become available, and time is needed after a shot to build immunity for peak flu season in June or July [see page 16]. But like any dodged bullet, we tend to live another day to worry about what's around the corner. Heart patients feel this more acutely after their cardiovascular event, resulting in the anxiety that Rosemary Harris explores in her article on page 36, and the clarity of rational understanding can help. Hence in this issue a series of ‘Heart2Heart’ features commences [see page 44], which explain simply the common forms of heart disease that present to cardiologists and how they are evaluated and treated. Thanks to technology, it’s a lot easier than the days of ‘zipper club’ open-heart surgery, and a regular ‘healthy technology’ section also begins with this issue on page 26, where Dr Victoria Wade shows that the future of online, real-time consultations is already here and has been saving and improving lives in South Australia for some time. Added to the potential for selfmonitoring of health that devices such as smart phones and watches hold [see page 19], our health is ever more in our hands.

STEVEN CHONG

Autumn 2015 • Healthy & Heartwise

healthy &HEARTWISE Editor Steven Chong steven@healthpublishingaust.com.au

Publisher Alistair Begg drbegg@internode..on.net

Advertising Nicole Prioste nprioste@bigpond.com P 0410 618 331

subscriptions info@isubscribe.com.au P 1300 303 619

Creative Wetdog Design steve@wetdog.com.au

promotions & distribution Emily Rundle emily@healthpublishingaust.com.au

Cover vol 55 – ita buttrose Channel 10

Printing Webstar ISSN 1833-8798

Editorial Correspondence PO BOX 863 POTTS POINT NSW 1335 E editor.heartwise@gmail.com W www.heartwise.com.au www.facebook.com/healthyandheartwise Contributions are welcome. Copyright © 2015. The opinions expressed by authors do not necessarily reflect the policy of the Publisher. All material in this magazine is provided information only, and may not be construed as medical 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 magazine is 20,000 CAB audit pending.

6 We hear you – letters page 7 Health alert – hot news briefs 43 Well read & watched – media reviews 67 Health on the shelf

On the cover 14 Maggie Beer's new project aims to make mealtimes in aged care facilities feel more like a feast for the senses

Healthy living 16 A quick shot in the arm can nip this year’s flu in the bud 28 If autumn has left you feeling dry and brittle, Dr Cris Beer has some refreshing advice 40 Dr Emmanuel Varipatis gives you the push required to leave Planet Smoking

Healthy women 20

Heart disease is an insidious killer of more women than breast cancer

real life health story 21

How new technology let Chris Russell go from a cold wet shock to a panel seat on ABC TV’s The New Inventors

healthy eating 22 Pickling, smoking, soaking and fermenting – does it preserve health as much as it can food? 42 Stars are in our aisles, guiding us to healthier food choices 49 Chef's chats with Matthew Evans and Teresa Cutter, plus 21 arresting autumnal recipes, including a spread on preserves and conserves

Healthy technology 26 Dr Tori Wade explains how telehealth can get you medical attention without you having to leave home

Healthy medicines 30 Pharmacist Gerald Quigley answers questions on celery for water retention, garcinia for weight loss, superfood shakes and steel-cut oats

Healthy & Heartwise • Autumn 2015

contents Healthy shopping 32 A cornucopia of coconut products has defined our decade’s food tastes but defied decades of conventional dietary wisdom

Healthy travel

34 Novotel Twin Waters Resort on the Sunshine Coast 38 Flying north for the winter? Heart patients can go long haul safely with just a little extra forward planning

healthY MIND 36 Anxiety, guilt, hypersensitivity and morbid thoughts are all commonly managed emotions after a heart event

heart2heart 44 A new section on heart conditions, starting with the most common: coronary artery disease 48 The drugs that lower high blood pressure are discussed with pharmacist Daniel Scandrett-Smith

22 dealing with diabetes

69 Medications that lower blood glucose levels 70 A healthy appetite depends on how two hormones mix Nerve damage – the long71 term complication from poorly managed diabetes 73 Is the humble egg a white orb of deadly cholesterol or a good start to the day? 75 Lifestyle change treats newly diagnosed type 2 diabetes 77 Take advantage of the cooler weather to get more active 78 Caring for an older person with diabetes 79 How to save your sight from the effects of hyperglycaemia 81 Diabetes news Autumn 2015 • Healthy & Heartwise

healthy &HEARTWISE Editor Steven Chong editor.heartwise@gmail.com

Publisher Alistair Begg drbegg@internode.on.net

Advertising Nicole Prioste nprioste@bigpond.com P 0410 618 331

subscriptions info@isubscribe.com.au P 1300 303 619

Creative Wetdog Design steve@wetdog.com.au

promotions & distribution Emily Rundle emily@healthpublishingaust.com.au

Cover vol 55 – ita buttrose Channel 10

Printing Webstar ISSN 1833-8798

6 We hear you – letters page 7 Health alert – hot news briefs 43 Well read & watched – media reviews 67 Health on the shelf

On the cover 14 Maggie Beer's new project aims to make mealtimes in aged care facilities feel more like a feast for the senses

Healthy women 20

Heart disease is an insidious killer of more women than breast cancer

real life health story 21

How new technology let Chris Russell go from a cold wet shock to a panel seat on ABC TV’s The New Inventors

Healthy technology 26 Dr Tori Wade explains how telehealth can get you medical attention without you having to leave home

Healthy medicines 30 Pharmacist Gerald Quigley answers questions on celery for water retention, garcinia for weight loss, superfood shakes and steel-cut oats

Healthy & Heartwise • Autumn 2015

contents Healthy shopping 32 A cornucopia of coconut products has defined our decade’s food tastes but defied decades of conventional dietary wisdom

Healthy travel

34 Novotel Twin Waters Resort on the Sunshine Coast 38 Flying north for the winter? Heart patients can go long haul safely with just a little extra forward planning

healthY MIND 36 Anxiety, guilt, hypersensitivity and morbid thoughts are all commonly managed emotions after a heart event

22 dealing with diabetes

letters Have your say about

We hear you! combine with uric acid and calcium to form growths. To prevent it reoccurring, I have to drink at least a litre of water, and avoid green leafy vegetables like kale, beetroot, carrots, asparagus, rhubarb, mushrooms, strawberries, berries and nuts – in fact, just about all my favourite foods! I’ve always had too much of a good thing! I have adjusted my diet and can still enjoy a good meal: fish, meat, dairy foods,

FRUIT & VEGGIES formed CORAL IN MY KIDNEYS! I am 72 and accustomed to people’s disbelief because I look so fit and healthy (well, a bit overweight, but I’m tall and get away with it!). Recently I asked my doctor about a persistent dull ache across the small of my back. She sent me to a physio, but it didn’t disappear, so I had an MRI. My back was okay but a very large kidney stone showed up. That was my first shock. And it wasn’t a neat stone, sterile, like many people happily live with, but a ‘staghorn’ that looks like coral, was silently taking over my left kidney and housed bacteria. My marvellous urologist pulverised it in two operations. Then came the second shock. All the healthy

foods I had enjoyed over the years (some of which I grow for freshness) had high levels of oxalates to protect them against intruders. They don’t harm the majority of people but with my type of metabolism, they

TED DOWLING Cardiac Rehab Nurse Specialist, East Perth, WA

www.facebook.com/ healthyandheartwise

 Healthy & Heartwise, PO BOX 863, POTTS POINT NSW 1335

Letters published next Heartwise (Winter vol 57) will receive one of the following great prizes: Kambrook Pressure Express digital pressure cooker – with modern one-pot technology, foods cook more quickly, saving time, money, nutrients and flavours. This versatile appliance has a RRP of $119.95 and can also sauté and slow cook with pre-set programs for perfect results each time.

Congratulations to these readers whose feedback Kambrook’s Size Select bread maker – select the desired bread was published this issue: setting, switch the timer on and wake up the next morning to

Ted Dowling wins Dr LeWinn’s Miracle Radiance Renewal Serum valued at $69.95 RRP and Day Cream Moisturiser valued at $49.95 RRP.

ANN HOWARD North Sydney, NSW

Thank you for the magazines sent to Derbarl Yerrigan Health Service’s Heart Health Program last week – all our group went home with smiles. With about 80% of our Aboriginal group having diabetes, it was appropriate reading and greatly appreciated.

If you have a health story you would like to share with HHW, contact us at:

Winners!

bananas, coconut and so on. And the good news is I can drink red wine/Guinness – I didn’t tell them about my whisky! But seriously white wine is no good – like grapes, high in oxolates. I thought it good to share with you because I had never heard of a ‘staghorn’ or oxalates and had no sign anything was wrong with my kidney except backache.

READ IN RED OUT WEST

Write in & WIN!  editor.heartwise@gmail.com  www.heartwise.com.au

healthy &HEARTWISE

Ann Howard wins a Vitamix Total Nutrition Center valued at $995 and a Vitamix flask, Vitamix Real Food Movement Celebrity Recipe Book and The Blender Girl Cook Book.

Healthy & Heartwise • Autumn 2015

the warmth and aroma of fresh homemade bread. The Size Select has a RRP of $99.95 and can create specialty loaves, pizza bases, sweet breads and even jams and chutneys. Australian Organic food pack – worth RRP $60 in products bearing the Australian Certified Organic Bud logo. Like more than 14,000 products, they have been audited from paddock to plate to ensure they are free-range, cruelty-free, non-GM, biodiversity-friendly, sustainably fished/farmed AND free from synthetic pesticides, herbicides, hormones and antibiotics.

letters Have your say about

TED DOWLING Cardiac Rehab Nurse Specialist, East Perth, WA

www.facebook.com/ healthyandheartwise

 Healthy & Heartwise, PO BOX 863, POTTS POINT NSW 1335

Ted Dowling wins Dr LeWinn’s Miracle Radiance Renewal Serum valued at $69.95 RRP and Day Cream Moisturiser valued at $49.95 RRP.

ANN HOWARD North Sydney, NSW

If you have a health story you would like to share with HHW, contact us at:

Winners!

READ IN RED OUT WEST

Write in & WIN!  editor.heartwise@gmail.com  www.heartwise.com.au

healthy &HEARTWISE

Ann Howard wins a Vitamix Total Nutrition Center valued at $995 and a Vitamix flask, Vitamix Real Food Movement Celebrity Recipe Book and The Blender Girl Cook Book.

Healthy & Heartwise • Autumn 2015

the warmth and aroma of fresh homemade bread. The Size Select has a RRP of $99.95 and can create specialty loaves, pizza bases, sweet breads and even jams and chutneys. Australian Organic food pack – worth RRP $60 in products bearing the Australian Certified Organic Bud logo. Like more than 14,000 products, they have been audited from paddock to plate to ensure they are free-range, cruelty-free, non-GM, biodiversityfriendly, sustainably fished/farmed AND free from synthetic pesticides, herbicides, hormones and antibiotics.

healthalert

Eat ζreek to halve heart risk Anyone can follow the Mediterranean diet and enjoy its health benefits, including men and women of all ages and levels of health, say Greek researchers conducting a 10-year study of it. Adults who most closely followed the diet of fresh produce, whole grains, legumes, nuts, fish, olive oil and moderate red wine were found to be 46% less likely to develop cardiovascular disease (CVD) compared to similar people who were less faithful to it. Most previous research on the universally praised diet has focused on middle-aged people but the Attica Study at the University of Athens studied 2500 local adults aged 18 to 89 for a decade from 2002. “Because the Mediterranean diet is based on food groups that are quite common or easy to find, people around the world could easily adopt this dietary pattern and help protect themselves against heart disease with very little

cost,” said Evaki Georgousopoulou, an Attica Study researcher who noted that urbanisation over the past 40 years meant more Greeks were adopting a Western diet. Nearly 20% of the men and 12% of the women developed CVD and although women usually stuck to it better, regardless of risk factors – such as being male and older, family heart history, low education, smoking, hypertension, diabetes, high inflammation and high cholesterol – adherence remained protective, and even more so than exercise.

Adults who most closely followed the diet...were found to be 46% less likely to develop CVD...

www.acc.org

Statins lower cholesterol – but raise diabetes risk! A population study in Finland has shown a strong association – a 46% increased risk – between the use of cholesterol-lowering medication (statins) and developing diabetes. Several studies since 2008 have shown 10–48% increased risk but usually involved people predisposed to heart disease (itself often linked with raised blood glucose) or lacking a confirmed diagnosis of diabetes. This study looked at the risk of type 2 diabetes and statins’ effects on insulin resistance and glycaemic control in 8749 non-diabetic men. After six years and accounting for the men’s age, exercise level, body mass index, waist measurement, use of tobacco, alcohol, antihypertensive [see page 48] and diuretic medication, those treated with statins were nearly half more likely to develop diabetes

46% increased risk of developing diabetes from the use of statins

2 hours after taking a statin, blood glucose levels significantly increased

than men not on statins. Moreover, the higher the dose, the greater the risk. Two hours after taking a statin, blood glucose levels significantly increased. Insulin sensitivity decreased by 24% and its secretion by 12%, and in greater amounts with higher doses. These effects probably drove the increased diabetes incidence, said the researchers. The authors stressed that while the size of the study makes their conclusions reliable, their subjects were all Caucasian men, so further research was needed to apply the findings to other populations. However, a long-term study of 153,840 postmenopausal US women in 2012 had found a similar level of increased risk regardless of race, age, obesity status or type of statin. Diabetologia 2015;58:1109–17, Archives Intern Med 2012;172:144–52 Autumn 2015 • Healthy & Heartwise

healthalert

Vitamin K

kind to older women Vitamin K, a nutrient we need from the diet in tiny amounts that play a major role in blood clotting, is the latest since vitamin D to be reappraised by science. Like ‘sunshine vitamin’ D, it appears in a few forms: K1, which is abundant in kale and other green leafy vegetables; and K2, which our gut bacteria make from meat and fermented foods. A Dutch study published in February found that 244 postmenopausal women who took daily vitamin K2 supplements

(180 mcg) for three years had significantly less stiffening of their arterial walls than similar women given placebo. In fact, carotid arteries that were stiff at the start of the study became more elastic. The same group of women also lost only a third of the bone mineral density (BMD) that those taking placebo lost, so reducing their risk of osteoporosis, and lost significantly less height in the middle of the spine. Several earlier studies suggested vitamin K may help prevent osteoporosis but more recently, its relationship with cardiovascular health has been explained. A 2013 study found the blood levels of vitamin K1 in 296 people with advanced artery calcification (hardening) were low (<1 nmol/L) compared to healthy people. Low serum vitamin K1 was significantly associated with calcified arteries in people taking antihypertensive medication [see page 48]. Higher K1 levels were also associated with improved recall of past personal experiences (episodic memory) in healthy men and women 70 or older in a 2013 Canadian study. And an analysis of blood samples collected from 110 healthy people suggested that most of all ages may be lacking vitamin K. The recommended daily allowances for the nutrient is based on it ability to clot blood and is set too low to delay osteoporosis and vascular calcification in adults over 40, suggested the Netherlands researchers. In March, a controlled trial in 82 pre-diabetic Iranian women reported 1000 mcg supplemental K1 over four weeks improved glycaemic status and insulin sensitivity. Thrombosis Haemostatis 2015; Osteoporosis International 2013;24:2499–507; American Journal Clinical Nutrition 2013; 98:197–208; Neurobiology of Aging 2013;34:2777–83; Food & Function 2014;5:229–34; Eur J Clin Nutr 2015

Don’t get mad, get even-tempered Sudden fury can kill and its victims are not just other people, cardiologists at Sydney’s Royal North Shore Hospital have found. People who experience intense anger – from ‘very angry, body tense, clenching fists or teeth’ up to ‘enraged, out of control, throwing objects’ – are nearly nine times more likely to have a heart attack within two hours, the doctors reported in a study with the University of Sydney. More than 300 patients who were admitted to emergency with heart attacks, mostly men with an average age of 58, were surveyed about the feelings before the onset of symptoms. Arguments with people including family, and work and road anger were the most common triggers for the rage that led to sudden

Healthy & Heartwise • Autumn 2015

blockages from ruptured plaques in coronary arteries in seven of the patients. Stress reduction training and avoiding situations that usually provoked severe anger could be preventive steps, or taking aspirin or a beta-blocker when angry or just prior, could protect people, suggested the researchers. Acute anxiety within two hours also was associated with increased risk of a thrombosis.

European Heart Journal: Acute Cardiology Care 2015; online 23 Feb

healthalert

Softening soft drink sales

Autumn–Winter

HEALTH CALENDAR MAY Crohns and Colitis Awareness Month 65 Roses Month – cystic fibrosis 1 White Shirt Day – ovarian cancer research 1–3 Shine a Light on Road Safety 3–9 Heart Week – Move More, Sit Less! Motor Neurone Disease Week Tourette Syndrome Awareness Week 10 World Lupus Day 11–17 National Volunteer Week 16 hae day – hereditary angiodema 17 World Hypertension Day 17–23 Food Allergy Awareness Week 20 World Autoimmune Arthritis Day

Sugar consumption in Australia, the US and the UK is dropping as public concern about its effects on weight and health grows, a number of sales reports by the food and beverage industry show. The ‘soft drink ‘ segment (carbonated drinks; cordials; bottled water, tea and coffee; sports and energy drinks; and juice) has continued to grow in size, volume and value globally overall – driven largely by the Asia-Pacific, Middle East and Africa. However, the largest category of sweetened fizzy drinks (e.g. Coke, etc.) is shrinking in Australia and US consumers are abandoning them for carbonated bottled (and coconut – see page 33) water, while retail sugar sales in the UK declined dramatically in 2014 and are forecast to fall 13% over the next five years. Until 2012, sales in the UK had surged, driven by a surge in home baking but this trend turned in 2013. From 2007 to 2015, the number of Australians drinking carbonated soft drinks in an average week dropped from 59% to 47% – Coca-Cola Amatil’s beverage earnings dropped a fifth just in 2014. Sugar-added iced tea products are the smallest category but grew the most in 2014, sometimes because of marketing as ‘healthy’. Since 2013, the Cancer Council, Diabetes Australia and the Heart Foundation have driven the ‘Rethink sugary drink’ campaign to tax sugar-sweetened drinks and restrict their sales and marketing to children.

24–30 Kidney Health Week National Palliative Care Week Macular Degeneration Awareness Week 25 World Thyroid Day 28 Australia’s Biggest Morning Tea – cancer 29 White Wreath Day/Sock it to Suicide 31 MS Walk + Fun Run World No Tobacco Day JUNE Bowel Cancer Awareness Month 1–7 Thyroid Awareness Week Heart Rhythm Week 11 On Your Feet Australia – heart disease and diabetes 14 World Blood Donor Day 14–20 Refugee Week 15 World Elder Abuse Awareness Day 15–21 Men’s Health Week 17 Red Apple Day – bowel cancer 21 Motor Neuron Disease Global Day 22–28 World Continence Week 29 World Scleroderma Day Stay in Bed Day JULY Eye Health Awareness Month Dry July – teetotalling for cancer 6–12 Sleep Awareness Week 12–18 Diabetes Awareness Week 20–26 National Pain Week 28 World Hepatitis Day

www.ausfoodnews.com.au; rethinksugarydrink.org.au

Autumn 2015 • Healthy & Heartwise

healthalert

Painkillers killing heart patients? Ibuprofen an other nonsteroidal anti-inflammatory drugs (NSAIDs) taken in combination with blood-thinners after a heart attack may be causing more heart risk and events instead of preventing them, a new study has found. Drugs that prevent blood clots forming, such as low-dose (75–100 mg/day) aspirin or clopidogrel, are often prescribed to patients after a heart attack or surgery [see page 46], and often they also take NSAIDs (of which aspirin is one type, although usually at higher doses) to ease pain. A nationwide survey of 61,971 Danish adults on anticoagulants recovering from their first heart attack found that at least 34% of them filled at least one NSAID prescription (in Australia they are available over the counter). After an average of 3.5 years, nearly a third had died, another third had another heart event and 5288 experienced bleeding. The probability of people on anticoagulants bleeding was roughly double if they also took

NSAIDs, and another heart event was 30–40% more likely. This link persisted despite the type of antithrombotic treatment or NSAIDs, or duration of their use, and the researchers advised caution to doctors prescribing NSAIDs for patients who’d recently had a heart attack. Similar results were found last year when the same researchers looked at patients with atrial fibrillation (AF), the most common form of cardiac arrhythmia where the heart rate speeds up and can cause a clot to form [see HHW55, pages 40–41]. When AF patients were prescribed anticoagulants to prevent stroke and also took a NSAID even in the short term, they had a significantly increased risk of bleeding and clotting, and especially when they took more than the recommended minimum dosage. “Until we know more about this issue, people with AF who are using a prescription drug to prevent stroke should use NSAIDs only when they believe the drugs are necessary,” the researchers warned patients. Journal of the American Medical Association 2015;313(8):805–14, Annals of Internal Medicine 2014;161(10):690–8

Helping heartache after heart attack New information resources have been developed for people recovering from a heart attack or surgery who often experience anxiety, depression or an emotional rollercoaster between both states. ‘Cardiac Blues’, a take-home information leaflet for patients and a guidebook and online training for health professionals, is designed to normalise the distress that cardiac patients experience and to alert them to the ‘red flags’ that can signal ongoing difficulties [see also HHW54, pages 16–17] and serious depression. Mental health advocacy group

beyondblue funded the development of ‘Cardiac Blues’ by the Heart Research Centre in Melbourne. The have been distributed to over 600 centres

10 Healthy & Heartwise • Autumn 2015

including all cardiac rehabilitation programs, coronary care units, cardiothoracic units and Medicare Locals across Australia. “These resources will help in two ways. They will support patients through normal emotional adjustment, and they will encourage patients at risk of depression to get help early,” said Dr Barbara Murphy, CEO of the Centre. “This is imperative because patients with ongoing depression are at increased risk of another heart attack and premature death.” www.heartresearchcentre.org

healthalert

When gut feelings bug you Microbes in our intestines can determine our moods and potentially our mental health and psychology, an emerging strand of research is revealing. Probiotics (e.g. brewer’s yeast used in Vegemite and the lactic acid species in supplements, yoghurt and other fermented foods; see pages 22–24) could thus in future be used to help prevent depression. The correct balance of gut microbes is becoming recognised as integral to proper gastrointestinal and immune function – but now it is thought to greatly affect the brain and behaviour, through both direct communication with nerves and hormones and nutrients they derive from what we eat. More than 90% of the ‘feel good’ brain neurotransmitter serotonin is made in our guts, its production stimulated by gut microbes, and in turn it affects immunity. Animal studies have shown that introducing specific bacteria can increase serotonin levels and reduce anxious and depressive behaviour, and an exciting recent Dutch study has trialled a combination of probiotic bacteria in humans.

Several Bifidobacterium and Lactobacillus species were given daily to 20 healthy adults without mood disorders for four weeks, while a control group received placebo the same time. When compared to the control group, supplemented people showed a much weaker tendency to react negatively when their mood changed normally – they were significantly less likely to mull over their unhappiness (ruminate) or become aggressive to themselves or others, reactions usually associated with depression. Multispecies probiotics might therefore be a useful future preventive strategy against depression, concluded the researchers. Cell 2015;161:193–4, Brain, Behavior, and Immunity; online 7 April

A diet fit for your genes

Caring about continence

Since the mapping of the human genome, the promise of identifying which foods and medicines best match our individual digestive systems and metabolisms has moved from theory to a commercial reality with easily available genetic testing. A survey of 9000 people in nine European countries has found that the public is receptive to the potential of nutrigenomics – the science of the interaction between nutrients and our

To draw attention to the plight of the 2.7 million unpaid carers of 140,000 Australians with incontinence, the Continence Foundation of Australia (CFA) will launch ‘Tell someone who cares’ nationally during World Continence Week of June 22–28. The campaign is supported by Carers Australia and outlines available support services in a carer guidebook, dedicated web pages and short videos on the CFA website. These include a National Continence Helpline (1800 33 00 66) staffed 8am to 8pm weekdays by continence nurse advisors who can help with information and referrals.

genetic makeup – to be the “next big thing in our fight against lifestyle-linked diseases,” said Lynn Frewer, professor of Food & Society at Newcastle University, UK. A US trial has also shown that using data from genetic testing to tailor diets motivates people to follow them more attentively. Healthy people aged 20–35 years received either personalised DNAbased dietary advice or general dietary recommendations for 12 months about their intake of caffeine, vitamin C, added sugar and sodium. There were no significant changes to either group’s diets at three months but by 12 months, people who were told to lower their salt intake because they had a gene for hypertension had made significant cuts compared to the general advice group, and the proportion of people who met the goal of 1500 mg/day almost doubled. PLoS ONE 2014;9:e110614, e11266

12 Heathy & Heartwise • Autumn 2015

continence.org.au

healthy HEARTWISE

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coverstory

Maggie

Beer The full

flavour

The ‘country cook’ who became a culinary legend introduced the Barossa’s pheasant, quince and verjuice to Australian households, and products bearing her name are a byword for originality and quality. Maggie Beer explains a philosophy guided by taste and flavour. HHW Your energy and stamina are legendary

and don’t seem to be slowing – how do you keep it up? Do you exercise or have any injuries or weak spots you have to watch? maggie Having just turned 70, I’m well aware of the years I’ve spent on my feet! But I do love walking along the roads where we live in the Barossa – it never feels like exercise but of course it is. Walking, either before or after my day, always helps to recharge me, so I try to incorporate that into every day no matter where I might be. HHW ‘Gourmet’ is still often associated with expense and rich or fatty food. Do you ever feel pressured to offer low-fat products? maggie Because my whole journey with food

14 Healthy & Heartwise • Autumn 2015

has always been based on what my palate deems delicious, I’ve never felt pressured to include low-fat options as part of my range, simply because I don’t choose to eat them myself. I’ve always gone with the notion of having a moderate serve of something closer to its origins, rather than looking to an altered, reduced-fat version. HHW The Maggie Beer Foundation promotes better food in the residential aged care sector, which you’ve said should follow more a lifestyle than medical model. People who have a heart or diabetes risk factor are also advised medically on diet and told tinned or frozen foods are okay nutritionally.What is your feeling around this?

coverstory maggie I’m driven by flavour, seasonality, balance and natural foods.Tinned and frozen foods may be nutritious but flavour is always my measure.

maggie Beef is a wonderful autumn meat, as is pheasant if you can source it, and partridge.

HHW You were one of the first Australian ‘foodies’ to champion fresh, seasonal and locally grown produce.The message is often heard now but at the same time globalisation and the pace of life has made fulfilling it trickier. Buying imported or takeaway food can be cheaper or easier – how do we prevent ‘local and ripe’ becoming an elite privilege? maggie The first thought that springs to mind is to have a veggie patch! Anything homegrown will always be cheaper and healthier than bought produce, but I’m also aware this isn’t an option for everyone, so the ever-increasing amount of local farmers’ markets is wonderful to see become part of our regular shopping options. Local produce is bound to be fresher because of the limited distance it is required to travel but there are things I can’t live without that don’t or can’t grow in my region.When we talk of‘low food miles’ we should keep that in context.There are also some ‘better for you’takeaway choices than others, and I think that’s what it’s all about, adding in the good things each day, rather than getting too caught up in what we’re doing wrong. The more we make good food choices, the better we feel and the less inclined to look to convenience as the deciding factor. We use flavour as our benchmark and we support Australian farmers or we risk our food security.

of verjuice, a medieval condiment similar to vinegar but gentler, when a winemaker helped you produce it from unsold grapes in 1984. Other traditions use crab apples and lemons. Have you considered these or cumquats? maggie I have often thought about different ways of making verjuice, but for me it always comes back to what we have on hand, and grapes are aplenty in our line of farming. So, for equal measures of providence and flavour, I keep returning to the tradition of grape-based verjuice.

HHW The Cook and the Chef TV

Maggie’s favourite • Red wine Pheasant Farm Homeblock Shiraz • Cookbook author Stephanie Alexander • Exercise Walking and Pilates • Film Babette’s Feast • Jewellery Pearls

show paired you with the Hilton’s executive chef Simon Bryant and brought your ideas and energy into households the nation over.What were the most valuable lessons you learnt from Simon over the four years? maggie Simon has so much passion for what he does but never lets things get overly serious to the point he forgets to enjoy himself. We had the same philosophy about produce, which confirmed so much in which I believed. I value his generosity in sharing his producers and his ability to explain the science of food in such an approachable way – and his cheekiness of course… HHW Autumn must hold special meaning to someone who grows produce because it’s the traditional harvest and food-preserving time. Are there any meats, however, we should be making more use of?

HHW You’re credited with the modern revival

HHW You’ve also promoted extra-virgin olive oil, particularly from the Barossa Valley. Does the method of pressing also matter and is it the best all-purpose cooking oil to use? maggie I couldn’t be without good extra-virgin olive oil in my kitchen, so for me it is the best all-rounder unless making mayonnaise, which calls for something milder in flavour.We take the pressing of our olives very seriously – there is nothing better than extra-virgin olive oil the moment it’s crushed. I’m always present as the first olives go through, and I check the oil is just as I like it: beautifully balanced flavour and such freshness in colour and aroma. HHW Lemon myrtle, macadamias, avocados, persimmons etc. were once obscure or exotic but became cash crops. Now we are seeing starfruit, dragon fruit, etc. Is too much introduced produce bad for our ecosystem? maggie The most important thing to me is working with the climate and that includes planting plants in regions where both the climate and water supply are naturally compatible. When you list the plants above, the only indigenous one is the macadamia and lemon myrtle. All others have been introduced. HHW How is your Foundation going? maggie My full efforts have been given to

the establishment and ongoing impact of my Foundation over the last year and I’m so excited by the results we are already seeing. The Foundation only began in May last year and we started green and idealistic. At times it seems a slow burn when there is so much you would like to do but the joy and energy has come from finding so many people doing wonderful work in so many fields and the ability to share ideas so we can all do things better. It’s intoxicating to continually learn! ♥ Autumn 2015 • Healthy & Heartwise

healthyliving

Theandflu you The vicious flu epidemic that swept America this year has already migrated to Australia for winter, and now is the time to vaccinate, says Dr Alan Hampson.

T Dr Alan Hampson, OAM, BSc, MSc, MD(Hon), FASM, is a virologist and Chairman of the Influenza Specialist Group

he urgency to get your flu shot this year has never been greater – not only has the 2015 influenza strain been more deadly than usual but rollout of the vaccine has been delayed, leaving you less time to get immunised. It won’t be until 20 April that it will be available from your GP – and pharmacist if you’re in South Australia – a month later than usual because two new flu strains different to those in the 2014 version have been added to the vaccine. Delays in manufacturing and testing the upgraded vaccine have also affected distribution. Although local supplies are available earlier, they are made by bioCSL and should not be used in children younger than nine due to risk of seizure.

What’s different in 2015 This year’s seasonal flu virus is similar to those of the past in terms infectiousness, onset, symptoms and appropriate treatment. The main strain this year in the US is an H3N2 influenza, which hits older adults and young children particularly hard (it has killed more than 100 kids and hospitalised about three seniors per 1000).

Cold v flu – know the difference Although ‘cold and flu’ medications lump the two infections together, they are very different beasts. Knowing the difference can help you avoid or treat each better and recover sooner. COLD

FLU

From more than 200 viruses

Type A or B; H3N2 is a subtype of A

Children can get up to 8/year

30% of children get flu each season

Adults get 2–3/year – more if parents of school-age children

Only 10–15% of adults get it each season

Symptoms in ear, nose and throat; slight aches; mild tiredness

Symptoms severe – muscle aches, high fever/chills, headache, dry cough and deep fatigue for weeks

Flu vaccine will not prevent

Vaccine protects against three types of flu, may reduce severity

16 Healthy & Heartwise • Autumn 2015

The vaccine used in the US was not that good a match for the circulating virus, however, and did not stem the epidemic well. The time lag for the H3N2 to reach peak incidence in Australia allows a small opportunity to update the vaccine. Vaccination should occur a few months before the H3N2 flu becomes prevalent. In temperate Australia, infection tends to increase in May and June then peak until September but it isn’t totally predictable. Northern Australia often sees a surge in cases in March or April, so the NT government recommends shots earlier.

Who needs a needle? Except for young children, people ‘at risk’ are not necessarily more susceptible to catching flu but will more likely get seriously ill if they do. You should seriously consider vaccination EVERY year, and are entitled to it free under the flu program, if you are: • 65 years and older • living with heart, respiratory/lung, kidney, neurological and immune-related diseases and diabetes • pregnant • indigenous and aged between 6 months and five years or over 15. Obese people and smokers are not eligible for free shots but should get vaccinated because they are more likely to suffer serious outcomes and appear to be more susceptible to infection.

Safety It used to be thought some medicines such as warfarin interact with flu vaccines but studies haven’t borne this out. ♥

healthyexercise

Fads or the

future? Craig Cheetham reviews high-intensity interval training and fitness apps, plus other devices that have gripped the exercise market. Do they help or hinder health?

Craig Cheetham is Director – Cardiovascular Care WA; Adjunct Lecturer, School of Sports Science, Exercise & Health, University of WA; President, WA Cardiovascular Health and Rehabilitation Association; and Exercise and Sports Science Australia’s 2012 National Exercise Physiologist of the Year

ike food and dieting, the exercise and fitness industry has seen many passing fads, from celebrities with fitness videos and training methods in the 80s to evolving exercise machines or equipment promising faster or better results. Usually, the adage ‘If it sounds too good to be true then it probably is’ stands! However, in fitness the winner remains the individual who is participating in anything where their arms and/or legs are moving for extended periods. Any exercise is good exercise, with the guarantee that it will improve fitness and function. The real question is whether it provides optimal outcomes. When considering which exercise is best for you, there is a need to establish a difference between achieving fitness versus achieving health. For decades it was thought there was a

18 Healthy & Heartwise • Autumn 2015

need to get fit because evidence shows that on average, people who are fitter live longer and have less health complications. However, further research shows that it is not fitness but more the number of days per week and the regularity of exercise that is the main contributor to better health. Because as you expect, those who exercise more often are also more likely to be fitter than those who exercise less. This is important when considering the merits of some of the recent exercise trends.

High-intensity interval training Some claim this technique only requires exercise three or four minutes per day! The basis of high-intensity interval training (HIIT) is to perform three or four very high-intensity and almost maximal bouts of exercise for one or

healthyexercise two minutes, two-to-three times each day. The evidence suggests that HIIT will increase fitness, support weight loss, release fats in the bloodstream and increase the uptake of blood glucose. However, there remains a lack of evidence to support HIIT influencing long-term health, whether it can generate the same benefit that regular lightto-moderate intensity exercise delivers, or whether people can persist with it long term. We can only extrapolate the findings reported occurring immediately after exercise or over a period of a few weeks to suggest HIIT will have a favorable benefit to health outcomes. But many experts are sceptical, thinking HIIT can improve fitness but not health. If you have or are at risk of heart disease or diabetes, HIIT could introduce a risk of adverse events during bouts of intense activity. Recently I coauthored a review of HIIT that found it was associated with four times more adverse events compared to traditional lightto-moderate, extended forms of exercise. It can also cause or contribute to joint/muscle pain. Therefore I would strongly encourage you to seek expert/medical opinion before engaging in HIIT if you have had a previous medical condition.

Fitness apps and devices are a good fad

Making exercise healthy ♥ E xercising most (five) days of the week has been shown to get most of the health benefits related to exercise – six or seven days will only get you minimal additional benefit. ♥ Achieving 30 minutes on these days is ideal – longer will achieve only minimal additional improvement. However, your goals may influence your planned duration, e.g. for weight loss or blood glucose control, longer bouts may achieve better results. ♥ Accumulating 30 minutes/day in blocks of a minimum of 10 minutes may achieve almost as much benefit as 30 consecutive minutes, new evidence suggests. ♥ Some is better than none – even five minutes still derives benefit. Similarly, once or twice per week yields better outcomes than if you don’t exercise at all. ♥ Consider your joint and muscle health while exercising – musculoskeletal pain is the most common reason people stop or don’t start to exercise. ♥ Don’t forget to measure – it will help you set goals, achieve the targets associated with improving health and keep you motivated to continue.

I would hate to suggest that all fads may not be beneficial or worth exploring. Currently devices can be worn that track activity, calorie expenditure, sleep, heart rate and other variables, as well as the volume, intensity and frequency of exercise. These can play an instrumental part in maintaining people’s activity levels, helping manage goal setting and meeting target measurements. Researchers have known for years that the moment you routinely take measurements for an individual, the increased monitoring improves health outcomes through the placebo effect. The value is in measuring. If we measure we get feedback that will then guide us to achieve either favourable or unfavourable consequences. The devices and apps of today do all this conveniently and relatively cheaply. Even better, some can compare your activities with friends or groups, another strategy that helps you maintain exercise levels. Fads of this nature that embrace new ways of doing things can be very advantageous. ♥ Autumn 2015 • Healthy & Heartwise

♥ healthywomen

y d La lers! l i K

The

experience different symptoms to men. Although men and women can experience the typical warning signs of a heart attack such as chest pain, a recent study reported a range of specific symptoms experienced by women within a month prior to their heart attack: • 71% felt unexplained or unusual fatigue • 48% had sleep disturbances • 42% experienced shortness of breath • 39% suffered indigestion • 35% felt anxiety. The study also highlighted that women and healthcare professionals often dismissed these symptoms as being signs of stress or part of normal ageing. Many women also tend to put off having their heart health checked because they feel that caring for their families is the number one priority, and making healthier lifestyle changes is too difficult.

Why and what you can do

It isn’t men, breast cancer or dementia but heart disease that stalks most women to their deaths. Nurse Practitioner Kathryn O’Toole tells them the truth they need to know.

ardiovascular disease (CVD) has been recognised as a major threat to the health of Australian women. This includes coronary artery disease [see page 44], stroke [see HHW55, page 24] and heart failure. In 2010, over 4800 women died of a heart attack. Every year CVD kills approximately 11,000 women – four times more than breast cancer. And risk factors for CVD are very common among Australian women, e.g.: • more than half are overweight or obese • almost half have high blood cholesterol • about three-quarters are inactive physically. But many women don’t know about this peril and too few take preventive action to lower their risk of heart attack or stroke.

Subtle symptoms dismissed as stress or age A disparity between men and women in treatment for CVD has been shown in research, which may have arisen because women usually

20 Healthy & Heartwise • Autumn 2015

ways 7 to win a woman’s

heart health 1. Be aware of your blood pressure and cholesterol profile 2. Maintain a healthy weight and waistline 3. Be physically active every day 4. Limit alcohol to one drink/day 5. Limit salt and processed foods 6. Quit smoking 7. Eat a healthy balance of fresh food groups

The risk of CVD seems to increase for women after menopause because decreasing levels of the hormone oestrogen leads to lowering of high-density lipoprotein (protective HDL cholesterol) and increases in low-density lipoprotein (harmful LDL cholesterol) levels. Therefore, it is essential women have a cardiovascular risk assessment completed by their healthcare professional. So knowing your risk of having a heart attack or stroke is the first step you can take. To get a realistic idea, follow-up the preliminary checks below and then the seven steps (left): 1. Have a heart-to-heart about your cardiac risk with your doctor who can arrange an electrocardiogram if necessary 2. Know your numbers – blood pressure, blood cholesterol profile, fasting glucose level, body mass index and waist circumference 3. Ask your healthcare professional about changing your lifestyle behaviours, such as smoking, alcohol consumption or being physical inactive. ♥ Kathryn O’Toole is a Nurse Practitioner and Director of the Cardiovascular Prevention & Rehabilitation Service SA in Adelaide: www.cprsa.com.au

li fe

reallifehealthstory ♥

re al

Instant expert help ETAMI stands for Early Triage after Acute Myocardial Infarct. Equipped ambulances can transmit the 12-lead ECG and other vital signs direct to the cardiology team at a major hospital, resulting in an immediate ‘on-site’diagnosis by the interventional cardiologist, followed by the option of direct transportation to theatre for the potential use of an angioplasty and stent to resolve the blockage [see page 47]. There was no need for an Chris with wife Gillian at Sanctuary Cove intermediate assessment at the nearest hospital. Coupled with the highly professional rehab program run from Sydney’s Royal North Shore Hospital (RNSH) after the heart attack resolved, ETAMI made the difference of not just survival but minimisation of heart damage. This means maximum enjoyment of my lifestyle now. At the recent 10-year anniversary of ETAMI, Professor Greg Nelson, Head of Cardiology at RNSH, reported that the ETAMI program had saved an average of 100 minutes in the resolution of a heart attack, and saved or improved the lives of hundreds of people within range of a hospital with an on-call cardiology team.

Mortality is a fearful thing! Chris Russell was healthy and enjoying boating when he had his heart attack. But with luck and new ambulance technology, a remote location was no barrier to rescue and expert intervention. Chris Russell is an agricultural scientist, former judge on ABC’s The New Inventors, and Ambassador for Heart Research Australia: www. heartresearch. com.au

t 51 I was a fit, non-smoking, outdoor-living former rugbyplaying, ex-military agricultural scientist – and going to live forever based on my health self-assessment aged 25–35! But in 2004 I fell into some very cold water in the Hawkesbury River and my world suddenly became a lot more finite and my mortality very apparent. Scary stuff! The cold shock had contracted my hardened coronary arteries into ‘fight or flight’ mode and the main right-hand one cracked, with a resultant clot some 10 mm long in a 5 mm diameter artery. Happily, Heart Research Australia had just the month before funded a trial of the now almost ubiquitous ETAMI system into a select few NSW Ambulances. One of these was within 10 minutes of me. Scary turned lucky!

Research, hope and charity None of the life-saving ETAMI would have been in place without funding from Heart Research Australia from the donations of thousands of ordinary Australians. It’s only one of a multitude of projects that this not-for-profit funds each year. Shortly after my heart event, I became a judge on ABC TV’s New Inventors that ran until recently – another role I enjoyed thanks to the quick resolution of the heart attack. Every week we examined and judged the best inventions from around Australia, from tin openers to gearboxes to air-powered cars. It showed me that innovation and research is key to turning life’s road blocks into speed humps. ETAMI is a great example: simple Aussie inventiveness resourced by simple Aussie generosity that gave me back my life to the fullest and will save many more to come. Through my second chance at life I have come to truly appreciate that ‘There is no present like time!’ ♥ Autumn 2015 • Healthy & Heartwise

healthyeating

An act of food preservation Home pickling, fermentation, activating, soaking, smoking and curing of foods are attracting new enthusiasts. Are they just more foodie fashions or are there real health benefits – or increased health risks? Milena Katz investigates.

he past five years have seen a throwback to days departed where smoking, soaking and fermenting foods has become much more popular – at least among the health conscious. Many culinary traditions throughout Europe, Asia and the Indian subcontinent have involved fermenting vegetables into dishes such as kimchi and sauerkraut for centuries in home kitchens. Smoking, a process that has flavoured and preserved meat and fish for whole populations before the advent of

22 Healthy & Heartwise • Autumn 2015

cheap and accessible refrigeration, has become trendy with an explosion of smoked foods and even restaurants that only serve smoked meals. But what about the health effects? Do we know enough to make an informed food choice when making a comparison with other cooking methods [see table, right]?

Smoking and curing – the ancient arts of preservation restored Smoking and curing are often performed together because smoking a meat or fish can reduce the amount of salt required to eliminate bacteria. Epidemiologists first noticed a connection between the consumption of smoked foods and stomach cancer in the 1960s. Japan, Russia and Eastern Europe have performed a lot of research in this area because smoked foods are staples. Combusting wood, gas or charcoal emits chemicals called polycyclic aromatic hydrocarbons (PHA). Nitrogen from

healthyeating

Milena Katz, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney

COOK METHOD

meat mixes with these to form nitrated PHAs. Exposure to these has been shown to cause various cancers in lab animals. Over the last decade there has been research to show that cured meats (not fresh red meat) is linked to elevated bowel cancer rates. Researchers found that deli meat, salami and ham should be limited in the diet and preservatives like nitrites are not healthy for human health. Frying and browning can produce dangerous compounds called acrylamides that are known to cause cancer. Acrylamide forms when starches and amino acids are exposed to high temperatures, so even without smoking foods, cranking up the heat to cook may not be a good idea. When burnt, fat in meat also form toxic furans and dioxins. The more salt-cured foods that people have, the more sodium they are consuming and this can potentially elevate blood pressure.

Fermentation rises again When microorganisms that naturally occur in food (e.g. bacteria, yeast or fungi) convert the carbohydrates within a food into alcohol or acids, fermentation occurs. For example, lactobacilli bacteria turn sugars and starch into lactic acid and yeast converts sugar into alcohol. Home preserving and pickling has enjoyed a resurgence with many people consuming fermented foods such as sauerkraut, miso, keffir and yoghurt to add microbes to the gut which promote a good balance of bacteria. Fermentation can help make foods more digestible, e.g. when milk is fermented into yoghurt, the milk sugar lactose is broken down into glucose and galactose, which are simple sugars that lactose-intolerant people can digest. Fermentation also extends the shelf life of products because lactic acid, alcohol and vinegar inhibit microbial activity within food that causes it to putrefy and decay. This includes

PROCESS

EFFECTS ON FOOD

HEALTH PROFILE

Roasting, baking, grilling

Hot (≥150°C) dry air browns surface of food – enhanced by convection/fan-forced ovens that circulate air

• Browning of carbohydrates and amino acids together is caused by the Maillard reaction that creates complex flavours and aromas • Kills bacteria, extends shelf life

• Form furans, dioxins and acrylamide, which cause cancer and should be limited • The Maillard reaction occurs slowly in our bodies at lower temperatures, especially in diabetes, activating inflammation

Boiling

Foods are cooked in rapidly bubbling liquid, most often water

• Best for high-cellulose (fibre) foods that • Boiling leaches some water-soluble vitamins into the boiling liquid so it is a good idea to take longer to digest and can endure high heat and agitation of boiling water: include the cooking liquid as part of the meal e.g. soup or stew potatoes, pasta, rice, greens, carrots, broccoli, pumpkin and cauliflower

Pressure cooking

Steam from boiling water or liquid cooks food in a sealed vessel

• Quicker than other cooking methods, which saves energy and time • Uses less water than boiling

Poaching

Food simmered in hot (not boiling) liquid

• Varying lengths of time required to kill bacteria • Gentler than boiling but takes slightly that may be on the raw food longer – cover pan to minimise liquid loss • Good for delicately structured foods e.g. • Nutrient loss may be greater than for boiling because of extended time fish, eggs and fruit

Frying

Food cooked in oil or fat

• Many foods can be fried, with the fat medium transferring heat and flavours, especially during deep frying

• Saturated oils and solid fats such as copha and plain vegetable oil affect cholesterol levels and are high in energy

Steaming

Steam transfers heat to food

• Subtle tastes retained but steam and subsequent condensation can degrade texture of some foods

• Considered the healthiest because most nutrients retained

Smoking

Foods exposed to burning plant matter, e.g. wood, to preserve and flavour them

• Smoke doesn’t usually penetrate far into food but adds flavour from burnt material • Helps seal meat and fish and prevent new bacteria colonising and spoiling

• By-products from burning wood, gas or charcoal combine with nitrogen in meat to form potential carcinogens

Salt, nitrites, nitrates and/or sugar added for flavour and preservation

• Salt or sugar draws water from within the food to outside and inserts salt or sugar molecules into food interior • Nitrites and nitrates add pinkish colour to food

• Microorganisms are dehydrated by the preservation medium • Some people are intolerant to nitrites and have adverse reactions. Higher salt intakes are linked to elevated blood pressure

Curing

• Reduced cook time has been shown to preserve more water-soluble nutrients than boiling, steaming and roasting • May increase digestibility of proteins and grains, seeds and legumes

Autumn 2015 • Healthy & Heartwise

healthyeating

Everyday preserved food products

Slowcook food on lower heat, limit smoked and cured foods and enjoy fermented products regularly, especially dairy ones. Keep an eye on the amount of salt in your food too!

Smoked and/or cured

Fermented

• Ham and bacon – often smoked for flavour and almost all have nitrites added • Salmon, mackerel, other oily fish – gravlax is salmon treated with salt, herbs and spices but not smoked • Kippers – herrings that are split, salted and smoked • Corned beef, biltong and jerky – usually salted with sugar and spices added • Sausage, salami and frankfurters contain nitrites and nitrates

• Bread – yeast ferments sugars in flour to form carbon dioxide and alcohol. Carbon dioxide is the raising agent that creates air holes and most of the alcohol is destroyed during baking • Sauerkraut, dill pickles and kimchi – vegetables mixed with salt or brine, then the acid produced by lactobacilli inhibits microbial growth and spoilage. Supermarket pickles have had vinegar (fermented alcohol) added • Kefir – fermented, slightly alcoholic milk drink that resembles runny yoghurt. Produced with a lactobacilli bacterial culture • Miso, tempeh and soy sauce – fermented soybean products. Added bacteria and fungi help break down phytic acid and enhance flavour

pickles, cheese, salami and wine. Fans of fermentation claim it can cure poor digestion, improve lethargy and boost the immune system. However, fermented foods’ main contribution is live probiotic ‘good’ bacteria to our guts. Strains of lactobacillus and bifidobacterium bacteria are the most commonly used probiotics – found in most commercial yoghurts – because they can survive the acidity of the digestive tract.

Are your nuts activated? Activated nuts became nationally famous in 2012 when chef Pete Evans revealed he included activated almonds in his diet. However, vegans and other food traditions have long soaked legumes and sprouted seeds – think of chickpeas or kidney

24 Healthy & Heartwise • Autumn 2015

beans – to reduce cooking time. The activation process requires nuts to be soaked in water for up to 12 hours. This is thought to deactivate phytic acid in nuts, which binds important minerals such as zinc, calcium and magnesium and prevents you digesting them. Like sprouting wheat, barley, mung beans or alfalfa from damp cotton wool, soaking nuts and seeds triggers the germination process – converting starches to simpler sugars and protein to simpler amino acids, making them and other nutrients more bioavailable. The research to date on this effect of soaking is only for legumes and beans, not nuts and seeds. After soaking, the nuts are dehydrated at low temperatures (40°C) until they are crisp. ♥

healthyeating

22 Healthy & Heartwise • Autumn 2015

healthyeating

Milena Katz, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney

COOK METHOD

PROCESS

EFFECTS ON FOOD

HEALTH PROFILE

Roasting, baking, grilling

Hot (≥150°C) dry air browns surface of food – enhanced by convection/fan-forced ovens that circulate air

• Browning of carbohydrates and amino acids together is caused by the Maillard reaction that creates complex flavours and aromas • Kills bacteria, extends shelf life

Boiling

Foods are cooked in rapidly bubbling liquid, most often water

Pressure cooking

Steam from boiling water or liquid cooks food in a sealed vessel

• Quicker than other cooking methods, which saves energy and time • Uses less water than boiling

Poaching

Food simmered in hot (not boiling) liquid

Frying

Food cooked in oil or fat

• Many foods can be fried, with the fat medium transferring heat and flavours, especially during deep frying

• Saturated oils and solid fats such as copha and plain vegetable oil affect cholesterol levels and are high in energy

Steaming

Steam transfers heat to food

• Subtle tastes retained but steam and subsequent condensation can degrade texture of some foods

• Considered the healthiest because most nutrients retained

Smoking

Foods exposed to burning plant matter, e.g. wood, to preserve and flavour them

• Smoke doesn’t usually penetrate far into food but adds flavour from burnt material • Helps seal meat and fish and prevent new bacteria colonising and spoiling

• By-products from burning wood, gas or charcoal combine with nitrogen in meat to form potential carcinogens

Salt, nitrites, nitrates and/or sugar added for flavour and preservation

• Salt or sugar draws water from within the food to outside and inserts salt or sugar molecules into food interior • Nitrites and nitrates add pinkish colour to food

• Microorganisms are dehydrated by the preservation medium • Some people are intolerant to nitrites and have adverse reactions. Higher salt intakes are linked to elevated blood pressure

Curing

• Reduced cook time has been shown to preserve more water-soluble nutrients than boiling, steaming and roasting • May increase digestibility of proteins and grains, seeds and legumes

Autumn 2015 • Healthy & Heartwise

healthyeating

Everyday preserved food products

Slowcook food on lower heat, limit smoked and cured foods and enjoy fermented products regularly, especially dairy ones. Keep an eye on the amount of salt in your food too!

Smoked and/or cured

Fermented

24 Healthy & Heartwise • Autumn 2015

♥ healthytechnology

Telehealth A your heart Technology has transformed lives and it can help save them. Telehealth conquers the tyranny of distance and Dr Victoria Wade has pioneered its use in South Australia. 26 Healthy & Heartwise • Autumn 2015

lthough surgery, procedures and physical examination will always be physical,telehealth can be used for initial assessment, follow-up and management. There are several different types of telehealth – the best known is video consultations where you talk with a medical specialist onscreen, and it can be claimed through Medicare if you live rurally. Hands-on work can be done with a GP or practice nurse who attends the video consultation with you at the local practice. Telehealth includes sending photographs or X–rays digitally and sending data or symptom reports from personal devices.

Lives saved in South Australia Telehealth has been used for several years in South Australia to help rural GPs and hospitals.

healthytechnology ♥ When a patient comes to a country hospital with chest pain, the information from their ECG is sent to a roster of cardiologists in a city where it can be read straight away, plus the cardiologist on call can give immediate advice. Essential blood tests can be done on the spot and the hospital can give clot-busting drugs quickly. The death rate from heart attacks in rural parts of South Australia has halved over the past 12 years, and has now come down to be the same as the death rate in the city. This is a major advance that should be introduced nationally.

Rehab can be reached After a person has had a heart attack, they can improve their health outcomes by going to rehabilitation sessions but these are usually held at larger hospitals and not everyone can attend. Only about 20% of patients who would benefit from rehab actually get to a program. Home telehealth can solve this problem – a combination of text messaging, telephone and linking patients to local resources has been shown to work very well to help people safely resume exercise and make the important changes to diet and lifestyle after a heart attack. Video consulting is also very useful for following-up patients after they’ve left a city hospital. For rural people, an outpatient appointment can mean several hours of driving for a 10-minute visit, so having a video consultation at the local general practice both saves time and helps keep the local doctor updated. One cardiologist says he would rather do follow-up visit this way than have the patients come in, because having the patient, the nurse and (if needed) the GP together at the same time led to better communication.

Self-monitoring signs and symptoms It is now relatively inexpensive to buy a device to measure blood pressure at home.Telehealth transmits the results directly from your device to your healthcare provider. Reminders can be programmed if you haven’t sent in any measurements for a while or alert you if your results are too high or too low.This has been shown in research to lead to better control of blood pressure. People with heart failure can measure their weight and send it daily to clinicians to watch out for sudden weight gain – a warning that their heart is struggling. If detected early, it can be managed with an increase in fluid tablets, preventing a hospital admission. Research trials in these areas are underway in Australia, which might lead to more uptake of home telehealth.

telehealth virtues

In children and in smartphones

• Increases access to care – for those who live remotely, have disabilities and/or are older • Eases health workforce shortages by cutting travel time and spreading specialists’ expertise more widely • Delivers care directly to the home – particularly helpful for people with chronic conditions

Telehealth can be used for very specialised areas of heart health, such as in children’s heart disease.This has not been done much in Australia but in Canada and rural US, children with a hole in the heart or other types of congenital heart problems are having part of their care delivered by telehealth. This can be of great benefit to parents, particularly in reducing the disruption to family life from ongoing specialist attention.To make this possible in Australia, we would need more technicians in rural areas able to do the specialised cardiac imaging tests. As the cost and availability of technology comes down, the opportunities in healthcare increase. Many devices are a fraction of the cost from even five years ago, and mobile phones and tablet computers are playing a greater role in all types of telehealth. ♥

Tori Wade, BSc, DipAppPsych, MPsych, BMBS, PhD, FRACGP, is Senior Research Fellow at the Discipline of General Practice, The University of Adelaide and Clinical Director, Adelaide UniCare e-Health & Telehealth Unit Autumn 2015 • Healthy & Heartwise

healthyliving

A fluid situation

Dehydration isn’t just a midsummer risk but a potentially fatal condition to which the medicated, active and ill are vulnerable all year round. Mouth, eyes and skin are the first to suffer and the Heartwise editorial panel’s new GP Dr Cris Beer explains how to keep your membranes moist.

E Chris Beer, MBBS, BBioMedSci, FRACGP, PT, is a holistic GP, personal fitness trainer and health coach practising on the Gold Coast, QLD

ven if your part of the world wasn’t left parched at the end of summer you might very well be without quite realising, as individuals’ body surfaces naturally and efficiently lose moisture when exposed to dry air. This is more noticeable in less humid locales and in people taking certain medications that also cause dehydration, including for blood pressure (hypertension; see page 48), bladder and prostate conditions, hay fever and other allergies, and some antidepressants. The areas of the body that suffer particularly with dryness include skin surfaces and the mucous membranes, namely the eyes, mouth and nose. Drying out of these areas not only feels uncomfortable but can cause a flare-up of long-term skin conditions such as itching (pruritus) and eczema; difficulty swallowing food (dysphagia) and bad breath in the case of dry mouth; and eye surface abrasions interfering with vision and leaving your eyes feeling itchy, inflamed or gritty.

Rehydrate and re-irrigate The following strategies reflect general approaches to providing relief from dryness. Skin moisturise regularly with fragrance-free creams or emollients. Avoid hot showers that further dry the skin and pat rather than rub yourself dry, if at all – applying moisturiser to wet skin tends to ‘seal’ in more water and a tip for eczema sufferers is to moisturise within three minutes after showering.Wear gloves when

28 Healthy & Heartwise • Autumn 2015

washing dishes and clean hands with gentler soaps made for dry/sensitive skin, or soap/ alcohol-free cleansers. Of all the supplements, only fish oil has shown some benefit for eczema. Mouth drink water regularly throughout the day and avoid excessive amounts of alcohol. Tea and coffee were once thought diuretic but once you have developed caffeine tolerance they cause minimal issues with dehydration. If mouth dryness is particularly severe because you don’t produce enough saliva to chew your food well, an alcohol-free, enzyme-based mouthwash from your pharmacy can help. Waking up with a dry mouth can be due to dehydration or medication but also mouth breathing while sleeping – itself a possible sign of allergies or sleep apnoea [see HHW55, page 71], both of which can be managed. Eyes Paradoxically, the most common sign of dry eyes is profuse watering and tears in an attempt to lubricate the eye surface. Many people will believe their problem is too much eye lubrication and not realise that it can be treated by further lubricating the eyes with artificial tears from a pharmacy.You need to use this regularly for best effects. A trial recently found fish-oil supplements to improve dry eyes but you need to take around 1000 mg/1 g a day. Keep in mind that certain medical conditions, some of which can be quite serious, can cause dryness. Speak with your GP if you suffer from dryness of your skin or mucous membranes. ♥

healthymedicines

Radio’s most knowledgeable pharmacist Gerald Quigley answers common questions about over-the-counter and complementary medicines.

Ask

Gerald

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

Fluid tablets or celery?

I have borderline high blood pressure. I try to cut down on salt but my doctor is talking about putting me on a diuretic so I pass more sodium. I heard that celery is a natural diuretic – would it help to take celery supplements or would I have to eat lots of it?

If you want to take a vitamin D supplement, then 1000 IU a day will maintain your current levels.

Conflicting opinions on salt intake appeared in a recent edition of JAMA Internal Medicine, in which a “modest” amount of salt might not harm older adults, but more than that could damage health. Expert comments focused on food choices around plant sources, not on salt or any other single dietary component. Celery is actually high in minerals including sodium but it also contains potassium for counterbalance. Celery has anti-inflammatory, chemoprotective, antioxidant and lipidlowering properties, and

30 Healthy & Heartwise • Autumn 2015

increases bile-acid excretion, resulting in lower serum cholesterol levels. Celery has traditionally been used to reduce fluid by promoting the flow of urine through the kidneys. In that way, celery is useful in urinary tract infections. Animal studies show that celery does have positive effects on blood pressure. But note they’re animal studies only. Eating lots of celery is impractical and won’t give predictable results. However, considering that celery is a whole food, regular intake when celery is in season is a sensible option.

Other natural fluidreducing plants: • parsley • dandelion • corn silk • green tea • artichoke • cucumber • grapes Many herbs have been shown clinically to support cardiovascular health generally. The botanical shown in most studies to work is hawthorn berry. Seek advice from your health practitioner, who can discuss the options with your doctor.

healthymedicines

Garcinia & diabetes

Everyone’s talking about garcinia for weight loss. Does it work and can I take it if I have diabetes? We really do seek the ‘magic pill’ for weight loss, don’t we? Garcinia – also and less exotically known as brindleberry – is now popular because of its endorsement by the US media personality Dr Mehmet Oz. There has been many involving garcinia, some going back to 1998. Sadly, inconsistency is rather common, and that reflects the differences in many of the extracts of this herb. Favourable results with garcinia seem to result when it is used with other measures, and following the usual disclaimer on weight-loss products: “Use in conjunction with appropriate food choices and exercise regimes.”That’s why you need your dietitian. Dietitians are wonderful food choice managers who can help you understand the energy values of each food you use, usually after reviewing a food diary. I would prefer you seek this advice instead of relying on the inconsistent results seen with garcinia. If you try to lose weight without professional help, you can end up undernourished.

Superfoods to shake up my day

I’m really busy working two-to-three part-time jobs, and often I just can’t sit down and eat a meal, let alone cook and prepare a healthy one with fresh veggies. I know cheap takeaways all the time aren’t healthy – do you think that the new superfood powders for shakes will get me through these times?

Slick marketing implies that any of the new ‘superfoods’ will either help you become a ‘super person’, or regain that status if you ever had it! Most superfoods highlight the importance of antioxidants to minimise the ageing process and ‘stop you being tired of being tired’. With all of this, we must never forget the original superfoods that have been part of our food choices for a very long time before the new superfoods were discovered in the deep jungles of the world. Fish, lean meat, unrefined grains, richly coloured fruits and vegetables and the healthy oils such as olive oil, now seem to be undervalued as to their role in overall health. The hectic pace of your lifestyle constrains your ability to plan. A superfood will never take

the place of a regular tuna salad, or a chicken sandwich on wholemeal bread – both of which take little time to prepare. Being able to actually sit and savour the taste of the food you have prepared is an important part of the digestive process. Mindless eating in front of the TV isn’t ever a wise decision. Being constantly busy seems almost normal these days, but adequate rest is fundamental to maintaining your immune, emotional, mental and physical health. The superfood supplement won’t replace these options and, in fact, might even create an unrealistic expectation on your energy levels each day. Supplements can support what you have set in place, but they will never replace the basic aspects of sensible nutrition.

Should I have my oats steel cut or rolled?

Last issue you talked about betaglucan in oats helping cholesterol levels. Would I get the same benefit from kibbled steel-cut oats and are they better than plain rolled oats?

Recent research in Annals of Nutrition and Metabolism showed that consumption of oatmeal rather than ready-to-eat cereal at breakfast may result in greater feelings of fullness and lower calorie intake at lunch, especially in overweight people. Organic steel-cut oats are made by slicing the whole groat (inside of the oat kernel) with a steel cutter. Because they are not rolled, they are raw and retain the natural nutrients from the wholegrain: fibre, B vitamins and minerals. Rolled oats are usually oat groats that have been de-husked, steamed and then rolled into

flat flakes under heavy rollers before being stabilised by being lightly toasted. There are many oat versions but not all are equal! Betaglucan is a unique fibre that creates a viscous, fine gel in the stomach that binds bile acids. Bile acids need cholesterol to be manufactured in the liver. The result is lower levels of circulating cholesterol. Betaglucan fibre is more soluble than regular oats, allowing more efficient gel formation. Oats are healthy in whichever form but for clinically proven cardiovascular benefits, betaglucan is the best option. Autumn 2015 • Healthy & Heartwise

healthyshopping

Coconut-shy no more!

We’ve got a lovely bunch of coconut products – the water, milk, cream, oil, flesh, flour and sugar are the decade’s diet darlings. Is it still deadly, a newly exonerated villain like the egg, a slimming superfood or marketing hype gone nuts, asks Steven Chong.

C STEVEN CHONG is the Editor of HHW

Coconut oil fatty acids Fatty acid

Per 100 g

Lauric

Myristic

16.8

Palmitic

8.2

Caprylic

7.2

Capric

Stearic

2.8

Oleic

Other

oconut has gone from dessicated baking ingredient and discredited tanning oil to shiny new tonic drink, beauty and dental treatment and trendy dietary staple. The latter category divides dietitians and has nutritionists going nutty, as anything edible – the water is a different story [see opposite] – from the coconut palm is 90% saturated fat, which most dietary guidelines restrict. Saturated fats are associated usually with animal products such as meat and full-fat dairy, but coconut is one of the few plants rich in the lipids officially frowned on since the 1970s, rendering it to generations since a mere subtropical sprinkle on lamingtons or part of the whimsy of an Iced VoVo. When coconut oil is hydrogenated into solid vegetable shortening such as Copha – integral to classic confectionary such as rocky road, chocolate crackles and white Christmas – trans fats are formed, enriching many an Australian childhood with later heart risk.

in Medical Observer that its effect on heart disease risk is largely unknown. As well as being inconsistent, the evidence about the health effects is unclear because the saturated fatty acids in coconut have most often been studied in isolation rather than mixed as they appear in natural cold-pressed, organic or virgin or coconut oil (VCO). It is VCO that is now promoted as healthier after the Asia and Pacific Coconut Community published a standard in 2003 defining it as “obtained from the fresh and mature kernel of coconut by mechanical or natural means … which does not lead to alteration of the oil.” Critically, as lipid expert Professor Tom Brenna of Cornell University told The New York Times, earlier studies used coconut oil that was partially hydrogenated and contained trans fats – dried coconut was crushed, cooked and chlorinated to refine a bleached oil used as a food additive. Studies have also shown VCO has more antioxidants than its refined cousin.

Fatty facts about coconut oil

How saturated fats can be healthy

Coconut oil in its totality raises total and protective HDL cholesterol but some studies have found increases in the harmful cholesterol type, LDL. Nuts for Life dietitian Lisa Yates wrote

Coconut oil’s three most abundant saturated fatty acids are lauric acid (also in breast milk), myristic acid (a defining fat in nutmeg) and palmitic acid (highest in palm oil but also the

32 Healthy & Heartwise • Autumn 2015

healthyshopping most common in animals, plants and microbes). Their molecular structure allows them to pass from the gut directly into the circulation and bypass the lymphatic system, so bile salts are not required for digestion and healthy HDL cholesterol rises. Dr Marie-Pierre StOnge of Columbia University says these fat molecules are transported directly to the liver, “where they’re likely to be directly burned off as fuel and raise the metabolic rate slightly.” Moreover, it also has been shown that when palmitic acid is consumed with the plantbased omega–3 linoleic acid – just as it occurs naturally in coconut, palm and olive oils – cholesterol does not rise. Some studies have also found myristic acid raises HDL cholesterol as well as LDL, and the LDL increases are not significant. Capric and caprylic fatty acids are in coconut oil in lesser amounts; they also appear in goat’s milk, which gives them their name. Like the above saturated fatty acids they are digested easily and, as Lisa Yates points out, can be extracted and used for special diet supplements to intravenously feed people who are malnourished or absorb food poorly.

The micronutrients in coconut water VITAMIN C

MINERAL

mg/100 ml

2.4 mg

Calcium

B1 (thiamine)

0.03

Iron

0.29

B2 (riboflavin)

0.06

Magnesium

B3 (niacin)

0.08

Phosphorus

B5 (pantothenic acid)

0.04

Potassium

250

0.03

Zinc

0.1

B9 (folate)

0.003

Manganese

0.1

in minerals potassium, magnesium, calcium, phosphorous and B-group vitamins, whose proportions and about 2% sugar content affect its flavour and taste [see table]. This electrolytic composition earns the juice’s status as a rehydration fluid superior to water but as Dr Karl Kruszelnicki told ABC Radio, it is also mildly laxative so you would lose more fluid if you drank a large amount. Nor is coconut water identical to human plasma and suitable to treat acute dehydration intravenously beyond a few days because its calcium and potassium levels are too high and sodium concentration too low. Nonetheless, as with soya, cranberry and green tea products that came before them, coconut water products have migrated from a marginal treat for health zealots to a mainstream option at any store. Coco-Cola, PepsiCo and Red Bull China have bought interests in companies that first developed and popularised them, and now use concentrates or add sugar, flavours or sweeteners to increase shelf life, cut costs and diversify the market. However, intact green coconuts also now appear in both supermarkets and health food stores, providing the opportunity to enjoy the liquid and gel-like flesh within fresh and whole. ♥

Going to water Coconuts take a year to mature and when five-to-seven months old, increasing volumes are harvested green to supply the world’s mounting demand for a healthy alternative to soft and sports drinks: coconut water. Each tender young coconut yields between a cup and a litre of sterile, low-GI water rich Coconut product

mg/100 ml

Production/by-products

Nutritional values per 100 g ENERGY (kJ)

Water – from immature nut

• Fermentation → vinegar • Low GI (~55)

Flesh/meat – kernel from mature nut

• Drying → dessicated coconut • Dry processing → copra • Toasting → chips/flakes

Milk

• Grated flesh is mixed and dissolved in water

CARB (g)

FAT (g)

PROTEIN (g)

FIBRE (g)

SODIUM (mg)

24.23

0.2

0.72

1.1

105

1290

3.4

30.1

3.4

7.8

659

16.1

1.6

0.3

Cream

• Paste separated from milk after refrigeration

805

3.7

19.3

1.5

0.8

Oil

• Virgin oil cold-pressed from mature flesh

3607

100

Flour

• Gluten free, absorbs liquid in cooking readily

2772

23.7

64.5

6.9

16.3

1641

91.9

1.9

234

Sugar – from sap of • Low GI (54) coconut tree flowers • Rich in nutrients

Autumn 2015 • Healthy & Heartwise

♥ healthytravel

Lagoon, la plage, la vie Novotel Twin Waters Resort offers a pristine beachfront location on Queensland’s Sunshine Coast where you can stretch, golf, swim, kayak, relax and be indulged. Novotel Twin Waters is on Mudjimba Beach about an hour north of Brisbane

verlooking a private beach-lined lagoon in 36 hectares of bushland just 5 km from the Sunshine Coast Airport and an hour’s drive north of Brisbane, Novotel Twin Waters is a premium four-star holiday resort with outdoor, rejuvenation and wellbeing options for mind, body and spirit. Twin Waters offers a large range of leisure facilities and activities for all ages on its doorstep – kayaking, a kids’ club, bike and running tracks and more. In keeping with Novotel’s wellbeing focus, guests can switch on the resort’s complimentary in-room yoga channel.

Luxury, leisure and 18 holes Other facilities include an outdoor heated pool and spa, Nouveau Restaurant, Aqua Bar & Lounge,

34 Healthy & Heartwise • Autumn 2015

Deli Market and Café, Fish and Chippery, Lagoon Day Spa, Xperience Segway tours, Water Park and an 18-hole championship golf course. The resort’s Lagoon Day Spa offers every treatment your body could want. With several treatment and massage rooms and an overwater lagoon location, privacy and peace is never hard to find. Couples should not forego the massage suite for two, complete with aromatherapy spa bath and chilled champagne on hand. Adjacent Twin Waters Golf Club is a sportsperson’s dream. The 18-hole course is recognised internationally as one of the top six resort courses in Australia – naturally it’s the best on the Sunshine Coast. The par 72 championship course was designed by five times British Open champion Peter Thomson and partner Mike Wolveridge, and the stunning setting and challenging layout charge an enjoyable round for all players.

Making the Sunshine Coast sparkle With unspoiled, endless surf beaches, Blackall Ranges or the unique Glass House Mountains, the Sunshine Coast has a unique natural beauty. If it’s relaxing on the beach, touring the food and wine trail, outdoor adventures, dining, shopping at local markets and boutiques or getting your adrenaline pumping, Novotel Twin Waters Resort’s Discovery Desk can help you with information and bookings. Guests can visit Australia Zoo made famous by ‘Crocodile Hunter’ Steve Irwin, Eumundi Markets, a lush hinterland rich in local arts and crafts, and the heritage-listed Fraser Island – the world’s largest sand island and an ecotourism delight. Novotel Twin Waters Resort is famous for its great variety of 361 rooms and suites, including lavish overwater lagoon suites, resort rooms (ideal for couples and small families), and one and two-bedroom suites if you want space and self-catering facilities. However, our lagoon suites offer the completely indulgent Sunshine Coast experience, resting on Novotel’s expansive saltwater lagoon and featuring a kingsized bed, lounge area and opulent spa bath. ♥ For more information or to make a reservation, visit www.novoteltwinwatersresort.com.au

♥ healthymind

Rosemary Higgins, DPsych (Health), MAPS, MCHP, is Senior Research Fellow, Heart Research Centre; Honorary Associate Professor, Department of Psychology, Faculty of Health, Deakin University; and Health Psychologist at Cabrini Health

The anxious afterlife Have you survived a heart event only to feel anxious, troubled and worried? It’s natural, says Associate Professor Rosemary Higgins, and it can be helped.

nxiety, fear and worry are common in people who have had a heart attack, especially in the early days of recovery. At this time, the experience of anxiety is so common that it can be seen as a normal reaction. Patients need to come to terms with living with heart disease and may talk about being ‘scared to death’ or ‘frozen by fear’. While this does not mean that patients have an anxiety disorder, they may experience many symptoms of anxiety. An intense anxiety reaction is not surprising, considering the overwhelming intensity of

36 Healthy & Heartwise • Autumn 2015

physical symptoms that patients experience during a heart attack. Many patients will believe that they have somehow cheated death. Extreme levels of fear, dread and panic may be felt by patients during and after their heart attack. Patients will ask themselves,“Will I get through this? What will happen to my family if I don’t? How will I cope? Will I be damaged? Will I be able to get back to my normal life?”

Death anxiety After going home, patients need to adjust to living with heart disease. Those with

healthymind ♥ heightened anxiety can become distressed and excessively vigilant, both expecting and dreading another heart attack. Some patients report feeling as though The ‘Sword of Damocles’ is hanging over them as they struggle with the ever-present knowledge of their own mortality. Such patients will continually scan their body, monitoring for any signs of further heart problems. Normal aches and pains are misinterpreted as signs of an impending heart attack. This can lead to feelings of panic and being ‘frozen with fear’, then distress about bodily sensations. Anxiety related to this distress leads to more symptoms, greater distress and, for some, absolute panic.

Other causes of anxiety Heart patients will be concerned about the impact of their illness on their working life, financial security, current commitments and future plans. It is important to seek appropriate reassurance about this because the future may not be as dire as it first seems. About 90% of working-age patients go back to their jobs after a heart attack, according to Dr Barbara Murphy, Director of Research at the Heart Research Centre in Melbourne. Anxiety is not all in the mind. It is a product of our ‘fight or flight’ reflexive reaction to the belief that we are under threat. People experiencing anxiety have a range of physical and mental symptoms [see box below]. In some cases, anxiety symptoms may feel very similar to the original cardiac symptoms. It is little wonder that some patients end up feeling panicky or having full-blown panic attacks. If in doubt about whether symptoms are cardiac or anxietyrelated, it is important to see your doctor and not attempt to self-diagnose.

Ask the expert How is anxiety treated? Psychologists will use a range of treatments that have a high rate of success in leading heart patients to an improved quality of life as well as better health outcomes, including: • Education about anxiety reactions • Relaxation training to reduce symptoms • Challenging beliefs about the illness • Behaviour modification • Support with the existential crisis of a heart attack • Building resilience. Medicines used to treat anxiety can include heart medication, such as beta-blockers, or psychotropic medication, such as antidepressants. Regardless of treatment, it is important that anxiety is recognised early to ensure better health outcomes and lessen the impact of heart disease on the individual and their families. Dr Marlies Alvarenga, MAPS, MCCLP, is Honorary Senior Research Fellow, Heart Research Centre and Director, Psychocardiology Clinic MonashHeart, Monash Medical Centre.

When worry makes things worse While some anxiety is normal after a heart attack, if ongoing it can lead to more health problems. Patients who are anxious may avoid

Are you anxious? Common symptoms • Preoccupying thoughts of death or illness • Feelings of impending doom • Sweating • Dizziness and nausea • Bowel problems

• Pounding heart or rapid heartbeat • Fast breathing and hyperventilation • Muscle tension or shakiness • Being restless or on edge • Irritability

physical activity because they might fear what will happen if their heart works too hard. Some people will self-medicate their anxiety, using cigarettes, alcohol or other drugs. Others can comfort eat to reduce anxiety symptoms. All this can adversely impact on cardiac health. Anxiety can lead to a poorer quality of life for both the patient and their families. You may fear being alone, be concerned about resuming your usual life, and/or reluctant to travel too far from the treating hospital. This leads to a very restricted life, which may increase relationship tensions. You may need extra assistance to manage your anxiety if: • anxiety continues as your physical health improves • your anxiety gets worse over time • you have frequent panic attacks • you have frequent distressing flashbacks to your heart attack • your anxiety stops you getting back to life. ♥ Autumn 2015 • Healthy & Heartwise

healthytravel

Preflight prep There are only one or two heart incidents per million people flying – but with the world more airborne than ever, high-risk patients will still worry it could be them. Steven Chong talks to an expert and researches how you can fly from A to B without anxiety.

any people travelling overseas this time of the year head to the northern hemisphere for its warmer weather, meaning in many cases a long-haul flight there and/or back. Most are routinely made aware by airlines or travel agents of the risk of conditions such as deep vein thrombosis (DVT) but it’s particularly relevant to heart-risk patients who may be more susceptible to their blood clotting, and following the circulationstimulating exercises on safety cards or in inflight magazines may not be sufficient. “A sluggish circulation – especially in someone overweight and even more in a smoker – predisposes to clotting of the veins in the calf,” warns the Traveller’s Medical and Vaccination Centre, which advises to “Avoid tight-fitting clothing, exercise the feet and ankles while sitting, and get up and take a small walk now and then. Avoid alcohol or take it with plenty of water or soft drink.” In guidelines for heart patients proposed by Yale University researchers in 2004, consideration of wearing compression stockings was also advised in its preflight checklist [see right] of common-sense steps, such as carrying adequate medications and a copy of your medical history and doctor’s and family’s contact details.

An expert perspective Professor Michael O’Rourke, a cardiologist with the Victor Chang Institute at Sydney’s St Vincent’s Hospital since the 1970s, helped introduce semi-automatic defibrillators to all

38 Healthy & Heartwise • Autumn 2015

working ambulances in NSW and Qantas and other international aircraft. Professor O’Rourke says flight advice is now fairly liberal for heart patients. Its safety is clear in the high number of Asian patients who come to Australia for heart surgery and then fly back fairly promptly after their procedure. And the Mayo Clinic, a hospital that leads the world in its specialised care for complex medical cases, is fairly isolated geographically in the US, but critical patients are flown there all the time, Prof O’Rourke explains. “Qantas took a more conservative approach with their overseas passengers because it often took two days to get to destinations in Europe or the US, so there was more chance of something going wrong,” Prof O’Rourke told Heartwise. “However, they led with having defibrillators on board and this – with funding from Kerry Packer following his emergency bypass – drove their inclusion in all NSW ambulances. “Although it’s safe to fly with most heart conditions, the higher incidence of heart events is usually because the process is stressful on a practical level at airports and on planes. Making a flight on time, packing and carrying bags and worrying about security, passports, tickets, leaving home, the flight itself and plans upon arrival all push the cardiovascular system to an aroused state.” Although life and holidays throw up the unexpected that can defeat the best-laid plans, feeling that you’re at least prepared helps lower stress, and the checklist (right) may help you cope with cardiac contingencies. ♥

Preflight checklist for heart patients 4 Talk to your doctor to see if any preflight testing may be warranted to assure that the cardiac disease is stable

4 C arry adequate supplies of prescribed medicine

4 Carry a copy of your medical history

4 C arry phone

numbers for your doctor(s) and family members

4 During the flight,

consider wearing compression stockings, pass on the alcohol, and drink plenty of fluids to avoid blood clots.

healthytravel

any people travelling overseas this time of the year head to the northern hemisphere for its warmer weather, meaning in many cases a long-haul flight there and/or back. Most are routinely made aware by airlines or travel agents of the risk of conditions such as deep vein thrombosis (DVT) but it’s particularly relevant to heart-risk patients who may be more susceptible to their blood clotting, and following the circulationstimulating exercises on safety cards or in inflight magazines may not be sufficient. “A sluggish circulation – especially in someone overweight and even more in a smoker – predisposes to clotting of the veins in the calf,” warns the Traveller’s Medical and Vaccination Centre, which advises to “Avoid tight-fitting clothing, exercise the feet and ankles while sitting, and get up and take a small walk now and then. Avoid alcohol or take it with plenty of water or soft drink.” In guidelines for heart disease patients proposed by Yale University researchers in 2004, consideration of wearing compression stockings was also advised to avoid blood clots in its preflight checklist of common-sense steps such as carrying adequate medications and a copy of your medical history and doctor’s and family’s contact details.

An expert perspective Professor Michael O’Rourke, a cardiologist with the Victor Chang Institute at Sydney’s St Vincent’s Hospital who since the 1970s helped introduce semi-automatic defibrillators to all working ambulances in NSW and Qantas and

38 Healthy & Heartwise • Autumn 2015

other international aircraft, says flight advice is now fairly liberal for heart patients.The safety is manifest in the high number of Asian patients who come to Australia for heart surgery and then fly back fairly promptly after their procedure. And the Mayo Clinic, a hospital that leads the world in its specialised care for complex medical cases, is fairly isolated geographically in the US, but critical patients are flown there all the time, Prof O’Rourke explains. “Qantas took a more conservative approach with their overseas passengers because it often took two days to get to destinations in Europe or the US, so there was more chance of something going wrong,”Prof O’Rourke told Heartwise. “However, they led with having defibrillators on board and this – with funding from Kerry Packer following his emergency bypass recovery – drove their inclusion in all NSW ambulances. “Although it’s safe to fly with most heart conditions, the higher incidence of heart events (1–2 people per million) due to flying is usually because on a practical level the process is stressful at both the airport and on the plane – making a flight on time, packing and carrying luggage and worrying about security, passports, tickets, leaving home, the flight itself and business or holiday plans upon arrival all push the cardiovascular system to an aroused state.” Although life and holidays in particular throw up the unexpected that can defeat the best-laid plans, feeling that you’re at least prepared helps lower stress, and the checklist below by the Yale researchers can help you cope with cardiac contingencies.

Preflight checklist for heart patients 4 Talk to your doctor to see if any preflight testing may be warranted to assure that the cardiac disease is stable

4 C arry adequate supplies of prescribed medicine

4 Carry a copy of your medical history

4 C arry phone

numbers for your doctor(s) and family members

4 During the flight,

consider wearing compression stockings, pass on the alcohol, and drink plenty of fluids to avoid blood clots.

healthyliving

Escape Planet Smoking

Ex-smoker Dr Emmanuel Varipatis is a GP and empathic and passionate advocate for quitting smoking who has developed a new way of looking at the single best – and often hardest – sacrifice to improve your health.

o stop smoking and cease all intake of any nicotine requires a smoker to not just overcome their nicotine addiction but their addiction to, and their love of, the actual habit of smoking. Current quit methods involve nicotine replacement therapies such as patches, sprays, lozenges or gum; e-cigarettes, prescription drugs; therapies such as hypnosis or acupuncture; quit classes and groups; and‘cold turkey’. None of these paths alone has a particularly high success rate and for those who eventually manage to quit, it’s usually after an average of eight serious attempts. The ‘Escape Planet Smoking’ method to quit smoking helps a smoker reach a deep and personal understanding of their smoking

40 Healthy & Heartwise • Autumn 2015

addiction, which they then use to follow a logical and sequenced quitting process.

Why quitters fail so well, every time What goes through the mind of a smoker when they are trying to quit? Conflicting and competing messages and self-talk along the lines of “I MUST quit because of how it affects my health, family and finances BUT: • I already know from experience that I can’t beat the cigarette • smoking is my best friend and is always there for me – I enjoy having a puff! • I am smoker. After so long, it’s part of who I am and who would I be without it?

healthyliving • a life without smoking is scary and daunting • why struggle today when I can always quit tomorrow?” The end result is that the smoker’s mind is divided and not wholly set on the goal – the logical part of them is trying to quit while at the same time the emotional parts of them are resisting desperately and trying to hold on to smoking. So it’s a battle against themselves, which is very hard to win.

How to succeed The solution is to become aligned in the one direction so all parts of the mind have the same intent and goal, and the smoker no longer self-sabotages their quit attempts. This involves realising that these internal competing voices exist, understanding where they come from and how they are created, and how they drive deep attachments and beliefs around smoking. My approach starts with seeing a smoker as a non-smoker and examining the stages involved in the creation and evolution of their ‘Planet Smoking’. The model includes three layers of addiction and one saboteur: 1. Nicotine addiction – at the core of a smoker is the damage done to parts of the brain involving pleasure and reinforcement (the dopamine reward pathway). Once damaged from smoking just a few cigarettes, the reward centre only properly releases dopamine – the ‘feelgood’ neurotransmitter produced to reward us for satisfying biological demands such as food and sex – with top-ups of nicotine. Without nicotine, the nervous system experiences the mild but constant discomfort, edginess and restlessness of withdrawal.This withdrawal is at its peak after only a few hours after the last smoke but fades away in days. 2. Smoking addiction – much of our brain is automated and reflexive, and reacts to withdrawal by finding ways to keep the reward centre releasing dopamine. It tags the act of smoking – the lighting up and multisensory overload of taste and smell – as beneficial and lays down a neural pathway to make you crave smoking rather than just nicotine. It then reinforces it by making you crave smoking in various trigger situations (drinking, driving to work, having a coffee, etc.). These addictions will produce powerful craving discomfort compared to the minor discomfort of nicotine withdrawal.

3. Emotional addiction – the self-aware, conscious part of our brain develops reactions and attachments to these discomforts and rewards, as well as to the habit and cravings. • “I can’t beat the cigarette” is the belief that develops after repeated failed quit attempts. • “I am a smoker” is the self-identity that develops over the years of spending five minutes smoking several times a day. Smoking becomes an integral part of your life and who you are until it is frightening to think of ‘amputating’ it. • “Smoking is my best friend” – 20 times a day, a cigarette satisfyies the dopamine reward centre. It is the most reliable and achievable reward in a smoker’s life, and is always there in good times and bad. • Fear of the unknown – quitting your smoking world involves leaving what is safe, comfortable and familiar for the uncertain, scary new world of non-smoking.

The saboteur of procrastination Smoking kills but usually only after several decades – the delayed consequences rob urgency for quitting immediately, and for failing

Quitting your smoking world involves leaving what is safe and familar for the uncertain, ‘scary new world’ of non-smoking. to stay non-smoking. This sets smoking apart from all other drug addictions where physical and mental consequences are obvious early on, and the urgency is powerful and immediate. Thus most smokers sabotage their quitting, which isn’t usually attempted with a stubborn determination to succeed at all costs! Some can and do quit ‘cold turkey’, but only after they overcome their saboteur: procrastination.

Escape your smoking planet Escape Planet Smoking helps smokers to unpack their habit into the above components so they can understand what’s driving their conflicting internal messages around smoking. Specialised mental exercises and lifestyle changes help them quit successfully and become non-smokers free of attachments to their former smoking world. ♥ Emmanuel Varipatis, MBBS, FACNEM, is a GP in Sydney. His Escape Planet Smoking book and interactive website will be released in 2015 Autumn 2015 • Healthy & Heartwise

♥ healthyeating

Eating with the ST RS

Will the government’s new system for evaluating the healthiness of packaged foods help Australians lose their collective paunch and source better nutrition? Milena Katz shows us the stars.

he Health Star Rating (HSR) website was finally launched at the end of 2014 by the Commonwealth Department of Health after working with representatives from the food industry, consumer and public health groups. It is modelled on the star ratings on white goods and electric appliances describing energy efficiency – the more stars, the better!

Health Star Ratings are supposed to be a new way to give health information about a product at a glance – much like the controversial Heart Foundation Tick [see HHW52, page 9].The scale runs from half a star to five stars, with foods awarded five stars deemed the most nutritious. An algorithm is used to rate the individual product and take into account kilojoules plus three ‘negative’ nutrients – saturated fat, sugars and sodium – that are linked with an increase in the risk factors for type 2 diabetes, heart disease, gallbladder disease and obesity.This is pitted against the content of fruit, vegetable, nuts or legumes.The panel can display one single ‘positive’ nutrient such as protein or fibre. The HSR system is voluntary so companies can decide whether or not to use it on their packs.The percentage of daily energy intake in kilojoules can remain on packaging as well but that is up to the manufacturers.

Health Star Ratings rated This initiative is a step in the right direction. Although it is not the answer for everything diet related, it is one way to make an easy comparison within any given category in the supermarket – provided the relevant food companies decide to implement the scheme. Most larger companies would have the ability to analyse their foods to adopt the HSR because of inhouse expertise, but don’t forget the smaller companies may make great products too – so check the whole label! ♥

Milena Katz, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney

Falling or rising stars ➚★ A positive of the HSR system is ➚★ The criteria are based on current ➘★ The scheme is voluntary. that dairy foods and nuts are rated evidence-based nutritional Companies that make products without penalty despite their higher science. This may change in the that are not healthy, such as triplenatural levels of saturated fat. future, however, as more research chocolate and fudge cookies, are ➘★ The system only shows limited is performed, especially around less likely to adopt the HSR because information. For example, it doesn’t saturated fat. their products would not be rated consider how many preservatives ➘★ All foods are compared by the well and not be as marketable. are present, vitamin and mineral same weight or volume (100 g/ml). ➚★ The HSR is a very useful way to content, where the food was However, people do not consume compare similar products within grown or whether it is a wholefood, the same amounts of each food, i.e. a category e.g. two muesli bars organic or sustainable. as much peanut butter as fruit juice. side by side.

42 Healthy & Heartwise • Autumn 2015

mediareviews

well read & watched An app for diabetes, plus newly released books on diet, pain, dementia, walking, sight-seeing, ageing and cancer prevention and management.

The End of Pain By Jacqueline Lagacé, Scribe, $29.99

The author began experiencing back pain in her mid-40s that steadily worsened and spread. No conventional treatment could help, driving her to try a diet developed by Dr Jean Seignalet, a French medical specialist who recommends no dairy, wheat or roasted animal protein. Within days, her arthritis responded and drawing on her background as an academic researcher at Montreal University, she explains the science behind her recovery.

Diabetes Australia app

The Mediterranean Diet Cookbook

www.diabetesaustralia.org.au, free

Rockridge Press, $19.99

A well structured, easy-to-use app that comes with multimedia news, recipes, health tips, articles, research studies, events and a directory to health service providers and state stores of Australia’s peak body for people with diabetes. Shopping lists and reminders can be inputted. Free registration gives access to additional content.

The anointed favourite of health departments, experts and researchers is briefly explained before 150 simple recipes follow in functional, unadorned chapters divided into meal type and main ingredients. Rich in fresh colourful produce brought together with simple cooking methods, this simple handbook is a sure-fire guide to experiencing the healthiest diet in the world.

Ultimate Record Breaking Destinations

Walking for fitness, pleasure and health

By Samantha Wilson, New Holland, $29.99

By Helen Vause, Exisle, $24.99

Each page turn yields another stunning location you’ve probably never heard of but instantly want to be in – sumptuous full-page photographs make it seem you’re already there. The page opposite explains why each of the 100 destinations meets a superlative that makes it the most heavy, bright, cold, etc. A coffee-table paperback that inspires itineraries, bucket lists or a moment’s imagined escape.

Subtitled A complete guide for women of all ages, this paperback shows how walking outdoors can fit well with women’s family, social and work life. Written by a long-time NZ walker and journalist, the book shows how to start, bring children or compete, what to wear, and the multiple health benefits it can bring. Technology and equipment for women of all ages and stages are also addressed.

Sod Seventy! The Guide to Living Well

Preventing Cancer

By Muir Gray, Bloomsbury, $24.99

By Drs Richard Béliveau and Denis Gringas Allen & Unwin, $35

One of the UK’s senior medical knights shows how he deals with his seventh decade: working to improve abilities such as balance, flexibility and strength and maintaining healthy bones and joints, muscles and digestion. But the mind, emotions and healthcare decision-making are also covered to give a practical and empowering day-to-day hardcover companion.

University of Quebec oncology researchers and authors of bestselling cancer-fighting cookbooks explain 10 lifestyle changes that could eliminate three-quarters of the four chief types of cancer now affecting the population: lung, colon, breast and prostate. Diagrams, photos and jargon-free text bring to life the current knowledge about prevention and aiding recovery.

Autumn 2015 • Healthy & Heartwise

heart2heart Condition

Heart2heart // Condition // Diagnosis // Surgery // Medication

Coronary artery disease

Alistair Begg, MBBS, FRACP, FCANZ, DDU is a cardiologist at Ashford Hospital, Adelaide, and Publisher of HHW

Behind most heart attacks is a set of congested blood vessels that genetics and an unhealthy lifestyle have weakened. Cardiologist Dr Alistair Begg explains the most common heart condition.

oronary artery disease (CAD) stalks the globe as humanity’s biggest killer – it is the most common form of heart disease and leading cause of death, the World Health Organization and UN reported in 2012. Known also as ischaemic or coronary heart disease, CAD begins in childhood and progresses over decades through hardening of the arteries – as a result of coronary vessels losing their elasticity from long-term raised blood pressure. As a layer of cholesterol, calcium, cell debris and fibrin (a tough, fibrous clotting protein) accumulates on the arteries’ inner lining (endothelium) as a plaque, it thickens and stiffens, further affecting circulation [see diagram, opposite]. Both age and cholesterol deposits contribute to CAD but the plaques are relatively brittle and at risk of breaking, potentially causing a heart attack or stroke.

44 Healthy & Heartwise • Autumn 2015

CAUSES • RISK FACTORS • Family history • Age • Male

• Smoking • High blood pressure • High cholesterol, triglycerides • Obesity – especially abdominal • High blood glucose • Lack of exercise • Stress • Early menopause

Can’t be helped/ changed!

You can change

The stealthy assassin kills most Usually CAD is ‘silent’ and symptom-free until it is advanced and strikes suddenly – a plaque ruptures and breaks off or forms a clot, blocking blood and oxygen supply to the heart. This causes a heart attack but over a third of heart attacks are silent with no chest pain. Stable CAD, however, can cause angina – predictable chest pain on exertion or after heavy meals – and added breathlessness, dizziness or fatigue during exercise. Interestingly, women are more likely to experience atypical CAD symptoms than men, such as excessive shortness of breath, or just feeling tired and unwell (malaise).

Avoiding CAD Smoking is the most common and strongest risk factor for CAD, especially in young people – every puff carries millions of oxidative toxins that instantly tense arteries, raise blood pressure and trigger the release of inflammatory immune cells. Tobacco is associated with at least half of CAD cases but is also the most preventable risk factor – although not easiest to quit [see pages 40–41].

Obesity is associated with about a fifth of CAD cases, while a sedentary lifestyle and lack of exercise is linked to about 10%. Having any form of diabetes doubles if not quadruples your risk of CAD, which develops earlier and more severely. High blood glucose levels damage blood vessels on top of natural hardening and hypertension, therefore managing blood glucose can halve CAD risk. Alcohol, poor nutrition, stress, unhappiness, ethnicity, a poor level of education, living alone, low socioeconomic status and increased amounts of chemicals in the blood indicating inflammation, such as homocysteine and lipoprotein (A), have all been associated with CAD risk. When any physical, genetic or lifestyle variable has been found to correlate consistently to a significantly greater chance of CAD, it becomes a risk factor. Any particular risk factor identified doesn’t necessarily cause CAD (or vice versa) – being overweight does not guarantee CAD but it does increase the likelihood of it developing, especially if other risk factors are present, and the two often coincide.

Cross-section showing the progression of coronary artery disease

Autumn 2015 • Healthy & Heartwise

Heart2heart // Condition // Diagnosis // Surgery // Medication

Coronary artery disease heart2heart

heart2heart Diagnosis

Cats and angiograms Heart2heart // Condition // Diagnosis // Surgery // Medication

They’re not pets nor angels bearing telegrams but what they tell cardiologists might bring you comfort and good tidings – or mean further treatment. As diagnostic tools, CT scans and angiography show how far CAD is progressed, continues Dr Alistair Begg.

Safety

he gold standard for diagnosing coronary artery disease (CAD) has for many years been the angiogram. A dye is injected into an artery feeding the heart, and over the next 10–15 seconds an X–ray of your heart captures a cross-sectional image of it with a ‘road map’ of the arterial blood supply. How much arteries have narrowed with cholesterol or soft plaque can be visually assessed and the cardiologist then decides on the best treatment, be it medication, stenting or bypass surgery. The heart’s main internal pumping chamber, the left ventricle, can also be checked.

Preparation If you take warfarin, usually you can continue it or have the dose reduced for an angiogram. Aspirin should be continued because often the angiogram may find a problem that may need treatment when aspirin generally becomes mandatory. It is a good idea to bring an overnight bag when attending an angiogram in case you need to stay for surgery.

The procedure In a sterile catheter lab, a cardiologist will inject the dye or ‘contrast’ via a small tube or catheter inserted under local anaesthetic through a small cut into either the artery in the groin or arm. The site of incision is shaved and cleaned with an antiseptic solution and a sterile drape will be placed over the site of the incision. The catheter tube is then advanced up the artery

46 Healthy & Heartwise • Autumn 2015

towards the heart and contrast or dye is injected down the catheter into the coronary artery. Immediately, an X–ray is taken of the outline of the dye’s progress. You will be on a special X–ray table for the angiogram. The camera or X–ray plate will come very close to your chest to take the most accurate pictures. There are two main coronary arteries with different origins, and therefore a second catheter will subsequently be passed up into the aorta, and a further injection will be made and further X–rays will be taken. A third catheter may then inject contrast into the heart cavity to show the function of the heart’s left ventricle. It might cause you to feel a hot flush but it passes quickly. Following this procedure, the groin catheter may be removed. The whole angiogram procedure takes about 30 minutes.

An angiogram reveals the roadmap of coronary arteries

Tell radiography staff if you are currently taking any diabetes medications [see pages 68–69], have kidney disease or previously reacted to X–ray angiograms. You must advise the radiographer if you are or think you might be pregnant. You will absorb a small dose of X–ray radiation, however the benefits of detecting CAD outweigh any potential risks from this limited exposure. The risks involved in angiograms are mainly related to the dye – allergic reactions may lead to a rash or swelling, which should be reported immediately. Severe reactions involving the heart are extremely rare and you are continuously monitored, with staff on standby to handle any emergencies. The most common complication of coronary angiography is bleeding or minor bruising, particularly in the groin region. You must lay flat and be monitored for anything from two to four hours following the procedure, or less if a collagen plug is applied to the wound in the groin or arm. Serious blood loss is extremely rare, as are blood clots or infection. Heart attack or stroke during angiography is extremely rare, at one per 1000 procedures performed, and the risk of death is even less. Generally, most patients can drive 24 hours after an angiogram. However, if there is significant discomfort or bleeding in the groin it is probably safer to wait until the cardiologist clears you to resume driving.

Surgery heart2heart

Balloons and tubes

Preparation

Angioplasty and stenting are now the most routine cardiac operations for CAD, where tiny balloons and metallic tubes are inserted into arteries to prop them open. Dr Alistair Begg explains.

The procedure

Stent insertion to a diseased coronary artery

A small tube-like sheath is inserted in your groin or wrist, through which another tube (catheter) is inserted. These ‘guide catheters’ are thin and hollow. X–ray pictures of the coronary arteries are obtained by injection of contrast dye through a catheter placed in each of the affected coronary arteries. A fine guiding wire is passed through each catheter until it reaches the narrowing where plaque has been located. A stent wrapped around an angioplasty balloon is slid through the catheter. The stent expands when the balloon is inflated for about 30–60 seconds, then the balloon is deflated and withdrawn. The stent remains in place like a scaffold while the guide catheter is removed, followed by the removal of the tube from the groin or wrist [see diagram]. Surgery is usually performed under some light sedation and painkillers may be given intravenously. Afterwards, you are usually admitted to a coronary care unit and monitored overnight. Blood tests and scans are taken next day and if there are no complications, you’re normally discharged. Generally, once the surgical wound has healed, normal life can resume within a few days. However, if stenting is performed to treat a heart attack or if there is damage to the heart muscle, there may be restrictions and even a delay in discharge from hospital.

Safety The risks are similar to a coronary angiogram because it is a similar procedure. Bleeding is the main complication with a slightly greater incidence due to the use of increased bloodthinning medication. The risk of heart attack requiring repeat coronary stenting or bypass surgery is about one in 500, and the risk of kidney failure, stroke or blood clots smaller still. For six to 12 months following angioplasty and stenting there is a small but significant risk of renarrowing within the stent, which can range 5–20% depending on the location, size and type of the stent and the presence of diabetes and other complications. Restenosis is usually gradual in onset and usually leads to a recurrence of the initial symptoms. Autumn 2015 • Healthy & Heartwise

Heart2heart // Condition // Diagnosis // Surgery // Medication

he purpose of a coronary angioplasty and stent is to flatten the plaque, squeeze open a coronary artery and restore its normal blood flow. A tiny balloon is inserted in a catheter in your groin or wrist artery then fed through it into the narrowed coronary artery. Salt water and X–ray dye is injected into the balloon so it swells for about 30–60 seconds, dilating the artery and restoring proper blood flow. Usually a small expandable, slotted metal tube called a stent is placed at the site of the narrowing to prevent the artery from tearing or springing back to its narrowed size and limit scarring on the arterial lining from the balloon (restenosis). It prevents angina – tightness in the chest when the heart is deprived of blood, although not to the point of heart attack. Stenting is also performed as emergency treatment for a heart attack, or where no symptoms have appeared, but you are thought at high risk of heart attack.

You must fast between two and six hours prior to angioplasty and stenting. Presurgery, your groin is shaved and an antiseptic solution applied. Usually you are given aspirin, strong blood-thinning tablets and heparin, which help prevent blood clot formation.

heart2heart Medication

Antihypertensives The most commonly prescribed heart medicines lower blood pressure to take the pressure off the heart and reduce wear and tear on our circulation. Dr Alistair Begg and pharmacist Daniel Scandrett-Smith explain. Heart2heart // Condition // Diagnosis // Surgery // Medication

S Daniel ScandrettSmith is a clinical pharmacist at Ashford Hospital, Adelaide, South Australia

o great is the danger of hypertension, both in terms of the number of people it eventually kills and the damage it inflicts upon the cardiovascular and other organs, that medicines to control it are the most prescribed in Australia. Even if you have not had a heart attack or stroke or been diagnosed with CAD, if like one in three Australian adults you are found to have this one risk factor, your GP will want to lower your blood pressure and discuss the possibility of starting antihypertensive medications.

Five types of antihypertensive Each class of antihypertensive has its own way to lower blood pressure: 1. Calcium channel blockers slow the movement of calcium ions through cell membranes in the smooth muscle of blood

Blood pressure drug

Common side effects

ACE inhibitors (e.g. perindopril, ramipril)

• cough (10–20% of patients) • headache • fatigue

Angiotensin receptor blockers (e.g. irbesartan, telmisartan)

• dizziness, headache

Beta-blockers (e.g. atenolol, metoprolol)

• lethargy • cold extremities • decreased exercise tolerance • depression • nightmares • erectile dysfunction

Calcium channel blockers (e.g. amlodipine, diltiazem)

• headache • water retention/swollen ankles • constipation (mainly verapamil) • flushing

Thiazide and related diuretics (e.g. frusemide, spironolactone)

• dizziness • gout • muscle cramps • urgency to urinate • raised blood glucose • gout • muscle cramps • urgency to urinate • raised blood glucose

48 Healthy & Heartwise • Autumn 2015

vessels. This action dilates arteries and slows the heart. 2. Diuretics – ‘fluid tablets’ that remove excess salt and water from the body to lower the blood pressure. Some are not suitable for everyone – people with diabetes need to be careful because thiazide diuretics in particular can raise blood glucose levels. 3. ACE inhibitors – reduce the activity of an enzyme that activates angiotensin, the hormone that constricts blood vessels. In turn, this lowers blood pressure. ACE inhibitors are often tried first for hypertension because there is evidence that they protect other organs as well as the heart. 4. ARB drugs – blocks the angiotensin receptors in the vessels’ muscle so they don’t react to the hormone and are often used as an alternative to ACE inhibitors. 5. Beta-blocker drugs counter the action of adrenaline on the heart. This reduces the heart’s rate of contraction, allowing it to rest and fill, thereby lowering blood pressure. Your doctor will decide which antihypertensive is best for your high blood pressure, based on your health, history and how well you respond to them. Some people are commenced on two or three antihypertensives and the dose and combination of each is changed according to their effects, desired or otherwise. Staying on antihypertensives long term is required for them to have benefit but many people tire of taking many medicines, sometimes several times a day. Combination antihypertensives are thus becoming more common, where two or three different classes at fixed doses are combined in the one tablet.

Side effects All antihypertensives can cause dizziness when you rise from sitting or laying, especially when you first commence them, if you take more than one, or increase the dosage. The table (left) from the Heart Foundation shows more specific side effects by drug class. ♥

RECIPES...

autumnfood&cooking

From morning mueslis and French toast to lunchtime rolls, soups and casseroles, then onto veggie curry, roast rabbit and fried fish mains – Paul and Blair from My Kitchen Rules, Hugh Fearnley-Whittingstall from Foxtel’s River Cottage Australia and innovative vegan foodies Megan May, Lee Holmes and Sue Quinn share some of their newest recipes.

The season of mists and mellow fruitfulness endows a rich and colourful bounty of pumpkin, fennel, eggplant, beetroot, avocados, tomatoes, pears and cumquats baked, braised or roasted with the warmth of cinnamon, maple syrup, sage and curry spices. Lentils and beans bolster meals’ nutrition with energy and fibre, while you can also explore the latest healthy food prep techniques of soaking to activate almonds, and preserving autumn produce to ferment sauerkraut, produce pesto, culture a chutney or make a marvellous marmalade!

For dessert there’s a Spanish rice pudding, zero-alcohol high-fibre rumballs and amazing Anzac biscuits with the toasty, cocoa–coffee–hazelnut flavour of all-Aussie wattleseed!

Heartwise has exclusive one-on-one chef’s chats with Matthew Evans of SBS TV’s Gourmet Farmer Afloat and bestselling author, blogger, fitness trainer and creator of the ‘healthy chef’ food supplement range, Teresa Cutter. Matt explains things you never knew about Australian seafood and Teresa talks us through her life and inspiration, making this cooking section a feast for the season. Each meal has healthy eating tips highlighted in gold and its nutrient profile assessed by Accredited Practising Dietitian Milena Katz. A ★ GOLD STAR RECIPE is lower in kilojoules and/or carbohydrate, and higher fibre and potassium. These meals can be consumed more regularly and are the healthier choices. Autumn 2015 • Healthy & Heartwise

chef’schat HHW: Doctors encourage people to eat more coldwater fish for the health benefits of omega–3 fatty acids and chitin from shellfish is used for supplements for joint disorders like arthritis.With all the catches that you, Nick and Ross have been eating, have you found your own health improve? Ha! We’ve felt no great effects. But we always eat a varied diet with seafood as part of that. Some of the less known, cheaper species are higher in omega–3 if that’s what you’re after, e.g. mullet, sardines, cocky salmon. And cooked appropriately, they taste terrific. HHW: Your TV series and cookbook challenge a few widely held beliefs, namely that local fish supplies are infinite and that wild fish are healthier than farmed. Just how is the fish we buy in supermarkets sourced and is it sustainable? I think the realisation that fish is a finite resource is a relatively new concept to many Australians because we’re not really exposed to the fisheries collapses seen overseas. But I also think the tide has turned – many people are worried about the oceans and that their choices can have a better or worse impact, so knowledge is key. Surprisingly, a lot of supermarket fish has a very good chain of custody. Some is from certified sustainable fisheries, particularly bigger brands of packaged fish. Companies have been put under pressure internationally to clean up their acts. I can’t comment on Woolworths because they declined to be interviewed about sustainability but Coles are making efforts to ensure all their homebrand and fresh fish is from reliable sustainable fisheries into the future. HHW: Why are Atlantic salmon and Southern bluefin off-limits for you? I’m a bit of a fence-sitter when it comes to salmon. But I wonder about the feeding of poultry and mammalian meal (essentially a by-product of slaughter) to them. For me, the more sensible fish to eat are smaller, mature quicker and lower down the food chain, such as whiting, garfish and sardines, which aren’t such voracious feeders.

50 Healthy & Heartwise • Autumn 2015

Open seas’ son

Recipe and images from The Gourmet Farmer Goes Fishing, by Matt Evans, Nick Haddow and Ross O’Meara, Murdoch Books, 2015, $49.99

Whether from the shore, reefs and rockpools, rivers and bays or open sea, Matthew Evans covers all of Australia’s favourite seafood via a voyage around Tasmania in SBS’ Gourmet Farmer Afloat. Newly delicious species surface, as do easy tips for preparing aquatic produce. But what’s available, cheap, healthy and plentiful is changing swiftly, he tells Heartwise.

chef’schat

Braised clams with beer & chorizo

Southern bluefin tuna have been in trouble for years – they’re on the Federal Government’s endangered species list. Yet we still catch them, fatten them in pens, and wild stocks are taking a very long time to replenish to sustainable levels. I reckon we should leave them alone until stocks recover substantially.

If they are honest about three things: exactly what fish it is, exactly where it came from, and how it was caught or farmed, then you can make your own choices about fish to buy. There are good operators all over the country – you just have to grill them more than you grill your trevally.

HHW: You advise to eat prawns sparingly because prawn farms are on the point of collapse – this may be a surprise when we’re used to plentiful and cheap prawns. What’s going on there? Years ago there were 300 or so boats fishing Australia’s Northern Prawn Fishery. Skippers tell of gigantic hauls of prawns (and turtles and dugongs…). Even today, with only about 50 boats, by-catch (other fish caught incidentally when they net for prawns) can be huge – five-to-10 times more than prawns. So prawns come at an environmental cost and because there’s fewer boats and fewer prawns caught, they’re more expensive. Overseas prawn farming has many unanswered questions, so that’s not a great option either. I reckon we should make prawns a special occasion food. The good news is that most Australian prawns are now harvested sustainably off the north coast and the Spencer Gulf Fishery off the South Australian coast.

HHW: What should people look for if they’re buying tinned fish products? Sadly, usually with tins you’ve got no idea where the fish was caught. Nearly all tinned tuna sold in Australia is ‘made in Thailand’ but the fish could be from anywhere. Greenpeace has put together a fabulous site to compare the sustainablilty of tinned brands. If you’re in a hurry at the supermarket, look for ‘pole and line caught’ because it means it’s far more sustainably harvested than some methods. A lot of reputable brands have a little picture of man on a boat fishing to make it easier.

HHW: Which fish/seafood suppliers and retailers would you say are good to buy from in terms of sustainability and quality?

Serves: 2 Cooking time: 20 minutes

HHW: What’s seasonal in autumn in terms of seafood and fish? Fish seasons very dramatically all over the country, so there’s no hard-and-fast rules. The problem with a great fishing trip could be the glut at the end. I hear of recreational fishers who come home with 10 fish and throw eight away because they don’t know what to do with them. I say don’t catch them unless you’ll eat them and that might mean preserving. If you’re buying fish, you might find a glut of one variety going cheap. If you can preserve them you get to enjoy them another day, too. ♥

1–2 tbsp olive oil, for frying 1 small chorizo, skinned, diced 1 leek’s pale stem, washed, diced 2 bay leaves, preferably fresh 1 garlic clove, peeled and chopped (optional) 1 large/2 smaller ripe tomatoes, chopped (or ½ cup tinned) 250 ml wheat beer or similar 1 handful flatleaf parsley, coarsely chopped 1 kg clams/vongole, scrubbed, purged (if wild) and rinsed 1. Heat olive oil in a large lidded saucepan over low heat. Gently fry chorizo to release some fat. Add leek, bay leaves and garlic. Cook about 10 minutes or until leek is translucent and very soft. 2. Add tomato and stir until it starts to soften and break apart. Increase heat, add beer and parsley and boil 1 minute. Add clams and lid, letting them steam and boil, shaking pan vigorously now and then. Clams should open in 3–4 minutes and be removed. Discard any that don’t open. 3. Tip clams into a big serving bowl with the juice and serve with bread to soak up the liquid.

Autumn 2015 • Healthy & Heartwise

chef’schat

Cutter to the

HHW: Your great-aunt and uncle taught you as a child to harvest and cook from their veggie patch. Was there less influence from your parents? My mum was a simple cook who my great-aunt and uncle brought to Australia when she was 21. She pretty much worked in hospitality day and night to put my sister and I through school. So my aunty and uncle looked after me for most of my early childhood. Dad was a crane driver by day and a fisherman by night. He taught me how to fish – by age 10, I could scale and gut whiting and peel the prawns we caught!

‘Healthy Chef’ Teresa Cutter has run a café, trained stars, written the best-selling 80/20 Diet and provides a stream of recipes plus a supplement range on her popular blog. She tells her story to Heartwise.

HHW: You were the heaviest in your class at age nine and the shock made you give up deep-fried food and second helpings. It still motivates you now. At that age it’s easy to try extreme solutions – why didn’t you? I was influenced by people around me and what I read or saw on TV. I loved making the healthy recipes I saw from shows such as Richard Simmons’. Playing basketball and netball also made my body strong and I started to feel good about myself. If I didn’t eat properly I felt weak and couldn’t concentrate, so my sport suffered. I needed to fuel my body so I could play well and feel healthy and energised. HHW: You first trained as a classical French chef. What attracted you? I started my apprenticeship in fine dining at a new five-star hotel in my home of Bunbury. It was tough – most of the chefs were French and “Merde!” was commonly heard in the kitchen! I loved the excitement of service – my hands and arms were quickly scarred from countless burns and cuts. I would start my shift super early just to get ahead and watch the other chefs prepare food and cook. It blended into nights and 14–16-hour days become normal but because the hotel was small, I learnt to do pretty much everything. I was very fortunate to train with some great chefs – we made every single thing from scratch and the essence of cooking in all its glory was magnificent.

Teresa is proud to be Ambassador for Australian Organic

52 Healthy & Heartwise • Autumn 2015

chef’schat

chase

Teresa’s apple & cinnamon bread Serves: 14 PREPARATION & COOKING TIME: 1 hour 10 minutes + 1 hour cooling 450 g/3 cups grated red apple 2 tsp baking power ¼ tsp sea salt 3 organic free-range eggs ¼ cup macadamia nut oil ½ tsp cinnamon 1 tsp vanilla bean paste/extract 2 cups wholemeal spelt flour

Images from Perfect Digestive Health by Teresa Cutter, Healthy Chef, $34.95, photographer Alan Benson

HHW: While a chef you also gained accreditation as a fitness trainer. Why did you leave bicycle racing and fitness figure competitions for contact sports? My husband Paul loves martial arts and encouraged me but I wanted to be able to take care of and defend myself – you choose sports based on your state of mind and how you feel at the time. Muay Thai and wrestling kept my mind and body strong and helped me deal with work, stress and life much better. I’m now kinder to myself and do quite a bit of Pilates. I’ve gone back to bike riding and love walking in the mornings as a form of meditation. It’s good to change things up a bit to keep it fun. HHW: Few chefs would leave the kitchen to study nutrition at uni! What’s the best thing it taught you? Prof Anish Singh, my immunologist in Perth, recommended Deakin because I wanted a more rounded approach to health, nutrition and my cooking. It also helped me research food ingredients that are important in making our Healthy Chef functional food products actually work and make a difference to someone’s health. HHW: Your books The 80/20 Diet and 101 ways to lose weight were rated number one on iTunes. What’s your key weight loss message?

We’ve stopped cooking and preparing food, we don’t eat enough fresh fruit and vegetables and we don’t move enough. In my blogs I always go on about making food yourself and knowing what’s in it. I hear a lot from people confused and feeling ‘food anxiety’ from trying their best to do the right thing. Eat whole foods and customise your diet based on your unique needs – nutrition isn’t as complicated as it’s often made out. We’re all different and it’s not one size fits all. My best advice would be to take a step back, breathe and listen to your body – take time to consider which foods do and don’t make you feel good. My great aunt and uncle had it right: fresh fruit, vegetables and some protein – no-fuss, budget-friendly, nourishing food that is easy to prepare daily. Keep it simple and make it yourself. HHW: In 2012 you sold your organic café in Sydney to launch The Healthy Chef range of organic, gluten-free powdered food supplements. Why? It came from my own personal search for supplements I could use in my busy schedule to fuel and repair my body.We start with the highest-quality raw and pure ingredients – no by-products or additives, just plant-based wholefoods. All the products are cold-processed to preserve protein structure, vitamins, minerals and antioxidants.

1. Preheat oven to 180°C. Combine apple, baking powder, salt, eggs, oil, cinnamon and vanilla in a bowl and mix well. Add wholemeal spelt flour and mix in lightly – do not over-mix. 2. Line a loaf tin (e.g. 10.5 cm x 26 cm) with baking paper and spoon in mixture. Bake as is or garnish with sliced apple and cinnamon for a caramelised flavour. 3. Bake 1 hour or until an inserted skewer comes out clean. Check after 45 minutes and cover with foil if needed. Remove from oven and cool 1 hour before removing from tin.

HHW: Why is your latest book devoted to digestive health?   When I was six or seven I was often in hospital as I developed pneumonia a couple of times. Antibiotics destroyed good bacteria in my digestive system so I really had to focus on the food I ate. The book began as a simple eating plan but evolved because digestion is far from simple. Nutritional medicine emphasises the gut – where we receive the benefit of food. And better digestion leads to a healthier body and mind. ♥

Autumn 2015 • Healthy & Heartwise

recipesbreakfast Maple nut granola Kris Abbey Preparation time: 10 minutes Cooking time: 10 minutes Nutritional information per serve (serves 4) Energy 2070 kJ , Fat 31.4 g, Protein 14.2 g, Saturated fat 6.5 g, Fibre , Sodium 158 mg, Potassium 328.8 mg 2 cups raw, whole rolled oats 1 cup sliced raw almonds  ½ cup shredded coconut ¼ cup raw sunflower seeds ¼ cup raw sesame seeds 2 tbsp pure maple syrup (preferably Grade B) 1 tbsp cinnamon  1 tsp coconut oil ¼ tsp vanilla extract 1 large pinch fine sea salt 1. Combine all ingredients in a mixing bowl and mix well with your hands so everything is coated. Don’t worry if the coconut oil is solid – your hands will melt it. 2. Spread the mixture onto a baking sheet and bake in a moderate oven for 10 minutes, until very lightly toasted. Cool then store in a jar in the fridge for up to two weeks. 3. Eat plain, with some berries, Greek yoghurt or a splash of almond milk.

From The Low Hi Diet, New Holland, 2014

French toast two ways Blair Tonkin & Paul Bullpitt French toast bacon Preparation time: 5 minutes Cooking time: 10 minutes Nutritional information per serve (serves 4) Energy 2099 kJ , Fat 21.8 g, Protein 25 g, Saturated fat 8.2 g, Fibre 1.8 g, Carbohydrate 50.1 g, Sodium 440.6 mg, Potassium 101.4 mg Dietitian’s tip: A high-protein option, try a multigrain bread to boost fibre!

French toast peaches Preparation time: 10 minutes Cooking time: 15 minutes Nutritional information per serve (serves 4) Energy 2089 kJ , Fat 24.8 g, Protein 16.6 g, Saturated fat 12.3 g, Fibre 3.6 g, Carbohydrate 52.4 g, Sodium 440.4 mg, Potassium 340 mg Dietitian’s tip: An easy way to add fruit to your day – to reduce carbohydrate, try one slice of bread instead of two 6 large eggs 2 tbsp icing sugar 2 tsp butter 6–8 thick slices of bread

BACON & MAPLE SYRUP 250 g middle-cut bacon, rindless 3 tbsp maple syrup/ honey

CARAMELISED PEACHES 40 g butter 4–5 ripe peaches, sliced and pitted  2 tbsp brown sugar Icing sugar, to dust

1. To make the French toast, whisk the eggs and icing sugar in a shallow bowl until smooth.  2. Heat a frying pan over medium heat then add the butter to melt. 3. Soak the bread in the egg and sugar mixture for a few seconds on both sides. Fry each side of the bread until golden.  4. In another pan, fry the bacon over a medium heat until crispy. Serve the French toast with a few pieces of bacon and drizzle over the maple syrup. 5. To make caramelised peaches, melt the butter in a frying pan over medium heat until foaming. Add the peaches, cook and turn after about 4 minutes, or until golden brown. Add the sugar and cook, stirring, until the mixture thickens. Do not overcook the peaches or they will fall apart. Add slices of caramelised peaches to the French toast and serve dusted with icing sugar.

54 Healthy & Heartwise • Autumn 2015

breakfastrecipes The breakfast burrito Blair Tonkin & Paul Bullpitt Preparation time: 15 minutes Cooking time: 15 minutes Nutritional information per serve (serves 4) Energy 2715 kJ, Fat 29.6 g, Protein 26.4 g, Saturated fat 12.6 g, Fibre 12.4 g, Carbohydrate 60.9 g, Sodium 1366 mg, Potassium 319.4 mg Dietitian’s tip: Use low-fat mozzarella for less fat and salt 1 tsp oil 1 red onion, diced   2 garlic gloves, finely chopped   6 shortcut bacon rashers, roughly diced  200 g can four-bean mix, drained and rinsed 1 large red chilli, seeded and thinly  sliced (optional)   2 tsp tomato purée or 12  cherry tomatoes, quartered   ¼ cup loose flatleaf parsley

Salt and pepper, to taste  Sour cream, to serve  Avocado, sliced, to serve  8 wholemeal burrito wraps SCRAMBLED EGGS  4 eggs  2 tsp light cream Salt and pepper, to taste 100 g Cheddar or Parmesan, grated (shredded)

1. To make the scrambled eggs, whisk together eggs, cream and seasoning in a small bowl. Pour the mixture into a small non-stick pan and heat over a low heat. Occasionally stir with a large spoon to prevent the egg mixture from sticking to the sides. 2. When the egg mixture starts to form small lumps, add cheese and stir until melted through. Remove from heat when the mixture has a small amount of liquid in the base of the pan. Continue to stir occasionally because residual heat will continue to cook the rest of the mixture. 3. Heat oil in a frying pan over medium heat. Add onion, garlic and bacon and fry until the bacon is crispy. 4. Add beans, chilli, tomato purée and 2 tsp of water and cook until the beans soften slightly. Remove from heat, add parsley, season to taste and mix through. 5. To serve, spread sour cream and sliced avocado on burritos. Add some bean mixture and scrambled eggs. Fold and enjoy. From 2 Dads – food for family and friends, New Holland, 2014

From The Unbakery, Murdoch Books, 2015, $45

Chia, almond & apple bircher with cinnamon & activated almonds Megan May Preparation time: 15 minutes + activating almonds Soak time: 30 minutes Nutritional information per serve (serves 3) Energy 891 kJ, Fat 9.1 g, Protein 4.6 g, Saturated fat 0.6 g, Fibre 8.8 g, Carbohydrate 28.1 g, Sodium 89.3 mg, Potassium 165.5 mg ★ GOLD STAR RECIPE ¼ cup/20 g chia seeds 1¾/ 435 ml cups almond milk 2 apples or pears 3 tbsp lemon juice 2 tbsp sultanas 1 tsp cinnamon plus extra to serve ¼ cup/25 g crushed dried activated almonds (soaked 10–12 hours, washed then dehydrated) 1. Mix chia seeds and almond milk in a bowl for a few minutes until the chia starts to absorb the milk. Make sure there are no clumps. Leave 30 for minutes until the chia seeds have fully absorbed the almond milk. 2. Grate the apples or pears and mix with some of the lemon juice to prevent it from browning. 3. M ix the sultanas, cinnamon and grated apple/pear with the chia seed mixture. 4. Serve sprinkled with crushed dried activated almonds & extra cinnamon. Autumn 2015 • Healthy & Heartwise

recipeslunches Eggplant & green bean curry Sue Quinn Preparation time: 10 minutes Cooking time: 25 minutes Nutritional information per serve (serves 4) Energy 2346 kJ, Fat 36.7 g, Protein 10.8 g, Saturated fat 25.1 g, Fibre 9.4 g, Carbohydrate 24.8 g, Sodium 58 mg, Potassium 908 mg Dietitian’s Tip: Vegetarian and high in fibre – try using olive oil if you are watching your saturated fat intake CURRY PASTE 1 large brown onion, chopped 3 garlic cloves, chopped 2 thumb-sized pieces of ginger, chopped 1 large red chilli, finely chopped 1 tsp ground cumin 1 tsp ground coriander 1 tsp cardamom 1 tsp turmeric 1 tsp curry powder MAIN 4 tbsp extra-virgin

coconut oil 6 small eggplants, cut into 6 cm wedges 300 ml puréed tomatoes 270 ml coconut milk 300 g green beans Celtic sea salt Freshly ground black pepper 80 g activated almonds, roughly chopped, to serve Handful of chopped coriander, to serve Juice of 1 lime Lime halves, to serve

1. P lace all the curry paste ingredients in a food processor with 2 tbsp of filtered water and pulse for a few seconds. 2. Heat 2 tbsp of the coconut oil in a large frying pan over medium–high heat and fry eggplants 5 minutes until browned. Remove from the pan to a paper towel to drain. 3. Heat the remaining coconut oil in the pan and cook the curry paste ingredients about 3 minutes. Add eggplant and stir until well covered in paste. Add puréed tomato and coconut milk and simmer, partially covered, for 10 minutes. Add beans and cook another 6 minutes. 4. Season, add almonds, coriander and lime juice and serve with lime halves on the side. From Easy Vegan, Murdoch Books, 2015, $39.99

Creamy roasted tomato soup Hugh Fearnley-Whittingstall Preparation time: 15 minutes / Cooking time: 50 minutes Nutritional information per serve (serves 4) Energy 1143 kJ, Fat 25.1 g, Protein 7.4 g, Saturated fat 2.6 g, Fibre 4.8 g, Carbohydrate 20.7 g, Sodium 59.2 mg, Potassium 179.6 mg Dietitian’s tip: Enjoy with a sourdough bread roll 1.2 kg tomatoes 4–5 garlic cloves, chopped 3 tbsp rapeseed/ sunflower oil S ea salt and freshly ground black pepper 7 5 g cashew nuts, plus extra to finish (optional)

2 00 ml light vegetable stock or water A pinch of sugar (optional) TO FINISH Extra-virgin rapeseed oil Dusting of paprika (optional)

1. Preheat the oven to 180°C. 2. Cut the tomatoes in half and place in a large roasting tray – they should fit snugly. Scatter over the chopped garlic, trickle over the oil and season well. Roast for 25 minutes, then scatter the cashews over the tomatoes. Return to the oven for a further 20 minutes until the tomatoes are soft and pulpy and maybe a little charred in places. 3. Scrape the tomatoes, cashews and the garlicky pan juices into a blender. Add stock or water and purée. Pass this through a sieve, which will remove pips and tomato skin. 4. When you’re ready to serve, reheat gently. You can add a little water if the soup seems very thick or the flavour too intense. Season further if needed and add a pinch of sugar if the tomatoes’ acidity needs tempering. 5. Ladle into warmed bowls and finish with a swirl of extravirgin oil plus a few chopped cashews and a dusting of paprika, and a generous sprinkling of pepper. Also very good served cold with plenty of shredded fresh basil or mint leaves.

lunchesrecipes From The Gourmet Farmer Goes Fishing, by Matt Evans, Nick Haddow and Ross O’Meara, Murdoch Books, 2015, $49.99

Chicken with lentils & rosemary Hugh Fearnley-Whittingstall Preparation time: 10 minutes Cooking time: 1 hour 20 minutes Nutritional information per serve (serves 4) Energy 3576 kJ, Fat 51.4 g, Protein 84.6 g, Saturated fat 14.5 g, Fibre 4.8 g, Carbohydrate 16.3 g, Sodium 820 mg, Potassium 283.7 mg Dietitian’s tip: Trim chicken of fat before cooking 2 tbsp olive oil 1 large onion, sliced 4 garlic cloves, chopped Leaves from 2 sprigs of rosemary 200 g red lentils, well rinsed 500 ml chicken or veg stock

8 whole free-range chicken thighs, or 1 medium chicken (about 1.75 kg), jointed into 6–8 pieces Sea salt and freshly ground black pepper Flatleaf parsley, chopped, to finish

Crab rolls with Meyer lemon mayonnaise

1. Preheat the oven to 180°C. Choose a flameproof casserole dish or a wide, ovenproof pan that will hold all the chicken pieces snugly.

Matthew Evans

2. Put the casserole over a medium-low heat. Add the oil, then the onion and cook, stirring regularly, for 6–8 minutes until it begins to soften. Add the garlic, rosemary and some salt and pepper. Cook gently for a further 5 minutes, then stir in the lentils and stock.

Preparation time: 10 minutes

3. Season the chicken thighs and place skin-side up in the casserole. Most of the chicken skin should be above the liquid surface so it can brown later. Bring to a simmer, then transfer to the oven and bake uncovered for 1 hour. Check that the chicken is cooked right through and the lentils are soft. If not, return to the oven for 10–15 minutes and test again. Skim off any excess fat. 4. Taste the lentil liquid and add more seasoning if needed. Serve, scattered with chopped parsley, as is or with steamed broccoli or spring greens on the side. River Cottage Light & Easy, Bloomsbury, 2014, $49.99

Nutritional information per serve (serves 2) Energy 1546 kJ , Fat 9.9 g, Protein 19.6 g, Saturated fat 1.5 g, Fibre 0 g, Carbohydrate 49.9 g, Sodium 298.9 mg, Potassium 0 mg Dietitian’s tip: Serve with a green salad ★ GOLD STAR RECIPE 50 g cooked crab meat 2 tbsp Meyer lemon mayonnaise ½ hard-boiled egg, chopped 1 tsp chopped French tarragon 2 small bread rolls, pref ciabatta-style A few chervil sprigs (optional) MEYER LEMON MAYONNAISE 3 egg yolks 2 tbsp Meyer lemon juice 1 tsp dijon mustard 100 ml olive oil 100 ml sunflower oil 1 tsp warm water, as required 1. For the mayonnaise, whisk together the egg yolks, lemon juice and mustard in a large bowl. Blend the olive and sunflower oils together in a cup then slowly add to the egg mixture, whisking constantly. Season to taste. If mayonnaise is too thick, stir in the teaspoon of warm water. Cover and refrigerate until serving. 2. In a small bowl, mix the crab meat, mayo, hard-boiled egg and tarragon. Season to taste with salt and freshly ground black pepper. Cut bread rolls nearly in half and spoon in crab mixture, garnishing with chervil if desired.

Autumn 2015 • Healthy & Heartwise

recipesdinner Pan-fried fish with fennel & beetroot remoulade Blair Tonkin & Paul Bullpitt Preparation time: 15 minutes + 10 minutes refrigeration Cooking time: 6 minutes Nutritional information per serve (serves 4) Energy 2264 kJ , Fat 32.3 g, Protein 38.2 g, Saturated fat 6.4 g, Fibre 3.8 g, Carbohydrate 21.6 g, Sodium 802 mg, Potassium 1349 mg Dietitian’s tip: Use mackerel or salmon for omega–3 fatty acids 4 firm, oily fish fillets, skin on Sea salt  and freshly ground black pepper Extra-virgin olive oil Lemon wedges, to serve REMOULADE 2 baby fennel bulbs, trimmed, thinly sliced 2 baby beetroot, thinly sliced  60 g mayonnaise (see opposite) 60 ml lemon juice

4 sweet gherkins, finely chopped 2 tsp capers, drained and chopped  3 tsp wholegrain mustard MAYONNAISE 2 egg yolks 3 tsp lemon juice Pinch of salt  200 ml olive oil Freshly ground white pepper

1. For mayonnaise, place egg yolks, lemon juice and salt in a large bowl and whisk until the mixture thickens. Add the oil to the mixture slowly, whisking constantly. Stir in pepper. Mayonnaise can also be made using a food processor. Store in fridge until ready to use. 2. Season the fish skin with salt and pepper, cover and refrigerate for 10 minutes. Remove from refrigerator and pat dry with paper towel. 3. Heat oil in a non-stick pan over a medium heat. Cook skin-side down for about 4 minutes or until skin is crispy. Turn and cook until firm. 4. For the remoulade, combine the fennel and beetroot, mayonnaise, lemon juice, gherkin, capers and mustard in a large bowl. 5. Divide remoulade among the serving plates and top with fish. Serve with lemon wedges or dill fronds. From Two Dads – food for family and friends, New Holland, 2014

Roast rabbit saddle with bread & sage stuffing & braised lentils Stefano Manfredi Nutritional information per serve (serves 6) Energy 3138 kJ, Fat 42.5 g, Protein 51.9 g, Saturated fat 15.8 g, Fibre 6.3 g, Carbohydrate 39.4 g, Sodium 1120 mg, Potassium 912 mg Dietitian’s tip: Use a small amount of mozzarella to reduce salt! 1 onion, diced 4 garlic cloves, crushed 100 g butter 2½ cups/150 g fresh breadcrumbs 50 g Italian mustard fruit, thinly sliced ¾ cup/100 g Parmesan cheese, grated 4 tbsp chopped flatleaf parsley 4 tbsp chopped sage leaves Sea salt and freshly ground black pepper 8 slices prosciutto 2 farmed rabbit saddles (approx. 1.5 kg), each carefully boned as one whole piece 2 tbsp extra-virgin olive oil

58 Healthy & Heartwise • Autumn 2015

dinnerrecipes

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

BRAISED LENTILS ½ celery heart, finely chopped 1 carrot, finely chopped 1 onion, finely chopped 1 leek, sliced 5 mm thick 2 garlic cloves, minced 80 ml extra-virgin olive oil 4 tbsp rough-chopped flatleaf parsley 1 rosemary sprig, chopped 1 thyme sprig, chopped 500 g Puy or tiny blue-green lentils, washed well 1 litre vegetable or chicken stock 200 g puréed tomatoes

1. To make stuffing, lightly fry onion and garlic in butter until soft but not coloured. Remove from heat and add to breadcrumbs, mustard fruit, parmesan, parsley, half the sage, salt and pepper. Mix well and let cool. 2. Lay prosciutto slices flat in two sets of four so each slice slightly overlaps. Put one rabbit saddle on each set of four slices. Place just enough stuffing evenly in middle of each saddle so it can be rolled – too much will be difficult to hold. Roll so that prosciutto covers rabbit completely in a tight sausage. Wrap tightly in plastic wrap and refrigerate 2–3 hours. 3. An hour before serving, take rolled rabbit out of fridge to reach room temperature. Preheat oven to 200°C. 4. Remove plastic wrap and lay rabbit rolls in a roasting tin. Sprinkle olive oil over each roll. Add remaining sage leaves, season. Roast for 15–20 minutes. Insert a skewer into centre of roll – if rabbit is cooked, juice runs clear. Remove from oven and rest for 10 minutes before slicing and serving with lentils. 5. For lentils, lightly fry vegetables and garlic in olive oil in a large saucepan for a few minutes without colouring them. Add parsley, rosemary and thyme and cook for another minute or two. Add lentils and stir. Add stock and tomatoes until lentils are covered. Simmer 30–50 minutes until tender. Add more liquid if needed, season to taste.

Potato & spinach vindaloo Sue Quinn Preparation time: 20 minutes Cooking time: 55 minutes Nutritional information per serve (serves 4) Energy 1463 kJ, Fat 15.4 g, Protein 6.4 g, Saturated fat 1.1 g, Fibre 8.9 g, Carbohydrate 50.6 g, Sodium 1140 mg, Potassium 1303 mg Dietitian’s Tip: Spices are healthy – add some lentils to boost protein CURRY PASTE 4 cardamom pods 2 tsp coriander seeds 1 tsp mustard seeds 1 tsp fennel seeds 2 cloves 3 tsp ground cumin 1 tsp ground cinnamon 2 tsp hot curry powder (use 1 tsp if you prefer a milder curry) 2 medium red chillies, seeded and finely chopped 1 tsp fine sea salt 2 tbsp tomato paste (concentrated purée)

40 ml white wine vinegar 30 ml vegetable oil MAIN DISH 2 tbsp vegetable oil 2 onions, chopped 175 g tin chopped tomatoes 1 tbsp caster sugar 1 tsp fine sea salt 650 g boiling potatoes, peeled and chopped into 3 cm dice 100 g English spinach or silverbeet Chopped coriander to serve

1. For the curry paste, toast the cardamom pods and seeds in a dry fry pan until fragrant. Transfer to a mortar, add the cloves and pound. Discard the empty cardamom pods, shaking out the seeds, and pound to a powder. Add the remaining paste ingredients and pound to a wet paste. Set aside. 2. H eat vegetable oil in a large lidded pan and gently cook the onions for 10 minutes, or until very soft and golden at the edges. 3. A dd curry paste and stir for 3 minutes, being careful not to burn paste. 4. A dd 455 ml water, tomatoes, sugar and salt and simmer gently 10 minutes. 5. A dd potatoes – they need to be just covered with liquid, so top up with water if necessary. Cover with lid slightly ajar and cook 20 minutes. Remove lid and simmer for 10 minutes more, or until the potatoes are tender and the sauce thick. Taste and add more salt or sugar if needed. 6. Add the spinach to the pan, cover and cook until just wilted. Gently stir to combine vegetables. Serve immediately, sprinkled with coriander.

From Easy Vegan, Murdoch Books, 2015, $39.99

Autumn 2015 • Healthy & Heartwise

recipesdesserts Rice pudding Spencer Clements Preparation time: 5 minutes Cooking time: 35 minutes Nutritional information per serve (serves 4) Energy 1865 kJ , Fat 19 g, Protein 12.5 g, Saturated fat 12.8 g, Fibre 1.5 g, Carbohydrate 59.8 g, Sodium 123 mg, Potassium 12.9 mg Dietitian’s Tip: This pudding is a good source of calcium – use light milk if watching fat intake 1 litre milk 1 cinnamon stick  1 vanilla pod (bean), seeds removed  Zest of 1 lemon  100 g bomba rice 115 g caster sugar 50 g unsalted butter 1. Pour the milk into a pan and add cinnamon stick, vanilla and seeds and lemon zest. Place the mixture over a medium-to-high heat and bring to boil. Stir the milk a few times as it heats to stop it burning on the base of the pan. Be careful – it may suddenly boil over. 2. Just as the milk starts to bubble and rise, add the rice and stir. Allow to simmer for 20 minutes, stirring at all times, then stir in the sugar and cook for another 10 minutes. 3. Remove from the heat and add the butter – keep stirring so that the butter emulsifies as it melts. Remove and discard the lemon zest strips and the cinnamon stick and vanilla pod and allow to cool, stirring every 30 minutes or so. From Glutenfree Tapas, New Holland, 2014

Amazeballs Blair Tonkin & Paul Bullpitt Preparation time: 30 minutes

From Two Dads – food for family and friends, New Holland, 2014

Nutritional information per amazeball (makes 15–20) Energy 697 kJ, Fat 9 g, Protein 4.2 g, Saturated fat 1.9 g, Fibre 3.6 g, Carbohydrate 19.3 g, Sodium 9.8 mg, Potassium 156 mg Dietitian’s Tip: A healthier alternative to rum balls or biscuits 100 g walnuts, chopped 100 g slivered almonds 2 tbsp pumpkin seeds 200 g Medjool dates, pitted and chopped  70 g soft dried apricots, chopped  70 g prunes, pitted and chopped  2 tbsp unsweetened cocoa powder  2 tbsp goji berries

1 tbsp peanut butter   2 tbsp honey   1 tbsp ground cinnamon ¼ tsp nutmeg Zest and juice of 1 lemon Coating options Desiccated coconut Sesame seeds Unsweetened cocoa powder

1. L ightly toast the walnuts and almonds in a small frying pan over medium heat. Combine the nuts and pumpkin seeds in the bowl of a food processor and pulse until finely chopped. Add the dates, apricots and prunes and process until smooth. 2. A dd the remaining ingredients and process until the mixture starts to form a ball. Remove from the processor and divide into golf ball-sized portions, rolling each between your palms. 3. R oll each ball in one of the coating options above and store refrigerated in an airtight container for up to 2 weeks.

60 Healthy & Heartwise • Autumn 2015

dessertsrecipes Baked pears with almonds & apricots Hugh Fearnley-Whittingstall Preparation time: 20 minutes Cooking time: 30 minutes Nutritional information per serve (serves 4) Energy 827 kJ , Fat 7.2 g Protein 4.2 g, Saturated fat 0.6 g, Fibre 5.9 g, Carbohydrate 30.7 g, Sodium 3.7 mg, Potassium 350 mg Dietitian’s Tip: A high-fibre dessert! ★ GOLD STAR RECIPE 2 very large/4 smaller ripe pears 50 g whole almonds, roughly chopped 8 unsulphured dried apricots, chopped

From River Cottage Light & Easy, Bloomsbury, 2014, $49.99

Finely grated zest and juice of 1 lemon 2 tbsp cloudy apple juice 1 tbsp runny honey

1. Preheat the oven to 180°C. Line a baking dish with baking paper. 2. P eel the pears and slice in half lengthways. Scoop out the cores with a melon baller or tsp to create a cavity about 4 cm in diameter. Take a little slice from the underside of each pear so they will sit steady and put them cut side up in the baking dish. 3. Combine the chopped almonds, dried apricots and lemon zest. Distribute the almond mixture between the pears – it will fill the cavities and overflow to the cut surface of the pears too. Sprinkle the lemon juice over the pears, spoon on apple juice, then trickle over the honey. 4. Cover the dish with foil and bake for 20 minutes, until the pears are tender, then uncover and return to the oven for 7–10 minutes or so to lightly toast the almonds. 5. S erve hot, with any juices spooned over.

From The Outback Chef, New Holland, 2014

Anzac biscuits with wattleseed Jude Mayall Preparation time: 25 minutes Cooking time: 20 minutes Nutritional information per serve (serves 4) Energy 2182 kJ , Fat 25.8 g, Protein 5.9 g, Saturated fat 15.1 g, Fibre 3.5 g, Carbohydrate 66 g, Sodium 327 mg, Potassium 73.6 mg Dietitian's Tip: Increase the serve size to 8 to reduce kilojoules 1 cup rolled oats ¾ cup plain flour ½ cup sugar  1 tsp golden syrup 20 g ground, roasted wattleseed  1 tsp bicarbonate of soda  ½ cup melted butter or margarine  2 tsp boiling water 1. Heat oven to 160°C. Mix oats, flour and sugar together.  2. Mix golden syrup, wattleseed, soda and boiling water. While frothing, add melted butter then pour mixture into dry ingredients. Mix thoroughly.  3. Place spoonfuls on an oven tray, allowing room for the mixture to spread.  4. Bake for 18–20 minutes. Allow to cool on biscuit rack. Autumn 2015 • Healthy & Heartwise

recipespreserves&conserves Mango & coriander chutney Nicky Arthur Preparation time: 5 minutes Dietitian’s tip: Serve with meat and chicken dishes to balance flavours Nutritional information per serve (25 g) (makes 1 cup) Energy 210 kJ , Fat 2.8 g, Protein 0.5 g, Saturated fat 2.4 g, Fibre 1.3 g, Carbohydrate 6.9 g, Sodium 61.3 mg, Potassium 83.2 mg 2 cups mango, chopped 1 cup fresh coconut meat ¼ tsp cayenne pepper  ¼ tsp chilli flakes  ¼ tsp Himalayan pink/Celtic sea salt ¼ cup coriander, roughly chopped 1. Process all ingredients for 10 seconds in the blender. Do not over-process.

From The Power of Living Raw, New Holland, 2014

Basil pesto Lee Holmes

Supercharged Food: Eat Clean, Green & Vegetarian, Murdoch Books, $35

Preparation time: 15 minutes Dietitian’s Tip: A nutrient-packed flavour enhancer! Nutritional information per serve (25 g) (makes 1 cup) Energy 676 kJ, Fat 15.8 g, Protein 3.8 g, Saturated fat 1.7 g, Fibre 1.8 g, Carbohydrate 3.6 g, Sodium 121 mg, Potassium 127 mg 160 g blanched almonds 2 garlic cloves, peeled 2 large handfuls of basil leaves 80 ml cold-pressed extra-virgin olive oil 1 tbsp freshly squeezed lemon juice 2 tbsp yeast flakes Small pinch of Celtic sea salt 1. Place the almonds in a food processor and whizz until fine. Add the garlic and pulse, then add the basil and whizz again. With the motor running, slowly drizzle in the olive oil until you have the desired consistency, then add lemon juice, yeast flakes and salt. 2. This pesto will keep in a sealed container in the fridge for up to 1 week and can be refreshed with an extra splash of extra virgin olive oil.

62 Healthy & Heartwise • Autumn 2015

preserves&conservesrecipes Sauerkraut Nicky Arthur Preparation time: 30 minutes RESting time: 30 minutes + 4–21 days Dietitian’s tip: A probiotic hit! Serve as side dish to fish or chicken sandwiches Nutritional information per recipe Energy 2101 kJ , Fat 27.9 g, Protein 4.8 g, Saturated fat 24 g, Fibre 13.4 g, Carbohydrate 68.9 g Sodium 612.8 mg, Potassium 832.2 mg 1 red cabbage 2 carrots 2 tbsp salt 1 tsp celery seeds

1 tsp dill seeds, divided 1 tsp black peppercorns, divided 1 bay leaf

1. Shred, slice or grate the cabbage and carrots and place in a large bowl. From A Homegrown Table, New Holland, 2013

2. Add salt and toss to combine, then set aside for 30 minutes. 3. Knead the vegetables then tip them into a mason jar. Add the spices and manually compress the vegetables, squeezing out moisture. 4. If there is no extracted liquid, make a brine to help cover the vegetables. Bring ½ cup of water with a ½ tsp salt to the boil, then let cool. Pour over vegetables, leaving 2.5 cm of head space in the jar. Add a weight to help press the vegetables down. Seal jar – contents will bubble visibly over the next few days.

Emma Dean Preparation time: 45 minutes cooking time: 1.5–2 hours

5. Once a day, loosen the lid to let the fermentation gases escape. Push down into the liquid any vegetables that have moved up the jar or above the weight. 6. As the lactic acid probiotic bacteria proliferate, the cabbage turns into sauerkraut and by day 4 it can be eaten. However, for best flavour leave it for 1–3 weeks. Warmer temperatures speed up fermentation, while cooler slow the process. Refrigerating slows down fermentation so, once ready, store in the refrigerator. From The Power of Living Raw, New Holland, 2014

Cumquat marmalade

CHEF's tip: The oval-shaped cumquats have a slightly sweeter flavour Nutritional information per 20 g serve (mAkes 6–8 jars) Energy 153 kJ , Protein 0.2 g, Fibre 0.5 g, Carbohydrate 9.3 g, Potassium 15 mg 1 kg cumquats 1 litre water 1 kg white sugar 1. Slice the cumquats very finely. Remove the seeds and put aside. Gather the seeds and put them in a muslin cloth and tie top with string. 2. P ut the cumquats, seed bag and water into a heavy-based saucepan and bring to the boil. Simmer for 30–60 minutes (depending how thinly you have sliced them) until the skin is soft. Remove the seed bag. 3. Add the sugar and simmer for another 30 minutes. 4. To see if the marmalade is ready, drop a small dollop onto a cold plate. If it tenses up and sets a bit, it is ready. If not, simmer another 10–20 minutes – this varies and may take a few tests. 5. Once ready, carefully pour into sterilised jars and cover with lid.

Autumn 2015 • Healthy & Heartwise

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64 Healthy & Heartwise • Autumn 2015

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Autumn 2015 • Healthy & Heartwise

readersurvey 3. How much of the advertising in Healthy & Heartwise do you read? n 1 All n 2 Most n 3 Some n 4 Hardly any 4. In which of the following ways do you read Healthy & Heartwise? n 1 Print only n 2 Mostly print, sometimes online n 3 Half and half n 4 Mostly online, sometimes print n 5 Online only 5. Would you recommend Healthy & Heartwise? n 1 Yes n 2 No 6. Which of the following have you read in the past 6 months? n 1 Prevention n 5 Weight Watchers n 2 Women’s Health n 6 Good Taste 3 n Australian Healthy Food Guide n 7 Good Health n 4 Diabetic Living n 8 None of these 7. Have you experienced any of the following conditions in the past 12 months? n 1 A stroke n 8 Vision loss/problems n 2 A heart attack n 9 Hearing loss n 3 High blood pressure n 10 Incontinence 4 n High cholesterol n 11 Foot/leg ulcers n 5 Poor circulation n 12 Food allergy/intolerance n 6 Heart disease n 13 Injury n 7 Diabetes n 14 Other (specify):________ 8. I visit a doctor: n 1 Weekly n 2 Monthly n 3 Every three months n 4 Less often 9. I visit a pharmacy: n 1 Weekly n 2 Monthly n 3 Every three months n 4 Less often

THANK YOU! YouR completed survey puts you in the draw to win: • 2 nights at Gaia Retreat & Spa with meals and activities included – see details page 64 • 1 of 4 Nude by Nature OR The Aromatherapy Company skincare gift packs • 1 of 50 copies of the What’s Wrong With My Heart? DVD The first 100 respondents win a FREE one-year subscription to Healthy & Heartwise valued at $30!

66 Healthy & Heartwise • Autumn 2015

10. Which of the following have you bought in the past 6 months? n 1 Low-fat food products n 2 Low-salt food products n 3 Vitamins, minerals, herbal supplements n 4 Low-GI food products n 5 Organic/biodynamic products n 6 Heart Foundation Tick products n 7 Omega–3 products n 8 Vegetarian/vegan n 9 Gluten-free food products n10 Low/no-sugar food products n11 Fish (tinned or fresh) 11. How many times have you purchased the following medicines or supplements in the past 6 months without a prescription?

Pain killers (paracetamol/ibuprofen) Low-dose aspirin Fibre supplements Iron supplements Calcium/vitamin D supplements Fish oil capsules or liquid Detox kits and products Products for arthritis Antacids and reflux products Hay fever and allergy medication Cold and flu preparations

n1 n1 n1 n1 n1 n1 n1 n1 n1 n1 n1

2 3–5 6+

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n4 n4 n4 n4 n4 n4 n4 n4 n4 n4 n4

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healthyproducts ♥

Health on the

Shelf Our choice of the best health buys!

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Love your heart for less! Tablelands Reduced Cholesterol 500 g spread contains active plant sterols that lower the amount of cholesterol your body absorbs – research indicates that for best results consume 25 g/day of a plant sterol-based spread, which is equivalent to two or three slices of bread with this spread. Tablelands is available in Coles and Woolworths for a great ‘value for money’ price. It is also suitable for vegetarians, has 65% less saturated fat than butter, and has the Heart Foundation Tick of approval. See www.peerlessfoods.com.au for more information.

What is NutriKane D™? NutriKane D™ is a safe, innovative natural product produced from whole plant sources including gluten-free grains, natural flavours and sugar cane varieties (sucrose removed). NutriKane D™ is classified as a food for health purposes. Scientifically researched by MediKane, NutriKane D™ assists intestinal health and when consumed with meals, it has been shown to lower the GI of foods. For stockists, see www.nutrikane.com.au or call 1300 889 962.

Open your eyes to OPSM If you have diabetes, it’s important to have regular eye examinations to monitor eye health and help detect any issues early. An Optos Daytona Ultrawide Digital Retinal Scan, which views 200° of the retina in one scan (four times more than a standard 45° scan using fundus photography) can help identify any retinal concerns. Ask an OPSM optometrist if an Ultrawide Scanner is suitable for you. Fees apply. Autumn 2014 | Healthy & Heartwise

diabetesmedicines

Lowering blood glucose Chances are you are prescribed more than one type of medicine for managing your diabetes, and they will change. Dr Pat Phillips explains how they lower blood glucose levels.

I Dr Pat Phillips, MBBS, MA, FRACP, MRACMA, is Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service

nsulin was the first hypoglycaemic agent introduced to Australia in the 1920s, followed by metformin and the sulphonylureas that were used in the 1950s. There was little change until the 1980s but since then, and especially in the past 10 years, the range of medicines that lower blood glucose levels (BGLs) has increased. In 2015, including the insulins, we have 10 classes of hypoglycaemic agents with many different brand names within each class. Because there are so different brands, I’ll refer to the chemical ‘generic’ names of the medications, which is usually in smaller type beneath the brand name on a medicine label, e.g. the active ingredient in Diabex is the chemical metformin. The simplest way to think about all these medications is to group them in terms of

what they do to each of the five organs in the body that affect BGLs [see ‘Hypoglycaemic medications’ table below].

The gut Your gastrointestinal tract or gut is much more than a tube with food entering one end and bowel movements leaving the other. There are complex signalling systems through nerves and hormones that coordinate the function of stomach, intestines, pancreas and gall bladder, and which give feedback to the brain. After eating, the large intestine makes a hormone (glucagon-like peptide or GLP) that tells the pancreas to make more insulin, the liver to stop releasing glucose (which otherwise

Hypoglycaemic medications Organs affected

Hypoglycaemic medications

Actions

The gut

acarbose

slows carbohydrate digestion

GLP (glucagon-like peptide) agents

↓ appetite; slow stomach emptying

metformin

↓ liver glucose output

glitazones

↑ insulin effect

sulphonylureas

↑ insulin release

GLP agents

↓ glucagon release

The muscles

glitazones, metformin

↑ insulin effect

The kidneys

gliflozins

↑ kidney glucose loss

The liver The pancreas

69 Healthy & Heartwise • Autumn 2015

diabetesmedicines would increase BGLs), the stomach to slow the release of food to the small intestine and the brain to feel ‘full’ and stop eating. The drugs affecting BGLs through gut-related actions are: • acarbose – slows carbohydrate digestion, giving the body more time to deal with the glucose entering the bloodstream • GLP agents – either increase the levels of GLP or inject proteins that mimic its actions.

The liver The liver can store glucose from a meal as a form of starch (glycogen) and later break down the glycogen and release glucose into the blood to be used by other organs. It acts as a buffer for blood glucose – pulling glucose in when BGLs are high after a meal and sending it out when BGLs are low. Two hypoglycaemic medications affect liver glucose metabolism: • Metformin reduces the amount of glucose released into the bloodstream. • Glitazones increase the effect of the insulin made by the pancreas. Metformin and the glitazones also affect the muscles’ use of glucose.

The pancreas

Including insulin, 10 classes of drugs lower blood glucose

The pancreas makes enzymes and alkali that are poured into the gut to help digestion and makes insulin that is released when food is absorbed. Insulin helps guide the nutrients into appropriate organs e.g. glucose is stored in the liver and muscles, fats are stored in visceral fat. The pancreas also makes another hormone (glucagon) that is usually released when BGLs are low. In type 2 diabetes, glucagon continues to be released, even when BGLs are high, and adds to its rise. Two hypoglycaemic medications affect the pancreas: • Sulphonylureas – increase insulin release, even when BGLs are low (which is why they can cause hypoglycaemia). • GLP agents (the gliptins exenatide and liraglutide) increase GLP activity, which then increases insulin release and decreases glucagon release. The increased insulin and decreased glucagon both lower BGLs.

The muscles Originally published in Conquest Spring 2014

Your muscles can use a lot of glucose. They can also store glucose for later use, although the muscles can’t release it into the blood as the liver does. The two hypoglycaemic medications

that affect the liver also affect the muscles. Both glitazones and metformin increase the effectiveness of the insulin made by the pancreas. This increases the muscles’ uptake of glucose and lowers BGLs. Although the glitazones and metformin have the same overall effect, they work in different ways and together have larger BGL effects than either alone.

The kidneys The kidneys filter 140 litres of fluid a day normally, and pass 1–2 litres as urine. The rest of the fluid and the substances in that fluid are reabsorbed, including glucose. Someone with an average BGL of 6 mmol/L would filter 156 g of glucose a day and reabsorb it all. However the kidney’s capacity to reabsorb glucose is limited, so if the BGL is above a certain level (the renal threshold), some glucose is lost in the urine – glycosuria. The gliflozins reduce the kidney’s capacity to reabsorb glucose, lower the renal threshold and cause glucose to be lost in the urine. It is taken from the blood and reduces the BGL. Because the lost glucose could have been used to produce fat, the body has effectively lost fat and the gliflozins usually cause some weight loss. There are effectively seven different hypoglycaemic medications (other than the insulins) with different mechanisms – the GLP agents, gliptins and exenatide/liraglutide effectively work the same way. Theoretically, all seven could be used together and each would add to the BGL-lowering effect of the others. In practice, only two or three are used together and if BGL remains high, insulin is used.

Insulin itself The insulin Australians now use is purer than in the 1920s and doesn’t come from animals. Syringes and other injecting devices make using insulin much more simple, safe and comfortable. While the other hypoglycaemic agents usually cannot lower BGLs adequately long term, insulin nearly always can. Many people will use the medications in the table for some years but will eventually need to add insulin.

The future Researchers are always looking for new ways to control blood glucose, with the ideal being a medication that will reproduce what happens in the body of someone without diabetes. We’ll see lots of new agents in the future – some just further brands but some completely new classes of hypoglycaemics. ♥ Autumn 2015 • Healthy & Heartwise

healthyeating

The good appetite It can be a ravenous beast or mild as milk, leading us to cravings, potential ‘diabesity’ or glowing calm and satisfaction. To help us discipline it so it works for us, Milena Katz unpicks the complex science behind our hunger.

unger was an important survival mechanism for our ancestors, prompting them to hunt and forage for food to survive. Now the body of research on appetite has grown to cover fields such as genetics, hormone regulation, behaviour, psychology and diet. If appetite is our guide, kidnapper or at least companion through every life stage from infancy until our final years, how can we listen to our hunger, trust it and eat responsibly?

A tale of two hormones Science has discovered more about two hormones that drive our appetite, leptin and ghrelin. Put simply, their role in influencing body weight is a complex process.

Milena Katz, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney

Leptin is an appetite suppressor that signals satiety to the brain, i.e. the body has obtained enough energy stores, such as in body fat. Levels of leptin are lower when you’re thin and higher when you’re fat because it is made by fat cells. They also vary according to when you last ate and your sleep patterns. However, many obese people have developed a resistance to the appetite-suppressing effects of leptin, even though they have higher levels of it. In one experiment, rats given doses of leptin ended up eating less but only for about two weeks. This suggested that the rats developed a resistance to leptin’s appetite-curbing effects. Ghrelin increases appetite and plays a role in influencing body weight. It is released primarily in the stomach and is thought to signal hunger to the brain. Research shows that ghrelin levels rise dramatically before you eat, signalling hunger. They then go down for about three hours after the meal.

How foods interact with appetite When we eat, leptin travels to various parts of our bodies to tell us we’ve had enough (i.e. we feel ‘full’ or sated). But when we eat fatty meals, this signalling system doesn’t work so well. Eating fat tends to lead to eating increased kilojoules of energy, weight gain and storage of body fat. Researchers have seen some of these effects after only three days of a high-fat diet. Interestingly, a diet rich in either high-fibre carbohydrates (e.g. wholegrains) or protein suppresses ghrelin more effectively than a diet high in fat. Sleep also influences leptin and ghrelin levels. A small study showed sleep deprivation was associated with an increase in ghrelin levels, appetite and hunger compared with getting a full eight or more hours a night. ♥

Watching waistlines and appetite • Start a meal with a low-energy, high-nutrient entrée such as a soup or salad to reduce the overall amount that you eat. • Eat lots of vegetables and some fruit. Studies show that people who have nine or more serves per day take in less energy overall. • Don’t skip meals – people who skip breakfast tend to weigh more and overconsume kilojoules during the day. A 2008 study found that people eating three meals compared with two meals containing the same amount of energy increased their satiety over 24 hours. • Don’t worry about manipulating your protein, fat or carbohydrate intakes to lessen hunger. The focus should be more on filling up on low-energy foods rather than on proportions of fat, protein and carbohydrate in your diet.

Autumn 2015 • Healthy & Heartwise

diabetescomplications After living with diabetes for 20 years, about half of them have some nerve damage about a fifth have severe, troublesome damage. They may who feel reduced sensation in their feet, often accompanied by numbness and tingling. Some may experience a build-up of burning or shooting pain, aching, or pain at the slightest touch with symptoms tending to be worse at night. High blood glucose levels (BGLs) cause diabetic neuropathy by damaging the very small blood vessels that supply oxygen to nerves at your extremities. Both feet are most commonly affected but sometimes hands are too after enough time – 43% of those with diabetic neuropathy who were surveyed said they were diagnosed at least 10 years ago – with a glove-and-stocking distribution.

Failure of NERVE Nerve damage is a long-term result of raised blood glucose, and half of people with diabetes experience pain or numbness in their feet. Eventually it affects daily life but as pain medicine specialist Dr Nathan Taylor explains, many suffer in silence.

N Dr Nathan Taylor, BSc(Med), MBBS, FANZCA, FFPMANZCA, is a specialist in Pain Medicine at Royal North Shore Hospital, Sydney

erve pain cuts a bigger than expected swathe through Australia’s workforce every week, a survey has found, with six out of 10 people who experience it missing work at least one day. As part of the Global Year Against Neuropathic Pain, Pfizer’s ‘Share Your Pain’ campaign involved an online survey of 300 Australians with long-term pain and found that nerve pain costs more in lost productivity than arthritis, which compels only 43% to miss work once a week.

The painful diabetes connection Sciatica, chilblains, cold sores, pinched nerves and even back pain were considered causes of nerve pain, however diabetic neuropathy is of greatest concern to people with diabetes.

71 Healthy & Heartwise • Autumn 2015

Others can’t ‘feel your pain’ Doubly cruel is the fact that diabetic neuropathy leaves no physical trace of illness or infirmity, isolating its victims from sympathy that someone with a visible injury or obvious symptoms might receive. Most people diagnosed with neuropathic pain avoid talking about it because they feel others don’t understand it, and 30% think it would burden others. A strong majority (86%) take medication daily to help manage their symptoms – this can be as simple as paracetamol and/or ibuprofen but both have side effects long term, and prescribed opioid painkillers such as codeine and oxycondone can lead to dependence and withdrawal.

Getting the right help However, GPs and pain medicine specialists have other management strategies for pain that can empower you to take control and get back to normal life. A pain management plan is usually part of this, and 41% of survey respondents with nerve pain said they have a pain plan, compared with 25% of people who live with other pain such as arthritis. For diabetic neuropathy, control of BGLs is all-important to stop the damage its causing, so if you have diabetes with pain or numbness in your feet or hands that just doesn’t settle, you need to speak to your healthcare professional. They will help acute symptoms and get your BGLs lower, and possibly help with a referral to a pain clinic or specialist for appropriate treatment. Pfizer has set up the website www.nervepain. com.au to provide information about nerve pain, videos, FAQs, a pain questionnaire and resources such as a sleep diary. ♥

eatingwithdiabetes

eggs start

Have you been putting all your eggs in the ‘too unhealthy’ basket? Katherine Baqleh has just studied how eggs affect heart risk factors in people with type 2 diabetes and finds they can quite safely have egg in their face.

73 Healthy & Heartwise • Autumn 2015

eatingwithdiabetes

E Katherine Baqleh, MNutrDiet, BMedSc, is an Accredited Practising Dietitian, Accredited Nutritionist and owner of Health Victory Nutrition Experts in Sydney

ggs are a dietary source of cholesterol, so many people have limited their egg consumption to reduce their risk of coronary artery disease (CAD; see page 44). However, dietary cholesterol actually has only a small effect on blood cholesterol levels, with most recent scientific evidence revealing that for most people, there is no association between egg consumption and increased risk of heart disease or stroke. Although a few population studies have reported greater risks with the consumption of more than one egg daily, including for people with diabetes, there are few well-designed clinical trials that support this finding.

Eggs excel nutritionally But eggs are actually one of nature’s greatest superfoods, possessing a nutrition profile that commends itself with high biologicalvalue protein of 7 g per egg, and high levels of selenium, iodine, vitamins A and E, B-group vitamins, folate, iron and the antioxidants lutein and zeaxanthin. Particularly for the ovo-vegetarians or those that do not eat fish regularly, eggs are a valuable source of omega–3 fatty acids, with one serve of eggs (2 x 60 g) providing 71% and 127% of the adequate intake for men and women, respectively. Recommendations from the National Health and Medical Research Council’s 2013 Australian Dietary Guidelines, The Heart Foundation and a more recent three-month controlled trial (e.g. the DIABEGG study by the University of Sydney and RPA Hospital) highlight the numerous benefits all Australians can obtain from consuming up to six eggs a week.

Eggonomical health Eggs are now seen as an affordable, nutritious and convenient way to improve the protein content of any diet – an important nutrient for satiety [see page 70], weight management, improved insulin sensitivity and blood glucose control. When consumed within a cardioprotective diet reduced in saturated fat and rich in vegetables and fruits, lean meats, fish, legumes, wholegrains, nuts and seeds and low-fat dairy products, eggs are unlikely to increase risk of cardiovascular disease. Given there does not appear to be any increased health risks associated with consumption of eggs, why not try a boiled egg as a filling snack, or an omelette or poached egg on wholegrain toast for breakfast or lunch more often? ♥ Autumn 2015 • Healthy & Heartwise

diabetesreallifestory

Tackling diabetes before it tackled me

A weight loss of just 5–10% is enough to improve management of diabetes and reduce your risk of heart disease, stroke and some cancers.

Katherine Baqleh sees newly diagnosed cases of type 2 diabetes all too frequently. She explains how dietary advice helped a typical patient go from confused to confident and in control within months.

A Katherine BaQLEH, MNutrDiet, BMedSc, is an Accredited Practising Dietitian, Accredited Nutritionist and Founder of Health Victory Nutrition Experts in Sydney

lex*, a 43-year-old male IT specialist, knew something was wrong when he noticed that he was becoming excessively thirsty, passed urine more often than normal, had a ravenous appetite, felt fatigued and lethargic, and was less ‘on the ball’ than he used to be. Alex raised his concerns with his GP and performed glucose tolerance testing, after which his doctor diagnosed him with type 2 diabetes. This was an unwelcome shock, especially since he didn’t know anyone else in the family with diabetes and considered himself fairly active outside of work.

Cutting through confusion Initially overcome with fear and sadness that he would not be around to see his two children grow up, Alex spent countless hours scrambling through books, magazines and websites. “I drowned in the information I read online,” he recalls. Becoming more stressed by the lack of clarity, Alex decided to seek the advice of an Accredited Practising Dietitian for help. “So many people told me to stop eating bananas and potatoes, and that I should avoid

75 Healthy & Heartwise • Autumn 2015

or reduce how much rice, bread and pasta I ate,” Alex told me. “My wife does most of the cooking and, having been told to omit all these foods, I felt I was a burden.”

Putting good principles in practice Diabetes management comes down to a few key principles: meal timing and regularity, meal composition and portion sizing, physical activity and, occasionally, medication. After a thorough nutrition assessment, Alex realised that although he was aware of the healthier options, he did not put many of them into practice. “Listening to the dietitian, I thought, ‘I know this – the importance of both food quality and food quantity.’ I just needed to hear it from a professional,” he said. Education began as simply as identifying the components of the five food groups and the balance on the plate between low-GI carbohydrates, high-quality proteins, a variety of vegetables or salad, and good fats. He also learned about eating according to his energy requirements and his blood glucose levels, food myths and mindful eating.

diabetesreallifestory Getting active, getting results After learning that healthy eating with diabetes doesn’t need to be difficult or involve different foods to the rest of the family, Alex became more comfortable managing his condition. “I knew the ‘what’ but not the ‘how to’ of diabetes management, so I was glad that the dietitian provided me with suggestions and tools to better deal with my condition in a way that was practical and could also realistically fit into my lifestyle. I was even able to creatively fit in more time for exercise.” After a few short months, Alex managed to drop his weight by 9 kg (8% of his total body weight), shave 7 cm off his waist circumference (bringing him closer to the target of 94 cm for men), maintained his blood glucose levels within a tighter range and even dropped his HbA1c (test results over a three-month period) by 1.1%. Alex felt happier, slept better, had more energy, and was feeling much more satisfied with the foods he was eating. “The variety of foods I was encouraged to eat was great,” he now says. “I was scared I’d be put on a rabbitfood diet!” ♥ *Name changed for the purposes of confidentiality.

diabetes&exercise

All-round autumn action Now the weather is off the boil, blending different exercise styles gets easier and more comfortable, says Christine Armarego.

T Christine Armarego, ESSAM, MAppSci (Ergonomics), MAppSci (Ex Rehab), is an accredited exercise physiologist and manager of The Glucose Club

he arrival of autumn heralds the start of the cooler months. Often over the warmer season we have had more sunshine to inspire us to be more active and of course more daylight hours, which has made it easier for us to fit exercise into the light of day. If we’ve been lucky, we’ve been on holidays too, so we may have had more opportunity to try new things. So if you have been sticking to your New Year’s resolutions and been more active than last year, the change in weather can challenge your ability to stay with it long term. To be successful, we need to plan! We have to further consider the weather and the shorter days. Do you have a plan? You have a few options: either adapt what you are currently doing to suit the change in weather, try

77 Healthy & Heartwise • Autumn 2015

something new if the weather won’t allow it or lastly (and my favorite), a combination of both! In the warmer months many people want to go outside but, as the weather cools, indoor activities can become more practical and popular. It’s important that we consider all kinds of exercise because each plays a role in managing diabetes.

Cardiovascular exercise This is essential for our heart health as well as managing our blood glucose levels, so how do we keep up our cardio as the weather cools? If you love walking, running or cycling outdoors, you can change when you’re active to avoid the rain. You’ll need to check the weather report but it can be done. Or you can choose to be active indoors, such as in a shopping centre

diabetes&exercise (just not at a retail pace!), or use a treadmill or bike at a gym. If a gym’s not an option, you can consider hiring a treadmill or an exercise bike just for the winter months as back-up when the weather fails you. If you only have one time to be active and you’d still rather be outside, then wearing a thin but waterproof jacket will protect you from the elements and you won’t overheat either. If swimming is your thing, you can move your laps indoors to avoid the cold, but often swimming in the rain is one of the nicest things to do! The water is warmer than the air temperature so it’s warmer in than out, and it’s only the committed swimmers who are there, so none of the huge crowds that you get in summer. You can also consider aqua aerobics classes – they are on at all times of the day and at different fitness levels. Lastly, if your old cardio plan doesn’t fit in with any of these suggestions, perhaps you can consider trying something new, for example joining a dance class or an exercise class with others that will get you huffy and puffy indoors. If you do start to use a gym, think about using different cardio equipment if you can. Using a rower or cross trainer uses upper and lower limbs at the same time, so can be a great allbody workout.

Strength/resistance

Using elasticised resistance cords or bands (Right), provides the physical benefits of more traditional weight training

Originally published in Conquest Autumn 2012

Strength or resistance training is essential for diabetes management, our bone health and our ability to remain functionally independent as we age. If you are already doing resistance training outdoors, you can move to indoors with a resistance cord. A resistance cord is like a portable gym so you can take it anywhere, is light and you can do almost any exercise with them! You can continue to use your body weight with sit-to-stand exercises, modified push-ups, etc. See an Accredited Exercise Physiologist for an individualised program. Or you can consider using a gym. While that can seem quite daunting, there are usually plenty of staff at a good gym to help you and again your local Accredited Exercise Physiologist can design a program for you – particularly if you have any injuries to be considered. If injuries are not your concern why not try a pump class? There are classes that mix

resistance, aerobics and flexibility work for all levels of ability and fitness, including seniors.

Flexibility Flexibility exercises don’t directly lower blood glucose levels but are important for your range of motion and to reduce how sore you are after exercise, helping you to be active daily. Stretching after a walk/run/cycle/swim resistance training in the sun can be lovely but now with the cooler weather, we need to take it indoors. You can get a stretching mat for as little as $30 from any good sports store and use it to stretch on after your exercise. It can double as a space for floor-based resistance training too, so it’s money well spent. If you like doing several exercise classes, finish with flexibility work so you can combine your cardio with your flexibility work in one step. If you like, consider yoga classes for both flexibility and relaxation of the mind. As we get further into autumn, think about how you might continue to be active – will you adapt your current exercise plan, try something new or combine the two? Whatever you decide, make sure you are still having fun and getting the results you want! ♥ Autumn 2015 • Healthy & Heartwise

asktheexperts

diabetes

& QA

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

Diabetes care in the elderly

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 This question from Conquest Autumn 2014

Ask Trisha Email your queries about diabetes to editor.heartwise@gmail. com with ‘Ask Trisha’ as the subject

I am a registered nurse working in an aged care facility in Queensland. I read about new guidelines for managing older people with diabetes that stated it might not be safe to aim for tight blood glucose control. Can you explain the main points about caring for older people with diabetes and any guidelines you suggest?

People older than 65 are more likely to have diabetes than younger age groups because insulin resistance increases and insulin production declines with age. Over 25% of older people have diabetes and almost half the population of older people have pre-diabetes. Diabetes affects older people differently from younger people. Older people are more likely to have diabetes complications and other conditions, as well as higher risk of disability and premature death. Older age is generally defined as over 65 years but older people are highly individual in terms of their health status and life experiences. Management must, therefore, be planned to suit the individual, not according to their age. Care should be planned with the individual whenever possible, and family carers’ needs considered when relevant. Key points to consider when planning care are: • Physical, mental, psychological and sensory changes that can affect the person’s ability to self-care (functional status). • Well-balanced diet and activity program. • Setting blood glucose and HbA1c targets to suit the individual e.g.: – HbA1c 7–7.5% if the person is self-caring and independent and at low risk of hypoglycaemia. –H bA1c 8–8.5% for frail older people and those at risk of hypoglycaemia (on glucoselowering medicines, do not recognise hypos, have kidney or liver disease, are malnourished or are cognitively impaired). • Preventing persistent high blood glucose

levels (BGLs), which can lead to dehydration and urinary incontinence. • Managing blood pressure to reduce cardiovascular risk but avoiding postural hypotension (dizziness on getting up). • BGL monitoring regimen appropriate for the BGLlowering medication regimen [see pages 68–69]. • Regular comprehensive holistic geriatric assessment that includes checking for issues such as pain, cognitive changes, falls, kidney function, nutritional status and mental health. • Many older people are malnourished even if overweight, e.g. low protein stores in muscles, magnesium, vitamins D and B12. • Counselling to stop smoking and reduce alcohol intake. • Proactive planning for life events such as stopping driving, and for supportive and end-of-life care. • Regular general health screenings such as mammograms and prostate checks. • Regular medicines reviews to reduce where possible the number of medicines the person takes, especially drugs that need to be used with care for older people. • Educating the individual with diabetes, their carers and health professionals. Some infomation that might help includes: • Good Food and Health Advice for Older People Who Want to Help Themselves: An Infomation Booklet for Older People, Families and Carers by Victorian Government Department of Human Services, 2007. ♥ Autumn 2015 • Healthy & Heartwise

asktheexperts

diabetes

& QA

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

Diabetes care in the elderly

Ask Trisha Email your queries about diabetes to editor.heartwise@gmail. com with ‘Ask Trisha’ as the subject

diabetes&eyes left: Proliferative diabetic retinopathy – large haemorrhages over the retina right: Diabetic macula oedema – lipid (white spots) and dot haemorrhages at the macula

Eye dropsy Macular oedema can follow from diabetic retinopathy, the most common eye complication of diabetes and leading cause of permanent vision loss in working-age Australians. Dr Andrew Chang explains.

A Dr Andrew Chang, PhD, MBBS, FRANZCO, FRACS, is principal vitreoretinal surgeon at the Sydney Retina Clinic and Day Surgery: www. sydneyretina.com.au

t the very centre of the retina lining the back of each eyeball is the macula, which provides central, detailed vision you use every day to read, drive and recognise faces.You may have heard of macular degeneration – where cellular wastes accumulate on the macular and eventually obscure your central vision – which affects one in seven Australians over 50 and is our leading cause of blindness [see HHW55; pages 14–15, 31]. In macular oedema, blood vessels feeding the retina are damaged by persistently high blood glucose levels (BGLs), and leak on to the macular. It becomes soggy and swollen so central vision becomes blurred, although peripheral sight can remain.

Damage done by diabetes Macular oedema develops from diabetic retinopathy, where high BGLs first begin to damage the tiniest of capillaries supplying blood to the retina [see HHW54; page 67]. These blood vessels’ walls weaken and ooze fluid onto the retina. In response to losing blood supply, the damaged cells release a protein that encourages growth of new vessels, like new shoots branching out in a plant root system. However, these are fragile, grow intermittently and don’t carry blood well. ‘Floaters’ or clouds appear to cross your vision from lost fluid and

79 Healthy & Heartwise • Autumn 2015

new capillaries bleeding into the gel in the eye. About two-thirds of people diagnosed with type 2 diabetes will develop diabetic retinopathy within 20 years. Although fewer Australians – an estimated 45,000 over age 35 – progress to macular oedema, there are probably more who go undiagnosed.

Signs of a soggy macular When the capillaries leak fluid through to the macula underneath the retina, it swells like plaster beneath wallpaper, affecting central vision. Symptoms of macular oedema can include blurred or double vision, the appearance of blind or dark spots, colours looking washed out and lines distorted. People can commonly lose up to half their central vision and still manage – but once deteriorating vision becomes noticeable it’s usually too late to reverse the damage. This is why having your eyes tested every two years is so important – if detected and treated early, much severe vision loss can be prevented. If high BGLs continue, capillaries supplying the retina become so damaged that they close completely. Retinal ischaemia occurs – blood and oxygen circulation to the retina is lost and the nerves die, leading to blindness.

How is macular oedema treated? Some medicines for macular oedema bind to the protein that damaged cells release, depriving the blood vessels of it. This reduces fluid leakage from the damaged capillaries and stops new vessel sprouting. It involves injections into the eye but there are no significant side effects. Good BGL management is key to keeping the capillaries healthy and preventing diabetic retinopathy, as is lowering blood pressure and cholesterol. So no smoking, regular exercise and better nutrition are essential lifestyle changes. And every two years, ask your GP for a referral to have your eyes checked. ♥

dealing with

Diabetes

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diabetesnews

Chef stirs pot on childhood obesity Jamie Oliver has claimed 15 May as Food Revolution Day, when governments internationally will be petitioned to mandate practical food education in their school curricula. “In most countries around the world, dietrelated disease kills more people than ever before. Forty-two million children under the age of five are either overweight or obese. Kids as young as eight years old are being diagnosed with type 2 diabetes, which used to be a disease for people over the age of 40,” the celebrity chef lamented. The petition targets G20 countries to make students’ food knowledge and preparation skills compulsory, and cites his native UK’s

‘School Food Plan’ and similar nutrition education programs in Mexico, Brazil, Finland and Japan as proof it can work. “I believe that it is a child’s human right to be taught how to grow and cook fresh nutritious food at school. By fighting for every child’s right for quality food education, we can help reverse the global rise of obesity and diet-related disease. Together we can force governments around the world to stop ignoring this issue.” www.foodrevolutionday.com

Blueberry teas fight diabetes Hailed by the American Diabetes Association as a ‘diabetes superfood’ and singled out as a brain protector par excellence by neuroscientist Dr James Joseph at the US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, whose landmark 1999 research showed it could reverse age-related decline in memory and coordination, the humble blueberry is one of the most intensively researched fruits. Studies have shown blueberries block carbohydrate metabolism in the intestine by up to 90% compared to hypoglycaemic medication acarbose [see page 68], and lower blood glucose 37% in people with type 2 diabetes. Now the Menzies Institute in Hobart is investigating a blueberrybased herbal tea for its potential to reduce insulin dependence in people with diabetes. Containing blueberry fruit and leaves, raspberry, spearmint leaves and cinnamon, the locally made infusion

has had anecdotal success in local cases of type 2 diabetes. Laboratory studies of the tisane showed that insulin could better transport glucose into muscle, said Menzies’ Senior Research Fellow Michelle Keske. “By doing that it lowers blood glucose levels and it does that by stimulating blood flow," she said. Ms Keske added that treatments that stimulated blood flow were few, however the blueberry tea’s antioxidant polyphenols and flavonoids could have this effect. "Because the tea is a complex mixture of a number of plant products, we don’t know if it’s one compound or the combination that seems to make it work," Dr Keske said. www.abc.net.au

type 2 diabetes STARTs in liverS The molecular process behind the dysfunction of insulin, which leads to type 2 diabetes and hyperglycaemia, has been identified by a US research team. The discovery paves the way for more effective diabetes medicines that target its root cause. Levels of hepatic acetyl coenzyme A, a liver molecule needed to regulate the conversion of amino acids and lactate to glucose, decrease when insulin suppresses the liver’s glucose production by inhibiting fat breakdown, the researchers found. Reversal of this process from inflammation in fatty tissue has led to increased liver glucose production and hyperglycaemia in high-fat-fed rodents and obese, insulin-resistant adolescents. “These studies identify hepatic acetyl coenzyme A as a key mediator of insulin action on the liver and link it to inflammation-induced liver insulin resistance and type 2 diabetes,” said Gerald Shulman, professor of medicine and cellular and molecular physiology at Yale School of Medicine. Cell 2015;160:745–58 Autumn 2015 • Healthy & Heartwise

diabetesnews

Heart, pancreas and kidney

– Australians’ most diseased organs Cardiovascular disease, diabetes and chronic kidney disease–Australian Facts is a series of five new reports by the Australian Institute of Health and Welfare (AIHW) that closely tie the three chronic vascular diseases in terms of their combined national economic

Risk factors

and health burdens. Up-to-date statistics and other reported trends indicate several other aspects are common to the illnesses, such as causes, biological processes, prevention, management and treatment. At the time of press, four reports had been released.

Prevalence & incidence in 2011–12

2 in 3 adults have at least three risk factors associated with the vascular diseases

Mortality in 2011

CVD + diabetes + Chronic kidney disease together caused

52,899 deaths

of Blood tests of adults showed signs of diabetes but one in five did not report having it, so stay undiagnosed

32%

www.aihw.gov.au

Hospital care in 2012–13

had high blood pressure

36%

of all deaths

Between 1981 and 2011, the CVD death rate for males females fell by FELL bY

CVD, CKD and diabetes were associated with

16% smoked daily 81 Healthy & Heartwise • Autumn 2015

20%

of all admissions nationally

71%

67%

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