Spring
greening stir-fried, steamed & salad vegetables
Dining out
with diabetes – what to look for on menus
Will
lapband
work for you? Michael Moore
Glycemic - how it load
Sydney Summit restaurant chef’s tips on managing diabetes from his new cookbook
relates to GI
Should you be
Sweetness without sugar
cutting
carbs?
Winners
Have your say about Healthy & Heartwise Dietitian vs. chef Michael Moore may have created the impression that people with diabetes should avoid foods high in carbohydrates, such as rice, pasta, porridge and Bircher muesli with added sugar [HHW 51, pages 46–7]. This is not consistent with best practice in the dietary management of diabetes, which allows modest portions of such staple and nutritious foods. Added sugar (sucrose) has a medium GI and is okay in moderation within the context of healthy foods. Agave syrup is expensive and hard to get, so people with diabetes need not worry about using plain table sugar instead. Prawns are a nutritious, low-fat seafood and should not be discouraged on the basis of cholesterol content. Nicole Senior, APD, Sydney, NSW
Say goodbye to diaformin I always pick up your magazine at the doctor’s and, being there now, decided to write to encourage your readers. I was diagnosed with polycystic ovarian syndrome (PCOS) 15 years ago, with seriously high insulin levels. The doctor said I would need diaformin 1500mg daily for the rest of my life or probably end up with type 2 diabetes and fertility problems. For six years, I took the medicine despite difficult side effects. One day, I decided to do more about it and read everything I could about PCOS, insulin resistance and low-GI eating. I overhauled my diet, cutting out all the refined carbohydrates and adding lots more legumes, lean meat and vegetables. Now I’m proud to say I’ve been off diaformin for three years and my insulin has dropped from a whopping 22 down to 8! I’ve also
lost about 8kg without dieting! So be encouraged that eating low GI really can help a lot for those with diabetes, metabolic syndrome and PCOS. Julie Filippis, Beverly Hills, NSW
Congratulations to readers who had their letters published in this issue. They will receive a Kambrook Quatro Multi-Cooker, valued at $79.95 RRP, which is the first to combine a slow cooker and rice cooker that can sauté, slow cook, steam and cook rice.
The perfect distraction I recently visited my local pathology office to have a blood test. Like many people, I am quite nervous around needles so I was feeling a little on edge while waiting. I noticed some copies of your magazine on the counter in the waiting room –– what a great distraction! I couldn’t believe that it was free. I thoroughly enjoyed reading various articles and loved the friendly layout. I felt much more relaxed going in to be jabbed as I hadn’t been panicking at all while waiting. Well done on such an informative, interesting magazine. Peta Mycoe, Redcliffe, WA
Cutting through inertia I have just read your Spring issue [HHW 51] and was so impressed with its easily applied articles that I have already subscribed. They are relatively short with helpful relevant details and seem very practical. The philosophy contained in some articles –– that if you can’t do all of this, at least do that to get the ball rolling –– motivates me to try. May I suggest the following as a regular inclusion: a) a credit card-size summary of the article on eating out would be great as a readyreckoner, and b) A4-size posters in large print to stick on walls to remind/ encourage us to eat healthily and exercise more? If these items already exist in other avenues such as government programs, include them in your magazines. Ray Wildman,Nelson Bay, NSW
Let us know If you have something you would like to share with us at HHW, please email us at emily@healthpublishingaust. com.au or write to AMA House, Suite 207, 69 Christie St, St Leonards NSW 2065 and be sure to include your full name and address. Privacy will be upheld on all contact information. Letters published in the upcoming Autumn issue will receive a Toby’s Estate Tea and Coffee hamper, valued at $250 RRP. It contains Toby’s Estate coffee, tea, organic drinking chocolate and the new book Coffee Trails. Toby’s Estate is a premium coffee roaster and tea and chocolate merchant, trading quality products and services with integrity and without compromise while ensuring that its business operations are fair and sustainable. For further information, please visit www.tobysestate.com.au.
Spring 2011
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20 22
From the Editor As we slide into another summer after a turbid spring, priorities turn to end-of-year rituals such as Christmas and holidays. For many, it’s hardly a languid time until Boxing Day, with preparations for family get-togethers, gift-buying and getaways competing with wrapping up the year’s work or study obligations. Particularly after the weather-induced turmoil of last summer, Heartwise wants its readers to have a safe and healthy festive season, so this issue includes a special feature on coping in an acute emergency situation, in addition to the expert advice you’ve come to expect about maintaining long-term wellness and prevention of disease. There’s been no let-up in the media’s focus on obesity and overweight — nationally and internationally — as our news pages show, yet experts and authorities appear as intractably divided over how best to address it as do individuals confronted with the innumerable conflicting messages over nutrition and diet. The UN meeting reported on page 7 ended with good intentions and consensus but no binding targets nor regulatory changes flagged. This issue emphasises the importance of fitness over fatness, which is the takehome message from evolving health research, and will hopefully shift some of the obsessive focus about weight and dieting. Our much-loved recipes are handpicked for seasonal relevance and the new star rating analysis continues, however for this season upper levels of total and saturated have been raised so that seafood — a classic staple for Aussie summers and full of healthy omega–3 fatty acids — can be included in all its glory. Gerald Quigley, respected Melbourne pharmacist and popular radio broadcaster, also joins Heartwise from this issue with a regular Q&A-style column where he answers your questions about supplements and medicine; while Dr Ginni Mansberg contributes her first article on women’s health, focusing on those hot-weather bugbears for ladies, cystitis and thrush. Compliments of the season! Steven Chong EDITOR 4
Summer 2011
14 e hear you – letters W page 7 Health alert – hot news briefs Subscribe & win 7 nights’ 34 accommodation and breakfast at Balgownie Estate Vineyard Resort & Spa Valley near Melbourne, plus a dinner 44 Well read & watched – media reviews 3
On the cover 14 Kate Ceberano’s approaches health like her music: eclectic, creative and enthusiastic
Healthy living 16 How you can survive an emergency situation when holidays go awry 18 Medication and alcohol safety 20 Even in summer, you may not be getting
enough vitamin D, so here’s how you can 27 Asthma and lung disease in the spotlight 28 Broadband is coming to an area near you and could help save lives 29 There may be more culture in your mouth than in a tub of yoghurt
Healthy weight 22 Fitness is more important than fatness
Healthy shopping 24 The truth behind sauces, dips, dressings and other condiments
Healthy women 30 Dr Ginni Mansberg advises on treating urinary tract infections
Healthy supplements 32 Pharmacist and broadcaster Gerald
50
40 53 79
Quigley answers common health queries
Healthy food 36 Making your diet a lot less salty is made easy
Healthy heart 38 High blood pressure is the most common reason for GP visits but can be lowered without drugs 40 All about cholesterollowering medications
Healthy men 42 Alan Pease shares his experience with erectile dysfunction
Real life story 45 Heart attacks can be surprisingly subtle, as this reader discovered
Healthy eating 48 2010 MasterChef winner Adam Liaw bring Asian food to Australian kitchens
50 J ulie Goodwin, our first MasterChef winner, updates us on her travels and new book 52 S ummer breakfast, lunch, dinner, side, BBQ, dessert and diabetes recipes – with nutritional analysis specially revised for the season
Dealing with diabetes 67 Gestational turned to type 2 diabetes for a mature mum 69 W ill an antioxidantrich diet help your diabetes? 71 Y ou have two professions to choose from when it comes to eye care 73 D r Alan Barclay explains how to lower the GI of any meal
75 U pdating the dynamic market of blood glucose meters 79 A kitchen stocked for managing diabetes is healthy for any family 80 People with diabetes need to put feet first, says podiatrist Ross Green 81 Diabetes health alert
24 CORRECTIONS: SPRING VOL 51 • Page 53 sodium content is 306mg • Page 55 2 cups salt-reduced stock required • Page 60 sodium content for layered fruits is 47mg • Page 61 disregard ‘unsalted butter’ and ‘2 tbsp extra butter’ • Page 64 sodium content for barramundi is 639mg and moved to carbohydrate
Summer 2011
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Dr Ginni Mansberg
BMed, Grad Dip Journalism Ginni is Channel Seven’s Sunrise and Morning Show GP, as well as resident doctor on the Body&Soul radio show. She writes for numerous magazines, such as Women’s Health and Practical Parenting, and is author of the bestseller Why Am I So Tired? Ginni practises as a family doctor in Sydney and has three children while running a popular blog, www.drginni.com.
Editor Steven Chong Publisher Michael Sant Health Publishing Australia Marketing Director Kent Mudge Subscriptions Manager Sue Sant
Professor Sandra Capra AM
Editorial Coordinator Emily Rundle
BSc (Hons), Dip Nutr & Diet, MSocSc, PhD, FDAA Professor Capra has had a long career in nutrition and dietetics which has encompassed clinical, community, food service, management, research and teaching roles. She is currently professor of nutrition at the University of QLD. Sandra is a fellow and life member of the Dietitian’s Association of Australia and President of the International Confederation of Dietetic Associations (2004–2010).
Advertising Michael Sant, Kent Mudge P (02) 9439 1599 Graphic Design PMG Media ISSN 1833-8798 Printed by Caxton Webb
Chris Tzar
BSc (HMS), MSc (Ex Rehab), AEP Chris is an accredited exercise physiologist and NSW president of the Australian Association for Exercise and Sports Science (AAESS). As director of the Lifestyle Clinic within the Faculty of Medicine, University of NSW, Chris has extensive experience providing physical activity and lifestyle management programs for people with diabetes and cardiovascular disease.
Editorial Correspondence Health Publishing Australia AMA House Suite 207, 2nd Floor 69 Christie St, St. Leonards, NSW 2065 P +61 2 9439 1599 F + 61 2 9439 1688 E hhm@goodhealthpublications.com
W www.heartwise.com.au
Effie Houvardas
BSc (Nutrition), MSc (Nutrition and Dietetics), APD Effie Houvardas is an Accredited Practising Dietitian with over 12 years’ experience in nutrition and dietetics. Effie has worked in a variety of areas, including clinical, health promotion, private practice and consultancy as well as teaching at TAFE and working for community diabetes associations.
Contributions are welcome and should be typewritten and double spaced on one side of the page. Unsolicited manuscripts will be returned only if accompanied by a stamped, selfaddressed envelope. Copyright © 2011. The opinions expressed by authors do not necessarily reflect the policy of Health Publishing Australia. 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 50,000 and has been audited by the Circulations Audit Board 31 March 2011.
Professor Trisha Dunning
RN, Med, PhD, Grad Certs Obstetrics, Infant Welfare, Paediatrics, Family Planning, Aromatherapy, Relaxation Massage, Grad Dips Health Education, Professional Writing. FRCNA, CDE, Sigma Theta Tau. Chair in Nursing at Deakin University and Barwon Health. Professor Dunning is an active member of a number of diabetes organisations and committees including the Australian Diabetes Educators Association and The International Diabetes Federation. She is widely published in books, journals and magazines on the issues of diabetes.
CAB Audited March 2011
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Summer 2011
r Salt: NZ the breadwinne New Zealand leads Australia in the drive to reduce salt content of bread, according to a trans-Tasman study released in September. Our daily bread accounts for a fifth of each Australian’s salt consumption and most sodium intake in both countries. The resulting increased blood pressure is a leading contributor to the heart disease and strokes that kill one in three Australians, said Professor Bruce Neal from Sydney’s George Institute for Global Health. Nutrition information on packaged breads sold at supermarkets in NZ and Australia was collected over a four-year period by the Institute and the University of Auckland. But there was no change in the average sodium concentration of bread over that time. In fact, the proportion of Australian
UN meets to chew fat World obesity levels have doubled since the 1980s, said the World Health Organization (WHO) at a landmark meeting of United Nations General Assembly called in New York [see also HHW 50, page 4]. The September meeting was the first time the UN met to discuss health issues since the HIV/AIDS epidemic in 2001. This time the focus was on obesity and other long-term, usually lifestyle-related diseases. The four most dangerous and common were highlighted: heart disease, cancer, lung disease and diabetes. “Let there be no doubt that noncommunicable diseases have reached epidemic proportions,” said General Assembly President Nassir Abdulaziz Al-Nasser, stressing they were the biggest cause of death worldwide, with more than 36 million people dying from them each year — accounting for 63% of global deaths. “And these deaths could largely have been prevented.” “The prognosis is grim,” warned Secretary-General Ban Ki-moon,
breads with the maximum sodium target of 400mg per 100g rose from 29% to 50%. “By comparison, there were in improvements in both the proportion of NZ bread products meeting the NZ Heart Foundation target as well as the mean sodium levels,” added Prof Neal. But Dr Jaqui Webster, coordinator of the local AWASH (Australian Division of World Action on Salt & Health) campaign, said it was worrying Australian bread manufacturers had not met targets since it was the first priority in the voluntary campaign begun in 2007 [see also HHW 49, page 10]. However, George Weston Foods, which makes Tip Top and Burgen, was singled out for praise from Dr Webster for its efforts. www.georgeinstitute.com.au, www.mja.com.au because the WHO predicted this death rate would increase to 80% in the next decade as populations in developed nations aged and developing countries gained access to globalised trade and product marketing of tobacco, alcohol and food. Alarming as those figures were, “we know how to drive them down”, Ban Ki-moon said, explaining that preventing these diseases could cost next to nothing, and even save money. “When people cycle to work instead of driving, they get exercise and the planet is spared more greenhouse gas emissions,” he said, adding that when children were fed a nutritious diet at school, attendance rose, and those eating habits could last a lifetime.
WORLD OBESITY Kills 2.8 million
people a year
Attributed to
44% of diabetes 23% of heart disease 7–41% of cancer cases www.un.org highest level.” Obesity is adding significantly to the burden of “diseases that break the bank”, added Dr Chan, and is lowering life expectancy even among poorer countries where processed foods high in salt and sugar had become the new staple foods as “the cheapest way to fill a hungry stomach” [see above].
Margaret Chan, DirectorGeneral of the WHO, demanded a watershed event to head off a “slow-motion disaster … Today’s high-level meeting must be a wake-up call for governments at the Summer 2011
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HEALTH CALENDAR World AIDS Day International Day of Persons with Disabilities Folic Acid Awareness Week Australia’s Healthy Weight Week Ovarian Cancer Awareness Month World Cancer Day International Asperger’s Day Organ Donor Awareness Week National ‘Sunnies’ for Sight Day
1 December 3 December 2–8 January 23–30 January February 4 February 18 February 21–28 February 25 February
We’re lax on laxatives Common laxatives such as bisacodyl are effective for chronic constipation, a recent review has confirmed, and the Gut Foundation says they should be used more in Australia.
Do we need a fat tax? Denmark is the first country in the world to introduce a ‘fat tax’, where foods containing more than 2.3% saturated fat attract a levy of about $2.95 per kg of saturated fat. The tax, expected to inflate prices of the bacon and pastries for which the country is famous, would most affect full-fat dairy products, meat and snack products and fast food, adding about $180 to a family of four’s annual grocery bills. The Danes were the first to ban trans fats, and already pay a separate tax on high-sugar products (e.g. sweets and soft drinks), bestowing upon the nation some of the lowest obesity rates in the developed world. By contrast, the OECD reported last year that Australia leads the developed world in the obesity race, prompting local public health groups and nutrition experts to renew calls for government to tax unhealthy food, regulate marketing and ‘stand up to the food industry’. Dr Gary Sacks, a researcher from Deakin University’s WHO Collaborating Centre for Obesity Prevention, wants government to step in because “Research has shown restrictions on the marketing of unhealthy food and drinks to children would be highly costeffective — existing self-regulatory
approaches aren’t working. Other cost-effective options are traffic-light food labels and taxes on unhealthy foods and drinks, such as soft drinks, combined with subsidies of fruit and vegetables.” However, the industry peak body, the Australian Food and Grocery Council (AFGC), said a ‘fat tax’ would not address our obesity levels, as the GST applies to processed foods but hasn’t slowed the problem. Also, such a tax was dismissed by the Henry Tax Review and could discourage consumption of calciumrich dairy products. CHOICE is also campaigning for traffic-light labelling but the AFGC — which points out that leading manufacturers have agreed to reduce saturated fat in cooked and smoked sausages and cold meats (excluding salami) to less than 6.5g per 100g — says they are too simplistic and instead wants to focus on Daily Intake Guides. The Cancer Council wants to ban cartoons in junk-food advertising, while the Australian Medical Association wants a ban on advertising junk food to children. www.abc.net.au
The study concluded that stimulant laxatives (bisacodyl, sodium picosulfate and polyethyline glycol) were significantly more effective than placebo in treating chronic constipation. Professor Terry Bolin, President of the Foundation, said that some of the myths surrounding laxatives discouraged Australians from using them appropriately. “Some people have the mistaken view that laxatives are either harsh or ineffective in chronic constipation. These are clearly misconceptions and The Gut Foundation has been trying to correct these myths for many years,” said Prof Bolin. “Laxatives are often overlooked in favour of increased fibre. Fibre is an important preventative measure but for people who need additional assistance in dealing with the problem, sensible use of stimulant laxatives in the recommended dose can greatly improve quality of life,” said Prof Bolin. “Many people have problems with increased fibre because of bloating and discomfort. For these people, laxatives are an effective option.” www.gutfoundation.com
PHYSICAL
The Tick
Nasty bloodsuckers! Nearly killed my friend’s dog! Not ticks. The National Heart Foundation Tick. Oh that Tick! The one they put on healthy foods? Ah yes but are they healthy? Yes they’re assessed and ‘tick the boxes’ for recommended levels of salt and saturated and trans fat. Generally yes but it actually ended up being ‘best in category’. And manufacturers are charged for that assessment and to use the Tick, making quite a lot of money for the Foundation. You mean that’s what makes them Tick? Don’t get smart. It could be a time bomb, in terms of public health. Sounds like you’re the smart one. The industry spends a fortune on making healthier foods – and they usually cost more to buy! Yes, and a Tick helps sell them. But a lot of people started to question it when McDonald’s got a Tick. Ticked-off about the Tick? Fast-food chains should be praised for doing the right thing! Those wraps and salads didn’t exactly fly off the
ACTIVITY counter, though, yet the whole chain enjoyed the ‘halo effect’. But all fastfood chains will have Ticks phased out from next year and the NHF will make public quarterly audits on “the foods Australians eat most often”, including take-away. And will the Tick keep ‘ticking over’? Like all ticks, it needs partnership. In this case, more supermarket ownlabel products. And what will McDonald’s do? They’re rolling out kilojoule labelling on their menu boards as we speak. Otherwise they’ll keep flipping burgers – a lot of developing countries are lovin’ it. Well, understandable and fair. The convenience, taste and marketing tie-ins with give-away toys have universal appeal... Or they’re counting on ‘pester power’ from kids watching the ads and the food is actually addictive, as some claim. Come on, it’s hardly tobacco! As addictive as cocaine or heroin, suggests research in lab rats. They’d rather eat junk than healthy food even if they get electric shocks.
Forget fat – get fit Government and health professionals should move past obesity and overweight and focus instead on physical inactivity to check the march of chronic disease in the community, say exercise experts. Rob Newton, Professor of Exercise and Health Sciences at Edith Cowan University, said fitness not fatness should be the mantra. “Research clearly demonstrates that normal-weight people who are sedentary are at far greater risk of morbidity and mortality than overweight people who are physically active and fit,” Prof Newton told the Australian Conference of Science and Medicine in Sport in Fremantle.
30+ minutes/day of moderate-intensity exercise reduces risk/incidence of:
lung cancer by
20% 30% 50% 70% 50% breast cancer by
colon cancer by
prostate cancer by
type 2 diabetes by
“Dementia and in particular Alzheimer’s disease progression is markedly slowed by appropriate exercise. Exercise is now deemed a critical adjuvant treatment in the management of cancer,” said Prof Newton. www.sma.org.au Summer 2011
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The cuppa that cheers
Drinking coffee may protect you against depression, suggests a new study from Harvard School of Public Health. Using data from 50,739 women in the Nurses’ Health Study, the researchers found that women who drank the most coffee cut their risk of developing depression by as much as 20%. The study ran from 1980, when the women had an average age of 63 years, until 2004, asking them every year about their caffeine consumption. Women who drank 2–3 cups of coffee per day had a 15% decrease in risk for depression compared to those who drank at most one cup. Those consuming four or more cups a day cut their risk by 20%. Decaffeinated coffee did not have the same effect, and the risk decreased in line with increases in consumption. Archives of Internal Medicine 26.09.2011
Country women’s hearts at risk Older women in Australia’s rural and remote areas are more likely to die prematurely from heart disease than those living in urban centres because of less access to specialists but also less early action from themselves, a new study reports. Regional women also have a higher incidence of cardiovascular disease yet “are less likely to access specialist services,” said study author Susan Jordan from the University of Queensland. “This may mean they do not receive optimal treatment.” In fact, only 30% of the women surveyed reported having had an ECG and their use of statins and antihypertensive medicines was low. Rural women aged between 77 and 83 years were also nearly fourfold more likely to report never consulting a cardiologist and almost three times as likely to have never had an ECG than women from major cities. Another Australian study also showed LDL cholesterol to not meet target levels in 69% of women surveyed compared to 56% of men. If people 10
Summer 2011
were prescribed statins, 53% of men and 72% of women continued to have total cholesterol levels higher than the target. “Communication with your doctor and increased awareness of cardiovascular risk are critical to better management,” said cardiologist Dr Paul Bridgman. Internal Medicine Journal, 3.10.2011
Supplement safety in question Taking daily vitamin and/or mineral supplements could increase risk of premature death or cancer, suggests two recent studies from the US. In the Iowa Women’s Study, researchers from the University of Minnesota have been following 38,000 women since 1986, when their average age was 62. By the end of 2008, about 40% of them had died, and women who’d reporting taking daily supplements were slightly (2.5%) more likely to have died than those who did not. The observational design of the Iowa Women’s Study could not establish a direct cause and effect but it did distinguish between different types of supplements. Supplemental copper increased risk the most, by 18%, and multivitamins the least (2.4%). Iron and folic acid –– commonly recommended for women –– increased risk by about 4 and 6%, respectively. Calcium supplements, which are even more broadly prescribed for mature women and previous research had suggested increased cardiovascular risk, were found here to be protective against premature death, lowering the risk by 3.8%. The Selenium and Vitamin E Cancer Prevention Trial (SELECT), on the other hand, recruited 35,533 men from the US, Canada and Puerto Rico to be given daily the mineral selenium and/or highdose vitamin E or placebo. After 7–12 years, the men were followed up and checked for prostate cancer, and those who had taken vitamin E were significantly more likely to test positive for it. Archives Internal Medicine 10.10.2011.
Walking with heart
The hypnotic painkiller Postcards from Heart Foundation Walking groups When Morgan Chetty of Castle Hill, Sydney, had a very severe heart attack a little over five years ago, he was 57 years old. “I was given no chance of survival. A paramedic told my wife that only prayers could save me,” explains Morgan.
hoebe Morgan and P
Morgan was in a critical condition for almost two weeks before transferring to round-the-clock monitoring in a ward where he regained consciousness. A defibrillator has been implanted in his chest.
“I spent five weeks in hospital and left with a walking stick. When I got home, I felt weak, tired and had no energy to do the things I loved. I was shaken by my ordeal and depressed,” said Morgan. “One day while sitting in the park, I saw a man wearing a red Heart Foundation Walking shirt, walking with a group. I made some enquiries and joined the group. “On my first day after about 200m, I thought, “This isn’t for me!” But by the end, the group made me feel so welcome that I had to give it a proper go and I’ve been walking with the group ever since! “I look forward to walking with them twice a week. The people are just fantastic. I have become stronger and thoroughly enjoy the social side of group walking. “Since my heart attack, my wife and I have made three overseas trips and we hope to do many more. Often I reflect on how things may have been different if I hadn’t spotted the man in the red polo-shirt. I really don’t think I could have come this far without the support and friendships I’ve made through my walking group.” To join or start a Heart Foundation Walking group near you, visit www.heartfoundation.org.au/walking or call 1300 36 27 87.
ng: the Walki
road
ds
d frien
ss an to fitne
Hypnotic therapy could significantly benefit the 3.2 million Australians enduring long-term (chronic) pain, who should discuss it as an option with their doctors, said a visiting international rehabilitation expert. Professor Mark Jensen, Vice Chair for Research in the Department of Rehabilitation Medicine at the University of Washington, called for hypnosis to be considered a ‘mainstream’ treatment option at the Australasian Faculty of Rehabilitation Medicine annual scientific meeting in Brisbane mid-September. “Imaging studies have shown that Hypnotic Therapy influences all the cortical areas and neurophysiological processes that underlie pain,” said Prof Jensen, “What people do to manage pain and that they think about pain, and their social environment, can all influence pain and its negative impact on functioning.” The intensity of daily ‘background pain’ can be reduced by hypnosis and recent clinical trials in people with disabilities had demonstrated specific effects of hypnosis over and above those based on expectancy (placebo) alone, added Prof Jensen.
Rehab physicians could train patients in self-hypnosis to achieve immediate pain relief and provide audio recordings of treatment sessions to enhance effects, suggested Prof Jensen, who added that this would ease the burden on carers. “Hypnosis still has a certain stigma to it,” admitted Prof Jensen, “However, we are seeing this treatment option used to manage debilitating physical and psychological conditions, including phobias and addiction.” www.racp.edu.au
Summer 2011
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And a Happy New Year! Buy the 2012
Seasons greetings from
To help you celebrate the festive season healthily and heartwise, we asked leading health promotion organisations for suggested gifts, new-year resolutions and holiday activities.
Australian Women’s Health Diary
and you’ll get the latest health and wellbeing information, the perfect daily organiser and free pen. On sale for just $14.95 at newsagents, Commonwealth Bank branches and selected Woolworths supermarkets, all proceeds go to the Breast Cancer Institute of Australia. It can also be purchased online at www.bcia.org.au or by telephoning 1800 423 444. Move over, chocolate boxes and sweet treats! These five fun gift ideas from the Dietitians Association of Australia are sure to be a hit among the whole family. Oh, and they’re healthy too! See www.daa.asn.au for more information: • Backyard games – get your family moving with a new cricket set, football, skipping rope or hula hoop • Gift vouchers – instead of a video game, CD or book voucher, try gift vouchers to a roller-skating rink or swimming pool, or shout
“Christmas is traditionally a time when we overindulge but it’s easier than you think to have a happy, healthier Christmas Day,” said Tony Thirlwell, Heart
Foundation CEO – NSW:
• For a healthier Christmas roast, use oils such as canola, sunflower or olive oil to brush on meat and vegetables 12
Summer 2011
• Cook the meat on a rack and the vegetables in a separate dish • Lots of tasty fruits are in season at this time of year – mangoes, apricots, nectarines, peaches, plums, cherries and berries are at their best over Christmas. Serve sliced on a large platter for a delicious and refreshing dessert. Try sprinkling with some fresh mint • Top your Christmas pudding with Heart Foundation Tick approved custard or ice-cream
Nutrition Australia is an independent member organisation that aims to promote optimal health for all Australians by encouraging food variety and physical activity. For more information, visit www.nutritionaustralia.org: • Dancing lessons, or try a gift voucher for yoga or pilates • Mini herb garden – a great gift for those without a garden • Sports equipment – skipping ropes, balls, tennis racquets • Healthy food hamper – think olive oils, raw nuts, dried exotic fruits like mango — add colour with some fresh summer fruits • Mediterranean cookbook and a bottle of good-quality olive oil.
the family to a horse riding tour • Beach games – head out to the beach with a new volleyball set, Frisbee, body board • Fruit and vegetable seeds – inspire family or friends to plant fruit and vegetable seeds, such as strawberries, tomatoes, chillies; or herbs such as rosemary or thyme • Healthy cooking classes – enlist a family member or friend in a cooking class to learn healthy cooking techniques.
• Make the most of the summer weather by getting active – go swimming, enjoy a walk after lunch, play some backyard cricket or go to the park. The Heart Foundation has a number of cookbooks available that make great Christmas presents. To order, call 1300 362 787 or visit www.heartfoundation.org.au/ Get_Involved/Shop_Online.
K ate Ceberano Her music, background and outlook are a tribute to hybrid vigour, showing that fidelity to diverse elements can lead to sustained success on and off stage, as she tells Steven Chong.
HHW: We’re interviewing you while you’re in the UK recording a new album, Originals. Is it all new material and how does it fit in with your recorded music? Kate: It’s all original so far and I’m having the most amazing time returning to writing and finding where I’m at right now. It seems the interior world is never more obvious than in the songs themselves. I’ve written albums during breakups and make ups, but this album is in a whole other place. The art of living itself seems to be offering all the inspiration I could need. And people and their struggles interest me: writing for them, giving a voice to their daily triumphs and trials. Loving it! HHW: Your ‘Alive’ show toured Melbourne, Sydney and Adelaide in October. Is travelling easier now that your daughter Gypsy is nine or does she prefer staying in Melbourne with your extended family? Kate: We work it out as we go along. No fixed rules apply to a family like ours. Gypsy is, as her name suggests, able to travel and loves the game of music and who her mummy is. I know she’ll get over me eventually and the whole shebang as she gets into teenage-dom but while she can roll with the punches, she can come with me whenever, wherever. I love her company! HHW: Your family background is colourful but still threw up some surprises in an early episode of Who Do You Think You Are? Have any rediscovered connections changed life since? Kate: My affair with Adelaide has deepened, which is a good thing as I’m spending a lot of time there. Also, I feel proud my career had afforded me the luxury of having a record of my family so meticulously documented. I’m glad Gypsy will have it to discover –– made me feel like I belonged more to Australia in a weird way.
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Summer 2011
HHW: Your grandmother Kathleen was a strong influence while growing up in a bohemian Melbourne household. Interestingly, your maternal grandparents started experimenting with alternative lifestyles back in the 1930s — not your parents a generation later! It must have been that much harder for them — what kept them motivated? Kate: No, quite the opposite: their lives were rich and full of adventure, music, philosophy. They had friends who were poets and dreamers, homeopaths and healers. Holistically speaking, they were in a place far more advanced than their contemporaries. If they struggled, it was simply how to make ends meet — which is all artists’ struggle. There’s often no monetary support for new ideas. And natural foods back then were not considered valuable, nor the industry that it’s become today. HHW: They owned health-food shops, practised vegetarianism and nudism and Kathleen’s husband went from the theatre to communism to Scientology. As a proud third-generation Scientologist you credit it with giving you courage to be honest. Does it influence art as much as life? Kate: Scientology is a big part of my life and I use it daily. It’s given me useful knowledge about life and how to improve the world around me. Like my grandparents and parents, I have always sought to make things better for others. Life has many parts to it and often the influences of others around can make it seem incomprehensible. But I apply some of the simplest tools of Scientology and get the most amazing results. For me it’s a very practical philosophy: simple and easy to apply. HHW: Your father is a Hawaiian-born Filipino and one of the highest ranked karate masters outside of Japan — plus a former US Marine bugler! Did he teach you any martial arts when you were young, alongside your brother? Kate: Sadly, I always thought it was a little unfeminine! I didn’t realise then how very beautiful it actually is. Sometimes when something is so accessible you can take it for granted. No, I wanted to be a dancer. And later became obsessed with flamenco as an art form. HHW: Flamenco has very precise technique and is hard on feet. Any injuries from this or salsa or Zumba?
HHW: Your diet seems very healthy in any case, with no white rice, sugar, canapés nor entrées, and minimal alcohol. Drinking hot water for clear skin sounds Asian — is it? Kate: No, hot water just helps if you tend to abuse coffee (like I do!) and feel guilty about it. Having been a smoker for years, too, I get a little obsessive about habits like coffee so I’ve got to replace it with only healthy habitss. HHW: Tell us about your latest gig as Artistic Director for Adelaide Cabaret Festival this and next year. Kate: I’m loving it so far. It’s hard and the learning curve is intense, but I’m up for the challenge. I have an incredible producer who is very experienced, so I feel very supported. We are searching worldwide for interesting artists who are really extending all definitions of cabaret. HHW: Last year you launched the Berlei Curves Spring Summer collection as their ambassador, and earlier this year their Bra Recycle Program. Plus you’re now ambassador for the Breast Cancer Foundation in Victoria — is all this from being a self-confessed buxom Melbourne girl? Kate: I guess so. I love my work with both companies because of the support they offer women of all shapes and sizes. We have an epidemic in both areas: crippling selfimage problems and critical body reconstruction and illness. They both require care, research and cure. ❤
Kate: I don’t get to dance anymore, which is sad. It did require hours of training to get any good at it, and even then success is not assured. And let’s face it, the world doesn’t need another out-of-work flamenco dancer! All dancing has a degree of injury involved but it all depends what you want to communicate. You’ll have more fun straining to creating beauty than you will just ‘getting fit’.
Condiment: Sauerkraut
HHW: You now use the Tracy Anderson Method, developed by Gwyneth Paltrow’s personal trainer. But is the aerobic and Pilates aspect easier than the very-low-calorie diet?
Musical style: 80s British
Kate: It all comes down to the amounts. In the end, every body is unique and the only rule is, “Is it healthy?” and don’t have too much of it even if it is! You have to find what serves you both physically and mentally. I love Tracy’s Method because it holds some aesthetic interest for me, i.e. it’s balletic and has grace in its application.
Kate’s favourite: Dish: Giovanna’s arancini balls Restaurant: Vue du Monde bistro, Melbourne Film musical scene: ‘America’ from West Side Story Sport: People watching Holiday destination? Paris
Steven Chong, BA (Communications), is Editor of Healthy & Heartwise Summer 2011
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Holiday survival No one wants to contemplate it but anyone planning a holiday has to consider what to do right when things go wrong. Survival expert Nick Vroomans gives essential advice. So you’re considering a holiday trip — perhaps the adventure of a lifetime or just an annual get-away to explore more of this wonderful country of ours. A longdistance car trip, maybe? Day walks and off-road excursions into interesting places would be nice. The real question is, “How prepared are you for an emergency?” I’m often asked the question, “What would I take if I was in a survival situation?” The answer is simple: I would take only what I had with me at the time and probably wouldn’t have any other options. You see, coping in a survival situation is just that – coping. Generally, you come as you are. But I’ll revisit this question a little later.
Imagine the unthinkable When planning your trip, start by checking yourself first. Most people check the car, boat or aeroplane before they set off. But I recommend you start with the most important bit: YOU. History shows that people who are unfit are most likely to suffer the most in an emergency situation. By unfit, I include both physical and psychological fitness. Medical check-ups, first-aid kits that include personal medication, and the one many people forget about: dental check-ups. And what about the mental side of things? Are you ready for any emergency that might arise, or are you the type of person who says it can’t happen to you? Do you have the determination you need to survive at all costs? I call it tenacity or the will to live. I have spoken to many survivors over the years and they overwhelmingly support the fact that rescue was the focal point of their survival experience. The thought that nobody knows where you are is all-consuming in these circumstances, but one that can be easily avoided with a little pre-planning.
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Summer 2011
Help off the beaten track A detailed Search and Rescue (SAR) plan is essential if you intend to go into more remote areas. Let others know where you are going, when you intend to get back and any other information that may be of assistance to searchers. When you are in a survival situation, you will be comforted by the thought that somebody will be out there looking for you — that thought will keep you alive. This brings me to communication, particularly in isolated areas. UHF, VHF and HF radios are very useful but all have limitations. The mobile phone is often the best method of communicating but you must plan for the fact that reception is limited outside population areas. If you find that you can’t get 000 reception in an emergency, try dialling 112. This number will reach the same 000 emergency call centre but will utilise any available service provider in the area. Also, this number overrides the pin number and is a free call. If you still can’t get through, try texting as you may find you have greater range. Emergency Position-Indicating Radio Beacons (EPIRBs) are very good and should be considered as a must-have when travelling in very remote or inaccessible areas.
When danger strikes Once in a survival situation, the initial minutes of an emergency may have a dramatic effect on the outcome. Having a survival mindset will make all the difference. As mentioned earlier, wanting to survive and knowing that you can is half of the survival battle, and there have been numerous instances of people with no survival training and little equipment surviving impossible situations based largely on their determination to live. In other words, when reality hits, accept the fact that you are in a survival situation, check that you are safe and, if danger exists, relocate. Assess each danger on its own merits and act accordingly. When you are safe, sit down and assess the situation that has unfolded. This will serve two functions: you will gain a clearer understanding of the challenge that faces you, and taking a moment to sit down will help to stave off the panic reaction. Work through the Priorities of Survival, i.e.:
protect yourself from further harm or deterioration check yourself for injuries and treat them straight away adjust your clothing to suit the elements, get some good shelter and start a fire consider your rescue options, hydrate and finally see what food you have available. If you work through this checklist, you will be well on the way to surviving any remote-area situation anywhere in the world. Most importantly, once you are in a survival situation you will need all the protection you can get, and clothing is the first layer of defence against the elements. I remind people daily that clothing is the shelter you carry around with you at all times.
Dress for distress Travel in Australia is often conducted in the summer months or in areas where the weather is warmer, for obvious reasons. Therefore, it is sensible to be prepared for heat injuries resulting for overexposure to the sun and temperature extremes. There are still Australians who insist on wearing shorts and T-shirts because they believe that they are cooler wearing these clothes. This is a fallacy. Long-sleeved shirts, long trousers and broad brimmed hats are essential for direct protection from the sun and for thermal insulation. It should come as no surprise to note that people who work in extreme environments always wear protective clothing. Remote-area workers such as cattlemen, mine workers, explorers and station employees all wear long trousers, long shirts and big hats. And desert tribes the world over wear long, loose fitting clothing, usually light in colour. You won’t find people who work in extreme environments wearing shorts. You may find shorts comfortable, but they are certainly not protective and you will definitely be reminded of this at night when you are cold and being bitten by every insect in the area, or being torn to shreds by the bush.
Oh, and what is the one thing I would I take with me if I had the option? A lighter. Good luck! ❤
Nick Vroomans is Director of Staying Alive Survival Services (www.stayingalive.com.au), Chief Instructor of the Australian Defence Force Combat Survival School and author of Alive and Kickin’ Summer 2011
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The national situation In Australia, there has been concern over people drinking too much alcohol and there is a good website detailing the daily limits: www.health.gov.au/internet/alcohol/ publishing.nsf/Content/standard
Drugs
& booze
Is alcohol decreasing the effectiveness of your medicines, or putting you at risk of an adverse event? Pharmacist Carlene Smith reviews the field in the lead-up to the festive season. Some recent UK research published in British Medical Journal (2011;342:d671) found that moderate alcohol consumption was associated with favourable changes in certain markers, such as increased HDL (the ‘good’ cholesterol), which give an indication of a person’s cardiovascular disease (CVD) risk. So perhaps light-tomoderate alcohol consumption may lead to the reduction in CVDr risk. However, as the researchers note, when people drink more than a moderate amount of alcohol (i.e. more than one drink or about 2.5–14mL a day), the relationship with cardiovascular outcomes becomes complex, with the risk of stroke increasing with higher alcohol consumption. The researchers say that this finding supports the need for limits on consumption. The Alcohol Policy Coalition, made up of Australia’s leading health groups, released a paper in September challenging the common belief that red wine helps prevent heart disease. Their review of the evidence shows any positive effects of alcohol have been “hugely overestimated”. 18
Summer 2011
The Pharmacy Guild of Australia has run an Alcohol Awareness Campaign and it was found that people better understood what daily limits meant when they “saw” pictures. You may find your prescription folder with the recommended daily limits included, just to remind you.
Alcohol adverse effects If you do have alcohol regularly, it can affect how you metabolise some of your medicines. Once medicine is in your body, it usually goes to your liver or your kidneys to be metabolised. If there has been long-term use of alcohol then your liver may not be working as well as you thought and the medicines cannot break down as quickly. This can lead to the medicines building up and of course you are more likely to experience adverse effects. If you start experiencing any new symptoms such as headaches, nausea, vomiting or a rash, it is important that you inform your GP. You must also tell the GP about your alcohol intake. It may be a matter of reducing your medicine dose to help your body cope, or reducing your alcohol intake.
Case study John Somersby was a sprightly man of 71. He started retirement thinking he was not going to enjoy it because he had worked all his life and could not really envisage what life would be like without his workmates. He used to have a glass of wine at 5pm, then another at 6 with his dinner and then another, just because he could ... but there was no work tomorrow. John had osteoarthritis and was taking the maximum dose (four times a day) of paracetamol. It seemed to be keeping his pain under control. As part of his regular check-up, the GP did some liver function tests and was very concerned. The paracetamol is metabolised via the liver and, with his regular alcohol, John’s liver was really ‘under the weather’. John was advised to reduce his alcohol and also his paracetamol. John said he “had a bit of a fright” and realised that if he was going to enjoy his retirement he would have to look after himself. ❤ Carlene Smith, BPharm, AACPA, is a pharmacist who works with pharmacies conducting Home Medicines Reviews
What does
vitamin D
The sunshine vitamin is deficient even in Australia, and its importance being appreciated afresh. Dietitian Lisa Renn explains why. Vitamin D is a fat-soluble vitamin whose importance was first discovered when infants fed cod-liver oil were cured of rickets (a bone disease in children known to be caused by vitamin D deficiency). Its main role is to maintain calcium and phosphorus levels within a range to maintain bone health and normal neuromuscular function, and enhance immune function. Vitamin D deficiency may also be associated with an increased risk of bowel cancer, heart disease, infections and autoimmune diseases, although more research is needed for conclusive evidence. We do know, however, that vitamin D is essential for good health and most our body’s supply comes through sun exposure.
Who’s at risk of vitamin D deficiency? It was once thought that in our sun-drenched country Australians would not be susceptible to vitamin D deficiency, however this is not the case. The National Health Survey will provide more up-to-date information later in the year but in New Zealand, up to half those tested were deficient and data from the Ausdiab study (2000–2005) showed that 39% of Australian women and 22% of men over 25 years of age were deficient in vitamin D. Those particularly at risk include: dark-skinned people – vitamin D is not absorbed as well from the skin due to the increased levels of melanin acting as a filter to the UV radiation, which is needed to produce vitamin D 20
Summer 2011
housebound or institutionalised people in nursing homes can be particularly at risk. people who cover up for religious or cultural reasons fair-skinned people who avoid sun exposure breastfed babies whose mothers are low in vitamin D. Breastfeeding is highly recommended as the best food for baby, however lactating mothers need to be aware of their vitamin D levels people with conditions or medications affecting vitamin D metabolism, such as obesity, end-stage liver disease, kidney disease, conditions that cause fat malabsorption (such as cystic fibrosis and coeliac disease), inflammatory bowel diseases and some drugs that increase breakdown of vitamin D (such as anticonvulsants).
Signs and symptoms of deficiency Vitamin D is crucial for bone and muscle development and in preventing osteoporosis. Vitamin D deficiency may not result in any obvious symptoms but, without treatment, it can have significant health effects and increase a person’s risk of musculoskeletal conditions, such as: bone and muscle pain rickets (soft, weakened bones) in children osteopenia (weak, fragile bones – also known as osteomalacia or osteoporosis) in older adults although not conclusive, there is research investigating links with autoimmune diseases such as type 1 diabetes, MS and rheumatoid arthritis, plus heart disease and some cancers.
Supplements If your blood tests show a low level of vitamin D and you don’t feel that you are able to significantly increase your sun exposure, you may need to take a supplement. Vitamin D supplements are readily accessible over the counter and relatively cheap to purchase. They come in the form of tablets or drops and vitamin D3 is the preferred supplement for use (not vitamin D2).
DO? How do we get vitamin D? Vitamin D comes mainly from sun exposure and in small amounts from food. Once vitamin D is made in the skin or absorbed from food through the intestine, it is changed into its active form – a hormone – by the liver and kidneys. It is then available to help our body build strong bones and teeth.
The main food sources include: fatty fish (salmon, mackerel, and herring) meat eggs fortified foods, such as margarine.
A level of 20–25mcg/day is thought to be adequate to maintain levels, however you may require a much higher dose initially to actually increase a low level of vitamin D. Your GP or pharmacist will be able to recommend the appropriate dose. As vitamin D is a fat-soluble vitamin unlike B-group vitamins or vitamin C, any excess is stored in the body rather than passed out in the urine. As such, vitamin D can build up to toxic levels and can also have an effect on other medications, either increasing or decreasing their effectiveness, so your dosage and vitamin D levels should be monitored by a health professional.
How much sun? What is the balance between vitamin D and skin cancer risk? The Cancer Council states that the rule of thumb is that when the UV is below 3, sun protection is not required unless in alpine regions, near highly reflective surfaces such as snow, or outside for extended periods of time. When UV is low, seek exposure for your face, hands and arms. You can check the UV alert in newspapers or the Cancer Council website’s UV alert tracker: www.cancer.org.au
Average dietary intake
Adequate intake
Latitude
Winter
Summer
2–3mcg/day
5mcg/day
Northern states
Normal activity will maintain vitamin D levels
A few minutes’ exposure on either side of the peak UV periods (10am–3pm) most days of the week
Southern states
2–3 hours/ week – seek sun exposure to face, arms and hands
A few minutes’ exposure on either side of the peak UV periods (10am–3pm) most days of the week
It is unlikely that most of us can reach the vitamin D target by food alone; we need the sunshine exposure to provide the majority of our vitamin D. Margarine, which is fortified with added vitamin D, is the major food contributor to vitamin D levels but it’s also one of the things people cut down on when they are trying to lose or maintain weight. Most people only get 5–10% of their vitamin D needs from food.
Testing and diagnosis Your GP can test your vitamin D levels by a routine blood test. The level of vitamin D considered to be deficient remains controversial, however, currently <50nmol/L would be considered low; others believe that a level below 75nmol/L should be the marker of low vitamin D status.
Note: Dark-skinned people may require 3–6 times more sun exposure to store adequate vitamin D ❤ Lisa Renn is an Accredited Practising Dietitian and author of Body Warfare: The Secret to Permanent Weight Loss (Brolga Publishing, 2011) Summer 2011
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Notall about
weight Shortcomings of the BMI
There is more to health and obesity than just a raw number on the bathroom scales, says exercise expert Christine Armarego. Given chronic disease and obesity are at an all-time high worldwide, it’s no wonder that we use the scales as our benchmark of success for our health. But what you weigh doesn’t tell the whole story and weight isn’t the only thing to consider regarding your health. People often assume a low weight signals health and heavy means unhealthy but that isn’t always the case. Worse still, people commonly believe that thin people are fit and heavy people are not — but people of low weight face other chronic diseases (e.g. osteoporosis) and some heavier people are the epitome of health — just look at some of our sporting greats! Why? Your weight includes your bones, organs, muscle mass, fat mass as well as all fluids and wastes. It can change during the day (try weighing yourself first thing in the morning and then at the end of the day), across the week and, for women, across the month. This is due to changes in fluids and wastes. Body Mass Index (BMI) is a measure of our weight to height, classing people as under, normal, overweight or obese. This value puts you in a category compared to other adults (20–80 years of age) which, with other factors — cholesterol, blood glucose level, blood pressure and waist circumference — can indicate your risk of chronic disease. However, it is not the only thing to consider concerning health. 22
Summer 2011
BMI cannot assess body composition. Muscle is a denser tissue than fat so weighs more per unit of volume. So at times, a person’s BMI alone may indicate they are overweight or obese when in fact they simply have more muscle mass than the average person. Also, a person with normal or low BMI might not have enough muscle mass but appear healthy according to the categories. Many people find it very hard to lose weight even if they are exercising and watching what they eat. They assume that their efforts are in vain and often give up their newly formed healthy habits. Plus they are likely to be losing lots of health benefits if they stop improving their diet and lifestyle, such as lower blood pressure and cholesterol; better management of blood glucose levels; and improved cardiovascular fitness, muscle endurance, functional capacity (i.e. you can do more!), joint integrity, range of motion or flexibility, balance and mood. When we increase exercise and improve our nutrition, we increase our muscle mass and reduce our fat mass. As muscle weighs more than fat, significant changes in our body composition can happen without any real changes on the scales. Researchers are now using DEXA or MRI scans to ascertain exactly what changes are occurring when introducing different forms of exercise. BMI can require large changes in weight to result in a category change, so can be a relatively insensitive and discouraging guide. Yet we know that even a weight change of 5% is significant enough to improve management of and help prevent type 2 diabetes. For people with injuries or chronic conditions, sometimes the weight loss required to change BMI categories is unrealistic.
Fitness more important Research is building to show that being fit is more important than being thin [see also page 82]. Although we have long known that people who exercise live longer than people who don’t, it used to be thought that its ability to keep you slim protected you from various lifethreatening diseases associated with being overweight, such as heart disease, diabetes and cancer. However, a 2006 study from Texas has shown that people with the lowest fitness levels were 4.6 times more likely to die at any point than people with the best fitness levels. The study’s message was that your fitness level has a significant impact on your health and chances of dying, regardless of how much excess body fat you have. So an overweight person who exercises regularly will live longer than a thin person who is unfit. A study published this year of more than 2400 people has also shown that our fitness is more able to predict our capacity to be independent as we age than our weight, BMI or waist circumference. Additionally, a long-term study of 7500 men aged 20 to 96 years showed this year that BMI cannot identify loss of muscle mass. In fact, research published in May found that inactivity and low cardiorespiratory fitness are a greater health threat than obesity.
Why use BMI? Why are we still so focused on weight loss? The answer is simple: weight and BMI are easy to measure, accessible to everyone and all of us know what kilograms mean. It’s best to think of weight and BMI as a guide but not be too beholden to them. MRI or DEXA scans will get more detailed information about your body composition but this is not necessary to see changes in your health. If you are making good lifestyle changes and are staying
or getting fit, you’ll live longer and healthier despite the BMI category you fall into. This is not license to gain weight or eat anything and think that you will stay healthy but maybe this summer, rather than jumping on the scales every day, get out there and get moving to increase your fitness. That’s the sure-fire way to prevent chronic disease and have excellent quality of life — not just quantity. Don’t judge the success of your lifestyle changes on whether or not you lose weight. Other measures you can use to see if your changes are working towards getting you healthier are:
1. Blood pressure 2. Blood glucose levels 3. Cholesterol 4. Waist circumference (you need to measure it consistently)
5. Fitness – can you complete exercises more easily
or with less effort or can you do more of them? Can you walk up that hill faster? Can you keep up with others in the exercise class when you couldn’t at the start? 6. Energy levels – are you able to do more than just recover over the weekend ready for the next week? 7. Mood – do you feel generally happier and cope with stress better? 8. If you have arthritis, has your joint pain or stiffness improved? 9. Is your balance better? ❤ Christine Armarego, ESSAM, MAppSci (Ergonomics), MAppSci (Ex Rehab), is an accredited exercise physiologist and manager of The Glucose Club Summer 2011
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Getting
saucy
Jump aboard the gravy train and weave your way around the 300-odd condiments lining your grocery shelves with Simone McClenaughan. Spread from one end of the supermarket to the other, condiments seem innocent enough. From dips to stocks, sauces and mayonnaise, they cover around four aisles and united they stand about 300 strong. They’re quick, easy, apparently just like Mum used to make and can even transform your meal.
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Summer 2011
Taking stock Mayonnaise – there are more than 20 kinds to choose from, including fat free, light, traditional and enriched with omega–3. Sauces – there are at least 100 types available, including tomato and BBQ, marinades, stir-fry and simmer sauces, as well as gravy and finishing sauces that come either as powders or liquids. There are fat-reduced and salt-reduced options. Chutneys and relishes – there are approximately 40 different varieties, covering an ever-growing assortment of vegetables and fruits. Dressings – transform a bowl of salad leaves with any of 40 different dressings. There’s a host of different flavours and within most there is full fat, low fat and fat free. Dips range from traditional creamy ones to salsas and pestos. There are around 50 of them, with low-fat, light and skinny choices available. Stock – a key ingredient for soups and basting, the category includes powdered, liquid and paste forms, with salt-reduced options.
For special diets Some people forget that since condiments aren’t the main ingredient in a dish, that they might not be suitable for certain diets. Spokesperson for the Dietitians Association of Australia and an expert in food allergy, intolerance, food law and health claims, Dr Alan Barclay points people with special dietary needs in the right direction. Vegetarian – Dr Barclay warns that condiments often contain animal proteins. “Look on the ingredient list for the addition of meat, pork, chicken and fish. Also be wary for the more subtle term ‘protein extract’.” If you still aren’t confident, call the manufacturer, importer or distributor because their contact details should be on the pack. Coeliac – gluten is common in condiments as the bulk of them are processed. Dr Barclay says to choose condiments that are naturally gluten-free, such as fruits and vegetables, fresh meats, eggs, nuts, legumes, milk, fats and oils and gluten-free grains, such as rice and corn. “If any ingredient in a product is derived from wheat, rye, barley or oats, then this must be declared,” Dr Barclay says. “Look for those that make a gluten-free claim on the label – they must list the gluten content in the nutrition information panel – it should have a value of zero or close to. Alternatively, look for the Gluten Free crossedgrain logo as products displaying that logo are endorsed by Coeliac Australia and are safe,” he advises. Lactose intolerant – creamy sauces, dips, dressing and mayo are the key condiments that lactose-intolerant people need to be mindful of. “Look for condiments that don’t contain milk, milk solids, non-fat milk solids, whey and milk sugar as ingredients. If they make a lactose-free claim they should contain 0g or no detectable lactose in the nutrition information panel,” Dr Barclay says. Low salt – salt helps add flavour to condiments and acts a preservative. Dr Barclay suggests looking for condiments that clearly state they have no added salt, are salt-reduced or low in salt. “There are a range of different salts used including sea salt, rock salt, garlic salt, chicken salt,” he says and adds, “They are all just salt and are no better for health. Check the nutrition information panel – low-salt foods have less than 120mg of sodium per 100g of food.”
celebrate WITH FLAVOUR Whatever the occasion, there's always a place for Waterthins Wafer Thins. And what wonderfully distinctive yet subtle flavours! Choose from the tasty goodness of Corn, Grain or Oat Crackers and partner with favourite toppings and dips or enjoy straight from the pack. Just delicious!
Some low-salt products have salt alternatives, such as sodium chloride and potassium chloride in them. Monosodium glutamate (MSG) is a common salt replacement as well and can cause reactions in some people [see also pages 36–37]. Low fat – creamy condiments, especially cheesy finishing and pasta sauces, cream-based Indian simmer sauces, mayo, dips and creamy dressings are the main culprits for being high in fat. “Look for condiments that contain no more than 3g of fat per 100g of solid food and no more than 1.5g total fat per 100g of liquid food,” says Dr Barclay. He also warns to be wary of the terms ‘lite’ and ‘light’: “These are the most ambiguous terms as they can refer to the colour or flavour of a food – not the fat or kilojoule content.” Low-fat products may have fat substitutes in them to reduce the fat content yet retain a similar taste and texture. Common substitutes in condiments are food starches, polydextrose, dextrin and maltodextrins, gums and pectin.
Proudly Australian made . Waterthins: Available from leading supermarkets nationally - www.waterwheel.com.au-
The three best choices 1. Fruit- and vegetable-based condiments because
they actually have some nutritional benefits and can be important sources of certain vitamins, minerals and antioxidants.
2. Low-fat condiments because sauces and relishes can be a significant source of kilojoules.
3. Low-salt condiments as many add-ons are high in sodium.
• • • • • • •
energy, listed in kilojoules (kj) protein, listed in grams (g) total fat, listed in grams (g) saturated fat, listed in grams (g) total carbohydrate, listed in grams (g) sugar, listed in grams (g) sodium (salt), listed in milligrams (mg).
Understanding claims
Label alert Food labelling laws in Australia require all manufactured foods to be labelled and to have a nutrition information panel. Labels should include: • product name • brand name • ingredient list (from the main ingredient to the ingredient with the smallest quantity) • nutrition information panel • use-by date • manufacturer details • product weight • nutrient claims • allergen information (such as traces of nuts or gluten free).
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Nutrition information panels must include the amounts of the following in each food:
Summer 2011
Many products have health and nutritional claims on the labels, such as: • reduced fat • light • cholesterol free • no added sugar • low salt. If they make these claims, they must prove them on the nutritional information panel. “Read the per-100g column of the nutrition information panel and choose the condiment with the lowest kilojoule, saturated fat and sodium content,” says Dr Barclay [see also pages 72–73]. ❤ Simone McClenaughan is a freelance health journalist
Take a
deep
breath…
Asthma, emphysema and other respiratory problems rob breath and vitality from millions of Australians, as David Goding reports. In Australia, more than two million people are currently affected by asthma – almost 10% of the population. And this figure is growing every year. “The source of the marked increase in asthma rates in the last two decades is not entirely clear,” says Dr Francis Adams, pulmonary specialist and author of The Asthma Sourcebook. “Air pollution has been implicated since the majority of asthmatics live in areas where pollution levels are high. Indoor pollution may also be a factor because windowless offices and airtight homes reduce air circulation, thus exposing asthmatics to higher levels of irritating substances.”
Types of breathing problems Asthma is the biggest cause of respiratory problems in Australia and is increasing globally, particularly among children and women. It results in the deaths of more than 400 Australians every year, according to Asthma Australia. Simply put, people with asthma have sensitive passages in their lungs, which contract when they are exposed to certain triggers, such as a virus, dust, cigarette smoke, pollen, some animals or simply a change in the weather. Chronic obstructive pulmonary disease (COPD) is really a collective term for a number of diseases that affect the airways of the lungs. The two most common forms of COPD are emphysema and chronic bronchitis, which share the symptom of breathlessness from the lungs being hardened, clogged with phlegm and unable to work efficiently.
Symptoms The symptoms of asthma and COPD can be similar, which is why they are often confused with each other
The launch of the Lung Foundation’s ‘Show Us Your Lungs!’ campaign in Syd ney in October used a fun and cheeky element of ‘flashi ng’ illustrated lungs to raise awareness of lung diseas e.
or treated as one condition, although they can vary dramatically between individuals. Symptoms of asthma include wheezing, breathlessness, coughing (particularly at night), tightness in the chest, and sometimes an over-production of mucus. COPD sufferers may experience all these symptoms as well as general fatigue, a susceptibility to chest infections and, in some cases, a slight blue tinge to the skin due to the body not getting enough oxygen, called cyanosis.
Treatment and management “Scientists are now poised to produce targeted treatments for individuals who are susceptible to asthma,” says Dr Adams of current research into genetics. The traditional approach to relieving asthmatic symptoms and preventing an attack are through relievers — such as puffers and nebulisers, which act quickly and are used during an attack to open the airways immediately — and preventers, which are slow acting and are ideally suited to people suffering from persistent asthma. If you haven’t had an asthma checkup for a while, it’s a good idea to see your doctor for a medication update. Going without medication completely can, in some instances, result in damage to the lungs and lead to COPD. This is not to discount a natural approach, however. Avoiding asthma triggers, including dust, is an important part of ongoing management, as is ensuring you live and work in fresh, clean air that is not too dry or humid. Exercise, rather than being avoided, can help manage asthma for most people, particularly if you ensure you warm up before starting and cool down afterwards. While there is no cure for the damage caused by COPD, medications can improve symptoms and even extend life. These include bronchodilator medications to open the airways, corticosteroids to reduce inflammation, expectorants to loosen phlegm, and oxygen therapy. ❤ David Goding is a freelance journalist
Summer 2011
27
benefits broadband The
of
Our imagination is the only limit on the potential of broadband to revolutionise healthcare, says Prof John Wilson.
For example, the Tele-stroke program allows neurologists to remotely assess CT scans of patients suspected of suffering acute stroke and enables early treatment with subsequent reduction in disability for the 48,000 Australians who suffer stroke each year. Thus greater immediacy can occur remotely through broadband in that vital ‘golden hour’ after someone has suffered a stroke. An ageing population, increasing rates of chronic disease and a shortage of health professionals are all expected to put significant pressure on Australia’s healthcare systems and budgets in coming years.
Online consultations and training IBES aims to reduce social isolation through the use of Internet strategies that aim to deliver appropriate skill and clinical information to those needing healthcare in a ‘patient-centred’ model. The potential of what our digital future holds for industry — and in the health sector — was demonstrated very effectively at the launch of a state-of-the-art broadband network test-bed laboratory in Melbourne in September. An impressive array of futuristic health applications powered by the National Broadband Network (NBN) was showcased at the launch by IBES, the Institute for a Broadband-enabled Society, at the University of Melbourne. University initiatives such as IBES are essential incubators for the development of these opportunities — fundamental building blocks of the eHealth industry — to the point where they become essential for the highest standards of healthcare. High-capacity broadband will deliver greater speed, better access, as well as the ability for multiple users to participate in these applications.
Why broadband? Such advances spring from the clinical necessity to overcome distances that hamper rural and remote communities; the skills shortage; and the ageing demographic.
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Summer 2011
To enhance the skill base of the population and healthcare workers, IBES has developed the UniTV platform to enable shared learning and virtual workspaces. This project has enormous potential for the training and skill development of healthcare workers and the public alike, and has received a Global Business Telecommunications award for innovation. Solutions such as this will become increasingly important for training, credentialing and recertification of the healthcare workforce in the coming years. Given the concentration of resources in capital cities, the vast distances across our country and rapid advances occurring in healthcare, the valuable work of IBES and centres like it will ultimately be seen as visionary. While many more initiatives are yet to flow from IBES, it has provided another example of where universities are capable of providing leadership and direction for the use of new technology. ❤
Professor John Wilson is with the Faculty of Medicine, Nursing and Health Sciences at Monash University
mouth!
Watch your
Not all plaque is bad — in fact, the germ culture in your mouth can be a sign of good health or chronic disease, a leading microbiologist tells Steven Chong.
Just as our skin and gastrointestinal tract teem with warring armies of microorganisms that play a vital role in maintaining health, our oral cavity is also a vast reservoir for bacteria with critical effects on the state of our teeth, gums and rest of our body. Once simplistically tarred as ‘germs’ to be eliminated, emerging research is showing oral microbial ‘flora’ to be so important that daily dental care regimes are being extended to cultivate their ideal balance.
brushes better than floss, or electric toothbrushes better than manual etc. than following a regular practice of oral self-care, said Prof Thomas. “People should use whatever they feel comfortable with, so long as they do it at least once a day.”
“The flora in the oral cavity is the most complex, diverse and integrated of microbial systems in human beings,” says Professor John Thomas, Director of the Biofilm Research Laboratory for Translational Studies in Medicine, Dentistry and Industry at West Virginia University in the US.
However, it is known now that rinsing should involve swishing a mouthwash in the oral cavity through the interdental spaces as well as the back of the throat (especially for halitosis), as the biofilm is throughout the mouth, extending beyond just the teeth and gums.
As individual as fingerprints Everyone’s mouth has a balance of various bacteria that is dynamic and different to anyone else’s, explains Prof Thomas. “Distinct for each person, our unique Oral Microbial Signature changes with age and may be a predictor of our oral and systemic health.” These bacteria live in communities or a biofilm, which is better known as plaque. “Biofilm (dental plaque) is an accumulation of microbial cells within a matrix. If biofilm becomes unbalanced, with greater numbers of disease-causing bacteria, there is an increased risk of developing caries, gingivitis, periodontitis, halitosis and endodontic diseases,” Prof Thomas told HHW. The aim of dental treatment was to promote the ‘good’ bacteria while limiting the growth of the bad, and Prof Thomas emphasised that while dentists can prescribe certain antibiotics that targeted these, only a daily regime of brushing, flossing and rinsing by the individual could maintain the healthiest balance. Even brushing the tongue was important as it was home to so many microbial strains, he added.
Experts agree on routine care It is less important to worry about whether tape is better than floss, waxed floss better than unwaxed, interdental
Also, antiseptic mouthwashes did not sterilise the mouth and thus kill all the microorganisms, but inhibited populations of specific ‘bad’ strains, and some contained essential oils — e.g. from eucalyptus, thyme, mint and wintergreen, familiar to anyone practising aromatherapy — because they were small, neutral and stable enough to penetrate the biofilm and alter its microbial populations.
Agape at a fresh-mouthed future Probiotics, the ‘healthy’ microbes such as lactobacillus commonly found in yoghurt and other fermented foods [see HHW 50, pages 38–39], may have a potential supportive role in keeping mouths healthy, suggested Prof Thomas. However, it is still uncertain which strains are ideal for the oral cavity and how they should be delivered, although a gum is now available. The effect of nutrition on oral health was generally still yet to be fully elucidated, continued Prof Thomas, but it was known that simple carbohydrates such as sucrose were especially damaging because bad microbes loved it. “Genetics, obesity and smoking also contribute,” added Prof Thomas. ❤ Steven Chong is the Editor of Healthy & Heartwise
Summer 2011
29
Cystitis
& thrush
If passing water feels like passing razor blades, you could have a urinary tract infection. Dr Ginni Mansberg gives the latest facts and tips on treatment and prevention. Itching, burning and stinging ‘down there’ are among the most common things seen in general practice and at the local pharmacy. It’s also something that women are embarrassed about and try to manage themselves with the help of a discount pharmacy and the Internet. I have devised some simple info for you to work out what’s what downstairs, when to go the pharmacy and when you’ll need to head to your GP.
Burning and stinging when you pass urine Smelly urine Needing to go to the toilet constantly but peeing only small amounts A dull ache in the pelvic area, especially while urinating Blood in the urine (not everyone gets this) Fever (this is uncommon with a simple uncomplicated UTI) Feeling blah – headachey, nauseous and tired.
Cystitis Urinary tract infections (UTIs) are bacterial infections of the lower urinary tract. That includes the bladder and the urethra, the tube that takes the urine from the bladder to the outside world. Like so many of the fun things, women are more prone to these infections than men. This is because we have an essential design flaw; our urethra is perilously close to the anus. Bacteria that are completely harmless in the colon can really wreak havoc in your bladder. One wipe in the wrong direction (especially after a number two) can send bacteria into the wrong spot and before you know it, you have those telltale symptoms [see box]. 30
Symptoms of a UTI
Summer 2011
Anything that traumatises the urethra can make the problem worse. For some women it’s frequent, let’s say ‘vigorous’ sex — hence the term ‘honeymoon cystitis’. I see lots of women who get this at the start of a new relationship. Menopause is the other big one that will see women who haven’t had cystitis for years running every five minutes to the toilet. It’s because the oestrogen in a premenopausal woman keeps the cells of the urethra plump and healthier than the slightly drier menopausal cells that can be traumatised at the drop of a hat.
Being diabetic, being pregnant and having conditions that stop you from emptying your bladder properly (e.g. chronic constipation, prostate issues or a catheter) also up your risk.
Getting rid of the razor-blade feeling If you suspect you have a UTI, you can go and chat about it to the pharmacist, but ultimately you will need to head to the GP to get the problem diagnosed and treated. A simple urinalysis (where your GP dips a stick into a urine sample in the surgery) will give the GP a pretty good idea of what’s going on, but you will need to send off a sample to the pathology laboratory. It’s not only to completely confirm the diagnosis but also confirm which bug is the culprit and the best antibiotic. With so many bugs becoming resistant to antibiotics these days, it is not uncommon for your GP to start you on one antibiotic only to call you a few days later and tell you that you need to swap because the test detected some resistance in some of the germs. The treatment is antibiotics. If you have some stinging and burning that goes away with some cranberry juice or some sachets of a urine alkaliniser, chances are it was never an infection per se. How long to take antibiotics for? It’s controversial. Studies show you only need them for three days (and women who get put on the right antibiotic first time get almost instant relief). But most GPs tell you to finish the course and a pack normally has a five-to-seven-day supply. Your doctor may indeed suggest you get sachets of a urine alkaliniser (e.g. Ural). These help with the burning and stinging symptoms but don’t do anything to help treat the infection. I have lots of patients who live on them. If you like the taste and have a deep wallet, knock yourself out. There aren’t many side effects. But you don’t need them and they won’t help you treat or prevent UTIs.
Avoiding a UTI Preventing UTIs can be a problem. Taking care to always wipe back to front is important. Similarly, peeing before and after sex is right up there. Drinking lots (around two litres per day) helps dilute the bacteria and possibly cranberry juice and tablets (unless you or your family members are prone to kidney infections, in which case avoid them!!). Some docs recommend avoiding baths, tampons and tight clothing. The evidence for that helping is pretty hopeless.
Fungal down below Not all that stings is a UTI. Thrush, a yeast infection of the vulva and vagina can do the same. It usually comes with itching, a white discharge and can cause painful sex. You don’t necessarily need to go to your GP to get your thrush sorted out. Many women can recognise the symptoms themselves. Treatments, which are generally over-the-counter anti-thrush creams, are effective in the vast majority of cases. If they don’t work, you’ll need to seek some help. One possibility is that you don’t have thrush, or that it’s not the end of the story. There are so many problems that can cause itch and pain downstairs, including dermatitis and some other infections — both sexually transmitted and non-sexually transmitted. The Candida yeast that causes thrush love a warm, moist environment with lots of oestrogen, so pregnant women are particularly prone. They also love having the normal healthy bacteria that compete for food being knocked off. Hence antibiotics can indirectly cause thrush. It isn’t sexually transmitted.
Thrush prevention Preventing thrush is a favourite topic on the Internet, where avoiding sugar will be strongly recommended. That’s not a bad principle – but not to avoid thrush. Studies haven’t found there’s any link to diet, nor wearing tight jeans. In theory, the hot sweaty conditions downstairs generated by tight pants would play a role, but this isn’t borne out in studies. Similarly off the hook is the pill. However, using a progesterone-only contraceptive like the Implanon or Depo shots might lower the risk by lowering your oestrogen levels. ❤ Ginni Mansberg, BMed, GradDipJournalism, is a Sydney GP and member of the HHW Editorial Advisory Panel
Summer 2011
31
Gerald Top pharmacist and radio personality Gerald Quigley introduces his new regular column where he answers frequently asked questions.
Q
What’s the difference between standard fish oil and the krill oil that I see in health outlets now?
The difference is all about how the essential fatty acids within these two oils are naturally packaged. In fish oil, the essential fatty acids (abbreviated to EPA and DHA) are packaged in the triglyceride form that requires a complex digestion process to enable absorption and use. However, in krill oil, the essential fatty acids are in phospholipid form, along with powerful antioxidants that prevent deterioration of those fatty acids. This allows for better absorption, bioavailability and protection against oxidation. This means that the availability of the DHA and EPA is so much better in krill oil. What’s more, the evidence as to its effectiveness in raising so-called ‘good’ cholesterol is very sound. Krill oil is also an effective anti-inflammatory. Additionally, fish oil can successfully intervene in the management of joint pain but it’s probably best to use it in liquid form to ensure adequate intake of the EPA and DHA. Otherwise you end up taking a handful of capsules! Many fish oils are flavoured now, making them much more palatable.
32
Additionally, I have found a range called Nature’s Blend, where essential fatty acids are mixed with honey, either smooth or crunchy peanut butter, mayonnaise or a yeast spread. This gives an easy way to keep topping up your essential fatty acid intake. Summer 2011
Q
I heard about coenzyme Q10 and its apparent benefits. Can I take it with my cholesterol-lowering medicine?
CoenzymeQ10 (coQ10) is the energy nutrient that drives all of our tissues, especially in areas requiring high energy, such as the heart [see HHW 50, page 33]. Thus far there are no clearly defined signs of when our levels of coQ10 are deficient. We do know that disease and ageing lower coQ10, and other vitamins — such as the B group and folate — are required for synthesising coQ10 within the liver. When our coQ10 levels are low, we feel tired and lethargic and often notice muscle pain. Statins lower cholesterol by blocking the action of an enzyme involved in the production of cholesterol. But when this enzyme is blocked, the production of coQ10 is stopped as well. This brings on the fatigue I’ve mentioned and of greater concern is that heart function might be impaired. Remember, the heart requires good levels of coQ10. Some statins deplete coQ10 more than others but routinely taking coQ10 in conjunction with statins is a sensible option to maintain energy levels. There are lots of different strengths available, too. I see better results with 150mg each morning, regularly taken without interruption. Other medicines increase our body’s requirements for coQ10, including betablocking drugs used for hypertension [see HHW 51, pages 42–3]. Conditions increasing our demand include candida infections, diabetes, ageing generally, and Parkinson’s disease.
Q
I finished a course of antibiotics recently and a friend suggested I take something to offset any tummy upset I might have. Is this essential?
Quite simply, our intestine carries billions of bacteria, all in delicate balance. Whenever there’s an imbalance, symptoms like bloating, flatulence, abdominal pain, constipation and diarrhoea arise. A person’s individual gut culture remains surprisingly constant throughout life.
Q
I have high blood pressure in my family history. Is there anything natural I can take to reduce my risk of this annoying condition?
Congratulations for taking the initiative in understanding that prevention is so much easier than coping with a condition. We don’t fully understand elevated blood pressure (hypertension; see also pages 38–39) but we certainly do acknowledge that it increases in the community, and in the individual, for many identified reasons. One of the most important considerations is nutrition. A nutrient-poor diet low in fresh produce and high in saturated fats both predisposes you to, and maintains, high blood pressure. Stress, smoking, heavy metal exposure and elevated blood levels of homocysteine are additional risk factors. Homocysteine levels can be controlled by taking folic acid. The most difficult thing is that high blood pressure doesn’t have symptoms. That’s why it’s called the ‘silent killer’ — it can cause damage to blood vessels, heart, brain and kidneys if undetected and left untreated. Reducing your risk is very much achievable and may I suggest considering olive-leaf extract as a supportive measure for cardiovascular health? My patients report that the Olive Leaf Extract from Esk, Queensland, gives them the best results, and I endorse their feedback. Maintain a healthy weight, and if you need to lose weight, ask your local pharmacist about the OptiFast Very Low Calorie Diet [see also HHW 51, page 56]. It’s a medically approved option that can be easily implemented. Regular exercise is fundamental. Try for half an hour a day as the basis. Some resistance exercise, such as pushing against a wall or lifting light weights, is important to include.
Fermented ‘probiotic foods’, such as yoghurt and even sauerkraut, are valuable for gut health. The most important action of a probiotic is to enhance the digestive process and reinforce good immune function. It’s generally agreed that a probiotic must be capable of colonising the intestinal tract to influence human health. An antibiotic, while obviously treating a bacterial infection, does adversely affect this delicate balance. In fact, some experts say it takes nine months for a gut to re-colonise after a course of antibiotics. What that means is that a person’s immune function can be severely affected, resulting in a tendency to recurring infections. An obvious solution is to therefore increase your intake of probiotic food, and consider a probiotic supplement as well. These supplements are widely available, and provide additional levels of microbes called Bifidobacteria, Lactobacillus and Saccharomyces. These big names are merely variants of a central theme. Flooding the gut with probiotic bacteria allows a rebalancing to occur smoothly. In fact, many people take a probiotic all the time, and find that issues like bloating and flatulence are minimised. We also know that yoghurt each day is a great addition to breakfast. Be reassured that there are no reports of a probiotic affecting any prescribed medication. They are essentially a food supplement and can form part of a healthy dietary routine. ❤
Do you have a health question for Gerald? Send it to emily@healthpublishingaust.com.au or Emily Rundle, Suite 207 AMA House, 69 Christie St, ST LEONARDS NSW 2065
Gerald Quigley, BPharm, is a community pharmacist and Master Herbalist in Melbourne and a presenter on radio 3AW.
Summer 2011
33
g n i k h a S
sa t
the
There are many flavoursome ways you can avoid the silent killer, dietitian Sue Radd reports. Most people believe they eat a fairly low-salt diet but a closer inspection of their dietary habits can reveal many hidden sources of sodium — the harmful part of salt — and, very often, surprisingly high levels of this killer condiment.
For many health conditions, the effects of dietary salt build up and you don’t feel them initially. As we age, these chronic effects then precipitate as a major cause of dietrelated disease for people over the age of 50. A study published this year suggests that the negative effects of salt can also be seen in the bodies of healthy people within 30 minutes of being eaten. A high-salt meal reduced the flexibility of arteries in these people by half — similar to the effect observed after eating a fatty meal!
Too much of a good thing? Sodium is an essential mineral required in very small amounts in the body to help regulate muscle and nerve function. It is also a component of all bodily fluids: blood, sweat and tears. But a high-salt intake (as occurs with a typical Aussie diet) has been found to aggravate or cause over 20 health-related problems, including high blood pressure, stroke, asthma, osteoporosis, severe vertigo, congestive heart failure, stomach cancer, kidney stones and diabetic retinopathy! Australians are eating 5–10 times more salt than the body needs and most of this comes without even reaching for the shaker — foods purchased at the supermarket, dining out or take-aways, and packet snacks. If you have reached midlife or already have hypertension, diabetes or chronic kidney disease, the latest health guidelines suggest you reduce your sodium intake to 1600mg per day (the amount contained in about one level teaspoon of salt).
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Summer 2011
habit
Did you know? High blood pressure is the most common reason for visiting a GP [see also page 38]. And the risk of heart disease starts early, with a blood pressure level of just 115/75mmHg and doubles with each increment of 20/10mmHg! All the more reason to know your figures and keep the pressure down!
Your meals at home – minus the salt Skipping salt and becoming adventurous with a range of flavoursome alternatives can boost your health, palate and culinary skills! But get ready for a little adjustment: it usually takes 4–6 weeks to adapt to a low-salt diet. By six months, your palate will have recovered enough to be described as truly normal for the first time since infancy. This means you will be able to detect and enjoy natural and subtle food flavours again.
10
easy ways to skip salt
1. Sprinkle fresh herbs into pasta dishes, vegetables and on meat 2. Source juicy, ripe tomatoes and fresh garlic for sauces 3. Add crushed garlic, ginger and chilli to stirfries or squeeze in some lime juice 4. Use red wine to spruce up stews, casseroles and bolognaise 5. Create an authentic pizza flavour with dried oregano and marjoram 6. Combine fresh fennel and dill to complement fish dishes 7. Toss basil leaves into a tomato-based dish 8. Drizzle lemon or vinegar on salads and fish 9. Roast capsicums, squash and parsnip to bring out their flavour 10. Stir in white wine when making risottos and chicken sauces
Stock your pantry with these flavour enhancers: • Herbs and spices (fresh and dried) • Lemon, lime and oranges • Wine and gourmet vinegars – apple cider, Balsamic, rice wine • Potassium salt substitute • Salt-reduced stock powders* (vegetable, beef, chicken) • Use salt-reduced powders sparingly as most still contain significant amounts of sodium. Salt Skip stock powder made by Eumarrah is low sodium. This is available from some health-food shops and by mail order: (03) 6273 9511.
Shopping the low-salt way What do terms like ‘40% less salt’, ‘reduced salt’ and ‘no added salt’ actually mean? Are products with these claims low enough in sodium? Next time you’re grocery shopping, take a closer look at the nutrition information panel. You may be in for a surprise!
Clever shopping swaps High-sodium food
Healthy alternative
Sodium saving!
Salted nuts (30g)
Unsalted nuts (30g)
106mg
Baked beans (125g)
Heinz No Added Salt baked beans
437mg
Fetta cheese (25g)
Low-fat ricotta cheese
285mg
Tuna canned in brine (96g can)
Tuna canned in springwater (95g)
175mg
Liquid stock (250ml)
Salt reduced liquid stock (250ml)
495mg
Eating out tips If you’re serious about feeling well and protecting your body from salt damage, it’s smart to avoid most fast foods (unless you’ve checked the company’s nutrition information). And next time you’re dining out, ask the chef to omit adding any salt or high-salt ingredients to your meal.
If you have a medical condition, such as high blood pressure or diabetes, source products that contain less than 120mg sodium per 100g. These are truly low salt/ sodium. For many processed foods, this can be difficult to achieve because salt also provides various functional properties e.g., it strengthens the gluten in bread and affects the ripening and texture of cheese. Reduced salt: the salt content has been reduced by at least 25% compared to the original formula but it may still be high e.g., salt-reduced soy sauce still contains around 3500mg sodium per 100ml, which is 29 times higher than acceptable if you are following a low-salt eating plan! No added salt: no salt has been added to the product. If sodium is contained within any of the ingredients, the overall product is still required by law to provide less than 120mg of sodium per 100g. You are safe in choosing ‘no added salt’ foods. Heart Tick: products with the Heart Foundation Tick aren’t necessarily low salt, although the level of sodium is reduced according to their requirements. Here are the sodium targets for a few of their food categories so you can see why it’s still a good idea to check the fine print:
• Breads – <400mg per 100g • Biscuits – <250mg per 100g • Cheeses – <750mg per 100g.
What’s in your salt shaker? Not all salt looks pure white. Unrefined salts may come in pink, brown, black or grey colours. While these pretty salts are often promoted as a source of minerals, they still contain massive amounts of sodium. Fancy salts are just a more expensive way of doing yourself harm! ❤ Sue Radd is an Accredited Practising Dietitian, Founding Director of the Nutrition and Wellbeing Clinic, an author and host of Culinary Medicine Cookshops in Sydney: www.sueradd.com, (02) 9899 5208
Summer 2011
37
Lower blood pressure
drug-free
Hypertension is a major risk factor for heart disease, the world’s number one killer. It is symptom free but it can be treated simply, says Angela Peris. High blood pressure (BP) means increased pressure in the arteries that carry oxygenated blood from the heart around the body. Blood pressure is measured in two numbers, such as 120/80. The top reading is called ‘systolic blood pressure’ and the lower reading is called your ‘diastolic blood pressure’. Systolic BP is the pressure that your heart has to exert to pump blood around the body. Diastolic BP is when your heart relaxes after pumping blood to the body Everyone’s BP fluctuates and never stays the same, varying to meet your body’s needs.
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Summer 2011
Measuring blood pressure Usually a systolic BP of 120–140mmHg, and diastolic BP of 75–85mmHg, is considered normal. Sometimes systolic BP can be higher than 140mmHg or diastolic BP higher than 85mmHg. The main concern is consistently higher readings, not a ‘one off’ higher reading. Many factors can influence BP measurements, e.g. size and placement of the inflatable cuff used, placement of the cuff, the BP machine or the operator’s technique, and how you feel at the time. Stress, anger or feeling anxious can affect your BP reading. The best time to measure your BP is when you are rested or have been lying down about 10 minutes. • A BP reading of 150/95 is considered to be high • A BP result of 180/110 is considered very high.
Why hypertension is ‘the silent killer’ High BP usually does not give you any symptoms or warning signs — you can have high BP and feel perfectly well. You may not know that your BP is high until it’s checked by a health professional, although occasionally some people may experience headaches due to hypertension. High BP can cause serious health problems if not managed well and kept within normal limits, such as stroke, heart attacks or kidney failure. Atherosclerosis (hardening of the arteries) with build-up of plaque can contribute towards high BP. When the arteries are narrowed, it increases the resistance that heart has to pump against, in turn increasing the pressure within the heart. Long-standing high BP can eventually affect the heart’s pumping chamber (left ventricle). When the resistance the heart has to pump against is high, it causes the heart muscle to get thicker, like when you lift weights and your muscles gets thicker and firmer. When this happens in your heart muscle, the left ventricle gets thicker and less effective in pumping blood out, which can lead to heart failure as well as other complicated heart conditions, e.g. hypertensive cardiomyopathy.
The burden of lifestyle factors Overweight and obesity is a major factor for high BP. When your heart has to pump blood through to extra body mass, it increases the pressure within the heart. Continuous strain on the heart muscle can contribute towards a sudden heart attack or related heart conditions. It is imperative that we maintain our body’s ideal weight to reduce the workload on the heart by maintaining the BP within normal limits. Cigarettes smoking can also contribute toward high BP by increasing bad cholesterol and clogging up your arteries. If you have high BP and take antihypertensive medications while smoking, you are fighting an uphill battle. Quitting cigarettes is crucial for everyone, especially if you are overweight, have diabetes, hypertension, high cholesterol or heart disease. Many people take antihypertensive medicines [see HHW 51, page 43] but none of them ‘cure’ high BP. They instead chemically maintain your BP within normal limits and quite often doctors need to increase dosage over time. Most BP medications have other side effects.
A risk factor, not a disease High BP itself is not a disease or illness. Most of the time, it is a ‘lifestyle issue’ and your body’s way of saying it is under ‘pressure’ and needs some urgent attention. It could be an unhappy work environment, family situation or just where you are in life. Your body may not be comfortable with how you are treating it – perhaps from unhealthy eating habits, excess weight, smoking, excessive alcohol consumption, as well as anger and aggression —as all these narrow and harden your arteries over time.
– with or to lower blood pressure without medication 1. Regular walking – 30 minutes/day for at least
5–6 days/week. If you are bored, listen to music or an inspirational talk on an iPod. Walking the dog or walking at a busy workplace doesn’t qualify as ‘cardio fitness’ exercise. If you work long hours, make the time to walk after work or on weekends.
2. Weight management – take ‘small steps’ toward managing weight: aim to lose 5kg within the next 6–8 weeks, then gradually get to a target goal you feel you can maintain. Make weight management easy and fun for you.
3. Stop smoking – this is a must for hypertension. You can quit within 60 minutes and become a nonsmoker: see www.cardiacwellness.com.au/ quitcigarettes.
4. Maintain normal cholesterol levels – increase your ‘good cholesterol’ levels with healthy food: fresh vegetables, fruits and more fish and nuts such as walnuts, etc.
5. Eat less meats, saturated fats and trans fats (in biscuits/cakes/baked pastries). 6. Drink water – keep yourself well hydratedif you
haven’t got heart or kidney failure, or had a recent heart attack.
7. Manage stress – look at your lifestyle and make changes to reduce stress.
8. Reduce salt – our bodiess need salt but avoid adding extra salt to food.
9. Do relaxation or meditation sessions – have quiet times alone when you can reflect on your life and your day and learn from your mistakes.
10. Start doing what you love doing – a hobby or visiting someone that you haven’t seen for a long time, walk along the beach, bush walking, or take a day off and stay in bed with a good book.
When you learn to live the life you dream of, your body will release the ‘pressure’. Listen to your body as everything you need for good health is free: walking, drinking water and fresh air. Take care of your heart so that your heart can take care of you. ❤
Angela Peris is registered critical care nurse, Director of the Peris Cardiac Wellness Centre and author of Loving your Heart: www.cardiacwellness.com.au
Summer 2011
39
Control
your
cholesterol!
What should your cholesterol levels be? The National Heart Foundation (NHF) has set some good target levels and, when your doctor orders blood tests, they will be looking to see if your cholesterol is at these levels: Targets for lipids* LDL cholesterol
<2.5 mmol/L
HDL cholesterol
>1.0 mmol/L
Triglycerides
< 1.5 mmol/L
* Lipid Management Guidelines of the NHF and Cardiac Society of Australia and New Zealand, position statement 2005
High cholesterol is another risk factor for heart disease that you can modify with diet. But if you’re already taking or about to go on medicines to lower cholesterol, how do they work? Pharmacist Carlene Smith explains. Cholesterol is a form of fat that is present in all healthy human cells. It is essential to many of the body’s processes, such as the production of hormones and vitamin D. However, it is believed that too much cholesterol can adhere to arteries and cause cardiovascular disease.
According to the NHF, more than 50% of Australian adults have blood cholesterol levels that are higher than recommended so are at increased risk of coronary artery disease and related conditions, such as heart attack and stroke. Having high blood cholesterol levels is known as hyperlipidaemia and it has become a marker to identify heart disease.
Are you at risk of heart disease? When it comes to preventing heart disease, there are some factors you can change and some you can’t. Risk factors you can’t change are:
• the intermediate-size ones are called Low Density Lipoprotein (LDL) and these are most associated with heart disease
• a family history of heart disease • increasing age • your gender (heart disease affects men earlier than women) • if you have type 1 diabetes. Risk factors you can change are: • high cholesterol • risk of developing type 2 diabetes • smoking • high blood pressure (hypertension) • physical inactivity • overweight/obesity • waist circumference • pattern of eating • your exposure to and your response to stress.
• the smallest particles are called High Density Lipoproteins (HDL), which can protect against heart disease.
Reducing these risk factors can reduce your risk of heart disease. If you already have heart disease then you will benefit from changing your lifestyle.
Most of the cholesterol in your blood is made by your own body, primarily in the liver, from where it’s released into the bloodstream, which then carries it in particles called lipoproteins. These lipoproteins are named according to how big they are and they can be measured in a pathology test: • the very large particles are called Very Low Density Lipoproteins (VLDL). Triglycerides are part of this group
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Summer 2011
The lifestyle quiz Answer these questions and add up your score — it may help you decide how to improve your lifestyle: YES NO Questions Do you walk every day? Do you go to a gym? Do you use plant sterols as margarine? Do you have 3 fish meals a week? Do you have 5 serves of vegetables each day? Do you have 2 serves of fruit each day? Score 10 for each YES and 5 for each NO • If you scored 30–40, you will have to make some big changes to your lifestyle to stay well • If you scored 40–50, you will have to make changes but you are on the right track • If you scored 50–60, well done — you are doing very well; keep up the good work!
Cholesterol-lowering medicines Although you can make lifestyle changes, you may need medicine to reduce your cholesterol. Remember, you have to take the medicine for it to be of benefit to you.
Fibrates are known to reduce coronary risk, especially in people with type 2 diabetes or who are overweight. • gemfibrozil: best taken twice daily before food • fenofibrate: can be taken at any time of the day with or without food Benefits: very effective when triglyerides are elevated.
Statins inhibit an enzyme that helps your body make cholesterol. As a result, statins can reduce total plasma cholesterol and LDL cholesterol. In addition, they can increase HDL cholesterol and reduce plasma triglycerides. There are many brand names but the generic drug names are easier to remember. Statin patients should be on a low-cholesterol diet as well as taking the medicine. • atorvastatin: can be taken at any time, alcohol can make adverse effects more likely • fluvastatin: can be taken in the evening without regard to food • pravastatin: best taken at night, alcohol can make adverse effects more likely • rosuvastatin: can be taken at any time without regard to food • simvastatin: best taken at night, alcohol can make adverse effects more likely Adverse effects: the most common include muscle pain, myalgia, headache, insomnia and elevated liver function test results.
Adverse effects: the combination of fenofibrate and statin has a higher risk of causing the adverse effects of muscular aches.
Other preparations Ezetimibe
Fish oil Nicotinic acid
Bile-acid binding resin Artichoke leaf
Statin therapy
Benefits: long-term reduction of LDL cholesterol can slow progression of atherosclerosis. The reduction can occur quite quickly and the rate of stroke will reduce.
Fibrates
Soluble fibre
Plant sterols
Green tea
A new class of drugs that can reduce cholesterol absorption; it can be used with statins to gain an extra 20% reduction. Known to support cardiovascular health; the dose is 3g daily. Can be effective in reducing cholesterol and triglycerides; the dosage is three times a day after food. It has the adverse effect of flushing, which can be very uncomfortable. Acts by binding the cholesterol. The dose is twice daily and it should not be taken with any other medicine. It can adsorb other medicines and it may cause constipation. Some research suggests that artichoke leaf extract (Cynara scolymnus) may help lower cholesterol. Artichokes also contain a compound called cynarin, believed to increase bile production in the liver and speed the flow of bile from the gallbladder, both of which may increase cholesterol excretion. Appears to reduce cholesterol absorption in the intestines. Soluble fibre binds with cholesterol so that it is excreted. Note that extra fluid intake is necessary. Soluble fibre can be found as a dietary supplement like psyllium powder, or in foods such as oats, barley, peas, beans, apples, prunes and berries, carrots, Brussels sprouts, broccoli. Naturally occuring substances found in plants and used in margarine. They are similar in structure to cholesterol and may help block its absorption from the intestines. About 10 cups daily will make it effective. Green tea can affect clotting time and can interfere with warfarin levels. ❤
Carlene Smith, BPharm, AACPA, is a pharmacist who works with pharmacies conducting Home Medicines Reviews
Summer 2011
41
Potent pointers Impotence or erectile dysfunction may be caused by separate health issues but it will end up affecting the rest of a man’s life, including their partner, Allan Pease tells Steven Chong. Sex is only the beginning of the impact of erection difficulties on a man’s life, a recent Australian survey has found, with confidence, self-image and sense of manhood the collateral damage. However, these psychological problems are ongoing and, as body-language expert Allan Pease points out, cut across domains in a man’s life that are not only linked to the bedroom. “The impact of the condition extends far beyond the ability to respond physically when aroused,” he says. Allan Pease has been known internationally as ‘Mr Body Language’ since his Definitive Book Of Body Language became a multimillion seller and the communication bible for organisations worldwide. He experienced erectile dysfunction (ED) following his prostatectomy 13 years ago [see HHW 51, page 25] and his options then were pills such as Viagra or Cialis, injections, vacuum pumps and implants. However, when prostatic nerves are damaged by either surgery or diabetes complications, only the latter two ‘mechanical’ options are viable.
What Australian men think For two-thirds of the 1000 men who took part in the national survey, their desire to ‘feel normal’, ‘feel like a man again’ and ‘concern for their relationship’ were the main reasons for speaking to a doctor about ED. Only a third elected sex as their main reason. “Many men define manhood by the ability to have an erection,” explains Allan. “Erection problems dramatically affect your confidence and you wonder if you’ll ever feel 42
Summer 2011
like a man again. It’s a compounding thing that goes far beyond the actual erection or having sex.” The research by Galaxy found that men with ED suffer high levels of anxiety induced by doubts about their virility and by constant reminders of their problem. Even just the thought of having sex caused anxiety in 43% of men with ED, while a half admitted to being reminded of their problem by simple physical contact with someone they find attractive. In fact, about 60% of men with ED admitted they avoided conversations about sex, while a third avoided situations that may lead to sex.
More than the bedroom “Everywhere you go you are reminded of your erection problem,” says Allan, “If you don’t take positive action you will never escape the condition.” Although half the ED sufferers admitted they might go to bed at a different time to their partner to avoid sex, more than this proportion said they were more concerned about the impact of ED on their partner and their own confidence levels. “Many men go into denial and buy toys like a big boat, a fast car or a pair of aviator sunglasses. They try to recapture their manhood by surrounding themselves with masculine things but it’s only a temporary thing.” However, less than half of sufferers sought treatment for ED and just 14% were using a prescription medication for it. Dr Michael Lowy, a Sydney sexual health physician, said on the report’s release that, “The successful treatment of erection problems should no longer be defined simply by a man’s ability to have sex. When we address the broad impact of erection issues, we can help men feel and act the way they did before the problems started.” ❤
For more on male reproductive health, see www.andrologyaustralia.org or call 1300 303 878. Steven Chong, BA (Communications), is Editor of Healthy & Heartwise
Manage Your Pain By Dr Michael Nicholas, Dr Allan Molloy, Lois Tonkin and Lee Beeston Published by ABC Books, $35 More than one in 10 of us suffer from continuous or recurring pain and if it persists longer than three-to-six months despite treatment, it is considered chronic. This ‘silent epidemic’, be it from arthritis, injury, nerve damage or cancer, is now so big as to demand its own medical specialty and the authors adapted their multidisciplinary work with the University of Sydney Pain Management and Research Centre at the Royal North Shore Hospital for this book, now in its third edition. Manage Your Pain explains the medical understanding of pain then runs through conventional and complementary treatments; how to pace activity so flare-ups are minimised and quality of life not sacrificed; practical exercises; impact on social life; relaxation, distraction and desensitising techniques; sleep; work and coping with pain in old age. 44
Breast Support
Body Warfare
Exisle Publishing, $30
By Lisa Renn
Two years ago, the author went for a free breast examination in a mobile unit and came away with a diagnosis of breast cancer. Her life irrevocably changed, she has since been in and out of hospital.
Brolga Publishing, RRP $27.99
Meanwhile, Gwendoline wrote this resource, recollection and synopsis of what she has learnt on the ‘Breast Cancer Highway’ to remission and reconstructive surgery. “You can dip in and out of the book, depending on where you are in the process,” she advises, and it’s directed equally to loved ones of cancer patients. The author is a clinical psychologist with severe depression, and she describes her experiences with irony, self-deprecating humour and an eye to selfreliance and independence. She addresses what to wear to a breast examination, and how to tell people of the diagnosis, stay positive and cope with an impending mastectomy. Breast Support includes contributions from medical specialists and is endorsed by the Breast Cancer Foundation. Summer 2011
Sometimes the spirit may be willing but the flesh less so, but diets — as well as fitness kicks, quit-smoking attempts or other selfimprovement programs — too often fail because resolve breaks down as we retreat into the comfort of inertia and habit. Lisa Renn, a spokesperson for the Dietitians Association, specialises in weight loss so is familiar the eternal pitfall of the mind and self-saboutage. She has written Body Warfare to ‘end yo-yo dieting forever’ with the psychological STAR strategy to change selflimiting beliefs and maintain motivation as a priority. This path will enable you to “have your cake and lose weight too”, eat without guilt, change bad habits and keep weight off forever, promises Renn. Although there are the usual chapters on exercise and nutrition, most of the book delves into how we constantly fool ourselves about our weight and potential for achieving and keeping a healthy one.
Barefoot Contessa, series 1 TIME LIFE, distributed by Shock Entertainment, RRP $24.95 Ina Garten is the Emmynominated celebrity chef who knows how to entertain with simplicity, style and fun. The show is shot in her New York State home to showcase her shortcuts and strategies for make-ahead menus, fabulous food and memorable parties. These two DVDs include 13 episodes from her TV show and include roast turkey, Mediterranean mezze and what to do with leftovers. Despite its US origins, the outlined measurements, ingredients and techniques translate well to an Australian context. ❤
To win a copy of one of these books, write to us with your choice and what you think of this issue of Healthy & Heartwise to emily@ healthpublishingaust. com.au Please include a full name and postal address. Privacy will be upheld on all contact information.
Conquering a Coronary For Liz Joshua, a heart attack was not that dramatic but certainly unwelcome. Nonetheless, it led to a renewed push for better health with help from an online community. About three years ago when I was 56, I had a heart attack. My father died at age 54 from a heart attack so I was aware of the genetic influence but thought that between a private practice and a full-time role at Queensland Health as a psychologist, I was too busy to get sick — I very rarely even caught a cold! Because I had never smoked, only drank the occasional glass of bubbly and ate reasonably well — minus a regular indulgence in full-fat cheese — I thought I was in the clear, especially after I passed the magic 54 mark. I was also compliant with medication that I took to control my high blood pressure.
Chest painful but no agony My wake-up call began after a very late shift at the hospital resulted in no sleep, followed by an early start the next morning. After a string of meetings, around 11.30am I started to feel unwell but tried to ignore it and keep working. However, a compelling pain in my chest started to radiate to my neck. It was not excruciating but it got my attention and soon after my heart rate increased dramatically and I began having cold sweats. I thought it was probably a good idea to mention how unwell I felt to a colleague. Later that day, I learned that — seemingly out of the blue — I had suffered a heart attack.
The road to rehabilitation Three years on and my lifestyle is quite different. After the heart attack, I completed a cardiac rehab program and lost 16kg in the first six months. I continue to monitor my weight and find it easy to maintain a happy size eight with
a whole new set of clothes. I go to the gym or walk/run every day and enjoy it. I’ve gone from being too scared to even get on a treadmill after the heart attack to running half-marathons. I reduced my workload significantly, with a close eye on stress management to reduce blood pressure. I have also explored different avenues of support for my health journey and most recently discovered a new online social network called Healthshare. I have joined their heart-disease community, connecting with other people living with cardiovascular disease and participating in various discussions with other members and experts. When facing a health challenge, feelings of isolation can be quite overwhelming so it’s wonderful that Australians now have a service like Healthshare to encounter others in a similar situation.
A new world of online friends and advice Since I now have a real interest in managing my health, I’m interested in topics like weight management, fitness and nutrition and I follow all these communities, too. They are part of my plan towards achieving better health so it’s great to have connection with like-minded people across all these areas — Healthshare is a one-stop-shop for health. I really have tried to change my diet and exercise, so have been able to reduce my medication substantially. I have a wonderful partner, four children and three grandchildren so I’ll do whatever it takes to lead a happy, healthy life for their sakes as well as my own. ❤ Go to www.healthshare.com.au for an Australian, health-oriented social network free to people aged 18+ years. It has more than 350 communities that individuals, health professionals and health associations can join. Liz Joshua is a psychologist with Queensland Health, Brisbane
Summer 2011
45
3 BRILLIANTLY simple breakfasts Festive desserts, 2 x MasterChef winners chats:
Adam Liaw Julie Goodwin
&
light sides & salad days
Christmas turkey & BBQ must-tries for
holidays
About
recipes This revised and simplified recipe guide will help you cook healthy meals over summer. Its criteria are based on an 8700kj diet using Australian Nutrient Reference Values (NRVs) for chronic disease prevention. The NRVs dietary targets suggest that for preventing chronic disease, the daily diet should comprise 20–35% energy from fat, less than 8–10% energy from saturated (and trans) fat, less than 1600mg sodium, between 45– 65% of energy as carbohydrate, and 28g fibre for women and 38g/day for men. The NRVs also suggest that low glycemic index (GI) carbohydrates be selected. Protein counts are included but there is no set upper limit. Our criteria have been developed based on these guidelines, assuming three meals and two snacks will be eaten each day. The fibre criteria also assume that two pieces of fruit per day are eaten as per current recommendations and that high-fibre breads and cereals are included. The criteria are stated per serve for each recipe.
Nutrient
Recipe
Star rating
Upper limit
Sodium
Main meal
≤450mg
750mg
S nack, dessert or side dish Baked goods*
≤150mg
250mg
≤250mg
300mg
Main meal
≤ 18g or ≤ 25g if sat fat ≤ 6g
45g if sat fat ≤10g
S nack, dessert or side dish
≤ 7g or ≤ 10g if sat fat ≤2g
20g if sat fat ≤5g
Main meal
≤6g
10g
S nack, dessert or side dish
≤2g
5g
Main meal
≥5g
N/A
S nack, dessert or side dish
≥2g
N/A
≤60g
75g
≤30g
45g
Fat
Saturated fat
Fibre
Carbohydrate Main meal S nack, dessert or side dish
The new criteria include: A star rating for each nutrient that meets its criterion. Should all nutrients listed receive a star, then the recipe is published as a “Gold star recipe”.
Nutrient cut-offs if recipes exceed the upper limits for fat, saturated fat, carbohydrate or sodium then they are not published unless modifications ensure they are below the upper limits. A minimum criterion for fibre has not been included to allow for dishes that consist entirely of ingredients such as meat, poultry, seafood or dairy foods, which are not a source of fibre. However, a tip for increasing fibre is included.
Healthy ingredients replace ingredients high in salt or
saturated fat e.g. salt-reduced ingredients (e.g. sauces, stock, canned vegetables), poly- or monounsaturated fats and low-fat dairy products instead of butter, copha, ghee or cooking margarine.
Special tips help you identify recipes high in beneficial
nutrients (minerals, fibre, omega–3 fatty acids, etc.), with a low-GI estimate and/or suitable for special diets. Recipes that don’t meet the criterion for carbohydrate include a tip for people with diabetes, as this has an immediate impact on blood glucose levels.
* A higher sodium level has been applied to baked goods, such as cakes and muffins, due to the use of self-raising flour
Understanding the recipe nutritional information This recipe provides 12% of average adult’s daily energy (kilojoule) requirements
This recipe meets HHW star criteria for fat, saturated fat and carbohydrate
Nutrition information per serve (4) Energy
1033KJ (12%)
Protein
50g
Fat
7g
Fibre
3g
Saturated fat
1g
Carbohydrate
45g
Sodium
700g
This recipe does not meet the HHW star criteria for sodium – look for a nutrition tip to lower the sodium content of this recipe Summer 2011
This recipe does not meet the HHW star criteria for fibre – look for a nutrition tip to boost fibre
47
Adam Liaw
how Liaw cooks now As if winning MasterChef in 2010 were not enough, the lawyer turned celebrity turned restaurateur has also written a groundbreaking book to get Australians finally tackling Asian cuisine. Adam Liaw talks to Steven Chong about life before and after Two Asian Kitchens.
HHW: Keeping up cooking while studying and working as a media lawyer must have been a stretch but you’re clearly an able multitasker, given you enrolled at university at age 16! What’s the system behind your amazing time management? With cooking, we too often fall into a false ‘dish-based’ time scale that starts from walking into the kitchen with raw ingredients and ends when the meal is ready. The whole concept of 10-minute meals or 30-minute meals is nice sometimes but I prefer to think more in terms of tasks and menus. There’s no law that says you can’t chop two days’ worth of vegetables at once, or do some of your dinner prep in the morning before you go to work. The real secret to managing time in the kitchen is the old concept of mise en place (everything at hand and set to go). Working five days a week, I’d usually spend a few hours on a Sunday planning a menu and making stocks, sauces, marinating meats and cutting vegetables for the coming week. With a bit of planning, cooking a meal in just a few minutes is actually really easy. HHW: Has it been hard to maintain a healthy weight during the long hours of sedentary legal work, frenetic commercial kitchen work and now opening your new restaurant? 48
Summer 2011
When I was a lawyer, the sedentary work wasn’t a problem for my health because there is a routine and I could easily fit exercise into my schedule. But these days I am travelling more than half my time, with a lot of dinners and food events, so it takes a lot more discipline to eat well and exercise regularly. To be honest, I haven’t done a very good job of it in recent times and I’ve put on a bit of weight! But I’m exercising more when I’m travelling and I’m trying to moderate some of the rich foods that so often surround me. HHW: You say Australians’ and Malaysians’ approach to food is fairly similar, as we’re both relatively new, multicultural societies. We also share rising rates of ‘Western lifestyle’ chronic diseases, and Asian people seem especially vulnerable to type 2 diabetes. Do you think the mix can disagree with some people’s health long term? Yes, I think people eating out of sync with their genetics can be problematic regardless of where they live, but I think the solution is to just cook and eat more at home and manage portion sizes. Even in Australia, Asian families at home generally eat quite differently to families with European heritage.
HHW: Cuisine is often credited with uniting disparate cultures and races but do you think the reverse can be true as well? In Malaysia, do ethnic tensions ever tend to impact upon the food? I don’t think so. The great thing about food is that it comes with a 100 per cent positive intention. Regardless of any political or racial tension, people will just eat what they want and what they’re exposed to. Nobody ever makes a dish out of malice or hatred. Even when there was that ridiculous ‘Freedom Fries’ issue in the US, people were only arguing about the name — nobody stopped eating fries.
We know the flavours we like but until we actually get in the kitchen and try to cook them, we don’t realise just how easy it is. HHW: What do you do for exercise and for R&R? For relaxation, I cook. Honestly, it’s always been the way I unwind after a hard day at work. If I am traveling and don’t have time to cook, I can get a bit frazzled. For exercise, I try to run when I’m travelling and stay at hotels with gyms. I like gyms more than free exercising because my work and travel schedule can be so chaotic that I like being able to slip into a routine at the gym. HHW: How do you suggest someone who is completely new to Asian cooking start? What sort of dish to try, which ingredients and utensils? I always suggest that people just pick a dish that they like to eat at a restaurant and try to replicate that at home. Asian food is something we’re very used to eating but not so used to cooking. We know the flavours we like but until we actually get into the kitchen and try to cook them, we don’t realise how easy it is. You don’t need specialist ingredients or equipment to start out. Any stir-fry done in a wok can be done reasonably well in a large frypan. HHW: Since winning MasterChef last year you worked at Tetsuya’s and Flower Drum and will soon open a Japanese pub/restaurant in Surry Hills, Sydney. Can you explain the concept behind izakaya? An izakaya is really just a very casual Japanese restaurant. When I lived in Japan, I liked to go to them and eat with friends, have a few drinks and just have a good time. I like fine dining once in a while, but good, simple and authentic food is where my real passion is and that’s what we want the restaurant to be: somewhere to eat some honest Japanese food, unwind with some nice beers and sakes, and have a great time. ❤ Steven Chong is Editor of HHW. Recipe and image both from Two Asian Kitchens, published by Ebury Press (Sydney, 2011).
Adam’s lemon chicken Serves: 4 as part of a shared meal Preparation time: 25 minutes Cooking: 10 minutes plus 30 minutes marinating
Ingredients 2 chicken breast fillets N eutral-flavoured oil to shallow-fry 2 egg whites 7 0g water chestnut flour or cornflour F inely shredded iceberg lettuce and cooked white rice, to serve Marinade 1 tbsp light soy sauce ¼ tsp sesame oil
½ tsp sea salt flakes 1 tbsp Shaoxing wine Sauce 3 tbsp caster sugar 60ml white vinegar F inely grated zest and juice of 1 lemon 1 25ml soup stock e.g. chicken 2 tsp arrowroot or cornflour 1 small carrot, julienned
Method 1 To make the marinade, combine all the ingredients in a small bowl or jug. 2 Place each chicken breast between 2 sheets of cling wrap and beat lightly to a uniform thickness of 1.5–2cm. Place in a shallow dish and add the marinade, turning to coat the chicken well. Marinate in the fridge 30 minutes. 3 Heat about 2cm oil in a large frying pan over medium heat. Beat egg whites until fluid and frothy. If the water chestnut flour is caked and granular, pound it in a mortar until a fine powder, then transfer to a plate. Dip chicken in egg white, then into flour. Fry for 3–4 minutes until golden brown, turn and fry another 3 minutes. Drain on paper towels. 4 To make the sauce, combine the sugar, vinegar, lemon zest and juice and stock in a wok over medium-low heat. Bring to a simmer, stirring to dissolve the sugar. Mix the arrowroot with a little cold water and stir into the sauce. Cook, stirring about 1 minute until the sauce is clear and glossy. Add the carrot and spring onion and cook for 30 seconds to soften. 5 Slice the chicken into 2.5cm strips Summer 2011 and arrange over the shredded lettuce. Pour the sauce over the top and serve with rice. Summer 2011
49
Julie Goodwin a good win for food Australia’s first MasterChef winner’s emphasis on homespun recipes and the kitchen as central to family life has won her enduring affection the nation over. With her second cookbook now published, she talks holidays, family, charity, dieting and, of course, cooking with Steven Chong. HHW: : You’ve just been in Italy with the family, keeping a blog as you explore western Europe’s oldest foodproducing regions with timeless culinary traditions. Which places stand out the most and how does it compare with Eastern traditions and customs around food you found in India and Vietnam? It’s impossible to pinpoint just one place as the standout — Venice, Rome, Florence, Amalfi Coast, Pompeii, Sicily — we had wonderful experiences, ate great food and loved every bit of it. The food obviously differs a fair bit between Vietnam and Italy, but interestingly many of the customs surrounding family cooking are similar. Both cultures use very fresh ingredients, for example. Despite clear cultural differences in food, essentially most human beings use food in the same way — for sustenance certainly, but also as the centrepiece of celebrations and gatherings. HHW: Your new book shows your love of family-shared meals — including vintage snaps from photo albums alongside memories and anecdotes. With Christmas coming up, most people face family meals but sometimes with dread because arguments do happen over the table, too. Have you ever had less-than-harmonious family meals? I was raised with the philosophy that you don’t spoil a special occasion with an argument. Any tensions or differences are to be put aside for another time. So no, we have never had arguments at our family gatherings. HHW: It’s interesting you prefer to use butter over margarine, which would draw the ire of many dietitians over its saturated fat content. Do you use it for taste, closeness to nature or its cooking properties? 50
Summer 2011
Butter contains cream and water and sometimes cultures — all natural products. Margarine contains vegetable oil, water, salt, milk solids, emulsifiers, preservatives, food acid, colours, vitamin supplements and flavours. Any dietitian who recommends the use of this amalgamation of oil and chemicals over a natural product would draw the ire of me! HHW: If you had to replace sugar, gluten or salt in a recipe, say for someone on a restricted diet, what would you use? I dislike the use of chemicals in food, which is why I prefer to cook from scratch. In this way, you know exactly what you are eating and if there’s anything to be reduced or avoided in the diet it can be. This includes artificial sweeteners and I would suggest that someone who needs to avoid sugar use natural sweeteners, such as fruit purées or juices instead. People who need to avoid salt should avoid salt. Glutenfree alternatives to many products can be found, and many recipes containing gluten are easily adaptable. HHW: Recently there was media coverage about your ambassadorship for Oxfam’s GROW! campaign — what is it and how did you become involved? Oxfam’s GROW! Campaign addresses the issues surrounding food justice in the world. It takes a global approach to food security, farming practices, and all the issues that impact people’s food supply. My role within the campaign is to bring awareness to Australians about how our actions impact world food supplies. Simple things, such as conserving energy, can help reduce the effects of global warming — which is having a real, immediate and devastating impact on many communities. Another thing I try to promote is to eat seasonally
appropriate food to avoid shipping out-of-season goods, and to maximise their nutritional value. HHW: Are there any other charities you work with? I also work with the 40K Foundation, which is committed to the education of children in some of the world’s poorest communities — education is the key to breaking the cycle of poverty for these communities and offers children hope. St Vincent de Paul offers practical and moral support to some of Australia’s most vulnerable people —the homeless, the struggling, the addicted, the marginalised. And the McGrath Foundation provides support to women who are on the frightening journey through breast cancer.
Cooking over a campfire is
so much fun
and everything tastes better on a campfire! HHW: There was also mention on your blog about the media getting distracted about your weight. It’s refreshing to have someone comfortable with their own shape and size — do you think the diet industry is doing more bad than good? It is absolutely correct that you refer to the diet industry as that — it is an industry. It makes billions of dollars by feeding off our insecurities. This is also driven by the media’s obsession with image. Dieting has long been shown to be ineffective and at times even dangerous. Young girls in particular are at risk of eating disorders and unhealthy behaviours. If the diet industry truly cared about health, it would promote self-acceptance and moderation rather than suggesting that a person can only be happy if they conform to a highly unrealistic standard. If we can accept that genes determine the colour of our eyes and hair, the size of our feet and length of our limbs, why can’t we accept that the shape and size of our body also has genetic predispositions attached? Why can’t we accept and even embrace the differences in people, instead of wanting everyone to look the same? HHW: In The Heart of the Home, you recall camping and caravan holidays around Australia from your youth. It’s that time of the year when many of our readers are heading off. Anything you recommend they take or consider foodwise? Definitely take some rudimentary cooking equipment — I recommend a cast-iron camp oven, a little fold-up BBQ and some wire coat hangers fashioned into marshmallow forks! Cooking over a campfire is so much fun and everything tastes better on a campfire. Definitely try the damper on a stick recipe in Our Family Table. ❤ Steven Chong is Editor of HHW. Recipe and images from The heart of the home, published by Ebury Press (Sydney, 2011).
Julie’s pavlova roulade Serves: 10–12 Preparation time: 20 minutes Cooking time: 20 minutes
Ingredients 6 egg whites 1½ cups caster sugar 1 tbsp cornflour 1 tbsp white vinegar 1 tsp vanilla extract 600ml cream, whipped 2 punnets strawberries
Method 1 Preheat the oven to 160°C (140°C fan forced). Grease and line a 26 x 34cm baking tray with non-stick baking paper. 2 In the bowl of an electric mixer, beat the egg whites until soft peaks form. Add the sugar a little bit at a time, beating constantly, until the sugar is dissolved and stiff peaks form. Sprinkle over the cornflour, vinegar and vanilla and very gently fold through the egg whites until combined. Spread the mixture into the baking tray and bake for 20 minutes or until just firm. Meanwhile, slice half the strawberries and save the rest for serving. 3 When the meringue comes out of the oven, allow to cool for 5 minutes. Sprinkle a fresh sheet of baking paper with cornflour and lay it over the top of the meringue. Place a clean tea towel on the bench and carefully turn the baking dish upside down so the meringue comes out on top of the baking paper/tea towel. Carefully remove the baking paper from the bottom of the meringue. Spread half the cream in a line along the long edge of the meringue closest to you. Press the sliced strawberries into the cream. 4 Carefully, using the tea towel as a helping hand, roll the meringue over the cream until it looks like a log. Carefully lift onto a serving plate, putting the join at the bottom. Serve with remaining cream and strawberries. Note: You can assemble the roulade up to 4 hours in Summer 2011 advance and refrigerate. It should be eaten the day it is made. Summer 2011
51
Sautéed mushrooms on toast 3 Vegetarian friendly!
Gold star recipe
Nutrition information per serve (4) Energy
925KJ (11% DI)
Protein
Fat
7g
Fibre
Saturated fat
1g
Carbohydrate
Sodium
Raspberry bircher muesli
3 source of antioxidants 3 Low GI estimate
Gold star recipe
Nutrition information per serve (6 not including toppings)
18g 5g 22g 306mg
Energy
1618KJ (19% DI)
Fat Saturated fat Sodium
14g 3g
Prepare the night before
Ingredients
Ingredients
1 tbsp olive oil 4 00g button mushrooms, thickly sliced 1 tsp sweet paprika 1 25g cherry tomatoes, halved
⁄3 cup flat-leaf parsley, coarsely chopped 4 thick slices wholegrain bread, toasted 1 cup low-fat cottage cheese
Method 1 Heat oil in a non-stick frying pan over medium–high heat. Add mushrooms and paprika to the pan and cook, tossing, for 6–8 minutes or until mushrooms are light golden. 2 Add the tomatoes and cook a further 3–4 minutes until tomatoes are warmed through. Sprinkle over the parsley, season with salt and pepper. 3 Top the toast with cottage cheese then spoon over the mushroom mixture. Serve. Recipe provided by Australian Mushroom Growers Association. 52
Summer 2011
11g
Fibre
8g
Carbohydrate
Preparation and cooking time: 15 minutes
1
Protein
250g rolled oats Juice of 1 lemon ½ cup of cranberry or apple juice ¼ cup warm honey ½ cup low-fat milk 1 cup Greek-style yoghurt plus extra to serve
54g 48mg
½ cup coarsely chopped roasted almonds plus extra to serve 1 large Granny Smith apple, cored and grated 1 ½ cups Creative Gourmet frozen Raspberries
Method 1 Combine oats, lemon juice, fruit juice and honey in a large bowl. Cover and refrigerate overnight. 2 Stir milk, yoghurt, nuts and apple through oat mixture. 3 Partially thaw raspberries. Stir half the raspberries through the muesli. 4 To serve, spoon into bowls, top with extra yoghurt and nuts, sprinkle with remaining raspberries and serve. Recipe provided by Creative Gourmet.
Cinnamon ricotta and strawberry French toast Gold star recipe Nutrition information per serve (4) Energy
1348KJ (15% DI)
Fat Saturated fat
14g 4g
Protein Fibre Carbohydrate
Sodium
14g 5g 35g 293mg
Preparation and cooking time: 10 minutes
Ingredients 4 slices Helga’s Quinoa and Flaxseed bread 2 eggs, beaten 1 tbsp polyunsaturated margarine ½ cup low-fat ricotta ½ tsp ground cinnamon
2 00g strawberries, hulled and halved 1 small banana, peeled and sliced 2 tbsp honey to serve 2 tbsp flaked almonds, toasted
Method 1 Dip one slice of bread into the beaten egg. Heat the margarine in a fry pan over a moderately high heat. Cook the French toast one slice at a time for 1–2 minutes each side or until golden brown. Continue cooking the remaining toast. 2 Mix the ricotta and cinnamon together. Slice each piece of French toast in half crossways and spread with half of the cinnamon ricotta. Top with half of the sliced strawberries and banana and sandwich with the remaining halves of the French toast. Finish with the ricotta, strawberries and banana. Drizzle with honey and scatter with the toasted flaked almonds and serve. Recipe provided by Helga’s.
Summer 2011
53
Tomato salsa granita with prawn salad
Rosemary chicken, hommus and tabouli rolls
3 High in fibre!
Nutrition information per serve (6) excluding dressing Energy
902KJ (10% DI)
Protein
24g
Nutrition information per serve (2) Energy
2291KJ (26% DI)
Fat
12g
Fibre
3g
Fat
Saturated fat
2g
Carbohydrate
3g
Saturated fat
Sodium
709mg
Sodium
29g 6g
Protein
34g
Fibre
8g
Carbohydrate
38g 533mg
a freezer for up to Nutrition tip: Granita will keep in er. tain con three months in an air-tight ain Nutrition tip: Serve with a multigr GI of this recipe.
Preparation time: 20 minutes Freezing time: 1 hour
Ingredients 4 Goulburn Valley vineripened tomatoes 1 medium green chilli, finely diced 1 small Spanish onion, finely diced 6 sprigs coriander 1 lime, zested and juiced 1 tbsp olive oil ¼ tsp garlic, crushed ½ tsp Tabasco sauce
Salad 1 large Goulburn Valley vine-ripened tomato, sliced 1 avocado, diced 6 slices smoked salmon 2 4 cooked and peeled prawns Tomato mayo dressing
roll to lower the
Preparation and cooking time: 20 minutes (plus cooling)
Ingredients 2 –3 Lilydale chicken thigh fillets (250g) 3 tsp olive oil 1 clove garlic, crushed 2 tsp fresh rosemary leaves, chopped 2 small Turkish rolls
⁄3 cup hommus ¼ cup char-grilled capsicum strips, drained ½ cup tabouli 1 cup baby rocket leaves Ground black pepper 1
Method
1 For granita, dice tomatoes finely and place in the food processor along with the green chilli, Spanish onion, coriander, lime juice and zest, olive oil, garlic and Tabasco sauce. Process 10–15 seconds. 2 Pour granita mixture into a shallow tray and freeze for 1 hour or until firm. 3 For salad, lay 1 slice of tomato into deep food ring, top with a little avocado, smoked salmon pieces and arrange prawns decoratively on the top. 4 Place salad on the serving plate alongside a scoop of tomato salsa granita, laid on a slice of tomato. Garnish with dressing and serve.
1 The day before, make 2 slashes in the thickest part of each chicken fillet. Combine oil, garlic and rosemary in a shallow dish. Add chicken and turn to coat with rosemary mixture. Heat a non-stick fry pan over a medium–high heat and cook chicken 6 minutes each side or until cooked through. Set aside on a plate for about 30 minutes to cool. Cover and refrigerate. 2 In the morning, slice chicken. Split rolls and spread each cut side with hommus. Top base of rolls with chicken slices, capsicum, tabouli, rocket and pepper. Cover with remaining roll halves and press down firmly. Cut rolls in half and wrap securely in plastic wrap. Place in lunchboxes with a cold brick or frozen drink.
Recipe provided by Goulburn Valley Tomatoes.
Recipe provided by Lilydale.
Method
54
Summer 2011
Avocado pizza
3 Vegetarian friendly!
Nutrition information per serve (8) Energy
Protein
5g
Fat
760KJ (9% DI) 9g
Fibre
3g
Saturated fat
2g
Carbohydrate
Sodium
19g 280mg
Preparation time: 10 minutes Cooking time: 20 minutes
Ingredients 1 prepared pizza base 3 tbsp tomato paste 1 clove garlic, chopped finely ¼ cup chopped shallots ½ cup sliced mushrooms 1 ⁄3 cup sliced olives 100g cherry tomatoes, halved ½ cup shredded mozzarella ½ cup fresh basil leaves 1 avocado, sliced
Method 1 Spread pizza base with tomato paste, sprinkle with garlic and shallots. 2 Arrange mushrooms, olives and cherry tomatoes on pizza base. 3 Top with cheese and bake in a moderate oven (180oC) for 20 minutes or until crust is golden. 4 Remove from oven, serve topped with basil and sliced avocado. Makes 8 slices. Recipe provided by Sanitarium Health & Wellbeing Company.
Summer 2011
55
Fish fillet with Aussie orange ginger hollandaise served with garlic and parsley tossed potatoes
Veggie stir-fry with coriander, mint and parsley
Nutrition information per serve (6)
Nutrition information per serve (4)
Energy 2597KJ (30% DI)
Protein
Protein
9g
Fat
44g
Fibre
2g
Fat
7g
Fibre
9g
Saturated fat
9g
Carbohydrate
11g
Saturated fat
1g
Carbohydrate
Sodium
46g
408mg
Energy
722KJ (8% DI)
Sodium
18g 731mg
Preparation and cooking time: 30 minutes
Ingredients 2 egg yolks 2 tbsp water 220g margarine, melted 1 tbsp lemon juice J uice of ½ Aussie orange ¼ tsp fresh ginger, grated 2 tbsp Aussie orange rind, grated 3 tbsp olive oil
6 fresh white fish fillets (approx. 200g each) 2 bunches asparagus 400g baby potatoes 1 tbsp margarine 1 clove garlic, crushed 1 tbsp parsley, finely chopped 1 tbsp capers
Preparation and cooking time: 15 minutes
Ingredients
Method 1 Mix the egg yolks and water into a glass bowl set over a pan of simmering water. Whisk until doubled in size and thick and creamy. Remove from heat and gradually whisk in the melted margarine, then lemon juice, Aussie orange juice and ginger. Rest over the pan of warm water. 2 Cut asparagus in half lengthwise and boil or steam asparagus until tender; drain. 3 Boil potatoes until tender, then drain. Cool and cut in half. Heat one tablespoon of margarine in a frying pan, add potatoes. Cook 6–8 minutes until crisp and golden. Add crushed garlic and parsley, salt and pepper to taste and coat potatoes. 4 Thickly slice Aussie orange and chargrill on the griddle until golden brown on both sides. 5 Heat the olive oil in a frying pan and cook the fish fillets for 3–4 minutes on each side until golden. 6 Serve the fish fillets on the asparagus with the potatoes and orange ginger hollandaise with capers. Place a chargrilled Aussie orange slice on the fish and sprinkle over Aussie orange rind. Recipe provided by Aussie Oranges/Citrus Australia. 56
tent of this
con Nutrition tip: To boost the protein vegetarian dish, add firm tofu!
Summer 2011
1 tbsp peanut oil 1 onion, finely chopped 1 tbsp Gourmet Garden Coriander 1 tbsp Gourmet Garden Parsley 1 tbsp Gourmet Garden Mint 1 bunch asparagus, coarsely chopped
1 bunch broccolini, coarsely chopped 200g sugar snaps 5 00g baby pak choy, trimmed 1 red capsicum, thinly sliced ¼ cup hoisin sauce 1 tbsp soy sauce 1 tbsp lime juice 125g bean sprouts
Method 1 Heat peanut oil in a wok; stir-fry onion, Gourmet Garden Mint, Coriander and Parsley until onion softens. 2 Add asparagus, broccolini, sugar snaps, baby pak choy and red capsicum. Stir-fry until tender. 3 Add hoisin sauce, soy sauce and lime juice to wok. Stir-fry until combined. 4 Remove wok from heat and stir through bean sprouts. Serve vegetable stir-fry with steamed rice if desired. Recipe provided by Gourmet Garden Australia.
Christmas Turkey with apple and raisin stuffing Nutrition information per serve (20 serves of about 150g Turkey) excluding vegetables Energy
1465KJ (17% DI)
Protein
Fat
13g
Fibre
Saturated fat
3g
Carbohydrate
Sodium
34g 2g 24g 750mg
Cooking time: 3 hours and 45 minutes plus preparation time
Ingredients 1 x 5kg Ingham whole Turkey 4 apples, halved lengthways 1 tbsp olive oil 2 0g salt-reduced polyunsaturated margarine, melted C ooked vegetables of choice, to serve Stuffing 4 0g salt-reduced polyunsaturated margarine
1 large brown onion, finely chopped 1 rindless bacon rasher, fat trimmed, finely chopped 6 cups fresh white breadcrumbs (approx. 12 slices of sandwich bread) 1 cup raisins 1 apple, peeled, core removed, finely diced ¼ cup sage leaves, roughly chopped 1 egg, beaten F reshly ground black pepper
Method 1 Preheat oven to 180°C. Place a rack into a large roasting dish. Pour ½ cup water into roasting dish. Wipe Turkey inside and out with paper towel. 2 To make stuffing, melt margarine in a large non-stick frying pan over medium heat. Add onion and bacon. Cook, stirring occasionally, for 4 minutes or until onion is soft. Remove from heat and leave to cool. Combine onion mixture, breadcrumbs, raisins, diced apple, sage, egg and pepper in a large bowl. 3 Fill upper and lower cavities of Turkey with stuffing mixture. Tie legs together with kitchen twine and tuck wings under Turkey. 4 Place Turkey onto a wire rack in a large roasting pan. Cook Ingham Whole Turkey as per packet instructions. 5 Place apple halves, olive oil and margarine in a large bowl and toss until apples are coated with oil mixture. Place into a large shallow ovenproof dish. Add apples to oven for the last hour of cooking. Stand cooked Turkey on a chopping board covered for 10 minutes before carving or serving on a large platter. If serving on a platter, place apples around the Turkey and serve with vegetables of choice. Recipe provided by Inghams.
Summer 2011
57
Passionfruit, avocado and spinach salad
Seared Regal King salmon with a salad of pomegranate, mint and fetta 3 Source of omegaâ&#x20AC;&#x201C;3s!
Nutrition information per serve (4 as a main)
Nutrition information per serve (6) Energy
880KJ (10% DI)
Fat Saturated fat Sodium
20g 4g
Protein
3g
Energy
Fibre
4g
Fat
45g
Fibre
Carbohydrate
5g
Saturated fat
10g
Carbohydrate
20mg
2792KJ (32% DI)
Protein
Sodium
26g 2g 30g 292mg
lthy fats Nutrition tip: Most of the fat is hea on. salm and found in olive oil
Preparation and cooking time: 15 minutes
Ingredients
Preparation time: 15 minutes
Ingredients 2 avocado, sliced 1 cup pawpaw, sliced thinly 100g baby spinach leaves 4 stalks celery, sliced 1 small Spanish onion, sliced
Dressing 1 lemon, juiced 1 orange, juiced 3 tsp olive oil 4 passionfruit 2 tbsp fresh mint, chopped
8 x 50g slices of Regal salmon, skinned 100ml sugar syrup 4 tbsp pomegranate seeds 1 small red onion, peeled and diced 1 small Lebanese cucumber, deseeded and diced
Âź cup extra-virgin olive oil 1 handful of fresh mint 1 handful of fresh flat-leaf parsley 1 handful of mixed salad leaves 7 5g reduced-fat fetta, crumbled Freshly ground pepper
Method
1 Place avocado, pawpaw, baby spinach, celery and onion into a salad bowl. 2 In a separate bowl, mix dressing ingredients. Pour over salad. Serve chilled.
1 Thread salmon onto bamboo skewers, season with pepper, set aside. 2 Mix sugar syrup, pomegranate, onion, cucumber and olive oil together. 3 Mix salad leaves and herbs together. Lightly season and arrange on 4 plates. 4 Sear the salmon on a smoking-hot griddle plate and place 2 on each plate. 5 Dress with the pomegranate dressing. 6 Scatter the fetta over the plates and serve.
Recipe provided by Sanitarium Health & Wellbeing Company.
Recipe created by Matt Kemp from Restaurant Balzac and provided by Regal King Salmon.
Method
58
Summer 2011
Mini pork souvlaki skewers Nutrition information per serve (24) Energy
185KJ (2% DI)
Protein
5g
Fat
2g
Fibre
<1g
Saturated fat
<1g
Carbohydrate
<1g
Sodium
30mg
Preparation time: 15 minutes Cooking time: 15 minutes
Ingredients 500g diced pork 400g Greek-style yoghurt 1 tsp garlic, crushed 1 tbsp basil pesto Grated rind and juice of 1 lemon 1 tbsp olive oil
Method 1 Thread 3â&#x20AC;&#x201C;4 pieces of diced pork onto each skewer. 2 Whisk together the yoghurt, garlic, pesto, lemon rind and juice and oil until well combined. 3 Spread half the yoghurt mixture over the skewers and allow to marinate for 20 minutes or up to 4 hours. 4 Cook skewers under a preheated grill or on a preheated BBQ for 2â&#x20AC;&#x201C;3 minutes each side. 5 Serve hot with remaining yoghurt dip as an accompaniment. Recipe provided by Australian Pork.
Summer 2011
59
BBQ chicken fillets in soy, ginger and honey
Barbecued steak with Thai flavours 3 High in iron
3 Source of zinc!
Nutrition information per serve (4) Energy
1165KJ (13% DI)
Nutrition information per serve (6)
Protein
33g
Energy
1059KJ (12% DI) Protein
31g
Fat
9g
Fibre
<1g
Fat
11g
Fibre
2g
Saturated fat
3g
Carbohydrate
9g
Saturated fat
3g
Carbohydrate
7g
Sodium
462mg
e with Nutrition tip: To boost fibre, serv les. etab veg n gree n steamed Asia
Preparation time: 3 hours 10 minutes Cooking time: 20 minutes
Ingredients 6 00g Lilydale Chicken Breast Fillet, skin off Marinade 2 tbsp salt-reduced soy sauce 1 tsp chopped garlic ½ cup pineapple juice ½ tsp grated fresh ginger
Pinch of coriander Pinch of cumin ½ cup sherry or mirin ½ tsp sesame seed oil 2 tsp sugar Garnish C hopped spring onions and sesame seeds
Sodium
421mg
Preparation time: 20 minutes Cooking time: 10 minutes
Ingredients 1 tbsp Thai mild red curry paste 1 tbsp Thai sweet chilli sauce 1 tbsp oil 4 x 200g rump steaks 1 25g punnet fresh whole baby corn
150g punnet snow peas 1 small red onion Juice of one lime 2 tsp salt-reduced soy sauce 2 tsp sesame oil 2 tsp fish sauce
Method
1 To make marinade, mix all ingredients in bowl. Pour marinade over breast and marinate for no more than 3 hours. 2 Strain off marinade and place in saucepan, bring to boil and reduce till half quantity. BBQ fillets on hot BBQ and continually baste with marinade. Don’t overcook breast, continually brush with the marinade. 3 Serve simply on steamed rice and brushed with reduced marinade. Garnish with chopped spring onions and sesame seeds.
1 Combine the curry paste, chilli sauce and oil. Brush mixture over both sides of each steak. 2 Preheat the barbecue flat-plate or char-grill plate to hot before adding the steaks. 3 Cook on one side until the first sign of moisture appears. Turn steaks once only. Test the steaks for degree of ‘doneness’ with tongs. Rare is soft, medium feels springy and well done is very firm. 4 Remove steaks from heat, loosely cover with foil and rest steaks for 5 minutes before serving. While steaks are resting, steam or microwave the baby corn and snow peas until vivid in colour but still crisp. Toss with the red onion and the combined lime juice, soy, sesame oil and fish sauce. Serve the steaks with corn and snow peas.
Recipe provided by Lilydale Australia.
Recipe provided by Meat & Livestock Australia.
Method
60
Summer 2011
BBQ Petuna ocean trout with mustard and celeriac salad Nutrition information per serve (4) Energy
2552KJ (29% DI) Protein
Fat
42g Fibre
Saturated fat
10g
40g 7g
Carbohydrate
Sodium
20g 411mg
Preparation time: 30 minutes Cooking time: 10 minutes
Ingredients ½ cup mayonnaise 1¼ tbsp Dijon mustard 1 tbsp lemon juice, freshly squeezed 8 00g whole (600g peeled) celeriac root 4 ocean trout fillets, about 180g 1 bunch watercress, leaves picked, washed
and drained well 1 tbsp olive oil Lemon wedges to serve Watercress dressing 2 tbsp olive oil 2 tbsp lemon juice 1 tsp zested orange rind ½ tsp wholegrain mustard 2 tsp honey
lthy Nutrition tip: Most of the fat is hea fats found in trout and olive oil!
omega–3
Method 1 For the celeriac salad, mix together the mayonnaise, mustard, lemon juice and a few grinds of black pepper. 2 Peel the celeriac root with a potato peeler and shred it coarsely, using a mandolin. Mix the dressing with the celeriac root and taste, adding pepper, mustard and lemon juice, to taste. The celeriac salad will keep for 2–3 days covered in the refrigerator. 3 Preheat a grill or barbecue to a medium heat, place a piece of baking paper (and rub with some oil - see TIP). Drizzle some olive oil on the ocean trout and season to taste. Place each piece of ocean trout on the grill and cook for three minutes on each side or until medium rare. 4 Place fish on plate and serve with celeriac salad and accompany with watercress tossed in dressing. TIP: To stop the ocean trout sticking to the char-grill, place a piece of baking paper and drizzle with oil. Baking paper should not be larger than the fish/cooking area, otherwise it’ll catch on fire. Recipe provided by Petuna.
Summer 2011
61
Pearl mango and lime sorbet
Luscious lemon delicious 3 High in calcium
Nutrition information per scoop (approx. 20) Energy
645KJ (7% DI)
Nutrition information per serve (6)
Protein
1g
Energy
Protein
6g
Fat
<1g
Fibre
2g
Fat
7g
Fibre
1g
Saturated fat
<1g
Carbohydrate
38g
Saturated fat
3g
Carbohydrate
1mg
Sodium
Sodium
762KJ (9% DI)
24g 120mg
Preparation and cooking time: 1 hour a delicious, fleshy Nutrition tip: Pearl mangoes are and smooth-tasting mango variety.
Preparation time: 30 minutes
Ingredients 5 large Pearl mangoes (2kg flesh) 400ml water 500ml sugar 200ml lime juice
Ingredients ¼ cup caster sugar 4 0g reduced-fat dairy blend 2 tsp lemon rind, finely grated 2 eggs, separated ¼ cup lemon juice
1 cup reduced-fat milk ¼ cup self-raising flour 250g seasonal fruit 4 small scoops reduced-fat frozen yogurt or ice-cream
Method
1 Skin and dice Pearl mangoes and place in a small pot. 2 Add the sugar and water. 3 Bring to a simmer and stir for 10 minutes, ensuring that the sugar is dissolved. 4 Place mixture in a blender, add lime juice while blending. 5 Pour mixture into a container and freeze.
1 Beat sugar, dairy blend and lemon rind together until light and creamy. Beat in egg yolks and lemon juice, then fold in milk and flour. 2 Beat egg whites until soft peaks form and fold into lemon mixture (the mixture will be slightly lumpy). Divide mixture between 6 lightly buttered ramekins or teacups. Place ramekins in a deep baking dish and fill dish with boiling water to halfway of the sides of the ramekins. 3 Bake at 180°C for 45 minutes. Serve immediately with seasonal fruit and frozen yogurt.
Recipe provided by Perfection Fresh Australia.
Recipe provided by Dairy Australia.
Method
62
Summer 2011
Macadamia Christmas cake Nutrition information per serve (16) Energy
1100KJ (13% DI)
Protein
3g 3g
Fat
13g
Fibre
Saturated fat
2g
Carbohydrate
Sodium
31g 30mg
Preparation time: 15 minutes Cooking time: 40 minutes
Ingredients ¾ cup (125g) margarine ⁄3 cup brown sugar 2 tsp grated orange rind 2 eggs ¾ cup wholemeal flour ½ cup plain flour ½ tsp baking soda ½ tsp mixed spice 1
1 cup each sultanas, raisins, currants ½ cup macadamia nut halves ¼ cup water ½ cup macadamia nut halves, extra 3 tbsp strained, heated apricot jam, to serve
Method 1 Lightly grease and line a 20cm square cake tin. Preheat oven to 180ºC. 2 Cream margarine, sugar and rind. Add eggs one at a time, mixing until well combined. 3 Add sifted flours, baking soda and mixed spice, stirring to combine. Stir through fruit, nuts and water. 4 Pour mixture into cake tin and bake for 20 minutes. Arrange remaining macadamia nuts on top. Cover cake with foil and bake for a further 20 minutes or until cooked. 5 Allow cake to cool in tin before turning onto a cooling rack. Glaze with apricot jam before serving. Recipe provided by Sanitarium Health & Wellbeing Company.
Summer 2011
63
Beef skewers with Italian salad
3 High in iron
Mushroom, pork and asparagus stir-fry
3 Source of zinc!
Nutrition information per serve (4) Energy
1772KJ (20%)
Protein
Fat
26g
Fibre
Saturated fat
6g
Carbohydrate
Sodium
Nutrition information per serve (4) 35g 3g 11g
256mg
Energy
2390KJ (27%)
Protein
Fat
19g
Fibre
Saturated fat
4g
Carbohydrate
Sodium
38g 7g 60g 739mg
ra are lower-GI Nutrition tip: Basmati and Doonga better choice a varieties of rice, which makes them for people with diabetes. serve with Nutrition tip: People with diabetes ain bread or legr who e.g. additional carbohydrate corn cobs.
Preparation time: 15 minutes Cooking time: 15 minutes
Ingredients 6 00g lean rump steak, diced into 2.5cm cubes 1 tbsp olive oil 1 tbsp dried oregano 8 bamboo skewers, soaked in water 2 tbsp lemon juice Salad 2 Lebanese cucumbers, diced
16 cherry tomatoes, halved 1 green capsicum, deseeded and cut into 2cm pieces 12 Kalamata olives 50g mixed lettuce leaves 1 cup (60g) toasted bread croutons 2 tbsp olive oil 2 tbsp vinegar
Method 1 Toss rump cubes in a bowl with olive oil and dried oregano. 2 Thread onto the skewers. 3 Cook for about 6–8 minutes on a preheated BBQ or pan, turning occasionally. 4 Drizzle with the lemon juice in the last minute of cooking. 5 Place skewers on a plate to rest for 5 minutes and cover loosely with foil. 6 Toss together cucumber, tomatoes, capsicum, olives, lettuce and croutons. 7 Pile onto 4 plates and drizzle with the oil and vinegar. Recipe provided by Meat and Livestock Australia. 64
Summer 2011
Preparation and cooking time: 15 minutes
Ingredients ¼ cup peanut oil 5 00g pork fillet, thinly sliced 4 green onions, thinly sliced 2 garlic cloves, finely chopped 2 cm piece ginger, peeled and cut into thin strips 1 tsp sesame oil 1 00g shiitake mushrooms, halved 3 50g cup mushrooms,
thickly sliced 1 bunch asparagus, trimmed, cut into 5cm pieces 1 bunch baby pak choy (bok choy), trimmed, stems chopped, leaves separated 2½ tbsp oyster sauce 1 ⁄3 cup salt-reduced chicken stock 4 cups steamed basmati rice, to serve
Method 1 Heat a wok over high heat until very hot. Add 1 tbsp oil and swirl to coat wok. Add half the pork. Stir-fry for 2 minutes or until almost cooked through. Transfer to a plate. Repeat using 1 tbsp oil and remaining pork. 2 Heat remaining 1 tbsp oil in wok over high heat. Add green onions, garlic, ginger, sesame oil and shiitake mushrooms. Stir-fry for 1 minute. Add cup mushrooms, asparagus and pak choy stems. Stir-fry for 2 minutes. 3 Add oyster sauce, stock, pork and pak choy leaves to wok. Stir-fry for 1–2 minutes or until leaves just wilt. Serve with steamed jasmine rice. Recipe provided by Australian Mushroom Growers Association.
Ricotta and tuna wholemeal pasta
Crispy fish with pineapple salsa
3 Source of fibre!
Gold star recipe Nutrition information per serve (4) Energy
1070KJ (12%)
Protein
Fat
10g
Fibre
Saturated fat
<1g
Carbohydrate
Sodium
Nutrition information per serve (5) 14g 1g 28g 425mg
can be Nutrition tip: Diced fresh mango is a fish en Froz le. app pine substituted for fresh fish. to ive rnat alte ient ven con nutritious and
Preparation time: 15 minutes Cooking time: 20 minutes
Ingredients 4 25g packet frozen Birds 2 tsp fish sauce Eye Oven Bake Crumbed ½ r ed onion, peeled and Fish Fillets – Original finely chopped 1 tsp fresh ginger, Pineapple salsa finely grated 1 cup fresh ripe pineapple, ¼ cup fresh finely diced coriander leaves
Energy
1947KJ (22%)
Fat Saturated fat
15g 5g
Protein
28g
Fibre
14g
Carbohydrate
54g
Sodium
335mg
Preparation and cooking time: 15 minutes
Ingredients 3 75g San Remo wholemeal spiral pasta 5 00g broccoli, cut into small florets 3 00g reduced-fat ricotta
¼ cup shredded fresh basil leaves 1 lemon, rind finely grated Freshly ground pepper 1 85g can chilli tuna, drained, flaked
Method
1 Cook frozen Birds Eye Oven Bake Fish Fillets following packet directions. 2 Combine salsa ingredients and serve with cooked fish.
1 Cook pasta according to packet instructions. Add the broccoli in the last 2 minutes of cooking. Drain. 2 Return to the saucepan. 3 Meanwhile, combine the ricotta, basil and lemon rind. Season with pepper. Add ricotta mixture and tuna to pan. Toss gently to combine. Divide among serving dishes. Top with freshly ground pepper to serve.
Recipe provided by Simply Great Meals.
Recipe provided by San Remo.
Method
Summer 2011
65