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Sex, soul, exercise & relationships their place in rehab
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Editorial advisory panel DR ALISTAIR BEGG MBBS, FRACP, FCSANZ, DDU Alistair has had 15 years of private practice experience in Sydney and Adelaide, and worked as a cardiologist at Flinders Medical Centre before joining SA Heart, Ashford, Adelaide in 2007. He has a particular interest in patients with chest pain, heart failure or significant risk factors, and is actively involved in cardiac rehabilitation. Alistair is Publisher of Healthy & Heartwise, author of What should I eat for my heart? and producer of preventive and rehabilitation educational resources: www.whatswrongwithmyheart.com
DR GINNI MANSBERG BMed, Grad Dip Journalism Ginni is Channel Seven’s Sunrise and Morning Show GP, and appears regularly on numerous radio programs around Australia. She writes for several magazines, such as Women’s Health and Practical Parenting, and is author of three books: How to Handle Your Hormones, How to Get Your Mojo Back and Why Am I So Tired? Ginni practises as a family doctor in Sydney and has three children while running a popular blog, www.drginni.com
CHRIS TZAR AEP, MSc (Ex Rehab), BSc (HMS) Chris is an accredited exercise physiologist with extensive experience in providing exercise therapy and lifestyle programs for people with diabetes, cardiovascular disease, musculoskeletal disorders, HIV/AIDS and cancer. Chris is Director of the Lifestyle Clinic in the Faculty of Medicine at the University of NSW, a Board Director of Eastern Sydney Medicare Local, Chair of Exercise is Medicine (Australia), and a National Board Director of Exercise & Sports Science Australia.
MILENA KATZ BSc (Nutr), BTeach, APD, AN Milena is an Accredited Practising Dietitian and founder of Ahead In Health, a Sydney-based private practice and nutrition consultancy. Milena works part-time within the Multicultural Health Service of NSW Health and has wideranging experience in clinical nutrition and education of healthcare professionals. Milena is particularly passionate about the nutrition status of older adults, especially residents in aged care facilities.
PROFESSOR TRISHA DUNNING AM PhD, RN, Med, FRCNA, CDE Professor Dunning is Chair in Nursing and Director of the Centre for Nursing and Allied Health Research at Deakin University and Barwon Health in Geelong, Victoria. She is a member of the Board of Diabetes Australia – Victoria and a Credentialed Diabetes Educator. Trisha is widely published in many peer-reviewed journals, sits on the Editorial Advisory Panel of Conquest and has written several books and book chapters.
From the
EDITOR
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o less a national figure than Ita Buttrose lends her visage to this Spring | Summer issue of Healthy & Heartwise, Australia's oldest preventive and newest rehab magazine in one. Ita gave us an exclusive interview about her lifelong interest in health, and personal passion for raising awareness about macula degeneration (MD) – which affects about one in seven Australians and is the leading cause of severe vision impairment after age 40. Like heart disease, type 2 diabetes and most chronic diseases, MD can be prevented and its progress slowed with wholesome nutrition and regular physical activity – and which diet and what types of exercise is Heartwise's bread and butter. Speaking of which,‘Eat butter’ was TIME Magazine’s June cover story, prompting dietitian Susie Burrell to remark to cardiac rehab specialists meeting in Sydney in August that “times they are achanging” in the worlds of clinical and popular nutrition if not in the public health arena, which you may find reflected in this issue. Interest in ‘clean’ eating, fermentation and fasting are part of the these changing times, and the use of the ‘paleo’ diet in weight control is explored on page 16. With fibre and salt remaining the two nutrients everyone agrees need increasing and decreasing respectively (except perhaps some fibre sources if you have IBS – see page 32), we've awarded Gold Stars to eight of our amazing recipes that have now been analysed for nutritional value – now including potassium, a fascinating counter to the sodium that pushes up blood pressure (see page 22). Seasonal recipes start on page 53 and hail from the likes of Curtis Stone, Michelle Bridges (see our one-on-one interviews on pages 54–57!), Miguel Maestre, Luke Mangan, Iain Hewitson, Ross Dobson, Eleanor Ozich and Sneh Roy. Enjoy reading and see you in Autumn when Heartwise will again begin to be published every quarter.
STEVEN CHONG
Spring | Summer 2014 • Heathy & Heartwise
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healthy &HEARTWISE EDITOR Steven Chong steven@healthpublishingaust.com.au
6 8 45 46
ON THE COVER 14
PUBLISHER Alistair Begg drbegg@internode..on.net
EDITORIAL & PRODUCTION COORDINATOR Emily Rundle emily@healthpublishingaust.com.au
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34 Contributions are welcome. Copyright © 2014. The opinions expressed by authors do not necessarily reflect the policy of the Publisher. All material in this magazine is provided
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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
How your sex life, intimacy and relationships may alter after a heart event Easy aerobic and resistance exercises you can do anywhere – chair optional! Lifestyle management for atrial fibrillation, the most common heart arrhythmia
HEALTHY EATING
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Whay Paleo, protein and unprocessed are today's weightloss buzzwords
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A year on from being Australian of the Year, Ita Buttrose reflects on healthy ageing and her passion for preserving good eyesight
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We hear you – letters page Health alert – hot news briefs Well read & watched – media reviews Health on the shelf
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magazine is 20,000 CAB audit pending.
How getting more potassium in your diet can help lower high blood pressure The benefits of wholegrains in heart and gastrointestinal health, diabetes, weight loss Could a FODMAP be causing your irritable bowel symptoms? ‘Free from’ foods for those with allergies, sensitivities or intolerances to common ingredients Chef's chats with Curtis Stone and Michelle Bridges 18 meals from top celebrity chefs with expert nutritional analysis – including summer salads and BBQ entertaining
HEALTHY HEART 24
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Healthy & Heartwise • Spring | Summer 2014
Strokes are just behind heart disease in terms of death rates but there's a huge gap in terms of national attention and after-care availability
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contents HEALTHY HEART 26
Lowering cholesterol with foods and fibre supplements
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HEALTHY TRAVEL 27
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How the high-risk heart patient can fly safely overseas without worry The Hunter Valley's Golden Door Elysia health retreat
HEALTHY SUPPLEMENTS 30
Pharmacist Gerald Quigley answers your questions
HEALTHY WOMEN 36
Incontinence managed through three decades of one woman's experience
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ASK THE EXPERTS 37
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Alarm symptoms and what to expect from bypass surgery – patients' questions answered by Dr Alistair Begg Sleep apnoea and the difference between type 1 and type 2 diabetes
30 HEALTHY MEN 38
Osteoporosis affects men too but the impact can be more shattering than in women
HEALTHY MIND 44
26 68
The thoughts and emotions needed for heart health
DEALING WITH DIABETES 68
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Are you just over blood glucose testing and diabetes? You could have burnout Exercising around an injury How sweeteners are taking over from sugar taking over our taste buds What new diabetes management guidelines mean for your care Diabetes news
Spring | Summer 2014 • Healthy & Heartwise
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letters Have your say about
We hear you! Welcome back Heartwise I must say it’s great to have Healthy & Heartwise back after two years’ absence. I am sure I speak for many readers in saying welcome back – It’s like an old friend as I have read all your back issues. My thanks to Dr Alistair Begg who returned this magazine to where it belongs on the shelves and will help so many people – a must-read from cover to cover. Please this time don’t stop printing it – with your magazine, we know help is just around the corner. I was 12 in 1953 when I went into Townsville General Hospital with rheumatic fever and found to have a heart murmur and given three years to live, and 40 when I was told I would have the aches and pains of an 80-year-old. Both sides of my family have diabetes and I was diagnosed with type 2 in 2008 – so there were many features in Volume 54 that
were very relevant to me. Over the years I’ve had six stents put in to stop clots in my legs, a total hip replacement and with chronic anxiety and major depression, I stress out a lot and have severe reflux, with mild diverticular disease and bleeding from the upper small intestine. But what worries me is low-grade but stable oesophageal cancer that still makes me bring gas up and that Losec doesn’t help. My answer to better control of diabetes type 1 and 2 is to put just one copy of Healthy & Heartwise in every doctor’s surgery. Not only does it calm you down reading the good information on its pages but when the magazine is passed around all is quiet in the waiting room! Douglas Elliott,
Wulguru, Queensland
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The best letter published next issue will win a Vitamix Total Nutrition Center valued at $995! With unsurpassed engineering and performing more than 50 food processes, the Vitamix can be used for any meal or snack. Whether you want more nutritious meals or to elevate your expertise and creativity in the kitchen, the Vitamix Total Nutrition Center breaks down whole foods so your body absorbs more of the vital nutrients.
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healthy &HEARTWISE
eating by blood type When I was 42 I had been overweight all my life, anaemic, depressed, infertile, had varicose veins and was overeating. I then discovered the greatest clue of all my life. This clue is largely for ‘type A’ vegetarians who probably don’t know that they are indeed A in a type O-dominated meat-eater society. In a nutshell, Leonardo da Vinci announced that blood is a life force, the penny dropped, I got a book on transfusions which led to Eat Right for Your Type by Dr Peter D’Adamo. This powerful information changed me forever. We have an obesity problem and most ‘As’ who eat any red meat are overweight and depressed. We cannot digest it and it lodges itself in the body as fat.
I had immediate results and felt totally satisfied with half the food I’d been eating, and gained lots of energy. I was not depressed, my body repaired itself. Over five-to-seven years I went from 85 kg to 68 kg and felt amazing. I became pregnant for the first time at 47 years old – the gynaecologist said it was a miracle – and didn’t seem to age until 55. I am happy without pills or drugs, just alkaline and natural vegetables, nuts, seeds, tofu, fish, rye but no dairy, red meat or acid foods that create inflammation. Borrow or buy the book! This is a win–win situation – cost-effective, natural and logical. Donna nEvin,
Killarney, Queensland
OTHER lETTERs publIsHEd NExT IssuE WIll REcEIvE a: • Dr. LeWinn’s Miracle Radiance Renewal Serum’s potent gel-oil serum, which deeply nourishes and renews dull and dehydrated skin. This quickly absorbed concentrate contains nourishing botanical essences such as rosehip oil to encourage regeneration, sea-buckthorn oil to restore radiance and tamanu oil to enhance skin firmness and elasticity. valued at $69.95 RRp. • Dr. LeWinn’s Day Cream Moisturiser enriched with vitamin a, which helps promote skin cell renewal while helping reduce the appearance of fine lines and wrinkles. containing vitamin b for moisture and soluble collagen for normalising and protecting, this cream will also rejuvenate and normalise skin tone. valued at $49.95 RRp. • Vitamix pack to inspire their culinary creations – with the Vitamix Real Food Movement Celebrity Recipe Book and The Blender Girl Cook Book as well as a vitamix flask so you can easily have your green smoothies on the go.
If you have something you would like to share with HHW, contact us at: steven@healthpublishingaust.com.au www.heartwise.com.au www.facebook.com/healthyandheartwise
Healthy & Heartwise • Spring | Summer 2014
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WiNNERS cONgRaTulaTIONs to the readers who had their letters published this issue. They will receive a body and home pack valued at $50.
healthalert
Rehab experts convene on sex, drugs & rock’n’roll Sex, The erection question medications Although important for health, sex can be a difficult topic for doctors to broach with their and lifestyle patients, said sexual medicine specialist Dr Rosie issues in King in her keynote presentation. However, there was a strong link between cardiac erectile dysfunction (ED) and cardiovascular rehabilitation disease because they often share a common of endothelial dysfunction, where blood were recurring cause vessels fail to dilate and contract correctly – to themes at the the point where ED usually precedes a cardiac by about three years. Australian event “Asking about ED gives the physician the Cardiac opportunity to aggressively intervene and modify Rehabilitation lifestyle habits to reduce the risk of an event, as the treatment of ED is straightforward and definitely Association’s in the province of most doctors,”said Dr King. Patients could therefore expect their doctor (ACRA) Annual to raise the subject by acknowledging how Scientific common ED is with heart disease, ask open-ended Meeting in questions, and reassure them that events and angina rarely occur during sexual activity – less Sydney in than 1% in the case of heart attacks. August. “A man can be considered fit enough to resume www.acra2014.com.au
8
sexual activity when he can walk 1 km on the flat in 15 minutes and then climb two flights of stairs within 10 seconds without chest pain or undue breathlessness,” Dr King said. Old research and media depictions had resulted in sex being seen as an Olympic sport, however, during intercourse the heart behaved as in any mild-to-moderate exercise, Dr King pointed out [see infographic, right]. Dr King’s suggestions for resuming sex safely included avoiding it after a large meal and heavy alcohol intake or in the early hours of the morning. “Have sex in a familiar place with a familiar partner in a comfortable position. The partner should also take a more active role. Keep a nitrolingual pump spray – which dilates blood vessels – or tablets in reach should chest pain occur,”advised Dr King. • see also pages 16–7
Healthy & Heartwise • Spring | Summer
HOW MUCH ENERGY DOES SEX TAKE? SEXUAL INTERCOURSE WITH ESTABLISHED PARTNER
Lower-range intercourse (normal activity) 2–3
Lower-range orgasm 3–4
DAILY ACTIVITIES
Light housework: e.g., ironing, polishing 2–4
Walking 1.6 km (1 mile) on the level in 20 min 3–4
Gardening (digging) 3–5
Heavy housework: e.g., making beds, scrubbing floors, cleaning windows 3–6 Upper-range (vigorous activity) 5–6 Lifting and carrying objects (9–20 kg) 4–5
= METs metabolic equivalent of task
Golf, mowing lawn, washing windows 4–5
Painting a room, wallpapering, etc. 4–5
healthalert The rehab diet Nutrition advice for heart patients is changing with new awareness about the body’s inflammatory processes, innovations in food processing and the supply chain as well as declining physical activity rates, dieititan Susie Burrell told ACRA delegates. While traditionally fat was considered bad universally, cholesterol in food raised blood cholesterol and carbohydrate quality was not important, now the type of fat and quality of carbohydrate is important and, “There are not good and bad foods, rather good and better dietary patterns,” said Ms Burrell. Studies comparing different ratios of fat, protein and carbohydrate had all shown similar weight loss at 12 months but they were not all equally sustainable, and more extreme diets that targeted one food or area could have negative effects and were tested in the long term. The Mediterranean dietary pattern appeared to have strong evidence for
7–10 SeRVeS of VeGeTABLeS PeR DAy
3 tbsp exTRA-ViRGiN oLiVe oiL reducing events in high-risk patients but in practice it meant 7–10 serves of vegetables, little dairy or red meat and minimal processed food daily, Ms Burrell pointed out. Low-carb diets had shown less risk of developing heart disease and diabetes and controlled fasting can have benefits for weight loss and cardiovascular signs, she added.
ReD MeAT occasionally
White MeAT
Caffeine costs kids’ rhythm Highly caffeinated energy drinks may be triggering cardiac events and also revealing arrhythmias due to underlying CVD, ACRA members were advised by keynote speaker Prof Chris Semsarian. “There is growing evidence that excess caffeine can influence the normal functioning of the heart, and in susceptible individuals, may even lead to cardiac arrest and sudden death,” said Prof Semsarian, cardiologist with the University of Sydney and the Royal Prince Alfred Hospital, who added it was most prominent in children and teenagers drinking energy beverages. “The main cardiovascular effects of high caffeine include increased heart rate, palpitations, increased blood pressure, improved exercise endurance, anxiety, insomnia, vomiting, nervousness and irritability,” said Prof Semsarian. Greater community education and awareness needs to be promoted about this risk, Prof Semsarian suggested, such as warnings on products and possible restriction of sale to children and adolescents, who were often targeted by advertising campaign and peer pressure. Spring | Summer 2014 • Healthy & Heartwise
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healthalert
1,500
2,000
2,750
3,000
4,800
6,000
sodium (mg/day)
3.8
5.1
7.0
8.9
12.2
15.2
salt equivalent (g/day)
Where’s the salt? HUMANS ARE consuming too much salt on a global scale, with 99% of the world’s adults exceeding the World Health Organization (WHO) recommendations of less than 2 g/day of sodium, or 5 g salt. In 119 of 187 countries that US and UK researchers studied, covering 88% of adults, the national sodium intake was at least 3 g/day. Sodium intake was highest in East and Central Asia, Eastern Europe and the Middle East, where it was 5–6 g/day. About three-quarters of the salt consumed is already in food before we reach for the salt cellar, hidden in everyday processed foods such as bread, breakfast cereal and processed meats. High sodium levels raises blood pressure, and with hypertension the biggest ‘silent killer’ worldwide, the WHO estimates that 2.5 million
10 Healthy & Heartwise • Spring | Summer 2015
deaths could be prevented each year if people adhered to their salt intake guidelines. The South African Government has aimed to meet the 5 g/day recommendation by 2020 through regulation of the food industry and public awareness campaigns, passing legislation in 2013 that set maximum salt levels in bread and other processed staples. A study released at the World Congress of Cardiology evaluated the effects of such regulations and found they could reduce CVD deaths by 11%. By preventing CVD in the first place, households could save about US$4 million per year, and the government could save approximately US$51 million/year in healthcare subsidies. BMJ online, world-heart-federation.org
healthalert
Spring–Summer
HEALTH CALENDAR OCTOBER Schoctober – Cardiac Arrest Survival Foundation Ocsober – Life Education Safe Work Australia Month Lupus Awareness Month Mental Health Month Foot Health Month – Australasian Podiatry Council 12 World Arthritis Day 12–18 National Nutrition Week
13–19 15
One pill fits all cardio patients THE POLYPILL – a fixed-dose combination of aspirin with commonly used medications that lower cholesterol and blood pressure in the one capsule – will improve heart patients’risk factors and how long they stay on medication, according to a Australian study presented at the World Congress of Cardiology. The George Institute for Global Health analysed data from 3140 people from Europe, India and Australasia who had cardiovascular disease (CVD) or were at high risk. They found 43% increase in patients staying on treatment at 12 months than if they received usual care, and there were corresponding improvements in blood pressure and LDL cholesterol results. The largest benefits were seen among patients not receiving all recommended medications when they started the study, which corresponds to most CVD patients globally. “Most patients globally either don’t start or don’t continue taking all the medications they need, which can lead to untimely death or further CVD events,” said Ruth Webster of the George Institute. However, Prof Salim Yusuf, President-elect of the World Heart Federation, warned that the polypill was no silver bullet: “[It is] not a replacement for a healthy lifestyle and should be combined with tobacco avoidance, a healthy diet and enhanced physical activity.” www.world-heart-federation.org
20 20–24 20–Dec 2015 26–1 Nov 27 NOVEMBER 1 7 9–15
12 13 14 17–23 19 24–30 30 DECEMBER 1 3 5 26 JANUARY 16–18 26 FEBRUARY
Carers Week 2014 Haemophilia Awareness Week Be Medicinewise Week Veterans’ Health Week Global Handwashing Day Ride2Work Nude Food Day – Nutrition Australia World Osteoporosis Day Sock It To Suicide Global Year Against Neuropathic Pain International Brain Tumour Awareness Week Pink Ribbon Day MOvember Changing the Face of Men’s Health Lung Awareness Month World Vegan Day National Walk to Work Day National Sunnies for Sight Day National Psychology Week Spinal Cord Injury Awareness Week Australian Food Safety Week World Pneumonia Day World Kindness Day World Diabetes Day National Cervical Cancer Awareness Week National Skin Cancer Action Week World Chronic Obstructive Pulmonary Disease (COPD) Day Australian Mesothelioma and Asbestos Awareness Week Buy Nothing Day – Adbusters World AIDS Day International Day of People with Disability International Volunteer Day National Leftovers Day – Foodwise
Ride to Cure Diabetes Big Red BBQ – Kidney Health Australia Ovarian Cancer Awareness Month International Congenital Heart Disease Awareness Month Red Feb Month – Heart Research Australia 4 World Cancer Day 16–22 Australia’s Healthy Weight Week MARCH 6 Lymphoedema Awareness Day 8–14 World Glaucoma Week 12 World Kidney Day
Spring | Summer 2015 • Healthy & Heartwise
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healthalert
No driving for a month after stroke STROKE SURVIVORS are returning to driving too soon and against medical advice, creating serious hazards and risking their own lives as well as others, warns a new Australian study. Male breadwinners of families were the chief offender among the 26.7% of NSW drivers who went back to the wheel before the recommended one month had passed since having a stroke. “Patients most likely to start driving were in fulltime employment, independent and confident in other areas of life. Some did not recall ever being advised not to drive,’’ Assoc Prof Maree Hackett of The George Institute of Global Health told the Annual Scientific Meeting of the Australasian Stroke Society in July. AustRoads’ Assessing Fitness to Drive guidelines state that stroke may impair a person’s driving ability either because of the long-term neurological deficit it produces or because of the risk of another stroke while driving.
Although strokes or ministrokes don’t commonly lead to vehicle accidents, when they did it was usually from an unrecognised vision issue. It is common, however, for stroke survivors to feel very fatigued and have difficulty concentrating and judging space, vision issues and challenges coordinating movement. “Often these symptoms are somewhat hidden. Stroke survivors may not even notice them until the symptoms have serious effect,’’ said Stroke Society President Professor Mark Parsons. This can lead to a false sense of security in people recovering from a stroke who are usually also under pressure to return to work and normal life. “When symptoms are clearly visible, such as a lack of movement down one side of the body, it is clear that a person should not be driving or at least not driving without appropriate aids in place,” advised Prof Parsons. www.strokefoundation.com.au
Further with fibre post-heart attack HEART ATTACK survivors will live longer if they eat more fibre, a longterm population study from Harvard has shown. Although it is known that fibre is a cholesterol-lowering nutrient of which we generally consume too little, there is not much evidence about its effects in people after they have had a heart attack. The Harvard researchers analysed data from the Nurses’ Health Study and Health Professional Follow-up Studies – two large US studies that have been following 121,700 female nurses and 512,529 male doctors since the mid-70s and 80s, respectively.
Higher intake of fibre post the heart attack was significantly associated with lower risk of death from any cause for both sexes. A person’s body mass index (BMI), activity level, dietary glycemic load and use of aspirin or statins did not alter this effect of fibre. In fact, overall for each 10g/day increase in fibre intake, risk of death was 15% less. All types of fibre decreased risk but cereal fibre from wholegrains was the most effective, followed by legume and fruit fibre. British Medical Journal 2014;348:g2659
12 Healthy & Heartwise • Spring | Summer
MOST HEALTH PROFESSIONALS KNEW TO INCREASE THEIR FIBRE INTAKE AFTER A HEART ATTACK, WHICH LOWERED:
RISK OF DEATH
31%
RISK OF DEATH FROM A HEART EVENT
35%
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Spring | Summer 2014 • Healthy & Heartwise
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coverstory
The only woman known the country over by her first name, Ita Buttrose is at once an icon, national treasure and powerful advocate for better health awareness among Australia’s seniors. She tells Heartwise about her vision – both the physical sense and how older Australians can remain active, valued and vibrant.
Ita
Ita’s fa vourite • Fashio n d
esigner We hail – Ca ed her a rrival on rla Zampatti. fashion the Aus sce tralia was edit ne back in the 70s whe n ing Cleo nI . I still lo beautif ve wear ul, class in ic g d her esigns t • Photo oday graphe r – Ross C • Opera offey – Tosca b y Puccin • Garde i n – Cent ennial P • Femal a rk, Sydn er ey retired N ole model – T SW Gov he rece n ernor, D ame Ma tly rie Bash ir
Ita with ingredients inspired by Eating for Eye Health
14 Healthy & Heartwise • Spring | Summer 2014
coverstory RIGHT: Ita with father Charles Buttrose
HWW How did your father’s
career as a journalist inspire your own? ITA I became aware of what Dad did for a living when I was about nine or 10, and he was the Editor of the Sydney Daily Mirror. Each morning over breakfast, Dad would tell me about the kind of day that awaited him at the paper.Those early-morning sessions and the regular late Sunday afternoon walks we took together, which sometimes involved visiting fellow journalists, impressed me. Dad’s world seemed exciting. He and his friends always had opinions, debating and discussing the issues of the day with vigour. The talk was zesty and laced with humour. It struck me that journalists enjoyed their work. I knew I wanted to be a journalist – I had determined that by age 11. HWW What inspired you to raise
awareness of macular degeneration (MD)? ITA It was because of Dad that I became Patron of the Macular Disease Foundation Australia in 2005. He was in his mid-80s when he lost his central vision to MD. It changed his life. As a journalist and author, Dad had always started his day reading a couple of newspapers. Suddenly this was no longer possible. As a journalist and author myself I couldn’t imagine not being able to ever read again. I was as devastated about Dad’s fate as he was. Having seen the impact of the disease on him, anything I can do to help spread awareness about the preventive steps people should take to protect their eyes is a priority for me. Unless you have witnessed a loved one or friend living with the challenges of vision loss, and appreciate how the simplest activities and joys of life can become great challenges, it is hard to believe “it could happen to me”. HWW How much was known about the
prevention of MD when your father developed it? ITA Dad developed MD in the mid-1990s when awareness was extremely low. Most people had no idea what MD was and little was known about how to prevent it. It’s only in the last 10 to 15 years, thanks to research, that we understand the enormous impact that diet and lifestyle has on macular
health. This is one of the reasons I’m so proud of Eating for Eye Health – The Macular Degeneration Cookbook, which I coauthored with talented chef Vanessa Jones, and all it offers to people who want the very best for their eye health. I’m passionate about making sure all Australians know that to a significant degree, they can eat away their risk of developing MD. HWW How have you maintained your
own health? ITA I have always made my health a priority, even back when my children were young and I was launching my career. Without doubt, we are so much better informed about diet and lifestyle these days and it’s interesting to see how many major diseases have very similar preventive health messages. For my eye health I eat a healthy, well-balanced diet that includes fish two-to-three times a week, dark-green leafy vegetables – especially spinach – and fresh fruit daily, plus a handful of nuts a week. I choose low Glycemic Index (GI) carbohydrates and limit my intake of fats and oils. I usually exercise every day.Walking is my preferred exercise these days and I try to walk for an hour every day. I also work out with weights a couple of times a week. HWW You were vocal about the plight of
older Australians during your 2013 term as Australian of the Year. Why is this important? ITA When I became Australian of the Year, I said I would use 2013 to raise awareness of a number of issues about which I felt strongly. Front and centre was to promote a more positive approach to ageing, to tackle what I perceive as ageist attitudes in our society, and to shine the light on medical research. I also wanted to encourage people to adopt preventive health strategies, especially for chronic diseases such as macula degeneration, dementia, arthritis and diabetes, all of which affect so many Australians as they grow older. I was overjoyed to watch my words falling on receptive ears and overwhelmed by the deluge of text messages, emails and letters that followed as many older Australians shared their personal experiences of ageing and disabilities. ♥
TO LEARN MORE about macular degeneration, order a free information kit or purchase a copy of Eating for Eye Health – The Macular Degeneration Cookbook,, call the Macular Disease Foundation Australia on 1800 111 709 or visit www.mdfoundation.com.au Spring | Summer 2014 • Healthy & Heartwise
15
♥ healthyweight
Does clean mean lean? Diets are as plentiful as grains of sand and tend to have the same sticking power – when it comes to weight loss, the conventional wisdom is ‘diets don’t work’, at least in the long term. But how wise is convention if people instead see results from paleo, fasting and clean eating, asks Steven Chong.
W STEVEN CHONG is the Editor of HHW
ith ‘Paleo diet’ the most Googled term of 2013, everything really, really old is new again. Not only does the paleolithic diet emulate the hunter–gatherer eating patterns of our Stone Age ancestors but revive ideas first popularised in the 1970s, and then rebooted in the early 2000s by Prof Loren Cordain of Colorado State University.
The power of protein While few dietitians quibble with the paleo diet’s emphasis on whole, unprocessed fruits and vegetables, and omega–3 fats from seafood or raw nuts and seeds — which mirrors the gold standard Mediterranean diet — they object to its scorn of carbohydrates and dairy. In September the Heart Foundation warned, “Advice such as‘avoid all grains or all dairy’ only ensures people will miss out on vital nutrients, and adds confusion to an already noisy world filled with fad diets and empty promises of rapid weight loss.” “Fad diets are not the way to achieve or maintain a healthy weight – it may sound a bit boring,but the key is to enjoy a variety of foods and be active every day,”said the Foundation’s National CEO Mary Barry. If not boring,‘a variety of foods’
16 Healthy & Heartwise • Spring | Summer 2014
does sound vague, and is undercut by full-fat dairy and untrimmed meats being restricted as sources of saturated fat – the same dietary advice now in question [see HHW54, page 10] as hapless in the face of an obesity epidemic and incongruous with 1960s Crete where highly processed low-fat milk was unknown and locals consumed everything from slaughtered livestock – fat, offal and bone.
Is paleo beyond the pale? Is paleo eating ‘just another fad’ that will go the way of the Zone and Pritikin diets? Its higherprotein, lower-carb approach overlap with that of the Atkins and South Beach that had peaked as Cordain’s books became bestsellers – although the proportions and underlying rationales differ, they all share a movement towards increased protein and fat intake at the expense of the carbohydrate levels recommended in the mainstream food pyramid. The Atkins ‘steak and butter’ plan, roundly denounced by the establishment in his time, was only at his death in the early 2000s shown to lead to weight loss, and morphed into the CSIRO Total Wellbeing Diet. Since then, the paleo diet has had a least five peer-reviewed studies published, showing positive effects on cardiovascular or diabetes markers – and bona fide weight loss – although these studies are not large and long enough to change public advice.
The exercise component Of course there’s more to weight management than just macronutrients. Meal combinations and timing vary among diets and some prescribe specific beverages or supplements, and nearly all recommend rest and sufficient exercise. CrossFit, the fitness world’s newest sensation, seeks to echo the intense bursts of physical activity of the Stone Age. The Biggest Loser trainer Michelle Bridges is one enthusiast, telling Heartwise: “CrossFit gives you great overall fitness to be functional for life. It’s tough and intense to improve strength and endurance, but also has pylometrics to stimulate agility, coordination and flexibility. It’s the group consciousness of getting through it together, even at different levels, that keeps you at it.” The food and fitness arenas are ever roiling with cycles, phases and innovation but after years of social media turbocharging viral transmission of trends, people can see in real time the weightloss results of their contacts adapting new ideas for themselves. In light of this, broadbrush public health dietary advice is seen as irrelevant to the individual and serving the food industries that fund dietetic groups and research – and,in view of how many people follow it,ultimately ineffective. ♥
♥ healthyrehab
DR ROSEMARY HIGGINS, MAPS, MCHP is Senior Research Fellow, Heart Research Centre; Honorary Senior Fellow, Department of Physiotherapy,
You may have your life after a heart attack but can you make love? Although physically most people can safely resume a sex life, emotional issues can also flow from such a life-changing event, says health psychologist Dr Rosemary Higgins.
Sex
and the heart patient
Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; Health Psychologist, Cabrini Health; Chair College of Health Psychologists, Victoria
A
fter surviving a heart attack, people commonly worry about sex. They may wonder whether they will ever have sex again. These fears and concerns are common and normal. Unfortunately, embarrassment can lead to silence. Patients may not ask questions. Health professionals may avoid the topic. Questions about sex may remain unasked and unanswered. This silence can have a long-term impact on a couple’s relationship and/or an individual’s identity and self-esteem.
demands of sex. They note that after bypass surgery, the wait is longer to avoid stress on the sternum or breastbone. While this news is reassuring, it is important to talk to your doctor to get the right advice for you. Unfortunately, not all couples receive the counsel and support that helps them resume their normal sexual life. Some patients have an extended period of delay or never return to sex after a heart attack, the reasons for this are many and varied.
Survival doesn’t mean celibacy
Heart-attack survivors can feel paralysed by fear of more heart problems. Patients commonly worry that sex could trigger another heart attack or cause them to die in bed. The sweating, breathlessness and faster heartbeat of sexual excitement can be an unwelcome reminder of the heart attack
Most people can go back to sex soon after a heart attack, according to the Heart Foundation of Australia. They advise that being able to walk up two flights of stairs without chest pain or shortness of breath generally means that your heart can cope with the
18 Healthy & Heartwise • Spring | Summer 2014
Facing fear
healthyrehab ♥ and their own vulnerability. Patients are not alone in this; partners commonly share these fears. While the anxieties generally reduce over time, well-timed reassurance from health professionals can be of great assistance in allaying them.
When sex isn’t an answer
7 ♥ TIPS • Be realistic about the speed of return to sex • Work together • Ask for advice and reassurance from health professionals • Keep close and communicate affection • Show love to your partner with cuddles and strokes • Consult your doctor if you have problems resuming sex • Exercise and a healthy diet will help your sex life and your cardiac health
Ask the expert Cardiac social worker Pamela Cohen provides reassurance and commonsense advice on resuming sex to patients attending cardiac rehabilitation. “In the recovery period, cuddle frequently and stick to sex with your usual partner.This can help with stopping intercourse if there are any symptoms,” says Pam. Pamela recites that for some couples having a ‘date night’ to mark getting back to sex can be a recipe for disappointment because a heavy meal and alcohol can impair performance. Among other tips, patients in her program are advised to reduce the stress and strain of sex by trying a side-by-side position, particularly after cardiac surgery. Mostly she advises couples to keep talking together about hopes and fears for the future, and to share the experience.
For some people who have experienced a cardiac event, sexual desire may fade into the background in the face of overpowering awareness of their own mortality. The heart attack is a lifechanging experience that crowds out and disturbs everything else in their life. The struggle to make sense of what has happened can lead to a temporary loss of libido. Libido can start to return to normal as patients recover physically and emotionally. Depression can also reduce sexual desire after a heart event. According to Dr Barbara Murphy from the Heart Research Centre,
In the recovery period, cuddle frequently and stick to sex with your usual partner ...
representing membership of the ‘zipper club’. Challenging the meaning of this scar can help patients to accept the changes in the body and identity that the scar represents. Returning to a normal sexual life after heart attack or surgery is an important goal of rehabilitation. Sexual partners can provide
Sexual desire may fade into the background in the face of overpowering awareness of mortality, but return as your health recovers around one in five patients go on to have depression after a heart attack or bypass surgery. Treatment of depression may be required before patients are ready to resume a sex life.
The scar unseen or love redeemed? Concern about their bypass scar may also lead to some patients avoiding sex or even showing their chest. The meaning of the scar is deeply personal. Some patients feel disfigured; others see the scar as a badge of courage or
valuable emotional support. A heart attack can be a trigger for couples to think about what is important in their life. Sometimes couples can drift apart. Others find a renewed and deepened commitment to each other as an unexpected consequence of this health challenge. Some patients report deepened feelings of love, gratitude and respect for their partner. Partners can report a realisation of the preciousness of their relationship. Continued communication and recognition of vulnerability are important starting points in this journey. ♥
Spring | Summer 2014 • Healthy & Heartwise
19
healthyrehab
Cardio physio Exercise is an essential part of cardiac rehab, and physiotherapist Dustin Williss takes you through simple principles safe for any heart patient.
I
f you weren’t active before your heart event or diagnosis of a heart condition or risk factor, then it’s even more reason to get active now. Providing your doctor has cleared you for moderate-intensity exercise, you can perform simple aerobic, stretching and resistance activities that work key circulatory, respiratory, neurological and musculoskeletal systems and organs to safely restore and maintain your fitness. There are psychological benefits too. Regular physical movement simulates the release of natural ‘feel good’ hormones and neurotransmitters that make us happier, puts stress hormones to use and releases tension.There is a social component if we participate with friends or in groups or at a gym or club, and the satisfaction of making and meeting sporting or fitness goals.
Motion is lotion for rehab A single small room with clear space of a few square metres, and ideally a sturdy four-legged chair, is all you require to perform these exercises for at least 30 minutes uninterrupted about five times a week at a moderate intensity, which means keeping a pace where you can hold a conversation without becoming breathless. In all of the exercises, technique is crucial so take time to get the alignment and positioning correct and concentrate on achieving the full range of motion. Each repeated movement (repetition) is slow and controlled, taking 3–4 seconds but you can go slower to increase your effort and intensity as your muscles strengthen. Keep your breathing regular throughout all the
exercises – holding onto breath will raise blood pressure. If you have an injury or are recovering from surgery, don’t exercise the affected site or extend an affected limb’s full range of motion. In these circumstances and if you are taking medication, a physiotherapist or exercise physiologist can customise a program but also monitor your body’s response to each exercise. NOTE: If at any time you feel any cardio symptoms such as pain in the jaw, neck, arm or chest, nausea or dizziness, cease the activity and seek medical help immediately.
Warm up Jogging
Strides
1. Build your confidence with regular movement by starting with walking for 5–6 minutes then increase the intensity to jogging on the spot. 2. Switch to stepping alternate legs forward and back for another few minutes, then jog on the spot again. 3. As your body warms up, it becomes easier to stretch upper-body muscles and joints. Hold each for at least 20 seconds and repeat with the opposite arms. 4. Return to walking on the spot then jogging, lifting your feet higher, keeping a moderate intensity.
Resistance Tricept stretch
Sit-to-stand
Use a chair to repeatedly stand from sitting without the aid of your hands. Sit-to-stand works your buttock and thigh muscles and hip joints. Perform 10–20 reps until your technique begins to fail. As you become more skilled, perform it with your arms stretched out front. Bicep curls can involve lifting weights or just cans of baked beans – perform three sets of 6–10 reps per arm with walking on the spot inbetween. Use the weights as you then progress to side steps, lunging alternate legs forward and working your triceps.
Cool down Bicep curls
Shoulder stretch
20 Healthy & Heartwise • Spring | Summer 2014
Spend a good 5 minutes on slowing down to a low intensity by walking again on the spot, stretching out your limbs and rolling shoulders back until all your joints and muscles are supple and not sore. Repeat your stretches as you return to your resting heat rate. ♥
DUSTIN WILLISS is senior physiotherapist and allied health team leader at Memorial Day Rehabilitation Centre: www.willissphysiotherapy.com.au
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healthy &HEARTWISE
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Spring | Summer 2014 • Healthy & Heartwise
21
healthyeating
HIGH BLOOD PRESSURE?
Have a banana!
As a mineral abundant in our body and in fresh food, potassium counters the effects of sodium on blood pressure and has multiple other benefits. Dietitian Milena Katz explains.
P MILENA KATZ, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney FOR MORE INFORMATION, VISIT www.foodstandards.gov.au
otassium is a mineral found in varying 3000–4000 mg/day, however no upper limit has amounts in almost all foods that been set for higher intakes that come from food is crucial for the proper function sources [see box]. of all of our cells, tissues and organs. It is How potassium spares the heart also an electrolyte, conducting electricity within the body along with other minerals In 2013, the British Medical Journal published such as sodium. Potassium is vital for the research that looked at 22 studies and heart because it promotes smooth muscle concluded that increased potassium intake contraction within the circulatory system, reduces blood pressure in people with which also makes it important for normal hypertension and has no adverse effects on digestive and muscular function. blood lipid concentrations, catecholamine It is important to keep the (‘stress hormones’ released from the adrenal body’s potassium level in glands) concentrations or kidney function balance, which depends on the amount of the minerals sodium and magnesium in the blood. Consuming too much salt (sodium chloride) can increase the body’s need for potassium HIGH MODERATE and once processed foods Leafy green vegetables Beans and peas were invented, people’s Root vegetables (potato, Tree fruits (apple, orange, balance of sodium and sweet potato) pear) potassium intake changed Vine fruit (tomato, cucumber, Milks, yoghurts quite dramatically, with zucchini, eggplant and Meats sodium consumption rising pumpkin) quickly and potassium Some fruits (banana, dropping. nectarine) While many people have * About 85% of dietary potassium is absorbed by the body heard that eating less salt lowers their blood pressure, what they probably have not heard is that it is wise to have more potassium. The potassium intake recommendation is about
POTASSIUM FOOD SOURCES*
22 Healthy & Heartwise • Spring | Summer 2014
healthyeating High potassium/low sodium foods* Food
Serve
Potassium (mg)
Sodium (mg)
Potassium– sodium ratio
1 medium
422
1
422:1
½ cup
305
1
305:1
1 medium
232
1
232:1
Orange juice
¾ cup
357
2
178:1
Grapefruit juice
¾ cup
252
2
126:1
½ medium
487
7
69:1
Raisins
½ cup
543
8
68:1
Prune juice
¾ cup
530
8
66:1
1 medium
926
17
54:1
Banana, raw Black beans, cooked without salt Orange
Avocado
Baked potato, plain, with skin * USDA National Nutrient Database, Sep 2011
in adults. Higher potassium intake was also associated with a 24% lower risk of stroke. Heart failure patients are often prescribed loop diuretics to get rid of excess fluid. These medications also flush potassium out with urine and cause the body to be depleted in potassium, which can lead to heart rhythm disturbances. Researchers from the University of Pennsylvania’s Center for Clinical Epidemiology and Biostatistics analysed data from about 360,000 patients with heart failure who began taking diuretics between 1999 and 2007. Half of them also took potassium supplements, and less of these people died from heart failure compared to those who did not supplement with potassium.
Other health aspects Population studies show a positive link between a diet rich in potassium and bone health, particularly among elderly women, suggesting that increasing consumption of foods rich in potassium may play a role in osteoporosis prevention. Potassium deficiency can also stem from diarrhoea, vomiting, excessive sweating (e.g. from fever or strenuous exercise) and malabsorption diseases such as coeliac and Crohn’s disease. Potassium-based salt substitutes and supplements should only be taken under supervision of a doctor as getting the balance right may be tricky. If you have problems with your kidneys, you should be guided by your doctor and may need to be careful about achieving just the right amount of potassium intake. ♥
Medications that May lower potassiuM levels If you are taking any of these medications, it is important for your doctor to test your potassium levels to see whether you need a supplement. Certain diuretics (spironolactone, amiloride, triamterene) help the body retain potassium where additional potassium intake can result in excessive levels (hyperkalaemia), so do not start taking a potassium-based salt substitute or supplement without medical advice. Thiazide diuretics • Hydrochlorothiazide • Chlorothiazide • Indapamide • Metolzaone Loop diuretics • Furosemide • Bumetanide • Torsemide • Ethacrynic acid Corticosteroids Amphotericin B Antacids Insulin Fluconazole – used to treat fungal infections Theophylline – used for asthma Laxatives Digoxin – Lowered blood levels of potassium increase the chances of toxic effects from digoxin, a medication used to treat abnormal heart rhythms and heart failure. Your doctor will need to test your potassium levels to make sure they are within the normal range.
Spring | Summer 2014 • Healthy & Heartwise
23
♥ healthyheart
Stroke
Australia’s second biggest killer and major disabler is way behind heart attacks for priority in the health system. Steven Chong reports on the neglected area of stroke care.
E
very 10 minutes someone in Australia has a stroke, pushing our annual total over 51,000. Nearly 12,000 will die from stroke and two-thirds of survivors will have some degree of disability, adding to almost half a million Australians who have survived stroke. Deloitte Economics, commissioned last year by the National Stroke Foundation, estimated that by 2032 this number will exceed 700,000, and that currently strokes cost the economy around $5 billion annually.
Surviving to suffer Two-thirds of stroke survivors require care to get through daily tasks such as dressing and going to the bathroom but the Foundation says support services are fragmented and access variable, thus failing to meet at least one health need for an extraordinary 84% of survivors. “Hospitals and community services continue to be ill-equipped to provide essential stroke treatment and ongoing support, meaning Australians are disabled when they shouldn’t be,” said Dr Erin Lalor, CEO of the Stroke Foundation. Strokes have been a national health priority since 1996 but have never attracted federal funds for a strategy to address the growing problem, so the Foundation called for a coordinated plan and targeted interventions.This year it again commissioned Deloitte to produce a report that showed the impact of stroke in each federal
Stroke care in crisis STEVEN CHONG is the Editor of HHW
electorate, where support was most needed and future hotspots that could be anticipated.
Stroke by state and a‘belt’ South Australia and Tasmania were found to have the highest rates of stroke survivors per capita, and the highest risk factors, such as high blood pressure, cholesterol and levels of physical inactivity [see table]. Consequently, these states will be home to about 250 strokes every 100,000 residents compared to a national rate of 217. Almost half the people in every state did too little exercise and with a quarter of Australians having high cholesterol and almost a fifth with hypertension, the data portray a largely sedentary population with stroke risk factors without any tell-tale symptoms. “Many of these people live without awareness of their risk and are therefore powerless to take control,” said the report, which urged governments to raise awareness and ensure GPs can provide the right advice and management. Deloitte found that NSW had most of the country’s top 10 stroke hotspots, with a ‘stroke belt’ running from Byron Bay to North Sydney. The stroke belt picks up again near Wollongong and runs south of the Victorian border, where the Mornington Peninsula ranks in the top five for strokes and survivors. In otherwise stricken South Australia, three Adelaide electorates are in the top five for stroke burden nationally. ♥
Strokes across Australia Region
Strokes 2014
Survivors (deaths) 2014
High blood pressure (% pop’n)
Atrial fibrillation (% pop’n)
High cholesterol (% pop’n)
4,092,898 (17)
433,940 (2)
6,081,876 (26)
Physical inactivity (% pop’n)
Australia
51,031
437,372 (11,418)
10,617,164 (45)
NSW
17,273
146,479 (3938)
1,338,239 (18)
145,987 (2)
1,965,337 (26)
3,428,981 (45)
Vic
13,017
110,296 (1886)
1,023,965 (18)
109,468 (2)
1,519,515 (26)
2,666,866 (46)
Qld
9443
83,111 (2015)
802,200 (17)
81,991 (2)
1,209,283 (26)
2,103,709 (45)
WA
4652
41,173 (999)
409,618 (17)
40,367 (2)
625,937 (26)
1,090,820 (45)
SA
4461
36,754 (1054)
323,625 (19)
36,934 (2)
463,397 (27)
808,453 (46)
Tas
1329
11,391 (292)
101,312 (19)
11,515 (2)
144,642 (27)
248,135 (46)
ACT
655
5891 (138)
65,590 (16)
5660 (1)
99,079 (25)
175,081 (45)
NT
201
2277 (28)
31,350 (14)
2019 (1)
54,686 (24)
95,118 (41)
24 Healthy & Heartwise • Spring | Summer 2014
The Foundation’s Clinical Audit Report 2013 showed that critical immediate stroke care had not improved in many areas since audits in 2009 and 2011. Although more – 70% – of audited hospitals had a dedicated stroke unit, only 58% stroke patients were treated in one. And despite guidelines recommending rehab commence early after a stroke,one-third of patients were not mobilised early after arrival to emergency and 15% were not mobilised at all.Less than half of patients with nutritional difficulties (stroke commonly affects swallowing) received treatment and only 23% with incontinence had a management plan, a decrease of 11% since 2009. Early aspirin use, blood-lowering medication on discharge and giving a care plan to patients to prepare them for life after hospital also failed to improve.
Taking low dose aspirin for cardiovascular protection?
Look for the Duentric coating. ®
Cartia® low dose aspirin has a Duentric® coating which is designed to protect your stomach from irritation that can be caused by the aspirin.
Download the free Cartia® app to help manage your heart health. Visit cartia.com.au or scan the QR code to download your Cartia® Protecting your heart app.
Available in pharmacies nationally.
cartia.com.au
Always read the label. Use only as directed. Cartia® helps prevent blood clotting and reduces the risk of heart attack and stroke in patients with known cardiovascular or cerebrovascular disease. For use under medical supervision only. The use of low dose aspirin may be only one component of your medical practitioner’s management plan to prevent you having a further heart attack or stroke. You should discuss this plan with your medical practitioner. Do not substitute other medicines containing aspirin, for this medicine, without first consulting your pharmacist or medical practitioner. Cartia® and Duentric® are registered trademarks of Aspen Global Incorporated. Marketed and distributed by Aspen Pharmacare Australia Pty Ltd. Aspen 34-36 Chandos Street, St Leonards NSW 2065. ASMI 23864-0714. CAR-CO-001-0814.
♥ healthyliving
Cholesterol – what we know and what you can do it is reabsorbed. As time goes by, further focus is being directed towards balancing cholesterol levels rather than aggressively reducing their total availability. What that means is that we balance, or modulate, these levels with clinically proven methods – sometimes foods and sometimes, nutritional supplements.
Fibre and plant sterols
Pharmacist and radio broadcaster Gerald Quigley gives a rundown on your options for managing cholesterol levels that don’t involve pills or tablets.
N
o dinner party these days is complete without a discussion on the variety of cholesterol readings as outlined by each of the diners:What’s high? What’s low? My doctor says this; mine says that. I don’t eat this or that. This focus on a number distracts us from the issues of cardiovascular health that are important, and one of those aspects is your blood cholesterol profile. Even experts can’t agree on the role in cardiovascular disease played by the particle size and types of cholesterol we have. However, some things are becoming clearer. Some arose as a by-product of a widely discussed TV program [see Vol 54, page 10], and others have emerged with the enthusiastic pursuit of health information by consumers.
We can’t do without cholesterol Cholesterol is an important parent molecule for all major sex hormones, including oestrogen, progesterone and testosterone. It’s an important player in our immune system and is important for brain function and the production of bile acids. Some experts call cholesterol an essential body ingredient. It’s made in the liver alongside bile acid that is kinked with amino acids glycine or taurine to form bile salts, which then passes down the bile duct into the intestine every day. Most of
Gerald QuiGley BPharm, is a community pharmacist and Master Herbalist and a presenter on radio 3AW, 6PR, 4BC and 2CC
26 Healthy & Heartwise • Spring | Summer 2014
We know that cholesterol is used in the liver to produce bile salts. Fibre, such as betaglucan in oats, absorbs bile acids from the gut for subsequent excretion, signalling that cholesterol in the body is sent back to the liver to make more bile salts.The overall result is that blood cholesterol levels are lowered. Sometimes claims on food attach themselves to this rationale and, to a certain degree, the claims are true. Clinical evidence though, in most cases, is scarce. However, betaglucan fibre has the science behind it. The ‘new kids on the block’ in balancing cholesterol levels are phytosterols. Also referred to as plant sterols, these are cholesterol-like molecules found in many types of foods and supplements. Unfortunately, phytosterols are difficult to quantify in foods because more than 200 of them exist! Measured phytosterol content in foods also varies between studies. The highest amounts of phytosterols are contained in nuts (especially almonds and walnuts), wholegrain products, vegetables and fruits. Flaxseed and wheat germ are the best wholegrain products. Although fruits and vegetables contain lower amounts of phytosterols compared to nuts and whole grains, they also contain a variety of vitamins, minerals, soluble fibre and other healthy ingredients that make them heart-friendly.The best options here are broccoli, Brussels sprouts, red onion, raspberry, and blueberry. Remember that cholesterol is merely one of the risk factors involved in cardiovascular disease. There’s no single food, nutrient, supplement nor drug that removes the overall cardiovascular risk — our health is our responsibility. ♥
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Weight loss for summer – does Paleo mean lean?
Sex, soul, exercise & relationships their place in rehab
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healthyeating
Going with the
grain
The fashion for carb cutting often means that wholegrains are sidelined but we then miss their many health benefits, says Melanie McGrice.
M
any fad diets around are quick to cut breads, cereals and grains from the meal planners, but before you decide to go ‘low carb’,‘paleo’ or ‘clean’, let’s look at some of the benefits of wholegrains.
What are wholegrains? Wholegrains are grains that incorporate all parts of the seed: bran, germ and endosperm.The grain may be ground, so even though a slice of wholemeal bread may not contain any actual‘whole’grains, it is still considered a wholegrain food because it contains all three parts of the grain that we need for good nutrition: • Bran is the outer layer of the grain and is rich in fibre important for a healthy digestive system • Endosperm provides carbohydrates and B vitamins for energy • Germ is rich in nutrients for the seed – further B vitamins, vitamin E, antioxidants and unsaturated fats. Common wholegrain foods include rolled oats, wholemeal and wholegrain bread, brown rice, popcorn, quinoa, hulled barley, wholemeal flour, bulgur wheat and wholemeal pasta.It is recommended that we aim to consume at least three 16 g/day serves of wholegrains to optimise health, e.g.a 30 g bowl of oats for breakfast and two slices of wholemal bread for lunch.
wholegrains had a 21% lower risk of cardiovascular events than those who consumed 0.2 serves/day. Wholegrains are rich in nutrients beneficial for cardiovascular function such as antioxidants, plant sterols, fibre and resistant starch to decrease cholesterol levels; and oleic and linoleic omega–6 fatty acids to increase protective HDL cholesterol. Oats are particularly rich in betaglucans, with research finding that 3 g/day betaglucan can decrease LDL cholesterol by about 10%.
Blood pressure People who consume 1–4 servings/day of wholegrains demonstrate less risk of developing high blood pressure than those eating less than one per day.
Diabetes Population studies suggest that people who consume three servings of wholegrain foods per day have a 30% reduction in their risk of developing diabetes. Furthermore, by swapping from processed cereals to wholegrains, those with diabetes often have improved insulin sensitivity. One study of overweight people with diabetes demonstrated that those who consumed a wholegrain-rich diet reduced their fasting blood glucose by
Heart health A 2008 meta-analysis found that consuming 2.5 serves/day of
28 Healthy & Heartwise • Spring | Summer 2014
10% and improved insulin sensitivity during the six weeks of the intervention.
Gut health A diet rich in wholegrains is believed to reduce the risk of bowel cancer, reduce symptoms of inflammatory bowel disease, decrease the risk of constipation and improve immunity. Although the dietary fibre found in wholegrains plays a significant role for these health benefits, recent research suggests that it may be their prebiotic effect influencing the probiotic microbes in our digestive tract that really makes the difference.
Weight management Contrary to popular belief, a diet rich in wholegrains is associated with a lower BMI and waist circumference.Wholegrains assist with long-term weight control, not just quick weight loss.For example, the US Health Professionals Study that followed more than 27,000 men over eight years found that with every 40 g/day increase of wholegrains, weight gain was reduced by 0.49 kg. Studies have shown that including wholegrains as part of a low-kilojoule diet is an effective way to lose weight. They help to control appetite hormones and often have a low Glycemic Index to keep you feeling full for longer. ♥
MELANIE MCGRICE, AdvAPD, MNutr, is an Advanced Accredited Practising Dietitian with a blog at www.melaniemcgrice.com.au
healthysupplements
Radio’s most knowledgeable pharmacist Gerald Quigley answers common questions about vitamin, mineral and herbal supplements.
Ask
Gerald
Gerald QuiGley BPharm, is a community pharmacist and Master Herbalist and a presenter on radio 3AW, 6PR, 4BC and 2CC
Vitamin D vs. sunblock
Q If you want to take a vitamin D supplement, then 1000 IU a day will maintain your current levels.
How can i get enough vitamin D if i use a sunscreen?
THe role of viTamin D in reducing the risk of chronic disease is well documented. As to what’s an adequate amount for you, blood levels of vitamin D tend to be referred to as ‘sufficient’ or ‘insufficient’ rather than as ‘deficient’ because experts can’t agree on minimum levels. That said, getting vitamin D through diet is a challenge. In an ideal world, we would all eat a balanced and nutritious diet, have little stress, avoid exposure to environmental toxins, drink pure and fresh water and enjoy adequate sleep each evening when the sun goes down, ready to bounce up and enjoy life as the sun rises. In our dreams perhaps? We get our vitamin D from the action of sunlight on our skin, from dietary sources like fish liver oils, oily fish, butter, egg yolk, milk and sprouted seeds, and from a vitamin D supplement if required. There are always demands on our stores of
30 Healthy & Heartwise • Spring | Summer 2014
vitamin D and they are greater if we are older; pregnant; vegetarian; have dark skin, poor gut absorption, cancer, diabetes or kidney disease; or take certain medications. There are better times to be out in the sun to help maintain our vitamin D levels — obviously the hottest times of the day need adequate sun protection but before and after those times, sun exposure is beneficial. Try to avoid direct sunshine between 11am and 3pm. The focus on vitamin D testing distracts from the knowledge we have about ‘sufficient’ levels. If you want to take a vitamin D supplement, then 1000 IU a day will maintain your current levels. Otherwise, use twice that dose to raise your levels to what is considered ‘sufficient’. In the meantime, experts argue the pros and cons of this really important nutrient. Make sure you get your share!
healthysupplements
Catching the right fish oil
Q There’s been no definitive research comparing the relative strength of fish oil with that from krill, much less calamari.
Fish oil, krill or calamari oil? Concentrated, high-strength or atlantic salmon? are they all the same?
We are still trying to understand all the health benefits of the omega–3 polyunsaturated fatty acids for which fish oil is recommended. They have been clinically shown to help reduce cardiovascular disease, slow deterioration of joint cartilage, improve cognitive function and support a healthy skin. Additional benefits are seen in dry-eye conditions as well. There’s been no definitive research comparing the relative strength of fish oil with that from krill, much less calamari. Take a minute to inspect the label on your omega–3 supplement. Add the numbers associated with the EPA and DHA, which are the names of the specific omega–3 fatty acids. For example, a standard-strength fish oil capsule of 1000 mg has 180 mg of EPA and 120 mg of DHA, giving a total of 300 mg of actual omega–3 in that capsule. Often there’s confusion about those figures but a 1000 mg fish oil capsule won’t contain 1000 mg of omega–3s. Adding to the confusion is that health benefits are associated with adequate blood levels of omega–3.The capsule is digested
in the gut and absorbed into the bloodstream. And that’s where krill oil has an advantage. The omega–3 oils in krill oil are ‘packaged’ in gut-friendly triglycerides, which allows better digestion, minimal fishy taste and better blood levels. So, what’s better? Each to their own, and we need to focus on the overall health benefits of adequate blood levels of both DHA and EPA, without losing those benefits in comparisons. Krill oil and fish oil are used in different ways within our body, and the cardiovascular benefits are, in my view, the most relevant issues within the ‘diseases of civilisation’ challenges we face. Choose the one you like, use it regularly — and that means an adequate dose every day — to gain maximum health benefits.
Macular degeneration
Q
some australian studies on macula degeneration showed that an antioxidant formula could help prevent or slow eyesight loss. When should i take it if i’m 50 and don’t have any signs yet but my parents do? in addition to a diet high in antioxidants such as zinc, vitamin C, selenium, lutein and vitamin E [see pages 14–5], supplementation with these antioxidants is important in the management of age-related macular degeneration (AMD) in people with existing disease. There is no evidence, however, that supplements benefit people who do not have existiing AMD. Studies by the Age-Related Eye Disease Study (AREDS) research group confirm that a combination of these nutrients combined will likely produce better results than any single nutrient alone. Other studies have shown that the lower antioxidant status in ARMD reflects decreases in a combination of nutrients. The specific daily amounts of antioxidants and zinc recommended in the latest AREDS2 trial were 500 mg vitamin C, 400 IU vitamin E, 15 mg
of beta-carotene (often labelled as equivalent to 25,000 IU of vitamin A), 80 mg of zinc as zinc oxide and 2 mg of copper as cupric oxide, 10 mg lutein and 2 mg zeaxanthin. Zinc plays an essential role in the metabolism of the retina, and older people are at high risk for zinc deficiency. B vitamins are also important, so appropriate supplementation of these nutrients may help if you can’t achieve them from food. Flavonoid-rich extracts of bilberry, Ginkgo biloba or grapeseed often appear in eye-health supplements and sometimes are suggested for AMD. In addition to possessing excellent antioxidant activity, all three extracts have been shown in lab studies to exert positive effects on retinal flow and function. Research in humans with AMD is strongest for gingko but still not to a level that public health organisations would recommend it.
Zinc plays an essential role in the metabolism of the retina and older people are at high risk for zinc deficiency
Spring | Summer 2014 • Healthy & Heartwise
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♥ healthyeating
FODMAPs when fibre fails If bloating, abdominal pain and excess wind follow from eating otherwise healthy foods, you may have a common sensitivity to some of their nutrients. Dr Sue Shepherd explains.
I DR SUE SHEPHERD PhD, BAppSci (Health Promotion), MNut & Diet, FACNEM (Hon), RFF, is an Advanced Accredited Practising Dietitian; Senior Lecturer at La Trobe University Department of Dietetics; and Human Nutrition Director – Shepherd Works, Melbourne: info@shepherd works.com.au
rritable bowel syndrome (IBS) is a very common condition that affects one in seven people. Symptoms include abdominal pain, bloating, distension, excess wind, diarrhoea, constipation or alternating bowel habits. IBS can be experienced by children and adults and both genders, although it appears more common in women.
The low-FODMAP diet A low-FODMAP diet is scientifically proven and is now used internationally as the most effective dietary therapy for IBS and symptoms of an irritable bowel. FODMAPs are a collection of sugars, found in foods naturally or as additives. FODMAP is an acronym that stands for: • Fermentable – broken down/fermented by bacteria in the large bowel • Oligosaccharides – fructans and galacto-oligosaccharides • Disaccharides – lactose • Monosaccharide – fructose in excess of glucose • Polyols e.g. sorbitol and mannitol.
How do FODMAPs trigger symptoms? FODMAPs can be poorly absorbed in the small intestine and therefore they continue their journey through the digestive tract and arrive at the large intestine.There, FODMAPs are
readily fermented by bacteria, contributing to gas production. Because the FODMAPs are concentrated (highly osmotic), they also attract water into the large bowel. The increased gas production and water can expand the large intestine and alter how quickly the bowels move.These two processes can then trigger the symptoms of IBS: excess wind, abdominal pain, bloating and distension, and changes in bowel regularity and habits (constipation and/or diarrhoea).
What to do People who suspect they have IBS should first speak to their doctor about their symptoms. It is important not to self-diagnose. It is recommended that such people be investigated for coeliac disease and any other conditions the doctor feels are relevant. You should not change your diet before speaking with your doctor because eliminating gluten, for instance, could provide incorrect results for a coeliac disease test. If IBS is confirmed, then a low-FODMAP diet is recommended. There are two steps to the low FODMAP diet: 1. strict restriction of all high-FODMAP foods for 6–8 weeks only, then an expert dieititian should be consulted for a review appointment to learn the second phase 2. customisation – where the type and amount of FODMAPs to avoid are identified so a longer-term diet can be established. It is best explained by a specialist Accredited Practising Dietitian (APD) who can show you all the foods that are low in FODMAPs and how you can enjoy a nutritious diet that helps manage your symptoms. Further information on the low-FODMAP diet and a food product range bearing the “FODMAP Friendly” logo suitable for those following a low FODMAP diet are at www.shepherdworks. com.au and www.fodmap.com. ♥
Examples of high-FODMAP foods Fructans
Galactooligosaccharides
Lactose
Excess fructose
Polyols
Custard apple, persimmon, nectarine, watermelon, globe artichoke, asparagus, garlic, legumes, lentils, leek, onion, shallot, spring onion (white part), cashew, pistachio, wheat, rye, barley (in large amounts)
Legumes, lentils, chickpeas
Milk, ice-cream, custard, yoghurt, ricotta cheese, cream cheese, cottage cheese
Apples, pears, mangoes, nashi fruit, boysenberry, watermelon, cherries, asparagus, Jerusalem artichokes, sugar snap peas, honey, highfructose corn syrup, agave
Apple, apricot, avocado, blackberry, cherry, nashi fruit, peach, pear, plum, prune, watermelon, cauliflower, mushrooms
32 Healthy & Heartwise • Spring | Summer 2014
WHAT SHOULD I EAT FOR
MY HEART? E BOOK
Your Healthy Eating Guide to Heart Health
BUY ONLINE from Amazon and iTunes
healthyshopping
Allergen-free shopping Foods free from increasing numbers of ingredients now abound to cater for soaring rates of food sensitivities, and dietitian Liz Beavis helps you shop for them worry-free.
‘F
ree from’ foods provide multiplying alternatives for people with allergies or intolerances, but don’t assume all of them are healthy —many ‘treat foods’ are now available gluten free, dairy free,
34 Healthy & Heartwise • Spring | Summer 2014
nut free etc. and, as always, these should only be a small part of your diet! Some products’ packaging will claim ‘free from’ gluten/dairy/nuts etc., however not all suitable products will make this claim. The only way to be sure is to read the ingredients list on the label, as Australian food laws require all ingredients to be disclosed [see HHW 54, pages 70–1]. Whether or not you have any food allergies or intolerances, focus your grocery shopping on whole, natural foods. You’ll get the best nutrition and know exactly what you are putting in your body without having to read any fine print!
healthyshopping Lactose intolerance Almost three-quarters of the world’s adults lack lactase, the enzyme required to digest the chief carbohydrate in milk. In most people, lactase levels reduce as they age but most lactose-intolerant people can ingest small amounts of lactose, say in a cake. Some milk products are low in lactose, including aged/hard cheese (e.g. cheddar, feta), butter and margarine, so you don’t have to avoid everything dairy. Reduced lactose (or lactosefree) milks and yoghurts are readily available.
Dairy intolerance Some people have a problem with the protein in dairy, either as a true allergy or an intolerance, in which case they will need to avoid all dairy products. Some alternatives are designed to provide many similar nutrients to milk, e.g. soy milk has a similar amount of protein, and many brands have calcium added, e.g. rice milks. Some alternatives, e.g. almond, oat and quinoa milks, may taste great in recipes but don’t provide the nutrients of dairy. Likewise there are alternatives to other dairy foods, including soy cheese and cream cheese, and soy or coconut yoghurt (quite high in saturated fat) and even soy cream and condensed milk available in your healthfood shop or online (e.g. vegan suppliers). If you use these alternatives regularly, check with a dietitian that you get sufficient calcium.
Gluten free People diagnosed with coeliac disease need to follow a diet strictly free from gluten-containing grains, including wheat, rye, barley and oats (which contain a similar compound and are often contaminated with gluten in processing). Many people do not have coeliac disease but feel that they don’t tolerate wheat or gluten. No individual flour is a direct substitute for wheat in baking (gluten provides enjoyable chewy texture), so generally a mix of flours (rice, potato, quinoa, buckwheat, tapioca and soy) is used. Readymade gluten-free plain and usually self-raising flours can be easily substituted. A growing range of packaged gluten-free products is available at supermarkets, including breads, pasta, breakfast cereals, biscuits, pastry and frozen crumbed fish. What about ‘wheat free’? This term can be confusing because it doesn’t always mean gluten-free so may not be suitable if you have coeliac disease. If you don’t have coeliac disease but do feel better eating less wheat, a wheatfree product may be suitable. Some people can tolerate breads made from spelt or kamut.
Other ‘free from’ foods Nut allergies used to be very rare but now most schools have at least one child with a nut allergy! As cross-contamination of products is common during processing, some manufacturers are creating nut-free production facilities so they can guarantee a nut-free product. Egg allergy is also more common – egg replacer can be used in cooking but egg-free custard powder, cake mixes, etc. are now also available, while the vegan section of your health-food shop has more. Artificial colours – research published in the Lancet in 2005 showed that artificial colours could affect children’s behavior. Many adults notice symptoms such as headaches after eating artificially coloured and/or flavoured foods. Some manufacturers are choosing to add colours from botanical sources to anything from confectionary to margarine – look out for beta-carotene, beetroot or turmeric in your lollies or biscuits! Preservatives – food has traditionally been preserved with salt, sugar, vinegar or oils. More recently a range of flavourless compounds has been developed to extend the shelflife of foods, however some people can experience symptoms such as asthma, rashes or migraines from consuming them. Some products are available preservative-free, e.g. dried fruits, that are as tasty as their preserved cousins, but a little more leathery. Some foods such as supermarket breads have replaced an artificial preservative with a natural product such as vinegar, whereas fresh bakery bread generally does not add any preservative. MSG (monosodium glutamate, additive numbers 620–625) is sometimes added to savoury foods to make them more tasty. Some labels will claim that the food contains no added MSG, but for people who are sensitive to glutamates (the component of MSG that can trigger symptoms including headaches, heart palpitations, rashes), alternative ingredients may contain natural sources of glutamates, such as yeast extract or hydrolysed vegetable protein. Some MSG-free foods may also contain another type of flavour enhancer (additives 627–635) that can also trigger symptoms in some people.
Low fructose Some people avoid foods containing fructose as high doses can exacerbate Irritable Bowel Syndrome. Fructose can be an ingredient in some sweet treats and even savoury foods, or ingredients high in fructose might be added, such as honey or apple juice concentrate (pectin) – see also page 76. Products intentionally low in these ingredients are marketed as ‘fructose free’, such as breakfast cereals and muesli bars. ♥ LIZ BEAVIS is an Accredited Practising Dietitian with Newtown Nutrition: www.newtownnutrition.com.au Spring | Summer 2014 • Healthy & Heartwise
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♥ healthywomen pessary you cleaned and inserted every day to hold the bladder up. It helped tremendously for five years then just stopped working, which is a shame and I haven’t seen any around since, and I got by with incontinence pads. I like to keep active in the community with a seniors public speaking group and tai chi — pelvic floor exercises have been a great help to me to get some control and better manage my symptoms. I learned them in 1994 when I participated in a local hospital study. They’re not that hard to master with persistence and guidance from a nurse advisor, who can make sure you are engaging the right muscles. In 2000, a urology professor suggested a webbing sling that was implanted. It worked until I ended up in hospital again with a lung infection. The webbing tore away at one corner, possibly from my coughing!
Incontinence Hartmann’s National Continence Report showed that incontinence remains both clinically underdiagnosed and social taboo despite it affecting more than one in five. Betty has had three decades of treatment and tells of the everyday reality as well as the promising new treatments she’s tried.
I
n 1984, I had a hysterectomy to remove fibroids and during the surgery they noticed a prolapsed bladder. My surgeon offered to fix it but did not get to do it because another problem arose and the anaesthetic was wearing off. My incontinence became more pronounced after the surgery although it wasn’t responsible – I was 42 and had three children by then, one of which was a breech birth without Caesarean. Thirty years later, I’ve had one form of incontinence or another and not had a month free to have and recuperate from prolapse surgery – work, children and now full-time care for my husband got in the way.
Early research participation In the late 1980s, I was classified as having heavy incontinence and participated in a clinical trial for an incontinence device. It was like a two-pronged
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Pads and the pelvic floor So I went back to pelvic floor exercises and the world of pads. Cheaper ones can lead to heat and sweat building up until you get incontinence-associated dermatitis, though luckily I haven’t had this. A brand from the supermarket was okay up until a carer friend put me onto specialised ones with better absorbency. The GP prescribes them so you have to pick them up from the pharmacy. They cost more but I can see why because they’re far better designed – in any case I’m nearly up to my PBS safety net and I alternate them with the commercial brand on lighter days. Heavy or light days vary according to how stressed or tired I am. I do my pelvic floor exercises every morning religiously and try to stay mindful of the correct muscles. But it’s like being conscious about posture or your breathing – I don’t sit around but walk a few kilometres a day, and do my own housework and cleaning, so it’s easy to get distracted while busy and then you lose control. ♥ Betty is 76 years old and now a full-time carer for her husband.
Can exercise aggravate? The Incontinence Foundation has launched the Pelvic Floor First initiative for men and women at increased risk of pelvic floor problems who exercise, play sport or participate in some form of physical activity. This includes women who are pregnant or have ever had a baby, menopause or gynaecological surgery; and men who have had surgery for prostate cancer: www.pelvicfloorfirst.org.au
asktheexperts
Cardiologist Dr Alistair Begg answers his rehab patients’ two most frequently asked questions. What happens when I go to emergency with chest pain?
AlistAir Begg, MBBS, FRACP, FCANZ, DDU is a cardiologist and Publisher of HHW
You will HAve an urgent electrocardiogram (ECG). This tells the doctor whether there is an urgent problem, such as heart attack, that requires immediate treatment. You will also have a blood test, commonly called a troponin measurement of an enzyme that is released into the blood when there is a lack of oxygen to the heart muscle. An elevation of troponin can indicate a critical narrowing or blockage in one of the arteries supplying the heart muscle. Based on results from both tests, the doctor decides whether to admit you to hospital for further tests, or schedule some tests to be performed in the clinic. If the problem is considered urgent, you will be taken directly to a special X–ray lab for an urgent cardiac catheter study to open a narrowed or blocked artery. This is essentially emergency plumbing because very prompt restoration of the flow
in the vessels that supply blood to the heart muscle can prevent the heart muscle dying from a lack of oxygen. In this situation, you will be given strong blood-thinning medication and medicine that dilates the arteries of your heart. You may also receive clot-busting drugs, especially if facilities to quickly open the artery with balloon catheter treatment are not immediately available.
I’m booked in for a coronary bypass – will it hurt much afterwards? After open-HeArt surgerY, you will be transferred immediately to the intensive care unit (ICU). As the general anaesthesia wears off, strong pain medication is provided intravenously. During the next day or so in ICU, you should not experience any discomfort. Shortly after you are transferred back to the ward and regain your awareness, the pain medication will typically be administered in
tablet form. Despite these strong painkillers, it is normal to feel at least some pain, discomfort or burning sensation at the incision site(s). There may also be some mild throat soreness from the breathing tube; an ache in the neck, shoulders, back or chest; or some minor discomfort in the chest or abdominal area where the drainage tubes were removed. However, often patients experience some discomfort only when sitting up; leaving or entering their bed; walking and exercising; or when they cough, sneeze and perform breathing exercises. When you are discharged, the pain levels should be mild to moderate only, for which you may be prescribed analgesics. Pain is personal and because people’s comfort levels vary, some require more pain relief. So to enable nurses and doctors to monitor, minimise and control pain after surgery, you must not hesitate to highlight any pain or discomfort before it becomes too severe. ♥
Spring | Summer 2014 | Healthy & Heartwise
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healthymen
Blokes with brittle bones Osteoporosis is an equal opportunity disease – a fifth of men over 50 experience fractures and suffer more from them than women. But it can be prevented and treated, says Prof Ego Seeman.
A
lthough fragility fractures are less common in men than in women, when they occur, they can be associated with comparatively poorer quality of life, and proportionally shorter lives. About one in five men older than 50 will have an osteoporosis-related fracture. This varies between countries but one Australian study anticipates it could be one in three men over 60.
Osteoporosis risk test for men • Have either of your parents broken a hip after a minor bump or fall? • Have you broken a bone after a minor bump or fall? • Have you taken corticosteroid tablets (cortisone, prednisone, etc.) for more than 3 months? • Have you lost more than 3 cm in height? • Do you regularly drink heavily? • Do you smoke more than 20 cigarettes a day? • Do you suffer frequently from diarrhoea (caused by problems such as coeliac or Crohn’s disease)? • Have you ever suffered from impotence, low libido or other symptoms related to low testosterone?
How men make old bones Like in women, half the bone mass men achieve until they reach their 30s is eventually lost, however men compensate better by forming more new bone on the outer surface. Declining levels of the male hormone testosterone slows the rate of this bone remodelling as men age, while smoking, heavy drinking and use of cortisone anti-inflammatories for joint pain and asthma also add to bone thinning. After age 65, both men and women can no longer efficiently absorb calcium from their food, so parathyroid hormone is released to make the bone give up its calcium into the blood stream. The result is bones with a porous shell, and the spongy honeycomb bone that acts like a shock absorber loses its ‘give’ under pressure. It cracks or may collapse, causing a fracture that in the spine can result in severe pain, loss of height and pronounced spinal curvature.
Prevention and detection Youth is the key time for prevention of osteoporosis, ideally consisting of sufficient exercise involving pressure and impact on the skeleton, plentiful dietary calcium and adequate sunshine for vitamin D.
A ‘yes’ to any of the above does not indicate osteoporosis but should be shown to your GP, who will advise if further tests are necessary.
EGO SEEMAN is Professor of Medicine, University of Melbourne, Austin Hospital, and President of the ANZ Bone and Mineral Society
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Many men don’t know they have osteoporosis until they’ve had a fracture but it can be detected earlier by a painless and non-intrusive bone mineral density (BMD) scan. However, even someone with a normal BMD can have a fragility fracture that needs immediate treatment, especially if vertebral, so try the ‘Osteoporosis risk test’ to see if you need a scan. The best studied medication for men with osteoporosis is alendronate, a bisphosphonate, while the bone-building parathyroid hormone helps to reconstruct the skeleton. Some medicines, such as corticosteroids (used in asthma, arthritis and kidney disease) and anticonvulsants, can hasten the onset of osteoporosis. Testosterone increases BMD in men who have low levels of it and, while calcium supplementation is not well studied in men, if you’re getting less than 1 g/day from your diet then you probably should take a supplement. ♥
CONFUSED
ABOUT
WEIGHT LOSS AND DIET?
GOOD AND BAD FATS? WHAT IS A HEALTHY BALANCED DIET ANYWAY?
HOW DO I SAFELY LOSE WEIGHT WITH A HEART PROBLEM?
WHAT IS A HEALTHY EATING PLAN FOR
HEART DISEASE TREATMENT AND PREVENTION?
WANT TO LOSE WEIGHT BUT CAN’T? WANT THE LATEST
INFORMATION ON CHOLESTREOL AND DIET
WITHOUT ALL THE HYPE?
Dietitian Kylie
will help you answer these questions and more... in this
Cholesterol & Weight Loss DVD Series DVD 1 - CHOLESTEROL Includes WHAT IS A HEALTHY BALANCED DIET? BLOOD CHOLESTEROL AND PLANT STEROLS FAT- THE DIFFERENT TYPES AND EFFECTS FRUIT, VEGETABLES AND FIBRE
DVD 2 - WEIGHT LOSS Includes BLOOD PRESSURE AND SALT ANTIOXIDANTS ALCOHOL LABEL READING
Available from:
www.whatswrongwithmyheart.com Other DVDs in this series include: EXERCISE WITH A HEART PROBLEM and CARDIAC REHABILITATION
This programme and more can also be accessed via the membership site http://heartrehab.litmos.com/online-courses
healthyrehab
Regular exercise, regular beat If you have arrhythmia, it’s most likely you have atrial fibrillation. Although it comes in many forms, lifestyle and diet is now known to be key to management. Craig Cheetham explains.
CRAIG CHEETHAM is Director – Cardiovascular Care WA; Adjunct Lecturer, School of Sports Science, Exercise & Health, University of WA; President, WA Cardiovascular Health and Rehabilitation Association; and Exercise and Sports Science Australia’s 2012 National Exercise Physiologist of the Year
A
trial fibrillation (AF) is the most common sustained arrhythmia. An arrhythmia is a disturbance in the electrical impulses of the heart, interfering with its natural ability to beat regularly and rhythmically with efficiency. The irregular heartbeats seen in AF typically result in the heart rate becoming faster – sometimes very fast. The symptoms may
40 Healthy & Heartwise • Spring | Summer 2014
be quite varied, from some individuals not knowing they have AF to others who suddenly feel very unwell with significant shortness of breath and dizziness. About four per cent of people older than 65 are affected, with this proportion doubling in individuals over 80 years. Large long-term follow-up studies have identified the prevalence of AF increasing between
healthyrehab low-sugar choices, plenty of fruit and vegetables and minimal alcohol intake.
CASE HISTORY: advice alleviates AF
EXERCISE • Regular physical activity (30 minutes five days a week of lightto-moderate intensity) plays a significant role in maintaining a healthy bodyweight as well as maintaining an appropriate blood pressure. • Where possible, maintain each bout of exercise for at least 10 minutes.
John developed AF during a relaxing threeweek interstate holiday when he felt short of breath on exertion much of the time, particularly walking up inclines, and felt quite tired at the end of the day. Although John enjoyed a full and active three weeks with his wife, he returned home to launch immediately back into his regular weekly golf routine. One of his golfing companions was his GP, who John commented to on some shortness of breath on the golf course. The GP identified John as having an irregular pulse and suggested an ECG would be useful because it was likely “his heart had popped into AF”. The diagnosis of AF threw John into a spin and he had six hospital admissions in a month for any unusual feeling or symptom that caused him to call an ambulance or present to hospital. I first saw him on his sixth admission and after discharge we had a consultation where I explained AF, its risks and how these risks are reduced, and reassured him that his symptoms were normal for him.We discussed medications, diet, physical activity and exercise, anxiety and depression. Following that single onehour consultation, he hasn’t been in hospital since. I am a strong believer that people only worry about things that they are unsure about. And if you provide not just reassurance but an understanding and a belief that they are okay, then most of the fear the anxiety and its influence on daily living then resolve.
WEIGHT LOSS • Weight loss is best achieved with sensible eating habits combined with regular physical activity and exercise. • Establishing routines is by far the most reliable means of ensuring diet and exercise habits stay on track. STRESS • Stress can detrimentally influence many variables that contribute to undesirable health outcomes, including its immediate effect of elevating blood pressure, reducing exercising habits and triggering cravings for unhealthy comfort foods.
the 1960s and 1980s, and again in the year 2000. The lifetime risk of developing AF is now one in four for those aged 40 years and older. This increasing risk is likely to be due to the increased prevalence of obesity and strong risk factors for AF such as high blood pressure and obstructive sleep apnoea [see page 68]. AF can be classified in many ways and not everyone has the same symptom picture – so how you feel when in AF often determines the most appropriate form of management.
Preventing AF As you may imagine, AF’s strong link with increased body weight and its associated problems can be significantly reduced through your own lifestyle choices, including: DIET • Reducing total energy/kilojoule intake • Reducing sodium (salt) and alcohol intake to decrease blood pressure • Eating habits used for heart disease or diabetes tend to be very useful to managing or preventing AF. These include low-fat and
SLEEP APNOEA • If you have signs of excessive daytime tiredness, feel like you don’t wake in the morning feeling refreshed, snore or fall asleep easily at times of inactivity (e.g. in front of the TV or reading), then it could be useful to discuss with your doctor. • Sleep apnoea is closely linked with many forms of heart disease, including AF, and plays a significant role in elevating blood pressure.
Life with AF For decades, it was thought that with the exception of medication and other medical interventions, AF could not be greatly influenced. However, an emerging body of research is demonstrating that weight loss and regular physical activity play roles in reducing the likely recurrence of AF. Exercising in well-controlled and appropriately managed AF is safe and you will receive just the same benefits from the time you invest in physical activity as someone without AF.Your doctors or an exercise physiologist with knowledge of cardiovascular health can guide you to the most appropriate exercise. ♥
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♥ healthytravel
Doorway to renewal Named after a mythical paradise for Greek gods and heroes, Golden Door Elysia offers professional lifestyle programs, comfort, therapies and activities amid idyllic surroundings. Emily Rundle reports. Emily Rundle, BComm, is Editorial & Production Coordinator for Heartwise
T
his retreat is definitely not all lettuce leaves, colonics and soul awakening. Perched on the top of a cliff overlooking the stunning vineyards and rolling hills one might think they are in another, more peaceful, world. It is no wonder that the Golden Door Elysia — specially designed and built in the Hunter Valley as a health and wellness retreat — and its worldclass programs have changed the lives of tens of thousands of guests for more than 20 years Upon arrival, guests are given a refreshment, shown through the expansive grounds and fitness facilities then have a wellness consultation with one of the retreat’s health professionals. They check your physical abilities, discuss any problems you might be dealing with and set your main health goals of your stay.This personalised service assists in developing strategies you can take with you through life.
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The variety of activities and programs at the Golden Door Elysia is extensive throughout the year and developed by nutritionists, dietitians, personal trainers and exercise physiologists. The classes on offer include tai chi, Pilates, stretch, gym circuit, spin, tennis, body balance, zumba, meditation, walking and deepwater running!
Nutrition, bodywork and ambience David Hunter, Elysia’s world-class Executive Chef, understands how important quality food is to maintaining a healthy mind and body and everything is portion-controlled to assist guests with how they should eat when back home. Herb-crusted salmon, delicious Thai salads, chicken and vegetable curry, steamed vegetables and quinoa bursting with flavours are some of the items on the menu. The spa facility and accommodation at Golden Door Elysia are really second to none. I enjoyed a 50-minute facial (in which I managed to fall asleep!) that left my skin spotless, luminous and soothed. If you are after a more serious spa treatment, the deeptissue massage is incredibly beneficial for your lymphatic drainage and sore muscles. Each suite can be tailored to guests’ desires including catering for couples, singles and adult families. Even on a warm sunny day, the ducted air-conditioning, deep bath including heavenly bath products, luxurious king-sized bed, balcony with bush view and relaxed lounge area make indoors so good that you don’t need to venture outside. Choose from three, five and seven-day programs at the Golden Door Elysia or extend your stay. Guests come to the retreat for different reasons and everyone can get something beneficial out of it, which is why it has become a benchmark for health and wellness throughout the world. ♥
reallifehealthstory ♥
To death and back
family members were told that he would be lucky to survive the flight. But Kenny’s luck held and Ken was able to visit him in Melbourne within a week. Kenny did not need surgery and was back in Albury less than a fortnight after his ordeal, where he immediately commenced an extended cardiac rehabilitation, as he needed longer than the standard six weeks.
Riding on luck
Kenny Anderson suffered a fatal heart attack yet survived with emergency help on the spot, a nearby hospital and help from his local heart support group.
K
en Every and Kenny Anderson have been in a running club together for many years and both are heart attack survivors – Ken since 1992 and Kenny since May 2005.Kenny went so far as to join the roughly 20% of heart attack victims who die from their first heart attack – he quite literally dropped dead!
When fate is fatal Now in his mid-50s, Kenny admits his diet was not the best but he was always pretty fit and active through regular runs, bike riding and squash. Kenny’s ‘fatal’ heart attack struck at a road crossing during an organised mountain-bike race in Albury, NSW. Luckily, however, local council workers on traffic duty had first-aid training, immediately administered CPR and called an ambulance fitted with a defibrillator. At Albury Hospital, the emergency team paddled Kenny back to life another seven times before encasing him in ice to drop his body temperature and minimise further damage. Fortunately, the air ambulance was available to get him to Melbourne that night but Kenny’s
Ken (LEFT) and Kenny at the end of the Great Victorian Bike Ride 2005
Where Kenny really lucked it in was being a mate of Ken’s and, in turn, Ken being Director and National Secretary of Heart Support-Australia Ltd (HS-A) and Heart Health Support Manager of the Albury Wodonga Branch of HS-A.With peer support from the branch members and an enormous commitment from Ken and Jeff Holloway, Kenny’s ride buddy in the fateful mountain-bike race, they all trained to compete in the 550 km, nine-day Great Victorian Bike Ride. Early in 2006, Ken and Kenny did the WA Ride from Albany to Perth and then lined up for a multi-day ride in Queensland just before doing the Victorian ride again. Kenny’s good run of luck ran out when he ended up unemployed after suffering a back injury and, between his crook back and one knee that is past its use-by date, he now can’t ride. He won’t be able to return to work as a mechanic but he volunteers 15 hours per week at a recycling depot that provides products for the needy and he still benefits from the support of the local HS-A branch, being a regular participant in their pole-walking group and other social get-togethers. Kenny’s summation of his unique journey is that he got good value from his local council rates, ambulance service and health fund subscription, Medicare levy but, most of all, Ken Every and the hardworking Albury Wodonga HS-A Branch! ♥
Spring | Summer 2014 • Healthy & Heartwise
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healthymind
Healing feelings Everyone has a negative side and yours could be behind your cardiovascular problems. For Angela Peris, hearts and minds cut both ways, with the heart affecting emotions but also vice versa – understanding this can aid recovery and prevent a relapse.
A
s much as a cardiac event can cause emotions such as fear, anxiety, shock and disbelief [see Vol 54, pages 16–7], the real cause of the cardiac event may also be due to emotional issues such as hurt, sadness and resentment. Extreme negative emotions can contribute towards a sudden heart attack. Being hurt badly through separation or breakup, or losing a loved one, can also contribute towards a sudden cardiac event. Therefore recovery from a cardiac event can become very much a personal re-evaluation. Reflecting on life, why the event happened and what contributed towards it or how it could have avoided are some of the issues people struggle with during rehabilitation. It is important to make the time to review your lifestyle and understand the emotions that may have contributed towards the event — and release these emotions.
Forgo blame and forgive When we harbour negative emotions, they can affect our health in many ways. We face emotional challenges within families, friends and communities every day, and learning how to forgive people and let go of hurt, sadness or anger may lift a huge emotional weight. Many people find it difficult to forgive people who have done ‘wrong’ or hurt them in some way. When we continue to blame others and not take responsibility for what happened, we
ANGELA PERIS is Director & Founder, Peris Cardiac Health & Lifestyle Retreat, Berrigan NSW: www. cardiacwellness. com.au/ Hearthealing
suffer more than the other person. Forgiveness is a very powerful and empowering exercise – but as difficult as it might be, it will release you from many of life’s challenges. You may never forget the incident or people involved, yet if you can forgive and let go, your life will be lighter and happier. And although people sometimes think they have forgiven people, they can still hold some negativity, no matter how rationalised. Forgiveness needs to be unconditional. When you can love and accept unconditionally those people or situations that you resented, you know you have forgiven them. Healing your heart is up to you and can be powerful. You are the only person ultimately in charge of your feelings, thoughts and life so take control and be responsible. ♥
10 STEPS to healing your heart 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
44 Healthy & Heartwise • Spring | Summer 2014
Accept people for who they are Forgive and let go of your past Surround yourself with positive people See the glass half full – not half empty Reflect on your life Be grateful for everything in your life Find your passion in life Know your purpose in life Have a vision of your dreams Do what you love and love what you do
mediareviews
well read & watched Health books, audiovisual and digital resources that could inspire change in your life, sustain a healthy, appy lifestyle or divert while on holidays.
The Paleo Cookbook exIsle PuBlIshINg, $24.99
this no-frills us compendium is the meat and potatoes of cookbooks for stone-age eating, with the briefest of introductions to the principles followed by a recipe for every page and nearly every day of the year. A few black and white pictures appear throughout chapters structured according to meal type, key mains ingredient and ethnic cuisine.
Diet DVD
www.whatswrongwithmyheart.com Ashford ANd sA heArt, $29.99
My heart, my life NAtIoNAl heArt fouNdAtIoN of AustrAlIA, fRee
this smartphone app is excellent for the heart patient to manage their medicines with a medication database, storage and tracking capacity for biometrics (unfortunately, to date this does not include INr results) and dosage data and reminders, information about heart attacks signs and what to do, and healthy recipes.
What’s Wrong With My Heart? www.whatswrongwithmyheart.com Ashford & sA heArt, $6.49
Cardiologist, author and publisher of hhW dr Alistair Begg has extended his cardiac patient resources to include an interactive app that features reference material about heart disease and health from his books; embedded videos from his dVd; universal data logs for medications, health statistics and path results (including INr and blood glucose); plus graphing and sending functions.
dietitian Kylie harman presents three hours of useful, accessible and practical advice and workshops in eating right for heart rehab and weight loss patients. Armed with sample food items, whiteboard and marker, packaging labels are analysed and claims and terms deciphered, nutritional profiles assessed and a healthy, sustainable eating pattern constructed.
Sugar Detox for Beginners exIsle PuBlIshINg, RRP $19.99
You can choose a three or 21-day sugar detox plan within this text, depending on your enthusiasm for jettisoning the 21st century’s everpresent, addictive ingredient: sugar. this slim volume reveals why we’re suckers for sucrose, tips for beating cravings and 77 recipes to get you away from the empty calories and helplessness before cakes.
Natural Remedies: An A–Z of cures for health and wellbeing By Mim Beim
How I Rescued My Brain
roCKPool PuBlIshINg, $29.99
sCrIBe, RRP $14.95
the prolific sydney naturopath and herbal tea guru suggests natural medicines for everything from acne to warts, with authoritative and witty answers for questions that every householder afflicted with an ailment typically asks. drawing more on tradition than scientific research, this is a reference for those wanting natural self-care.
By david roland
the author is a clinical and forensic psychologist, assessing the mental health of private patients in a country town. one day he wakes up in hospital with only foggy recollections of his life and how he got there, and difficulty understanding staff. It turns out he’s had a stroke but he decides on‘rewiring’his brain, drawing on several therapies and schools of thought.
Spring | Summer 2014 • Healthy & Heartwise
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♥ healthy living
Health on the
Shelf Our choice of the best health buys
Optislim Backed By a 20-year reputation, Optislim is now an Australian-made market leader of very low calorie diet (VLCD) programs. Optislim offers individual flexibility with an unrivalled range of products designed to help you lose weight, improve your health and regain your life — from a 48-hour detox program to re-energise and boost your metabolism through to nutritionally balanced and satisfying VLCD total meal replacements in shakes, soups and bars for weight loss. There’s also formulated LCD (low calorie diet) meal replacements in shakes, soups made with natural colours and flavours, great-tasting 100-calorie snacks and three-minute ready meals low in energy and fat. Visit www.optislim.com.au or freecall our customer service on 1800 882 408.
Betaglucare
Goodness Superfoods goodness superfoods extends its product range with new Better for U! Barley Clusters with Cashews, Macadamias and Cranberries and Wild Berries & Yoghurt cereal bars. The cluster cereals and the bars feature BARLEYmax™, a super grain developed by the CSIRO that may help reduce the risk of diabetes, heart disease and bowel cancer. They are an excellent source of fibre and contain 25% less sugar than leading brands. The product received 4.5 out of 5 in the Department of Health’s Star Ratings. Goodness Superfoods products meet the guidelines and nutritional standards of Diabetes Australia – Vic, the peak consumer body working to reduce the impact of diabetes.
Betaglucare is the natural healthy way to reduce cholesterol. Made from Nordic oats rich in beta-glucan, just one sachet a day as your breakfast routine will reduce your cholesterol.* Have with milk as a breakfast on its own, with cereal or yoghurt and fresh fruit. As well as reducing cholesterol, these crispy oat hearts are also high fibre and very low GI, so great for your gut health and for those seeking a low-GI diet. Each box contains 28 convenient daily sachet portions. Each 25 g sachet contains 3 g of beta-glucan, the amount proven in studies to reduce cholesterol. * combined with a healthy diet low in saturated fatty acids
Maxwell & Williams Maxwell & williaMs introduce a contemporary edge to food storage with the new Peek range of canisters. Made of highquality borosilicate glass, these beautiful containers are available in a range of sizes to suit a variety of foods. Clean and versatile with a touch of natural bamboo, Peek is proof that storage can be practical and beautiful! www.maxwellandwilliams.com.au
Gullon: Sugar-free biscuits never tasted so good Quality gullon Biscuit varieties are stacked with flavour yet are 99.5% sugar-free as well as extremely low in trans fats and cholesterol.They’re made from only high-oleic sunflower oil and have no palm oil. Gullon are a real hit with their impressive taste and health attributes! Whether you have diabetes or want to reduce your sugar intake, Gullon is a delicious way to satisfy any sweet craving. So indulge guilt-free. Gullon varieties are available in the healthfood aisles of Coles, Woolworths, major IGA and independent supermarkets, specialty delis and healthfood stores. See facebook.com/GullonSugarFree or www.maxfoods.com.au
46 Healthy & Heartwise • Spring | Summer 2014
ADVERTORIAL
HEART REHAB BY THE MY HEART? ASHFORD EXPERTS E BOOK
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The What’s wrong
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with my heart? suite of patient information resources is your multimedia companion to heart rehabilitation
Everything you need to know about your diagnosis, condition, treatment, medications, surgery and recovery is in a unique cardiac rehab education resource: What’s wrong with my heart? What’s wrong with my heart? is a suite of educational programs produced by cardiologist Dr Alistair Begg at Ashford Hospital, one of the first private hospitals in Australia to perform cardiac surgery and a leader in cardiac innovations. This comprehensive education resource captures the clinical advice, practical
answers and personal reassurance that Dr Begg’s team of cardiac health professionals have found their patients most need. The team’s insight and collective wisdom over thousands of practice hours also features patients’ stories of their own experiences in and out of hospital and specialist care. Expert commentary on the family of cardiac conditions, risk factors, devices such as stents and pacemakers, surgical procedures and coping strategies are now all available as hard copy, on DVDs, online and through apps.
ADVERTORIAL The DVDs
INTERVIEWS WITH CARDIAC REHAB EXPERTS AND PATIENTS What’s wrong with my heart? is produced with the Ashford multidisciplinary health care team whose successful model has been developed over many years. Cardiologists, cardiac rehab coordinators, a cardiac nurse practitioner and a surgeon, physiotherapist, pharmacist and dietitian explain in everyday terms how to modify your diet and lifestyle for a safe, steady recovery.
HEART ATTACKS, arrhythmias and murmurs, valve malfunctions, heart failure, angina, high and low blood pressure, artery hardening and other pathologies involved in heart disease are all given expert explanation in terms you can understand and learn from.
INDEXED CHAPTERS allow easy and convenient access to each topic, with a wealth of expert knowledge and clinical wisdom to complement your current cardiac rehab and prevention programs. A Diet and Medications DVD features a dietitian and pharmacist who elaborate on the everyday, lifelong aspects of cardiac rehabilitation that need commitment and attention: preventing a second event or further disease and disability through diet and/ or a medication routine. • Dietitian Kylie Harman talks you through basics of nutrition such as fats, cholesterol, salt, sugar, healthy swaps, fibre, labels and their dietitian’s role.
SEE INSIDE an operating theatre and the cuttingedge lifesaving technology that goes into pacemakers, stents, angiograms, diagnostic imaging and scanners.
ANIMATED 3D GRAPHICS and dynamic illustrations show what’s at work in your heart and blood vessels in health and in disease, and how surgical procedures affect your body.
• Pharmacist Daniel ScandrettSmith explains general medication management, drugs that lower cholesterol and blood pressure, blood thinners, heart failure medicines such as diuretics, and medication options for heart rhythm disturbances.
PATIENTS’ STORIES you can relate to. A cross-section of real-life heart patients share their reflections on the cardiac heart event, diagnosis and journey through treatment and rehabilitation to recovery.
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ONE-TO-ONE TUTORIALS ON CARDIAC EXERCISE, DIET AND MEDICINES Allied health care team professionals workshop for more than five hours on how to make easy, practical small steps to recovery through everyday awareness and management of your diet, physical activity and medications.
EXERCISE AT HOME ANY TIME Ashford’s physiotherapist and cardiac rehab coordinator Dustin Williss takes client Des through an hour-long real-time exercise session. The basics of a moderate-intensity exercise program suitable for rehab patients that can be undertaken any time and anywhere – minimal space and equipment required!
Dustin and Des go through warm-up exercises and stretches to get the body ready for bodyweight-bearing resistance exercises and then a cool-down. All the major cardiovascular, respiratory, nervous and musculoskeletal systems are worked, keeping your joints supple and increasing fitness levels to prevent injury and help your recovery.
HEALTHY EATING – ACHIEVABLE AND ENJOYABLE Clinical dietitian Kylie Harman presents one hour on the components of a heart-healthy and balanced diet, speaking on cholesterol and plant sterols, fibre, fats, sugar, salt, balancing diets, fruits and vegetables, alcohol, antioxidants, blood pressure management and swapping to healthier versions of the foods you enjoy. Kylie then devotes another hour to the vexed question of weight loss, with step-by-step smart swaps and easy dietary modifications that are realistic and achievable a reduced waist size. With the aid of a whiteboard, Kylie gives label reading tutorials on household staples and shopping items such as biscuits, yoghurts, chocolate and lasagnes – featuring brands and products we see every day.
MAKING MEDICINES EASY Clinical pharmacist Daniel Scandrett-Smith makes the most mind-boggling challenge of managing a heart condition easy to understand and implement. Heart disease usually means months or years of taking multiple medicines, sometimes several times a day – and most people stop even though it puts their lives at risk. Ceasing drug therapy is the major reason people have a second, and usually more damaging, heart event. But with a few medication management tips from a specialist in cardiology pharmacy, the chore of taking medicines becomes as routine and regular as clockwork. Daniel explains the how the drugs work, their dosage forms and directions, benefits, interactions and side effects, and gives tips on their storage, safety and how to get their best effect.
ADVERTORIAL the ebooks
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First among all heart patients’ thousands of questions are “What’s wrong?” and “What can I do?” Two essential online texts crystallise Dr Begg’s cardiology insights into an accessible format which you can bookmark on your devices.
E BOOK
Your Healthy Eating Guide to Heart Health
fifteen years of clinical practice and professional passion went into Dr Begg’s seminal text What’s wrong with my heart? and companion volume What should I eat for my heart? These books tackle key concerns that scores of Dr Begg’s patients repeatedly encounter upon learning they have a heart condition or risk factors for heart disease.
What should i eat for my heart? Why is animal fat bad but eggs okay for heart disease? Is a high-protein diet good for weight loss? What is glycemic Index and is coffee or tea better for me? Diet is such an important and constant consideration in managing heart disease risk and progression that Dr Begg enlisted help from dietitian Kylie harman to dedicate a whole book to it, which complements What’s wrong with my heart? The effects of food on risk factors such as blood pressure, cholesterol levels, body weight and blood glucose levels are outlined, with separate chapters on nutrition basics – including sample meal planners, decoded nutrition labels, lists of healthy swaps and foods high in healthy ingredients like omega–3s —exercise. Again, frequently asked questions, tabulated lists and readily accessible chapters and sections make this 100-page ebook ideal for saving and referring to on a mobile device.
BUY ONLINE from Amazon and iTunes What’s Wrong With my heart? What’s the difference between heart disease, heart failure and a heart attack? What does InR measure and what do triglycerides or betablockers do to you? the answers are in Dr Begg’s foundation ebook, which reveals all you want to know about cardiovascular
clinical testing, treatments, surgery, nursing and aftercare, rehab and medications. It’s not just medical and lifestyle decisions, either – psychological issues, what women heart patients need to keep in mind, health insurance, driving regulations and even flight clearance guidelines are addressed.
illustrated throughout with clear colour diagrams and charts, this comprehensive 400-page volume includes a glossary of medical terms, references, list of abbreviations, index and has breakout expert opinions, patient perspectives and case stories, frequently asked questions, and key summary points.
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APP-LY HERE FOR INSTANT HEALTH RECORDS TO TRACK YOUR PROGRESS An interactive digital data tracker for storing, monitoring and assessing your key cardio stats and pathology results, your medications, personal metrics and all the information you need to share with your health care rehab team.
Download the What’s wrong with my heart? app from GooglePlay or Mac App Store to link on your mobile devices.
Every heart condition, test, treatment defined, explained and examples provided • Record your health data: - blood pressure - cholesterol levels - medication doses - blood glucose levels - weight - INR readings. Technical detail demystified with clear illustration, animations and tables
• Monitor and graph changes in your results over time. • Compile log reports that you can email to your healthcare professional.
Watch professionals from Ashford’s cardiac rehab team explain heart conditions, surgery, aftercare, diet, exercise and lifestyle management
Encyclopaedic reference source on cardiology risk factors, medications and their side effects, diagnostic tests, exercise guidelines, how surgical procedures and implants work + glossary of medical terms!
51
ADVERTORIAL the course online
LEARN, READ AND WATCH ONLINE WITH THE EXPERTS Access Dr Begg’s rehab learning centre where you can see courses accredited by the Australian Cardiovascular and Rehabilitation Association – test course available for ACRA members!
Daniel Scandrett-Smith
Kylie Harman
Dustin Willis
LEARN AND BENEFIT FROM THE ASHFORD TEAM’S EXPERTISE
Libby Birchmore
Dianna Lynch
Face-to-face online tutorials with Ashford cardiac rehab professionals – hours of practical facts from decades of combined clinical experience: • Lower blood pressure with food and medicine, as explained by a dietitian, pharmacist and cardiologist • Manage you medications better with pharmacist Daniel Scandrett-Smith • Cardiac rehabilitation and prevention made simple • Balance cholesterol levels with your food choices as explained by dietitian Kylie Harman • Return to activity safely and simply with physio Dustin Williss’ one-hour exercise workout • Heart failure care with nurse practitioner Libby Birchmore and rehab coordinator Dianna Lynch as well as cardiologists involved • Weight loss made easy and achievable with dietitian Kylie Harman.
+
Read FREE back issues of Healthy & Heartwise magazine! PLUS
» DEALING WITH DIABETES SECTION »
healthy &HEARTWISE TRUSTED FOR HEALTH
Shelley Craft Making room to laugh The cholesterol controversy Exercise after a cardiac event
16
RECIPES
http://heartrehab.litmos.com/online-courses
with fresh seasonal ingredients
AUTUMN | WINTER 2014 VOL 54
RELAUN EDITIONCH WITH
NEW
REHA FOCU B S
COLD COMFORT FOOD avoid winter weight gain
BREAST CANCER
what screening means
A LEG UP INTO LEGUMES $7.95
What can I eat with a gastric bypass or lapband? www.heartwise.com.au
recipeguide&salads
RECIPES explained...
Would you have guessed that sugar and salt-cured salmon by Luke Mangan was healthy for someone with diabetes? Or a
corn and crab omelette helpful in preventing macula degeneration? Or that you can make a delicious and antioxidant-rich green-tea cake without gluten? Heartwise’s recipes for the warm half of the year are full of pleasant surprises from celebrity chefs around the world. Each dish has healthy eating tips highlighted in gold and its nutrient profile –
including potassium values, which can help you lower your blood pressure [see page 22] – provided by Accredited Practising Dietitian MILENA KATZ. A ★ GOLD STAR RECIPE is lower in kilojoules and/or carbohydrate, and higher in fibre and potassium. These meals can be consumed more regularly and are the healthier choices.
Japanese coleslaw
From Eating for Eye Health by Ita Buttrose & Vanessa Jones, New Holland 2014
Vanessa Jones PREPARATION TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 1326 KJ, FAT 9.2 g, PROTEIN 5.5 g, SATURATED FAT 1.1 g, FIBRE 10.3 g, CARBOHYDRATE 39.4 g, SODIUM 71.3 mg, POTASSIUM 1120 mg ★ GOLD STAR RECIPE Fantastic fibre-rich salad high in potassium From Michelle Bridges Total Body Transformation, photography Julie Renouf, published by Viking, RRP $29.99.
Beetroot, fetta & walnut salad Michelle Bridges PREPARATION TIME: 10 MINUTES COOKING TIME: 30 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 1675 KJ, FAT 34.7 g, PROTEIN 11.2 g, SATURATED FAT 7.4 g, FIBRE 6.2 g, CARBOHYDRATE 15.6 g, SODIUM 135 mg, POTASSIUM 640 mg ★ GOLD STAR RECIPE A lower-carb everyday recipe that packs a protein punch 350 g trimmed baby beetroot 1½ tbsp extra-virgin olive oil 3 tsp red-wine vinegar Freshly ground black pepper 1 large handful (40 g) baby rocket 100 g fetta cheese, cubed 30 g walnut halves 1. Steam the baby beetroot for about 30 minutes or until soft then peel, quarter and allow to cool in a bowl. 2. Mix the oil, vinegar and pepper together and toss with the beetroot. 3. Place the baby rocket in another bowl with the fetta and walnuts. 4. To avoid staining everything red, serve adjacent rather than tossing together.
½ wombok (Chinese cabbage), washed and shredded 1 carrot, peeled and grated 1 daikon (white radish), peeled and grated 2 Fuji apples, peeled and grated 1 tbsp black sesame seeds DRESSING ¼ cup mirin
1 tbsp sesame oil Juice of 2 lemons 1 tbsp Japanese rice vinegar 1 clove garlic, minced 1. Make the dressing by whisking together all the ingredients in a bowl until combined. 2. Toss the cabbage, carrot, daikon and apple together in a serving bowl. Pour over the dressing, sprinkle with sesame seeds.
Tangy sweet potato salad Ross Dobson PREPARATION TIME: 10 MINUTES + 30 MINUTES SITTING COOKING TIME: 20 MINUTES From Fired Up: Vegetarian NUTRITIONAL INFORMATION PER SERVE (SERVES 4) by Ross Dobson, Murdoch ENERGY 1202 KJ, FAT 21.2 g, PROTEIN 1.1 g, Books, RRP $34.99, SATURATED FAT 3.6 g, FIBRE 1.7 g, CARBOHYDRATE 9 g, photographed by Brett SODIUM 295 mg, POTASSIUM 140 mg Stevens and Nicky Ryan Serve with grilled fish to increase protein
1 medium-sized sweet potato, sliced 5 mm thick 2 tbsp rice bran oil 1 tsp caraway seeds 2 dill pickles, finely chopped
3 tbsp roughly chopped mint leaves 1 large red chilli, finely chopped 2 tbsp apple cider vinegar ¼ cup extra-virgin olive oil 1 tsp caster sugar
1. Preheat the barbecue grill to medium. Put the sweet potato, rice bran oil and caraway seeds in a bowl and toss to coat the sweet potato well. 2. Tumble the sweet potato over the grill, then use tongs to spread them out so they don’t overlap. Cook for 8–10 minutes on each side, or until caramelised and tender. Place the hot sweet potato in a bowl. Add the dill pickles, mint and chilli. 3. In a small bowl, combine the vinegar, olive oil and sugar, then drizzle over the sweet potatoes, gently stirring to combine. Set aside for 30 minutes for the flavours to infuse. 4. Season to taste with sea salt and freshly ground black pepper and serve. Spring | Summer 2014 • Healthy & Heartwise
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chef’schat
The new Stone Age Curtis Stone is Australia’s greatest food export who has brought our produce, creative flair and informal style to London and Hollywood, winning global fame and commercial success en route. Health is a natural result of his food philosophy, he tells Heartwise.
HHW: While “a greedy little monster who couldn’t get enough food” as a child, you were also active outdoors and have stayed lean despite being surrounded by and fascinated with food. Do you still get time to exercise or are you just disciplined about when and what you eat?
54 Healthy & Heartwise • Spring | Summer 2014
I’d love to say that I’m disciplined about what I eat but I still can’t help myself when it comes to food. I’m a bit like a vacuum – I Hoover up whatever is in sight. A couple of days after Easter this year, I had to get rid of all of the chocolate eggs sitting around at home because every time I walked past them, I’d pick up a couple on the run. I guess I’ve been able to stay lean because I have a balanced diet and eat as many fresh foods as I can. I try to steer pretty clear of the processed stuff. I’m probably busier than I’ve ever been right at this point in my life with a growing family (baby #2 due in September), and I’ve recently opened my little restaurant Maude in Beverly Hills, so my feet are hardly touching the ground. However, I try my best to exercise about three-tofour times a week. I change my routine between swimming, running, hitting the gym and walking our dog Sully. HHW:Your food philosophy was forged in Marco Pierre White’s Michelin-awarded restaurants, where local and seasonal ingredients were treated simply. Surfing the Menu, where you met primary producers around Australia, cemented this. Now you’re living in the US, how does their produce and farming compare with Australia, and is there any US ingredient that we should have here? I split my time between the US and Oz and I feel so lucky because both countries grow top-quality produce.I’ve been fortunate enough to personally meet and hang out with plenty of Aussie and American farmers through my work with Coles, and because my restaurant has a monthly menu focusing on hyperseasonal produce, I’ve been travelling around California sourcing the best produce I can get my hands on.Meeting farmers personally and seeing the hard work that goes into growing food spurs me on further to make their produce shine on the plate – and encourages me to reduce waste to an absolute minimum. Kale is becoming increasingly popular in Oz, which is great because I ‘ve become a little bit of kale fiend since moving to LA. It’s basically on every menu here, and I grow it in my garden and juice it most mornings.
chef’schat HHW: Butter is one of your five essential ingredients but dietitians and healthy eating guidelines recommend low-fat spreads and margarines and dairy products generally. Do you ever use these and do they need particular consideration? I don’t often substitute butter for spreads because of the difference in flavour but I do try to watch the amount of butter that I’m using with anything from my morning toast to a decadent dessert. Many restaurants slip quite a lot of butter into their dishes so that is something to watch. While a dinner out at a nice restaurant is really special once in a while, I’m a big campaigner for cooking homemade meals as often as you can. Not only is it a great way to call the family together but you know exactly what goes into your food. HHW: How would you modify a meal for a person with diabetes, especially if like you they have a sweet tooth? It’s always good to follow your doctor’s orders for specific health circumstances such as diabetes, especially in the case of sugary sweets. There are a couple of key tricks to enjoy the sweet stuff minus the inclusion of too much sugar: • Eat in season. Fruits in season are naturally sweet so you can enjoy them as they are or treat them very simply to enhance and complement their flavours. For example, grilled peaches in summer take on a natural caramelised and more interesting flavour. Sit the peaches on a bed of natural yoghurt and top with a grating of lime zest — super-delicious! • Replace sugar with natural sweeteners such as honey, maple syrup and even dried dates. I often like to mix chopped dates into breakfast muffins, in place of most of the sugar. • And a final thought: plate dishes beautifully. Even if you’re having the simplest dessert of sliced banana with a drizzle of honey or caramel, it’ll look more enticing and feel like a treat when presented with care on a pretty plate — a bright green sprig of mint helps too! ♥
ServeS: 12 PreParation time: 15 minuteS CooKinG time: 1 hour 45 minuteS + 1 hour CoolinG + 8 hourS refriGeration
Curtis’s New York cherry cheesecake Butter for the pan CRUST 12 whole digestive biscuits 3 tbsp sugar 75g unsalted butter, melted FILLING Four 250 g packets cream cheese, room temperature 1 ¼ cups sugar 2 tsp finely grated lemon zest 1 tbsp lemon juice 1 tsp pure vanilla extract 4 large eggs
SOUR CREAM TOPPING 2 cups sour cream 3 tbsp sugar CHERRY TOPPING 500 g fresh cherries, halved and pitted 3 tbsp sugar 1 tbsp lemon juice
Recipe from What’s for Dinner?, Random House, 2013
1. Position a rack in the centre of the oven and preheat the oven to 180°C. Lightly butter a 23 cm springform pan. 2. In a food processor, grind the biscuits into very fine crumbs. Add sugar and melted butter and pulse until moistened. Press the crumb mixture evenly onto the bottom and 4cm up the sides of the pan. Bake for 12 minutes or until crust is a shade darker. Cool on a rack, then wrap three layers of wide heavy-duty foil around the outside of the pan. 3. Clean the food processor bowl, then blend the cream cheese and sugar until smooth. Add the lemon zest, lemon juice, and vanilla; pulse to combine. Add the eggs and pulse until blended. 4. Pour the filling into the crust-lined pan. Place the pan in a large roasting pan. Pour in enough hot water to come halfway up the sides of the springform pan. Bake for about 1 hour 15 minutes, or until the filling is set except in the centre when the pan is gently shaken. 5. In a medium bowl, stir the sour cream and sugar to blend. Spoon the mixture onto the hot baked cheesecake and smooth it over the top. Continue baking the cheesecake for 15 minutes, or until the topping is set. Let the cheesecake cool in the pan on a rack for 1 hour. 6. Run a paring knife around the edges of the cheesecake to loosen from the pan sides. Cover loosely with plastic wrap and refrigerate for at least 8 hours. 7. Combine the cherries with the sugar and lemon juice in a medium bowl. Let stand at room temperature, tossing occasionally, for about 30 minutes, or until juices form. 8. Remove the pan sides from the cheesecake. Slice cake with a large sharp knife (wet and wipe clean after each cut) and serve with cherry topping spooned over. Refrigerates for 2 days. Spring | Summer 2014 • Healthy & Heartwise
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chef’schat HHW:Your 12-week Body Transformation (12WBT) follows the classic formula of weight loss through cutting back on energy in and increasing energy out through exercise. Is that suitable for everyone? It may be seen as old-fashioned, but like salt and pepper or lamb and rosemary that always go together, you don’t need to get fancy and mix things up.You should always keep mobile with at least simple squats and push-ups, and look at what you’re ingesting and burning off. I don’t want people to become obsessed with counting calories; I want people to understand why they haven’t been able to lose weight or why they are gaining weight. Consider a general day’s worth of eating and what we do to expend that – most people sit for long periods and forget they’ve had a muffin with their coffee but when you add it up, you realise. There’s no surprise that fresh food holds the least calories but if you look at my cookbooks, they’re not full of carrot sticks and lettuce leaves. It’s food that I love cooking and that will help you look amazing.
Bridges unabridged Since shaking up The Biggest Loser, Michelle Bridges has become a one-woman fitness revolution inspiring thousands to shed more than 500 tonnes of collective body weight. With nutrition comprising at least half of the weight-loss equation, she’s also a foodie and tells Heartwise about her 12-week Total Body Transformation program.
HHW: You recommend taking supplements such as multinutrient formula plus vitamin C, and have launched a signature range with Blackmores. Why, if people eat as you suggest? I believe in whole and real food. But the reality is that you can’t always get some because of the season, plus daily we battle stress, changes in environment such as air-con or weather, and pollution. So I still take a multi and in winter take vitamin C and salmon oil. My vision with Blackmores came from going into a chemist or health food store and finding it so disorienting and confusing that I’d go away with just a multi. People needed a range that’s simple with the benefits spelled out, so my supplements cover the basic bases of what you need. HHW: The book recommends that we forget low-fat products but also cautions that butter and full-fat milk or yoghurt is high in the saturated fat ‘bad guys’. Can you explain in
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Photography Henryk Lobaczewski
light of the health debates over fat, cholesterol and sugar? What annoys me about the fat vs carb debate is sweeping statements that everyone takes out of context.My advice is to eat a minimal amount of animal-based food but having said that, I would have butter but not margarine and normal-fat cheese in my fridge — but also low-fat milk because I like the taste! Portion control plays a part as well – I wouldn’t smear slabs of butter on my toast and a cheese like Parmesan has a strong flavour so you don’t need much. HHW: The cardio side of the 12WBT emphasises running or jogging but what if people have joint pain? If you can’t run outdoors for whichever reason, there are low-impact treadmills, stationary bikes and cross-trainers you can use.Boxing gets the heart rate up too. About three years ago I tore my hamstring off the bone, so for six weeks was on a grinder for just my upper body.I was in a world of disbelief over that, thinking it could be all over.But I was very vigilant and diligent with rehab with an osteopath and hot- and cold-water training and have more or less recovered 100 per cent. HHW: How did your injury happen in one so fit and flexible? I had been feeling a little niggle and an ache just below my gluteals and realised they were probably small tears.So I did light a jog with my dog but he raced off and tripped me over, and his lead caught on my bad leg! If you injure yourself, get rehab and sort it out.It’s like a faulty car – you get it fixed. HHW: Could a person with diabetes use the 12WBT? I would manage diabetes almost the same as a weight-loss diet, although if you have type 1, you may not need to lose but increase weight.Again, healthy wholefood produce and green leafy vegetables, small protein portions, and agility and cardio as well as strength training.Consistency is the most important thing. HHW: You’ve spoken out against caged eggs and anti-gag laws that food companies want to prevent animal welfare activists from
Michelle’s eggwhite omelette with toast ServeS: 1 PreParation time: 5 minuteS CooKinG time: 5 minuteS Image and recipe from Michelle Bridges Total Body Transformation, photography Julie Renouf, published by Viking, RRP $29.99.
filming their practices. What should ordinary consumers do? I do my best to make smart, conscious food choices and try not to shove it down people’s throats.What’s ethically produced changes all the time and I stay in touch with fisheries about what’s sustainable, buy organic or free range and talk to the butcher about where their meat comes from. I don’t eat red meat often – maybe once every week, chicken and fish once or twice a week, while other meals are vegetarian. ♥
5 egg whites 1 spring onion, chopped Freshly ground black pepper 4 cherry tomatoes, halved Olive oil spray 1 slice wholegrain bread, toasted 1 small clove garlic, peeled 1. Whisk the egg whites in a bowl until combined. Add the spring onions, pepper and tomato. 2. Heat a small non-stick frying pan and spray with olive oil. Pour in the egg mixture and cook for 2–3 minutes or until cooked through. 3. Serve on a slice of toasted bread that has been rubbed with garlic.
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recipesbreakfast Coloured fruit salad Tessa Kiros PREPARATION TIME: 10 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 5) ENERGY 580 KJ, FAT 0.7 g, PROTEIN 2.5 g, SATURATED FAT 0.1 g, FIBRE 3.7 g, CARBOHYDRATE 33 g, SODIUM 1.7 mg, POTASSIUM 311 mg ★ GOLD STAR RECIPE Serve with low-fat Greek yoghurt to boost protein 700 g watermelon 200 g cherries, stoned 200 g small strawberries, hulled 2 peaches or nectarines, de-stoned and sliced 1 pomegranate Juice of 1 orange 1. Cut up the watermelon into chunky slithers and deseed. Put in a bowl with the cherries, strawberries and peaches. 2. Halve the pomegranate and squeeze the juice from one half into the bowl. Carefully pick out the seeds from the other half, making sure there is no white pith attached, and add to the bowl. 3. Add the orange juice and mix gently but thoroughly. From The Recipe Collection by Tessa Kiros, Murdoch Books 2014, RRP $59.99
Buckwheat pancakes topped with orange & honey Eleanor Ozich PREPARATION TIME: 25 MINUTES
From My Petite Kitchen Cookbook by Eleanor Ozich, Murdoch Books 2014, RRP $39.99
NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 2963 KJ, FAT 21.7 g, PROTEIN 27.1 g, SATURATED FAT 12.2 g, FIBRE 6.9 mg, CARBOHYDRATE 100 g, SODIUM 760 mg, POTASSIUM 520 mg To lower carbohydrate content, serve with fresh berries instead of honey and oranges 130 g buckwheat flour 310 mL milk of your choice 2 free-range eggs 1 tbsp honey/maple or agave syrup, plus extra to serve 1 tsp baking soda
Extra-virgin coconut oil, ghee or butter for greasing 2–3 oranges, peeled, pith removed and cut into wedges Plain yoghurt to serve
1. Put the flour in a large bowl with the milk, eggs, honey, bicarbonate of soda and a pinch of sea salt. Blend until a smooth batter. 2. Melt the coconut oil or ghee in a large frying pan over medium heat. Using one large spoonful of batter for each pancake, ladle the batter into the pan — you should have room to cook three pancakes at a time. Cook for 1–2 minutes on each side until golden. 3. Repeat with the remaining batter, keeping the cooked pancakes warm. Serve with the orange wedges, yoghurt and some extra honey.
breakfastrecipes Corn & crab omelette topped with watercress salad Vanessa Jones PREPARATION TIME: 5 MINUTES COOKING TIME: 10 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 2442 KJ, FAT 42.8 g, PROTEIN 26.8 g, SATURATED FAT 18.4 g, FIBRE 7.3 g, CARBOHYDRATE 23.3 g, SODIUM 587 mg, POTASSIUM 271 mg ★ GOLD STAR RECIPE Try with low-fat milk and halve the butter to reduce fat content 4 eggs 100 ml milk 200 g tinned corn kernels, drained 100 g crab meat 1 bunch tarragon, chopped Sea salt and freshly ground black
pepper 50 g unsalted butter 1 small bunch watercress 1 tbsp verjuice 1 tbsp extra-virgin olive oil
1. Whisk the eggs, milk, corn, crab meat, tarragon and a little salt and pepper in a bowl until combined. 2. Heat an omelette pan to a low heat, add the butter and when melted pour in the egg mixture and cook for 4 minutes. 3. Finish cooking under the grill for a further 6 minutes. 4. Put the watercress in a bowl and coat with verjuice and the extra-virgin olive oil. Top the omelette with the dressed watercress and serve.
From Eating for Eye Health by Ita Buttrose & Vanessa Jones, New Holland 2014
From Don’t give me eggs that bounce, HammondCare Media 2014
Serve with green salad to boost fibre and make the meal more filling
Perfect boiled egg with sourdough soldiers Peter Morgan-Jones PREPARATION TIME: 1 MINUTE COOKING TIME: 10 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 1) ENERGY 1507 KJ, FAT 16.7 g, PROTEIN 17.2 g, SATURATED FAT 6.9 g, FIBRE 1.9 g, CARBOHYDRATE 33.9 g, SODIUM 518 mg, POTASSIUM 196 mg 2 large eggs 2 slices sourdough toast, buttered, crust removed and cut into fingers Sea salt and pepper to taste 1. Place the eggs in a small stainless steel pan and add enough cold water to cover them. Put the lid on the pan and place over high heat until boiling for 1 minute. Remove from heat and wait for 5 minutes. 2. Remove the lid and carefully remove each egg. Cut the top off each egg before serving in egg cups. Season to taste and serve with sourdough soldiers. Spring | Summer 2014 • Healthy & Heartwise
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recipeslunches Nick’s chilli chicken Sneh Roy PREPARATION TIME: 20 MINUTES COOKING TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2081 KJ, FAT 12.4 g, PROTEIN 30.5 g, SATURATED FAT 1.9 g, FIBRE 1.4 g, CARBOHYDRATE 62 g, SODIUM 464 mg, POTASSIUM 411 mg ★ GOLD STAR RECIPE Serve with Basmati instead of jasmine rice because it has a lower GI 2 tbsp vegetable oil 2 tsp ginger paste 2 tsp garlic paste 500 g chicken thigh fillets, cut into 2.5 cm pieces 1 long green chilli, deseeded and sliced 1 small red capsicum, diced ¼ cup chopped spring onions 1 cup chicken stock 1 tsp vinegar 1 tsp soy sauce 4 tsp cornflour ¼ cup chopped spring onion tops, to garnish Steamed rice and sliced cucumber, to serve 1. Heat 1 tbsp of the oil in a saucepan on high heat. Add 1 tsp each of the ginger and garlic pastes. Add the chicken and sauté for a few minutes until browned. Remove from heat, take the chicken out of the pan using a slotted spoon and place into a bowl. 2. Return the pan to the heat and add the other tbsp of oil. Add the remaining ginger and garlic pastes, chilli, capsicum and spring onions. Season with salt. Sauté for a minute, then add the chicken stock, vinegar and soy sauce. Return the chicken to the pan. 3. Reduce the heat to low and simmer for 3–4 minutes.Combine the cornflour with ¼ cup water and stir in.Cook until the sauce boils and thickens. 4. Remove from the heat and garnish with spring onion tops. Serve with hot steamed rice and cucumber. From Tasty Express, RRP $39.95, Ebury Australia 2014
Soft shell crab & sauté of edamame Miguel Maestre PREPARATION TIME: 10 MINUTES COOKING TIME: 5 MINUTES
From Miguel’s Tapas a la Maestre, New Holland 2014
NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 3410 KJ, FAT 31.4 g, PROTEIN 30.9 g, SATURATED FAT 2.6 g, FIBRE 17.2 g, CARBOHYDRATE 93.2 g, SODIUM 2620 mg, POTASSIUM 200.6 mg Remove salt to reduce the total sodium. If most of the rice flour is not used in the coating, carbohydrate per serve will be lower 500 g frozen edamame (soy) beans 1 chorizo sausage, chopped 1 garlic clove, finely chopped 1 bunch chives, chopped Juice of 1 lime 2 tbsp preserved lemon, sliced lengthways DEEP-FRIED CRAB 200 g rice flour 2 tsp chilli powder 2 pinches Szechwan pepper 2 tsp hot paprika 2 tsp sea salt 4 soft shell crabs, cleaned, quartered Vegetable oil for deep-frying 1. Place edamame beans in a small bowl. Cover with water. Stand 5 minutes. Drain. Remove beans from shell and discard shells. 2. Heat a large saucepan. Add chorizo. Cook over medium heat until fat starts to dissolve. Add garlic, chives and beans. Sauté, stirring occasionally until beans are tender. Stir in lime juice and preserved lemon. 3. To prepare crab, combine flour, chilli powder, Szechwan pepper, paprika and salt in a shallow bowl. 4. Dust crab portions in flour mixture. Deep-fry until golden. Drain on absorbent paper. Serve crab with edamame sauté.
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lunchesrecipes 1. Mix the rock salt and sugar in a bowl.
Sugar & salt-cured salmon with asparagus & orange salad & goat’s curd Luke Mangan PREPARATION TIME: 15 MINUTES + 2 HOURS REFRIGERATION COOKING TIME: 5 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2465 KJ, FAT 41.6 g, PROTEIN 32.1 g, SATURATED FAT 6.8 g, FIBRE 5.2 g, CARBOHYDRATE 18.9 g, SODIUM 827 mg, POTASSIUM 688 mg ★ GOLD STAR RECIPE This is a healthy recipe as most of the rock salt and sugar are washed off the fish during preparation 160 g rock salt 100 g soft brown sugar 400 g piece of fresh salmon 50 ml cognac Extra-virgin olive oil, for drizzling ½ cup dill, finely chopped 4 tbsp goat’s curd
SALAD 2 oranges, peeled, deseeded and cut into segments 100 ml extra-virgin olive oil 16 asparagus spears, trimmed 50 g roasted hazelnuts, peeled and roughly chopped ½ cup parsley leaves 4 tbsp tarragon leaves 250 g baby silverbeet leaves
2. Skin and bone the salmon and place on a flat tray. Pour the cognac over and rub it into the flesh. Rub both sides of the salmon with the salt and sugar mix. Cover with plastic wrap and leave in the refrigerator for 2 hours to cure. 3. Rinse the salmon with water, then pat dry with paper towels. Place the salmon on a clean tray and drizzle with a little olive oil. Scatter the dill over the fish and press it on with your fingers. Slice the salmon very thinly using a sharp knife and set aside. 4. For the dressing, squeeze any orange juice from the discarded piths and skin into a bowl, then whisk in the olive oil. If you don’t have enough juice, take one of the orange segments and squeeze the juice in. Season with sea salt and freshly ground black pepper and set aside. 5. Half-fill a saucepan with water and add a little sea salt. Bring to a simmer, add asparagus and blanch for 2 minutes. Remove and cool in iced water, then drain on paper towels and pat dry. 6. Add the asparagus to the orange segments, along with the hazelnuts and herbs. Add most of the orange dressing and toss well to combine. 7. To serve, lay the salmon slices on four serving plates. Add three dollops of the goat’s curd to each plate. Arrange the salad over the top, drizzle with the remaining orange dressing and serve. From Salt Grill by Luke Mangan, 2013 Murdoch Books, RRP $59.99, photographed by Adrian Lander
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recipesBBQ&entertaining Throw a prawn on the barbie Iain Hewitson PREPARATION TIME: 40 MINUTES COOKING TIME: 10 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1459 KJ, FAT 12.8 g, PROTEIN 34.7 g, SATURATED FAT 1.5 g, FIBRE 2 g, CARBOHYDRATE 15.7 g, SODIUM 406 mg, POTASSIUM 517 mg ★ GOLD STAR RECIPE Add some vege kebabs and whole cobs of corn to the BBQ for a complete meal 16–20 large green (raw) prawns in the shell Olive oil spray 2–3 fresh mangoes, peeled and flesh chopped Vinaigrette Fresh coriander sprigs
Mushroom bulgolgi Ross Dobson PREPARATION & COOKING TIME: 20 MINUTES + REFRIGERATION TIME NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 443 KJ, FAT 5.4 g, PROTEIN 5.6 g, SATURATED FAT 0.6 g, FIBRE 2.7 g, CARBOHYDRATE 9.9 g, SODIUM 750 mg, POTASSIUM 547 mg Mushrooms are a good sense of potassium –enjoy in season 200 g fresh shiitake mushrooms 200 g oyster mushrooms 200 g medium-sized field mushrooms 4 pine mushrooms or 2 large king oyster mushrooms, thickly sliced 1 tsp toasted sesame seeds
From Fired Up: Vegetarian by Ross Dobson, Murdoch Books, RRP $34.99, photographed by Brett Stevens and Nicky Ryan
MARINADE ¼ cup Korean or Japanese soy sauce 1 tbsp sesame oil 1 tsp toasted sesame seeds 2 spring onions, thinly sliced on an angle 2 garlic cloves, finely chopped 1 tbsp finely grated fresh ginger
1. Combine the marinade ingredients in a bowl. Cut off and discard any large stems from the mushrooms. 2. Lay the mushrooms in a large, flat dish, pour the marinade over and turn to coat. Cover and refrigerate for 3 hours, or overnight, turning the mushrooms every now and then. 3. Remove the mushrooms from the fridge 30 minutes before cooking to bring them to room temperature. 4. Preheat the barbecue grill to medium. Use tongs to shake the excess marinade off the mushrooms, then arrange them on the grill. Cook the mushrooms, turning them often for 10–15 minutes, or until dark, tender and aromatic. Serve warm, sprinkled with the sesame seeds.
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1. Soak 16–20 wooden skewers in cold water for 30 minutes. Then devein the prawns and push a skewer through each prawn, starting at the tail. 2. Spray all over with oil and carefully cook on a preheated BBQ, regularly turning and spraying with more oil as needed. When pink and firm when squeezed, place on a platter and scatter the mango over. Then sprinkle with the vinaigrette and scatter the coriander over the top.
From Huey’s All-Time Favourites, New Holland 2014
BBQ&entertainingrecipes
From What’s for Dinner?, Random House, 2013
1. To make the marmalade, heat a large heavy frying pan over medium–high heat.Add the butter and swirl the pan to melt it.Add the onions and cook, stirring occasionally, for about 5 minutes, or until they begin to soften.Reduce the heat to low and cook for about 12 minutes, or until the onions are tender. 2. Sprinkle in the sugar and stir well.Add the wine and vinegar and cook, stirring often, for about 15 minutes, or until the liquid is reduced and syrupy.Season to taste with salt and pepper.Reduce the heat to very low and keep warm, stirring occasionally. 3. Meanwhile, make the aïoli: In a small bowl, whisk the mayonnaise, lemon juice, mustard and garlic together. Season to taste with salt and pepper then set aside.
Sliders with red onion marmalade & blue cheese Curtis Stone PREPARATION TIME: 10 MINUTES COOKING TIME: 40 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 5167 KJ, FAT 60.8 g, PROTEIN 69 g, SATURATED FAT 19.8 g, FIBRE 23.6 g, CARBOHYDRATE 85.8 g, SODIUM 1967 mg, POTASSIUM 50 mg Try not to add salt at every step of the recipe RED ONION MARMALADE 45 g unsalted butter 3 medium red onions, halved and cut into half-moons 5 mm thick ½ cup sugar 1 cup dry red wine ¼ cup red wine vinegar Sea salt and freshly ground black pepper QUICK AÏOLI ½ cup mayonnaise 1½ tsp lemon juice 1 tsp Dijon mustard
2 garlic cloves, finely chopped Sea salt and freshly ground black pepper SLIDERS 750 g lean beef mince Olive oil, for coating Sea salt and freshly ground black pepper 8 slider buns or wholemeal dinner rolls, split in half 1 cup crumbled blue cheese 60 g/3 cups baby rocket
4. To make the sliders, prepare an outdoor grill for medium-high cooking over direct heat.Shape the beef mince into 8 patties slightly wider than the diameter of the buns.Set the patties on a baking tray, coat them with a little olive oil and season with salt and pepper.Brush the cut sides of the buns lightly with olive oil. 5. Transfer the patties to the grill and cook for about 3 minutes or until the bottoms are browned.Turn the patties over and top with the cheese.Grill covered for about 2 minutes longer for medium–rare, or until an edge of a patty (not covered with cheese) feels slightly resilient when pressed lightly.Remove patties from grill. 6. Add the buns oiled side down to the grill for about 1 minute or until lightly toasted, then remove.Spread the buns with the aïoli and mound the rocket on the bottom halves.Top each bottom half with a patty, followed by a generous amount of the marmalade and the upper half of the bun.Serve hot.
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recipesdinner Sticky pork chops Kim McCosker NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1341 KJ, FAT 5.9 g, PROTEIN 36.8 g, SATURATED FAT 2 g, FIBRE 0.1 g, CARBOHYDRATE 29.9 g, SODIUM 323 mg, POTASSIUM 985 mg ★ GOLD STAR RECIPE Use less honey if watching carb intake 4 x 170 g lean mid-loin pork chops 1/3 cup Worcestershire sauce 1/3 cup pure honey 1/3 cup no-added-salt tomato paste 1. Preheat the oven to 160°C. In a large frying pan, cook the chops over medium–high heat for 1 minute each side. 2. Remove from the pan and let sit for a minute for the juices to reabsorb. Place the chops in a shallow baking dish. 3. In a small bowl, stir together the remaining ingredients and pour over the chops. Cover and bake for 30 minutes, turning with 10 minutes to go.
Pan-fried fish with vinegar Tessa Kiros
From The Recipe Collection by Tessa Kiros, Murdoch Books 2014, RRP $59.99
PREPARATION TIME: 5 MINUTES COOKING TIME: 15 MINUTES
NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 3490 KJ, FAT 58 g, PROTEIN 52.2 g, SATURATED FAT 7.4 g, FIBRE 1.9 g, CARBOHYDRATE 10.3 g, SODIUM 712 mg, POTASSIUM 22.7 mg A great option for increasing healthy fats in your diet 2 baby fish (each about 300 g), cleaned, gutted and scaled Coarse salt A little plain flour 125 ml olive oil
2 garlic cloves, peeled and squashed 2 bay leaves 2½ tbsp chopped rosemary leaves 125 ml white wine vinegar
1. Pat the fish dry, salt well, then pat in flour on both sides. Heat the oil in a frying pan large enough to hold both fish.When hot, add the fish and cook for a few minutes over high heat until golden underneath.Turn over and salt. 2. Add the garlic and bay leaves and throw in almost half the rosemary. Cook again until the fish is golden underneath.Turn over carefully, taking care not to break the fish, and salt the new topside. 3. The heat should still be high, so sit the garlic and bay on top of the fish if necessary. Add the vinegar and let bubble for 5 minutes until thickened. 4. Add the rest of the rosemary and some black pepper and spoon the liquid over the fish a few times.There should be lots of sauce for serving and the fish will be cooked through. 5. Take the whole pan to the table.The rosemary garlic oil is delicious scraped from the bottom of the pan with chips or bread.
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From 4 Ingredients Diabetes, Simon & Schuster 2013
dinnerrecipes Lamb leg steaks with mint & apple cider sauce Eleanor Ozich Preparation time: 5 MINUTES Cooking time: 16 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 2) ENERGY 4886 KJ, FAT 76.9 g, PROTEIN 75.5 g, SATURATED FAT 26.3 g, FIBRE 1 g, CARBOHYDRATE 19 g, SODIUM 750 mg, POTASSIUM 1123 mg Use smaller fat-trimmed steaks for a lighter version 2 large organic lamb leg steaks, each about 300 g and 2 cm thick, at room temperature 2–3 tbsp olive oil MINT AND APPLE CIDER SAUCE 60 ml apple cider vinegar 2 tbsp honey 1 large handful mint leaves
Empanadillas Miguel Maestre PREPARATION TIME: 15 MINUTES COOKING TIME: 50 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 6) ENERGY 4434 KJ, FAT 51 g, PROTEIN 36.4 g, SATURATED FAT 7.8 g, FIBRE 5.9 g, CARBOHYDRATE 97.7 g, SODIUM 1268 mg, POTASSIUM 176 mg Reduce salt to make this recipe healthier 1 tbsp olive oil 1 large onion, thinly sliced 375 g plain flour 375 g strong bread flour 2 tsp salt 1 tsp paprika 250 ml extra-virgin olive oil 250 ml white wine 300 g passata
From Miguel’s Tapas a la Maestre, New Holland 2014
3 hard boiled eggs, chopped 100 g fresh or frozen peas 425 g can tuna in olive oil, drained 2 piquillo peppers, sliced lengthways 4 cornichons or capers, sliced 1 egg, lightly beaten
1. Preheat oven to 180°C. Line an oven tray with baking paper. Heat oil in a small frying pan. Cook onion until soft and golden brown. Set aside.
1. Sprinkle the steaks with a good pinch of sea salt and freshly ground black pepper, then rub on both sides with the olive oil. Set aside. 2. To make the sauce, put the vinegar and honey in a small saucepan over low heat and bring to a gentle boil. Remove from the heat, then add the mint and a pinch of sea salt and freshly ground black pepper. Stir well, then cover with a lid. 3. Heat a chargrill pan or frying pan over high heat. Cook the lamb for 3 minutes on each side for medium–rare. Leave to rest for 5 minutes. 4. Carve the lamb and serve drizzled with the sauce. From My Petite Kitchen Cookbook by Eleanor Ozich, published by Murdoch Books 2014, RRP $39.99
2. Sift flours, salt and paprika into a large bowl. Stir in combined oil and wine to form a soft dough. 3. Divide dough in half. Stretch half over base and sides of a 24 cm round, loose- based flan tin. Line with baking paper. Fill with rice or baking beans. Cook in the oven for 10 minutes. Remove paper and rice. Cool. 4. Spread with passata. Top with cooked onions, eggs, peas, tuna, peppers and cornichons. 5. Stretch the other half of the dough into a 24 cm circle and top the pie. Trim edges and press with a fork to seal. Make three holes on top of the pastry to let steam out. 6. Brush empanadillas with egg. Cook in the oven for about 40 minutes or until pastry is golden and cooked. Serve hot or cold. Spring | Summer 2014 • Healthy & Heartwise
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recipesdesserts Matcha tea cake Frédérique Jules, Jennifer Lepoutre & Mitsuru Yanase PREPARATION TIME: 10 MINUTES COOKING TIME: 45 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 8) ENERGY 1319 KJ, FAT 14.8 g, PROTEIN 2.6 g, SATURATED FAT 1.2 g, FIBRE 0.9 g, CARBOHYDRATE 43.1 g, SODIUM 117 mg, POTASSIUM 12.8 mg Enjoy the benefits of green tea in this interesting cake 190 g gluten-free flour mix 150 g sugar 1 tsp xanthan gum 1 tsp baking powder 1 tsp matcha tea powder 2 eggs 1⁄3 cup canola oil, plus extra for greasing 200 ml soy/rice milk ½ vanilla bean, halved lengthways and seeds scraped Icing sugar, for dusting 1. Preheat oven to 180°C. 2. Combine the flour mix, sugar, xanthan gum, baking powder and matcha tea powder in a large bowl.
Honey cake
3. Whisk the eggs, canola oil and milk together in another bowl. Add the wet mixture to the dry ingredients, stir in the vanilla seeds and mix. Pour the batter into a greased 1.25–1.5 L loaf tin and bake for 40–45 minutes.
NUTRITIONAL INFORMATION PER SERVE (SERVES 8) Collection by Tessa ENERGY 2343 KJ, FAT 28 g, PROTEIN 4.8 g, SATURATED FAT 16.2 g, Kiros, Murdoch Books 2014, RRP $59.99 FIBRE 1.1 g, CARBOHYDRATE 76.9 g, SODIUM 216 mg, POTASSIUM 150 mg A high-carb cake so eat with a meal low in carbs, such as steak and salad
4. Cool in the tin, dust with icing sugar, then serve the cake with fresh berries.
From Good Without Gluten, Murdoch Books 2014, RRP $29.99.
Tessa Kiros
150 g butter 115 g dark brown sugar ½ cup honey 200 g plain flour 1½ tsp baking powder ½ tsp ground cinnamon 1 tbsp finely chopped rosemary leaves
From The Recipe
2 eggs, beaten LEMON ICING 2 cups icing sugar 100 g butter, softened 1 tsp grated lemon zest 2 tbsp lemon juice
1. Grease and line the base of a 22 cm springform cake tin. Put the butter, brown sugar and honey in a small saucepan and add 1 tbsp water. Heat gently, stirring once or twice, until the butter melts and the sugar dissolves. Leave to cool for 15 minutes. 2. Preheat the oven to 180°C. Sift the flour, baking powder and cinnamon into a bowl and add the rosemary. Add the honey mixture and eggs and beat until smooth. 3. Pour into the tin and bake for 35–40 minutes, or until a skewer comes out clean when you poke it into the centre. Leave in tin to cool. 4. Sift the icing sugar into a bowl. Add the butter, lemon zest and juice and 1 tbsp water and beat until smooth. Spread icing over top and side of cake.
dessertsrecipes Lemon ricotta cake Peter Morgan-Jones PREPARATION TIME: 15 MINUTES COOKING TIME: 45 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 8) ENERGY 1666 KJ, FAT 18.4 g, PROTEIN 11.2 g, SATURATED FAT 5.4 g, FIBRE 1.9 g, CARBOHYDRATE 48.5 g, SODIUM 83.4 mg, POTASSIUM 249 mg An interesting cake that provides calcium and protein 75 g butter 170 g caster sugar 100 g ricotta 3 eggs, separated 175 g plain flour 3 tsp baking powder Grated zest from 1 lemon
From Don’t give me eggs that bounce, HammondCare Media 2014
50 ml fresh lemon juice 30 g flaked almonds (garnish) Icing sugar, to serve 250 g ricotta mixed with 300 g vanilla yoghurt to serve 1 cup figs or strawberries to serve
1. Preheat oven to 180°C. Grease a 23 cm springform tin and line the bottom with baking paper. Dust tin with a little flour. Cream the butter and sugar together until smooth. Beat in the ricotta. 2. Beat the egg yolks, add 1 tbsp of the sifted flour, lemon juice and zest and then add to the ricotta mix. Sift remaining flour and baking powder and beat into the ricotta mix until blended sufficiently.Whisk the egg whites until they form peaks. Fold carefully into the ricotta mix using a metal spoon. 3. Pour into the lined tin and sprinkle the top with the flaked almonds. Bake for 45 minutes at 180°C, remove and let cool. Sprinkle with icing sugar and serve with figs or strawberries and blended ricotta and yoghurt.
From 4 Ingredients Diabetes, Simon & Schuster 2013
Cashew crème Kim McCosker PREP TIME: 5 MINUTES + OVERNIGHT SOAKING NUTRITIONAL INFORMATION PER SERVE (SERVES 8) ENERGY 395 KJ, FAT 7 g, PROTEIN 2.9 g, SATURATED FAT 1.2 g, FIBRE 0.5 g, CARBOHYDRATE 7 g, SODIUM 1.9 mg, POTASSIUM 103 mg A great option for those who are dairy-intolerant 120 g raw unsalted cashews 1 tbsp fresh lemon juice 1 tbsp honey 1. Place the cashews in a bowl and cover with water. Soak overnight. Drain, reserving liquid, and transfer the soaked cashews to a blender. 2. Add the lemon juice and ¼ cup of reserved liquid and blend until smooth. Stop a couple of times to scrape the mixture down over the blades to ensure a smooth blend. Spring | Summer 2014 • Healthy & Heartwise
67
livingwithdiabetes glucose meter are a tool to help you and your healthcare team make changes and work towards a healthier you. These numbers are not an end in themselves. How you choose to use them will depend on the type of diabetes you have, how long you have had it and your personal needs and choices.
The diabetes distress dilemma Diabetes may lead to specific problems and increased stress that we often call ‘diabetes distress’ [see box]. It is not inevitable that you will have all or any of these problems because are different – it is, however, important to understand that diabetes is in itself a full-time job whose management can bring increased stress. This can make it easier to be gentle on yourself when things get tough and to seek support. Daily life and general stress levels can affect your diabetes control. How your diabetes is going can in turn affect your stress levels – so it is a bit ‘chicken and egg’. Getting general stress under control will assist with your diabetes management. Likewise, feeling settled with your diabetes management will decrease your overall stress. Diabetes burnout is a common problem, particularly if you are under too much stress. The daily effort to manage diabetes can become grinding, especially when the results are not what you wanted despite you working hard and doing all you can. Burnout is much more than feeling a little down. It is an overwhelming feeling of helplessness and hopelessness that you cannot continue managing your diabetes – people often give up at this point and depression can occur.
Putting the brakes on burnout
1. Which elements of diabetes are causing you problems? Sometimes ‘just diabetes’ is described as the problem but just specific issues may cause difficulty and you are actually doing okay otherwise. For example, you may be checking your BGLs and exercising regularly but finding what you eat hard to manage. Realising what you have achieved gives you perspective and something to build on. 2. What’s happening in life that might be conflicting with diabetes care? What obstacles and barriers are making it harder to manage diabetes? How might you deal with these other parts of your life? Sorting them out will in turn make diabetes management easier.
CAUSES OF DIABETES DISTRESS • Worry about food changes • Management of BGLs • Weight management • Going onto insulin/medication • Hypoglycaemia (low BGL) • Depression and mood swings – shown to be higher in people with diabetes • Relationship and sexual problems • Work stress, discrimination in relation to your diabetes • Disclosure – wondering if you should tell people about your diabetes • Lack of understanding or support from family/friends • Guilt, fear, worry, panic and anxiety about diabetes and your future • Risk of complications • Feeling alone and isolated • Seeing or hearing about all the things that can go wrong • Feeling out of control • Other mental health problems such as eating disorders • Feeling overwhelmed and exhausted • Lack of information 3. What do you expect of your diabetes management currently? What are your targets? 4. Are your goals realistic right now? We can expect too much or too little of ourselves. You may need to work harder or ease off on your diabetes management, depending on what else is happening in your life and with your health. 5. Are there difficult emotions you need to process? Sadness, anger and grief can arise
More than feeling a bit down, burnout is an overwhelming state of hopelessness from diabetes diagnosis or another event. These emotions can be uncomfortable but very important. Acknowledging, accepting and working through these feelings so you can move on with your life can help.
Do not suffer in silence Ask for help when you need it. This may be from your usual doctor, diabetes educator or other health practitioner, or a friend, family member or someone else you trust. Alternatively, an independent counsellor or psychologist can listen and provide support. ♥ Helen Edwards, BASW, MAASW, is a Diabetes Educator and Founding Director of Diabetes Counselling Online: www.diabetescounselling.com.au Spring | Summer 2014 • Healthy & Heartwise
68
livingwithdiabetes
Diabetes burnout
Diabetes can affect you physically, emotionally, socially and psychologically. Recognising these demands and balancing them with the rest of your life will prevent you from feeling overwhelmed, says Helen Edwards.
D
iabetes requires self-management every day. This means you need to be in the driver’s seat and you should be at the centre of your diabetes management team. Diabetes is often an unpredictable and tricky disease to manage. It can feel frustrating and pointless, and can complicate life in general! Targets in diabetes are important, such as blood glucose levels (BGL), HbA1c or A1c (the average BGL over the past 8–12 weeks), blood pressure and so on. However, this can make you
feel like you are ‘sitting an exam’ every day. The results of BGL checks, managing your weight, choosing healthy foods, managing insulin ratios and exercise, etc. can lead to guilt, worry and stress. If you start to feel you are not ‘doing the right thing’ and/or ‘getting the right results’, it can lead to diabetes distress and you may end up blaming yourself. Talking about ‘high and low’ BGLs and not ‘good and bad’ can be a healthy place to start. The results from your home blood
69 Healthy & Heartwise • Spring | Summer 2014
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Asktheexpert
diabetes
& Qa
Prof Trisha Dunning answers common questions arising from her extensive career in diabetes management.
Snoring or the hum of a machine?
Q
I have sleep apnoea and I use the CPAP machine at night. I think it helped with the snoring but I worry whether its humming noise affects my partner’s sleep and her memory. Can you explain?
Professor Trisha Dunning, AM, PhD, RN, MEd, FRCNA, is the Chair of Nursing at Deakin University and Barwon Health, and VicePresident of the International Diabetes Federation These questions from Conquest Autumn 2014, Summer 2012
Ask Trisha Email your queries about diabetes to steven@healthpublishingaust.com.au with ‘Ask TrishA’ as the subject
a
research shows partners’ sleep quality and general health are affected by the symptoms associated with sleep apnoea, especially snoring — in fact, it is often the reason the individual seeks medical advice. sleep apnoea is where the person stops breathing for about 10 seconds or longer when they are sleeping.When breathing stops, the person becomes restless, gasps for breathe, wakes and then goes back to sleep. These episodes can occur several times a night. Quality ‘slow-wave’ sleep is important to how people store information in the memory bank in the brain. The brain also files the emotions the person felt at the time with the stored memories; women are more likely to store emotion-laden memories. Management options for sleep apnoea include mouth appliances that open up the back of the throat, such as wearing a continuous positive airway pressure mask (CPAP) during sleep. The mask is not very comfortable but it is effective for many people. CPAP increases pressure in the throat and improves sleep quality. Modern CPAP machines are not as noisy as the older versions but they do make an electrical humming noise that can disturb some. Likewise, CPAP machines are not very sexy. You and your partner should discuss these issues and how you can resolve them with your doctor or a sleep specialist.
Is my type 2 diabetes becoming type 1?
Q
I was diagnosed with type 2 diabetes about seven years ago and was put on diet and exercise for about a year before my GP started me on metformin and then other
71 Healthy & Heartwise • Spring | Summer 2014
tablets to help me make insulin. Last week my doctor said the tablets were not controlling my blood glucose and I need insulin. My blood fats are high, too. I am worried because my diabetes seems to be getting more serious and complicated. Has my diabetes changed to type 1?
a
You still have type 2 diabetes. Both types 1 and 2 diabetes are serious and require regular monitoring and a great deal of self-care. Often when the BGL is high, the blood fats are also high. Controlling the blood glucose can help reduce the blood fats, but you might need tablets as well. research shows that in type 2 diabetes, the beta cells in the pancreas slowly lose their ability to produce insulin, so there is not enough to keep the BGL in an acceptable range.This means the tablets that stimulate the pancreas to produce insulin are not effective.These would probably be the ‘other’ tablets your doctor started. Metformin helps the cells take up glucose. Usually medicines that stimulate the beta cells are stopped when the person starts on insulin. however, metformin is often used with insulin because it helps the insulin move the glucose into the cells. it would be useful to discuss these issues with your diabetes educator or doctor and perhaps seek advice from a dietitian. Write down your questions before you visit them so you do not forget to ask important information. ♥
exercise&diabetes
Exercise after injury One of the biggest barriers to fitness and exercise is an injury but there are rehab exercises for almost any sort. Christine Armarego shows how pain needn’t stop play.
A CHRISTINE ARMAREGO, ESSAM, MAppSci (Ergonomics), MAppSci (Ex Rehab), is an accredited exercise physiologist and manager of The Glucose Club
n injury can really put the brakes on some people moving into a healthy lifestyle and often is a reason why otherwise active, sporty people stop exercising altogether. They think “I’ll just give it a rest” but in reality they rarely return to regular activity.
8 reasons to stay active You can exercise around an injury, and there are several reasons why you should: 1. Maintain appropriate blood glucose and HbA1c levels 2. Maintain a healthy weight 3. Maintain cardiovascular fitness
73 Healthy & Heartwise • Spring | Summer 2014
4. Maintain your mood — important if you are in pain! 5. Maintains overall fitness while the injured part recovers 6. Maintains the exercise habit so you don’t have to restart, or helps you form one if you haven’t started one 7. A chance to try new activities until you can return to your previous ones 8. An opportunity to start exercising at a comfortable level and build from there. Eventually you will end up exercising the injured part with specific and targeted
exercise&diabetes
Exercises for common injuries
NECk & SHoUldEr • Walking • Hydrotherapy • leg weights • Arm weights for the non-affected shoulder • Cycling
BAck Ranges from a minor strain or overuse to more serious disc and nerve problems. Consider: • Hydrotherapy • Walking • Cycling (stationary bike) • Pilates or core-specific exercises
LEG • Arm ergo at the gym • Swimming with a pull buoy to support legs • Hydrotherapy • Upper-limb weights • Exercises for nonaffected leg • Pilates or core-specific exercises
rehabilitation and exercise program to return you to your previous exercise.
exercises from a health professional like a physiotherapist — it’s called rehab!
It’s essential that you keep your injury monitored
Getting started
Pace it with a professional
1. Get your injury checked by your GP and then a specialist or allied health professional as per your GP’s recommendation. 2. Follow their recommendations for exercise for the injury and ask what can you do around it — and see the ‘Exercises for common injuries’ diagram above. 3. Once you are out of the acute phase (up to at least six weeks), get along to your local Accredited Exercise Physiologist. They can help you build and progress your
It’s essential that you keep your injury monitored — ask your allied health professional to help you determine when to progress and when to back off. Rest is important to recovery! So start gradually and listen to them. Ask them specifically about other exercise you can perform for the rest of your body and what you need to be careful about. Don’t let an injury derail your healthy lifestyle or prevent you from getting one. It is possible and those of us in the medical and allied health professions are here to help! ♥
Spring | Summer 2014 • Healthy & Heartwise
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diabetesreallifestory Evidence overcomes laziness
Grant on holiday in France in June
Weight – lift it to lose it! Exercise physiologist Kelly McLeod shares a case history where three months of highintensity resistance training shed 40 kilos and reversed a diagnosis of type 2 diabetes.
G KELLY MCLEOD, BSc(Health & Sports Sc), ESSAM is an Accredited Exercise Physiologist at the University of NSW Medicine Lifestyle Clinic
rant was referred to the Lifestyle Clinic by his GP early 2013 to help manage his type 2 diabetes. He was shocked by his diagnosis in 2010 and despite lapband surgery and medication, was still having difficulty managing his weight and blood glucose levels (BGLs). Weighing 136 kg and measuring 137 cm around his waist, Grant had a BMI of 43.9 and high risk of developing complications and even premature death. The gold standard for monitoring diabetes is HbA1c or glycosylated haemoglobin, which provides a three-month reading of blood glucose control over the long term. Ideally, HbA1c is less than 6% for people with diabetes — Grant’s HbA1c of 6.8% meant he was at risk of developing foot, eye and kidney conditions. Grant’s health was also affected by other conditions, including high blood pressure and cholesterol levels, and depression. Working from home as a writer meant a lot of time sitting rather than moving.
75 Healthy & Heartwise • Spring | Summer 2014
Grant wanted to beat diabetes and felt ready to make a serious lifestyle change. But his motivation posed the biggest barrier to exercise. “I have a laziness towards exercise,” he commented during our initial appointment. Walking the dog every day wasn’t enough so he was looking for help to make a lasting difference. Grant was taking metformin, one of the most commonly prescribed medications that lowers blood glucose, but became very interested to learn that exercise could deliver similar results. A landmark analysis of research found in 2001 that people with type 2 diabetes can achieve HbA1c reductions of 0.74% and 1.2% with aerobic and resistance exercise, respectively. A six-month study showed a year later that sedentary, overweight people with type 2 diabetes who undertook high-intensity resistance training (HIRT) reduced their HbA1c by up to three times more than if they just followed a healthy eating weight-loss plan.
Going strong Grant began the ‘Strength Clinic’ program for the kickstart he wanted. Coming two-to-three days a week for supervised HIRT, Grant soon learnt about exercise technique and intensity to complement his newfound understanding of the health benefits. The Lifestyle Clinic programs focus on developing the client’s self-managing skills so they have strategies to manage motivation. Grant’s self-confidence and exercise knowledge increased immensely over the 12-week program. A recent glucose tolerance test revealed that Grant is now normoglycaemic, i.e. his BGLs are in a healthy non-diabetic range. His fasting BGL is 4.9 mmol/L and HbA1c is 5.8%, meaning his risk of diabetes complications such as heart or kidney disease is low. He has lost 40 kg and 32 cm around his waist! Then there are additional benefits – increased strength and aerobic fitness. Clients are encouraged to move to a community gym or home-based programs when they finish and since early 2014, Grant has been exercising independently in his local gym. He attends six days a week and performs a variety of aerobic and resistance exercises. Every three-tosix months Grant sees his exercise physiologist to review his program and keep motivated. Grant now has a new lease on life, feeling in control of his health and lifestyle using exercise and nutrition as pillars for diabetes management. ♥
eatingwithdiabetes
Sweet is the flavour of our globalised century, with sugar the number one commodity driving tastes and dietary intake. Its links with ‘diabesity’ has led to a new world of alternative sweeteners opening up. Dietitian Milena Katz investigates.
A
n explosion of new sweeteners has hit your local shops in the last five years and many of these are being labelled‘natural’. We are now finding foods such as yoghurts, biscuits and dairy desserts tasting sweet despite being labelled sugar free. So how do we decide what to use in cooking and our daily cuppa?
MILENA KATZ, BSc (Nutr), BTeach, AN, is an Accredited Practising Dietitian in private practice in Sydney
Synthetic v natural First, there is the distinction between the artificially made sweeteners and the more hyped, naturally occurring ones. Artificial sweeteners are often called non-nutritive because they generally provide little or no
77 Healthy & Heartwise • Spring | Summer 2014
kilojoules and usually do not affect blood glucose when consumed in small quantities. Several intense synthetic sweeteners are approved for use in Australia and New Zealand. These are alitame, acesulfame potassium (Ace K), aspartame, advantame, cyclamate, neotame, saccharin, sucralose, steviol glycosides and thaumatin. When shopping, the most common sweeteners you will find in your packaged foods are aspartame (food additive code 951, Nutrasweet™, Equal™) and sucralose (food additive code 955, Splenda™). They are both much sweeter than sugar (sucrose) so often
eatingwithdiabetes Sugar alcohols Sugar alcohol
Sources
Uses
Energy (kJ/g)
Xylitol
Commercially extracted from birch tree bark or corn cobs
Mints and chewing gums that warn of its laxative effect if consumed in excess
8.37
Mannitol
Found naturally in strawberries, onions, celery, mushroom and pumpkins. Commonly produced via the hydrogenation of fructose, which is formed from either starch or sucrose
Coating for hard candies, dried fruits and chewing gums because it is resistant to absorbing air moisture
6.7
Sorbitol/ glucitol
Derived from glucose in cornstarch. Most sorbitol is made from corn syrup, but it is also found in apples, pears, peaches and prunes
Often used in sugar-free gum and soft drinks, jellies, jams, baked goods and sweets
11
aspartame and sucralose are mixed with maltodextrin or dextrose so that they become only as sweet as sugar. Once mixed, these provide about 0.5–1 g of carbohydrate, which is significantly less than a teaspoon of sugar (4 g of carbohydrate). And importantly, aspartame contains the amino acid phenylalanine, so a warning label is required on any product containing aspartame for people with the rare genetic disorder phenylketonuria (PKU), who cannot metabolise phenylalanine. Familiar natural, nutritive sweeteners include sucrose, fructose, agave nectar, fruit juice and honey. Each provides about 16.75 kJ/g.There are also sugar alcohols (also known as polyols – see table) such as xylitol and sorbitol, which are considered nutritive sweeteners, providing an average of 8.37 kJ/g because of their incomplete digestion and absorption.
Sucrose – poison or passion? There is growing media attention about how detrimental sucrose or cane/table sugar is for human health. Dietary guidelines continue to recommend limiting added sugars, which usually occur in food manufacturing and at our tables in hot drinks, cakes and biscuits. Sucrose appears in sauces such as tomato, barbeque and sweet chilli. Our palettes are primed to enjoy sweetness so it takes time to adjust to the tastes of foods with limited sugar. Reports show that finally the consumption of sugar in Australia at least has slowed down and the message of sugar reduction is hitting our homes.
Fructose minus fuss Fructose is a fruit sugar often made from sugar cane, sugar beets and corn. Pure fructose is sweet, white and comes in the form of small crystals. From plant sources, fructose is found in honey, fruits, flowers, berries and root vegetables. The synthetically manufactured sweetener high-fructose corn syrup (HFCS) uses hydrolysed cornstarch as the raw material for
Putting a little sweetness in your diet Use small amounts of sweeteners and check your blood glucose to see their effect on you
Agape over agave Agave syrup is made from several species of agave plant. Most agave syrup comes from Mexico and South Africa. It has a fructose content even higher than high HFCS (by weight) and therefore has a higher potential to lead to insulin resistance and significantly increased triglyceride levels.
Wholefoods, such as fresh fruits and dairy, to boost the flavours of your desserts
Stevia of South America
Cook and bake with less sugar than specified in the recipes Infuse tea with dried fruit, such as apricots and sultanas Bake fruits such as apples and pears and serve with natural yoghurt to get a sweet treat
its production. Often, HFCS is used in soft drink manufacturing, especially overseas. Fructose was always advised for diabetes because it does not trigger the production of insulin by pancreatic beta cells. Fructose has a low Glycemic Index (GI) of about 20, compared with 100 for glucose and 70 for sucrose. Fructose is also much sweeter than sucrose at room temperature, so people with diabetes can use less of it. Studies have compared HFCS to table sugar and found that most measured short-term physiological effects are equivalent for blood glucose, insulin, leptin and ghrelin (appetite hormones) levels. Consuming large amounts of fructose may trigger fructose malabsorption, metabolic syndrome, elevated triglyceride and insulin levels, and accelerated uric acid formation.
A plant cultivated by indigenous tribes for 1500 years and made into a sweetener by the Japanese in the 1970s, stevia is now used around the world in foods and beverages. In Australia, stevia was approved for consumption in 2008. Some stevia sweeteners have an added bulking agent for palatability and reduced aftertaste. It has negligible effect on BGLs so is popular for people with diabetes. To make stevia resemble sugar granules, an extract from the plant is blended with a sugar alcohol [see table] and bulked up with an excipient such as maltodextrin (a refined starch that breaks down into glucose), which can add kilojoules via carbohydrate. Brand names with bulking agents include SweetLeaf (inulin) and PureVia (dextrose and cellulose). ♥
Spring | Summer 2014 • Healthy & Heartwise
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livingwithdiabetes
NEW management guidelines Care of diabetes evolves with medical understanding of its many influences and effects. Self-care is also changing – and being customised to suit your needs, as Jayne Lehmann explains. Jayne Lehmann, RN, is a Credentialled Diabetes Educator with EdHealth Australia: www.edhealthaustralia.com
Type 2 diabetes goals What can you expect from the new guidelines? Here’s a snapshop taken from their executive summary: • Eat a normal healthy diet – a Mediterranean diet is helpful if at risk of cardiovascular disease • If overweight, try to lose 5–10% of your body weight e.g. 80 kg = 4–8 kg weight loss • If very overweight, extra strategies to support weight loss should be discussed • Do at least 30 minutes of moderate physical activity on most/all days • Don’t smoke • Drink no more than 2 standard drinks per day • Generally aim for long-term glucose level (glycosylated haemoglobin or HbA1c) under 7% unless otherwise suggested • Keep blood fats (lipids) under control to decrease risk of heart disease, aiming for: – Total cholesterol <4 – HDL cholesterol >1.0 – LDL cholesterol <2.5 – Triglycerides <2 • Blood pressure ≤130/80 mmHg • Annual urine test result for microalbumin <3.5 for women and <2.5 for men • Keep vaccinations up-to-date, including flu, pneumococcal disease
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J
ust as you keep your diabetes knowledge up-to-date so too does your general practitioner. The Royal Australian College of General Practitioners (RACGP) has released updated General Practice Management of type 2 diabetes 2014–2015 to guide GPs in their advice to people with type 2 diabetes. This is the 18th edition of the guidelines and the first written completely by members of the RACGP Diabetes Network. Current research was reviewed and guided the advice in the guidelines.While it has been distributed to GPs across Australia, you are likely to also find it in the office of your diabetes educator and other health professionals interested in diabetes care.
WHO NEEDS TO SELF-MONITOR? The RACGP guidelines recommend people with type 2 diabetes check their blood glucose levels (BGLs) regularly if: • using insulin to treat their diabetes • changing their insulin dose in response to BGLs • taking one of the sulphonylurea class of diabetes medicines (e.g. gliclazide, glibenclamide, glipizide, glimeperide) that can cause low BGLs (hypoglycaemia) • pregnant or planning a pregnancy • feeling unwell or with an infection • they have a haemoglobinopathy, a condition that affects red blood cells and can skew HbA1c results • BGLs are checked for high or low patterns. Let’s face it, monitoring BGLs can be a pain – literally! Given the time and effort it takes, it’s best to make sure it’s working for you. To look for high or low patterns in your BGL monitoring: • check levels across the day • know what you are looking for • know what to do when you find it. Research has shown you can improve BGLs by doing seven tests (before and two hours after each meal and before bed) for three days. This sounds like a lot but what if it means you can have a break at other times?
livingwithdiabetes MONDAY
TUESDAY
8:00
8:00
10:00
10:00
12:00
12:00
14:00
HOW YOUR DIABETES CARE MAY CHANGE 1. Check with your doctor that it is safe for you to aim for the levels recommended in the RACGP guidelines: • BGLs 6–8 mmol/L fasting, 8–10 mmol/L two hours after meals • HbA1c under 7% (53 mmol/mol).
14:00
16:00
16:00
18:00
18:00
20:00
20:00
EVENING
2. Check your BGLs in a structured way for quality not quantity of results. The table below suggests when to change blood glucose monitoring (BGM), which a diabetes educator can help you customise.
EVENING
WEDNESDA 8:00
If you use meaningful information, you don’t have to check as often and you can have a break when all is well!
Y
10:00 12:00 14:00 16.00 18.00 20.00 EVENING
THURSDAY 8.00 10.00
Ask yourself:
12.00 14.00
3pm doctor ’s 16.00 appointment – then a BRE AK 18.00 from tests !! 20.00 EVENING
Yes
No
Are my levels high or low right now?
Increase BGM
Decrease BGM
Do I want to gather information about my levels quickly? e.g. hypoglycaemia
Increase BGM
Decrease BGM
Am I at risk of a hypo?
Increase BGM
Decrease BGM
Have a break
Increase BGM
Check 2 hours after eating it
Don’t check
Is everything okay with my levels? Do I want to see the impact of a food on my levels?
If you test intensively for 3 days, you may not have to check as often and can have a break ⇑ Testing before and two hours after each meal and before bed for three days helps show patterns in your glycaemic control
The intensive testing helps you structure your testing to see where your BGLs are forming patterns of lows and highs. Your doctor or diabetes educator can review these and suggest changes to get them back on track. Other options are to check: • once a day or twice a week but not at the same time – rotate the times (among the seven times above) to check levels across the day but over a longer time period • 2 hours after eating something and you want to check its impact on BGLs • if you are sick or have an infection • if your levels go up or down.
Answers
3. Act on any patterns of high or low levels by reviewing your: • food • exercise stress • illness or infection • medication – ask your doctor or diabetes educator for the targets you should be aiming for given your specific health issues. More than likely, they will be using the new guidelines in their advice! Go to www.adea.com.au to find a diabetes educators near you who can help you: • choose the right meter • get an accurate BGL result • understand what their BGL results mean • act on the result to make a difference to their health • customise their BGM • have a break from BGM when levels are on target. ♥
Spring | Summer 2014 • Healthy & Heartwise
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diabetesnews
NUTRIENT WARS
Kidney disease climbs DIALYSIS AND kidney transplants have more than doubled in the first decade of the 21st century in Australia and could do so again in the next 10 years, says the Kidney Research Group at the University of Sydney. The most serious and life-threatening form of end-stage diabetic kidney disease increased 130% between 2000 and 2010, one of the largest increases of any developed country. In 2012 nearly 1000 Australians commenced dialysis or kidney transplantation at a cost of approximately $80,000 p.a. per patient, and this number could more than double by 2025 if the incidence of diabetes continues to rise, the Group’s report warned. While poor glycemic control accelerates the progression of kidney disease, worsening renal health in turn increases the rate of diabetes complications, said Dr Tim Mathew, National Medical Director at Kidney Health Australia. “It really is a sinister relationship,”Dr Mathew said.“Diabetic kidney disease is reaching epidemic proportions, with direct healthcare costs now approaching $1 billion annually.” The number of people with diabetic kidney disease is also projected to grow from about a quarter to half a million in the next decade. About a quarter of people with type 2 diabetes will develop the complication.
Diabetic kidney disease is often not diagnosed until much of the person’s renal function is gone and life-saving treatment no longer possible. In end-stage kidney disease, less than 10% of renal function remains. Almost 5000 Australians with end-stage kidney disease from diabetes now depend on a transplant or dialysis to survive. “For every diabetes patient with end-stage kidney function, another 60 have earlier stages of diabetic kidney disease. Many more people will progress to dialysis or transplantation if we don’t intervene now,”said Dr Mathew. However, North America and several European countries had managed to stem the rise in new cases of treated end-stage kidney disease through using more effective diabetes therapies and kidney-protective blood pressure medicines. Increased funding is needed to support the prevention and early detection of diabetic kidney disease, Dr Mathew said.“Monitoring for kidney disease must be made a high priority for all people with type 2 diabetes and more effort needs to be made to ensure that glucose control is optimised and other issues such as blood pressure and lipids targets are met. This means better control of diabetes in the first instance.” www.kidney.org.au
END-STAGE DIABETIC KIDNEY DISEASE
INCREASED 130% BETWEEN
20 00
10 20
DIETARY GUIDELINES for diabetes management need reappraisal with a view to reducing carbohydrate content, say the authors of a major nutritional review. Numerous US physicians coauthored the review that set out several points of evidence for discussion. Low-carbohydrate diets – less than 130 g/day or 26% of total energy intake – have been shown to reliably reduce high blood glucose, the chief feature of diabetes, said the reviewers. And during the epidemics of obesity and type 2 diabetes, analysis of US nutrition surveys between 1974 and 2000 showed that increases in energy intake were due almost entirely to increased carbohydrate. The benefits of carb restriction do not need to include weight loss because metabolic changes were more relevant, the doctors said, although they found no other diet was better when it came to losing weight. The authors also presented evidence that low-carb diets reduced or eliminated medication for diabetes and had no side effects compared to intensive drug treatment. Nutrition 2014; online 16 July
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diabetesnews
Is Big Farmer to blame? OUR CONTEMPORARY environment, particularly in agriculture and the food chain, has encouraged and contributed to our unhealthy lifestyle choices and resulted in soaring rates of type 2 diabetes, says leading public health figure Prof Stephen Leeder. “Agricultural subsidies for cash crops can be a health hazard,” warned Prof Leeder in the Medical Journal of Australia, pointing to subsidised corn and soybean oil in the US that led to cheap ultraprocessed foods and highfructose corn syrup sweetening beverages – now appearing in Australian convenience stores – linked with obesity [see pages 76–7]. “But with reduced subsidies corn farmers are now planting orchards and growing vegetables. Cause and effect cannot be disentangled, but changes in agriculture are occurring in parallel with health awareness. Farm incomes are recovering in parallel with increased sales of fruits and vegetables,” noted
Prof Leeder. Food processing practices also needed to improve to lower sugar and salt levels and replace trans and saturated fats as occurred recently in the US under consumer pressure, legislation and an innovative industry. Prof Leeder, who is with the Menzies Centre for Health Policy at the University of Sydney, also criticised urban planning and infrastructure that discouraged walking. “Instead, sitting sullen and stressed in traffic jams is normative… More safe bicycle lanes, aesthetic rather than cracked and lumpy footpaths, and accessible public transportation systems increase physical activity levels.” MJA 2014;201(4):185–6
Diabetic women’s hearts more at risk MEN DEVELOP DIABETES AT AROUND
120%
OF THEIR WEIGHT,
WOMEN DEVELOP DIABETES AT AROUND
160%
OF THEIR WEIGHT
WOMEN WHO have type 2 diabetes are at 40% greater risk of heart disease than diabetic men, according to Australian research. Health researchers at the University of Queensland looked at the results from 64 studies and found that women who developed diabetes had an additional 44% risk of being diagnosed with coronary heart disease (CHD) – but this was probably not from differences in treatment. Although the same researchers had found previously that diabetic women have a 46% higher risk of dying from CHD and a 27% higher risk of stroke than men with diabetes, and men in the past received better diabetes treatment, more recent studies show women often get better treatment. Lead investigator Prof Rachel Huxley, from UQ’s School of Population Health, said the difference was due to women spending longer periods in a
81 Healthy & Heartwise • Spring | Summer 2015
prediabetic state, with persistently high blood glucose levels just below the threshold for diagnosis of type 2. Where men develop diabetes at around 120% of their normal weight, women are not likely to develop it until they are 160% of their normal weight. “Women’s metabolic and vascular risk factor profile has to deteriorate to a greater extent than men to become diabetic,” said Prof Huxley. This makes early detection and screening for prediabetes crucial, especially in women with a history of gestational diabetes, she added. Diabetologia 2014; online 22 May
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