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SPRING 2015 VOL 57

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SUBS 13! CRIBE & GIFT PA WIN! CK O

SPECIAL FEATURE SUPERFOOD DECODER Know your cocoa from your cacao

CERTIFI F AUSTRALIA ED O N PRODU RGANIC CTS

Zaetta forever! Tania teaches how to stay eternally toned The gutsy route to strong immunity

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Clever ways to save your memory

in-season ingredients, nutrients analysed

Inflammation – fighting it with food $7.95

HEALTH & THE OLDER WOMAN: HORMONES, BONES & BODYWEIGHT 3

Autumn 2012

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

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

KATHERINE BAQLEH BMedSci, MNutrDiet, APD, AN Katherine is an Accredited Practising Dietitian and nutritionist and founder of Health Victory Nutrition Experts, a private practice and nutrition consultancy located in clinics across Sydney. Katherine currently conducts private consultations, seminars and conferences in a number of community and corporate settings. Her main passion lies with cardiovascular disease, diabetes and weight management.

ASSOC PROF ROSEMARY HIGGINS DPsych (Health), MAPS, MCHP A psychologist with an interest in chronic disease and mental health, Rosemary was recently made Honorary Associate Professor in the Faculty of Health at Deakin University. She is a Senior Research Fellow with the Heart Research Centre at The Royal Melbourne Hospital. Rosemary also practises at Cabrini Health, Malvern, and is Chair of the College of Health Psychologists, Victoria. Follow Rosemary on Twitter @higginsrosemary

From the

EDITOR

s the season of renewal and change, spring is the best time for appreciating all that's new, fresh and stimulating. It’s therefore a very good time to be getting a new look and feel for Heartwise, which for its 15 years’ worth of volumes has always been a glossy, and for the past several had a reverse back cover and regular department, ‘Dealing with Diabetes’. As you now behold, the shine has turned to matte and diabetes retains a dedicated presence (see page 70) but, thankfully for the ease of production and your own comfort, the right way up. Increasingly, cardiovascular disease and diabetes are thought of as two outcomes of the same metabolic disorder with overlapping symptoms and risk factors, and share prevention strategies that don’t cease with diagnosis, surgery, medication or rehab. Good nutrition, rest and exercise remain essential to health before and after any sort of medical intervention, so remain Heartwise’s focus over the following 72 pages. That is eight pages fewer than usual but there is also less advertising. Although many readers would not mind this and it’s great for editorial independence, few independent publishers can maintain such a model financially. But few are not nought! Editorial quality can be maintained without the classic tension with advertising if readers vote with their credit cards and subscribe. Whether you found this copy in a doctor’s waiting room or pathology or rehab centre, or saw it on a newsagent or supermarket shelf, contact iSubscribe as per the details of the offer on page 13 and sign up. If you already receive and enjoy Heartwise, encourage your friends, families or groups to read and subscribe, too – there are prizes to win and an independent voice, ‘trusted for health’, to continue to hear.

STEVEN CHONG

Spring 2015 • Healthy & Heartwise

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COPHA COPS UNFAIR CALL ON READING p g 2 HHW5 n i ing r in r i i ing in ri n n r “When coconut oil is hydrogenated into solid vegetable shortening such as Copha – integral to classic confectionary such as rocky road, chocolate crackles and white Christmas – trans fats are fomed, enriching many an Australian childhood with later heart risk.”

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CHERYL LAUK Peerless Foods, Braybrook, VIC FROM THE EDITOR: It is true and often overlooked that Australian margarine manufacturers took the

initiative with the Heart Foundation in the 1990s to reduce levels of trans fats, and particularly commendable when US manufacturers are only now doing the same. Instead of hydrogenation to make margarines soft but solid at room temperature, Australian producers now use esterification, where vegetable oils are mixed with milk, water and salt. It seems even less well known that Copha is now among these Australian products virtually free of trans fats, because the erroneous claim is repeated in the local medical trade press as well as online. Heartwise stands corrected. Although this may be of limited comfort to adult readers whose childhoods would have run into the 1990s at the latest, it’s good news for today’s fans of rocky road and chocolate crackles, no matter their age.

WINNERS!

i HHW,

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LETTERS PUBLISHED NEXT HEARTWISE (SUMMER 2015 VOL 58) WILL RECEIVE ONE OF THE FOLLOWING PRIZES: Australian Organic food pack – worth RRP $60 in products bearing the Australian Certified Organic Bud logo. Like more than 14,000 products, they have been audited from paddock to plate to ensure they are free-range, cruelty-free, non-GM, biodiversity-friendly, sustainably fished/ farmed AND free from synthetic pesticides, herbicides, hormones and antibiotics. TePe oral care gift basket including interdental brushes, available nationwide in selected pharmacies or online from www.oralcare4u.com.au. The product range includes nine colourcoded sizes, angled brushes, everyday and specialist toothbrushes and dental sticks. The gift basket is worth $52.70 – and much more in saved dental bills for caries and gum disease! Healthy & Heartwise • Spring 2015

p r r n 0 p r 100 g i i i i r rg rin n r i n r n 1 0 in n n i n i i n r n i n rg rin n r r r r n r rg rin r r r n g p r 100 g n r r i p n in ir i i i r n r in n r r n p i i pri ri in r n n n i n

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

CONGRATULATIONS to these readers whose feedback was published this issue: Stuart Miller wins a Kambrook Pressure Express digital pressure cooker, which cooks foods more quickly, saving time, money nutrients and flavour, and has a RRP of $119.95 Cheryl Lauk wins a Kambrook Size Select bread maker worth RRP $99.95, which creates specialty loaves, pizza bases, sweet breads and even jams and chutneys.

healthalert

Past, present and future were the themes of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) 25th Annual Scientific Meeting in Melbourne in August, where international and local speakers showcased their research and clinical initiatives.

25 years of refining rehab Five rules for bestpractice rehab A MULTIDISCIPLINARY ACRA panel has identified the core components for secondary prevention of cardiovascular disease: helping doctors, hospitals and patients ensure that one heart event doesnâ&#x20AC;&#x2122;t lead to another. The expert panel collaborated on the guidelines for the past two years, the first national set for a decade, said ACRA President Stephen Woodruffe during his national keynote address. The core components for optimal care of heart patients were published in Heart, Lung and Circulation this year and include: 1. Referral to a cardiac rehab (CR) service that best suits their individual needs, as soon as possible after diagnosis or before discharge from hospital, including a referral to a GP for long-term care. 2. An initial individualised assessment that includes physical, psychological and social dimensions with referral to appropriate services (internal or external to the CR service) based on patient needs, with ongoing review, discharge assessment and follow-up. Family members can be included in this process, said Mr Woodruffe. 3. Support to help patients return to previous everyday activities, including employment,

Healthy & Heartwise â&#x20AC;˘ Spring 2015

driving, sex, and maintain them life-long. If the heart or other conditions prevent this, the CR service should focus on maximising potential and providing coping strategies, such as an exercise program. 4. Tailored education and skill development to motivate and enable self-care and lifestyle changes, addressing of multiple risk factors and continued use of medications as prescribed. 5. Data collection and reporting on key performance indicators to promote continuous improvement of the CR service. Mr Woodruffe said that the core components will develop into a web-based document and ACRA would seek collaboration with relevant groups, such as the Heart Foundation and the Cardiac Society of Australia and New Zealand.

The core components show what prevention of a second heart event, and rehab after the first, should include. www.acra.net.au

healthalert

Do health apps really help? SMARTPHONE AND TABLET APPS designed to help improve health are now plentiful but of poor quality overall, according to a Sydney University study presented at ACRA. Lis Neubeck led researchers in the literature study that searched databases to determine patients’ ideal components and features in an health-related app, such as: • Persuasive technology that communicates effectively • Lifestyle choices only change with sufficient motivation, ability and appropriate triggers • Change is most likely if the app is widely used and ideal features are present, such as simplicity, clear choices, easy navigation and concise, credible and trustworthy information • A doctor’s recommendation carries a lot of weight, particularly for older patients. The capacity to track blood pressure, cholesterol and physical activity levels increased users’ engagement and encouraged pursuit of longerterm goals, while self-monitoring was likely to increase behaviour change. Networked social support, comparison and rewards – whether trophies/credits or badges for completed tasks, ranking or positioning on shared boards – also drove behaviour change and loyalty but only 25% of exercise and diet apps used rewards. Negative messages were found among the apps, warned Ms Neubeck, with 107 promoting

Apps that tracked biometrics & physical activity levels increased use

smoking downloaded by more than six million users. Moreover, the food industry had developed advertising-based games where products were offered as a reward or incentive. Privacy issues around data sharing and personal safety were a major barrier to app uptake, and more than half the users had abandoned apps because of concerns with personal information security. Only 30% of health apps had privacy policies, which often were not in plain English. Age was no barrier to app usage, as at least 75% of over-65s had downloaded one. However, apps not adapted for declining eyesight were less likely to be used.

Waist or BMI measures obesity best? THE CONTEST BETWEEN waist circumference and body mass index (BMI, i.e. weight divided by height squared) as the best indicator of obesity was highlighted at ACRA’s conference when results from a study comparing the two were presented. Wendan Shi and colleagues from The University of Sydney looked at the data for 72 adults with a diagnosis of heart disease and/or type 2 diabetes, a BMI of 27–39, and who took part in an earlier Sydney weight-loss trial for four months. The BMI and waist circumference (WC) midpoint between the last rib and hip crest; around the hips (WC-wide); and just

above the midpoint at the waist (WCnarrow) were recorded and compared. Analysis showed that WC strongly correlated with BMI, especially in women. WC-wide was most closely associated with BMI in males; WC-mid is most closely correlated with BMI in females. Regarding cardiovascular risk, WC measures were better

predictors than BMI of a heart event; WC-narrow for males and WC-mid for females were effective measures for CVD risk prediction. A waist measurement indicated obesity when it went beyond 107.2 cm for males and 101.7 cm for females. “WC-narrow is the best measure to detect visceral fat change over time for males, WC-mid was the best for females,” added Ms Shi. Spring 2015 • Healthy & Heartwise

healthalert

Advice you don’t take sitting down DESKBOUND WORKERS should stand and move instead of sit for as much as half the working day, advise new employer guidelines following from research exposing the health risks of today’s sedentary lifestyle. British public health experts and David Dunstan from Melbourne’s Baker IDI Heart and Diabetes Institute reviewed long-term observational studies of the health of office workers and trials where employees stood and/ or moved more, and recommended they aim to accumulate two hours of standing and light activity/walking during work hours. Eventually this should increase to four hours a day, or proportionally less if part-time, by splitting work between desk and standing, ‘standing agenda’ items in long meetings, using sit–stand desks and portable phone Standing for headsets, or taking up to half short active standing a full-time breaks. Prof Dunstan, workday will Baker’s Head of transform Physical Activity the office Research, said “the most encouraging workplace. evidence” demonstrated that this improved blood glucose and insulin levels, and also reduced fatigue, joint aches and back pain in office workers. Those who sit the least compared to those who sit the most have more than twice the risk of developing type 2 diabetes and heart disease, 13% greater risk of cancer and 17% increased risk of dying early, the evidence showed. “Adults who sit for 10 hours per day have an estimated 34% higher risk of early death even if they exercise regularly,” added Prof Dunstan. But just as we shouldn’t sit still for long, extended static standing postures should also be avoided, due to risk of swollen ankles and varicose veins. And employers needed to warn staff of the dangers of prolonged sitting both at home and work. British Journal of Sports Medicine 1.6.2015; www.theconversation.com.au, www.bakeridi.edu.au

10 Healthy & Heartwise • Spring 2015

Don’t bypass care after open heart

Circulation 9.2.2015

HAVING YOUR CHEST opened up and a blood vessel from your thigh grafted onto a blocked coronary artery may sound like the result of failed heart disease prevention but it’s actually often the beginning, says an expert panel of cardiothoracic surgeons and anaesthetists. Coronary artery bypass graft (CABG) surgery, the most common open-heart procedure for treating coronary artery disease (CAD; see HHW56 page 44), can successfully reduce immediate heart risk. However, for years after, the risk of complications remains high. While CABG might be seen as ‘replumbing’ of coronary arteries, it doesn’t descale the pipes or stop them narrowing and blocking up again. Patients must continue to work with their healthcare team to hold back CAD progression and reduce the risk of a heart event, and earlier this year the American Heart Association Council of Cardiovascular Surgery

healthalert

Spring

HEALTH CALENDAR OCTOBER

1 2–11 4–11 8 10–18 11–17

and Anesthesia released 10 key points to guide a heart-healthy post-CABG recovery: 1. Aspirin 81–325 mg/day before and within six hours after CABG surgery to reduce the grafted vessels closing and future cardiac events. Aspirin or another antiplatelet medication such as clopidogrel should be continued indefinitely. If you have CABG without a bypass machine to pump and oxygenate your blood, two antiplatelets daily might be needed for a year. 2. The blood-thinner warfarin is not recommended unless you have atrial fibrillation (AF) or a mechanical prosthetic valve. 3. Cholesterol-lowering statin medication is generally recommended at high doses for patients <75 years, and less for those intolerant of higher doses or at greater risk of interactions with other drugs. 4. Beta-blockers around the time of CABG surgery to reduce the risk of later AF. 5. A blood pressure target of 140/85 mmHg. 6. Measurement of fasting blood glucose and HbA1c levels (with a goal of <7%) is appropriate pre-CABG. 7. Stopping smoking is critical, and nicotine replacement therapies or quit medications may be prescribed. 8. Cardiac rehab is equally critical post-CABG, so you should be referred soon after surgery. 9. Checks should be made on your emotional and mental wellbeing after CABG to rule out depression. 10. Annual flu vaccination is recommended because it has reduced the risk of heart patients dying or being hospitalised for CAD.

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NOVEMBER

1 6 9 8–14 8–15 10–30 Dec 13 14 15–21 16–22 17 18 25 30 DECEMBER 1 3 5 10 26 JANUARY 16–18 26

Breast Cancer Awareness Month Shoctober – Defibrillator Awareness Month Ocsober – Life Education Safe Work Australia Month Walktober – Heart Foundation Mental Health Month Foot Health Month – Australasian Podiatry Council International Day of Older Persons World Vegetarian Day National Organic Week Mental Health Week World Sight Day Walking with Wellness Week – Pedorthic Association National Nutrition Week Haemophilia Awareness Week Carers Week 2014 World Arthritis Day Veterans’ Health Week Be Medicinewise Week Ride2Work Nude Food Day – Nutrition Australia Sock It To Suicide Pink Ribbon Day Blue Knot Day – Adults Surviving Child Abuse MOvember – men’s health Lung Health Awareness Month National Asbestos Awareness Month World Vegan Day Walk to Work Day National Sunnies for Sight Day National Hat Day – Australian Rotary Health National Psychology Week Spinal Cord Injury Awareness Week Psychology Week Food Safety Week DineSmart for homeless World Kindness Day Walk to Work Day World Diabetes Day Skin Cancer Action Week Antibiotic Awareness Week International Lung Cancer Awareness Day World Chronic Obstructive Pulmonary Disease (COPD) Day Wear Orange Wednesday – SES White Ribbon Day – eliminating domestic violence Buy Nothing Day – Adbusters

World AIDS Day International Day of People with Disability International Volunteer Day Human Rights Day National Leftovers Day – Foodwise

Ride to Cure Diabetes Big Red BBQ – Kidney Health Australia

Spring 2015 • Healthy & Heartwise

healthalert

Arteries’ taste for garlic GARLIC HAS TRADITIONALLY been a household panacea but scientific research into its cardiovascular benefits has returned mixed results. Part of the reason is that it is prepared and used in many different forms in trials that are not ade uately replicated. However, most of the positive cardiac evidence surrounds aged garlic extract (AG ) with uni ue active compounds that are not found in fresh or powdered garlic, says S cardiologist r Matthew udoff. In une r udoff visited Australia to present his AG research findings to a cardiology meeting, which he says are the first to examine direct effects on arterial function. We found AG helps to reduce soft pla ue within the arteries. Studies show that most heart attacks are caused by soft pla ue, an in amed part of the artery that can burst, said r udoff, Professor of

Medicine at Harbor- CLA Medical Centre. r udoff used cardiac computed tomography angiography to accurately measure calcium deposits and pla ue build-up in 1 1 middle-aged patients with metabolic syndrome (a prelude to diabetes) who were given 1 g AG or a placebo daily in the year-long trial. Results showed diastolic blood pressure was reduced by an average . mmHg and coronary artery calcification was 1. times less than in the placebo group. ur studies demonstrate the benefit of AG on both pla ue changes over time and new pla ue formation. We have completed four randomised trials to date and all have led us to concur that AG is both benefiial for slowing artery hardening and reversing the early stages of heart disease, r udoff said. Journal of the American College of Cardiology 2015 5(10 S)

Arrhythmia another stroke risk factor PATIENTS WHO HAVE recently developed atrial fibrillation (AF) have changes in their blood and platelets putting them at even higher risk of stroke than those who’ve long had the common heart arrhythmia, according to South Australian research. My research found ... impaired response to a particular signalling molecule that acts to limit the formation of blood clots, thus increasing the risk of inappropriate clot formation, said niversity of Adelaide researcher r Nathan Procter. Currently, AF patients’ stroke risk is determined via physical examination Heathy &&Heartwise Heartwise •• Autumn Spring 2015 2015 12 Healthy

rather than diagnostic imaging or blood pathology tests. r Proctor hopes his finding increases the urgency of treating patients’ risk of stroke when they are admitted to hospital with early-onset AF. Anticoagulants may have to be taken routinely early on to prevent clots once AF appears, said Professor ohn Horowit , head of Cardiology at The ueen li abeth Hospital in Adelaide. Prof Horowit plans a follow-up study in patients in the Hospital’s Stroke nit to further emphasise early intervention. www.australianheartresearch.com.au

Think zinc for colds ZINC LOZENGES may ease and shorten typical symptoms of the common cold, according to a review of placebo-controlled trials co-authored locally. Researchers from Sydney niversity and the niversity of Helsinki found that the duration of nasal discharge was shortened by , cough by and muscle ache by 5 when patients took 0 2 mg day of inc acetate in lo enge form. The period of having symptoms of hoarseness was also cut by , nasal congestion by and scratchy throat by a third but there was no effect on headache and fever, and no significant effect on snee ing and sore throat duration. verall, using inc acetate lo enges which dissolve slowly in the mouth to release high levels of free inc ions in high doses cut the length of a cold by 2 . When inc in a different form was used, e.g. citric acid, there was an average 20 reduction. It is not certain how inc helps a cold but it may be by stopping the cold virus from reproducing and boosting key immune cells, and the effects are not localised to particular regions where symptoms arise. However, most studies commenced treatment within the first 2 hours of symptoms. BMC Family Practice 2015 1 :2

coverstory

Tania ZAETTA She dared and won, riding the wave of global TV stardom from Baywatch to Bollywood, mixing with prime ministers, billionaire businessmen, athletes, performers, models and celebrities – even smooching a pre-Bachelor Sam Wood! Through it all, Tania Zaetta stayed poised, professional and generous – and is now even more inspired to help women improve their health and wellbeing.

14 Healthy & Heartwise • Spring 2015

coverstory HHW Who Dares Wins threw a mid-20s

Victorian TV co-presenter in the deep end, literally and repeatedly, for four years of non-stop, high-risk stunts in far-flung locations. Its new format became known as reality TV and took off all over the world, taking you with it – were you seeking that much adventure? TANIA It was definitely a surprise – I was just happy to have a full-time job to pay my rent! We had no idea of how successful the show would be and the enormity of all the record-breaking dares we took on. I’m adventurous but not at all a thrill seeker and am pretty scared of everything, so being faced with all these potentially dangerous challenges was terrifying! I did plenty of fast talking so the contestant completed each dare and I didn’t have to! Half the time I ended up taking the dares myself and it made great TV because I was scared as hell and always making nervous jokes, but was also very focused on achieving the task. The sense of achievement after, combined with a bit of adrenalin, gives you quite a powerful feeling of, “If I can do that then I can do anything I put my mind to”. And that’s the mentality my parents raised me with and have taken with me every step of my career. HHW During your TV work you became certified as a Pilates instructor – how did you first discover it? TANIA It was recommended by a physio about 15 years back after been diagnosed with a ruptured disc — worst pain I ever felt! Pilates was pretty much unheard of here then but I was told it was a form of core-strengthening and muscle-lengthening rehabilitation to get injured professional athletes back on the field quickly. I thought,“If it’s good enough for them then it’s certainly good enough for me!” Not only did Pilates help my back so I could move more freely, it corrected and aligned my posture so that I was standing taller pain-free, in fact never felt better. I became more aware of how I moved each day and was soon in the habit of activating my core every time I bent to pick something up, get in and out of cars – even when I sneezed. Anyone with back injuries will tell you they dread sneezing! That sudden, involuntary movement that comes with a sneeze can throw any back out! And although I hadn’t been to a gym in months because of the injury, my body shape was firmer, I felt lean and sculpted, my tummy was flat and legs and butt defined. Voila! I’d just found the perfect exercise system that not only helped injuries but also gave you a long, lean, toned, strong body – I was hooked.

I knew Pilates was a form of exercise that everyone needed to know about so I became a certified instructor so I could share it. I’ve devised my own combination of Pilates exercises that help flatten your tummy and firm your butt in a matter of weeks by activating the deep abdominal muscles and working the three main gluteal muscles in your buttocks. HHW What is the difference between that

and Barre Pilates, which you also teach? TANIA Barre Pilates is a newer form of Pilates which includes ballet-inspired limb movements that dancers use to stay in shape. It focuses on small isometric exercises that work a muscle to exhaustion, so tones your arms and legs as well as core. It raises and lowers the heart rate to get fast results, with fat-burning increased and the metabolism boosted for hours after a workout. HHW Initially you followed your mother to become a natural beauty therapist specialising in health and nutrition – is that the basis for your complexion keeping radiant into your forties? TANIA I’d say glowing skin is definitely a result of my long-term healthy eating habits combined with a few good beauty products. I grew up in rural Victoria near the Murray River, and not only did my Mum raise us with great food education given her interests but also with an abundance of fresh home-grown fruit and vegies (now called organic produce). It was balanced with a steady protein source from our various paddock-roaming livestock (now called hormone-free meat) and eggs from the chook pen (now called free-range). This helped shape my tastebuds for all the yummy natural foods I now love to eat every day. Oddly enough, it has a new trendy name: ‘clean eating’! It is not a fad diet but basically means eating more foods in their natural state before processing and human intervention that adds sugars and other nasties the body just stores as fat – usually around your tummy. It’s not at all complicated. HHW You lived in India for a year or so as the first foreigner to make it in Bollywood in four consecutive hits. What made you that determined to succeed somewhere so foreign instead of, say, the US or UK? TANIA You’re right, it would’ve been far easier in any other country but me being me – loving a good challenge and breaking new ground – well this just sounded perfect. Who Dares Wins was hugely popular in India and Asia and Mike Whitney and I filmed many versions in India. The attention made it difficult to leave the hotel

Spring 2015 • Healthy & Heartwise

coverstory so all we could do was watch Bollywood on TV, hear its songs on the radio and read about it on every page of the papers, along with cricket. I’d been told that a foreigner hadn’t really been able to conquer the world’s biggest film industry and thought, “Now there’s a challenge if ever I heard one!” So I moved from the UK to Mumbai. It was total madness and chaos but also exciting with good and bad times – certainly the hardest thing I’ve ever done. Not one to give up, I managed four leading roles then moved back here to focus on my long-term career goals and to be closer to my family. Amazing experience and plenty of unbelievable stories to tell my kids one day! Plus I learnt a lot about using herbs and spices for health and weight maintenance. HHW Your new book Trim & Tone with

Tania is for women to use as a complete fitness, nutrition and lifestyle guide and coincides with your ‘6-Week Trim & Tone Online Weightloss Program’. Why do you think so many people now struggle with their weight – is it more dietary choices or lack of exercise? TANIA It’s a combination of both really and not entirely the fault of the individual. There are far too many processed and packaged foods that are detrimental to health and weight management; full of synthetic ingredients, sugars, preservatives, chemicals, etc. with no nutritional value. Food education is vital and I explain very simply and briefly how food works in your body and what it’s used for. Once people know this, they start to make better food choices. Because of modern life we are also either sitting in cars, at computers or in front of the TV far too much. You need to ‘move it to lose it’ and keep your body active and strong so it can support you when you’re older, which is why Pilates is my choice – it suits every age and fitness level. HHW Diet and nutrition is a fraught area with clashing theories and varying evidence about nutrients, foods, products and claims – how do you work out what’s healthy and who to believe? TANIA The media can make it very complicated for us all with its constant conflicting reports so it’s important to do your own research and find what works for you, especially if you have allergies or food intolerances. Don’t buy into fads and diets and don’t worry about trying to be skinny, focus on being healthy.

16 Healthy & Heartwise • Spring 2015

Pilates helped my back so I could move more easily, and corrected my posture so I was standing taller pain-free – in fact I never felt better!

coverstory If your meals are realistic then they can be maintained long term, which is what you should aim for. I’m not an advocate of the other extreme eating methods because they sound like hard work and cut out a lot of yummy food groups that should be enjoyed. Each to their own, though, and they have a place for people with intolerances or allergies and of course being vegetarian or vegan I completely understand as that is often a personal choice. I’m not a huge eater of red meat myself. Making better organic food choices can be as simple as switching refined processed sugar for organic stevia, which means you replace sugar with a healthier sweetener with zero calories – so you can literally have your cake and still lose weight! I have created all the recipes in my book and online program and use organic stevia or other natural sweeteners like sultanas, which turn my sweet treats into healthy treats that don’t increase your waistline. HHW For someone who worked hard to

I believe in going back to basics and helping people be trim and toned. If you eat wellbalanced meals of as many fresh foods and meats as possible and let your body function properly then you can lose any excess weight safely and for the long term.

Tania’s attributes her svelte figure to Pilates and Barre Pilates, which she demonstrates in her book and online program

HHW You recommend the South American sweetener stevia over artificial ones with aspartic acid and you’re promoting September as Australian Organic Awareness Month. Are there organic stevia products and do you only use organic goods? TANIA I prefer to choose certified organic where possible because it’s by far the better option for your health, but I’m not fanatical and I don’t think you need to be, which is what Australian Organic Awareness Month is all about. I think that’s the key: not to be extreme about any of your food choices and there’s certainly no need to be restrictive and leave you feeling like you’re missing out on anything.

make a globally respected name for yourself in a fickle and demanding industry, how did you manage when times were tough? TANIA There have been absolutely hard times and I’m sure there will continue to be as that’s just life in general. Like everyone, I have up and down days but I have goals and I stick to them. Exercise releases ‘happy endorphins’ so if I’m having a testing day I’ll go for a big walk to help clear my mind. It’s not the destination that defines the type of person you are but the journey along the way. No two days are ever the same and as Mum always says,“If you don’t have a bad day occasionally then how do you know how wonderful it feels to have a good day?”

Australian Organic Awareness Month runs through September. For more information go to www.facebook.com/AustOrganicLtd Images from Trim & Tone with Tania, RRP $29.99, New Holland, 2015. Access a free chapter and Tania’s ‘6 Week Trim & Tone Online Weightloss Program’ at www.taniazaettaprogram.com Spring 2015 • Healthy & Heartwise

healthytravel

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For information and bookings call 1300 886 091 or visit www.oakshotelsresorts.com

18 Healthy & Heartwise â&#x20AC;˘ in r 2015

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g r pr in in n r r r ing r r ng g in n p n r ni r r 2 r n n r r n r i gn i ri i ri i n HHW55 p g 0 1 n in r i i n n r n p r n gi n i r i r n rn i i pp r n n in ng p r n n i i rg ni ri i p in r r i i n r ing n r r i rS n r i ri i i in r r g r r i r i n pr r n n r i r in i ri i n r i r pr p r i n n r n r r r i n r n in r r n n n g r ing pi n r pp n g r pr n p p g n ng p p i

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pi Emily Tutt is a Community Champion for REDFEB by Heart Research Australia: www.heartresearch.com.au Spring 2015 â&#x20AC;˘ Healthy & Heartwise

healthyexercise

Getting

INTENSE

More active cardiovascular, diabetes and weight management can be as simple as stepping up the pace of whichever exercise you’re most comfortable with, says exercise physiologist Daniel Hollams.

DANIEL HOLLAMS, BSc (Sports Science), ESSAM, is an Accredited Exercise Physiologist formerly with the North Shore Cardiovascular Education Centre at Royal North Shore Hospital, Sydney Adapted from Conquest Spring 2012

20 Healthy & Heartwise • Spring 2015

healthyexercise

he word ‘hibernation’ comes from the Latin for winter and although humans can’t lower their metabolism to sleep for months, they may well feel like it! After a season of less daylight, cold evenings, colder mornings, wind and rain, our activity levels easily – even naturally or inevitably – decrease. It might be sleeping in, missing training, driving instead of walking. A blessed relief at times but if too often and not balanced with a reduction in energy consumption via food, we acquire that ‘winter belt’. In people with heart disease and/or diabetes, and especially for the overweight and obese, additional fat cells are not just inert ‘filler’ but an active source of inflammation [see pages 26–7].

Back in the swing for spring An approach that resists weight gain on both fronts – the energy you take in as food and burn off in physical activity and metabolism – is more balanced, healthy and effective that rushing to extreme measures, such as fad diets or intense ‘boot camp’ training. As an exercise physiologist (EP), I specialise in making exercise accessible and enjoyable for as many people as are willing – and exercise is how you spend more energy. But I also encourage patients to make small changes on both sides of the ‘energy equation’ because some careful choices around food intake, paired with an increase in daily activity, makes weight loss sustainable long term by not leaving us feeling hungry and grumpy.

Energy expenditure and metabolism It may not be what you’d expect but as we get older, the amount of energy required by our body to maintain basic life functions actually decreases! It’s because we naturally lose lean muscle mass as we age and, coupled with less activity, by middle age we usually see our weight increase even if our diet doesn’t change. The current national recommendation of 2.5–5 hours/week of moderate-intensity (or half that time of high-intensity) physical activity is for basic health benefits only. This is a level that promotes a healthy lifestyle, affecting our blood pressure and cholesterol levels, and reduces our risk of stroke, heart attack and diabetes or its complications. However, to lose weight, the guidelines suggest 5–7.5 hours/week of moderateintensity activity, i.e. we need to exercise at

the same intensity for longer. Or we can work at a higher or more vigorous intensity for the same amount of time. The examples in the box [below] show how working harder can achieve greater results, no matter where you start.

Which intensity is right for me? For safety’s sake, we always talk about doing the activity to a moderate intensity where you can ‘walk and talk’ comfortably. Each person will have a different point at which they can do this and it will improve with better fitness, making it the most accurate and specific measure of safety for your body. For ‘healthy’ people, vigorous exercise is also recommended for weight loss. But if you have health concerns and/or advancing age (over 45 for males and 55 for females), moderate intensity is safer. If you want to work beyond a moderate intensity, such as in interval training where you switch between moderate and high-intensity activity [see HHW56, page 18], supervision by an EP is advised, in conjunction with your GP. Everyone should consult their GP before starting a new exercise program and people with type 1 diabetes should also ask about their medications to allow for blood glucose changes from activity and energy expenditure. A safe way to spend more energy is to use the concept of fartlek, the Swedish word for ‘speed play’. It involves set times of faster and normal-paced exercise, allowing the heart to work harder but not for so long that it leads to being completely breathless, e.g. walking a minute at a comfortable pace then increasing to a brisk pace for a minute, etc. This uses more energy than your usual walk without sustained vigorous-intensity stress on your body. ♥

Everyone should consult their GP prior to commencing a new exercise program, and people living with type 1 diabetes should discuss their medications with their doctor.

Working for weight loss: all about intensity • 1 kg of body fat has the energy value of approximately 35,000 kJ • The average person walking at around 6.5kmh – a solid walk, not a dawdle – expends around 1200–2000 kJ. At around 8 kmh, a definite power walk, you can use between 2300 and 2900 kJ. • Similarly, if you are cycling for an hour, your energy expenditure can increase from around 1000–1250 kJ at a leisurely pace, up to about 1700–2000 kJ at a moderate intensity. • Energy expenditure is shown in ranges to allow for gender differences as well as the size of the individual. A larger person will use up more energy for the same activity because they are a bigger ‘machine’ to move.

Spring 2015 • Healthy & Heartwise

healthyliving

guts It takes

to stay well

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O STEVEN CHONG is the Editor of HHW

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22 Healthy & Heartwise â&#x20AC;˘ Spring 2015

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healthyliving From faith in fibre to a fascination for faeces Fibre had long been the go-to nutrient for bowel health, with its virtues of promoting better digestion and colorectal health well established. Its additional ability to ‘soak up’ excessive blood cholesterol and glucose make its daily dietary inclusion essential for anyone but the most FODMAP-sensitive [see HHW54, pages 26, 28]. However, the lack of controversy may have left fibre looking relatively bland and, like bran sprinkled routinely over cereal, sensible but dull compared to the idea of our bodies crawling inside and out with warring germs, some of them affecting and controlling our health like puppeteers. Bulked stools never gripped public interest so much as the concept that our bodies were battlegrounds for both friendly and unfriendly bacteria, whose mass deaths from a course of antibiotics explained the diarrhoea and recurrent infections that could run on for months following.

The immune connection

Bacteria: the good, the bad and the unbalanced Our relationship with our 1.5 kg of resident microbes is usually mutually beneficial if not codependent – far from being parasites or pathogens, probiotic bacteria live symbiotically in our gut, breaking down fibre – also called prebiotics – into fatty acids and other nutrients. About 100 years ago, Ilya Mechnikov, a Russian zoologist whose work in immunity won a Nobel Prize, was the first to see microbes as more than just agents of disease. He believed toxic gut bacteria caused ageing while lactic acid bacteria could prolong life as it did for Bulgarian peasants, so he drank a glass of sour milk every day. This inspired Japanese scientists to isolate bacteria from faeces and patent a strain of the ‘good’ lactobacilli found in drinking yoghurt (i.e. Yakult) and other fermented foods such as sauerkraut and miso – now acclaimed as superfoods [pages 36–41]. ‘Bad’ bacteria, such as E. coli that Nobel prize-winning Australians found cause stomach ulcers, often coexist, just in numbers too small to cause symptoms.

The revelation that two-thirds of our immune system’s cells are located in the sticky mucus lining the 200 m2 surface area of the small intestine is also a game changer for how the gut is viewed because it offers a rationale for the growing incidence of food allergies and sensitivities, whether to peanuts or gluten, and why they often coincide with bowel disorders. The children of women who take probiotics during pregnancy tend to have less risk of food allergy and atopic dermatitis than those who do not, and trials of probiotics in people with atopic dermatitis and hay fever have shown success in relieving symptoms. It is not clear how but it seems that our gut microbes communicate with our immune cells and modulate their response, making them less likely to see other cells as foreign invaders and mount an inflammatory defensive response. The intestines also share a lot of the brain’s biochemistry, housing most of our neurotransmitters such as serotonin, and the relationship between our microbiota and learning and mental health is another exciting research avenue for a potential new wave of treatments that heal the mind through the gut. Entirely different species of microbes continue to be identified in various parts of our digestive tract and their complex and interdependent roles in our metabolism are still being discovered – like space exploration, the inner galaxies found only hint at the enormity of what we don’t yet understand. ♥ Spring 2015 • Healthy & Heartwise

healthywomen

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O CRIS BEER, MBBS, BBioMedSci, FRACGP, PT, is a holistic GP, personal fitness trainer and health coach practising on the Gold Coast, QLD

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LIFESTYLE FACTORS YOU CAN CHANGE TO SAVE YOUR SKELETON BONE BUILDERS

BONE ERODERS

CALCIUM – women 50+ should eat 1300 mg/ day calcium, i.e. 4 serves/day dairy or cress, white beans, almonds, tinned salmon or sardines. Supplement if you cannot get this from diet, preferably at night when bone repair increases but don’t take too much – very high doses (>2400 mg/day) have been linked with heart disease.

SMOKING causes faster and greater bone loss, and increases fracture risk compared to non-smoking women. Because smokers can reach menopause up to two years earlier, it is thought that tobacco may interfere with oestrogen metabolism.

VITAMIN D helps increase the absorption of calcium, regulates its levels in the blood and strengthens the skeleton. Vitamin D3 is made in the skin after exposure to sunlight but many Australians are deficient from staying indoors. Usually 10–15 minutes/day outdoor sun exposure to face, arms, hands or legs is sufficient.

ALCOHOL – more than two standard units of alcohol daily is known to have direct detrimental effects on bone-forming cells and on the hormones regulating calcium metabolism.

Mushrooms, egg yolk, liver and fatty fish have small amounts of vitamin D3 and D2 and the International Osteoporosis Federation recommends people over 60 to supplement with 800–1000 IU/day because it can reduce the risk of falls by 20% – your GP can test your levels. WEIGHT-BEARING EXERCISE such as walking with light weights help to prevent BMD loss and increase balance and muscle strength. Aim for 30 minutes most days per week.

24 Healthy & Heartwise • Spring 2015

CAFFEINE – more than 300 mg/day reduces calcium absorption.

SALT – high sodium intake increases the amount of calcium we excrete in urine. The daily upper limit for Australian adults is 2300 mg, or 1600 mg to prevent chronic diseases such as osteoporosis.

MEDICAL CONDITIONS e.g. hyperthyroidism, hyperpituitism and eating disorders. Medications used to treat breast cancer, arthritis, asthma, Crohn’s disease and Addison’s disease can lower BMD. SITTING for 9+ hours/day is associated with a 50% greater risk of hip fracture compared to women who are sedentary for fewer than 6 hours daily.

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n in ig r ASSOCIATE PROFESSOR AMANDA SALIS, PhD, leads basic research and clinical weightloss trials at The University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders

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Spring 2015 • Healthy & Heartwise

healthyeating

Anti-inflammatory

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n n pr n p ni r ging i n r i n in r Katherine Baqleh p in

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KATHERINE BAQLEH, BMedSci, MNutrDiet, APD/AN, is an Accredited Practising Dietitian and nutritionist at Health Victory Nutrition Experts

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26 Healthy & Heartwise â&#x20AC;˘ Spring 2015

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healthyeating

FIREFIGHTING WITH FOOD CALM DOWN YOUR BODY’S INTERNAL ‘SPOT FIRES’ WITH A FEW SIMPLE DIETARY CHANGES AND ADDITIONS: • Eat a variety of colourful fruit and vegetables every day, especially avocado, berries, citrus, tomatoes and leafy greens, for their large amounts of highly bioavailable fibre and antioxidant nutrients such as polyphenols, vitamin C and zinc, which lower blood levels of pro-inflammatory chemicals. Lower levels of antioxidants such as beta–carotene are associated with increased inflammation. the liver to begin the inflammation process. It is a vicious cycle that worsens over time – prolonged inflammation can worsen insulin resistance, blood glucose control and blood cholesterol levels, which provokes further inflammation.

• imit refined carbohydrates and highly processed, sugar laden foods and beverages. These are usually high in energy/calories and Glycaemic Index (GI), elevating your blood glucose and insulin levels, which in turn can exacerbate inflammation.Low-GI alternatives are higher-fibre wholefoods, such as fruits and vegetables, and wholegrain (not wholemeal) breads and cereals.

Are antioxidants always anti-inflammatory?

• Swap red meat for oily fish such as salmon and sardines, limiting cooked red meat to 80–100 g cooked portions twice per week. Limit processed meats such as sausages and salami and choose lean cuts of meat because their saturated fatty acids are thought to stimulate the production of inflammatory chemicals.

Anti-inflammatory and antioxidant processes are linked when it comes to cell protection, and many foods can act on both. Antioxidants are heavily used as a natural anti-inflammatory to prevent oxidative (free radical) damage. Although oxidants such as tobacco smoke, alcohol and processed cooking oils cause damage, others are found naturally in small amounts in the body. These oxidants have different purposes, such as improving immunity against viruses and bacteria; activating enzymes; producing hormones; and damaging muscle after exercise, which is in fact essential for muscles to adapt to training. When overloaded with free radicals, a natural bodily response is inflammation. Although necessary for healing, excessive inflammation impedes it and can lead to further long-term inflammation. Anti-inflammatory foods work to limit the production of proinflammatory compounds but antioxidant supplements (e.g. vitamins A, C, E and some minerals) in high doses can actually behave like free radicals, and may interfere with the cardiovascular gains of endurance

• Spice up your cooking with generous shakes of turmeric fresh or powdered , cinnamon, ginger, chilli and garlic – spices include some of the most concentrated dietary sources of antioxidants. Turmeric has been used in traditional Indian medicine for millennia, with its wide-ranging inflammatory actions linked to its levels of the compound curcumin. • ake extra virgin olive oil your first choice – its antioxidant compound phenolic acid can decrease and block inflammation. Standard olive oil works well for cooking and can be alternated with canola, avocado and coconut oils for variety. • Avoid deep fried or oily takeaway because the saturated and trans fatty acid content may trigger inflammation. • Add a small handful of mixed and unsalted nuts or seeds (especially walnuts, chia and almonds) to dishes, or eat as a snack. They help improve blood lipids and contain antioxidant minerals such as zinc and selenium, and vitamin E, which protects fats against oxidation. • Explore new teas – green tea contains strongly antioxidant polyphenols, and liquorice root tea contains glycyrrhizin, a naturally sweet chemical that is antiinflammatory. It can raise blood pressure, however, so it’s best to limit to two cups daily. Spring 2015 • Healthy & Heartwise

healthymind

Old cogs

new tricks r r in r in ini n ri n ng i i n n ng ing n r p pr n ni Dr Helena Popovic.

28 Healthy & Heartwise â&#x20AC;˘ Spring 2015

healthymind

he rapidly expanding field of neuroplasticity has shown that the brain can change its own structure and function. Your brain can grow new cells, circuits and connections in response to what you do, what you think and how you behave. It’s an exciting, empowering discovery – an adaptable brain means we are not mere passive victims of our genes; we can play an active role in how our brains develop through life! And we can significantly reduce – even halve – our risk of developing dementia, including Alzheimer’s disease, with lifelong mental stimulation, social connection and physical exercise.

It’s all in the attitude

inspire and excite us. What are you passionate about? What brings you joy and fulfillment? What makes you feel more connected to people you love? Seek and do. There isn’t one specific set of activities that boost brainpower; it’s whatever engages and challenges you. Excitement and passion change our brain chemistry through the production of the neurotransmitters dopamine, acetylcholine and noradrenaline, which spark creativity, strengthen focus and energise every aspect of thinking. These neurotransmitters keep our brains healthy as we age. Studies have also demonstrated that aspirations turn on our brain cells much more powerfully than needs. When people wired to brain scanners were asked to think about their aspirations, more brain cells became active than when they think of things they need to do. We have a ‘use it or lose it’ brain and the more brain cells we activate regularly, the more we preserve them and keep them functioning optimally.

A positive attitude to ageing, and living in a way that brings us meaning, purpose and connection with other people is the best way to stay physically and mentally healthy till our very last days. A 2002 research paper reported that people with more positive perceptions of ageing lived an average seven-and-a-half years Finding new challenges longer than people who felt Which places have you always negatively about getting old. wanted to visit? Projects This held after gender, you’ve been meaning to socioeconomic status, start or finish? Skills you’d loneliness and overall like to learn? Write health were taken a list and start into account. In planning how you’ll fact, the effect of a make the items Get comfortable with being uncomfortable. positive attitude happen. Even As soon as you master something, take on something new. on survival and if you never By all means continue your favourite pastimes but add a layer cognition was fully achieve a of complexity or do something completely different as well. greater than goal, simply The brain needs ongoing stimulation through new experiences. the effect setting and of a healthy striving Boredom and monotony are poison to the brain. lifestyle! to reach it BRAIN BOOSTERS INCLUDE LEARNING: Having low blood benefits • a new language pressure, normal cognitive • musical instrument cholesterol function. The • art or craft such as painting, needlework levels and never effort invested or woodwork smoking each added to achieve • physical activities requiring coordination around four extra something is and timing, e.g.dancing, juggling. years to life – only as important as the half that of a life-affirming mastery. If something outlook. When it came doesn’t challenge you, to cognition, when older it won’t change you. There’s • people were exposed to positive and nothing more exhilarating than constructive messages about ageing embarking on a project you aren’t quite immediately before a series of memory tests, sure you’re able to accomplish [see left]! they performed better than people told or Joining a book club, reading poetry, shown something negative about ageing. creative writing, starting a new hobby or enrolling in a formal course are classic ways Something to plan for to build mental capacity. However, it is key The most important thing to keep our brains that you find it mentally challenging and at their best is continuing to set goals that enjoyable – crossword puzzles and Sudoku

TIME FOR SOMETHING COMPLETELY DIFFERENT

Spring 2015 • Healthy & Heartwise

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30 Healthy & Heartwise • Spring 2015

STAYING SHARP A WALK IN THE PARK Exercise stimulates the production of a protein called brain-derived neurotrophic factor (BDNF), which acts like a fertiliser for neurons. BDNF promotes the formation of new brain cells and connections between them. It is particularly active in areas of the brain linked to learning, memory and complex thinking. The more you exercise, the more BDNF you produce and the better your cognition and memory. A 2006 study reported that people older than 60 who engaged in brisk walking three hours a week over a six-month period increased both grey matter and white matter and enlarged their overall brain volume. Exercise also stimulates the release of feel-good chemicals such as endorphins, serotonin, dopamine, oxytocin and noradrenalin. These neurotransmitters improve mood and positivity. In fact, one hour of exercise a day has an antidepressant effect equivalent to that of medications such as Prozac and Zoloft!

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DR HELENA POPOVIC is a medical doctor, international speaker and best-selling author of In Search of My Father – dementia is no match for a daughter’s determination: www.drhelenapopovic.com www.winningatslimming.com

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Keeping an ear for music

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To see Australian Hearing’s music video for Troy’s song ‘I Can Hear You Now’ or how you can get your hearing checked, visit www.hearing.com.au

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One in four Australians will have some kind of hearing loss by 2050. But up to 37% of that may be prevented by following 10 steps for safer listening, says Wendy Pearce. 1. TURN DOWN THE VOLUME Don’t listen to your personal music player at very high volumes and never to drown out background noise. If the music is uncomfortable for you to listen to, or you can’t hear external sounds when you’ve got your headphones on, then it’s too loud. It’s also too loud if the person next to you can hear the music from your headphones. 2. USE THE 60:60 RULE To enjoy music from your audio player safely, listen to your music at 60% of the maximum volume for no more than 60 minutes a day. 4. WEAR NOISECANCELLING HEADPHONES These filter out background noise and allow you to have the volume lower. Earbud-style earphones and ordinary headphones are less effective at reducing background noise.

4. DON’T PUT UP WITH WORK NOISE If you’re experiencing noise at work, talk to your HR department or your manager and ask for advice on reducing the noise and getting hearing protection. 8. WEAR EAR PROTECTORS Wear ear protectors (earplugs or earmuffs) if you are using noisy equipment such as power drills, saws, sanders or lawn mowers. 9. BE CAREFUL IN THE CAR Listening to music in a confined space increases the risk of hearing damage. 10. GIVE IT A REST! Give your ears time to recover after they’ve been exposed to loud noise. Increasing the recovery time reduces the risk of permanent deafness.

5. TURN IT DOWN Turn down the volume on your TV, radio or hi-fi a notch. Even a small reduction in volume can make a big difference to the risk of damage to your hearing.

If you are concerned about your hearing, a free and simple 15-minute hearing check is the first step you should take – ask your GP for what checks they can run, and a possible referral. ♥

6. USE EARPLUGS WHEN LISTENING TO LIVE MUSIC They can reduce average sound levels by between 15 and 35 decibels. They’re widely available at many live music venues and shouldn’t spoil your enjoyment of the music.

WENDY PEARCE is Head of Clinical Support, Australian Hearing: www.hearing.com.au Spring 2015 • Healthy & Heartwise

healthyheart

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

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healthyheart More than half of cardiac patients have some degree of OSA but Professor Jackson says it is frequently unrecognised. Diagnosis requires a sleep test and often patients would remain (not quite) blissfully unaware of their condition were it not for a partner complaining! Fortunately, effective treatments are available such as the Continuous Positive Air Pressure (CPAP) device worn overnight to keep airways open, which improves sleep markedly – see HHW53, page 16–7 and HHW55, page 71.

The insomnia phenomena

more likely to have ongoing depression and anxiety 12 months later. Of further concern to Mr LeGrande is that those patients who report poorer sleep are also less likely to take their regular heart medications and to be less confident that they can cope with the challenge of having heart disease.

Sleep disorders and the heart Insufficient sleep puts people at higher risk of heart problems than lifestyle factors such as diet, exercise and smoking. Indeed, adults older than 45 who are sleeping less than six hours a night have double the risk of heart attack or stroke compared to those who sleep six-to-eight hours a night. Even for younger adults, poorer sleep habits place them at higher risk of heart disease. People younger than 45 who slept poorly had higher blood pressure and higher blood cholesterol, leaving them at higher risk of heart problems in the future. Professor Alun Jackson, Director of the HRC, sees sleep as a vital area of research because sleep disorders, cardiovascular disease and depression are all interrelated – each condition causes and contributes to the other. The two main sleep issues that are associated with worse heart outcomes are obstructive sleep apnoea (OSA) and insomnia.

Snoring effects not so boring Obstructive sleep apnoea places people at increased risk of having a heart attack. Patients with OSA often snore loudly and awaken a number of times during sleeping when they struggle to breathe. Many may wake feeling unrefreshed and then experience fatigue problems throughout the day.

Between 10 and 20% of patients with heart disease have some level of insomnia. Not surprisingly, many patients report poor sleep in hospital. This can be for a range of reasons, including the noisy and unfamiliar environment, pain and the impact of treatments. Worry about health and concern about the future, plus other emotional reactions, can keep people up or stop them returning to sleep if they wake up in the small hours. After leaving hospital, it may take some weeks for sleep to return to normal. For some patients, poor sleep patterns persist either as new-onset insomnia or as part of an ongoing pattern of poor sleep. Psychologists can provide cognitive behavioural therapy (CBT) – counselling based around changing ingrained negative thoughts and feelings to produce healthier habits and behaviour. CBT is commonly used to treat anxiety and depression, and has been recognised as highly effective in treating insomnia. ♥

Sound sleep strategies • Exercise regularly but avoid vigorous physical activity prior to sleep unless it’s sex, an established soporific – see HHW55, pages 8, 18–9 • Your bedroom needs to be dark, quiet and comfortable • Turn down lights as you are approaching your bedtime • Do not use digital devices with screens in the hour prior to your desired sleep time – blue light emitted from smartphones, monitors and tablets interferes with your sleep hormones • Alcohol and caffeine in coffee, tea and other energy drinks can steal your sleep • Be prepared to ‘surf the wave’ of sleepiness when it comes – use this as a cue to go straight to bed • Do not expect to always sleep through the entire night – it is normal to have periods of deep and light sleep and a number of brief awakenings are normal • Avoid checking the time repeatedly if you wake up because this can increase anxiety and prevent resumption of sleep • Try to wake up at the same time every day, which will help you to establish good sleep routines • Ask your doctor about sleep tests for sleep apnoea and/or counselling for insomnia

Spring 2015 • Healthy & Heartwise

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36 Healthy & Heartwise • Spring 2015

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healthyshopping In 2007, the European Union restricted the use of the word ‘superfood’ on food packaging unless it was supported by credible evidence. Eight years later, celebrity chefs, cooking shows, athletes and internet-fuelled dietary, lifestyle and fitness trends are driving demand that sees worldwide stampedes for (then shortages of) quinoa and kale, the superfoods of 2014. “Predictions are that cauliflower, Brussel sprouts and amaranth will become some of the most in-demand superfoods for 2015,” said market research firm Mintel, which noted the use of product claims such as ‘all natural’, ‘vegan’ and ‘vegetarian’ had doubled in the past five years.

Super or duper? Like any ill-defined marketing buzzword, ‘superfood’ is open to abuse or at least overuse. It may be employed simply to whittle down an oversupply of a cash or subsidised crop; or a health benefit is presumed but could be thwarted by other constituents (e.g. tannins in tea, phytates in legumes or poorly absorbed iron in vegetables) or the quirks and complexities of individuals’ digestion and overall health and nutritional status. Some superfoods become victims of their own success, their halo slipping from poor production practices, being adulterated or adulterants, e.g. soy, the ‘milk’ from which became the dairy alternative for 65% of the world’s adults who are lactose intolerant, with extra benefits for heart and hormone health, until the level of its processing became clear and consumers flocked to relatively wholefood soymilk Bonsoy – only to then get thyroid disease because the kombu seaweed added to thicken it was for some batches dried and powdered, hence more concentrated in iodine, than the usual whole fresh algae.

Heartwise superfoods It would be churlish to reject superfoods simply because they’re trendy exotics – most staples, from China’s tea and oranges to South America’s potatoes, coffee and chocolate, were introduced at some stage to the AngloEuropean pantry we’ve inherited. And they’re not all just about fashion and PR because everyday bananas, spinach, liver or eggs can indeed be superfoods and despite the current vogue for ancient wholegrains, they don’t have to be whole foods. Some processed food products are also called ‘functional foods’, e.g. yoghurt – its lactic acid bacteria repopulate our gastrointestinal tract and regulate our immune response to infection and allergens [see pages

22–3; HHW56, pages 23–4]. Other foods contain superfoods used as ingredients, such as milk, eggs or margarine fortified with omega–3 fatty acids; energy drinks with the caffeine-rich fruit guarana; or the baked goods now using gluten-free ‘ancient grain’ flours such as spelt instead of wheat. Heartwise’s ‘SUPERFOODS’ are those currently available in the Australian mainstream food and beverage market, grouped by the health areas for which they are most useful. Nutrients each food has been found ‘HIGH IN’ relative to other foods per unit measure or serving are listed. ‘HEALTHY EATING TIPS’ describe the health benefits shown in published research studies (ideally but rarely double-blind placebo-controlled randomised trials), and culinary ‘organoleptic’ properties (taste, texture, aroma, etc.). There are different methods of measuring nutritional variables such as antioxidant activity, levels of bioavailable nutrients or the quality of a protein source, and sources informing Heartwise’s selection are listed on the right.

Too super to be here Conspicuous by its absence is hemp, one of the most versatile and ancient of all plants with seeds that render an oil rich in antiinflammatory omega–3 and omega–6 fatty acids, antioxidants zinc and vitamin E, and is a rich source of complete protein. The seeds have a creamy texture and grassy flavour and no phytates nor psychoactive cannabinoids, nonetheless Australia alone prohibits its sale for oral consumption to spare the public ‘confusion’; like colostrum-rich raw milk but infinitely safer, it features in health food stores among cosmetic products for external use only. Another omission is touted as the ‘next big thing’ after its cousins soy and sorghum, but is richer in protein and may help fight the worsening epidemics of diabetes, obesity and heart disease. Lupins – legumes so bitter-tasting that farmers traditionally grew them just to nitrogenise soils – have had sweeter varieties bred selectively in Western Australia, which produces most of the global supply, and genetically sequenced by the CSIRO. Sweet lupins are a strong source of cholesterol-free protein (40%), starch-free fibre (30%) and potassium, and food enriched with their low-GI, gluten-free flour – available from health food stores – satisfies appetite more rapidly and longer than wheat flour. Research suggests it lowers blood pressure and cholesterol and avoids spikes in blood glucose levels, and can even mimic the taste of sausage meat, leading to the food industry developing it as a premium plant-based protein source.

SOURCES Benham A. Greenilicious: 101 ways to love your greens. Arbon Publishing, Sydney, 2015. Bryant S. Vegetables, grains & other good stuff. Penguin, Sydney, 2015. Chaplin A. At home in the whole food kitchen. Jaqui Small LLP, London, 2015. Ebsco Health Library. EBSCO Information Services, Ipswich, Massachusetts, US. Freer C. Superlegumes: Eat your way to good health. Murdoch Books, Sydney, 2015. Healthnotes, Inc, dba Aisle7, 2015. http://health.walmart. com/health-wellness-center/. Langley S. ‘Key trends for Australian and New Zealand consumers in 2015, Mintel.’ Australian Food News, 27 October 2014, online at http:// www.ausfoodnews.com.au Manheim J. Superfood juices, smoothies & drink. Murdoch Books, Sydney, 2015. McGee H. McGee on Food & Cooking. Hodder & Stoughton, London, 2004. Rogers S. The Cook’s Garden. New Holland, Sydney, 2011. The world’s healthiest foods, http://whfoods.com, The George Mateljan Foundation, 2015. Webmd.com United States Department of Agriculture. National Nutrient Database fot Standard Reference Release 27, The National Agricultural Library, Washington, 2015. Wahlqvist ML (ed). Food & Nutrition, 3rd edn, Allen & Unwin, Sydney, 2011.

Spring 2015 • Healthy & Heartwise

healthyshopping GENERAL HEALTH SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Açai [ah-sigh-EE] – berry from a palm common to the Amazon

Protein, vitamin A, antioxidant anthocyanin (10–30X red wine), fibre, iron, calcium

• Some studies suggest higher antioxidant activity than other produce • Improved metabolic markers in overweight people in 30-day trial

Bananas – orig. Malaysia 4000 yr ago; eaten whole, blended, puréed or dried; sweetest fruit after dates and jujubes/Chinese dates

Potassium, fibre, zinc, calcium, iron, folate, vitamin B6, pectin and prebiotic fibre

• Sustained energy, natural detoxifier, good for diarrhoea and constipation

Baobab fruit of the great ancient ‘bottletrees’ of Africa, Madagascar and Australia that store up to 100,000 litres of water in their swollen trunks

Vitamin C – the claim ‘six times more than an orange’ stands; oranges average about 50 mg/100 g compared to fresh boabab pulp 400 mg/100 g

Tangy, tart flavour of grapefruit, pear and vanilla; Australian variety “tastes like sherbet and is very refreshing”

Coconut – the biggest nut cracks to give coconut water, butter, vinegar, oil, milk, cream, dessicated/flaked flesh; flowerhead sap gives palm sugar and wine [see HHW56, pages 32–3]

Highest in saturated fatty (esp. lauric) acid than any other plant oil and most animal products

• Lauric acid raises healthy HDL cholesterol • ‘Haunting’ nutty, slightly sweet flavour • Water used as sports drink

Fish – cold/deepwater/pelagic, such as tuna, salmon, sardines, mackerel, cod

Omega–3 fatty acids DHA and EPA, vitamin D, iodine, calcium in bones, vitamin A in liver oil

Retinal, neural and cognitive development, heart function, bone health, inflammatory conditions, dry skin

Lúcuma [loo-KOO-ma] – fruit from the lower Andes, consumed since Incan times

B group vitamins, antioxidant betacarotene, iron

• Maple–pumpkin flavour with undertones of cashew • Low-GI sweetener

Maca – radish-like root a staple food and stimulant/tonic in the Andes for 6000 years; now promoted as aphrodisiac

Protein (10%), fatty acids, sterols, fibre, iron

• Some trials show effect on menopausal symptoms, sexual function, sperm count • May help coping with stress

Maqui – Chilean berry made into jam, juice, astringent, ingredient, powder

Antioxidants, esp. vitamin C

• Easily oxidises so airtight storage required • Muted blackberry flavour

G A S T R O I n T E S T I n A L & I M M u n E H E A LT H SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Berries with yellow carotenoids attract bird/ animal consumption for seed dispersal, and antioxidants protect flesh

Anti-inflammatory, antimicrobial antioxidant anthocyanidins, carotenoids, catechins, ellagic acid, betacarotene, fibre (pectin)

Ginger – fresh, dried, powdered, crystallised/ glacé, fermented to wine or pickled, added to spice meals or infused in teas

Pungent anti-inflammatory phenolic antioxidants Raises body temperature and circulation; suppresses (some more concentrated in dried extracts) coughs; eases indigestion, nausea, wind, morning and travel sickness; mixed results in trials for osteoarthritis

Kefir – lactic acid bacteria and yeasts ferment milk

Yeast-based and Lactobacillus sp. probiotics, propionic acid

Rebalancing gut bacteria, treating GI symptoms, improving immunity

Sauerkraut – cabbage fermented by lactic acid bacteria, similar to Korean kimchi and Polish pickled cucumbers

Lactic acid probiotics, vitamins C, B and K, calcium, magnesium, fibre, enzymes, antioxidant carotenoids lutein, zeaxanthin

Probiotics support GI health; fermentation makes nutrients more digestible

Goji or Chinese wolfberry is rich in zeaxanthin, an antioxidant carotenoid; dried Inca/Aztec/golden or physalis berries have greater antioxidant capacity and highest fibre (24%) of all dried fruit from multiple tiny seeds

Tea – chai traditionally is black tea brewed with Theanine, fluoride, dditional myriad antioxidants Cardamom reduces wind, however too much tannin can spices (e.g. cinnamon, coriander seed, cardamom, and phytochemicals from spices constipate etc.) and milk – kombuchu/tea kvass is black tea fermented with Lactic acid, B vitamins, mucilage, glucosamines yeast and bacterial starter

Flavour increases with fermentation time; may help joint stiffness, gut dysbiosis, immunity

Wheatgrass juice from shoots of sprouted seeds

Antioxidant, anti-inflammatory, antibacterial phytochemicals, e.g. chlorophyll

Fresh juice may reduce ulcerative colitis symptoms and increase haemoglobin so blood more oxygenated

Yoghurt – unsweetened Greek/labneh/ strained has whey/lactose removed

Lactic acid probiotics, calcium

Regular consumption associated with lower risk of chronic disease, premature death

38 Healthy & Heartwise • Spring 2015

healthyshopping HEART & CIRCuLATORY HEALTH SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Algae – chlorella is a freshwater single-cell microalgae powdered for shakes etc. or in supplements; nutrient levels vary greatly with production and processing

Complete protein (66%), betacarotene, iron, zinc, chlorophyll, vitamins B2, B12

• 5 g/day lowered total and LDL cholesterol and triglycerides in a recent trial of people with elevated levels • Cell walls must be broken/cracked for digestion

– spirulina, a blue–green single-cell algae from salty lakes in Mexico and Africa, harvested and usually powdered

Protein ( 0%), B vitamins (B12 inactive in humans), vitamin E, betacarotene, chlorophyll, omega–6 GLA fats

• May improve cholesterol profile • Inconclusive results for weight loss and enhanced immunity

Almonds – relatively low oil content means longer shelf life – meal useful as high-protein flour substitute

Antioxidant vitamin E, copper, magnesium, fatty acids (50%), potassium

• Improve cholesterol, blood pressure levels and reduce artery plaque build-up • Skins have a flavonoid that boosts antioxidant protection of LDL cholesterol

Avocado – excellent as a healthy spread or dip, infant food, thickener for shakes

Vitamins A, B, E, iron, calcium, potassium, beta– sitosterol, oleic acid, fibre

• Reduces high total serum cholesterol, triglyceride levels

Cacao [ka-kOW] – the raw bean before processing to make cocoa then chocolate [see HHW54, pages 4–5] – powdered or offcuts/nibs

Magnesium, fibre, iron, antioxidant flavonoids (dark chocolate 0% cocoa), energy from fat and carbohydrate

• Improves mood, cognition, blood pressure • May lower heart risk • Rich intense flavour

Cruciferous vegetables – broccoli, cabbage, Brussels sprouts and kale are healthiest steamed briefly in a sealed pan – bok choy, choy sum, gai lum in Asian stir-fries

Antioxidant vitamins C, E, K and carotenoids betacarotene and lutein, thiocyanate indole3-carbinol, B vitamins (esp. folate), calcium, iron, fibre

• Folate converts harmful homocysteine to amino acid methionine • Lower oxalate levels in Asian greens ease mineral absorption

Fish – cold/deepwater/pelagic, such as tuna, salmon, sardines, mackerel, cod

Omega–3 fatty acids DHA and EPA, vitamin D, iodine, calcium if not deboned

• Retinal, neural and cognitive development, cardiovascular function, bone health, inflammatory conditions, dry skin

Flaxseed a.k.a. linseed – used 000 years for food Omega–3 ALA (30%; highest in all plants), protein • Gum in fibre emulsifies and volumises in baking and to make linen fabric; crush to access fatty acids (30%), fibre (30%), anti-inflammatory lignans • Lignans decrease inflammatory markers in blood that oxidise rapidly in heat and light (highest after sesame seeds) • 2 tbsp/day found to decrease cholesterol and oxidation Oats – convenient in muesli, porridge, snack bars, Thiamin, calcium, potassium, magnesium, fibre crumble; milk from soaking a new dairy alternative (betaglucan), tryptophan

• Betaglucan lowers cholesterol levels • Steel-cut and rolled higher fibre/lower GI than quick oats

Onions and garlic – garlic must be crushed or aged for maximum health benefits

Sulphur compounds, flavonoids, chromium, vitamins B6 and C

• Blood-thinning, antibiotic, can lower cholesterol and blood pressure

Tea – most beneficial and least fermented is white (leaf tips), then green, oolong and black tea; green tea matcha powder widely used as food ingredient

Antioxidant polyphenol flavonoid catechins, fluoride, theanine, caffeine, theobromine

• Lowers total and LDL cholesterol; population studies suggest catechins cardioprotective • Can lower folate absorption; contains oxalates

Walnuts – waxy/flakey skin rich in phenols

Omega–3 ALA, vitamins E, B6 and B3, amino acid arginine, fibre, phytosterols, copper, manganese

• Cardioprotective, improves arterial function and circulation • ALA is anti-inflammatory and antioxidant

CAnCER PREVEnTIOn SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Cruciferous vegetables – broccoli, cabbage, Brussels sprouts and kale are healthiest steamed briefly in a Tsealed pan – bok choy, choy sum, gai lum in Asian cuisine

Antioxidant vitamins C, E, K and carotenoids betacarotene and lutein, thiocyanate indole-3carbinol, B vitamins (esp. folate), calcium, iron, fibre

• Sulphurous compounds reduce DnA damage to protect against cancer • Lower oxalate levels in Asian greens ease mineral absorption

Mushrooms – medicinal use universal but apanese researching maitake, reishi and shiitake immune effects

Selenium, zinc, folate, copper, vitamins B6, C, D; fibre, amino acids

Betaglucans and polysaccharides are immune boosting, antiviral, antibacterial; lentinan reduces breast cancer risk

Tea – most beneficial and least fermented is white, then green, oolong and black tea

Antioxidant polyphenol catechins, fluoride, theanine

Protective against cancer, heart disease, clotting, inflammation, dental caries; helps concentration, cognitive performance Spring 2015 • Healthy & Heartwise

healthyshopping LOW-GI ENERGY SOURCES SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Amaranth – ancient (5000 y.o.) grain from South America

Protein (18%), fats (8%), calcium, magnesium, fibre

• Gluten-free; cooks 20 mins, can be popped • Sweet nutty flavour, corn-like aroma

Barley – 10,000 y.o. Egyptian grain; Fibre (highest of grains with more betaglucan • Lowers blood pressure, cholesterol and blood glucose (de)hulled barley is a whole grain but pearl barley than oats), molybdenum, manganese, selenium, levels has bran removed; barley tryptophan, propionic acid • Rich malty nutlike flavour and chewy texture – grass sold for juicing like wheatgrass • Tryptophan a calming amino acid – water is strained after boiling grain then mixed with lemon, etc. Buckwheat – seed of rhubarb relative native to Complete protein (13%), vitamin B group Asia, used in apanese soba noodles

• Gluten-free • Earthy flavour, quick cooking, light texture

Chia – used by indigenous north/Meso Fibre (30%), protein (1 %), omega–3 ALA (24%; • Gluten-free Americans for endurance; soaking prior to eating highest after flax), calcium, antioxidant phenols • Soluble fibre gum may be useful in weight loss but raw releases a thickening mucilage and isoflavones uneven trial results Coconut – the biggest nut cracks to give coconut Highest in saturated fatty (esp. lauric) acid than • Lauric acid raises healthy HDL cholesterol water, butter, vinegar, oil, milk, cream, dessicated/ any other plant oil and most animal products [see • ‘Haunting’ nutty, slightly sweet flavour HHW56, pages 23–4] • Water used as sports drink flaked flesh – flowerhead sap gives palm sugar and wine Mesquite flour or meal from ground seed pods used as sweetener by native Americans

Protein, calcium, iron, lysine, fibre, tannins, inulin Low GI, gluten-free; slimy polysaccharide gums stabilise blood glucose levels

Millet – 6000 y.o. tiny seed grain from Africa Protein (16–22%), alkaline ash, copper, can be popped, brewed, baked into Indian roti or phosphorous made into porridge and couscous

• nutty earthy flavour, fluffy or creamy texture • Gluten-free and low GI

Quinoa [keen wah] – ancient (>6000 y.o.) Incan Folate (highest of grains), complete protein (13% • Gluten-free grain that cooks fast; rinse away bitter saponins of essential amino acids), calcium, magnesium • Light texture, mild nutty flavour prior • Low-GI Spelt – ancient ancestor of wheat commonly grown organically because of tough protective husk

Protein (17%), manganese

• Lower gluten, higher fibre and protein than wheat • Chewy texture, slightly sweet nutty flavour

Teff – 3000–5000 y.o. Ethiopian seed smaller than millet and cooks similarly but quicker

Calcium, whole protein

• Gluten-free; rich earthy chocolate flavour

Wheat – freekeh/farik is young green wheat roasted, rubbed and cracked – emmer/farro is an ancient ancestor of modern wheat

Fibre, protein, calcium, iron, zinc

• Low GI so suitable for diabetes • Chewy texture

VISUAL & EYE HEALTH SUPERFOOD

HIGH IN

Berries with yellow carotenoids attract bird/animal Anti-inflammatory, antimicrobial antioxidant consumption for seed dispersal, and antioxidants anthocyanidins, carotenoids, catechins, ellagic acid, protect flesh vitamin C, betacarotene, fibre (pectin)

HEALTHY EATING TIPS Goji or Chinese wolfberry is rich in zeaxanthin, an antioxidant carotenoid that protects the macula; blueberries high in lutein and zeaxanthin

Cruciferous vegetables – broccoli, cabbage, Brussels sprouts and kale are healthiest steamed briefly in a sealed pan – bok choy, choy sum, gai lum more peppery tasting

Antioxidant vitamins C, E, K and carotenoids • Sulphurous compounds reduce DnA damage betacarotene and lutein, thiocyanate indole-3• Yellow carotenoid lutein in green leafy vegetables good for carbinol, B vitamins (esp. folate), calcium, iron, fibre macula protection • Lower oxalate levels in Asian greens ease mineral absorption

Eggs – boiled or poached are quick healthy options; omelettes and scrambled eggs tastier

Vitamin B12, folate, protein, choline, iodine, selenium, carotenoids lutein and zeaxanthin

Good source of high-quality protein and carotenoids for long-term macula health, including people with diabetes [see HHW56, page 2]

Fish – cold/deepwater/pelagic, such as tuna, salmon, sardines, mackerel, cod

Omega–3 fatty acids DHA and EPA, vitamin D, iodine, calcium in bones, vitamin A in liver oil

Retinal, macula, neural and cognitive health, inflammation; overdosing with liver oil can cause vitamin A toxicity; while larger oily fish contain higher levels of toxic heavy metals

40 Healthy & Heartwise • in r 2015

healthyshopping Liver – most nutrient-dense organ meat, which are Protein (30%), B group vitamins esp folate, vitamins Liver stores fat-soluble vitamin A and copper, so more nutritious than standard retail muscle cuts A and D, copper, iron, phosphorous, zinc, selenium, overconsumption can lead to toxicity from excessive levels of tryptophan these nutrients Sauerkraut – cabbage fermented by lactic acid bacteria, similar to Korean kimchi

Probiotic bacteria, vitamins C, B and K, calcium, magnesium, fibre, enzymes, lutein, zeaxanthin

Fermentation makes cabbage nutrients more digestible; antioxidant lutein and zeaxanthin good for eye health

JOINT & MUSCULOSKELETAL PAIN SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Ginger – fresh, dried, powdered, crystallised/ Pungent, anti-inflammatory phenolic antioxidants Raises body temperature and circulation; suppresses glacé, fermented to wine or pickled, added to spice (some more concentrated in dried extracts) coughs; eases indigestion, nausea, wind, morning and meals or infused in teas motion/travel sickness Turmeric – yellow spice powdered from the rhizome common in Indian cuisine

Anti-inflammatory, antioxidant curcumin, betacarotene

May help with joint pain; aching head and muscles; indigestion with wind; circulatory health

REPRODUCTIVE & UROLOGICAL HEALTH SUPERFOOD

HIGH IN

HEALTHY EATING TIPS

Cranberries – native only to northern hemisphere; usually available locally frozen, as a juice or product ingredient, and in supplements

Proanthocyanidin epicatechins, phenolic acids; fibre; manganese, vitamin C

Proanthocyanidins prevent cystitis-causing bacteria from adhering to urinary tract lining

Maca – radish-like root a staple food and stimulant/tonic in the Andes for 6000 years; now promoted as aphrodisiac

Protein (10%), fatty acids, sterols, fibre, iron

• Some trials show effect on menopausal symptoms, sexual function, sperm count • May help coping with stress

Pumpkin seeds – oil is used as a salad dressing

Protein (35%), omega–6 and 9 fats (50%), chlorophyll, copper, magnesium, zinc, lutein

May relieve symptoms caused by enlarged prostate

HORMONAL/METABOLIC BALANCE SUPERFOOD

HIGH IN

Flaxseed a.k.a. linseed – used 7000 years for food Omega–3 ALA and antioxidant flavonoid lignans and to make linen fabric (highest in all plant sources), protein (30%), fibre (water-soluble mucilage)

HEALTHY EATING TIPS • Lignans act as phytoestrogens • 30 g/day ground flaxseed lowered blood pressure and glucose levels after 12 weeks in a recent study

Seaweed – plentiful and up to a third protein when dry; colours change on cooking:

Fucoidan sulphated glucosaccharides, iodine, iron, • Sodium may raise blood pressure; iodine thyroid activity calcium, copper, amino acids • Anti-inflammatory fucoidans researched for joint pain

– dulse, red algae used by Scottish in soups

Betacarotene, iodine

– nori (laver), red algae farmed, minced and toasted phosphorescent green in sheets for sushi and UK flat cakes; flakes can be sprinkled over food

Betacarotene, iodine, highest protein of seaweeds, • Colour changes to green, flavour more grassy and texture vitamin B12, omega–3 fatty acids crunchy on cooking • Starches provide gelling agents agar-agar and carrageenan

Tangy smoky-tasting salt substitute with chewy texture

– wakame, brown algae used dried or fresh in miso Sodium, iodine, vitamins A, C, E, B group, K, folate, • Delicate texture soups and salads fibre, carotenoids • Produces sugar alcohol mannitol and mucilage algin – kelp/kombu, a brown algae used to flavour and thicken stocks or Bonsoy soy milk

Vitamins A, C, E, B group, K, folate, fibre, magnesium, iodine, carotenoids

Soy beans steamed whole as edamame, or: Isoflavone phytoestrogens, fibre, compete and – boiled and fermented with mould, salt, yeast heat-stable protezin, polyunsaturated fatty acids, and roasted grain into shoyu sauce or miso paste; probiotic bacteria when fermented tamari does not use wheat so is gluten-free

As above; savoury and meaty flavour (umami taste) from glutamic acid • May moderate bone lost and menopausal symptoms; saponins lower cholesterol • The browner the pigment, the more highly antioxidant • Savoury and meaty flavour (umami taste)

– tofu, formed from curdled soy milk after beans are soaked in water

Complete protein, iron, calcium, oxalates, phytates, • Gluten-free phytoestrogens • May lower LDL cholesterol

– tempeh, whole soy beans soaked, dehulled and partly cooked, then fermented with a culture and mould

Protein, fibre and vitamin content higher than tofu, Earthy flavour increases with age; fermentation reduces probiotic bacteria, manganese phytates so nutrients more bioavailable

in r 2015 • Healthy & Heartwise

HEART2HEART Condition

LIBBY BIRCHMORE, BN, MNP, FFACNP, is a consultant cardiac nurse practitioner

CONDITION

Heart failure

DIAGNOSIS

Fatigue, breathlessness and fluid retention are all signs of a weak heart struggling to pump. Heart failure is the most common cardiac condition after heart attack and coronary artery disease and usually follows from them, explains cardiac nurse practitioner LIBBY BIRCHMORE.

MEDICATION

MANAGEMENT REHAB & RECOVERY

lso known as an enlarged heart, cardiomyopathy, systolic dysfunction or leftventricular dysfunction, heart failure means that your heart fails to pump or contract efficiently as before – not that it’s at the point of giving up altogether! Chronic or congestive heart failure (CHF) is life long and requires daily medication and careful monitoring. Sometimes symptoms can worsen [see box], and patients often describe having good and bad days. It is also possible that your heart will become weaker as you get older, and will require some changes to your medications and other treatment. It’s important that you and your family begin to understand your condition, and work with your healthcare team to achieve the best outcomes.

Symptoms of heart failure include: • Breathlessness may indicate fluid accumulating in lungs and leave you unable to perform your usual activities, or perhaps you wake up with a dry cough and find it difficult to breathe when you lay down. If so, it is important you contact your doctor of heart failure nurse. • Cough may also indicate increased fluid accumulating in your lungs, or could be a side effect of one of your medications. Seek advice before stopping the medication. • Increased fatigue from a weakened heart not supplying sufficient blood to your muscles and other organs. • Weight gain often occurs quickly and is associated with fluid retention. • Swollen feet, ankles and/or abdomen from fluid leaking out of capillaries into the surrounding tissues. Fluid retention (oedema) may occur gradually, and initially you might notice your shoes getting tight. Your abdomen may feel bloated and uncomfortable, and you may experience loss of appetite. • Dizziness is most often associated with low blood pressure but can be related to a change in your medication. If this occurs, seek medical advice before stopping any medication. • Heart palpitations may be related to a problem with the heart’s electrical system, and it is important to see your doctor if you feel your heart racing. If you also feel chest discomfort, ring an ambulance, as it may be urgent. • Chest pains or discomfort that spreads to the arm and jaw requires urgent action. If you have been prescribed an angina spray or tablet, you should use it immediately. If the symptoms persist after 10 minutes, call an ambulance.

Why hearts fail For many people, the development of heart failure is gradual, and it becomes more common as we age. Its typical cause is coronary artery disease (CAD; see HHW56, pages 44–5] – blockages or narrowing in the coronary arteries, which may have caused a heart attack and damaged the heart muscle. Some people who suffer angina [see HHW54, page 34] can develop CHF from circulation to the heart being reduced long term. Less common causes are problems with the heart valves or thyroid gland, or

overconsumption of alcohol. Often the cause of CHF is difficult to identify because it can develop after a viral infection or other diseases, and sometimes remains a mystery. Family history and genetics can play a role in rare cases that usually emerge at a younger age. To prevent CHF, management of cardiovascular risk factors, such as high

42 Healthy & Heartwise • Spring 2015

cholesterol levels, depression/anxiety, smoking and being overweight or mostly sedentary, must be addressed in your overall care. High blood pressure is particularly important to lower because almost two-thirds of people with CHF have hypertension, which eventually stretches and thickens the pumping chambers of the heart.

These test results will be reviewed by your cardiologist and a treatment plan developed that will include a range of medications to slow down the progression of disease, relieve your symptoms, and minimise the risk of an acute episode of breathlessness or irregular heartbeat (arrhythmia).

Your cardiac care team You may see a number of health professionals periodically for CHF. Your cardiologist will liaise with your GP, who will monitor your overall health and manage any non-cardiac conditions. Specialist heart failure nurses and/or nurse practitioners provide education and regular support to you and your family as needed. They may also assist your doctors to monitor your condition and adjust your medications when appropriate, and develop a care plan. A comprehensive management plan may include referrals to other health professionals such as dietitians, physiotherapists, exercise physiologists and community pharmacists. This healthcare team will rely on you to learn as much as possible about your condition so that you can help monitor and manage your symptoms.

Spring 2015 • Healthy & Heartwise

MANAGEMENT

about the size, volume and thickness of the heart muscle, how well the walls of the chambers move with each contraction, and the condition of the valves. A specially trained technician asks you to bare your chest and lay on your left side, then a probe covered in gel is placed on your chest to obtain readings that will be interpreted by your cardiologist. • hest –ray can show whether your heart is enlarged or whether there are any changes in your lungs, which may indicate congestion from fluid retention. • oronary angiogram may be required if your cardiologist suspects that CAD is the cause of your heart failure, or if you have angina-type chest discomfort [see HHW56, page 46]. • lood tests will obtain an overall picture of your health, including:

MEDICATION

sually your GP will refer you to a cardiologist to confirm a diagnosis of heart failure, identify the cause and develop a treatment plan. The cardiologist will ask you about your health and symptoms, and make a comprehensive physical assessment. You will have your blood pressure checked while you are sitting or lying, and again when you stand up. A check of your abdomen and your legs will identify any fluid retention, and your body weight will be recorded. You will then need to undergo a number of tests that may include: • Electrocardiogram E traces your heart’s electrical activity and can help identify any narrowings or blockages of your coronary arteries. • Echocardiogram is an ultrasound test that most effectively diagnoses heart failure. An ‘echo’ provides information

DIAGNOSIS

At least two types of cardiogram and several blood tests help cardiologists diagnose heart failure, find its likely cause and develop a treatment plan. LIBBY BIRCHMORE is one of a team of health professionals who then support and share your management of it long term.

CONDITION

Echo, ECG, tests and a team

- Biochemistry tests of your kidney function, blood glucose levels and cholesterol. You may also be asked to undergo another cholesterol blood test after fasting for 12 hours, and if you have diabetes, require an HbA1c test. - Full blood count examines your blood cells to rule out anaemia as a cause of your heart failure. - Thyroid function test checks how your thyroid gland is functioning because an overactive thyroid gland can cause high blood pressure and/or an irregular heartbeat. - B-type natriuretic peptide (BNP) test – BNP is a hormone secreted from the walls of the lower chambers of the heart as they work harder. BNP levels aren’t checked routinely but can help the doctor identify the cause of your breathlessness if you are acutely unwell.

REHAB & RECOVERY

Diagnosis HEART2HEART

HEART2HEART Medication

Water pills and retention CONDITION

Heart failure requires daily treatment, often in the form of taking diuretics to flush fluids from your body that your circulation cannot. But water retention or oedema also requires vigilance, as can low fluid and mineral levels, says cardiac nurse practitioner LIBBY BIRCHMORE.

DIAGNOSIS

MEDICATION MANAGEMENT REHAB & RECOVERY

nce a diagnosis of heart failure is confirmed, it means normal cardiovascular function is unlikely to completely return, so treatment shifts to assisting the heart to pump as effectively as possible. Your doctor will prescribe a range of medications with dose amounts and timings that will change according to your condition. Often they will increase the strength of your tablets when you are well. Conversely, when you are unwell it may be necessary to reduce the dosage until you have recovered. Some heart medicines can make you feel unwell when you start taking them because your body needs to adjust to changes in blood pressure and heart rate. However, never stop or cut back on any of your medications without consulting your doctor. If you forget a dose, there is no need to take extra when they are next due – wait instead and take the next dose as scheduled.

Diuretic dos and don’ts If you have been prescribed diuretics or water/fluid tablets to help you pass more urine, it is important you take them as prescribed to manage your fluid levels. Common examples include hydrochlorothiazide, frusemide, indapamide and spironolactone, although they will be known by different brand names or even be combined with another type of antihypertensive [see HHW56, page 48]. Diuretics are mostly used to control symptoms such as fluid in the ankles but stronger water tablets such as frusemide are more effective in

relieving fluid congestion. Frusemide elevates the rate of urination and, as it can act within 30 minutes or so, you may need to be close to toilet facilities for the next four-to-six hours. Urinating more can result in dehydration and depletion of your levels of important minerals, such as potassium [see HHW55, page 23]. Low potassium can disturb cardiac rhythm, which can be dangerous, so your doctor may co-prescribe a potassium chloride electrolyte supplement or a diuretic that doesn’t flush out potassium, such as spironolactone.

Daily dosing for life Your GP, heart failure nurse and pharmacist are key people involved in your medications, so talk to them about any side effects you experience.

44 Healthy & Heartwise • Spring 2015

Ask your heart failure nurse to help you manage your medications, especially if you take several different tablets. This includes over-the-counter pain and cold medicines, herbs, supplements, vitamins and minerals. Some natural medicines and antiinflammatory painkillers such as ibuprofen (Nurofen) can interact with heart medications and worsen symptoms, so check with a pharmacist before starting on anything new. Whenever you see any of your health professionals, it may be helpful if you bring a list of the medications and supplements you are taking. NOTE: People with CHF can become seriously ill if they contract seasonal influenza or pneumonia, so must get vaccinated against these infections.

Management HEART2HEART

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he most common symptom of congestive or chronic heart failure (CHF) is fluid retention, which can occur even if you are taking diuretics, so an important part of your action plan for CHF management is keeping a daily record of your weight [see box]. Weigh yourself each morning after going to the toilet and before eating, and track any changes. If your weight is the same each day, your fluid levels are okay. If your weight is increasing because your diet has changed, the gain should be gradual but if that weight consists of fluid, the change will be sudden and may require medical attention. If your weight drops or rises by two or more kilos over a 48hour period, you should contact your doctor or nurse.

Watching your water If you gain weight from water retention, your doctor or nurse may ask you to: • reduce uid intake two litres of uid a day (including water, tea, coffee, soft drinks, soup, custards, etc.) is plenty for most people but you may be asked limit it to 1 1.5 litres for 2 hours, particularly if you have signs of worsening heart failure • increase your diuretic dosage do so for the next three days but inform the doctor nurse if you have not lost weight by the third day if you continue to gain weight without taking an extra diuretic, contact your doctor nurse promptly. ou may need to reduce your uid intake until your weight stabilises or you get help • restrict your salt intake because

If you are losing weight significantly, you may become dehydrated on diuretics, especially in very warm weather. If so, seek advice from your doctor or nurse before taking your daily diuretic and drink less caffeinated beverages (e.g. coffee, tea and energy/ soft drinks), which are mildly diuretic. Alcohol should be limited to 1–2 standard drinks per day, with at least two alcohol-free days per week. For some patients, alcohol is toxic to the heart muscle and causes heart failure, so must be avoided completely.

Keeping active Regular physical activity has been shown to reduce hospitalisation and improve survival overall in CHF patients, so is strongly encouraged. Your GP or cardiac nurse can refer you to an exercise physiologist or physiotherapist, who tailors a program to restore as much strength and function as possible [see HHW54, page 20]. Resistance training with light weights is suitable for all patients because its helps restore muscle mass, but avoid heavy weights. The safest exercise is walking at a steady pace where you could chat with someone beside you. If you have angina, carry your spray on you, and ideally a mobile phone too.

Spring 2015 • Healthy & Heartwise

MANAGEMENT

Restrict fluid and salt intake as per medical advice

MEDICATION

Weigh yourself daily and keep a record

DIAGNOSIS

sodium makes your body retain water. Many foods we eat each day contain more sodium than we realise, so learn to look for its content on food packaging see HHW5 , pages 1 2 . A dietitian can help you lower your salt intake see HHW52, pages .

Action plan for heart failure

CONDITION

Weight is an important marker of heart failure – a kilo of extra weight is said to equal a kilo of congested fluid. But managing it with regular exercise and a balanced diet eventually becomes part of a healthier everyday life, as LIBBY BIRCHMORE explains.

REHAB & RECOVERY

Weight and lifestyle

HEART2HEART Rehab & recovery

Succeed at living with heart failure CONDITION

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DIAGNOSIS

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Will I ever get a holiday?

46 Healthy & Heartwise â&#x20AC;˘ Spring 2015

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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 CANâ&#x20AC;&#x2122;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

RECIPES...

Springfood&cooking

Heartwise was fortunate to secure an interview with the figurehead to whom modern Australian dining owes most, Stephanie Alexander. The celebrated food writer and chef taught the importance of quality fresh produce to a generation of chefs who now dominant the food scene and judge the dishes on hit TV shows such as Masterchef and My Kitchen Rules. We have a chef’s chat with Stephanie about her history, ideas, Foundation and why label reading and ‘food anxiety’ alarms her. On the other hand, Tobie Puttock, a Melbourne chef whose skill in Italian cuisine led to success in London alongside Jamie Oliver, explains why he’s found ‘clean eating’ doesn’t have to mean boring cooking or bland meals. Whether super green smoothie, bar of muesli, porridge of ancient grain or scrambled eggs, Heartwise’s springtime breakfasts cover a season of gradually warming weather and growing market selection of fresh fruit, herbs, legumes and vegetables. Two of them earn a Gold Star for excellent nutrition from dietitian Milena Katz but all are excellent sources of sustained, low-GI and often gluten-free energy to get your day going. Snacks and sides start from easy rice cakes with avocado and broad bean smash, Maggie Beer’s roast baby onions or Chrissy Freer’s root veges served as a salad, mini-quiches from Tania Zaetta’s new book and a fascinating gourmet creation involving hermit crab tails (we suggest King prawns if the crabs are so hermitic you can’t find any), miso paste and bean blossoms by the award-winning chef Peter Gilmore, who has just moved from Quay, one of ‘The World’s 50 Best Restaurants’ since 2009, to Sydney Opera House’s flagship restaurant Bennelong. Tender green leafy shoots of spring onion, French shallot, leek, watercress, silverbeet and kale are put to good use in a soup or broth – an economical and convenient way to spread folate, fibre and antioxidant-rich nutrition over a few days or nights, seasonings and flavours often deepening over that time. Ribollita, the famous Tuscan soup we also feature, means ‘reboiled’ and traditionally consisted of leftover minestrone and bread. There’s vegetarian, seafood or chicken options but as always with a soup, the stock is integral.

Duck breast, beef meatballs, roast pork belly and pan-fried trout number among the mains dishes, providing rich flavours that you can match with braised peas, ginger and coriander and any of the sides suggested. The duck and trout is courtesy of Paul West from the Lifestyle Channel’s River Cottage Australia, shot on the south coast of NSW, but you can get the country-style ingredients in most supermarkets and delis. We may have missed winter but you haven’t missed rhubarb season, so we feature a delicious nutty rhubarb crumble stacked with healthy fatty acids, protein and fibre by Olivia Andrews, plus her mandarin, pistachio and chickpea cake that wins a Gold Star. And if any season is good for chocolate, what about cacao, the less-processed, more antioxidant-rich version? With avocado and coconut oil, Lily Simpson shows it can make a fascinating dairy-free mousse and still get a Gold Star for nutrition.

Each meal has healthy eating tips highlighted in gold and its nutrient profile assessed by Accredited Practising Dietitian Milena Katz. A GOLD STAR RECIPE. is lower in kilojoules and/or carbohydrate, and higher fibre and potassium. These meals can be consumed more regularly and are the healthier choices. Spring 2015 • Healthy & Heartwise

In the footsteps of chef’schat

ALEXANDER Stephanie Alexander r i i ri n r rr r ri ing r ni r n n ri n i r g i r n n r r r n rn HHW: You’ve just been to South America and Turkey but travel since age 21 has been a big part of your writing and cooking. How do you decide where to go? n r n p i p in r n r n n ri r n r ii n r rg n p ri n ing r r ing ir r n n n r p rg HHW: Which country had the biggest culinary changes in 50 years of trips? r i n n i r n ir n n in nin r p r n r p n r g in r in

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HHW: Your mother was the prime force behind your cooking and your earliest memories include her using an Aga cooker.These UK design classics are very large, expensive and uncommon in Australia but great for the classic British meals your mum liked to cook. Why and how an Aga? p i i r n g n r i r n i n pr r ri i rning i 10 r r pp g r n ri r ing in n ri n r n r n r n r r ing i i n pi ng i i i n HHW: Your 1996 book The Cook’s Companion has become a bible to generations of chefs, which was its goal; how long did it take to write? Are people taking to the app for it?

50 Healthy & Heartwise • Spring 2015

chef’schat

Stephanie’s silverbeet & potato torte SERVES 6–10 150 g young silverbeet Salt 150 g potatoes Extra-virgin olive oil 1 onion, finely chopped 2 tbsp parsley, freshly chopped 150 g ‘stretchy’ cheese (e.g. mozzarella), chopped or grated 1

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Freshly ground black pepper 1 large egg Olive oil pastry 200 g plain flour ½ tsp salt 1½ tbsp extra-virgin olive oil ½ cup cold water

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HHW: Anxiety around nutrition and label reading saddens you because you prize flavour and the physical properties of food. You must notice in the children you teach increased concern over nut allergies, and with all the diets and food you’ve seen, have any struck you as making sense? i p i n i in r n nn r r gni r r g n in rgi r r n r i nn gr i n i r ri ing n gr p r ri i i r p ii i i n i p n n in p n i in p ri n ing i p i r ng r n r n ppr ing ing n i in r r r n n i HHW: Your Foundation is about instilling a love of food – growing and gathering ingredients, cooking and eating together – in primary school children. How are they getting on? r i n pr S p ni n r i n r n n i n p r ng i r r ng r n pr gr i ri r n prin ip n p r n r n ng in ir i ppr ing in r ring ir i g r n ing i i i r r n n p p n in r in n ir n n r r ir i g r n p pr gr n i i pr n pr n 10 r i pri r p p i n♥ Spring 2015 • Healthy & Heartwise

chef’schat

Tobie HEALTHY OR NOT to be? r

rn n n i r Tobie Puttock n n p rp i n i ri i r HHW: Congratulations on your first book with your partner Georgia! It’s also your first to leave Italian cuisine and look at health. You say it’s been your favourite to write – did Georgia help renew your relationship with food? n n r p r n n ing i n r r n i n i n ri r r n r i ni r gi n i n i in

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52 Healthy & Heartwise • Spring 2015

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HHW: The traditional Mediterranean diet is meant to be the world’s healthiest yet we think of Italian food as pasta, pizza, gelato, etc.! What went wrong and is Italian just not that healthy? i n i r i in ning n in i pp n p r r i n i in pi p r p r p n gr r ip i n i in i r i p i n r HHW: You use extra-virgin olive oil for roasts, baking and soups but add a knob of butter to stove-top egg-based breakfasts. The Heart Foundation still rejects butter as it’s high in saturated fats but some claim that, like in coconut oil, these may be metabolised differently and can even help weight loss, e.g. ‘bulletproof coffee’. What do you think? i in r r r r r r n g gr r i g ri gg i n r irgin gg i i i n pp n i r n r in i

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Recipe and images from The Chef Gets Healthy, Lantern, RRP $39.99

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HHW: Former professional snowboarder Kevin Pearce, who’s made a remarkable recovery from a traumatic brain injury in 2009, is an inspiration to you. Did his or your own car accident and vision scare put you off the snowfields? r i n r in r i r n ing g pr p r n in n ing r n r ing i n g n p i n n n n ng r in i g pr r r n r r n n ing i pp

Tobie’s baked eggs with capsicum & tomatoes 1 tbsp extra-virgin olive oil 1 small red onion, thinly sliced 1 red capsicum, quartered, deseeded, slivered 400 g cherry tomatoes 1 large clove garlic, finely chopped 1 red bird’s-eye chilli, finely chopped (optional) 4 eggs Handful of flatleaf parsley leaves, shredded Sea salt & cracked black pepper Freshly grated parmesan, to serve (optional) 1 r i 2

HHW: Your brush with retinopathy, where your left eye lost a third of its vision, must have been alarming. A lot of our readers have diabetic retinopathy, where capillaries in the eye leak fluid and potentially lead to blindness, and can begin at a young age. Yours was linked to stress yet you cured it by adding yoga, Pilates and running to your dietary changes. Which type of yoga helped and does stress put us all at risk of retinopathy? r in p i n n r i i n r nr g r n r r n n r n n n i n i r n r n i i r n ig ng r r r 20 r in i n r ing i

HHW: In one clip on your YouTube channel you activate almonds by soaking them, a practice made famous by Pete Evans [see HHW56, page 24]. Do you do this for the nutritional effect (if so, do you feel a difference?), the taste or for functional reasons? r r n i n r n ing p p n n n in i i r rn in i

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HHW: In Adelaide last December you opened Jamie Oliver’s popup kitchen Ministry of Food with Ian Curley. Why did he choose a suburban shopping centre? p p i p n rn i ri i p ng r i n i gi p p i n pr i n ri i n r n ir ii n r p in n r rg ♥ Spring 2015 • Healthy & Heartwise

recipesbreakfast Flat belly smoothie Sally Obermeder PREPARATION TIME: 5 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 1) ENERGY 750 kJ, FAT 14.1 g, SATURATED FAT 5.2 g, PROTEIN 4.6 g, CARBOHYDRATE 13.7 g, FIBRE: 6.4 g, SODIUM 218 mg, POTASSIUM 759 mg GOLD STAR RECIPE 1 cup baby spinach ¼ avocado, peeled and de-stoned ¼ cup broccoli florets 1 frozen banana Large handful of mint leaves 3 raw almonds 1 tsp coconut oil 1 cup almond milk 1 tsp stevia, to taste 1. n

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From Super Green Smoothies by Sally Obermeder & Maha Koraiem, Allen & Unwin, RRP $19.99

From Lose Wheat in 4 Weeks – An Easy Plan to Kick Grains, Sonoma Press, 2015, RRP $29.99

Soft scrambled eggs with goat cheese & chives PREPARATION TIME: 5 MINUTES COOKING TIME: 5 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 1) ENERGY 1104 kJ, FAT 20.5 g, SATURATED FAT 10.5 g, PROTEIN 17.7 g, CARBOHYDRATE 1.9 g, FIBRE 0.1 g, SODIUM 764 mg, POTASSIUM 147 mg DIETITIAN’S TIP: A high-protein, low-carb base – serve with corn kernels or baked beans for a complete meal GOLD STAR RECIPE ½ tbsp unsalted butter 2 eggs 1 tbsp finely chopped fresh chives

Sea salt Freshly ground white pepper 2 tbsp fresh goat cheese, unchilled

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54 Healthy & Heartwise • Spring 2015

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breakfastrecipes Apricot, almond & sesame muesli bars Megan May PREPARATION TIME: 15 MINUTES SETTING TIME: 1 HOUR MAKES: 10 BARS 10 cm x 3 cm NUTRITIONAL INFORMATION PER BAR From The Unbakery, ENERGY 1371 kJ, FAT 23.7 g, SATURATED FAT 9.4 g, Murdoch Books, $45 PROTEIN 6.7 g, CARBOHYDRATE 26.1 g, FIBRE 4.9 g, SODIUM 124 mg, POTASSIUM 248 mg DIETITIAN’S TIP: A high-protei 1 cup dried activated Pinch sea salt almonds ½ cup dried apricots ¼ cup whole flaxseeds 1/3 cup raw honey ¼ cup raw tahini 1/3 cup sesame seeds Zest 1 large lemon ¼ cup melted cold-pressed | 1 cup desiccated coconut coconut oil 1½ tsp cinnamon 1. Pulse almonds in a food processor until lightly chopped. Crush flaxseeds into a flour in a blender and place in a bowl with the chopped almonds, sesame seeds, lemon zest, desiccated coconut, cinnamon and salt. 2. Whizz apricots in a food processor until they are in small pieces and sticky (which helps hold the bars together). 3. Place the honey, tahini and melted coconut oil in a bowl and mix until combined. 4. Mix the honey and tahini mixture with the dry mixture until well combined. 5. Line a 20 x 15 cm tin with plastic wrap or baking paper and spread out the mixture evenly. Place another sheet of plastic wrap or baking paper on top and press down firmly to ensure it’s packed well. 6. Refrigerate 1 hour until firm. Cut into 10 bars and can be kept refrigerated within baking paper sheets for 2–3 weeks.

Quinoa & chia porridge Olivia Andrews PREPARATION TIME: 10 MINUTES COOKING TIME: SLOW COOKER 2 HOURS, STOVETOP 25 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1331 kJ, FAT 9.6 g, SATURATED FAT 0.4 g, PROTEIN 7.6 g, CARBOHYDRATE 51.6 g, FIBRE 11 g, SODIUM 174 mg, POTASSIUM 344 mg 1 litre unsweetened almond milk 2 Granny Smith apples, peeled, coarsely grated 1 vanilla bean, split & seeds scraped 60 g quinoa flakes 3 tbsp chia seeds

3 tbsp finely chopped dates 3 tbsp dried cherries, cranberries or chopped dried apricots Honey, raspberries & toasted slivered almonds, to serve

IN THE SLOW COOKER 1. Put all the ingredients in the slow cooker on low for 2 hours. 2. Remove vanilla bean, then serve with honey, raspberries and toasted slivered almonds. ON THE STOVETOP 1. Put almond milk, apples, dates, vanilla bean and seeds in a saucepan over low heat. Cook for 20 minutes until the apple starts to break up. Add the remaining ingredients and cook for 5 minutes until thickened. 2. Remove the vanilla bean then serve porridge with honey, raspberries and toasted slivered almonds.

From Whole Food Slow Cooked, Murdoch Books, 2015, $35

Spring 2015 | Healthy & Heartwise

recipessides&snacks

From The Detox Kitchen Bible, Bloomsbury, $49.99

Avocado & broad bean smash on brown rice cakes – Lily Simpson PREPARATION TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 2): ENERGY 1265 kJ, PROTEIN 6.9 g, FIBRE 1.8 g, POTASSIUM 194 mg, FAT 18.2 g, SATURATED FAT 3 g, CARBOHYDRATE 29.4 g, SODIUM 323 mg Minimise salt, minimise blood pressure rise TO SERVE 4 brown rice cakes Lime wedges

2 avocados 1 tsp lemon juice Handful of spinach 50 g cooked broad beans ½ cucumber, diced 1 tsp lime juice

Pinch of crushed dried chilli 1 tbsp chopped fresh coriander, plus extra leaves 4 fresh mint leaves, finely chopped, plus extra leaves Pinch salt only but pepper to taste

1. Peel and de-stone the avocados. Place flesh from one avocado in a blender with lemon juice, spinach and broad beans, and blend to a rough paste. 2. Dice remaining avocado and place in a bowl with the cucumber, lime juice, chilli, chopped coriander and mint. Mix through the avocado paste with salt and pepper to taste. 3. Pile on top of the brown rice cakes, add the whole herb leaves and serve, with lime wedges for squeezing over.

56 Healthy & Heartwise | Spring 2015

sides&snacksrecipes Honey-roasted pumpkin, borlotti bean, broccolini & hazelnut salad Chrissy Freer PREPARATION TIME: 15 MINUTES COOKING TIME: 40 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4): ENERGY 1624 kJ, PROTEIN 14.1 g, FIBRE 11.4 g, POTASSIUM 909 mg, FAT 17.3 g, SATURATED FAT 1.9 g, CARBOHYDRATE 49.1 g, SODIUM 316 mg High-protein, high-potassium vege meal rich in carotenoids 1½ tbsp honey 1½ tbsp olive oil 2 tsp coarsely chopped rosemary 800 g pumpkin, seeded & cut into wedges 2 tsp red wine vinegar 250 g broccolini, trimmed 400 g tin borlotti beans, drained & rinsed 1 head radicchio, trimmed & leaves torn 2 tbsp lightly toasted hazelnuts, rough chopped 1. Preheat oven to 200°C. Line a large baking tray with baking paper. Combine 1 tbsp honey, 1 tbsp olive oil and rosemary in a large bowl. Add pumpkin and toss to coat. Place on tray and roast for 30–40 minutes or until golden, turning at 15–20 minutes. 2. Meanwhile combine remaining honey, oil and vinegar in a bowl. Set aside.

From superlegumes, Murdoch Books, $35

3. Cook broccolini in boiling water until just tender. Drain. Combine vegetables, beans and hazelnuts in a bowl. Add honey dressing, gently toss and season. Spring 2015 | Healthy & Heartwise

recipessides&snacks Baby onions roasted in vino cotto Maggie Beer SERVES: 4 PREPARATION TIME: 15 MINUTES COOKING TIME: 1 HOUR 10 MINUTES Vino cotto is a high-energy condiment, so use sparingly! Onions are great as a side dish instead of a grain-based one NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1126 kJ, FAT 14 g, PROTEIN 1.1 g, SATURATED FAT 2 g, FIBRE 1.8 g, CARBOHYDRATE 36 g, SODIUM 390 mg, POTASSIUM 180 mg Sea salt flakes & freshly 500 g baby onions, outer ground black pepper skin removed ¼ cup extra-virgin olive oil Sprigs of lemon thyme, to garnish ½ cup vino cotto

From Maggie Beer’s Winter Harvest, Penguin, $29.99

1. r n 1 0 ni n in in roasting pan with a large piece of foil (enough to fold over the onions), then place the onions in the centre of the foil. 2. Whisk together the oil and vino cotto and pour over the onions, then season. Fold the foil over the onions and seal r p r nr r1 r r n i ni n n 3. Increase the oven temperature to 200°C. Open the foil p r n r rn p n n r r r 10 minutes to caramelise the onions. Garnish with lemon thyme and serve as an accompaniment to roasted or grilled meats or fish, or dot with goat’s cheese and flat-leaf parsley and serve with crusty bread.

King prawn, fermented chilli & bean blossoms

Peter Gilmore

For a special occasion – serve with a carbohydrate-rich side dish. Thai black jasmine rice makes a vivid, high-antioxidant contrast. 100 g clarified butter 24 king prawn tails Fine sea salt 50 g bean sprouts, topped

& tailed 50 g unsalted butter, melted 120 bean blossoms

NUTRITIONAL INFORMATION PER SERVE (SERVES 8) ENERGY 1785 kJ, FAT 33.8 g, PROTEIN 19.3g, SATURATED FAT 13 g, FIBRE 2.2 g, CARBOHYDRATE 13.4 g, SODIUM 1780 mg, POTASSIUM 53 mg GARLIC OIL 100 ml grapeseed oil 2 garlic cloves, thinly sliced

From Organum, Murdoch Books, RRP $100

58 Healthy & Heartwise • Spring 2015

1. Warm the oil to 50°C in a small stainless steel saucepan. Add the garlic, remove the pan from the heat and infuse for 2 hours at room temperature. 2. Strain, discarding solids, and refrigerate oil until required.

sides&snacksrecipes

Easy mini-quiche cups From Trim & Tone with Tania, New Holland, $29.99

Tania Zaetta S 12–15 15 MINUTES 1 HOUR 10 MINUTES

S 100 g mild Korean fermented red chilli paste 50 g Korean fermented whole yellow-bean miso 15 ml garlic oil 10 ml virgin black sesame oil 1.

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NUTRITIONAL INFORMATION PER MINI-QUICHE (MAKES 12–15) ENERGY 229 kJ, FAT 3 g, PROTEIN 3.9 g, SATURATED FAT 0.7 g, FIBRE 0.4 g, CARBOHYDRATE 1.1 g, SODIUM 124 mg, POTASSIUM 56 mg

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6 eggs 2 tbsp light cottage cheese ½ cup smoked salmon 2 shallots, chopped Chia seeds Chilli flakes Pepper, pinch of salt Coconut oil/spray

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Spring 2015 • Healthy & Heartwise

recipessoups&broths Thai broth with ‘rice’ noodles Omid Jaffari PREP TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) From raw, ENERGY 585 KJ, FAT 7.4 g, SATURATED Murdoch FAT 1.5 g, CARBOHYDRATE 15.6 g, Books, PROTEIN 1.5 g, FIBRE 1.3 g, SODIUM 2015, 384 mg, POTASSIUM 627 mg $49.99 A refreshing, no-fuss spring vegetable broth for supper or afternoon tea 1 litre coconut water 2 celery stalks, chopped 2 spring onions, chopped 1 French shallot, grated 2 garlic cloves, grated 2 tbsp sesame oil 2 zucchini ½ tsp salt 4 red radishes Small handful Thai basil leaves 1. Blend the coconut water, celery, spring onions, shallot, garlic and 1 tbsp sesame oil in a blender for 1 minute. 2. Cut the zucchini thinly into ribbons and combine with the remaining sesame oil and the salt in a medium bowl. Set aside for 5 minutes for the ribbons to soften. 3. Thinly slice the red radishes and set aside. 4. Divide the liquid between four soup bowls and add a quarter each of the zucchini and radishes. Top with the basil leaves.

Watercress, leek & coconut soup Lee Holmes SERVES: 2 PREPARATION TIME: 10 MINUTES COOKING TIME: 35 MINUTES 1 tbsp extra-virgin coconut oil or 2 tsp ghee 1 onion, diced 1 garlic clove, crushed 1 leek, white part only, finely sliced 1 medium turnip, peeled and diced

From Heal Your Gut, Murdoch Books, 2015

85 g watercress, rinsed, plus extra to serve 270 ml tin coconut milk 375 ml vegetable stock Freshly cracked black pepper, to taste

1. Melt the oil or ghee in a medium saucepan over medium heat. Add the onion and garlic and cook, stirring frequently, for 3–4 minutes or until transparent. Add the leek, turnip, watercress, coconut milk and stock, then bring to the boil. Reduce the heat to low then simmer, covered, for 20 minutes. 2. Remove from the heat and allow to cool slightly, then purée in a food processor or blender until smooth. Reheat if necessary, then grind over black pepper, garnish with extra watercress and serve.

60 Healthy & Heartwise | Spring 2015

recipessoups&broths Seafood chowder Olivia Andrews PREPARATION TIME: 5 MINUTES + 1 HOUR SOAKING COOKING TIME: 2¾ HOURS (SLOW COOKER) 15 MINUTES (STOVETOP) NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2417 KJ, FAT 33.4 g, SATURATED FAT 11.8 g, CARBOHYDRATE 30.9 g, PROTEIN 28.8 g, FIBRE 2.2 g, SODIUM 1569 mg, POTASSIUM 405 mg To reduce saturated fat, try olive oil instead of butter 16 clams, soaked 1 hour, drained & rinsed 40 g butter 1 leek, white parts only, halved lengthways then thinly sliced 2 garlic cloves, finely chopped 1 rindless bacon rasher, cut into batons 1 tbsp cornflour 1 litre fish or seafood stock 1 fresh or dried bay leaf Leaves from 4 sprigs thyme Pinch cayenne pepper 500 ml milk 150 g skinless hot-smoked salmon fillet, flaked into large pieces 12 scallops Chopped parsley, extra-virgin olive oil & crusty bread, to serve

IN THE SLOW COOKER 1. Heat a large frying pan over medium–high heat. Add the clams and cover with a lid. Cook 1 minute until the shells have just opened. Transfer to a bowl and set aside. 2. Reduce the heat to medium and add the butter to the pan. Cook the leek, garlic and bacon for 4 minutes until lightly golden, then sprinkle in the flour and cook for 1 minute, stirring. Gradually stir in the stock, then add the bay leaf, thyme and cayenne pepper. 3. Season with salt and pepper then transfer to the slow cooker. Cook on high for 2 hours, then turn down to low. Stir in milk and add salmon, scallops and clams with any juices. Cook 30 minutes until the fish and seafood is cooked through. 4. Serve with chopped parsley, extra-virgin olive oil and crusty bread. ON THE STOVETOP 1. Heat the butter in a large frypan over medium–high heat. Cook leek, garlic and bacon for 4 minutes until lightly golden, then sprinkle in the flour and cook for 1 minute, stirring. Gradually stir in the stock, add the bay leaf, thyme and cayenne pepper. 2. Bring to the boil, add clams and cover with a lid. Cook for 1–2 minutes until they start to open. Add the milk and bring near to simmering. Add salmon and scallops and cook 2 minutes until the seafood is just cooked through and the clams have opened. Season with salt and pepper. 3. Serve with chopped parsley, extra-virgin olive oil and crusty bread.

From Whole Food Slow Cooked, Murdoch Books, $35

Spring 2015 • Healthy & Heartwise

soups&brothsrecipes

From superlegumes, Murdoch Books, $29.99

Ribollita with parmesan chilli croutons – Chrissy Freer PREPARATION TIME: 25 MINUTES (+ SOAKING) COOKING TIME: 1 HOUR NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 1344 KJ, FAT 7.9 g, SATURATED FAT 1.7 g, CARBOHYDRATE 47.5 g, PROTEIN 15.8 g, FIBRE 6.9 g, SODIUM 770 mg, POTASSIUM 568 mg A low-fat, high-fibre, high-protein side dish 1¼ cups dried cannellini beans, soaked overnight & drained 1 tbsp olive oil 1 large onion, finely chopped 2 celery stalks, diced 3 garlic cloves, crushed 1 tsp fennel seeds, lightly crushed 5 cups low-salt vegetable or chicken stock

180 g kale/silverbeet, coarsely chopped PARMESAN CHILLI CROUTONS 4 slices sourdough bread, torn to bite-sized pieces Olive oil spray, for coating 2 tbsp finely grated parmesan cheese ¼ tsp dried chilli flakes

62 Healthy & Heartwise • Spring 2015

1. Place the beans in a large saucepan and cover with cold water. Bring to the boil, then reduce the heat to medium and simmer for 45 minutes–1 hour or until just tender. Drain and set aside. 2. Meanwhile, preheat the oven to 180°C. Heat the olive oil in a large saucepan over medium heat. Add the onion, celery and cook, stirring, for 5 minutes or until softened. Add the garlic and fennel seeds and cook, stirring, for 30 seconds or until fragrant. 3. Add the stock, cooked beans and kale/silverbeet. Bring to the boil then reduce the heat to low and simmer for 15 minutes. Season to taste with sea salt and freshly ground black pepper. 4. Meanwhile, to make the parmesan chilli croutons, place the bread on a large baking tray lined with baking paper. Spray with olive oil, then sprinkle with the parmesan and chilli flakes. Bake 10–15 minutes or until golden and crisp. 5. Serve soup scattered with the croutons. To store, cool completely, cover and freeze in airtight containers.

recipesmains Beef meatballs Delphine de Montalier PREPARATION TIME: 15 MINUTES COOKING TIME: 25 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 1): ENERGY 1461 KJ, FAT 8.7 g, SATURATED FAT 0.4 g, CARBOHYDRATE 30.2 g, PROTEIN 38.5 g, FIBRE 9.3 g, SODIUM 146 mg, POTASSIUM 1683 mg

From River Cottage Australia Cookbook, Bloomsbury, 2015, $45 From 5:2 Lifestyle, Murdoch Books, 2015, RRP $35

GOLD STAR RECIPE A fantastic main meal for one – enjoy with baked vegetables 2 medium tomatoes, about 200 g /3 1 tsp ground cumin 1 small red chilli 150 g minced beef, 5% fat 1 small French shallot,

chopped 1 cm piece of ginger, grated 5 coriander sprigs, chopped 5 mint leaves, chopped

1. Purée the tomatoes with 100 ml water, salt, pepper and cumin. Put in a medium saucepan with the chilli over medium–high heat for 20 minutes. 2. Meanwhile, combine the beef mince in a bowl with shallot, ginger, coriander, mint and some pepper. Shape into walnut-sized meatballs. 3. Brown meatballs in a non-stick frypan over high heat for 2 minutes, then add to the sauce and continue cooking for 3 minutes. Remove the chilli from the sauce before serving!

Crispy-skinned duck breasts Paul West PREPARATION TIME: 10 MINUTES COOKING TIME: 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4): ENERGY 2025 kJ, FAT 26 g, SATURATED FAT 8 g, PROTEIN 58 g, FIBRE 0 g, SODIUM 1365 mg, POTASSIUM 0 mg, CARBOHYDRATE 0 g Cook with the skin on but don't eat it! 4 free-range duck breasts Salt flakes & pepper 1. Bring duck breasts to room temperature and using a sharp knife score the skin in a crosshatch pattern but do not cut the flesh. Add salt and pepper. 2. Place a heavy-based frypan over a medium heat. Once the pan is hot, add breasts skin-side down. Cook until most of the fat has rendered out and the skin is crisp and golden – about 6 minutes. 3. Turn breasts over and cook another 2–3 minutes, spooning over rendered fat. Serve pink in the middle for maximum moisture and flavour. 4. Transfer to a board and leave 5 minutes. 5. To serve, slice the breasts and accompany with a sweet, port-based sauce, some crunchy blanched greens and a big spoonful of mashed potato. Spring 2015 • Healthy & Heartwise

recipesmains Panfried trout with braised peas Paul West 15 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 2944 kJ, FAT 43.3 g, SATURATED FAT 8 g, CARBOHYDRATE 33 g, PROTEIN 45.2 g, FIBRE 9.2 g, SODIUM 960 mg, POTASSIUM 311 mg Exclude the speck to reduce the energy, fat and salt levels! 200 g piece of speck, cut into batons Oil for frying 1 small brown onion, finely sliced 2 garlic cloves, minced 250 ml chicken stock 2 cups podded green peas 1. r 2.

4 trout fillets, skin on Salt and pepper Knob of butter Small bunch of mint, finely chopped 1 lemon ½ cup slivered almonds, toasted

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Roast pork belly with verjuice & Seville marmalade glaze

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From River Cottage Australia Cookbook, Bloomsbury, 2015, $45

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PREPARATION TIME: NUTRITIONAL INFORMATION PER SERVE (SERVES 12) ENERGY 1989 kJ, FAT 35.8 g, SATURATED FAT 12.5 g, CARBOHYDRATE 6.9 g, PROTEIN 31.8 g, FIBRE 0 g, SODIUM 241.9 mg, POTASSIUM 311 mg

Serve with vegetables such as carrot and pumpkin to boost carbohydrate level 1 large clove garlic, chopped Sea salt flakes 1 tbsp minced ginger 115 g Seville marmalade 2 tbsp verjuice 1.

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64 Healthy & Heartwise • Spring 2015

From Maggie Beer’s Winter Harvest, Penguin, $29.99

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dessertsrecipes Raw cacao, ginger & avocado mousse Lily Simpson PREPARATION & COOKING TIME: 10 MINUTES + REFRIGERATION NUTRITIONAL INFORMATION PER SERVE (SERVES 4) ENERGY 649 kJ, FAT 9.8 g, SATURATED FAT 6.8 g, CARBOHYDRATE 18.9 g, PROTEIN 0.9 g, FIBRE 2.7 g, SODIUM 18.8 mg, POTASSIUM 124 mg GOLD STAR RECIPE A sweet hit that's healthy and low in carbs! 2 tbsp coconut oil 2 avocados 1 vanilla pod, split lengthways 1 tsp finely grated fresh ginger 3 tbsp coconut water 3 tbsp raw cacao powder 3 tbsp runny honey 1. Put the coconut oil in a small pan and heat gently for 5 minutes until melted. Remove from heat. 2. While the coconut oil is melting, slice avocados in half and remove the stones. Scrape the flesh into a blender or food processor. Scrape the seeds from the vanilla pod and add to the blender. 3. Add the grated ginger and coconut water and blitz until smooth. Now add the coconut oil along with the raw cacao powder and honey. Blitz for 2 minutes until completely smooth. (If you don’t have a blender you can mix manually but the texture may not be as smooth.) 4. Spoon the mixture into four small ramekins or dessert glasses and leave refrigerated 1–2 hours before serving.

From The Detox Kitchen Bible, Bloomsbury, 2015, $35

Spring 2015 • Healthy & Heartwise

recipesdesserts

Whole Food Slow Cooked, Murdoch Books, $35

Honey rhubarb nut crumble Olivia Andrews PREPARATION TIME: 5 MINUTES COOKING TIME: 2 HOURS (SLOW COOKER) 1 HOUR (OVEN) NUTRITIONAL INFORMATION PER SERVE (SERVES 6) ENERGY 3344 kJ, FAT 68.6 g, SATURATED FAT 21.3 g, CARBOHYDRATE 40.9 g, PROTEIN 15 g, FIBRE 9.7 g, SODIUM 76.6 mg, POTASSIUM 671 mg A high-energy dessert from the various nuts – cut into 12 pieces instead of six to reduce energy per serve ½ cup melted coconut oil 2 x 500 g bunches rhubarb, trimmed & cut in 5 cm lengths ½ cup honey 2 tsp vanilla extract 1 tsp ground ginger 1 tsp ground cinnamon

1 cup almond meal 1 cup macadamia nuts (toasted if using slow cooker), coarsely chopped 1 cup blanched almonds ²/3 cup walnuts, toasted, coarsely chopped

66 Healthy & Heartwise • Spring 2015

IN THE SLOW COOKER 1. Lightly oil the slow cooker. Combine the rhubarb, 4 tbsp of the honey, vanilla, ginger and cinnamon in the slow cooker. 2. In a bowl, combine the remaining ingredients (including the rest of the honey) and scatter over the rhubarb mixture. 3. Cook the crumble on high for 2 hours. IN THE OVEN 1. Preheat the oven to 180°C and oil a 1.5 litre baking dish. Combine the rhubarb, 4 tbsp of the honey, vanilla, ginger and cinnamon in the prepared dish. 2. Cover with foil and bake for 30 minutes until the rhubarb is tender. 3. In a bowl, combine the remaining ingredients (including the rest of the honey) and scatter over the rhubarb mixture. Return to the oven and cook, uncovered, for 30 minutes until the crumble is golden.

dessertsrecipes Mandarin, pistachio and chickpea cake Olivia Andrews PREPARATION TIME: 20 MINUTES COOKING TIME: 1 HOUR 50 MINUTES NUTRITIONAL INFORMATION PER SERVE (SERVES 12) ENERGY 972 kJ, FAT 8.8 g, SATURATED FAT 1.3 g, CARBOHYDRATE 31.9 g, PROTEIN 8 g, FIBRE 3.9 g, SODIUM 104 mg, POTASSIUM 178 mg GOLD STAR RECIPE A high-protein, low-fat cake with healthy ingredients 3 mandarins, unpeeled 150 g pistachio kernels, plus 1 tbsp extra, coarsely chopped, to garnish 400 g tin chickpeas, drained & rinsed ¾ cup caster sugar 4 eggs ½ cup plain flour 1 tsp baking powder Icing sugar, for dusting

1. Place mandarins in a large saucepan, cover with cold water and bring to the boil, then drain. Cover with cold water again, return to the boil, then reduce the heat to low and simmer for 45 minutes, adding more water to the pan as necessary. Drain and set aside to cool. 2. Preheat oven to 170°C. Lightly grease a line with baking paper a 22 cm round cake tin. 3. Cut mandarins into quarters and discard seeds. Crush pistachios in a food processor to fine crumbs then remove and set aside. Add chickpeas to the food processor and whizz to fine crumbs. Add mandarins and process until smooth. 4. Use an electric mixer to whisk the sugar and eggs in a large bowl until thick. Add the mandarin mixture and fold in until well combined, then add the ground pistachios, flour and baking powder and stir until well combined. Spoon the batter into the prepared tin and smooth the surface with the back of the spoon. 5. Bake 50 minutes or until a skewer inserted into the centre comes out with a few moist crumbs. If the cake browns too quickly, cover the top loosely with foil. Set aside to cool 20 minutes, then carefully remove tin and cool on a wire rack. Serve dusted with icing sugar and garnished with extra chopped pistachios.

Spring 2015 • Healthy & Heartwise

mediareviews

Well read & watched From skin, obesity, diabetes and gut health to edible native flora and the world’s secrets and symbols – all are potentially in your hands in these exciting new books.

sports science and medicine since the 1980s, Prof Noakes has both popular fitness books and ground-breaking athletics research to his name. So high profile a convert from conventional wisdom drew criticism but thousands followed him, leading to this bestseller now going global. His Banting diet is named after the first famous dieter, an obese undertaker in Victorian London whose elimination of starches, alcohol and dairy became standard medical weight-loss advice until Ancel Keys changed everything. Noakes’ seditious essay consumes a third of the book – the rest being vivid recipes by a Paleo nutritionist and chef.

I, Superorganism JON TURNEY, ICON BOOKS, $29.99

Wild Foods Learning to love your inner ecosystem is UK science writer Jon Turney’s subtitle for his enthusiastic journey through the very bowels of what it is to be. This isn’t metaphor nor philosophy but the ‘inner’ revolution imploding medicine, whose next wave of treatments and prevention will involve manipulating the trillions of microorganisms inside and on us [see pages 22–23]. Up-to-date with the breaking science that is for everyone deeply relevant personally, Turney fluently explains how complex genetics, archaeology and microbiology are teaming up with medical science to understand what’s going on in the former ‘black box’ of the gut. It has the potential to upend our sense of self and pave the way for a new generation of drug therapy involving pre and probiotics for everything from MS to rheumatoid arthritis, asthma, allergy and IBS.

The Real Meal Revolution PROF TIM NOAKES & OTHERS CONSTABLE & ROBINSON, $19.99

Tim Noakes is the sort of expert you want on your side if you commit health heresy by trying a Paleo-style low-carb, high-fat diet to lose weight – as he did in 2011 after noting positive studies about the Atkins diet. One of South Africa’s most celebrated academics in

68 Healthy & Heartwise • Spring 2015

VIC CHERIKOFF, NEW HOLLAND, $39.99

The author began supplying Sydney restaurants with foraged native spices, berries or paperbark from vacant lots, urban gardens and bushlands in the 1980s, and has since commercialised some for food products and supplements. Lemon myrtle and wattleseed have caught on but Vic Cherikoff longs for an authentic Australian cuisine where the Kakadu plum and bush tomatoes are not mere garnishes or flavourings. Steeped in biochemistry and pharmacology qualifications, Cherikoff is deeply critical of Australian agriculture’s environmental, health and nutrition impacts. He explains how indigenous ingredients can be used in cooking and food, plus their exceptional nutritional profiles. It’s not the most organised, focused or beautiful of books but full of expert zeal and factual nuggets as uniquely pungent, biting and peppery as the subject.

Understanding Type 2 Diabetes PROF MERLIN THOMAS, EXISLE, $49.99

A book and eight CDs from a clinical scientist with the Baker IDI Heart and Diabetes Institute explain the chronic disease of our time, its impact on your body and what you and

mediareviews your healthcare team can manage it. Aimed at the newly diagnosed patient, the book is crammed with facts from the science and practical tips about diet and lifestyle, covering every sort of complication and consideration about blood glucose levels. The audiobook is simply the book – including table of contents – read aloud by a deadpan Prof Thomas for those with deteriorating eyesight or no time to pore over a text-heavy paperback.

The Eczema Diet KAREN FISCHER, EXISLE, $29.99

If spring brings you out in a rash, eating alkalising anti-inflammatory foods and unrefined oils might help you as it has for Karen Fischer’s daughter and many others enduring the agony of eczema. An Australian nutritionist with other skin care books under her belt, Karen provides a comprehensive guide for the itchy of all ages, including skin care, stress, dandruff, cradle cap treatments, chemical sensitivities and dietary additives, menus and recipes, and healthy shopping lists. Like anything diet and immune related, atopic dermatitis is not easy to quell but making the science of skin easily understood helps sufferers at least get a sense of control, and in that way this revised second edition of a bestseller seems to scratch an itch.

Fermentation for Beginners DRAKES PRESS, $16.99

As this slim paperback says, without fermentation there would be no wine, cheese, salami, bread or sourdough, nor the repopularised dishes of sauerkraut, kombuchu and kimchi. The health benefits and enjoyment of making them for yourself are explained, and recipes touch everything pickled and cured from corned beef to buttermilk, cottage cheese, vinegar, gravlax, even root beer, Medieval-style mead, cider and kvass. It’s not illustrated nor in

metric measures being a US title, but conversion tables reside next to the index. Differences in terminology may also confuse and not all ingredients are available locally but here’s a concise and practical way to dip a toe into the bacterial bath of a brew.

Fat Planet DR DAVID LEWIS & DR MARGARET LEITCH RANDOM HOUSE, $35

Obesity is neither a sign of gluttony, sloth nor any other moral weakness on the part of the individual, say these British psychologists. We’re stuck in an ‘obesity trap’ because of the time pressures and stress of modern life combined with an unrestrained food processing industry that has so successfully manipulated and trained our appetite and satiety hormones that we’re pretty much hooked on overeating, binging and craving sugary, fatty, salty foods. Looking through the history of dieting and attitudes to body fat up until the latest neuroscientific, social and psychological research into obesity, they discuss how individuals and families can avoid adiposity, and how communities and society at large can escape the fat planet.

The Secrets of the Universe in 100 Symbols SARAH BARTLETT, EXISLE, $29.99

We’re visual beings and the ordering of what we see into symbols for others to understand is one of our civilising traits. Every culture from prehistory had its store of symbols, each one invested with meaning for the next generation to grasp. Which symbols and what meanings are the concerns of this lavishly illustrated compendium that combs the world and every period you’ve never heard of to come up with 100. From the evil eye, swastikas and dragons to Fibonacci fractals, the author decodes what each means, and their intriguing potential to help make sense of our own lives. Spring 2015 • Healthy & Heartwise

diabetesmedication

People with diabetes or heart disease are often prescribed daily medications to control their blood lipid levels. Dr Pat Phillips looks at how statins and other cholesterol-lowering agents work. DR PAT PHILLIPS, MBBS, MA, FRACP, MRACMA, is Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service

hen we talk about cholesterol, we should be clear about which members of the ‘cholesterol family’ we are discussing – the so-called HDL or LDL cholesterol (there is also VLDL and IDL, for instance, which are less well known): •H high density lipoprotein cholesterol is thought to be ‘good’ because high levels are associated with lower risk of cardiovascular disease and events (heart attacks and strokes) • low density lipoprotein cholesterol is thought to be ‘bad’ because high levels are associated with higher risk of heart disease and events.

70 Healthy & Heartwise • Spring 2015

At present, we only have medications that lower total and LDL cholesterol, and none that significantly increase HDL cholesterol. One was developed but caused problems and was withdrawn. The medications in use lower cholesterol in two ways – blocking production of cholesterol in the liver or blocking absorption through the gut.

Cholesterol in food and in the body Cholesterol has an interesting journey in the body, although about 80% of it is made within it and the remainder comes from the diet. In the duodenum (following the stomach),

diabetesmedication the cholesterol we’ve eaten is combined with the cholesterol in the bile. A proportion of the total amount of cholesterol is absorbed from the small intestine and circulates through your body while the rest is eliminated in bowel movements. Cholesterol is insoluble in water and needs to be carried in special proteins – the lipoproteins – that move through the organs of the body. The liver actually makes fat (triglyceride) from the fatty acids and glucose absorbed from the gastrointestinal tract and exports the triglycerides via VLDL (very low-density lipoproteins) to be stored or used in the muscle. As the fat is removed, the VLDL becomes LDL, which is removed from the blood by the liver.

Statins block the activity of a key enzyme that makes LDL cholesterol in the liver, causing the blood level of LDL cholesterol to decrease.

A dynamic equilibrium Cholesterol is an important molecule because it has many functions in the body – making cell membranes and hormones such as oestrogen and testosterone. The liver regulates the total amount – when there’s too little, the liver takes over and increases the amount of cholesterol it makes by increasing the activity of the key enzyme (HMG-CoA reductase) that makes cholesterol.

Statins Statins block the activity of a key enzyme that makes LDL cholesterol in the liver, causing the blood level of LDL cholesterol to decrease. All the statins have chemical names ending in ‘statin’, e.g. simvastatin. Several studies in people with diabetes have shown that statins reduce the risk of heart attack by 25%. So if your risk of a heart attack in the next five years (see www.heartfoundation.org.au) is 20%, taking a statin will reduce that risk by 25% (to 15%). Looking at this more broadly, if 40 people with a five-year risk of heart attack of 20% are split into two groups of 20 and one group takes a statin and the other half doesn’t, at the end of five years four people not taking a statin will have had a heart attack but only three in the statin group.

Cholestyramine and ezetimibe

Adapted from Conquest Summer 2014

These medications block the absorption of cholesterol from the gut, which reduces the amount of cholesterol getting to the liver. Cholestyramine is a resin that binds cholesterol in the gut and ezetrol is a chemical that stops cholesterol absorption by the cells lining the intestine. Cholestyramine is usually taken mixed in something (e.g.

orange juice) because its texture is a bit gritty. Ezetrol is available as a tablet. Both medications work very well with a statin because the combination stops two ways the liver gets cholesterol (absorption of cholesterol from the gut and making it). Ezetrol has been combined with simvastatin in one tablet, which makes the combination very convenient to take.

Cholesterol lowering in the future Researchers have looked at ways to increase HDL cholesterol but not yet found a suitable method. New injectable drugs have been developed that increase ‘recycling’ of cholesterol by the liver, and are still undergoing trials prior to becoming available from doctors. These drugs increase the number of LDL receptors in the liver that ‘mop up’ the excess LDL cholesterol in the bloodstream, and are thought to be particularly useful for hereditary high cholesterol, or where standard drugs are either ineffective or not well tolerated. ♥ Spring 2015 • Healthy & Heartwise

Statins block the activity of a key enzyme that makes LDL cholesterol in the liver, causing the blood level of LDL cholesterol to decrease.

Cholestyramine and ezetimibe

Adapted from Conquest Summer 2014

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Blood glucose DR PAT PHILLIPS, MBBS, MA, FRACP, MRACMA, is Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service.

monitoring A USER’S GUIDE

Just a droplet of blood shouldn’t also involve sweat and tears! Dr Pat Phillips explains how consistency is key to reliable and meaningful results.

he blood glucose self-monitoring system that people with diabetes use to test and indicate their blood glucose levels (BGLs) comprises a blood glucose meter, a lancet device, blood glucose testing strips and a bottle of quality control solution.

How does the meter work?

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Adapted from an article in Medicine Today, July 2014

The process of self-monitoring measures the amount of glucose in the blood you’ve put on the testing strip. A chemical reaction occurs between the strip and glucose, generating a signal that the meter converts into the reading

you see (see Figure). The meter is set up so that the reading you see gives a value similar to what a pathology lab would get from a blood sample taken from one of your veins:

Meter

Signal (either a colour change or electron generation assessed → by the meter)

Spring 2015 • Healthy & Heartwise

livingwithdiabetes How do I get the best results?

or hungry from high BGLs). If you have low a BGL (hypoglycaemia) because you take insulin or a sulphonylurea tablet, you should test before you drive and every two hours while driving. Diabetes Australia recommends ‘You need to be above 5 to drive’ (i.e. your BGL should be higher than 5 mmol/L).

The chemical reaction between the glucose and the chemicals in the strip can be distorted by storage, temperature, medications and any contaminants on your finger. Meters need to be adjusted (calibrated) for different batches of strips – some do this automatically and some require you to reset the meter with a calibration strip. To get accurate results, make sure your meter, strips and technique are all in good shape – see ’10 tips for testing’. You can check that you are getting accurate results in three ways:

•

1. Test/retest – Test your BGL and then retest it with a different blood sample and a new strip. The two values should be within 30% of each other. 2. Quality control – Use a quality control fluid on the strip in place of your blood. The fluid is known to have a certain blood glucose value and you can compare this with the meter reading. 3. BGM vs. pathology lab results – Your doctor can arrange an external BGL test, which is best done before breakfast so the value is not high. It’s most important that your meter gives reliable results when your BGLs are low. If you do a test on your meter immediately (i.e. within minutes) before and again after the nurse takes the blood sample for the laboratory, you and your doctor can compare your device’s values with the laboratory result.

How often should I test? A comprehensive schedule for self-monitoring includes tests before and two hours after each meal, during the night and a quality control check as well! Fortunately such a full schedule is rarely needed. You’re doing BGL tests to help you and your diabetes professionals modify your lifestyle and medication; you’re not doing them just to fill out the spaces in your selfmonitoring diary. •

for you You may wish to test if you feel ‘funny’ (typically, dizzy and//or weak from low BGLs) or unwell (possibly thirsty

74 Healthy & Heartwise • Spring 2015

for your professionals They like to see a record of your BGLs over the past week or so, particularly the BGLs before meals. They can then advise you on changes to your medication and/or lifestyle. If you think you are testing too often or infrequently, work out a schedule with your diabetes team that will provide all the information you need.

Where can I get help? Your doctor and/or Diabetes Nurse Educator can advise you on getting the most out of your self-monitoring. The National Diabetes Services Scheme (NDSS) is free and gives you access to subsidised suppliers without a doctor’s prescription. To join, go to ndss.com.au.

10 TIPS FOR TESTING 1.

ook after your glucose meter. lean it often and don’t leave it in direct sunlight or somewhere it will get hot, such as in the car.

egularly check the meter’s accuracy. ou may need to calibrate it each time you start using a new packet of test strips.

heck the expiry dates on the strips and uality control uid. iscard any past that date.

rotect the strips from heat, bright light and high humidity. eep them in the bottle or foil packets until you use them. on’t leave them exposed to the sun or in the car.

Always wash your hands with soap and warm water before you do a test. This makes it easier to get a blood sample and removes any substances that might affect the results.

se a fresh lancet each time – for hygiene and to reduce pain and tissue damage from worn lancets. ispose of used lancets in a sharps container.

rip the recommended amount of blood onto the strip – don’t smear it.

ecord the blood glucose level that the device indicates so you and your diabetes professionals can compare it to other recent results to observe patterns.

heck your levels more often if you are unwell, when you get an unexpected reading and, if you are taking insulin or a sulphonylurea medication, and every time you drive.

10. Join the ational iabetes Services Scheme subsidised strips.

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