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Iodine in Pregnancy.....Why is it Important?

24/7/2018

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Iodine is a mineral found in soil and seawater. It is something that the body does not make, but it is essential for the health of your thyroid; as it is a component of the thyroid hormones. Therefore our intake must come from our diet.

​During pregnancy our iodine requirements increase from 150mcg/day to 220mcg/day.  This is so we can support the needs of the rapidly growing foetus, and ensure that they have enough for their own brain and thyroid development, as well as enough for mums thyroid.

Mild iodine deficiency in pregnancy has been shown to be related to poor thyroid function in mum and the foetus, as well as implications on brain development. A severe deficiency can be associated with stillbirth, congenital abnormalities, speech and motor difficulties, and more. So it is quite a serious issue.

In New Zealand we have low levels of iodine in our soil, so our homegrown foods have low concentrations. The iodine status in New Zealand has been a concern for some time; Iodised salt was implemented in the 1920's, with levels bumped up in 1934. Still not combating the problem, in 2009 there was a change for mandatory use of iodised salt in commercially baked bread.

Good food sources of iodine are diary products, cooked fish and seafood, and eggs. Seaweed containing foods like sushi can also be a good source.  While not advocating for an increase in salt use, I would also encourage using iodised table salt over the 'fancy' sea salt and himalayan salt when you are adding it to foods. 

During pregnancy we have access to a funded iodine only supplement of 150mcg/day via your GP or lead maternity carer (LMC). This is now recommended to take along with a balanced diet as it is felt that it is unlikely most women will meet their iodine requirements through diet alone.  If you are taking a pregnancy specific multivitamin, this should have extra iodine added to it, but it pays to check. We also want to be careful that we don't go overboard with supplementation from various sources, so please check with your GP, LMC or dietitian before taking any additional iodine containing supplements.

If you would like to see some of the research that has been done in NZ relating to iodine there is some information at :

https://www.health.govt.nz/our-work/preventative-health-wellness/nutrition/iodine


If you are concerned that you are not getting a good balanced diet and want to chat about how to change this, then give me a call :)

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Is PCOS Taking Over Your Life? Can Nutrition Help?

5/7/2018

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​Polycystic Ovary syndrome (PCOS) effects 5-10% of women of reproductive age, and impacts those with the condition in a number of different ways. In fact 25% of people with PCOS may not show any symptoms.
 
PCOS is an endocrine disorder, and diagnosis includes having at least two of the following: irregular periods, androgen excess (high levels of male sex hormones), and cysts on the ovaries.  Other conditions that may cause these symptoms should also be ruled out first.

Women with PCOS may experience insulin resistance, weight gain/difficulty losing weight, increased facial or body hair, acne, metabolic syndrome (leading to an increased risk of CVD and type 2 diabetes), infertility, higher risk of gestational diabetes, and increased risk of miscarriage.
 
So how does nutrition come into it?
Some of the features are obesity, insulin resistance and metabolic syndrome (high lipid levels, high blood pressure, high blood sugar levels); therefore what we eat can play a significant role in the health for PCOS women. The main goals of nutrition are usually to improve insulin resistance and reduce androgen excess.
 
Weight Loss
A 5-10% weight reduction can improve the androgen excess symptoms and improves fertility chances. How you go about this weight loss could come in many different ways, but making sustainable changes and keeping a positive relationship with food are important.
 
Carbohydrates
Both the type and amount of carbohydrate are important in managing insulin resistance. We are clear on what the type of carbohydrate should be – less refined carbohydrate, lower GI and lower glycemic load. How much, is still a debatable topic. Cutting all carbohydrates out is most likely a little drastic, and for many not sustainable long term; but given the westernised diet, I would say many do need to make a change to their carbohydrate intake.
 
Think moderate portions of whole-grains such as oats, quinoa, freekah, barley, wheat bran, spelt etc. While minimising your intake of biscuits, cakes, crackers, lollies, white bread, and added sugar in food and drinks.
 
Vegetables
EAT MORE! You cannot have too much of the non-starchy varieties.
One in three New Zealanders do not get in the minimum 3 serves a day. Vegies are high in important vitamins, minerals, fibre and antioxidants. They are useful for filling up without providing an excess of calories in those trying to lose weight.
 
Omega-3
There has been some research suggesting that omega-3 may help with lowering testosterone, help with insulin resistance, and lower triglyceride levels. More research is needed to make this a firm recommendation particularly around supplementation levels, but in the meantime consuming regular oily fish in place of meat to increase your intake of omega-3 is good for you, even outside of having PCOS. Other good sources of omega-3 are walnuts, chia seeds and flaxseeds.
 
Exercise
Exercise is not only good for your mental health, but helps improve insulin resistance and will be important in helping with weight loss.

We should be aiming for a minimum of 150mins of exercise a week with a mixture of cardiovascular and resistance training. This doesn’t have to be in a gym, there are plenty of home-based exercises you can do.
 
 
Finally there is also some interesting research and approaches going on in the areas of magnesium, chromium, vitamin D, resveratrol, isoflavanoids and inositol. Watch this space, and I think I’ll write about some of these individually, but perhaps some of you with PCOS may need extra support in these areas.
 
How a PCOS friendly day might look:
 
Breakfast
Porridge made with oats and milk. Topped with some chopped walnuts and berries
 
Snack
Chopped up carrots, cucumber and celery with hummus
 
Lunch
Tinned salmon tipped onto leftover roast veggies, spinach and quinoa. Topped with some feta, and chopped almonds, and a lemon juice or olive oil vinaigrette dressing.
 
Snack
Piece of fruit and yoghurt
 
Dinner
Chicken, chickpea and vegetable curry on brown rice


If you suffer from PCOS and want some support and advice on a way forward in managing your nutrition in this condition then get in contact with me to talk.
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Bariatric Surgery Is the Easy Way out.....Or Is It?

18/5/2018

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​ Over the last few months there have been a few articles about weight loss surgery, and I keep reading comments about surgery being “an easy way out” and that they should try “insert diet here” or “ stop being lazy”.

As someone who has worked on and off in this area for the past 7 years I find these comments really frustrating, and I know clients often feel disappointed when people they know have this type of negative reaction, rather than finding out more information about the surgery and supporting them in their choice to improve their health in this way.
 
So with this in mind I thought I would pop down a few of the things those undergoing bariatric surgery have to go through and why it isn’t “the easy way out”.

  • After surgery the new stomach is so small and swollen that clients have to follow a special texture modified diet for  6 weeks or so – liquids, puree and then soft food. Long term, most clients have to stay with soft/moist food to be able to keep it down comfortably.
 
  • Initially the portion sizes are tiny! Think ¼ cup of food per meal. It can also take up to a year to actually be able to eat 1-1.5 cups of food per meal, which is now the new normal portion size for them.
 
  • Protein! This is a surgery client’s new favourite macronutrient. All meals revolve around protein, and despite wanting to eat other things this needs to come first. Food choice is taken away for the first 6 months or so really until they can eat a bigger volume of food.
 
  • There is a very high risk of vitamin and mineral deficiencies if you do not regularly take your multivitamin.
 
  • Gastrointestinal issues are very real – think vomiting or pain after meals if the food texture is wrong, if eating too quick, or if eating too much. How about possible ‘dumping syndrome’ if a high sugar/fat food is eaten – think diarrhoea, sore tummies, or drops in blood sugar levels.
 
  • Healthy eating and regular exercise are still needed after surgery. Don’t think you can just have surgery, eat poorly, not exercise, and expect the weight to come off/stay off.  Surgery clients are working just as hard on their diet and exercise as non-surgery clients.
 
Now that may all seem a little bleak, BUT, I have seen many peoples lives changed for the better because of surgery supported weight loss, and these were people who had tried all sorts of different weight loss methods for years. Why it was successful has so many different factors both related to the surgery itself, but also related to the person having surgery.
 
I have also seen real struggles and major problems post surgery. It is not the easy way out by any means and comes with real risks (short and long term). This is why surgery is not for everyone, and I think anyone considering this option needs to go in with their eyes wide open to the reality of it, be in a good psychological space, know that it is only a tool and not a quick fix, and be prepared to put themselves first on this journey.
 
So, if you know someone who is thinking about surgery, or had surgery. Be kind to them, their journey is their choice, and having a supportive group around them will aid in their success.
 

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Five Tips To Work On Your Fertility Chances

13/4/2018

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Are you thinking about trying for a baby? Be it your first or your fourth; Here are 5 diet and lifestyle aspects to consider when starting this journey.
 
Find your healthy weight
Did you know your fat cells produce oestrogen? So if you have too little fat you may not be getting enough, and if you have too much fat you might be producing too much. Neither of which is helpful for a woman’s chance of falling pregnant.
 
Higher than normal oestrogen levels in men due to high body fat levels may also impact on sperm quality and count.
 
What to do? Restrictive crash dieting to lose weight, or eating lots of high fat/sugar foods to gain weight, is not the way to go! I would suggest talking with a professional about safely ensuring you are eating not only for the weight loss/gain goal but also getting in adequate nutrition to maximise your fertility chances.
 
Start your lifestyle changes early
If you perhaps are not living the healthiest of lifestyles and are thinking you would like to start a family in the not too distant future, then it might be worth starting to make changes now.
 
Did you know that sperm cells take 72 days to mature? So the one swimmer fertilising your partners’ egg today, was actually a product of your lifestyle a few months ago. Is it the best swimmer it can be?  

This is also why any changes to diet and lifestyle may take a number of months to be effective in terms of increasing fertilisation chances.

Watch your alcohol intake
Alcohol has been shown to negatively impact both male and female fertility.  We do not know how much alcohol exactly that is though, which makes recommendations for safe limits hard.
 
Do you need to cut out alcohol completely? Probably not, but if you want the best chances you shouldn’t be out there binge drinking. Minimise your alcohol intake as much as you can, but don’t guilt yourself over the glass of bubbles at your mums birthday either.
 
Look at your iron and selenium intakes
Iron needs double during pregnancy. So if you are already low pre-conception, make sure you get yourself replete before getting pregnant – the quickest way to do this may be an iron supplement, but you should discuss this with your GP.
 
Red meat is the highest and most bioavailable source of iron in the diet. We should be aiming for a couple of serves a week. If you do not eat red meat there are other ways to achieving a good iron intake, it can just take a bit more thought and planning to ensure there is enough.
 
Selenium may have a role to play in male sperm quality. We have naturally low levels in our NZ soil, so the amount we get from food may be reduced. Maximise your intake with regular high selenium containing foods like brazil nuts, tuna, turkey and chicken.
 
Take your folic acid
Folic acid supplementation has been proven to reduce the risk of neural tube defects that can occur during the first trimester. In NZ, recommendations are that you should be taking 800mg of folic acid daily a month before falling pregnant and up to 12 weeks gestation. There are some instances where the recommendation is more though. As soon as you start thinking about trying for a family, then go and see your GP to discuss your folic acid needs.
 
Good food sources of folate are green leafy vegetables (such as spinach and broccoli), citrus fruits and juices, wholemeal bread and legumes. It can be difficult to get the increased folate needs for preventing neural tube defects from diet alone though, which is why we recommend supplementation on top of a good diet.

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Protein as we age

22/1/2018

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​Most of you have probably heard the word protein. You possibly associate it with body builders, athletes and gym bunnies trying to gain muscle.  What you may not be aware of is that protein is essential for everyone and we are becoming more aware of how important it is as we age.

Protein is a key nutrient that makes up and/or is involved in a wide range of functions –think muscle mass maintenance/growth, hormones, outer membranes of cells, enzymes and antibodies for our immune system.

There has been research showing that after the age of 50 muscle loss increases and it also becomes harder for our bodies to make more muscle! Not a great combination.

This little situation does matter too, as good muscle mass can help maintain strength and mobility. Good strength and mobility can mean greater independence for the person, and potentially reduces the risk of falls and fractures. A good protein intake also ensures that all those functions described above can work optimally.  

It is not all doom and gloom however, with good quality protein sources and resistance exercise, those over 50 can help minimise this issue. There is limited research into exactly the amount needed for each age group, but there is plenty of experts that believe that 1-1.2g/kg body weight/day is a good place to aim for *.  Current recommendations are for a minimum of 0.8g/kg body weight/day.

So what is good quality protein?
Animal meats provide you with the most protein per typical serve of food, and are also high in leucine which has been shown to trigger muscle synthesis if you reach a level high enough.

Your next best sources of protein per typical serves are things like:
  • Lentils, chickpeas, beans
  • Eggs
  • Diary products  - Whey protein is also very high in leucine!

Ideally a combination of foods should be eaten to get a whole host of nutrients as well as protein.

What do we do about it?
While most adults in NZ do not struggle to get in enough protein, as per the 2008/2009 national nutrition survey, in practice I found a lot of our older population were not meeting their protein needs (particularly those with illness). There would often be a reduction in their protein foods choices; I think most often because they can be a bit more time consuming to cook, and also cost. It would not be unusual to have  breakfast of being a piece of marmalade on toast with a cup of tea, a cup of vegetable soup at lunch with a slice of bread, and then maybe a small frozen piece of fish with some vegetables at dinner.

If you are older or have older loved ones, I encourage you to make sure that you/they are having regular high protein sources in the diet everyday and encourage some resistance exercise a few times a week for an optimal muscle profile.

Also don’t think because you are younger that you are off the hook either – if you are not getting good sources of protein and not doing regular resistance exercise then you are potentially losing overall muscle mass too and not setting yourself up well for your future older adult self.

*If you have any kidney impairment, I would ensure that you talk to your doctor or dietitian before increasing protein intake, as too much protein could compromise your kidney function.
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12 Week Programme

15/1/2018

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Do you need some regular support to help get you healthier in 2018? 

Consider joining my 12 week programme
  • 1 x 60min initial appointment
  • 6 x 30min follow ups spaced every 2 weeks
  • Weekly emails with tips and a recipe to keep you on track
​
The programme does not have fad diets and no strict meal plans to follow. These do not work long term! Instead I want to help you look at not only your food choices, but also the reasons and behaviour behind those choices. The aim is for long term sustainable change.

Give me a call if you would like to discuss your needs in more detail. No obligation to go ahead if it is not for you
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Surviving Christmas Day

19/12/2017

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​There is no need to panic about healthy eating come Christmas day. Believe it or not, these two things do not have to be mutually exclusive.

I am all about enjoying the food we eat, and so should you. There is nothing worse than feeling completely guilty at the end of a delicious meal with your loved ones to ruin a day.

So how can we be both healthy, but not feel deprived....
  1. Don't use the day as a 'free for all' excuse to eat and eat. Still focus on listening to your bodies cues for hunger and fullness. Lets be honest, you tend to not feel that well after eating past the point of feeling full, so why do it? You actually aren't enjoying the food by that point.
  2. Plate Model - Instead of worrying about whether the foods on offer are 'healthy', and if you should or shouldn't eat them, try to balance your meal out like the plate model. That is, 1/2 plate non-starchy vegetable dishes, 1/4 plate carbohydrate foods and 1/4 plate protein foods. This way, you can still try a bit of everything but your distribution of foods is in such a way that your getting a healthier balance.
  3. If you do grazing platters before the meal aim to have some healthy options like vegetable sticks and hummus on there. Then walk yourself away from the grazing platter once you have had a nibble. The longer you stand in front of it, the more you will likely eat mindlessly. If you are still hungry, you can always walk back to it.
  4. Get the family into an activity - try and incorporate some games or activity into your christmas day traditions. This might be a walk along the beach after lunch or before dinner; it could be ensuring the family gets a game at christmas like a basketball, tennis racquets, waterslide, water balloons etc and then opening and playing with these to get people moving.
  5. Have some fresh summer fruits included in your desserts. Make most of your plate with these and then just take a small piece on whatever else is on offer (if you even want it).
  6. If you do drink alcohol try alternating your alcoholic drinks with water. There are also some pretty tasty flavoured soda waters these days that can be a good alternative to alcohol.
  7. The majority of food present on christmas day is able to be eaten at other times of the year if you really wanted it. You don't need to eat it like you will never see it again.

Remember it is just ONE day and our health is not determined by a single day. 

​Merry Christmas :)
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Let's Get Moving!

13/12/2017

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A healthy diet is only one part of a healthy lifestyle. It is also really important to get regular activity in.

The Ministry of Health physical activity guidelines recommends that healthy adults do a minimum of 150mins of moderate aerobic activity spread over a week. Although for extra health benefits aiming for 300mins of activity spread over the week is ideal.

Moderate activity is something that gets your heart rate up. You should still be able to talk, but you will be breathing heavier than if you were chatting to a friend over coffee.

Muscle strength training should also be incorporated twice a week. Plenty of ways to do that without joining the gym if you are not a fan. Take a look online for some home exercises.

If you aren't quite up to these levels yet - don't panic - just start slowly increasing at a level appropriate to you. Something is better than nothing! 

With the weather like it is in Taranaki right now, and facilities like the walkway and the parks there is good reason to get out and about. Take a friend (human or furry) to make it even more enjoyable ☺
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Are you listening to your hunger cues?

5/12/2017

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How many of you listen to your bodies hunger cues and stop eating when you are full? Or don't start eating until you feel hungry?

This is a skill that as healthy adults we are not always good at implementing. There are lots of reasons why we don't, but I think a major one is that we eat not only for fuel, but for taste, enjoyment and emotion. Which of course is not always a bad thing, but we need to make sure we are getting the balance right.

Young children are much more in tune with eating for their hunger levels. If you have spent time with them you will notice how some days they may eat much less or much more than usual. They will happily leave food on their plate, yet they are growing and developing. They are listening to their bodies, fuelling themselves with amounts of food they need for that point in time.

This is my nephews plate from lunch yesterday, not much left, but some. He had gone from regularly putting it into his mouth to eat, to just playing with his food and being interested in other things around him - indicating he was done. As an adult, if that was your plate, how many of us would just eat that little bit left on the plate thinking "I'm full, but there is not much left on the plate so i'll eat it anyway" Or as a parent, eat that leftover of the childs plate for no other reason but to finish it.

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If you think you are someone who does not eat to their hunger cues well then I encourage you to practice it.....you don't get good at anything overnight....you need to practice and most likely fail at it a few times before you get it right.

✔️ Take a moment before eating and think about how you feel - are you actually hungry? or are you about to eat for another reason? 
✔️ Reassess that feeling through the meal
✔️ Slow down with your eating you so you can allow your body to realise it is getting fed. It is a complex system and can take 20mins for the feedback loop to get back to your brain. 
✔️ Stop eating when you feel just comfortable (ie hunger cues are gone)
✔️ If you are going through the motions of eating and not enjoying/tasting your food; if you are feeling quite full in the stomach area; if you feel sluggish, you have passed the point of comfortably being full and eaten too much.

Don't feel compelled to continue eating if you have not finished your plate, put it away for later/another meal. If you are regularly not finishing your plate, then you need to reassess how much you are putting on your plate in the first instance.

Go on, give it a go 😀

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    Sarah Tuki

    On this page you'll find Sarah's nutritional thoughts as well as recipe ideas.

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