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''Let food be thy medicine and medicine be thy food.'' Hippocrates, 460 B.C.

Menopause and diet

May 10, 2019/ Martyna Beloviene R.D.

As well as a loss of fertility, other physical changes may happen including an increase in blood pressure, changes in cholesterol levels and weakening of the bone.

These symptoms are mainly due to falling oestrogen levels, and can last for just a few months or for several years. The range of symptoms and how severe they are, can be different for each woman. Early symptoms can include weight gain, hot flushes, night sweats, irritability, poor concentration, more frequent headaches, joint pains and irregular or heavy periods. Over the long-term, loss of oestrogen increases the risk of heart disease and bone weakness.

During the menopause, muscle mass reduces meaning that fewer calories may be needed. Over time this can lead to weight gain. Being careful about energy intake and doing more physical activity can help prevent weight gain.

From the age of about 35, there is a slow loss of calcium from the bone in both men and women. However, this increases during menopause because of the loss of oestrogen. Many nutrients help keep bones healthy, so it’s important that the diet is balanced. You can do this by choosing a variety of foods and consuming plenty of fruit, vegetables and foods from the milk and dairy group as these are a source of calcium. For most women this would mean aiming for two to three portions of calcium-rich foods every day which can include: a third of a pint/ 200ml semi skimmed milk, a matchbox size piece of cheese, a small yoghurt or a milk-based pudding like custard or rice pudding. Vitamin D is also very important for bone health.

It is thought that during the menopause a woman’s risk of developing heart disease goes up to the same level of a man of the same age. That's why it is recommended to eat less saturated and trans fats.

Some women choose to eat foods or take supplements containing plant oestrogens to help with symptoms. Plant oestrogens are a group of substances found in plant foods such as soy and red clover. They are similar, but much weaker than human oestrogen. It is thought that if they are eaten regularly they may have positive health benefits including reducing hot flushes and improving levels of fat in the blood, but more research is needed before the helpful benefits of plant oestrogen are proven. Sources of plant oestrogen include calcium-enriched soya products like milk, yoghurts and soya and linseed breads or a red clover supplement.

Sources:

BDA (The Association of UK Dietitians)

Snacking at work

March 14, 2019/ Martyna Beloviene R.D.

Those of you who do shift work understand the unique challenges when it comes to healthy eating. Staying energized during the duration of your shift is important as the work is active, fast-paced, and requires a lot of communication and focus.

If you choose carefully and plan ahead healthy snacking can become another way to help you get all the nutrients you need to stay healthy and feel energized. Snacks can keep your blood glucose (sugar) levels stable throughout the day if you find your energy level drops between meals. This can help to curb your feeling of hunger between meals and stop you from eating too much at mealtimes. On the downside, some snack foods can be a source of extra fat, sugar and salt, so choose carefully and keep portion sizes sensible.

Smart snacking tips

Learn to recognize true hunger and fullness. Skip the urge to nibble when you are bored, tired, upset or stressed. Keep a stock of healthy snacks on hand. You’re less likely to be tempted by vending machines or convenience shops which tend to stock unhealthy snacks. Try not to snack in the hour before a mealtime. Choose snacks which fill you up. Such as cereal bars, fruit and nuts, and low fat yogurt. Keep your snacks to 400 calories a day or less. For example, with two 200cal snacks. The rest of your calories can come from meals. Most women need no more than 2,000 and men no more than 2,500 calories per day. Don’t snack directly from a large container, bag or box. Try having a drink first – we often mistake hunger for being thirsty, so have a large glass of water and if you are still hungry after ten minutes, you can have a snack as well. Limit servings of regular pop and fruit drinks. They are high in calories and low in nutrients. If you can’t resist some chocolate or crisps, take to work smaller portions so you’re not tempted to eat too much. Also try to combine such snacks with healthier option. For example:

* Have one cookie with a piece of fruit rather than 2 or 3 cookies.

* Have small portion of your crisps with raw vegetables.

Often it’s not just a matter of knowing what choices are better choices – if you’re really hungry and there are no healthy snacks around, it’s very easy to eat something unhealthy instead. Keep healthy snacks at your desk or in the office refrigerator. Bring a bag of fresh fruit to work each week or keep a stash of rice crackers in the desk drawer. It can be easiest to start by focusing on just one ‘danger’ time of the day, say mid-afternoon or evening snacks and try one of these strategies out!

The very first step to healthier snacking is to actually start thinking about what it is you are putting in your body. All you need to do is begin considering the ingredients, checking out the nutrition facts on the back of the package and just give it some extra thought before you grab a snack. Put something more nutritious where you can see it and you’ll be more likely to enjoy that instead. With just a little forward planning, it’s easy to make your snacks a healthy and valuable part of your diet.

Sources:

BDA (The Association of UK Dietitians)

Heart UK

Everynurse.org

PEN: Practice-based Evidence in Nutrition

About Cholesterol

February 1, 2019/ Martyna Beloviene R.D.

Cholesterol plays a vital role in how your body works. There is cholesterol in every cell in your body, and it's especially important in your brain, nerves and skin. Cholesterol has three main jobs:

1. It’s part of the outer layer, or membrane, of all your body’s cells;

2. It’s used to make vitamin D and steroid hormones which keep your bones, teeth and muscles healthy;

3. It’s used to make bile, which helps to digest the fats you eat.

Where cholesterol is found?

Cholesterol is found in foods from animal sources. Meat, fish, eggs, butter, cheese, and milk all have cholesterol in them. Fruits, vegetables, and grains (like oatmeal) don't have any cholesterol.

But most of cholesterol is made in the liver.

Cholesterol is carried in your blood by proteins. When the 2 combine, they're called lipoproteins.

Good and bad guy?

The two main types of cholesterol are:

* LDL (low-density lipoprotein) cholesterol, or "bad cholesterol," carries cholesterol from the liver into the bloodstream, where it can stick to the blood vessels. The LDL cholesterol is the bad kind, so call it "lousy" cholesterol — "L" for lousy.

* HDL (high-density lipoprotein) cholesterol, or "good cholesterol," carries the cholesterol in the blood back to the liver, where it is broken down. The HDL is the good cholesterol, so remember it as "healthy" cholesterol — "H" for healthy.

Anyone can have high cholesterol, even if you are young, slim, eat well and exercise. That’s because high cholesterol can be caused by different things – it can be caused by an unhealthy lifestyle, but it can be genetic too.

What happens if you have high cholesterol?

If you have too much cholesterol in your blood, it can be laid down in the walls of your arteries. Fatty areas known as plaques can form, and these become harder with time, making the arteries stiffer and narrower. This process is called atherosclerosis.

Narrowed arteries. When the arteries become narrower, it’s harder for blood to flow through them. This puts a strain on your heart because it has to work harder to pump blood around your body. Eventually, the heart can become weak and can’t work as well as it should.

Blood clots can form over the fatty, hardened parts of the arteries. The blood clots can block the artery completely, cutting off the blood flow. Bits of the blood clots can break away and become lodged in an artery or vein in another part of the body, which can cause a heart attack or stroke.

What can happen if your arteries become clogged up?

If your arteries become clogged up it can affect the blood flow around your body and lead to a number of diseases of the heart and blood vessels. High cholesterol doesn't have any obvious symptoms, but it can increase your risk for conditions that do:

* Coronary heart disease (coronary artery disease)

* Angina (chest pain)

* A heart attack

* Heart failure

* Stroke

* Mini strokes

* Peripheral arterial disease (This is when one or more of the arteries leading to the legs and feet become blocked or narrowed, so not enough blood can reach them. This can make your feet feel cold and painful, especially when walking.)

* Vascular dementia (It’s caused by problems with the blood supply to the brain – either by a stroke or mini strokes, or because the blood vessels in the brain have become too narrow.)

What causes high cholesterol?

Lots of different things play a part in your cholesterol levels, including your lifestyle, any other health problems you may have, and your genes. And these can all add up.

* Your lifestyle (eating too much saturated fat, smoking, drinking more alcohol than is recommended, not being physically active).

* Your genes (High cholesterol can be genetic, meaning you inherit it from your parents.)

* Your overall health (being overweight, carrying your weight around your middle, an underactive thyroid gland, type 2 diabetes, liver disease, kidney disease, certain medications).

* Other things that can affect your cholesterol levels (your age – raised cholesterol and damaged arteries become more likely with age. Being male – men are more likely to have high cholesterol and heart attacks than women. South Asian background. A close family member, such as a parent, brother or sister, has had high cholesterol, heart disease or a stroke.

Source

PEN: Practice-based Evidence in Nutrition

https://www.heartuk.org.uk

https://kidshealth.org

https://www.nhs.uk

Staying well during cold and Flu season

January 21, 2019/ Martyna Beloviene R.D.

Your immune system defends your body against illness. It is the immune system’s job to keep viruses out. If viruses do get in, the immune system seeks out and destroys them. A healthy diet is important to keep your immune system working at its best.

Eat well balanced diet to get all of the nutrients your body needs. Vitamins, minerals and protein are important for a healthy immune system. Be physically active. It can help the immune system stay strong and ready to fight infections if they occur. Reduce stress: If you have a lot of stress, it can weaken your immune system. That makes you more likely to catch a cold or the flu. Get enough sleep. Wash your hands often with soap and water for at least 15 seconds. When you are not near a sink, use hand sanitizer. You can get a cold or flu virus by touching your eyes or nose after you touch a surface that has germs on it. Avoid close contact with people who have a cold or flu.

Can any foods or supplements help with colds?

Some foods and supplements, such as vitamin C, zinc and probiotics can help you have fewer colds, help the cold go away more quickly, reduce cold symptoms.

Source

PEN: Practice-based Evidence in Nutrition

History of sugar

January 3, 2019

It seems as though no other substance occupies so much of the world’s land, for so little benefit to humanity, as sugar. Sugar was first produced from sugarcane plants in northern India sometime after the first century CE. The derivation of the word “sugar” is thought to be from Sanskrit, and Sanskrit literature from India, written between 1500 - 500 B.C. provides the first documentation of the cultivation of sugar cane and of the manufacture of sugar in the Bengal region of India. The Sanskrit name for a crudely made sugar substance was guda, meaning “to make into a ball or to conglomerate.”

The history of sugar has five main phases:

- The extraction of sugar cane juice from the sugarcane plant, and the subsequent domestication of the plant in tropical Southeast Asia sometime around 8,000 B.C.

- The invention of manufacture of cane sugar granules from sugarcane juice in India a little over two thousand years ago, followed by improvements in refining the crystal granules in India in the early centuries A.D.

- The spread of cultivation and manufacture of cane sugar to the medieval Islamic world together with some improvements of production methods.

- The spread of cultivation and manufacture of cane sugar to the West Indies and tropical parts of the Americas beginning in the 16th century, followed by more intensive improvements in production in the 17th through 19th centuries in that part of the world.

- The development of beet sugar, high fructose corn syrup and other sweeteners in the 19th and 20th centuries.

Known worldwide by the end of the medieval period, sugar was very expensive and was considered a 'fine spice', but from about the year 1500, technological improvements and New World sources began turning it into a much cheaper bulk commodity.

There are records of knowledge of sugar among the ancient Greeks and Romans, but only as an imported medicine, and not as a food. The Greek physician Dioscorides in the 1st century (AD) wrote: "There is a kind of coalesced honey called sakcharon [i.e. sugar] found in reeds in India and Eudaimon Arabia similar in consistency to salt and brittle enough to be broken between the teeth like salt. It is good dissolved in water for the intestines and stomach, and [can be] taken as a drink to help [relieve] a painful bladder and kidneys."

The crucial problem with sugar production was that it was highly labour-intensive in both growing and processing. Because of the huge weight and bulk of the raw cane it was very costly to transport, especially by land, and therefore each estate had to have its own factory. There the cane had to be crushed to extract the juices, which were boiled to concentrate them, in a series of backbreaking and intensive operations lasting many hours. However, once it had been processed and concentrated, the sugar had a very high value for its bulk and could be traded over long distances by ship at a considerable profit. During the 1390s, a better press was developed, which doubled the amount of juice that was obtained from the sugarcane and helped to cause the economic expansion of sugar plantation. Sugar prices declined slowly as its production became multi-sourced, especially through British colonial policy. Formerly an indulgence of only the rich, the consumption of sugar also became increasingly common among the poor as well. During the 18th century, sugar became enormously popular. As Europeans established sugar plantations on the larger Caribbean islands, prices fell, especially in Britain. By the 18th century all levels of society had become common consumers of the former luxury product. At first most sugar in Britain went into tea, but later confectionery and chocolates became extremely popular. Many Britons (especially children) also ate jams. The cane sugar plant, which is native to a tropical climate, requires both a lot of water and a lot of heat to thrive. Sugarcane quickly exhausts the soil in which it grows, and planters pressed larger islands with fresher soil into production in the nineteenth century as demand for sugar in Europe continued to increase.

Human physiology evolved on a diet containing very little sugar and virtually no refined carbohydrate. In fact, sugar probably entered into our diets by accident. It is likely that sugarcane was primarily a “fodder” crop, used to fatten pigs, though humans may have chewed on the stalks from time to time.

In the 21st century, the grip of sugar is stronger than comparable scourges like tobacco, or even alcohol.

Small amounts used to sweeten foods are fine, preferably at mealtimes, so there is less risk of damaging your teeth. However, many of us have too many high-sugar foods and drinks too often.

Free sugars are those added to food (e.g. sucrose (table sugar), glucose) or those naturally present in honey, syrups and unsweetened fruit juices, but exclude lactose in milk and milk products as well as those sugars contained in fruit that is still intact – i.e. not juiced. SACN has recommended that free sugars account for no more than 5% of daily energy intake.

This is equivalent to:

19g or 5 sugar cubes for children aged 4 to 6

24g or 6 sugar cubes for children aged 7 to 10

30g or 7 sugar cubes for 11 and older

The SACN (The Scientific Advisory Committee on Nutrition) Report found that high intakes of sugar were associated with greater risk of tooth decay and obesity. Sugar-sweetened beverages (sugar-rich drinks) in particular were shown to increase Body Mass Index (BMI) in teenagers – this age group tends to drink the highest volume of sugary drinks. There is also some research that suggests that having too much sugar in the form of sugar-sweetened beverages increases the risk of type 2 diabetes.

According to experts, children in the UK exceed the maximum recommended sugar intake for an 18-year-old by the time they are 10. Children are consuming around 13 cubes or 52g of sugar a day, says PHE (Public Health England), based on results from the National Diet and Nutrition Survey. Half of the sugar in children's diets comes from sugary drinks, sweets, biscuits, cakes, puddings, sugary breakfast cereals and higher-sugar yoghurts and puddings.

Parents can try swapping:

- A higher-sugar yoghurt (e.g. split-pot) for a lower sugar one, to halve sugar intake from six cubes of sugar to three cubes

- A sugary juice drink for a no-added sugar juice drink, to cut back from two cubes to half a cube

- A higher-sugar breakfast cereal (e.g. a frosted or chocolate cereal) for a lower sugar cereal, to cut back from three cubes to half a cube per bowl

Making such swaps every day could remove around 2,500 sugar cubes per year from a child's diet, but swapping chocolate, puddings, sweets, cakes and pastries for healthier options such as malt loaf, sugar-free jellies, lower-sugar custards and rice puddings would reduce their intake even more, according to the Change4Life campaign website.

PHE is working with the food industry to cut 20% of sugar from the foods children consume most by 2020.

What once was a luxury item or a medicine, today is like a curse. Our modern addiction to sugar is killing us. To break this curse we need to go back in time and have sugar on our tables only occasionally and enjoy it as a luxury item.

Sources:

https://en.wikipedia.org/wiki/History_of_sugar

https://www.iflscience.com/plants-and-animals/history-sugar-food-nobody-needs-everyone-craves/

https://www.bda.uk.com/foodfacts/sugar

https://www.gov.uk/government/news/10-year-olds-in-the-uk-have-consumed-18-years-worth-of-sugar

https://www.bbc.co.uk/news/health-46720303

Personal experiences in how to reduce sugar intake:

https://www.bbc.co.uk/news/health-46739905

https://timefortruth.blog/2017/12/14/the-sugar-curse/

About allergies

November 19, 2018/ Martyna Beloviene R.D.

Definition describes allergy as damaging immune response by the body to a substance, especially a particular food, pollen, fur, or dust, to which it has become hypersensitive.

Today allergies are very common. They are particularly common in children. Some allergies go away as a child gets older, although many are lifelong. Adults can develop allergies to things they weren’t previously allergic to.

So what really happens in the body when person is exposed to allergen? The foreign substance coming in contact with the body acts as an antigen, something which stimulates an immediate response from the immune system. Because the person is hypersensitive to the substance and identifies it as a threat, the body reacts in an extreme manner. The immune system’s protective white blood cells create antibodies that attach both to the foreign substance and to other bodily cells in a way that signals them to release inflammatory chemicals like histamine and serotonin, part of its defense strategy against infections. That makes the muscles of internal organs constrict and causes other visible symptoms of allergic reactions.

Allergic reactions usually happen quickly within a few minutes of exposure to an allergen. Such allergic reactions can cause sneezing, a runny or blocked nose, red, itchy, watery eyes, wheezing and coughing, a red, itchy rash, worsening to asthma or eczema symptoms.

Most allergic reactions are mild but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. Anaphylaxis is a sudden, severe allergic reaction that may cause death. Common triggers of anaphylaxis include food products, insect stings and certain medications. Symptoms of anaphylaxis typically begin rapidly after contact with the allergen and include itching, hives and breathing difficulties. Anaphylaxis is always a medical emergency. Fatal complications of an episode of anaphylaxis include cardiac arrest, respiratory arrest and shock.

Being allergic to particular food can make life really difficult and take the fun out of things such as eating out or parties. However, there are a number of simple things that can be done to help you so you can participate in many fun activities whilst also enjoying your food.

1. Read food labels - all pre-packed foods sold in the UK are currently required by law to clearly show a list of ingredients on the label. There are 14 food ingredients that commonly cause allergic reactions that have been identified and these must be included in the ingredients list if they are present (1. cereals containing gluten – wheat, rye, barley, oats, spelt and kamut 2. molluscs – clams, mussels, whelks, oysters, snails and squid 3. crustaceans 4. fish 5. milk 6. eggs 7. soybeans 8. lupin 9. celery 10. mustard 11. sesame seeds 12. peanuts 13. nuts – almond, hazelnut, walnut, cashew, pecan, brazil, pistachio and macadamia (Queensland) nuts 14. food preservatives – sulphur dioxide and sulphites.) For foods sold without packaging e.g. in restaurants, cafes or delicatessens, allergen information must be provided in writing or verbally.

2. Nutrients - If you have to cut out complete food groups from your diet (e.g. dairy/wheat) then it is best to substitute foods with nutritional equivalents to avoid a deficiency. For example, if you are cutting out cow’s milk, try replacing with calcium-enriched alternative milks e.g. soya, oat, nut etc; if you are cutting out wheat, try wheat-free pasta/bread.

3. Use 'free from' products - Look out for and try new ‘free from’ products as this will help add variety and enjoyment to your diet. These are clearly labelled and are common foods that are made without the standard ingredients. For example pasta that is made from rice or corn instead of wheat, or custard that is made from soya instead of cow’s milk.

4. Plan ahead - For special occasions such as meals out, parties, weddings, day trips etc. plan ahead by letting your host/chef know your dietary requirements. Don’t be afraid to ask questions about how the food will be prepared. Take some suitable snacks with you in case there isn’t anything available that you or your child can eat.

5. Know your level of food avoidance - Find out if you have to avoid even tiny ‘trace’ amounts or if you can have small amounts without triggering a reaction. Knowing this can make a big difference in the day to day management of your diet. If your avoidance needs to be strict then you need to be aware of the risks of ‘cross-contamination’ (where some of the food you are allergic to can come into contact with other foods you eat). This is important both at home e.g. when using BBQ, grill, toaster, chopping boards, knives, dishcloths; and when shopping and eating out for example deli-counters, serving utensils, and salad bars.

6. Remember your medication - Always carry the emergency medication recommended by your doctor e.g. antihistamines/steroids/Adrenaline, Auto-injector etc. and make sure your friends and family know how to administer the adrenaline.

If you are unsure about which foods you can and can’t eat and need further dietary advice, ask your doctor to refer you to a dietitian.

Sources:

https://www.bda.uk.com/foodfacts/home

https://www.allergyuk.org/

Pumpkin

October 17, 2018/ Martyna Beloviene R.D.

Probably for most of us pumpkin will associate with Halloween. But just imagine what can be cooked using this precious fruit. I know, but it's not a vegetable. A pumpkin is a fruit, because it matches this dictionary definition of "fruit": The edible plant structure of a mature ovary of a flowering plant, usually eaten raw.
The word pumpkin originates from the word pepon (πέπων), which is Greek for "large melon", something round and large. Native to North America, pumpkins are widely grown for commercial use and are used both in food and recreation. Pumpkin pie, for instance, is a traditional part of Thanksgiving meals in Canada and the United States, and pumpkins are frequently carved as jack-o'-lanterns for decoration around Halloween, although commercially canned pumpkin puree and pumpkin pie fillings are usually made from different kinds of winter squash than the ones used for jack-o'-lanterns.
Pumpkin is a highly nutrient-dense food. It is rich in vitamins and minerals but low in calories. 100g of raw pumpkin provides only 26 calories. Pumpkin is 92% water, 6.5% carbohydrate, 0.1% fat and 1% protein.
There are many ways pumpkin can be incorporated into desserts, soups, salads, preserves, and even as a substitute for butter. Pumpkin is one of the best- known sources of beta-carotene which in our body is converted into vitamin A. Consuming foods rich in beta-carotene may reduce the risk of developing certain types of cancer, offer protection against asthma and heart disease, and delay aging and body degeneration. Pumpkins are also a powerful source of fiber. The fiber, potassium, and vitamin C content in pumpkin all support heart health. Pumpkins contain a wealth of antioxidants. Vitamin C, vitamin E, and beta-carotene have been shown to support eye health and prevent degenerative damage.

When choosing a pumpkin make sure it has a few inches of stem left and is hard and heavy for its size. Store uncut pumpkins in a cool, dark place for up to 2 months. When ripe, the pumpkin can be boiled, steamed, or roasted.

Here are some simple tips for including pumpkin in your diet: Make your own pumpkin puree instead of buying canned, make a pumpkin soup or pie. Try pumpkin pancakes. What about pumpkin bread or biscuits? Hummus or maybe mashed potatoes with pumpkin? There are many easy recipes you can find online. It's pumpkin season, don't carve it up. Cook it and eat it.

Few easy to make recipes can be found on

https://www.jamieoliver.com/search/?s=pumpkin

Climate change and our diet

October 9, 2018/ Martyna Beloviene R.D.

It's difficult to ignore warnings we hear about climate change. On Earth, human activities are changing the natural greenhouse. In its Fifth Assessment Report, the Intergovernmental Panel on Climate Change, a group of 1,300 independent scientific experts from countries all over the world under the auspices of the United Nations, concluded there's a more than 95 percent probability that human activities over the past 50 years have warmed our planet.

WHO (World Health Organization) published recommendations how we as individuals can help to reduce warming of our planet. Many policies and individual choices have the potential to reduce greenhouse gas emissions and produce major health co-benefits. For example, cleaner energy systems, and promoting the safe use of public transportation and active movement – such as cycling or walking as alternatives to using private vehicles – could reduce carbon emissions, and cut the burden of household air pollution, which causes some 4.3 million deaths per year, and ambient air pollution, which causes about 3 million deaths every year. The livestock industry is one of the most significant causes of global environmental damage – generating a fifth of the world’s greenhouse gas emissions. The UK’s reliance on imported protein crops is also driving deforestation in South America. This is having a devastating impact on the people who’ve lived on the land for centuries. Over the last 50 years the quantity of meat produced around the world has quadrupled while the global population has doubled. We could prevent 45,000 early deaths and save the NHS £1.2 billion each year if we switched to diets that contain less meat in the UK. Lower-meat diets could cut deaths from heart disease by 31,000, deaths from cancer by 9,000 and deaths from strokes by 5,000 each year. There is clear evidence of a link between high meat diets and a higher incidence of bowel cancer and heart disease with some evidence of a link between high meat diets and other cancers, diabetes and obesity. Processed meat is more damaging to health than unprocessed meats. In the UK our food based guidelines come in the form of the Eatwell Plate. The proportions on Eatwell Plate are: Bread, rice, potatoes, pasta and other starchy foods: 33 per cent; Fruit and vegetables: 33 per cent; milk and dairy foods: 15 per cent; meat, fish, eggs, beans and other non-dairy sources of protein: 12 per cent; Foods and drinks high in fat and/or sugar: 8 per cent. It is recommended that healthy adult should eat approximately 50 g of protein per day. What is 50 g of protein? 100 g of lean grilled beef stake contains 31 g of protein. 100 g of Chicken breast (grilled without skin) has 32 g of protein. Tinned tuna in brine (100 g) has 23.5 g of protein. 100 g of Cheddar cheese contains 25.4 g of protein and one big chicken egg has 10 g of protein. But what about processed meat? One small sausage has 5 g of protein, one slice of cooked bacon has 3 g of protein, slice of ham may contain up to 4 g of protein. Proteins are fundamental structural and functional elements within every cell of the body and are involved in a wide range of metabolic interactions. All cells and tissues contain protein, therefore protein is essential for growth and repair and the maintenance of good health. How to get recommended amount of protein and reduce meat consumption? Try to add pulses, beans, grains and nuts to your diet. For example 100 g of almonds contain 21.1 g of protein, 100 g of chickpeas contain 8.4 g of protein. On the Eatwell Plate meat, poultry, fish, dry beans, eggs, and nuts are classified as a single group of foods encouraging users to choose from a variety of quality protein sources at a glance. Advice is given as to what quantities of non-meat foods equate to a serving of meat. For example, 1 ounce of meat, poultry, or fish is equivalent to ¼ cup cooked dry beans, one egg, two tablespoons of peanut butter, or ½ ounce of nuts or seeds. Dairy products are also good sources of protein and other essential nutrients. Eating a variety of foods can improve general wellbeing, reduce the risk of conditions including heart disease, stroke, some cancers, diabetes and osteoporosis (thin bones) and help you manage your weight. You need to eat sensibly, choosing a varied diet from a range of foods, not smoking and keeping active are all great ways to boost your health. Eating less meat is not a silver bullet that will deliver healthy eating and living. But a growing body of evidence shows that we should get the majority of our nutrients from fresh fruits and vegetables, whole grains and pulses, with only small amounts of meat, dairy and fish as additional sources of protein.

Sources:

https://climate.nasa.gov/causes/

https://www.bda.uk.com

http://www.who.int/en/news-room/fact-sheets/detail/climate-change-and-health

https://cdn.friendsoftheearth.uk/

About coeliac disease

September 25, 2018/ Martyna Beloviene R.D.

Coeliac disease (pronounced see-liac) is a serious illness where the body’s immune system attacks it's own tissues when you eat gluten. This causes damage to the lining of the gut and means the body can’t properly absorb nutrients from food. Coeliac disease is not an allergy or food intolerance. Coeliac disease is a lifelong condition. Coeliac disease affects approximately 1% of the UK population. Coeliac disease is caused by a reaction of the immune system to gluten – a protein found in wheat, barley and rye. Some people are also sensitive to oats. When someone with coeliac disease eats gluten, their immune system reacts by damaging the lining of the small intestine. Coeliac disease is known as a 'multi system' disorder – symptoms can affect any area of the body. Symptoms differ between individuals in terms of type and severity.

Possible symptoms may include:

*severe or occasional diarrhoea, excessive wind and/or constipation

*persistent or unexplained gastrointestinal symptoms, such as nausea and vomiting

*recurrent stomach pain, cramping or bloating

*any combination of iron, vitamin B12 or folic acid deficiency

*anaemia

*tiredness

*sudden or unexpected weight loss (but not in all cases)

*mouth ulcers

*skin rash (dermatitis herpetiformis)

*tooth enamel problems

*depression

*liver abnormalities

*repeated miscarriages

*neurological (nerve) problems such as ataxia (loss of coordination, poor balance) and peripheral neuropathy (numbness and tingling in the hands and feet).

The condition can only be managed by consuming a strict gluten-free diet. On the gluten free diet you can eat any naturally gluten free foods such as meat, fish, fruit and vegetables, rice, potatoes and lentils. There are also gluten free substitute foods available, such as specially made gluten free bread, flour, pasta, crackers and biscuits. These are available in the free from section of the supermarket and health food stores. Gluten free bread and flour mixes are also available on prescription. A recent consultation by the Department of Health resulted in the decision to retain access to gluten free breads and flour mixes on prescription in England. There are now many wheat free products available to buy from supermarkets, health food shops and online. Wheat is found in many foods so a wheat free diet can be restrictive. Try to replace with suitable alternatives to ensure that your diet remains balanced. For further advice, ask your doctor to refer you to a dietitian.

Sources https://www.coeliac.org.uk and https://www.bda.uk.com/

Daily self-weighing

September 6, 2018/ US National Library of Medicine

One of the advises people hear when they try to lose weight is 'Do not weight yourself daily'. And reason for such advice is that daily body weight is variable due to changing amount in body water and intestinal content and other processes in our body which happen in 24 hours. But there are evidence and researchers state that daily weighing can actually be beneficial for effective long term weight loss. Professor David Lavitsky compared a group of first semester students who were asked to weigh themselves daily and to view a chart of their weight with a matched group of students who were weighed only at the beginning and at the end of their first semester. In two successive tests over 2 years, daily self-weighing prevented significant weight gain in the self-weighing group, whereas the controls who did not weigh themselves daily gained between 2 and 3 kg over the course of the first semester.
Published studies show that people who weigh themselves daily lose more weight, maintain the lost weight, and are better able to prevent gaining or regaining weight than are people who do not weigh themselves daily.

To read more about myths related with losing weight read full article via link (Myth 6: Daily self-weighing interferes with weight loss):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272668/

Obesity in the world

September 4, 2018/ Martyna Beloviene R.D.

There are a lot of ways to think about why obesity is a problem. There is no single reason an individual becomes obese, and it should be thought of as having a number contributing factors. Regardless of the causes, there are a lot of negative health consequences, including diabetes, heart diseases, stroke, and several types of cancer. In addition, the number of children and adolescents who are obese continues to rise, and the long-term consequences of developing obesity at a young age are only beginning to be characterized or understood. World Health Organization (WHO) explains what causes obesity and overweight. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. An increased intake of energy-dense foods that are high in fat; an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. How many calories per day do you think you consume? Do you know what the guidelines are? Government dietary recommendations in the UK are 2000 calories for women and 2500 for men. People are advised to reduce how many calories they consume from the 3 main meals of the day, in particular when eating on the go. People should aim for 400 calories from breakfast and 600 each from lunch and dinner. Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable.
At the individual level, people can:

- limit energy intake from total fats and sugars;

- increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; and

- engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).

Obesity world map can be accessed via this link:

https://www.worldobesity.org/data/map/overview-adults

Physical exercise and mental health

August 28, 2018/ The Lancet Psychiatry

Being active is great for your physical health and fitness, and evidence shows that it can also improve your mental wellbeing. Mental wellbeing means feeling good – both about yourself and about the world around you. It means being able to get on with life in the way you want. Evidence shows that there is a link between being physically active and good mental wellbeing.
There was a cross- sectional study done in USA and data analysed from 1 237 194 people aged 18 years or older. Individuals who exercised had fewer days of poor mental health in the past month than individuals who did not exercise.

Scientists think that physical activity helps maintain and improve wellbeing in a number of ways. Physical activity is thought to cause chemical changes in the brain, which can help to positively change our mood. Some scientists think that being active can improve wellbeing because it brings a sense of greater self-esteem, self-control and the ability to rise to a challenge.

Being active doesn’t mean you need to spend hours in the gym, if that doesn't appeal to you. Find physical activities that you enjoy and think about how to fit more of them into your daily life.

You can find out more about the study on:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30227-X/fulltext

At the individual level, people can:

- limit energy intake from total fats and sugars;

- increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; and

- engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).

Obesity world map can be accessed via this link:

https://www.worldobesity.org/data/map/overview-adults

About five-a-day

August 1, 2018/ Martyna Beloviene R.D.

Fruit and vegetables are part of a healthy, balanced diet and can help us stay healthy. It's important that we eat enough of them.

WHO (World Health Organization) aims to promote an increase in fruit and vegetables consumption, so that sufficient quantities become part of the daily diet in all countries. How to know if the amount of fruit and vegetables we consume per day is sufficient?

Many dietary guidelines include advice on the consumption of at least five portions a day. Scientists from Imperial College London led new research which analysed 95 studies on fruit and vegetable intake. The team found that although even the recommended five portions of fruit and vegetables a day reduced disease risk, the greatest benefit came from eating 800g a day (roughly equivalent to ten portions - one portion of fruit or vegetables if defined as 80g). The study included up to 2 million people, and assessed up to 43,000 cases of heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease, 112,000 cancer cases and 94,000 deaths. The team also analysed which types of fruit and vegetables provided the greatest protection against disease.

The researchers also examined the types of fruit and vegetables that may reduce the risk of specific diseases. They found the following fruits and vegetables may help prevent heart disease, stroke, cardiovascular disease, and early death: apples and pears, citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory, and cruciferous vegetables such as broccoli, cabbage and cauliflower. They also found the following may reduce cancer risk: green vegetables, such as spinach or green beans, yellow vegetables, such as peppers and carrots, and cruciferous vegetables.

The current UK guidelines are to eat at least five portions or 400g per day. However fewer than one in three UK adults are thought to meet this target. Most of us know that we need to eat more fruit and vegetables. So why aren’t we eating enough? Some of us not able to use vegetables before they would go bad and have to throw them away, others don't like flavour or texture. Also with our busy lifestyles we can't find time to cook. Achieving the five-a-day target is not too hard. With some planning ahead and being intentional about what we eat it is possible to improve our fruit and vegetables consumption.

Tips how to get your five a day

- Go for those in season: Opting for fresh produce as they are more likely to be locally grown, are value for money and often look and taste the best.

- Eat a rainbow: Variety is important. Different coloured fruits and vegetables contain their own combination of vitamins, minerals and fibre, so to get the most benefit, try to eat one portion from each colour group. Choose from red, green, yellow, white, purple and orange varieties of fruits and vegetables.

- Cut down or avoid butter, cream or cheese sauces! Even though fruit and vegetables are low in calories, remember that their calorie content is determined by what you prepare them with.

- Be careful not to eat too many dried fruits: While a 30g portion of dried fruits, like apricots, dates, raisins etc. counts towards your five-a-day, once fruit is dried it also becomes a concentrated source of sugar and calories. To minimise damage to teeth, keep to mealtimes and not as a between-meal snack.

- Treat your fruit and veggies right: Nutrients in fruit and vegetables can be easily destroyed during food preparation and by heat, so whenever possible eat raw. When cooking vegetables, try steaming, microwaving, roasting or poaching rather than boiling, so the maximum amount of nutrients can be retained. amount of nutrients can be retained.

- Keep your freezer and cupboards well stocked: Keep a supply of frozen and/or canned vegetables and fruits at home. They are a convenient alternative to fresh varieties, stay fresher for longer and they all count towards your five-a-day.

Difference between probiotics and prebiotics

July 28, 2018/ Monash University, Australia

Probiotics are preparations of live micro-organisms which when administered in adequate amounts may confer health benefits.

They are mostly found in your supermarket or pharmacy (sold as a product such as capsules) and in some foods such as yoghurts.

When you consume probiotics, the major challenge is for their organisms to survive passage through the stomach (which has a very low pH of 2 and will kill most bacteria) and gut. They must also survive the enzymes and other secretions produced naturally in our gut.

Once there, it can be hard to take up residency as they can be crowded out by other micro-organisms that are already there and well established.

The most common species used as probiotics are Lactobacillus and Bifidobacterium. Before these preparations can be sold to consumers, of course they need to pass a number of testing and safety assessments (to show they are non-pathogenic). While the use of probiotics has attracted a great deal of research focus the results from these many studies have been rather mixed and often dependent on the type of probiotic culture used (as there are many different types available).

The types of benefits that have been explored range from treatment of Travellers Diarrhoea and other gastrointestinal problems, to upper respiratory tract infections, allergies, various skin disorders, diabetes, weight loss to infantile colic.

In summary, with probiotics you are consuming the live micro-organisms directly. In contrast prebiotics are fibres that stimulate the growth of beneficial bacteria that are already present in your gut. The best way to improve our microbiota is a very active area of research worldwide and over the next 10 years great advances in our understanding will be made.

It is possible that a combination of both probiotics and prebiotics (called a symbiotic) may be best.

While the role of prebiotics and probiotics are still being explored – it is clear that increasing dietary fibre in the diet can have a very important protective role against a range of common diseases that affect our community including prevention and treatment of cardiovascular disease and Type 2 diabetes as well as various gastrointestinal disorders.

History of Probiotics

July 10, 2018

The history of probiotics can be traced to the first use of cheese and fermented products, that were well known to the Greeks and Romans who recommended their consumption. The fermentation of dairy foods represents one of the oldest techniques for food preservation.
The term "probiotic" originally referred to microorganisms that have effects on other microorganisms.

In the early 1900s, Russian scientist and Nobel laureate Elie Metchnikoff advocated the intake of fermented dairy foods containing live lactic acid-producing bacteria, believing this would reduce the number of harmful gut microbes that produced toxins linked to ageing.

He suggested in 1907 that "the dependence of the intestinal microbes on the food makes it possible to adopt measures to modify the microbiota in our bodies and to replace the harmful microbes by useful microbes". Metchnikoff himself introduced in his diet sour milk fermented with the bacteria he called "Bulgarian Bacillus" and believed his health benefited. Friends in Paris soon followed his example and physicians began prescribing the sour-milk diet for their patients.

In the 1930s in Japan, Dr Minoru Shirota applied Metchnikoff's theory and produced a fermented milk drink containing high numbers of a live Lactobacillus strain, robust enough to survive passage through the gut.

The World Health Organization's (WHO) 2001 defines probiotics as live micro-organisms that, "...when administered in adequate amounts, confer a health benefit on the host."

A group of scientific experts assembled in London, UK, on October 23, 2013, to discuss the scope and appropriate use of the term probiotic. The meeting was motivated by developments in the field since 2001. The panel's conclusions were published in June 2014. Probiotics must be alive when administered. One of the concerns throughout the scientific literature resides in the viability and reproducibility on a large scale of the observed results, as well as the viability and stability during use and storage, and finally the ability to survive in stomach acids and then in the intestinal ecosystem. Probiotics must have undergone controlled evaluation to document health benefits in the target host. Only products that contain live organisms shown in reproducible human studies to confer a health benefit can actually claim to be probiotic.

Did you know? We are born sterile (i.e. 100% human) but, within a few years, we become 90% bacterial. In adults microbial cells outnumber human cells by 10:1. There are about 100 trillion bacteria in the human gut, weighing over 1 kg. Many of the gut's bacteria perform useful functions, such as protecting against pathogens, supporting the immune system and producing beneficial by-products like vitamins and short-chain fatty acids.

Alkaline diet

June 25, 2018/ British Dietetic Association

Supporters of this diet believe that changing the foods they eat, consuming more alkaline and less acidic foods, will help change the pH balance of the blood and reduce health risks. Worryingly some wrongly claim it can treat cancer and that incorrectly ‘acidic’ foods cause osteoporosis.
BDA Verdict: Unfortunately, this diet is based on a basic misunderstanding of human physiology. While encouraging people to eat more fresh veggies is a good thing, the pH of your food will not have an impact on the pH of your blood – and you wouldn’t want it to! Your body is perfectly capable of keeping its blood within a very specific pH range (between 7.35 and 7.45). If it fails to do so you would become very ill very quickly and die if not treated! Diet can change the pH value of urine, but testing the pH of your urine just measures the pH of your urine and is not related to the pH of your blood, which cannot be affected by diet.

Ketogenic diet

June 19, 2018/ British Dietetic Association

This diet, is out there in many versions rather like Atkins or Paleo but the premise is the same: very low carb (around 20-50g per day or 5% total calories), relatively high in fat, moderate protein. Typically it excludes grains, dairy, legumes, soy, most fruits and starchy vegetables. The carbohydrates in the diet come mainly from non-starchy vegetables, nuts and seeds.

If you significantly decrease the amount of carbohydrate in your diet, the body switches from primarily burning carbohydrates, to burning fat, for energy. This causes an increase in levels of ketones in our bodies. Supporters claim it can help you to lose weight, control hunger and improve your health. Worryingly some say it can treat or prevent a number of different types of cancer which is just not true.

BDA Verdict: A carefully dietitian-planned ketogenic diet can be a very effective treatment for people with epilepsy. For weight loss, there’s no magic, the diet works like any other by cutting total calories and removing foods people tend to overeat. Initial side effects may include low energy levels, brain fog, increased hunger, sleep problems, nausea, digestive discomfort, bad breath and poor exercise performance. It can be an effective method of weight loss in the short term with careful planning but it is hard to sustain for many in the long term and most of the initial weight loss seen is often associated with water/fluid losses. It is never a good idea to ‘over-restrict’ any one food group (including carbohydrate), as this can mean it is more difficult to achieve a balanced diet overall with respect to vitamins, minerals and fibre in particular. If consuming high fat then the type of fat needs to be considered.

Appetite

June 5, 2018/ Martyna Beloviene R.D.

What is appetite and how can it affect my health? Oxford Dictionary appetite defines as a natural desire to satisfy a bodily need, especially for food; or a strong desire for something, such as food. Hunger is the physiological driver of appetite – mostly we recognize this as physical signals from our bodies that it’s time to eat – a rumbling tummy is a signal that our body is seeking food. In humans, our desire to eat can be driven not just by physiology but by our situation – for example, a delicious cake is available at work to celebrate someone’s birthday – we may not feel hungry at all when it’s time to have the birthday celebration or have little appetite but we may still eat a piece of cake, not to fulfill our hunger but because it is simply available and everyone else is having cake…so we have some too. How we respond to external signals to eat differ considerably – for example, some people seek food when they are upset or depressed, in others the exact opposite may occur and negative feelings induce a lack of appetite or desire to eat. A range of cultural issues can also impact on our appetite – for instance a food that is highly valued and desirable by certain people say for example, fois gras, may be very unappetising to another person.

Appetite can be affected by a wide range of factors including physical activity, psychological, social and cultural influences. It is a complex area with no simple explanation why everyone eats the food they do… but your own appetite and what drives it is very important to consider when you are thinking about making changes to diet.

When you don’t eat enough nutrient-rich foods, your body may lack vital vitamins and minerals, often affecting your energy, mood and brain function. You should aim to get your vitamins and minerals from eating a healthy, balanced diet with plenty of fruit and vegetables but in certain circumstances or for certain people, supplements may be beneficial e.g. folic acid for all women planning pregnancy; iron supplements for people diagnosed with anaemia; vitamin D for everyone in winter months, and all pregnant and breast-feeding women, older adults, and people with dark skins.

Feeling good comes from a diet that provides adequate amounts of healthy choice carbohydrate at regular times to keep blood glucose levels stable, and eating breakfast is a sensible habit. Diets should also contain a wide variety of protein and vitamin and mineral containing foods to support the body’s functions.

Dietary fiber

May 27, 2018/ Martyna Beloviene R.D.

Adequate fibre and fluid is important as part of a balanced diet to help maintain normal bowel function and prevent constipation. Dietary fibre or roughage is the portion of plant-derived food that cannot be completely broken down by digestive enzymes. Some types of soluble fibre absorb water to become a gelatinous, viscous substance which may or may not be fermented by bacteria in the digestive tract. Some types of insoluble fibre have bulking action and are not fermented. Dietary fibers are found in fruits, vegetables and whole grains. Soluble fibre is found in varying quantities in all plant foods (legumes: peas, soybeans and other beans), oats, rye, chia, and barley, some fruits (including figs, avocados, plums, prunes, berries, ripe bananas, and the skin of apples, quinces and pears), certain vegetables such as broccoli, carrots, and Jerusalem artichokes, root tubers and root vegetables such as sweet potatoes and onions (skins of these are sources of insoluble fiber also), psyllium seed husks (a mucilage soluble fibre) and flax seeds, nuts, with almonds being the highest in dietary fiber). Sources of insoluble fibre: whole grain foods, wheat and corn bran, legumes such as beans and peas, nuts and seeds, potato skins, lignans, vegetables such as green beans, cauliflower, zucchini (courgette), celery, some fruits including avocado, and unripe bananas, the skins of some fruits, including kiwifruit, grapes and tomatoes. Fiber help waste products to be eliminated from the gut in our bowel movements. Secondly, it's presence in foods can slow down the digestion and absorption of glucose. And last-the breakdown products formed when it is fermented by bacteria in the large intestine can help to reduce blood cholesterol.
How much fibre do we need? In 2015 the government published new guidelines with a recommendation that the population's fibre intake should increase to 30g a day for adults (aged 17 years and over). On average, we consume much less than this - about 18g per day. Children also need to increase their intake of fibre: 2 to 5 year-old: need about 15g of fibre a day; 5 to 11 year-old: need about 20g; 11 to 16 year-old: need about 25g.

To increase your fibre intake you could:

-Choose a high fibre breakfast cereal e.g. wholegrain cereal like wholewheat biscuit cereal, no added sugar muesli, bran flakes or porridge. Why not add some fresh fruit, dried fruit, seeds and/or nuts.

-Go for wholemeal or seeded wholegrain breads. If your family only typically likes white bread, why not try the versions that combine white and wholemeal flours as a start.

-Choose wholegrains like wholewheat pasta, bulgur wheat or brown rice.

-Go for potatoes with skins e.g. baked potato, wedges or boiled new potatoes – you can eat these hot or use for a salad.

-For snacks try fruit, vegetable sticks, rye crackers, oatcakes, unsalted nuts or seeds.

-Include plenty of vegetables with meals – either as a side dish/salad or added to sauces, stews or curries – this is a good way of getting children to eat more veg.

-Keep a supply of frozen vegetables so you are never without.

-Add pulses like beans, lentils or chickpeas to stews, curries and salads.

-Have some fresh or fruit canned in natural juice for dessert or a snack.

Examples of fiber in different foods: big slice of wholemeal bread (50g) contains approximately 3g of fibre. One medium apple with skin - 4.4g; medium banana - 3.1g; one cup of boiled lentils contains 15.6g of fibre; one small baked potato with skin - 2.9g.

It is very important to eat a range of types – which means including many different types of plant foods in your diet.

Dehydration in ageing adults

April 23, 2018/ Martyna Beloviene R.D.

Why dehydration is such a big issue when we are constantly bombarded with reminders to drink enough fluids? While dehydration may be preventable in care settings seems that it is still too common in the older person. Elderly people are vulnerable to dehydration and they may have difficulties accessing drinks. Fear of incontinence may also mean that some elderly people restrict their fluid intake. Following my first hand experience in working with elderly people I know that friendly prompt to drink more often can make a significant difference in aging adult life. Improving hydration can bring well-being and better quality of life for patients, allow reduced use of medication and prevent illness.

Ageing is a natural process that has effects on many body systems. Dehydration is associated with increased risk of disability and mortality; preventing dehydration can improve general health, functional ability and overall quality of life.

Water is essential to life and, we could survive for several weeks without food, but only for few days without water. Water has many vital functions in our body such as:

Solvent for ions and molecules.

Transport medium, especially for the excretion of osmotically active solutes such as urea and salts.

Lubricant.

Temperature regulation.

In 2010 the European Food Safety Authority (EFSA, 2010) published dietary reference values for water where adults, including elderly are recommended to have 2.5 L (men) and 2 L (women) intake of water daily. Most elderly should have a fluid goal of at least 1500 ml/day.

Older people are at greater risk of dehydration and a fluid loss of 20% can be fatal. Up to 10% of older people admitted to community hospitals suffer from clinical dehydration and up to 25% of immobile older people have chronic mild dehydration. Although drinking adequate fluids seems like a simple, easily achievable goal, preventing dehydration is a complex issue for the elderly, involving a range of factors from personal limitations to institutional issues such as staffing.

Following my firsthand experience in working with elderly people, I saw what drinking related difficulties they face each day. Elderly people living on their own often experience cognitive and physical limitations that affect their ability to not only obtain fluids but also to remember to drink and respond to thirst. Anxiety regarding toileting can lead to consciously choosing not to drink, which reduces the thirst sensation and the body’s ability to maintain appropriate fluid balance. Elderly dehydrated people are at particular risk of urine infections and falls and should monitor how much they drink in hot weather.

The effects of dehydration in older adults include: loss of appetite; increased risk of development of pressure sores; constipation; electrolyte imbalance; falls; altered cardiac function; urinary tract infections; unpleasant taste in mouth; headaches; drowsiness and confusion; irritability; loss of skin elasticity.

A hydration assessment by the multidisciplinary team should occur when the individual is admitted or re-admitted to a long-term care facility, on a quarterly basis, and with any change in the individual’s condition that may increase the risk for dehydration.

Urine colour is a minimally invasive test that is used to assessing dehydration. In general, the darker the urine, the more dehydrated a person may be. However, there are some limitations, including the effect of some food and medications, such as vitamin supplements, that can affect the colour of urine.

The elderly should be advised to drink smaller amounts more often rather than drinking large amounts at one time to avoid gastric distention, which quickly decreases the sensation of thirst. When an elderly person is dependent, the role of the caregiver and health professional is extremely important. One study recommends that adequate fluid intake could be achieved by simple interventions such as offering residents preferred liquids systematically and by having an adequate number of supervised staff to encourage and help them to drink more often.

How much fibre do we need? In 2015 the government published new guidelines with a recommendation that the population's fibre intake should increase to 30g a day for adults (aged 17 years and over). On average, we consume much less than this - about 18g per day. Children also need to increase their intake of fibre: 2 to 5 year-old: need about 15g of fibre a day; 5 to 11 year-old: need about 20g; 11 to 16 year-old: need about 25g.