Q&A with nutritionist Lynne Garton
Lynne Garton is a nutritionist and dietitian with more than 20 years' experience. She has a first in nutrition from King's College, London, and a postgraduate diploma in dietetics, and has practised as a clinical dietitian both in acute and community health settings.
Lynne has recently been involved in TV programmes such as the Truth About Food (BBC).
Working with WellWoman cancer insurance from Chartis, Lynne has been providing dietary advice on how to keep healthy and joined us in July 2011 to answer questions on everything from mid-afternoon energy slumps to IBS.
Q. Twotwins: I've read that red meat can increase the chances of developing cancer. On the other hand, we're told it's important to eat red meat for iron. What is a sensible amount of red meat to eat each week so you get enough iron but avoid the health risks?
A. Lynne: You're right on both counts! A recent report published by the The World Cancer Research Fund (WCRF) has concluded that red and processed meat increases the risk of bowel cancer, whereas fibre is protective. However, they do not suggest that red meat should be cut out of the diet completely, instead they recommend that people limit their consumption to 500g (cooked weight) of red meat a week - roughly the equivalent to five or six medium portions of roast beef, lamb or pork (a portion is around the size of a deck of playing cards). Furthermore, they recommend avoiding processed meats such as ham, bacon, pastrami and salami, as well as hot dogs and some sausages.
The Scientific Advisory Committee on Nutrition recently reviewed the impact of reducing meat in relation to iron intake in its report, Iron and Health. In this report it recommends that for the general population eating a healthy balanced diet, which includes a variety of foods containing iron, would achieve adequate iron status.
It also acknowledges the link between meat and bowel cancer and concludes that people who ate more should cut down to an average intake of around 500g/week (approximately 70g/day), as it would have little effect on the proportion of the population with low iron intakes.
As well as red meat, other food sources of iron include fortified breakfast cereals, dried fruit, beans and lentils, leafy green vegetables, sesame seeds, wholemeal bread and nuts. These foods are especially good for us, as not only do they provide iron, but they are also good sources of fibre, a nutrient which has been linked to protecting against bowel cancer. To help your body absorb iron from plant foods, include a source of Vitamin C with your meal. Good options are vegetables, fruit or a glass of fruit juice.
Q. Searchsquad: As someone with a family history of breast cancer, I have received a lot of advice from people about cancer prevention through diet. One of the most common suggestions is to avoid soya products and reduce my intake of lentils. Is this true?
A. Lynne: The question about the safety of these foods in relation to breast cancer is often raised due to the presence of natural plant compounds called phytoestrogens, which are found in soya and lentils, as well as foods such as chickpeas, flaxseed, and whole grains. Soya beans are a rich source of a particular type of phytoestrogen called isoflavones. These show structural similarities to the female hormone oestrogen, but they are not the same as this hormone. This is because they may have oestrogenic effects in some tissues, anti-oestrogenic effects in others, while in others they may not have any effect at all.
As lifelong exposure to oestrogen is associated with an increased risk of breast cancer, concern has been raised that due to the oestrogen-like effects of isoflavones they may be harmful to breast cancer patients and women at high risk of developing breast cancer.
However, this has been based on animal and laboratory studies. These studies cannot be used to determine the safety of soya in humans, as soya is metabolised very differently by humans compared to animals such as rats. Furthermore, often in these types of studies purified isoflavones or isoflavone mixtures are used. This does not reflect soya in its normal state nor does it reflect normal concentrations from soya foods in the diet.
On the contrary, a large number of human studies have found that soya isoflavones do not affect markers of breast cancer risk, including breast tissue density and breast cell numbers. In those women who have had breast cancer, emerging evidence is now suggesting that soya is safe to eat in modest amounts at around two servings of soya foods a day.
What's more, there's a large amount of evidence indicating soya is actually associated with a reduced risk of developing breast cancer and eating it earlier in life appears to offer the greatest protection.
Q. Calypso: A friend has recently been diagnosed with Hodgkin's lymphoma and is going through chemo at the moment. Can you offer any advice on what she should be eating both during chemo and after?
A. Lynne: Diet plays a significant part in the treatment of cancer as good nutrition helps the body stay strong during treatment, prevents or reverses weight loss, lowers the risk of infection and provides energy to help the recovery process. However, cancer treatments, including chemotherapy, can sometimes lead to side-effects that affect the ability to eat. The type of side-effects can vary from individual to individual and for this reason if your friend is suffering from any side-effects that are affecting her appetite or food intake, I would strongly suggest she asks her GP or consultant if she can be referred to a dietitian who can provide tailored dietary advice to meet her nutritional needs.
However, if she has no side-effects, has not suffered any weight loss, and has not been advised otherwise, then it's important for her to eat a well-balanced diet. This will provide her with the wide range of nutrients she needs during the treatment process. This involves choosing a variety of foods, including fruit, vegetables and starchy foods (such as bread, rice, potatoes, pasta, and breakfast cereals), low-fat dairy foods and foods containing protein (things such as lean meats, poultry, fish, eggs, nuts, beans and lentils). Finally, it's important to keep hydrated as water and fluids are vital to health.
After her treatment, if she has no eating problems or weight problems, the advice would also be to eat a well-balanced diet to keep as healthy as possible.
The WCRF, in its advice to prevent cancer, recommends that we should aim to maintain a healthy weight, be physically active and eat a diet that includes plenty of fruit, vegetables, whole grains, and pulses such as beans, while limiting our intake of red meat and processed foods that are high in fat, sugar and salt.
Q. Fringemonkey: What role does good nutrition play in fertility?
A. Lynne: Good nutrition is important to support the functioning of every part of the body, including the reproductive system in both men and women. Reproduction involves a complex set of finely tuned processes and anything that disrupts these, such as poor nutrition, can affect the likelihood of getting pregnant. Although no one specific food can increase fertility, an overall well-balanced diet can help greatly. This can also help achieve a healthy weight, as studies have shown that both women and men who are either overweight or underweight have lower chances of conceiving. Weight problems can also affect the hormones that control fertility.
Eating a variety of foods - ie plenty of fruit, vegetables (at least five a day) and starchy foods, especially wholegrain varieties such as brown rice, pasta, wholegrain bread and cereals, as well as moderate amounts of low-fat dairy foods, such as low-fat milk and yoghurts, and protein-containing foods, such as lean meats, chicken, turkey, fish, eggs, nuts, beans and lentils - will provide a wide range of nutrients that influence fertility.
For example fruit and vegetables provide good sources of antioxidant nutrients including Vitamin C, Vitamin E and beta-carotene. Antioxidant nutrients can help keep cells healthy, including cells of the reproductive system such as eggs and sperm. Zinc and Selenium are also important nutrients for healthy sperm.
Zinc can be found in foods such as lean red meats, dairy foods and whole grains. Whereas Selenium is found in Brazil nuts, eggs, lean meat, bread and fish.
Making sure that you eat good sources of iron-containing foods is also important, as one study found that infertility in women was due to a lack of ovulation related to iron status. Alcohol can also influence fertility by altering the levels of reproductive hormones and disrupting menstrual cycles. One study found that women drinking more than 10 units a week reduced their risk of conception compared to those drinking one to five units a week.
If you are trying to become pregnant, you should take a 400 microgram folic acid supplement each day. This should be taken until the 12th week of pregnancy.
Achieving a good nutritional status in both parents prior to pregnancy not only increases the likelihood of conceiving, but also helps ensure a healthy pregnancy and baby.
Q. Leolion: I feel jittery, sick and weak if I have go without food for more than an hour. If I eat sugary foods I tend to feel unwell about 30 minutes later. I have had a blood test for diabetes, which has come back normal. Can you give me some advice on foods with a low glycaemic index as I think I may be having hypoglycaemic episodes.
A. Lynne: Eating regularly, which includes three meals a day, as well as snacks in between if needed, is vital for keeping our energy levels topped up. But it's not just when we eat but also what we eat. Choosing the right types of foods will provide the nutrients needed to give us energy and keep our brains functioning properly during the day. Of particular importance are carbohydrate-containing foods. Carbohydrates get broken down in the gut to glucose (sugar) which is then absorbed into the blood stream. Eating too little carbohydrate may lead to low blood sugar levels, which can leave us feeling weak and light headed. It can also make it difficult to concentrate, as the ability to think and learn comes from an adequate supply of glucose to the brain.
Carbohydrates come from two main sources: starch and sugar. Starchy carbohydrates include potatoes, breakfast cereals, bread, rice, pasta and noodles. Sugars can either come from natural sugar such as fruit sugar (found in all fruit and fruit juices); milk sugar (found in dairy foods such as milk and yoghurts); added sugars like table sugar in the sugar bowl and used in cooking, sugar added to processed foods like biscuits, cakes, sweets, soft drinks and sauces; and honey.
Generally, the sugary carbohydrates are the easiest to digest and so give a rapid rise in blood sugars. In contrast, complex carbohydrates (such as the starchy foods) are broken down much more slowly and so result in a slower rise in blood sugars. To keep blood sugars stable between meals try to include starchy foods at all meals. Dietary guidelines advise that we should base our meals on these foods and they should make up one third of our diet, preferably wholegrain like wholemeal bread, wholegrain breakfast cereals, brown rice, wholewheat pasta, rye bread, etc.
The Glycaemic Index (GI) is the classification used to identify which carbohydrates are quickly broken down to glucose (high GI) and which are slowly broken down (low GI). The GI value of a food is dependent on the chemical structure of the carbohydrate, not the amount of starch or sugar present.
Fibre found in foods such as grains and beans act as a physical barrier, which slows down carbohydrate digestion and lowers the GI value. For example, the soluble fibre found in oats and fruit slows down digestion and lowers their GI value. Foods are designated a GI number one to 100. The lower the number, the longer it takes the body to break down and absorb the carbohydrate into the blood.
The GI value of a food only tells you how quickly or slowly it raises your blood glucose level if you eat it on its own. In practice, we would eat these sorts of foods in combination with other foods eg bread and margarine, which would alter the GI. Other factors that influence GI are cooking methods, food processing and how ripe a fruit is.
Using the GI concept is a useful way of lowering the overall GI of the meal by including more low GI foods. This could mean choosing breakfast cereals whose main ingredient is bran or oats, such as porridge, muesli, oat bran flakes and All Bran; eating pasta, basmati rice or couscous instead of mashed potato or short grain rice; including more pulses and vegetables such as beans, lentils and peas into meals for example adding these foods to stews and casseroles; and including fruit, vegetables or salad with as many meals and snacks as you can. However, you do still need to exercise some caution. A low GI food does not mean it is automatically a healthy choice meal or low in calories.
Q. Drzeus: I suffer from a 4pm energy slump nearly every day which leads to a carb overload (crackers/bread/cereal) and I then end up feeling bloated and sick. I'm so fed up of this cycle. I have yoghurt and fruit for breakfast, an apple mid-morning, a salad / fruit for lunch, salad and fish for tea.
A. Lynne: From what you report you eat there appears to be a clear lack of starchy carbohydrate containing foods in your diet. Carbohydrates are needed to provide our bodies with fuel and the answer to Leolion's question will also be relevant to you.
Just as muscles need fuel to function, so our brains also need fuel. Being able to focus and concentrate comes from the brain having an adequate supply of energy in the form of blood glucose. You say that this pattern of eating is resulting in carbohydrate overload, which could be your body's way of saying it needs this nutrient. Rather than waiting for this to happen, try to include starchy foods at each meal time. Choosing high-fibre varieties at these times such as wholegrain breakfast cereals, brown rice, wholemeal bread, potatoes with skin, wholewheat pasta, etc will help to stabilize blood sugars and help control the rate of glucose supply to the brain. Maybe add some unsweetened muesli to your yoghurt in the morning, or add the yoghurt and fruit to some wholegrain cereal. How about adding some couscous or pasta or pulses to your salad at lunch time? And why not include some new potatoes in skins to your evening meal of salad and fish?
Not only are you missing out on carbohydrates, but starchy foods also provide other important nutrients such as B vitamins, calcium and iron.
What about the timing of your meals? If you have your lunch at midday and don't eat until late in the evening you might need a mid-afternoon snack - don't feel guilty about it but choose something you are happy to eat and that will keep you going without feeling uncomfortable. For example, peanut butter/marmite/honey on a wholemeal English muffin; mashed avocado/low fat humus on two rye crispbreads; yoghurt fruit smoothie; a handful of dried fruit and nuts; or minestrone soup.
Your diet seems to be lacking in other important food groups as well. To keep our bodies and mind in tip-top condition it's important to eat a variety of foods from the major food groups, in the right balance. This includes plenty of fruits and vegetables (which you seem to be achieving), as well as starchy foods (which appear to be lacking), moderate amounts of low fat dairy foods (or their equivalents) and protein containing foods such as lean meats, fish, eggs, beans, lentils and nuts.
Although you say you have a yoghurt at breakfast, do you have any other sources of dairy? Dairy foods are a good source of calcium and it's important to ensure you have enough of this in your diet to maintain healthy bones. Are you eating enough of the protein-containing foods? Lean meats, beans, lentils and nuts also tend to be good sources of iron, as well as foods such as fortified breakfast cereals, dried fruit, leafy green vegetables and wholemeal bread. A lack of iron can increase the risk of anaemia with symptoms including tiredness and weakness.
Finally, it's important to stay hydrated. You don't mention how much fluid you drink, but even mild dehydration can result in light-headedness, dizziness, headaches and tiredness, as well as reduced alertness and ability to concentrate.
Q. Neepsntatties: I think I am suffering from an IBS type thing. I go through stages of feeling suddenly awful with a terrible headache, crampy and bloated tummy and very bad wind. I can't see a pattern in the episodes, although I know some things can trigger it like too much coffee. I have been to the GP who couldn't help and I am not sure what step to take next.
A. Lynne: Although you say you can't see a pattern of reacting to any specific food, have you kept a food and symptom diary? In this you write down everything you eat and drink, the time you eat as well as any symptoms that you suffer. It might also be useful to write down how you are feeling eg tired, stressed, etc as this may also have an impact on your symptoms.
Remember, symptoms may not be caused by the food you have just eaten, but what you ate earlier that day or the day before. If you haven't done this, then my advice would be to do this as the next step. Recording in this way might be able to identify certain triggers.
However, before you start cutting out foods from your diet, it's important to ensure these are replaced with suitable alternatives that provide similar nutrients. For example, if dairy is being cut out of the diet, the calcium that these foods provide needs to be replaced with other foods like fortified soya milk, nuts, dried fruit, fish with soft bones, etc.
To get further dietary advice on this, or to get more specific information on how to manage your symptoms, ask your GP to refer you to a dietitian or visit Freelancedietitians.org. In the mean time, this might also help. Eating regular meals; not skipping meals or eating late at night; taking time when eating meals; sitting down to eat and chewing your foods well may also help. If things still don't improve you should go back to your GP.
Q. Chillistars: What foods are recommended and what should be avoided by somebody awaiting surgery for a gallstone in the common bile duct and multiple small gallstones in the gall bladder?
A. Lynne: Unless your doctor has advised otherwise, currently there is no specific dietary advice to follow before gall bladder surgery. Instead, it's important to eat a healthy, well-balanced diet of small regular meals which includes foods from all the major food groups (fruit and vegetables; starchy foods especially high fibre varieties; low fat dairy foods or their equivalents like fortified soya, rice or oat milk; and non-dairy protein containing foods like lean meats, fish, eggs, beans and pulses).
Severely restricting fat is not needed before surgery, as a diet too low in fat can actually lead to gallstone formation. Again, the healthy principles in relation to fat apply. So choose healthy fats such as vegetable oils and spreads made from these oils (sunflower margarine, olive oil spread, etc) but watch how much you use; choose low fat dairy products such as skimmed, 1%, or semi-skimmed milk, low fat cheeses and yoghurts; eat lean meats and poultry (removing the skin from the poultry) and eat lower fat alternatives like lentils, chickpeas and beans; and limit amounts of high-fat desserts and snacks such as biscuits, cakes and chocolate.
If any particular foods cause you discomfort then avoid them, but remember to replace them with suitable alternatives (if appropriate) to stop you missing out on important nutrients.
Q. Icee: Since my daughter started nursery (and I went back to full-time work) eight months ago, we've had every illness under the sun - lots of colds, which always end in lingering chesty coughs, tummy bugs and generally feeling run down. I know this is par for the course and, thankfully, my daughter bounces back healthwise fairly quickly but I don't, in fact I'm just recovering from yet another cold, which became a chest infection requiring antibiotics. What can I eat to build up my strength/immune system as a preventative measure and when I get the next inevitable bug is there anything I should take/eat/avoid? As I seem to be susceptible to chesty coughs, people always say I should avoid dairy - is this true?
A. Lynne: While there is no one, specific food that can boost immunity, eating a well-balanced diet, that includes a wide variety of foods, can provide you with a host of nutrients that are all important for the immune system. This can be achieved by eating foods from all the major food groups (fruit and vegetables; dairy foods; starchy foods; non dairy protein containing foods and small amounts of fat and sugar containing foods), in the right amounts.
As well as ensuring you're eating your five portions of fruit and vegetables a day, try to eat a rainbow of colours so you are getting plenty of variety. It often gets reported that certain nutrients may offer added protection, in particular Vitamin C, Zinc and Selenium. Whilst these are some of the nutrients that are important for a healthy immune system, it doesn't mean that more is better! High doses of these nutrients will not provide added protection and they may actually do harm. In fact, optimal amounts of these nutrients can be achieved through your daily diet.
Eating your 'five-a-day' will help you get your daily intake of Vitamin C, which is important for the immune cells involved in defence against viruses. Particularly good sources of Vitamin C include peppers, broccoli, kiwi fruits and citrus fruits such as oranges. Despite being studied for more than 40 years, there is insufficient evidence to advise taking more vitamin C to prevent colds or the flu.
Zinc is present in a wide variety of foods, particularly in protein-containing foods. Good sources of zinc are lean meats, seafood, low-fat dairy products. Seeds and wholegrain foods are also sources of zinc, although zinc from these is less easily absorbed than the zinc in animal protein.
Selenium is found in foods such as Brazil nuts, fish, meat, offal, eggs and whole grain cereals.
Make sure you are eating plenty of iron-rich foods. Around 40% of women in the UK are not getting enough iron, which can increase the risk of anaemia. This increases the risk of developing infections. Iron is found in meat, fortified breakfast cereals, dried fruit, beans and lentils, leafy green vegetables, sesame seeds, wholemeal bread and nuts. Eating a wide variety of foods will help you get sufficient amounts of all the nutrients that are important for good health, including your immune system.
If you do get a viral infection, such as the flu, the old wives' tale of 'starve a fever, feed a cold' is not good advice as there is no evidence that "starving a fever" by reducing the amount of food eaten will reduce a fever. If we stop eating, we're not feeding our immune system with the nutrients it requires to function properly. If you feel unwell and don't feel like eating during these times, try to eat smaller, more frequent meals and healthy snacks to support your body's defenses and drink plenty of water.
There is a common view that dairy increases the production of phlegm when you have a cold, however there is no scientific evidence to back this up. This seems to have its origins rooted back to the 12th century when a practitioner recommended removing dairy products from the diet to help breathing or congestion problems. Clinical studies investigating this theory have found no such link.
Q. Scampbeast: My son (27 months) has recently been diagnosed with intolerance to potatoes. I need some ideas for alternative carbohydrates to give him at meal times; he doesn't like rice and will only eat pasta if it is in a sauce. I had been giving him vegetables mixed in with mashed potatoes but we can't do that anymore.
A. Lynne: It's important to ensure that your son's diagnosis has been made under medical supervision, as there are many tests currently available which are often unreliable and can give inaccurate information. If it has been done in association with a qualified medical professional I strongly suggest that you ask them to be referred to a paediatric dietitian.
Not only does your son need good nutrition to keep healthy, he is growing and developing so it is key he is getting everything he needs. This is important as excluding foods from the diet can result in nutritional deficiencies if they are not replaced with suitable alternatives. The dietitian can give you the most appropriate dietary advice that is tailored to your son's age, stage of development, family life, likes and dislikes, as well as monitor the diet to ensure that it's nutritionally adequate.
Potatoes are one food that is classed into the food group 'starchy foods'. Other foods in this group include breakfast cereals, pasta, bread, noodles, couscous, rice and specialty breads such as tortilla wraps, chapattis, pitas, etc. The foods in this group all provide similar nutrients and so if one food is being avoided in the diet, these other foods could be suitable replacements.
Q. Venna: My two-year-old daughter is dairy intolerant. She has been on special formula, then soya, since she was six months old. How do I keep the fat and calcium content of her food up to toddler levels? We use a dairy free spread, cook with olive oil and and lots of coconut milk, and sneak avocados into meals.
A. Lynne: Any specific dietary advice that is related to an intolerance or allergy in childhood is best discussed with a paediatric dietitian. They will be able to best advise you on the most suitable alternatives to dairy for your daughter as well as monitor your daughter's overall diet to ensure that she is receiving all the nutrients she requires to grow, develop and for good health. Your GP or paediatrician will be able to refer you.
This is especially important if she has to avoid a whole food group such as dairy. These are an important source of nutrients in the diet, especially calcium. If your daughter is a good eater then the recommendation for this age group is to have approximately three servings of these foods a day. Over two years of age, certain dairy milk alternatives such as soya, rice and oat milk, as well as soya yoghurts and desserts can be used. However, it's important to choose ones that are fortified with calcium. A paediatric dietitian can help you choose the right one.
Q. Boojabooja: My family are vegans. My daughter has just turned three and seems very healthy but I'd be grateful for any tips on getting the right omegas into her diet. She has a mix including flaxseed in her porridge every morning, but I'm wondering if there's anything else that she could eat. Also, I try to limit her soya intake as I'd hate her to develop an allergy. Do you think there's a dangerous amount of soya, for a young child?
A. Lynne: Just as you appear to show with your daughter's diet, well-planned vegan diets can be healthy and meet the nutritional needs throughout the lifecycle.
Omega-3 fats are a type of polyunsaturated fat. We often hear about the importance of fish in the diet as these provide the long chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are important for heart health, as well as eye and brain development. The short chain omega-3 fatty acid, alpha-linolenic acid (ALA), is found in flaxseeds (which you are already adding to your daughter's diet), walnuts and walnut oil, rapeseed (canola) oil, soya oil, dark green leafy vegetables and foods fortified with omega-3 fats.
Choosing oils such as rapeseed for food preparation and salad dressings, opting for a spread which is rich in ALA, having walnuts as a snack or on salads, eating a variety of dark green vegetables and green salad leaves such as spinach, rocket and salad and adding soya beans to casseroles can all increase the ALA in your daughter's diet.
However the shorter omega-3 fatty acids may not have the same health benefits as the longer chains, and although the body can convert some ALA into EPA and DHA, the conversion is believed to be limited. Nevertheless this conversion is influenced by a number of factors. One such factor maybe a high intake of another type of fatty acid, linoleic acid, which is typical of a vegan diet as it is found in vegetables, fruits, nuts, seeds and oils such as sunflower oil, safflower oil and corn oil. Having a high amount of linoleic acid in the diet may curb the body's ability to convert alpha-linolenic acid to these long chain omega-3 fatty acids. Vegans can achieve a better balance by using less sunflower, safflower and corn oils and more oils containing alpha-linolenic acid such as rapeseed oil, flaxseed oil or walnut oil. This encourages a better conversion.
Soya is a good food to include in a vegan's diet as it contains one of the highest quality vegetable proteins around (similar in quality to meat and milk protein), is low in saturated fat, a good source of polyunsaturated fats (especially the plant omega-3 fatty acids), and contains fibre, as well as various vitamins and minerals.
As soya foods have become more popular in recent years there are concerns that allergic reactions to soya may become more common. However in reality, although soya protein, like any protein, may cause an allergic reaction in sensitive individuals, relatively few people are actually allergic to soya.
Asian populations have eaten soya foods as part of their traditional diet for centuries and you might think that soya allergies would be higher in these countries than non-soya eating countries. However, this is not the case. Research from Japan, China, Thailand and Hong Kong show soya allergy is less common than allergy to milk and eggs.
Actually eating soya foods in early years may also help to reduce the risk of developing breast cancer later in life. Population studies investigating this early intake suggest that consuming very modest amounts of soya (such as one serving of soya milk per day) during the early years may reduce breast cancer risk.
Variety is important in the toddler diet and while there seems to be little guidance on the amounts of soya foods a three year old can have, like with any advice on diet and health it's important to eat an overall balanced diet, which can include moderate amounts of soya. Soya can be found in foods such as soya milk, soya yoghurts and desserts, tofu, miso, edamame (young soya beans), soya beans, soya nuts (roasted soya beans), soya mince and various meat alternatives.
Q. MrsOnTheMove: My daughter is eight and a half and overweight. As a family we eat healthily, exercise and cook food from scratch. I am concerned about my daughter's weight, as most of it is midriff and I was diagnosed with breast cancer over five years ago. I have spoken to my GP but was given no guidance on how to reduce her weight. How many calories should she be eating?
A. Lynne: The Guideline Daily Amount for calories for a girl aged five to 10 is 1,800kcal a day. This does depend on a variety of factors, including how physically active she is, which you mention is quite high. However, I wouldn't suggest calorie counting at this young age.
Is she really overweight? The first step would be to determine how overweight she is. Has she had her Body Mass Index (BMI) measured? This is usually done as part of the National Child Measurement Programme in Reception year (ages four to five) and Year 6 (ages 10 and 11). At this time, height and weight will be measured to calculate BMI. As your daughter is eight and a half, she hasn't reached the Year 6 stage.
However, it would be useful to determine the extent of the weight problem, if there is one, as it might be that she would benefit from a referral by your GP to a paediatric dietitian or a local weight management programme for children, if there is a genuine need.
Children change shape as they grow and develop. Girls enter puberty at around 10 years old but it varies from one to another. Generally though, as children are growing it's not necessary that they lose weight, instead it's better that they grow into their weight by maintaining their current weight while they continue to grow. But this will depend on how overweight they are.
Steps to take to help maintain a healthy weight include eating a healthy balanced diet as well as taking plenty of activity. Children learn by example and one of the best ways to teach your daughter to eat well and get active is to do it as a family. Congratulations on cooking from scratch as this helps to control how much fat and sugar is being added to your meals. Regular meals eaten together, without distraction, can also play an important part in healthy eating. If snacks that are high in fat and sugar eg chocolate, biscuits, sweets and fizzy drinks are a common feature in your daughter's diet, aim to replace them with healthier alternatives such as fruit.
The other aspect is to look at portion sizes - it's important not to supersize children's food portions. School lunches can play a valuable role in eating well. If she brings in a packed lunch then you can control what goes in it. A healthy packed lunch should include a source of starchy foods such as sliced bread, rolls, pitta, pasta, wraps; a protein source eg lean meat, fish, eggs or beans; a dairy food eg low fat cheese or a yoghurt; vegetables or salad and a portion of fruit (this could be fresh or dried fruit such as apricots or raisins). If she has school dinners, ask to see what the menu choices are to determine the best choices available.
At the same time as managing any weight issues, it's important to help your daughter develop a healthy body image and good self-esteem. So tread sensitively and be aware of not discussing this issue in front of her or bringing attention to it. Also, habits in childhood will remain as they grow into adults. So praise your daughter when she eats healthier foods or when she swaps an inactive lifestyle for a more active one. Maybe use rewards (which are not foods) such as a comic or a trip out when she makes a healthier choice.
If you do feel you need extra support, then I would suggest you ask your GP or school nurse if she can be referred to the appropriate services.
Q. Grumpygils: Is it healthy for schools to serve cake-y puddings (eg sponge and custard) to primary aged children every weekday as part of their lunch?
A. Lynne: Primary schools now need to ensure the lunches they serve up comply with the government's food guidelines and nutrient-based standards to ensure that nourishing food is provided more frequently. One of the food standards is that not less than two portions of fruit and vegetables should be available per day per child.
According to the School Food Trust, one way of achieving this is to provide fruit-based desserts, which include fruit crumble, apple pie, fruit sponge, apple cobbler, fresh fruit jelly, baked stuffed peaches, summer pudding and yoghurt/custard with fruit. As you can see, some of these puddings are pies, sponges, etc. However, because they contain fruit, they are seen as healthier alternatives than confectionary or puddings containing chocolate. Cakes and biscuits are also allowed at lunchtime but must not contain any confectionery like chocolate. Custard is a useful way of providing calcium and to comply with regulations it would be made with low-fat milk
Although these types of foods fit into the food-based guidelines, it's also important that the overall average school lunch complies with the nutrient-based standards. It's important to remember that there is no good food or bad food, just good and bad diets! So fruit-based desserts could fit into an overall balanced diet. To ensure this happens, 14 nutrient standards have been set that include amounts for overall energy, fats and added sugars.
Children are active and learning, as well as growing and developing, so need energy and key nutrients at lunchtime. The recipes for these dishes will meet a strict criteria and the portion size must be appropriate for their age.
These standards and guidelines are mandatory, which means that schools are legally obliged to comply. If you would like further information on this subject, the School Food Trust website provides a wealth of information.
Q. Danthe4th: Over the last year I have gained a stone in weight, most of it around my middle. I'm 5ft 5in and now weigh 11 stone. I'm nearly 44 and I've always been keen on fitness and exercise classes, but over the last year I've struggled to find the energy. I'm coeliac and struggle with my diet. I know what I should eat but when I'm in a rush the food tends to be high in fat or sugar. I've four children so I do cook from scratch as much as possible but i'm really finding it hard to eat properly. Do you have any tips for a dieting coeliac?
A. Lynne: Based on your weight and height, your Body Mass Index (an index which is used to determine whether a person's weight is healthy for their height) is coming out at just over 25. This puts you just into the overweight category (a BMI between 25 to 30 is classed as overweight). However, you report that a lot of the weight you have gained in the last year is around the middle. Having too much fat in this area (abdominal fat) can increase the risk of problems such as heart disease and diabetes. For women, a waist measurement of more than 80cm (32in) and for men, more than 94cm (37in) increases the risk of these health problems.
The good news is that you have identified that you want to do something about it. If it's taken a year to gain the weight, remember that it will take time to lose it. Resorting to quick-fix diets is not the solution. Instead, the best way to lose weight slowly and steadily is to make gradual changes to your diet. Making these changes permanently to your diet will help to keep the weight off.
The first step to making changes to your eating habits is to monitor what you are currently eating. Try recording everything you eat and drink, as well as the times you eat, for a week. Write down how you are feeling, as it maybe that you see a pattern emerging when you resort to eating unhealthier foods. For example, you mention that when you are rushed you tend to opt for foods which are high in fat and sugar.
The next step would then be to think of healthier strategies you can adopt to help prevent these unhealthy patterns occurring. This will require planning. For example, are you skipping meals? It's important to eat regularly, including making time for breakfast, to ensure that you don't get too hungry and consequently overeat. Think about your day ahead. If you know you're going to be out and about, make sure that you take healthy snacks with you. Good portable snacks include fresh or dried fruit. Why not make meals in bulk and freeze them? These will come in handy when you need a meal quickly. Alternatively, opt for quick, healthy meals, which could include jacket potato and baked beans, stir fries and rice, Spanish omelette and gluten-free bread, or gluten-free pasta and vegetable-based sauces. Healthy meals don't necessarily have to involve hours of preparation.
Although you need to follow a gluten-free diet for your coeliac disease, healthy eating recommendations for weight control are the same as for the general population. For example:
- While it's important to avoid sources of gluten (found in wheat, rye, barley and in some cases oats), you can still base your meals on starchy foods such as rice, potatoes, yams and gluten free grains such as millet, quinoa, gluten free bread and pasta. Choosing high-fibre varieties of these foods can help you to feel full for longer, making it less likely you'll snack between meals.
- Eat plenty of fruits and vegetables both at meal times and as snacks.
- Watch the amount of fatty and sugary foods. Your food diary can identify if these are creeping into your diet and why. Maybe it's because you're missing meals. In which case, make sure you eat regular meals to prevent this.
- Eat moderate quantities of lean-protein foods and low-fat dairy foods (or their equivalents) and choose cooking methods which avoid using too much added fats.
- Check your portion sizes - have these increased gradually?
- Finally, avoid drinking too much alcohol as alcohol is a concentrated source of calories with very little other nutritional value.
Losing weight will help shift the fat, including abdominal fat. Studies have found that fat stored in this area is especially responsive to regular physical activity. This doesn't mean you need to join a gym. Any activity which gets your heart rate up, eg walking, gardening, even dancing, can all help.
Just as you are making sure you are preparing healthy foods for your children, it's important that you also take care of yourself.
Q. iblossom: My daughter is a student and living in Spain. She eats late at night and misses breakfast and I suspect it is "food on the run" and high in calories - lots of pasta too. She has gained a lot of weight and has gone from a size 10 to a 12/14. She is determined to do more exercise, but is there anything she can do food wise to help the weight loss. I am reluctant for her to diet as she was once on the verge of anorexia. I read that eating more protein burns fat and also a supplement l-carntine helps.
A. Lynne: Leaving home and having to fend for yourself can often result in a change of eating habits for many young people. A different routine, change of lifestyle and in your daughter's case living in another country, can disrupt the dietary routine they were once used too. However, it's not all doom and gloom!
Making a few dietary changes that fit into this new routine can help her to get back on the healthy-eating track. As you point out, you are reluctant for her to go on a diet, and in fact a so-called 'diet' is not the answer. Adopting a healthy eating plan is a better option in the long term, as it will help to manage her weight, as well as provide her with the full range of nutrients her body and brain requires, keeping her healthy while she is studying.
It seems like you have already identified reasons for the weight gain. The first step would be to eat regularly, which means making time for breakfast. A number of studies have now shown that breakfast eaters tend to be a healthier body weight than breakfast skippers. A bowl of wholegrain cereal with low-fat milk, and a piece of fruit or glass of fruit juice, which is not only quick to prepare but also to eat, would make an ideal start to the day.
This type of breakfast will help her feel full for longer and therefore less likely to resort to fatty and sugary snacks before lunch. If she knows she is going to be out and about, suggest that she takes healthy snacks with her. Foods such as fresh or dried fruit, rice cakes or a small bag of nuts make ideal snacks.
Does she eat lunch out? If so she may want to consider preparing a lunch at home and taking this with her. In this way she can control what goes in it. Wraps, rolls, pitta, sandwiches, preferably wholemeal, filled with salad, lean meats, egg, fish, etc are healthy, portable lunches.
Main meals don't have to be a complicated affair. Quick meals can be just as nutritious. Stir fries, Spanish omelettes, jacket potatoes, baked beans on toast, etc are quick and easy to prepare. Pasta is also healthy and a great dish to cook when time is short. Watch the sauces that are added - tomato-based or vegetable sauces make healthier options. The fact she is living in Spain is a great opportunity to take advantage of the cheap fruit and vegetables, as well as adopt a healthy Mediterranean diet.
It would also be worthwhile looking at the portion sizes of her meals. Have these got bigger since moving away? Eating a balanced diet, which includes a wide variety of foods, is a healthier long term solution to weight management instead of resorting to 'fad' diets such as high protein diets or supplements.
Q. MalibuStac: I am currently quite overweight and trying to lose weight with diet and exercise. I have an underactive thyroid and PCOS. Do you have any advice on the best way to achieve results?
A. Lynne: If you are receiving treatment or medical care for your medical conditions, it would be advisable to ask your hospital doctor or GP to refer you to a dietitian. They will then be able to provide you with the most appropriate dietary advice taking into account these medical conditions and/or treatment you are getting.
There is no specific diet for women with Polycystic Ovarian Syndrome (PCOS). Eating a healthy balanced diet, as well as taking regular physical activity, can help with weight management. In addition to eating a varied diet, including foods from the major food groups (fruit and vegetables; starchy foods, preferably wholegrain; low-fat dairy foods and non-dairy, protein-containing foods), make sure you eat regularly (every two to four hours) and always include breakfast. This can help prevent you from getting too hungry before your next meal. Also, watch your portion sizes.
Women with PCOS may have higher levels of testosterone, resistance to the hormone insulin and glucose (sugar) intolerance. To keep blood sugars and insulin under control, as well as eating regularly, choose wholegrains and limit your refined carbohydrates (such as white sugar, white flour, white rice, white bread, biscuits, sweets, cakes, and sugary, fizzy drinks). It may also be useful to choose medium to low-glycaemic index foods more often than high-glycaemic index foods (see my answer to leolions) as they can help control your blood sugars as well as your appetite.
Q. HidinginaHardHat: I'm wondering how best to manage medication-related weight issues? I have fibromyalgia and IBS so my diet is very limited and the amount I can exercise is restricted due to the fatigue. Is it possible to eat myself well?
A. Lynne: Eating a well-balanced diet, which includes a variety of foods in the right proportions, is the best way to manage a healthy weight. Eating regularly, which includes having a breakfast, is also an important step for healthy weight management.
Although eating a well-balanced diet is important this can seem a challenge for people who have Irritable Bowel Syndrome (IBS). The symptoms of IBS vary from person to person and may include bloating, diarrhoea, constipation or a combination of these. Relieving these symptoms may require adaptations to the diet, and so dietary advice tends to get tailored to the individual. For this reason I would suggest you ask your doctor to refer you to a dietitian who will be able to advise you on appropriate foods to help with the weight management, while at the same time manage your IBS symptoms. They will also be able to determine if you are eating a nutritionally balanced diet, and suggest where improvements in the diet can be made if needed.
General dietary steps that you can follow, which will help with both the weight and IBS symptoms, include:
- Eating regular meals
- Don't skip meals or eat late at night
- Take time when you're eating your meals
- Sit down to eat and chew your foods well
A useful fact sheet on IBS can be found here. Finally, make sure you are adequately hydrated by drinking enough fluids. While this is important for everyone, fatigue is a common feature of fibromyalgia. As dehydration can also cause fatigue, this can make the problem worse.
Q. Thehusbandsatcricketagain: Over a year ago I was diagnosed with an under-active thyroid. I am now 10lb over my usual ideal weight. I have never had to deal with weight issues before, so am now struggling and no matter how little I eat the weight stays the same. My GP has told me that I am on the correct thyroxin level. Do you have any idea what I can do? I walk every day with the dog for an hour so I am taking exercise.
A. Lynne: If the 10lb was gained over the course of a year it maybe that just a small addition to the diet has accounted for this. It only takes eating an additional 100kcal a day over the course of a year to gain approximately 10lb. Are you now eating or drinking something regularly that you weren't eating a year ago? Have your portion sizes gradually crept up? A good way to monitor this would be to keep a food diary.
Writing down everything you eat and drink, as well as the amounts and times you eat, for a week can help to identify if extra foods are been eaten, or if you are eating more high fat and sugar foods. You may be able to identify unhealthy patterns which might also account for this weight gain.
If you do see something, make the necessary alterations to your diet. It's worthwhile remembering that if it took a year to gain this weight, then it will take time to lose it. Rather than resorting to quick fix diets, consider making small changes to your diet which in the long run can make big differences to your weight.
Eating a well-balanced diet, and choosing a wide variety of foods in the correct proportions can help to achieve this healthy eating plan and so help to manage weight issues. This involves eating regularly, including having breakfast, and choosing foods from all the major food groups in the right quantities:
- Plenty of fruits and vegetables - aim to reach the five-a-day target by including these at all meals as well as snacks.
- Include starchy foods (preferably wholegrain varieties) at every meal as they will help you feel full for longer, keeping you satisfied to your next meal.
- Choose moderate amounts of low-fat dairy foods eg skimmed or semi-skimmed milk, low fat cheeses and yoghurts.
- Moderate amounts of non-dairy, protein-containing foods such as lean meats, eggs, beans, lentils, fish, beans. Watch your cooking methods and try to use small amount of added fat/oil.
- Limit foods high in fat and sugar such as sweets, chocolates, cakes, biscuits, sugary drinks, etc. These provide very little in the way of nutrients apart from calories. Use butter, margarines and oils sparingly as these are high in fat and so can add to the calories.
- Control your portion sizes.
- Remember alcohol can add to the calorie content of the diet so keep within sensible limits.
- And finally, enjoy your food.
At the end of the day, weight loss or weight gain comes down to calories. If you eat more calories than you use up then you will gain weight and vice versa.
To lose 1lb of fat each week you need to create a calorie deficit of around 500 calories a day. As the average woman needs about 2,000 calories a day, this would mean following an eating plan of around 1,500 calories a day.
A useful website to get more information on how this can be achieved is the British Dietetic Association's weightwise site.
Q. Adewonder: My colleague (we're in social services) is supporting a young woman who has been bulimic since four years ago and is now in hospital on a monthly basis to get her potassium up. The eating disorder clinic isn't being great with her and we're struggling to find advice. She can't keep food down now, maybe reflux? We're putting pressure on the hospital to put her on a care plan etc, but she has bonded with my colleague. I was bulimic, and only found help through an NLP therapist privately. This is out of reach for her due to cost. I have found little dietary advice around bulimia - I was hoping for a book with meal planning, building up safety foods etc aimed at bulimics. Is there anything out there we could get for her? As professionals we're becoming really frustrated.
A. Lynne: Management of an eating disorder requires consideration from a physiological, psychological and behavioural perspective and for this reason a multidisciplinary team of professionals is required to best manage individuals with an eating disorder. For this reason my first line advice would be to get her referred to an eating disorder clinic where she can receive such multi-disciplinary input. However, you say she is already receiving care at such a clinic. I would suggest you continue talking to this team, explaining what your concerns are, and how best the issues surrounding her care can be resolved. A good website where you can get more information on eating disorders is beat (beating eating disorders) at B-eat.co.uk.
Q. Housewife: Am I too late to reverse damage done by 14 years of an orthorexic eating disorder? I am 45 years old, 5ft 2in and 7st 5lb. I am having CBT and diet advice to gain weight but am still very anaemic - 7st was my lowest weight.
A. Lynne: Orthorexia is a term that has been used to describe people who have developed a fixation with healthy eating. Although this may seem a sensible way of eating, it can have serious consequences, as this fixation can result in a severe restriction and avoidance of certain foods. This, consequently, can result in deficiencies in a number of important nutrients. Depending on which foods you have avoided in the past will determine which nutrients you have restricted. Thus any nutritional problems will be dependent on the specific diet you have followed.
The good news is that you have identified that this disordered way of eating is not healthy and are now taking steps to get back on the right track to replenish your body and return it to a healthy state.
You mention that you are now receiving Cognitive Behavioural Therapy (CBT) and dietary advice to gain weight, which is excellent news. It sounds like the treatment you are receiving is achieving weight gain, and I would suggest that next time you see your dietary professional you discuss the issue of anaemia and suitable foods to help with this. Iron-containing foods are important to include in the diet to reduce the risk of developing anaemia and can be found in foods such as meat, fortified breakfast cereals, dried fruit, beans and lentils, leafy green vegetables, sesame seeds, wholemeal bread and nuts.
To help your body absorb iron from plant foods, include a source of Vitamin C with your meal, for example vegetables, fruit or a glass of fruit juice.
Q. Topsi: What are your views on low-carb diets? Nothing too extreme like Atkins, but avoiding refined carbs etc?
A. Lynne: Low-carb diets such as the Atkins have become popular over the last few years mainly as a way of losing weight. While in the short term they do result in weight loss, in the longer term they appear to be no more successful than other weight loss methods. Rather than cutting out carbs, experts who have reviewed low-carb studies concluded that weight loss on these diets was associated mostly with cutting calories and not with cutting carbs. Side-effects of these types of diets include weakness, nausea, dizziness, constipation, irritability and bad breath. Furthermore, the long-term safety of these types of diets is unknown as the longest most of the studies have been studied for is around two years.
Carbohydrates come from two main sources: starch and sugar. Starchy carbohydrates include potatoes, breakfast cereals, bread, rice, pasta and noodles. Sugars can either come from natural sugar such as fruit sugar (found in all fruit) and milk sugar (found in dairy foods such as milk and yoghurts) or added sugars such as table sugar, honey, soft drinks and confectionery.
A number of these food groups not only provide carbohydrate but also other important nutrients. For example, starchy foods, especially wholegrain varieties provide fibre, B vitamins, calcium and iron. Dairy foods are an important source of calcium and protein, and fruit provides us with fibre, vitamins and plant specific nutrients. So if these food groups are restricted in an attempt to limit carbohydrates, then the associated nutrients could also be potentially at risk. Healthy eating guidelines recommend that 50% of our daily calorie intake should come from carbohydrates. In terms of food, this means that a third of our diet should be coming from starchy foods, a third coming from fruit and vegetables as well as eating moderate amounts of low-fat dairy foods and low-fat, protein-containing foods.
You mention limiting refined carbohydrates and this fits in well with these healthy eating guidelines. Cutting down on table sugar and added sugars found in sugary drinks, sweets, etc which, although provide us with carbohydrates, provide very little in the way of other nutrients. It's much better that we get our carbohydrates from nutrient-rich sources such as fruits, low-fat dairy foods and wholegrain starchy foods, including wholemeal bread, wholegrain cereals, wholewheat pasta, brown rice etc.
Q. WhencanIwine: Does a person who eats reasonably well need to include supplements in their diet eg multivitamins? Or is it more a case of supplements helping when the diet isn't healthy?
A. Lynne: This is a very timely question as the NHS has just published a report on supplements, who needs them and the evidence behind the claims. There are a huge range of supplements now available, such as vitamins, minerals, fish oils... the list goes on.
However, there is not a straightforward answer to your question as individual circumstances will determine whether or not a person would benefit from taking a supplement.
To keep the body functioning properly, most people should be able to get all the nutrients they need from a well-balanced diet and in the case of Vitamin D from sunlight. However, there is good evidence that certain vitamin supplements maybe beneficial to the health of certain groups of people eg elderly people, pregnant women and children between six months and five years old.
There may also be other circumstances that an individual might benefit from a supplement. In which case, this report suggests that you ask yourself a number of questions. Do you really need it? What do you think it will do? Is there solid evidence suggesting that it will work? Will it cause harm and what do reliable sources say?
To get more information on specific supplements, read the report.
The best way for most of us to get enough vitamins is to eat a varied and balanced diet. This includes plenty of fruit and vegetables; plenty of starchy foods; some milk and dairy foods; some meat, fish, eggs, and beans and other non-dairy sources of protein. Foods and drinks high in fat and/or sugar should be kept to a minimum.
In the case of Vitamin D, while a small amount is obtained through diet, most of this vitamin is made under the skin when it is exposed to sunlight.
If you are concerned about whether your diet is providing enough nutrients it's always advisable to discuss this with a health care professional. They can also advise you as to whether supplements will have health benefits for your particular circumstances.
Q. TrilllianAstra: Do you feel that there should be more education into the difference between 'nutritionist' and 'dietitian', given that one is a title that anyone can claim (including famously Ben Goldacre's dead cat) and the other is a qualified healthcare professional? Do you feel that confusion between the two has led to a lot of people wasting money and time and possibly hurting their health?
A. Lynne: I agree there is a lot of confusion about the terms nutritionist and dietitian, and it does cause confusion among the public regarding who to trust in terms of dietary advice. You're right in that anyone can claim to be a nutritionist; however, the term dietitian is now a legally protected title. Only those registered with the statutory regulator, the Health Professions Council (HPC), can call themselves a dietitian.
Furthermore, dietitians are the only qualified health professionals who assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease, which they translate into practical advice to help people make appropriate lifestyle and food choices.
Dietitians are the only nutrition professionals who are regulated by the state and governed by an ethical code. This ensures that they always work to the highest standards, so protecting the public. If they fail to do this, like doctors, they can be struck off the register. You can check to see if a dietitian is registered by checking the HPC website.
While anyone can call themselves a nutritionist, there are a number of credible nutritionists out there who often call themselves 'registered nutritionists'. Only registrants with the UK Voluntary Register of Nutritionists (UKVRN) can call themselves a 'registered nutritionist' or 'registered public health nutritionist'. These nutritionists have usually undergone a degree course in nutrition and only courses that have applied and met strict standards in nutrition are accredited by the UKVRN.
Graduates from these courses have direct entry on to the register. Registrants are expected to keep up to date through Continuing Professional Development (CPD). Appropriate action is taken if any individual on the register is found to have acted against or below the UKVRN's high standards. A nutritionist who is not registered with the UKVRN may not have met or be able to meet the UKVRN's recognised standards. To check whether a nutritionist is registered, visit Associationfornutrition.org.
Other so-called nutritionists may have gone through informal training, often short in length and do not have UKVRN or HPC recognised qualifications. For more information about the difference between dietitians, nutritionists and Nutritional Therapists see this link.
Disclaimer: The dietary advice provided is for informational purposes only and is not intended as a substitute for professional medical advice. The information is not for diagnosing or treating a medical or health condition. You should consult a doctor in all matters relating to your health, and particularly in respect to any symptoms that may require diagnosis or medical attention. Links to other websites that appear here are ones that have been found to be useful, but the accuracy of information on those links cannot be guaranteed.
Last updated: almost 2 years ago