So I trust that writing the word poo started to form a slight smile on your face. Let me see if I can make your face change a little more.

Your poo is made up of bugs. Dead bugs. Bacteria, viruses, fungi, and archaea (very similar to bacteria but different enough for scientists to give them another name). Some of these bugs played a helpful role for you in your body. They helped to digest some of the food that your body could not in a process known as fermentation. Fermentation is probably better known by some for the wonderful work it can do in alcohol, but a similar process is happening at the end of your gut.

You see, your body has always relied on bugs to help complete the job of digestion. In the process of bugs fermenting food that you haven’t been able to digest, by-products are release. These by-products work to keep you healthy (Stephen et al. Nutrition research reviews 2017:1-42).

For instance, some of the bacteria in your gut will ferment leftover food particles and release compounds that stabilise your blood sugars and improve your immunity (Adv Nutr. 2016 Jan; 7(1): 1–4). Other bugs do their job and in the process are thought to protect us from certain cancers, inflammation and allergies (Macfarlane. J Clin Gastroenterol, 2011 Nov; 45 Suppl:S120-7).

That is why health professionals will always recommend high fibre foods as the more fibre you eat, the more you are feeding these bugs and reaping the benefits. Fibre is the main type of food that these bugs eat because it is the stuff you can’t digest yourself so it travels through your gut to feed those bugs at the end.

There is a little more to your poo than bugs – there are also dead gut cells and water (heaps of it). But it is one more thing in your poo that may prove to be extraordinarily helpful during this difficult time. Something that will help us monitor how we are progressing with Covid-19 control and that is the appearance of the virus SARS-CoV-2 (the virus responsible for what we commonly refer to as Covid-19) in the poo of infected people.

Clever scientists in Brisbane, Australia have been able to detect the virus SARS-CoV-2 in untreated wastewater for the first time (Sci Total Environ. 2020 Aug 1; 728: 138764). This follows studies in Monte Carlo and USA that were able to then use complex calculations to estimate how many people this meant were likely to be infected with Covid-19 in the local area from which the wastewater was collected. Reports indicate we are not quite there in Australia but the possibility of monitoring Covid-19 cases at a population level seems to be close.

It is a way of checking whether the numbers we see through testing for the Covid-19 virus are accurate. Does an area with no positive cases also have no signs of Covid-19 in the wastewater?

So the next time you flush the toilet without so much as a glance at the wonderful creation below, perhaps a little word of thanks wouldn’t go astray.

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This will be short and sweet because I don’t want to dilute the point. Since early days with Covid-19 there has been suspicion around a certain nutrient playing a very protective role for people around the virus. This was based on the characteristics of people who well becoming really unwell, and unfortunately some passing away, and those who were getting milder symptoms (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30183-2/fulltext). Suspicions have been recently supported by the results of a small but high quality study in Spain. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/).

Adequate vitamin D levels may protect us from becoming very unwell with Covid-19.

Vitamin D is a nutrient, and for most of us, we will get most of the vitamin D we need through making it ourselves when sunlight hits our skin rather than from our diet (https://pubmed.ncbi.nlm.nih.gov/11700831/). Thus, having adequate vitamin D levels depends on us getting enough sun exposure. In Melbourne we know that almost half of us will have low vitamin D levels by the end of winter (https://pubmed.ncbi.nlm.nih.gov/11700831/). It makes me sit back and wonder if there is any relationship between the very place in Australia that is still struggling with Covid-19 and the place where winters are long and cold (excepting the amazing island of Tassie which has done well during Covid-19).

The key question is how do we balance getting enough sun exposure for adequate vitamin D levels while still being Sun Smart? Osteoporosis Australia have updated their guidelines to answer exactly this question and it can be found at: https://www.osteoporosis.org.au/new-recommendations-sun-protection-and-vitamin-d They recommend that when the UV rating is 3 and above, the sun protection is the priority, while at lower ratings, sun exposure for vitamin D may be helpful. Another great resource is the SunSmart App, which you can download on your phone for daily notifications around UV levels and getting enough vitamin D.

For many of us, particularly those of us who really prioritise being Sun Smart, or spend a lot of time indoors or covering by clothing, and those of us with darker pigmented skin, vitamin D supplements may be a good option. Most vitamin D supplements in Australia are effective because they are made from cholecalciferol. There are occasions where supplementation of any nutrient isn’t considered safe, so a quick chat to your GP or Dietitian is a good place to start (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext).

In summary, adequate vitamin D levels seem to be protective around the Covid-19 virus and you can get there through sun exposure at Sun Smart low UV levels or perhaps through vitamin D supplements.

Enjoy the emergence of the warmer weather and I hope you stay safe.

Sarah

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Last week I did a presentation to a wonderful group of year 11 students. I held up a packet of processed cereal and asked for their thoughts. The word that most students used to describe it was “bad”. In fact, there was only a single voice that rang out with a positive message to say that the cereal was “yum”. Why should it be considered bad I asked? “Because it has sugar”, came back the chorus.

What about the child that is low in energy and iron that gets an almighty nutritious boost from this cereal? What about the individual that absolutely loves the taste and ritual of having this cereal? Is it really okay to label this cereal as “bad”? How do you imagine these individuals feel if they eat it knowing that it’s been labelled that way?

I do a lot of work to help clients in their search for freedom from judgement around food. They get so much liberation from accepting all foods and getting rid of labels such as bad when it comes to food. They often move to simply asking their body to guide them how to eat in whatever form that takes.

The anti-sugar message is often one of the most difficult for clients to release, however. It seems as unlikely concept as believing The Joker has Batman’s best interests at heart. Let’s look at the truth of sugar to see if it holds an almighty “badness”.

Sugars are carbohydrates. Although it is often associated with table sugar, sugar includes all sweet carbohydrates. Sugars occur naturally in some foods such as fruit, honey, and dairy products, and may be added to added to foods during their manufacture, such as the sauce below.

Like almost all food, sugars are digested before moving from the gut into the body. This basically means that the sugar down is broken to really small pieces. The main small piece from sugar digestion is glucose. Here is a computer-generated image of one of the glucose molecules from the added sugar in the cereal in question (thanks to worldofmolecules.com):

As a comparison, let’s take a look at one of the glucose molecules of digested broccoli: Yes, even vegetables like broccoli contain a little carbohydrate that will be digested down to glucose.

Yep, the same. The body cannot tell whether the glucose came from cereal or broccoli at the point it is taken into the body.

What about rice malt syrup, made from brown rice so it must be a different type of sugar, right?

Coconut sugar?

Table sugar??

All the same.

I’ve really simplified digestion, but the point is that when foods are broken down so cleverly by the body, the simplest form that our body uses looks the same no matter which food you eat. When it comes to digesting foods with “sugar”, glucose is the simplest form. When glucose moves into the body, your body has no idea whether it came from jellybeans, broccoli, yoghurt or coconut sugar.

There are definitely differences in eating different foods. Some foods may have more sugar in them, some foods may have sugars that take a little longer to be digested, some foods also have heaps of nutrients and fibre while others may be just sugar, and there is a whole lot of difference in what the whole meal looks like. The point of this article, however, is that there is no difference in what the sugar molecule when it is taken into the body.

If the sugar is the same, then why do we consider it so bad when it comes from certain foods?

What if we could just embrace the different forms that sugar comes in?

For example, cereal with milk is a convenient option for breakfast and provides energy to sustain the day.

There isn’t much glucose that come from broccoli. It’s a food that will keep us full and often comes in a really satisfying meal.

A sports drink provides an instant boost of energy during a sporting event.

A slice of cake at a birthday party helps to connect us with family and make someone feel special.

If you are out there working hard to take care of yourself and looking out for information that helps you, you may have heard the message that sugar is bad. Now that you’ve heard a little more, I wonder what it would be like for you to have the freedom to remove the label of “bad” from sugar. What if it was just another food, alongside broccoli and milk?

While it might be hard to accept in our brains, our bodies might just be showing us by example.

Sarah

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Apparently the “girl-child” or La Nina caused this temperature change. How does this relate to nutrition and a Dietitians blog? The outcome for many of us was reduced exposure to the sun over summer and this puts us at risk of low vitamin D levels when the real winter hits.

Vitamin D is made by the body from exposure to the sun. In the southern states of Australia, we typically build up our levels with higher exposures over summer and levels reduce as we cover up more over winter.  This often leads to low vitamin D levels by the end of winter (Med J Aust. 2001 Oct 15;175(8):401-5). When this happens, suddenly having enough vitamin D in your diet becomes important because when there is not enough sun, your body relies on vitamin D from food.

In food, Vitamin D is found naturally in eggs and oily fish, but it also may be added to some foods including margarine, butter spreads and milk. To find out if your margarine, milk or butter has vitamin D, check the ingredients list. Vitamin D will be listed as an added ingredient. As it is only added in small amounts it will probably be the last ingredient listed. Here is an Ingredients list from Meadow Lea “Buttery” that shows added vitamin D (and A) as the last ingredient:

Ingredients:

Vegetable oils 60% (containing 47% canola oil), water, salt, emulsifiers [471, 322 (from soy], milk solids, preservative (202), food acid (270), natural flavour, natural colour (160a), vitamin A & D.

The other way that many of us will rely on to get enough dietary vitamin D over winter is a supplement.

This blog is reflecting on less sun exposure over the summer gone and I am not advocating sun exposure without consideration of skin cancer risk. Excellent resources on this fine balance are the SunSmart App (android and iOS) for advice on UV levels and skin protection and the Cancer Council summary at https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/preventing-skin-cancer

If La Nina meant more clothing worn over your recent summer, then maybe it is worth having vitamin D on your radar over winter.

Apparently La Nina is starting to weaken. Let’s make sure your vitamin D health doesn’t.

Sarah

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Whenever I see an article on bone health, I find it reasonably unglamorous. There are much brighter and shinier things to be reading. But the reality is that looking after bones is at some of its most important times while we are kids, while we are breastfeeding, and while we are pregnant. And yet, an estimated 90% of adult females and 70% of kids are not getting enough calcium, the ingredient our body uses to make strong bones. Which means if you are reading this, you yourself, or someone you care for is probably in need of a calcium check. So let’s make it easy and quick.

• What do we need to do? 

An adult body contains around 2% calcium, mostly in our bones! That is 1.4kg calcium in a 70kg body. We get that calcium by eating it. The best way to eat calcium is through foods, rather than through a supplement. High calcium foods are dairy products such as yoghurt, milk, cheese, ice cream and calcium-fortified products such as soy drink. There are small amounts in some other foods, but really, not enough to be considered good sources. I’d recommend using those sources as “bonus” supplies of calcium and focussing on enough of the main ones.

• How much do we need to eat?

2-3 year old kids need 1 ½ serves per day. That may look like a small tub of yoghurt and a slice of cheese.9-11 year old kids need roughly 3 serves per day. That typically means having a serve at a meal plus a serve at two snacks each day. For example, 2 slices cheese on toast at breakfast, a small tub of yoghurt as a snack and a fruit smoothie after school.

Older kids need 3 ½ serves per day. I’m sensing why it’s so hard to fit it all in. It can be done by appearing in 2 meals and 2 snacks each day.

4-8 year old kids need roughly 2 serves per day. Something like milk on cereal at breakfast and a small tub of yoghurt as a snack.

I’ll go through serve requirements using dairy products but these can be substituted for a calcium fortified product such as soy drink, or even a small tin (100g) of canned pink salmon with bones or 60g sardines.

Adult men, women, breastfeeding and pregnant women are best to get 2  1/2 serves daily. Something like milk on oats for breakfast, a snack on yoghurt, and feta cheese added to salad for lunch or dinner.

• 3/4 cup or 200g yoghurt

• 2 slices or 40g cheese

• ½ cup or 120g ricotta cheese

• 1 cup or 250ml milk

• Is there any way I can get my levels checked?

The short answer is no. Calcium levels in our blood are not reflective of bone health. There are ways to check your bone density but these are time consuming, expensive and not standard practice. Talk to your GP if you feel this is important to you.

• What about supplements?

A supplement is useful if you can’t manage the food strategies above. It’s a backup option as it won’t be used by your body well as a food source. Like trying to get the pleasure of chocolate from cacao beans…similar but oh so different.

Search for:

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