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.

The post Your poo and how it is helping during Covid-19 appeared first on Bayside Dietetics.

It interested me that Maya herself was not concerned about her son’s weight gain. She had noticed a change in her son’s body shape but in our session, she interpreted it in a totally different way. For her, it reflected the wonderful summer they had just shared as well as her son growing up. She did not attach any judgement to it and certainly didn’t value her son any differently.

This difference in interpretation shows how body image is purely about a personal reflection on it. We can have different perspectives, almost like when we talk about our recent summer holidays. You will notice you do not recall the detail of what actually happened but more offer an interpretation. For example, different interpretations of a rainy family trip may be “It was so much fun to be together, even though it rained a lot” or “The rain ruined our holiday” or even “It would have been better without rain but we made the most of it”. In the same way, body image is a representation of the body which means it can be interpreted in a neutral, positive or negative way (www.cci.health.wa.gov.au ).

If you can relate to Maya’s story and are curious with how to handle comments from others around your child’s body then there is something particularly important in your role as a support person, and that is to avoid helping your child to “fix” their body as a response. What I mean by this, is if the comment is around a larger body, a “fix” would be to lose weight, while comments around a thinner body would have a “fix” of weight gain.

A comment around spinach in my teeth? Yes, a problem to be fixed. Your child’s body, however, does not need fixing.

Any response to your child that helps them to “fix” or change their body is likely to have the effect of reinforcing that there is something to worry about. If Maya’s response is to help her son to lose weight, she would be reinforcing the concept that there is something wrong with weight gain or a larger body. The message to her son is that he isn’t wholly acceptable unless he changes his size or is small.

In the future, if he returns to a similar body shape and size then the feelings about judgement are likely to return. Unfortunately, this puts him at higher risk for health-damaging behaviours in the future including starvation, cigarette smoking and vomiting (O’Dea J (2005) ‘Prevention of child obesity: First, do no harm’ Health Education Research).

If you are motivated to make changes to keep your family healthy then go for it but the key is to do it to look after everyone’s health and not link it to trying to change anyone’s body and certainly don’t link it to the comments at school. For example, fill the shopping trolley with more summer fruits, freeze yoghurt as a great summer snack, increase how often your family goes to the park or pool. All these things take care of your child’s body but have no relationship to their size.

Where to get further help?

If you are concerned about your child’s body image, I am always a big advocate of the wonderful work GPs do in directing you to the right support network so that is a great place to start. Your GP can refer you onto Dietitians and Psychologists like me who specialise in the area.

If you are looking for more general information, then there are some great resources out there:

https://butterfly.org.au/body-image/body-image-explained/

https://headspace.org.au/friends-and-family/understanding-body-image-issues-in-children/

https://au.reachout.com/challenges-and-coping/body-image

A final word…

Let me leave you with a direct quote from Dr Samantha Thomas in her role as Senior Research Fellow, and Head of the Consumer Health Research Group (CHaRGe) at Monash University (www.ifnotdiet.com.au):

“Positive Body Image is not about creating an acceptable body ‘norm’ or about trying to make yourself look thinner, more beautiful, younger, or whatever. It’s not about trying to ‘hide’ or ‘make the best of’ who you are. That is called “Marketing”.

Because where bodies are concerned, there is no norm. Because we ARE ALL DIFFERENT! Which is what makes us REAL. And celebrating that difference is what positive Body Image is about.”

Instead of “fixing a problem” show your child that they are loved and valuable for whoever they are. You will be the expert at this.

Sarah

Please note that if you suspect your child has an eating disorder, or has been diagnosed with an eating disorder, this information should not be applied, and I encourage you to seek/continue help from your GP and specialised team.

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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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Part 2 of introducing solids to your baby.

Let me start by keeping your baby safe and growing well. Avoid nuts and other hard foods to reduce risk of choking, and keep the texture developmentally appropriate. Now here’s for some ideas:

 

#Store bought #Portable #Storable.

Every single one of these foods were store bought i.e. no fancy recipes required, and yet provide a healthy spread of flavours and textures.

 

The vegetables can be whatever you are planning for your own dinner, cut and cooked to a soft texture, then used as finger foods. This may be at dinner time too, or may be put into a container and saved as a snack for the next day. Providing it’s a safe texture, let your baby experience the range of different vegetables that you do.

 

The pasta world provides plenty of opportunity for self-feeding different textures. From penne as a great finger food starter to the more complicated spaghetti and small risoni when your baby’s skills are developing.

 

The rice I have pictured is in a lump that a baby can easily hold. It is regular rice, simply cooked, cooled and then a spoonful has been squished together to form a lump perfect for little fingers.

 

And don’t forget the vegetarian range for perfect little pieces – here I have egg and butter beans. I would have put in a falafel ball, had I thought of it yesterday!

 

Kid-friendly meat ideas are chop bones, soft fish chunks, meatballs and sliced cold turkey or chicken.

 

Finally, here is some inspiration for variety to the good old sandwich. While the main ingredients are the same, the subtle changes in texture within this picture will keep challenging your baby’s feeding skills. Including some crusts or spread on top is a perfect way to develop tongue and mouth muscles.

Menu Planning

There are sooooo many different ways to eat and feed your baby, which is why I usually hate prescribing a meal plan. But if you would like some inspiration on structure then feel free to use the parts of this that you like.

Mornings

A good time for an iron-rich cereal such as Weet-Bix/Farax or some cooked oats.

Finger fed babies may like some toast with avocado or cottage cheese.

Middle of the Day

Different types of bread products (see picture above) or some cooked rice or pasta.

Finger-food vegetables.

Egg or smooth peanut butter or hommus.

Evenings

Rice, couscous or pasta with fish or meat and cooked vegetables.

Snacks

Snacks usually come in only when breastmilk or formula is going out so it’s a good time to have a dairy option such as yoghurt, custard or cheese sticks.

Fruit makes a convenient snack too. No need for commercial products at this age.

Kids don’t care what time of day it is so if your baby is more inclined to eat snacks than a meal try cold chicken, cold cooked vegetables, sushi or a hard boiled egg at this time.

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Part One on Introducing Solids

“That’s not how we did it”.

Usually a catch-cry we attribute to our folks’ generation. But just the other day at a social event, I was in a conversation with a new Mum and young(ish) friend. The new Mum was talking about her plans to wait until 6 months to introduce solids to her baby and that she would use foods from her family meal. These plans elicited the said comment from her friend, who went on to describe having a baby that was so hungry she had started solids at 4 ½ months. This friend described using rice cereal and puree fruit with gradual change in texture over time.

Both Mums were obviously seekers of information and both were using this to make the best decision for their baby. But the range of information out there can make working out the best way to introduce solids, well, really difficult.

Let me get down to the truth of it, then you can decide the best way for you and your baby.

Fact 1: Breastmilk or formula provides all the nutrients your baby needs for the first six months of life.

This means, you have until six months of age to start introducing solids to your baby, before your baby is starting to be at risk of not getting enough to eat. You do not need to introduce solids earlier than this to make sure your baby is not hungry.

This information forms the crux of current advice and is a worldwide standard. It is more recent interest in allergy prevention that has questions being raised about introducing solids earlier than 6 months.

Fact 2: Before four months a baby’s body doesn’t cope well with solids.

We’re talking kidneys, gut etc. and not just the mouth. So we’re listening to this one!

Fact 3: We do not know for sure how best to prevent allergies in children.

But there are experts out there having a good crack at it. The expert body on food allergy in Australia is ASCIA. ASCIA states that to prevent risk of allergies in children, introduce solids around 6 months of age, but not before 4 months. They have a wonderful website that goes into more detail for you at https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

Fact 4: The advice to start solids when you baby is showing readiness has not wavered.

So this seems to be pretty consistent advice and worth listening to. Signs can be difficult to distinguish from general interest in watching what you are doing, but you are essentially looking for your baby being able to sit upright (with support), reaching out for your food and opening their mouth when you move the food towards it.

If you’ve decided your baby is ready, how to? There are various approaches, and all can work well, providing you are able to include a wide variety of foods. In Part Two of my blog on Introducing Solids – Food Ideas, expect to find more specific information on what food to provide your baby and meal and menu ideas.

 

As always, please take this blog as general advice. If you have any specific concerns about your baby, please come and see me at Bayside Dietetics or your preferred paediatric dietitian.

 

Eat Away!

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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.

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A little girl named Goldilocks went for a walk. She came across three plates of food. The first looked like this:

It didn’t look easy. It didn’t look nice. It made her feel bored and didn’t entice.

You see, Goldilocks is so interested in the world around her that it takes a good-looking meal to draw her to the table and hold her attention.

 

She moved to the second plate of food:

It looked too soft. It looked too chewy. It looked like hard work and the smell made her gooey.

Goldilocks is still developing her tastebuds and jaw muscles. Sometimes she is not in the mood for something that is hard to chew.

She moved to the third plate of food:

“I can chew that. The smell doesn’t linger. The vegetables I can pick up and dip with my fingers.”

She began to eat. As if by magic, three bears appeared at the house and sat down beside her to eat. The talked about their walk and asked her about her day. Goldilocks chatted away. Then she stopped. She looked at her rice and then looked at them with confusion. Daddy Bear served himself some rice and used a spoon to move it to his mouth. Goldilocks studied him carefully and then tried it herself. You see, role modelling is one of the most important things a parent can do for their child around food. In the same way a child will copy you with how to kick a football, they will use you as a role model on how to eat.

When dinner was over, Goldilocks skipped away, thinking how clever she was to have chosen what she ate for dinner.

But back at the house, peeping through the curtain, Mummy Bear smiled to herself. You see, she had been the one who chose what to put on the plates. She had been the one who was really in charge of what Goldilocks ate. And that makes for a happy ending.

 

Incredibly I’ve met Goldilocks. More than once she has come into my rooms with her exasperated parents. Food has that effect.

If you know Goldilocks too, perhaps try one of these:

• A self-serve dinner. Include things your child likes so you feel assured they’ll eat too. Putting your child in charge of serving themselves something new is a great way for it to happen.
• Role model eating a variety of foods at a family meal whenever you can.
• Help a really stuck child feel safe with change by making gradual changes with either taste or texture, not both. For example, long spaghetti pasta instead of penne.
• Offer new foods at a time your child is most hungry.
• Balance “sneaking” in vegetables, such as grating them into a sauce, with overt exposure. It’s normal to eat vegetables at dinner and nothing wrong with a child learning that.
• Offer young kids easy to pick up and easy to chew foods such as minced meat, cubed vegetables, sliced fruit, small pieces of pasta.

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