OnCore Nutrition - Two Peas in a Podcast – Details, episodes & analysis

SHOW NOTES

What impact does surgery have on the body?

• Intentional trauma 
• Physiological response 
• Psychosocial impact 
• Stress

When we think about surgery, it's essential to understand that it triggers a significant reaction in the body known as the 'stress response.' This response is a complex interplay of hormonal and metabolic changes directly linked to the degree of tissue damage during surgery. It can intensify if there are any complications after the operation. 

Let's break it down: The whole process starts when the hypothalamic-pituitary-adrenal axis, or HPA axis, kicks into gear. This leads to a surge in hormones like cortisol, growth hormone, glucagon and catecholamines. These hormones are important because they help the body cope with stress by boosting energy availability and adjusting other bodily functions.

• Ebb phase (0-48hrs)
• Increased catabolism of stored glycogen (glycogenolysis)
• Suppression of insulin secretion → transient hyperglycemia
• Increased catecholamines, cortisol, and inflammatory cytokines (IL-6, TNF-α)
• Flow phase (3-10 days)
• Hypermetabolism (increased BMR)
• Increased protein catabolism → muscle breakdown (to provide amino acids for tissue repair and immune function)
• Increased lipolysis (fat breakdown) for energy
• Sustained insulin resistance → continued hyperglycemia
• Enhanced GNG 
• Pro-inflammatory response → increased cytokines and acute-phase protein production

In the initial stages after surgery, the body releases a wave of pro-inflammatory cytokines. These cytokines jumpstart the healing process by promoting inflammation, which is important for healing surgical wounds. However, to keep this inflammation from going overboard, the body soon follows up with anti-inflammatory cytokines.

These inflammatory processes have widespread effects across the body. For example, they can influence how the hypothalamus regulates body temperature or how the liver produces certain proteins that help fight infection and aid in wound healing.

But here’s where it gets even more interesting: other hormones like glucagon, cortisol, and adrenaline also play a role in modulating these responses. They can affect everything from your blood sugar levels to how your cardiovascular system handles the stress.

So, why is all this important? Well, by understanding and managing these responses effectively, we can significantly improve how patients recover from surgery. It’s all about helping the body maintain balance during a time when it’s incredibly vulnerable

Disruption of Metabolic Homeostasis: Surgery often disrupts the body's normal metabolic balance, notably through insulin resistance, where cells fail to respond effectively to insulin, leading to 'diabetes of the injury.'

 

Insulin Resistance and Hyperglycemia: Insulin resistance can cause high blood sugar levels, significantly increasing the risk of surgical complications and mortality. Post-surgery, the body may enter a catabolic state, breaking down muscle instead of fat, which impairs wound healing, weakens the immune system, and reduces muscle strength.

 

Increased Risks for Vulnerable Groups: Elderly, diabetics, and cancer patients are particularly at risk due to their compromised metabolic and inflammatory states. These groups have less physiological reserve, leading to pronounced catabolic states and increased risk of severe post-operative complications.

 

Impact on Recovery and Outcomes: The metabolic chaos from insulin resistance to protein loss not only delays recovery but also exacerbates risks of infection and other complications. Effective management of these changes is crucial for improving surgical outcomes and ensuring that patients thrive post-surgery.

ERAS helps to mitigate these by 

Surgery isn't just about the physical repair or removal of tissue; it triggers a cascade of stress responses in the body that can complicate recovery. These include everything from the psychological impacts of anxiety and the physiological effects of fasting to direct tissue damage and the systemic reactions to it, such as fluid shifts and hormonal imbalances.

Key Components of ERAS:

Comprehensive Care: ERAS isn't just a single technique but a suite of practices designed to address every aspect of the patient's journey — before, during, and after surgery. This approach aims to minimise the stress responses by controlling pain, reducing fasting times, optimising fluid management, and promoting early mobility.

Minimising Fasting: One traditional practice that ERAS revises significantly is the preoperative fasting rule. Old guidelines that required fasting from midnight before surgery are now replaced with more lenient, evidence-based practices that allow intake of clear fluids up to two hours and solids up to six hours before surgery. This change helps maintain normal blood glucose levels, reduces stress, and decreases the body's shift into a catabolic (muscle-degrading) state.

Nutritional Optimisation: ERAS protocols emphasise the importance of not entering surgery in a depleted state. By allowing a carbohydrate-rich drink shortly before surgery, patients are better hydrated and less anxious, which in turn reduces insulin resistance and preserves muscle mass — critical factors in speeding up recovery post-surgery. Post-operatively, oral nutrition may be delayed by the medical team until bowel function returns, typically taking close to a week. This delay is stated to reduce postoperative complications such as abdominal distension and nausea/vomiting.For the first several days post surgery fluids of limited nutritional value such as water are provided to patient until tolerance is established leading to insufficient nutrition intake during this time increasing the risk of malnutrition. The ERAS protocol promotes early oral intake within 24 hours post surgery departing from traditional fasting practices. Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Therefore addressing malnutrition is a key component of the ERAS protocol.

Immune-Enhancing Diets: Post-surgery nutrition is just as crucial. ERAS encourages diets rich in nutrients that bolster the immune system and enhance wound healing. This includes omega-3 fatty acids, which help modulate the inflammatory response; arginine, which supports protein synthesis and tissue growth; glutamine, which is vital for cellular health and recovery; and nucleotides, which are essential for rapid cell division and immune function .Immuno-nutrition is a specialised medical nutrition therapy that has been shown to adjust the body's inflammatory response: It incorporates specific nutrients like omega-3 fatty acids, arginine, polyunsaturated fatty acids, and nucleotides. It's typically recommended starting 5-7 days before surgery and continuing post-operatively for over 7 days or until oral intake meets at least 60% of the patient's nutritional requirements.

How can we use this info to optimize surgical outcomes?

Patient education 

Early nutrition pre and post surgery - Minimise fasting time 

What is ERAS? How does it differ from traditional care/practice?

• Introduced by Henrik Kehlet in 1997, the Enhanced Recovery After Surgery (ERAS) protocol has revolutionised surgical practices by optimising perioperative care. 
• A key aspect of ERAS is its interdisciplinary approach, involving healthcare professionals from various specialties to minimise surgical stress and facilitate recovery. 

What is malnutrition?

Malnutrition, is defined as an involuntary reduction in body weight, muscle mass and physical capabilities, affects up to 65% of surgical patients and can worsen during hospital stays. Enhancing nutritional status and promoting functional nutrition therapy is essential, even for

patients without evident malnutrition, particularly when prolonged perioperative oral intake challenges arise. Addressing malnutrition is essential for preventing surgical complications, prolonged

hospital stays and higher healthcare costs. 

What are the benefits of ERAS for the patient?
It has been shown that the key physiological benefits include:

-enhances the body’s anabolic processes

-promotes wound healing, which is critical for patient recovery.

-Reduces the risk of nutritional depletion

-Minimises insulin resistance, a common issue post-surgery, allowing for better blood sugar control and improved metabolic function.

-Reduce protein catabolism

-And lowers the risk of pressure injuries, which can develop due to extended immobility after surgery.

What are the benefits of ERAS from a healthcare perspective? 

From a healthcare perspective, ERAS has been shown to

-shorter length of hospital stay for patients,

-Lower risk of ICU transfer rates

-reduce readmission rates

-And all of these improvements lead to lower healthcare costs, not just for the hospital but for the overall healthcare system, as fewer complications and shorter stays reduce the financial strain.

Step 1: Screen & Strengthen

• If you’ve lost any weight unintentionally in the lead up to surgery, or been eating poorly because of a reduced appetite, you may be at risk of malnutrition and it’s really important to address this prior to surgery. 
• Research suggests that between 40-50% of surgical patients have some degree of malnutrition. Pre-operative malnutrition is an independent predictor of poor post-operative outcomes. Addressing malnutrition is a key component of the ERAS protocol and why it’s effective in improving surgical outcomes for patients.
• Book an appointment with a dietitian who can guide you on appropriate dietary changes to minimise muscle loss, build you up and optimise nutritional status and stores pre-op. 
• A well-nourished body tolerates surgery better, heals faster, has a stronger immune system to fight infection, and experiences fewer complications.

Step 2: Consider Immunonutrition 

• If you’re planned for major surgery, especially certain cancer and abdominal surgeries, consider the use of an immunonutrition supplement in the 5-7 days pre op. These are the supplements loaded with arginine, n3s, glutamine and nucleotides to support the immune system and reduce inflammatory responses, potentially leading to fewer infections and better recovery.

Step 3: Build Your Strength & Energy Stores prior to surgery 

• Carb load with food in the days leading up to surgery - think that big bowl of pasta a footy player would have the night before the grand final. 
• ERAS protocols have significantly reduced or eliminated long periods of "nil by mouth" (NBM) before surgery.
• Ask your surgical team exactly when you need to stop eating solid food – it might be much later than you think, often around 6 hours before surgery for a light meal. For clear fluids, it could be as little as 2 hours before!
• We’ll make the most of every second to prevent unnecessary dehydration, hunger, anxiety, and preserve your body's energy

Step 4: The Pre-Surgery Carb Load using clear fluids

• Many ERAS protocols include a special carbohydrate-rich drink taken a few hours before surgery. Your hospital may provide this, but if they don’t, we can organise orders for you or point you in the right direction.  It’s usually a clear, sweet drink. Think of it as topping off your fuel tank right before the 'race'."
• These have been shown to reduce post-operative insulin resistance (which can slow healing), help maintain muscle strength, can reduce nausea, and improve overall wellbeing. It basically tells your body it's in a 'fed' state, not a 'starvation' state, heading into surgery.
• This is best done with tailor made medical nutrition drinks as they come prepped with the correct doses of maltodextrin-polymer carbs and a lower osmolality than other solutions, which essentially means they gentler on your gut and better for gastric emptying so they don’t linger in your gut during surgery. 
• Always follow surgical instructions, but ideally we’re aiming for 100 grams of carbohydrate the night before surgery and about 50 grams of carbohydrate in clear fluids approximately 2 hours before anesthesia. This might look like 4 x 200ml drinks the night before, and 2 the morning of surgery 
• If you can’t access these drinks, apple or cranberry juice are reasonable replacements. 
•  Drop us an email or message or give us a call if you’d like advice on where to get pre-op and immunonutrition supplement drinks. 

Then we move on to post op and 

Step 5 which is aiming to eat early.  

• ERAS encourages starting to eat and drink as soon as it's safe after surgery – often within hours, not days!
• As soon as your team says it's okay, try sipping water, then progress to other clear fluids, and then light foods as tolerated. Even small, frequent amounts help. This helps to stimulates your gut to start working again, reducing the risk of ileus – a slow, sleepy bowel, provides energy for healing, and can help you feel more normal, faster.
• If you haven’t been told you can eat or drink, keep asking the question! You are your best advocate! 

Another tip that can help here is step 6:  Chew Gum

• If your team allows it, start chewing sugar-free gum several times a day once you're able. It sounds simple, but it can be surprisingly helpful in mimicking eating even when you’re not allowed to, and can stimulate your digestive system to return to usual function sooner and reduce the risk of ileus.

Step 7 is to Nourish to Heal 

• This is where we bring in our good friend protein to optimise tissue repair and recovery 
• Include protein rich food at each meal, and chat to us if you’re finding this difficult because there are plenty of hacks if you’re not feeling up to chicken breast and steak! 

And finally step 8 is to Listen to Your Body

• While ERAS encourages early eating, we always want you to be tuned in to your body’s cues and speaking up to your medical team and us if something doesn’t feel right. 
• There are plenty of interventions that can be used to keep you comfortable while still optimising your nutrition to get the best outcomes from surgery. 
• Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., et al. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745-4761.
• Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Laviano, A., Ljungqvist, O., et al. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623-650.
• Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2019). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. Clinical Nutrition, 38(2), 576-586. (Note: The ERAS® Society website, erassociety.org, is the primary source for the most current and comprehensive suite of procedure-specific guidelines.)
• Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery, 152(3), 292-298.
• Thiele, R. H., Raghunathan, K., Brudney, C. S., Campos, S., Candiotti, K., Chaves, S., et al. (2016). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management in adults. Perioperative Medicine, 5, 26. (Note: This is an example of ASER/POQI consensus; look for other relevant POQI statements on specific surgical procedures and their nutritional components.)
• Soon, K., Levy, G. M., Cusack, L. A., Varma, S., & Nicholson, G. A. (2020). The effect of preoperative carbohydrate loading on patient outcomes in elective surgery: A systematic review and meta-analysis. Systematic Reviews, 9(1), 254.
• Lewis, S. J., Egger, M., Sylvester, P. A., & Thomas, S. (2001). Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ, 323(7316), 773-776.
• Osland, E. J., Hossain, M. A., Khan, S., & Memon, M. A. (2014). Effect of timing of oral feeding on patient outcomes after elective colorectal surgery: A systematic review and meta-analysis. Journal of Gastrointestinal Surgery, 18(5), 1039-1051.
• Braga, M., Gianotti, L., Nespoli, L., Radaelli, G., & Di Carlo, V. (2002). Nutritional approach in malnourished surgical patients: a prospective randomized study. Archives of Surgery, 137(2), 174-180.

Marimuthu, K., Varadhan, K. K., Ljungqvist, O., & Lobo, D. N. (2012). A meta-analysis of the effect of combinations of enhanced recovery after surgery (ERAS) interventions on postoperative outcomes. 

Annals of Surgery

, 

255

(4), 640-649.

SHOW NOTES

Post-COVID questionnaire: https://chroniccare.snapforms.com.au/form/post-covid-questionnaire

Post COVID Recovery steps

References

https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

https://www.bmj.com/content/372/bmj.n136

https://www.bmj.com/content/372/bmj.n136/rapid-responses

http://www.buckshealthcare.nhs.uk/pifs/nutrition-and-long-covid/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429479/

NICE (2020) “COVID-19 guideline scope: management of the long-term effects of COVID-19” https://www.nice.org.uk/guidance/ng188/documents/final-scope]

Leon et al. (2021) ‘More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis”. [ https://pubmed.ncbi.nlm.nih.gov/33532785]

Afrin et al. (2020) “Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome”. International journal of infectious diseases, 100: 327–332 https://pubmed.ncbi.nlm.nih.gov/17490952/]

Casas et al. (2016) “The Immune Protective Effect of the Mediterranean Diet against Chronic Low-grade Inflammatory Diseases”. Endocr Metab Immune Disord Drug Targets. 14(4): 245–254. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443792/] 

LaTrobe Research

https://www.latrobe.edu.au/news/articles/2022/release/possible-cause-of-long-covid-brain-fog

Souvenaid 

https://nutricia.com.au/souvenaid/

https://www.cuh.nhs.uk/news/friendly-gut-bacteria-speeds-long-covid-recovery/

https://www.pomi-t.co.uk/national-trial/

https://pubmed.ncbi.nlm.nih.gov/35334962/

https://pubmed.ncbi.nlm.nih.gov/33933299/

https://www.bda.uk.com/resource/long-covid-and-diet.html

https://www.buckshealthcare.nhs.uk/wp-content/uploads/2021/10/Nutrition-and-Long-COVID.pdf

https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-expert-shares-5-early-care-tips-for-people-with-long-covid/

https://www.todaysdietitian.com/newarchives/ND21p40.shtml

https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

https://www.google.com/amp/s/metro.co.uk/2022/03/15/long-covid-and-nutrition-can-you-eat-yourself-well-16237485/amp/

https://www.healthspan.co.uk/advice/long-covid-diet-and-lifestyle-changes-that-can-help

Smell training

https://www.fifthsense.org.uk/smell-training/

https://abscent.org/learn-us/smell-training/how-smell-train

https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac136/6569364?login=false

https://www.cidrap.umn.edu/news-perspective/2022/04/global-data-reveal-half-may-have-long-covid-4-months

Find and Fuel Your Fire Workshop

Tickets via Eventbrite

Getting a nutrition job is HARD! 

The Dietetics Workforce Report 2018

• There has been a 95% increase in dietetic grads over the last 7 years.
• Grads in Vic ↑ from 65 to 127 per year from 2010 to 2016.
• There is great concern that there is an oversupply of practitioners causing difficulties in new graduates finding positions and inhibiting movement for existing employees. 
• Many grads are still seeking work up to 12 mths post graduation.
• In this time, grads are driven to volunteering - but not always meaningful 
• You are highly qualified. There is a significant need for your skills. We have an ageing population, chronic disease and dietitians provide such important prevention and management care
• The report highlighted that Dietitians are highly qualified, however there are obvious gaps in business and professional skills in many courses. 
• Despite working in a clinical role 30% of dietitians had no clinical supervisor.

file:///C:/Users/laure/Downloads/Dietetics%20Workforce%20Report.pdf

Potential career pathways 

Clinical dietetics

• Popular!
• When we’ve advertised for grad jobs there have been >100 applicants. 
• A quarter of organisations reported receiving >50 applicants for junior positions and advertisements were rare! 
• Hard to get grad jobs 

Consultancy and private practice

• Often don’t graduate with skills for business set up and challenging to dive into sole practitioner position without prior experience. Requires ++ mentoring and supervision. 
• Important for your own development but also for the reputation of the profession 

Food service

Media and marketing

• Don’t expect to get here straight away - need some experience behind you 
• Be responsible with what you put out into the world, social media etc. Don’t know what you don’t know. 

Public health and nutrition

Eventually policy, health promotion, advocacy

• Often start as a public health dietitian, community dietitian

Food industry

• Consulting
• Food analysis and product development, sensory evaluation
• Food technology and science
• Research 

Nutrition research and education

• Generally requires specialisation and smaller projects or honours, masters, PhD

https://www.deakin.edu.au/exercise-nutrition-sciences/careers-in-nutrition-and-dietetics

https://www.myhealthcareer.com.au/dietetics-career/

Our tips

• Volunteer meaningfully
• Upskill 
• Get a mentor - a meaningful one
• Apply for everything - know your limits/hard passes
• Apply well
• Prepare for interviews 
• Seek feedback - and actually be prepared to take it 

Our upcoming workshops

https://www.eventbrite.com/e/find-and-fuel-your-fire-student-early-dietitian-nutritionist-workshop-tickets-112762650122

Wed 26th Aug at 6pm 

Sun 29th aug at 2pm

Topics to cover 

How to land the job you want

• Job application preparation
• Interview (including phone/video interview) preparation 
• Setting yourself apart 
• What NOT to do! 
• Volunteer / work experience opportunities
• Professional development 

Finding your career niche / Progressing your career 

• Specialising 
• Quality projects opportunities in nutrition 
• Education opportunities in nutrition 
• Research opportunities in nutrition 
• Conference / presentation opportunities 

Supervision and mentoring

• Finding the right supervisor

Innovation in dietetics  

• Identifying gaps
• Pitching your idea
• Introduction to grants and proposals 

Delivery 

• Online 
• 2hr workshop 
• 2 sessions - one evening, one weekend 
• ‘Take home’ toolkit of resources 

Fertility Nutrition

• Important to highlight that conception is a miracle! And for many couples this is not an easy journey. 
• 1 in 6 Australian couples are unable to become pregnant after a year of unprotected sex.
• Nutrition and lifestyle can play a role and have a positive effect on fertility, in fact, it may improve fertility by up to 69%! https://pubmed.ncbi.nlm.nih.gov/17978119/

Female Fertility

• A balanced diet is important, including a wide variety of fresh produce daily
• Mediterranean-style diets have been associated with improved fertility 
• Which foods and nutrients are important to include? 
  • Folic acid has been shown to be important in female fertility, even with assisted reproduction. It is recommended to include a daily prenatal multivitamin supplement with folic acid (400-500 µg/day) from 12 weeks pre-conception and for the first 12 weeks of pregnancy to decrease the risk of neural tube defects. This supplementation is particularly important in early stages of pregnancy when many women may not yet know they are pregnant, so if you have the opportunity to forward plan it’s always a good idea. 
  • Vitamin B12 - animal products, vegans should consider supplementation under guidance from their doctor or dietitian 
  • Omega-3 fatty acids - EPA and DHA are important for fertility, conception and foetal development 
  • Antioxidants are important for fertility and conception. They help to keep both our sperm and eggs healthy! Include a wide variety of plant based products including vegetables, fruits, nuts, seeds and wholegrains to boost beneficial antioxidants like vitamins C, E, folate, beta-carotene and lutein. It’s beneficial to try to get these nutrients from food sources and always speak to your doctor or dietitian before considering a supplement (especially Vitamin E).
  • Opt for complex, low GI, high fibre carbohydrates from whole grains, vegetables, nuts and seeds. 
  • Include plant-based proteins, reducing your reliance on animal proteins. Get creative with legumes and pulses, whole grains, nuts and seeds.
  • Seafood may have a positive association with fertility. Couples eating more seafood were pregnant sooner than those rarely eating seafood.
  • Choose full fat instead of low fat dairy
  • Iodine may be important - get this from seafood, seaweed (nori), potatoes, cranberries, strawberries iodised salt and our bread supply which is fortified. This is a good one to start with folate in the lead up to conception, and is included in most prenatal vitamin blends. 
  • Your eating window may be important. Some studies suggest that shifting towards an earlier eating pattern, with a larger breakfast and lunch and a smaller evening meal with reduced late-night eating, may improve fertility. 
• Which foods and nutrients are worth eating less of?
  • Swap out trans fats for mono- and omega 3 poly-unsaturated fats. This means less processed and fried foods, commercially-prepared baked   products and margarines.
  • Reduce processed meat intake. Replace these with lean meats, eggs, full cream dairy and plant alternatives such as legumes, tofu, nuts, seeds and grains. 
  • Reduce intake of refined carbohydrates found in sweet drinks, lollies, cakes, biscuits, desserts, and refined products like white bread, rice and cereals. Instead opt for the low GI options listed above. 
  • Energy drinks - it’s no surprise that they don’t do us any fertility favours. 
  • Reduce alcohol intake 
  • Don’t overdo the caffeine. Some studies have suggested that large intake (over 500 mg of caffeine daily) may take up to 9.5 months longer to get pregnant  https://pubmed.ncbi.nlm.nih.gov/9054236/
• Movement is important! Exercise has many benefits for your health, including increased fertility. A sedentary lifestyle has been associated with a higher risk of infertility and increasing movement has been found to reduce the risk of infertility. 
• Mindset and stress is another important factor. Managing stress and anxiety may be easier said than done, particularly when trying to conceive, so consider seeking professional support to optimising your mental wellbeing and therefore fertility. 
• Recommend tailored advice from a dietitian in the case of any medical conditions  including PCOS, diabetes or GDM, if you’re in a small or larger body and have any concerns, and if taking any complementary or alternative therapies. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30311-8/fulltext

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)90458-6/fulltext

https://www.thelancet.com/series/preconception-health

https://www.health.harvard.edu/blog/fertility-and-diet-is-there-a-connection-2018053113949

https://www.eatright.org/health/pregnancy/fertility-and-reproduction/fertility-foods

https://www.healthline.com/nutrition/17-fertility-tips-to-get-pregnant#1.-Eat-Foods-That-Are-Rich-in-Antioxidants

https://pubmed.ncbi.nlm.nih.gov/22425198/

https://pubmed.ncbi.nlm.nih.gov/11880759/

https://pubmed.ncbi.nlm.nih.gov/11594714/

https://www.pennutrition.com/KnowledgePathway.aspx?kpid=1323&pqcatid=146&pqid=1313 - sweeteners 

Male fertility 

• A balanced diet is important, including a wide variety of fresh produce daily
• Mediterranean-style diets have been associated with improved fertility and semen quality in men
• Which foods and nutrients are important to include? 
  • Omega-3 fatty acids - EPA and DHA are important for fertility
  • Antioxidants are important for fertility and conception. They help to keep both our sperm and eggs healthy! Include a wide variety of plant based products including vegetables, fruits, nuts, seeds and wholegrains to boost beneficial antioxidants like vitamins C, E, folate, beta-carotene and lutein. It’s beneficial to try to get these nutrients from food sources and always speak to your doctor or dietitian before considering a supplement (especially Vitamin E).
• Which foods and nutrients are worth eating less of?
  • Swap out trans fats for mono- and omega 3 poly-unsaturated fats. This means less processed and fried foods, commercially-prepared baked   products and margarines.
  • Reduce processed meat intake. Replace these with lean meats, eggs, full cream dairy and plant alternatives such as legumes, tofu, nuts, seeds and grains. 
  • Reduce intake of refined carbohydrates found in sweet drinks, lollies, cakes, biscuits, desserts, and refined products like white bread, rice and cereals. Instead opt for the low GI options listed above. 
  • Energy drinks - it’s no surprise that they don’t do us any fertility favours. 
• Movement is important! Exercise has many benefits for your health, including increased fertility. A sedentary lifestyle has been associated with a higher risk of infertility and increasing movement has been found to reduce the risk of infertility. 
• Mindset and stress is another important factor. Managing stress and anxiety may be easier said than done, particularly when trying to conceive, so consider seeking professional support to optimising your mental wellbeing and therefore fertility. 

Caffeine for fertility

You certainly don’t need to forego your daily coffee! If you’re trying to conceive it is a good idea to not overdo the caffeine. Some studies have suggested that large intake (over 500 mg of caffeine daily) may take up to 9.5 months longer to get pregnant  https://pubmed.ncbi.nlm.nih.gov/9054236/

Decaf -3mg caffeine per tsp

1 Tsp of instant coffee - 60mg per tsp

Espresso shot (30-35ml) - 90-200mg 

Percolated - 100mg per cup

Energy drinks - up to 110mg per serve

Cola - 40mg per serve

Black Tea - 50mg 

Green tea - 30mg

Chocolate - 60g of milk or dark Choc has about 30-40mg

Pregnant women can safely have two instant coffees a day and two to three cups of tea OR one cap/latte 

Pesticides fertility

Some studies suggest that higher consumption of produce prone to harbour higher pesticide residues may be associated with lower probabilities of pregnancy. Those looking to conceive may wish to consider where they source fruits and vegetables that may be more likely to hold residual pesticides, such as strawberries, spinach, capsicum, apples, pears, nectarines, peaches, cherries and grapes. 

While this is important to be aware of, washing fresh produce well will help to reduce exposure. And it’s important to keep eating PLENTY of fresh produce as the nutritional benefits of this is very important to consider (as well as any possible pesticide risks). For many, this may be easy to achieve with non-organic produce that’s easier on the purse strings. 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2659557

During Pregnancy

Things to be aware of / avoid

• Vit A - Beta carotene safe, avoid retinol/retinyl esters - upper limit for preformed vitamin A (retinyl esters and retinol from food and supplements) during pregnancy of 3000 µg /day (~10,000 IU). Be cautious of liver (≤1 serving/week), particularly in 1st trimester. Avoid any topical creams, ointments, serums which contain vitamin A or vitamin A derivatives. 
• Mercury in high doses may harm a developing baby's brain. Limit large loads of mercury by:
  • Limit orange roughy (sea perch) or catfish to 150 g/week and to have no other fish that week or 
  • Limit shark (flake) or billfish (swordfish/broadbill and marlin) to 150 g/two weeks and to have no other fish during those two weeks

Examples of low mercury fish that are high in omega-3 fats include sardines, mackerel, silver warehou, Atlantic salmon, canned salmon and tuna in oil and herrings. Pregnant women are advised to consume 300-450 g/week of lower mercury fish and seafood. 

• Food safety is important to minimise the risk of food-borne illness. Elevated progesterone levels in pregnancy suppressed the immune system, making women more prone to infection and illness. In particular, we want to reduce the risk of foodborne illnesses listeriosis, toxoplasmosis, campylobacteriosis and salmonellosis. The consequences of foodborne illness can be particularly devastating during pregnancy because both the woman and her foetus are at risk. Risk is very rare, especially in Australia (> 300,000 pregnancies per year and around seven cases of listeria during pregnancy). 

Listeria risk:

• raw or unpasteurized dairy products, fruit juices or cider
• soft and semi-soft cheeses (e.g. Brie, Camembert, feta), blue-veined cheeses, gorgonzola, Hispanic-style fresh cheeses (e.g. queso blanco) unless they are cooked until steaming hot 74°C
• refrigerated pâtés, meat spreads and smoked seafood 
• pre-packaged or prepared fruit/vegetable salads and raw sprouts 
• ready-to-eat deli meats and ready-prepared meals unless they are reheated until steaming hot (74°C)
• raw or undercooked meat, poultry, seafood and eggs.

Toxoplasma, Campylobacter and Salmonella infection:

• Unpasteurized milk products and juices. 
• Raw or undercooked meat, poultry, shellfish and eggs.
• Rinse fresh fruits and vegetables thoroughly. 
• Avoid raw sprouts.
• Follow safe food handling practices including washing hands and food preparation surfaces well.

Sushi - generally safe if the raw fish has been previously frozen, and is from a source that you trust. If raw fish hasn’t been previously frozen, it may contain small parasitic worms, called anisakis worms. And you don’t want day old rice - salmonella and listeria risk. 

• Alcohol - no safe level and the recommendation is to avoid alcohol during pregnancy 
• Avoid excessive flaxseed (linseed) intake - adverse events in rats 
• Artificial sweeteners - most common sweeteners in Aus - aspartame, stevia, sucralose, sorbitol, mannitol, isomalt, xylitol have been approved for use during pregnancy and lactation

https://www.pennutrition.com/KnowledgePathway.aspx?kpid=3043&tkid=22118&secid=3104#1

https://www.health.gov.au/resources/collections/pregnancy-care-guidelines-and-related-documents

https://www.health.gov.au/sites/default/files/lifestyle-considerations_0.pdf

Farmer's Markets https://mfm.com.au/ 

Get in touch

www.oncorenutrition.com

equiries@oncorenutrition.com

When it comes to dieting everyone is always looking for a quick fix.

Effectiveness of diets long term 

Interesting study https://www.bmj.com/content/bmj/369/bmj.m696.full.pdf

• It looked at “Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials”
• Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet.
• Outcome measures included change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, BP (systolic blood pressure & diastolic blood pressure), and CRP at 6 and 12 month follow-up.
• 121 trials made the cut (21,942 patients) - huge study
• Dietary intervention group assessed based on macro breakdown were:
  • Low carb (e.g. Atkins, south beach, zone)
  • Moderate marcos (e.g. Biggest Loser, DASH, Jenny Craig, Mediterranean, Portfolio, Slimming World, Volumetrics, Weight Watchers)
  • Low fat (Ornish, Rosemary Conley)
• Control group
  • Control diets included: maintain usual dietary habits, dietary advice (eg, received brochures, dietary materials including dietary guidelines, or consultation with a professional dietitian by email or telephone), and low fat diet (≤30% fat with or without advice about lowering calories). 
• Results:
  • Positive weight loss improvements at the 12 month follow-up diminished.
  • Improvements in cardiovascular risk factors largely disappeared except for Mediterranean diet for LDL reduction
  • Differences between diets are, however, generally trivial to small, implying that people can choose the diet they prefer from among many of the available diets to adhere to what works best for them.
• Bottomline: no matter if you like low carb, high carb, low fat, etc… diet’s are not effective in reducing weight and keeping it off.

Other large scale reviews confirm that diets simply don’t work 

Grade A evidence - NHMRC Clinical Practice Guidelines For The Management Of Overweight And Obesity In Adults, Adolescents And Children In Australia

• Weight loss following lifestyle intervention is maximal at 6–12 months. Regardless of the degree of initial weight loss, most weight is regained within a 2-year period and by 5 years the majority of people are at their pre-intervention body weight.
• Our suggestion: The intervention should never stop! 

Grade A evidence

• Modest weight loss improved CVD, T2DM risk factors and grade B evidence for sleep apnoea, joint issues, graed C for musculoskeletal problems, GI and urinary, self esteem, depression and QOL 
• For adults who are overweight or obese, strongly recommend lifestyle change—including reduced energy intake, increased physical activity and measures to support behavioural change.
• 6 For adults who achieve initial weight loss, strongly recommend the adoption of specific strategies, appropriate to their individual situation, to minimise weight regain
• NHMRC Guidelines  file:///C:/Users/Loz/Downloads/n57-obesity-guidelines-%20(1).pdf 

Also Scientific research that ideal BMI for longevity is 25-30kg/m2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855514/

https://www.bbmt.org/article/S1083-8791(05)01413-8/abstract

Why don’t diets work? 

A combination of physiology and psychology

For the physiology behind why it doesn't work Listen to Episode 18 

Interesting paper here https://www.ncbi.nlm.nih.gov/pubmed/23911805?dopt=Abstract

Dieting cycle

Biology: (listen back to ep18)

• Short term: 
  • Anyone who is below their set point (too thin for them) will experience many physiological symptoms, similar to that of starvation. 
  • What is important to know is that it doesn't matter what weight you start at, but rather what is normal for you.
  • Experience feeling of extreme hunger, metabolism suppressed so your body burns less energy, muscles use less energy during PA, feel cold, lethargic and obsessive over food - normal sx’s of your brain saying ‘alarm bells, food is needed’
  • Biological pressure to restore body weight gets stronger as weight loss increases.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/pdf/nihms904015.pdf
  • 
     
• Long term:
  • Some people will be heavier than when they started and others will develop disordered eating patterns

Psychological impact of dieting/weight stigma 

• Disordered eating patterns -greater emotional eating, uncontrolled eating, and loss-of-control eating
• Body image and self esteem concerns
• Psychological stress 
• Relationship breakdown
• Increased anxiety and depression

Summary 

• Weight is not tied to health and health looks different to everyone
• Lifestyle habits predict health better than weight alone
• If a ‘diet’ has a start and an end point - it’s unlikely to work. 
• There are some factors we don’t think of when it comes to health, e.g poverty, loneliness, hormones, low levels of physical activity.
• So much energy is wasted on trying to change weight, when we should focus on making other health improvements, e.g. exercise goal - start somewhere e.g. walking and progress, improved relationships with friends and loved ones, cook more 
• https://www.jabfm.org/content/25/1/9.full
• Willpower as a finite resource

What you can actually do

• Reduce decision fatigue
• Do it for YOU - explore your deep reasons why. We do this quite a lot with our clients. It may present as ‘the wedding’ or ‘reunion’ or to ‘feel better in my jeans’ or ‘fit into that dress’ but why is that actually important to you? Will it impact your self efficacy? 
• Use positivity. Research demonstrates that the feeling of success is more likely to drive positive change than actually achieving your goal 
• Emotions create habits 
• Micro goals - e.g change ‘exercise more’ to 2 squats per day, change ‘eat more veg’ to eat 1 carrot every 2 days. Can do more if you want, but you don’t have to. Beyond that is extra credit!
• Anchor your desired activities to things you already do, e.g. brushing teeth or showering. 

Common cancer nutrition myths

Sugar feeds cancer

More info here 

Juicing 

No evidence to support it’s use 

Can lead to deficiency in valuable nutrients, weight loss, protein energy malnutrition 

Antioxidant load can be potentially detrimental during radiotherapy and certain chemotherapy regimens. More information here. 

Alkaline diet

More info here

Organic 

• Studies on the foods themselves in terms of nutritional content, levels of chemicals and resistant bacteria
• Studies on the health of humans long term 
• When we look at organic vs non-organic there may be slightly higher concentrations of antioxidants in organic produce. This is only in general, as organic milk has been found to have lower mineral content, and varies depending on the source. 
• When we look at chemicals and pesticide residues, organic produce may reduce exposure to these but important to note that the levels of toxins in non-organic produce is generally well below safe limits
• When we look at health overall, in particular long term health of individuals that eat organic vs non organic produce, the benefits are far less clear. 
• No difference in cancer risk (studies of >600,000 women)
• Huge systematic reviews show no difference
• Some studies that report a difference need to be careful of other confounding factors. If we think about the profile of someone who may eat organic - they have chosen to and have the means to do so. In general,this often means they are more likely to be of a higher SES/income, better living environments, higher education level, health conscious therefore choose more fresh produce overall, get regular health check ups and screen for chronic diseases. It’s really difficult to attribute health benefits to the organic produce when there’s a whole bunch of other health-promoting behaviours, environmental and lifestyle factors contributing. 
• Bottom line: if you’ve got the means and it’s a priority for you - by all means! If you don’t - just keep aiming for your 5 serves of veggies and wash them well.

Soy

• Legume - soybeans or edamame - eaten whole or processed in numerous ways - fermented to produce tofu, tempeh, miso, natto. 
• Rich - rich in phytooestrogen ‘Isoflavens - which act like a weak oestrogen in the body. 
• Since many breast cancers need oestrogen to grow, it would stand to reason that soy could increase breast cancer risk. However, this isn’t the case in most studies.
• Most studies linking soy consumption to an increased risk of breast and other forms of cancer are 
• done in laboratory animals. But because humans metabolize soy differently than rodents, these findings might not apply to people.
• Most observational studies indicate that consumption of soy products may reduce the risk of hormonally driven cancers such as breast, prostate, or endometrial (lining of the uterus), and there is some evidence it may lower the risk of certain other cancers. This might be because the isoflavones can actually block the more potent natural oestrogens in the blood.
• Exposure early in life is beneficial and a change in soy intake in either direction, may be responsible for change in risk 
• Additionally, soy has been linked to a longer lifespan after breast cancer diagnosis.
• In a review of five long-term studies, women who ate soy after diagnosis were 21% less likely to have a recurrence of cancer and 15% less likely to die than women who avoided soy.

Dairy

• Dairy has been associated with reduced risk of colorectal cancer, but an increased risk of prostate cancer. Individualised advised, tailored to you, is key, 

Fasting

ESPEN Nutrition guidelines 

Anti-cancer diets 

There is no diet or food that has been proven to prevent or cure cancer

ESPEN Nutrition guidelines 

Other resources

https://www.wcrf-uk.org/uk/recipes/diet-cancer-myths-debunked

http://www.espen.info/wp/wordpress/wp-content/uploads/2016/11/ESPEN-cancer-guidelines-2016-final-published.pdf

Nil show notes. Contact us at enquiries@oncorenutrition.com with any questions, comments or requests.

40 meaningful things to do when stuck at home in a pandemic

1. Keep a routine

• Stick to a schedule. If you used to have a lunch break at 12:30, try to do the same. Factor in snack and tea breaks as well!
• And don’t forget to drink
• Position yourself somewhere that’s hard to get to the kitchen!

2. Check in with yourself. 

• There are so many reasons we eat beyond hunger and nutrients
• Why are you heading to the cupboard or fridge? Bored, procrastinating, stressed, emotions. Suss this out.
• Won't happen every time. But doing it sometimes might help reveal with honesty some patterns around your eating behaviours.

Strategies:

• Hunger fullness scale
• 10 minute challenge
• Put a wedge in
• During the meal - put your knife and fork down.
• Speed bump

3. Eat mindfully

• We can often find ourselves eating on autopilot, munching into a meal while our attention is on our screens,to-do lists, multi-tasking or wandering around the kitchen or house.
• Give yourself an opportunity to eat without distraction
• Serve your food for yourself how you would serve it to a special someone.
• Serve how much you want - rather than eating vita weats or crackers fresh out the packet, serve the 4, 10, however many you want on a plate! Prepare it.
• Sit down. Not at your desk. Grab a knife and fork or a drink.
• Switch off your devices, sit down uninterrupted.
• Give yourself the time and space to savour your eating experience and feel truly satisfied.
• Respect your food and yourself.

4. Just don’t buy it!

• If you struggle to stop at 1 or 2 tim tams and just end up feeling crap about it, don’t buy them!
• If you were trying to quit smoking would you have packets of cigarettes in the cupboard and fridge, in your desk drawer?
• Don’t dangle the carrot, it’s just cruel to yourself
• Nice vs kind
• Mindful eating starts well before you eat.
• Don’t shop hungry
• Review your goals - what you really want vs the quick high
• Check in at the shelves too!
• Research has shown that visual exposure to high calorie foods stimulates the striatum, a part of your brain that modulates impulse control, which may lead to increased cravings and overeating.
• Deprivation is not the answer. It is ineffective for long term weight loss and incredibly damaging to our relationship with food and our bodies.

5. Creative cooking!

• If you were fortunate enough to bulk purchase tinned tomatoes, now's your time to shine
• Home cooking vs take away = 20% fewer calories for the exact same meal
• Study of over 11000 ppl found that those who ate home cooked meals more than 5 x per week and better body comp (25% less likely to have excess body fat) and ate more veg and fruit.

6. Combat boredom

• Put a wedge in first: Walk to the letterbox, paint your nails, pat the dog, do 10 pushups...BEFORE you head to the kitchen.
• Consider why you’re bored on a larger scale.
• Online course, puzzle, book, create something (number paintings, ikea furniture), plants or home garden
• Our next episode we’ll be talking all about using your time to fuel your fire

40 meaningful things to do when stuck at home in a pandemic

Tim Spector experiment 

https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564

Tim Spector, professor of genetic epidemiology at King’s College London, enlisted his son Tom, a genetics student at University, to undergo an experiment where he lived on McDonalds food for ten days. 

Supersize me

• Spurlock ate at McDonald's three times per day - used himself as a guinea pig (n=1) for 30 days.
• Before starting the experiment he was assessed by doctors who confirmed he was in excellent health.
• He did minimal exercise and limited his steps to 5,000 per day to mimic the lifestyle of many Americans who don’t move much and eat fast food regularly.
• Average of 20.9MJ (5,000 kcal) (the equivalent of 9.26 Big Macs) per day during the experiment.
• 2.5 x the recommended caloric intake of average sized male 
• gained 11.1kg (24 lb) - 13% increase in weight 
• Increased his cholesterol
• Heart palpitations experienced
• Mood swings, sexual dysfunction, lethargy, fat accumulation in his liver. 
• It took him 14 months to lose all the weight gained 

Ultraprocessed Food

pre-cut and peeled pumpkin, potatoes and other veges, bagged salad leaves, bagged spinach, sliced vegetables, and unsalted, roasted nuts

Corn 

Apple

Canned, dried or frozen such as dried fruit, canned legumes/fish, cheese, pasta, frozen veg, pasteurized milk / yoghurt.

Recognisable ingredients

Make foods available out of season.

Canned corn 

Tinned apples

Food not in its original form or not naturally occurring, eg cereals, muesli bars, deli meats, oils, sugar and flours. 

Tortilla chips 

Apple juice 

Considered ‘junk food’ eg chips biscuits, chocolates, sweets, nuggets, energy bars, and carbonated and sugared sweet drinks. 

Doritos

Apple pie 

Other things that might be damaging your gut health

Smoking

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597605/

Artificial and naturally intense sweeteners

Saccharin, sucralose, stevia extracts shift the populations of gut microbiota. 

Several polyols (fermentable carbohydrates), including isomalt and maltitol, may increase bifidobacteria numbers in healthy subjects, as these polyols may have prebiotic actions.

Large scale human studies are needed 

https://academic.oup.com/advances/article/10/suppl_1/S31/5307224

We also know that in animal studies, when exposed to the artificial sweeteners, this saw a reduction in beneficial bacteria in the gut

https://www.ncbi.nlm.nih.gov/pubmed/25231862

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464538/

They can also give us a preference for a sweeter palate, meaning we crave or feel like sweeter foods..

Exercise (lack of)

• Recent studies suggest that physical activity may also alter the gut bacteria, improving gut health.
• Higher fitness levels have been associated with a greater abundance of butyrate, a short-chain fatty acid that's produced by fermentation of CHO’s in the lower GI tract, helps to keep the lining of our gut healthy and is also important for overall health.
• One study found that professional rugby players had a more diverse gut flora and twice the number of bacterial families, compared to the control groups matched for body size, age and gender 

https://www.ncbi.nlm.nih.gov/pubmed/25021423

https://www.hindawi.com/journals/omcl/2017/3831972/

https://www.ncbi.nlm.nih.gov/pubmed/25825908

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125889

Alcohol

https://www.ncbi.nlm.nih.gov/pubmed/22552027

• 20 days
• each individual consumed 272 ml of red wine OR de-alcoholized red wine or 100 ml of gin each day 
• Gin decreased the number of beneficial gut bacteria, 
• Red wine increased the abundance of bacteria known to promote gut health and decreased the number of harmful gut bacteria like Clostridium.
• The beneficial effect of moderate red wine consumption on gut bacteria appears to be due to its polyphenol content.
• Polyphenols are plant compounds that escape digestion and are broken down by gut bacteria. They may also help reduce blood pressure and improve cholesterol

What to focus on 

Prebiotic Fibre

• Chicory Root
• Jerusalem artichoke 
• Garlic
• Onion
• Leek 
• Asparagus 
• Less ripe bananas 
• Barley
• Oats
• Apples 
• Flaxseeds 
• Edamame