Polycystic Ovary Syndrome (PCOS)

     Posted on Tue ,22/01/2013 by admin

What is Polycystic Ovary Syndrome?

Polycystic (literally, many cysts) ovary syndrome (PCOS or PCO) is a complex condition, characterise by hormonal imbalances that affects the ovaries (the organs in a woman’s body that produce eggs). In PCOS, the ovaries are generally bigger than average. The outer surface of the ovary has an abnormally large number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating hormones from the brain).The ovaries are polycystic, with many small follicles scattered under the surface of the ovary (usually more than 10 or 15 in each ovary) and almost none in the middle of the ovary. In PCOS, these follicles remain immature, never growing to full development or ovulating to produce an egg capable of being fertilised.

This means that ovulation (releasing an egg) may rarely occur and can therefore lead to reduced fertility. In addition, periods may be irregular or absent. Other features include excess weight and body hair.

What are the symptoms of Polycystic Ovary Syndrome?

Symptoms that occur if you do not ovulate

  • Absent, irregular or light periods- periods can be as frequent as every five to six weeks, but might only occur once or twice a year, if at all
  • Fertility problems – you need to ovulate to become pregnant. You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is one of the most common causes of infertility.

Symptoms that can occur if you make too much testosterone (male hormone)

  • increased facial and body hair (hirsutism): usually found under the chin, on the upper lip, forearms, lower legs and on the abdomen (usually a vertical line of hair up to the umbilicus) .This is the only symptom in some cases.
  • Acne: which may persist beyond the normal teenage years.
  • Thinning of scalp hair (similar to male pattern baldness) occurs in some cases .

Other symptoms

  • Being overweight or obese: a common finding in women with PCOS because their body cells are resistant to the sugar-control hormone insulin. This insulin resistance prevents cells using sugar in the blood normally and the sugar is stored as fat instead
  • Miscarriage (sometimes recurrent): one of the hormonal abnormalities in PCOS, a raised level of luteinising hormone (LH – a hormone produced by the brain that affects ovary function), seems to be linked with miscarriage. Women with raised LH have a higher miscarriage rate (65 per cent of pregnancies end in miscarriage) compared with those who have normal LH values (around 12 per cent miscarriage rate).
  • Depression or poor self-esteem may develop as a result of the other symptoms.

Diagnosis

At least two of the following occur in PCOS, and often all three:

  • At least 12 follicles (tiny cysts) develop in your ovaries.
  • The balance of hormones that you make in the ovaries is altered. In particular, your ovaries make more testosterone (male hormone) than normal. The main hormones that are made in the ovaries are oestrogen and progesterone – the main female hormones, but the ovaries also normally make small amounts of male hormones (androgens) such as testosterone.
  • You do not ovulate each month. Some women do not ovulate at all. In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate then you do not have a period.

Therefore, it is possible to have polycystic ovaries without the typical symptoms that are in the syndrome. It is also possible to have PCOS without multiple cysts in the ovary.

Incidence

PCOS is relatively common among infertile women. If affects up to 10 per cent of all women between the ages of 15 and 50. In the general population, around 25 per cent of women will have polycystic ovaries seen on an ultrasound examination. But most have no other symptoms or signs of PCOS and have no health problems. The ultrasound appearance is also found in up to 14 per cent of women on the oral contraceptive pill.

What causes polycystic ovary syndrome?

The exact cause is not totally clear. Several factors probably play a part. These include the following:

1. A small increase in the amount of insulin and cellular resistance to its actions- insulin is a hormone that you make in your pancreas and its main role is to control your blood sugar level. Insulin acts mainly on fat and muscle cells to stimulate them to take in sugar (glucose) when your blood sugar level rises (as excess levels are toxic to cells). Insulin also stimulates the ovaries to produce testosterone (male hormone).

Women with PCOS have what is called insulin resistance, meaning that cells in the body are resistant to the effect of a normal level of insulin. Thus, more insulin is produced to keep the blood sugar normal.  Raised levels of insulin in the bloodstream are thought to be the main underlying reason why PCOS develops because this causes the ovaries to make too much testosterone. A high level of insulin and testosterone interfere with the normal development of follicles in the ovaries. As a result, many follicles tend to develop but often do not develop fully. This causes problems with ovulation: hence period problems and reduced fertility. Increased testosterone levels in the blood cause excess hair growth on the body and thinning of the scalp hair.
2. Raised luteinising hormone (LH) in the early part of the menstrual cycle- This hormone is made in the pituitary gland and stimulates the ovaries to ovulate and works alongside insulin to promote testosterone production. A high level of LH is found in about 4 in 10 women with PCOS. A high LH level combined with a high insulin level means that the ovaries are likely to produce too much testosterone.

3. Lower amounts of the blood protein that binds to and carries all sex hormones (called sex-hormone-binding globulin)- this  means that testosterone levels are higher and therefore more active. Sex-hormone-binding globulin levels are reduced in insulin resistance (meaning there are high insulin levels).

4. Hereditary factors- one or more genes may make you more prone to developing PCOS. PCOS is not strictly inherited from parents to children, but it may run in some families.

5. Weight- Being overweight or obese is not the underlying cause of PCOS. However, if you are overweight or obese, excess fat can make insulin resistance worse, a contributing factor to PCOS. This may then cause the level of insulin to not only rise even further, but high levels of insulin can contribute to further weight gain, producing a ‘vicious cycle’.

Risk factors for PCOS

  • a tendency in the family towards Type 2 diabetes (non-insulin dependent diabetes)
  • a close relative who already has PCOS
  • a tendency towards early baldness in the men in the family (before 30 years of age).

Nutritional and lifestyle approaches to PCOS

Research has shown that weight control improves many aspects of PCOS. Menstrual cycles become more regular, testosterone levels are reduced, fat and sugar metabolism improves, and spontaneous pregnancy may follow. Obese patients do not have to reach the normal body mass index; a weight reduction of even a few percent has clinical benefits. This is because visceral fat (intra-abdominal fat located inside the abdominal cavity, packed between the organs) is metabolically more hormonally active, and weight loss of a few percent is associated with significant loss of visceral fat.

Weight management through nutrition and exercise is now recommended to all overweight/obese women with PCOS (Kovacs 2006).

So, here are some tips to help reduce the hormonal imbalances associated with PCOS:

1. Research has shown that fat intake should be restricted to not more than 30% of total calories with a low proportion of saturated fat, which is found mostly in animal products such as meat and dairy. Healthy fats such as olive oil, nuts/seeds, avocados, and fish oil, and avocado are important parts of a PCOS–friendly diet however (Farshchi et al 2007).

2. Choose whole grain carbohydrates. The insulin level in your blood goes up after you eat. It increase the most after you eat or drink something that contains carbohydrates. Carbohydrates are found in grains (such as bread, pasta, rice, cereal, and potatoes), vegetables, fruits and drinks such as soda and juice. Even if you eat two foods that have the same amount of carbohydrate, they may have a different effect on your insulin level. This effect has a lot to do with the type of carbohydrate the food has.

Whole grain carbohydrates which contain fibre such as brown rice, whole wheat bread and pasta, oats, barley, etc. have a low Glycaemic Index (GI). GI is a term used to describe how a food affects blood sugar; the higher a food raises blood sugar, the higher the glycaemic index. The benefit of consuming low GI foods is that it helps keep your insulin level down, and also keeps hunger at bay for longer, thus aiding weight management. Sugary foods or refined grains (such as white bread, white rice and white pasta) on the other hand have a high GI and can cause insulin levels to go up and are also not very filling (which means you may feel hungry again shortly after eating them.

3. Always have some protein with each meal or snack- combining a carbohydrate food with protein lowers the GI because protein slows the release of sugar from foods into the bloodstream. This helps reduce blood sugar spikes and therefore helps prevent high insulin levels. Protein can be found in lean meats, fish, poultry, dairy products, tofu, eggs, beans, nuts and seeds. Try to consume plenty of plant proteins which are often high in fibre and low in fat, rather than just sticking to animal proteins.

4. Have balanced meals containing carbohydrates, protein, and fat - combining foods that contain protein or fat with a carbohydrate will help to slow down the absorption of the carbohydrate and keep insulin levels low. For example, have almond butter or hummus on bread rather than just a piece of bread by itself. A typical plate of food should consist of ¼ carbohydrates, ¼ protein and the remaining ½ plate of vegetables!

5. Have smaller, more frequent meals (every 3-4 hours) to help control blood glucose levels. Your insulin will go up much more if you have 3 cups of pasta than if you have 1 cup of pasta. This means it’s usually better to have small meals and snacks during the day than it is to have fewer really big meals to keep your insulin level lower.

6. Exercise- Research has shown that at least 150 minutes of moderate or vigorous activity per week for diabetes prevention. This is because exercise helps  your cells become more receptive to the effects of insulin which in turn helps lower insulin levels (Knowler et al 2002).

7. Supplements- there are a number of supplements which can be very helpful to rebalance hormones. Recommendations are based on your individual health profile and are discussed at your visit.

References

Cahill D (2010) Polycystic ovary syndrome (PCOS) last accessed 21.3.2013 online at http://www.netdoctor.co.uk/womenshealth/facts/pcos.htm

Farshchi H Rane A Love A Kennedy RL (2007) Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management.  J Obstet Gynaecol 27 8 762-73

Kenny T (2010) Polycystic Ovary Syndrome last accessed 21.3.2013 online at http://www.patient.co.uk/health/Polycystic-Ovary-Syndrome.htm

Knowler WC Barrett-Connor E Fowler SE et al (2002) Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346 393-403

Kovacs P (2006) Viewpoint: Lifestyle Modification is First-Line Treatment for PCOS last accessed 21.3.2013 online at http://www.medscape.com/viewarticle/522390

Healthy Eating

     Posted on Thu ,15/12/2011 by admin

Do we really need to worry about what we eat?

These days, more and more people are telling us that healthy eating is very important for our health and well being. However, is it really all that important? A human being is made up of roughly 63% water, 22% protein, 13% fat and 2 % minerals and vitamins (Holford 2005). Every single molecule comes from the food you eat and the water you drink. Eating the highest-quality food, in the right quantities, can help you to achieve your highest potential for health, vitality and freedom from disease. For example, there is good evidence that eating a healthy diet can reduce your risk of obesity and illnesses such as diabetes, heart disease, stroke, osteoporosis and some types of cancer, including those of the bowel, stomach, mouth, and breast (Cancer Research UK 2009).

But eating healthily doesn’t just reduce your risk of ill health, it will also help boost your energy levels, mood, concentration and help you handle stress better, making you feel better all round.

How have our diets and lifestyles changed?

Although we are living in the 21st century, our human genome is greater than 10,000 years old.  The genome refers to our entire DNA, including our genes. Genes carry information for making all the proteins required by the body. These proteins determine, among other things, how well the body metabolises food or fights infection, and sometimes even how it behaves. Our ancestors consumed only natural and unprocessed food from the environment which provided them with a diet of moderate protein, high in fibre, vitamins, minerals, antioxidants and other beneficial plant chemicals. Thus, many researchers argue that there is a striking discrepancy between the diet we were biologically designed to eat and what we actually eat today.

Rapid changes in diets and lifestyles have occurred with industrialisation, urbanisation, economic development and market globalisation. While standards of living have improved, food availability has expanded and become more diversified, there have also been significant negative consequences in terms of inappropriate dietary patterns, decreased physical activities and increased tobacco use. This has corresponded with an increase in diet-related chronic diseases which are becoming increasingly significant causes of disability and premature death. For example, traditional, largely plant based diets have been replaced by an emphasis on animal-based foods and energy-dense diets which are high in fat- particularly saturated fat, and low in complex carbohydrates. Alongside this shift in dietary patterns, we have also switched to a much more sedentary lifestyle due to motorised transport, labour-saving devices in the home, the phasing out of physically demanding manual tasks in the workplace, and leisure time that is predominantly devoted to physically undemanding pastimes (World Health Organisation 2003).

Can nutrition help prevent disease?

It has been calculated that, in 2001, chronic diseases contributed to approximately 60% of the 56.5 million total reported deaths in the world and to approximately 46% of the global burden of disease- this is expected to increase to 57% by 2020(World Health Organisation 2003).

Chronic diseases are largely preventable diseases (World Health Organisation 2003). Although more basic research may be needed on some aspects of the mechanisms that link diet to health, the currently available scientific evidence provides a sufficiently strong and plausible basis to justify taking action now (World Health Organisation 2003). Modern dietary patterns and physical activity patterns are risk modifiable behaviours. Furthermore, nutrition has been shown to have the capacity to modify the expression of critical genes associated with normal physiological processes, as well as those associated with the development of disease, including age-related processes and cancer (Choi & Friso 2010). But diet, while critical to prevention, is just one risk factor. Physical inactivity, is now recognized as an increasingly important determinant of health, and is the result of a progressive shift of lifestyle towards more sedentary patterns.

What should we be eating?

There is no single “diet” which suits everyone-one man’s elixir could be another’s poison. However, there are some basics which apply to us all. Most people in the UK eat and drink too many calories, and too much fat, sugar and salt, and not enough fruit, vegetables and fibre.

Increase Fruits & Vegetables

It has been estimated that eating at least 5 portions of a variety of fruit and vegetables a day could reduce the risk of deaths from chronic diseases such as heart disease, stroke, and cancer by up to 20% (Department of Health 2000). But eating fruit and vegetables can help to achieve other dietary goals too, including increasing fibre intake, reducing fat intake, helping to maintain a healthy weight, and displacing foods with added sugars.

The reason why fruit and vegetables are so beneficial is because as well as containing fibre, vitamins and minerals, fruit and vegetables also contain many complex plant components called phytochemicals.  Phytochemicals are nonessential nutrients, meaning that they are not required by the human body for sustaining life, but they have protective or disease preventative properties. It is well-known that plants produce these chemicals to protect themselves but recent research demonstrates that they can also protect humans against diseases.

How many fruits and vegetables do we need?

The UK government recommends that we have AT LEAST 5 portions (400g) of a variety of fruit and vegetables daily, 2 of fruit and 3 of vegetables.

One portion of fruit:

  • half a large grapefruit
  • a slice of melon
  • 2 satsumas
  • 3 dried apricots, or 1 tablespoon of raisins
  • A glass of 100% juice- but you can only count juice as 1 portion a day, however much you drink. This is because it has very little fibre.

One portion of vegetables:

  • 3 tablespoonfuls of cooked carrots or peas or sweet corn
  • 1 cereal bowl of mixed salad.
  • Beans and other pulses, such as kidney beans, lentils and chick peas, count only once a day, however much you eat. While pulses contain fibre and protein, they don’t give the same mixture of vitamins, minerals and other nutrients as fruit and vegetables.
  • Potatoes don’t count towards 5 A DAY because they are starchy

Increase healthy fats

Eating too much fat can make us more likely to put on weight, because foods that are high in fat are also high in energy (calories). Being overweight raises our risk of serious health problems. However, this doesn’t mean that all fat is bad. We need some fat in our diet because it helps the body absorb certain nutrients, provides energy and essential fatty acids that the body can’t make itself.

Reading nutrition labels on food packaging can help you to reduce the amount of fat you eat:

• High fat foods: more than 20g of total fat per 100g
• Low fat foods: less than 3g of total fat per 100g

Reduce Saturated fats

There are two main types of fat found in food: saturated and unsaturated. Saturated and unsaturated fat contain the same amount of calories, but most people in the UK eat too much saturated fat: about 20% more than the recommended maximum. Eating a diet high in saturated fat can cause the level of cholesterol in your blood to build up over time which can increase your risk of heart disease. The main sources of saturated fat are meat and dairy products.

  • The average man should eat no more than 30g of saturated fat a day.
  • The average woman should eat no more than 20g of saturated fat a day.

Look out for “saturates” or “sat fat” on the label: this tells you how much saturated fat is in the food.

  • High: more than 5g saturates per 100g. May display a red traffic light.
  • Low: 1.5g saturates or less per 100g. May display a green traffic light.

Unsaturated fats

There are also 2 kinds of unsaturated fats: monounsaturated fats which are found in olive oil and avocados, and polyunsaturated fats called omega-3 and omega-6 which are found in nuts, seeds and oily fish.

Omega-3 and omega-6 polyunsaturated fats are essential for optimal functioning of the brain and nervous system, immune system, cardiovascular system and skin health. Pumpkin and flaxseeds as well as oily fish (including salmon, mackerel, trout, herring, fresh tuna, sardines and pilchards) are rich in omega- 3 fats, while sesame and sunflower seeds are rich in omega-6 fats.

We should aim to eat a small handful of a combination of seeds and nuts daily, as well as eat at least one portion of oily fish weekly. In addition, by increasing our intake of plant foods, as opposed to animal foods, we naturally shift to a more healthy fat consumption.

Avoid hydrogenated and Trans fats

Trans fats are formed when manufacturers turn liquid oils into solid fats. Think shortening and hard margarine. Manufacturers create trans fats via a process called hydrogenation, a process by which vegetable oils are converted to solid fats simply by adding hydrogen atoms. Why hydrogenate? Because hydrogenation increases the shelf life and flavour stability of foods. Indeed, trans fats can be found in vegetable shortening, margarine, crackers, cereals, candies, baked goods, granola bars, chips, salad dressings, fried foods, and many other processed foods.

Like saturated fats, trans fats can raise cholesterol levels in the blood. This is why it’s recommended that trans fats should make up no more than 2% of the energy (calories) we get from our diet. For adults, this is no more than about 5g a day.

Increase fibre

Fibre is the structural part of a plant that supports and holds it together. Fibre can be chewed, swallowed and subjected to stomach acid, yet much of it passes through the body unchanged.

Fibre is important because it:

  • stimulates the digestive tract and helps it work efficiently
  • encourages the presence of health-giving bacteria in the large intestine
  • softens the stool (bowel motion) and helps prevent constipation
  • slows down carbohydrate absorption, makes you feel fuller and so helps to control your appetite, and therefore helps with weight management
  • has also been associated with a decreased incidence of certain cancers of the digestive tract.

There are two types of fibre:

  • Insoluble fibre- insoluble fibre is less easily broken down by bacteria in the colon, so it passes through the gut, helping other food and waste products move through the gut more easily. It holds water very effectively (up to 15 times its weight in water) thus contributing to an increase in stool weight. Fruit and vegetables with their skins and pips, wholegrain cereals (wheat, quinoa, rye, rice) as well as nuts and some pulses are good sources of this kind of fibre.
  • Soluble fibre-this fibre forms a gel-like substance which can bind to other substances in the gut. It also has the extra benefits of lowering cholesterol levels and slowing down the entry of glucose into the blood, thereby helping to maintain good energy levels, concentration and mood. Fruits, vegetables, oats and pulses are good sources.

How much fibre do I need?

The recommended intake of fibre for adults in the UK is 18g a day, but 20 g -35 g in the US. However, most people in the UK don’t eat enough – the average intake is 12.6g a day for women and 15.2g a day for men.

So what does 18g of fibre look like? A few examples of the amount of fibre in some common foods include the following.

  • One bowl (30g) of high-fibre cereal, e.g. bran flakes – 4g
  • One slice of wholemeal bread – 3 to 4g (white bread contains less than half this amount)
  • One baked potato (with skin) – 5g
  • Half a tin of baked beans (200g) – 7.7g
  • Portion of dried figs (50g) – 3.8g
  • One medium-sized apple – 1.8g

Don’t forget the fluid

Without fluid, dietary fibre cannot do its job. Insoluble fibre, in particular, acts like a sponge absorbing water, increasing stool weight and size, thus putting pressure on the bowel wall and facilitating the movement of the stool. Without fluid this fibre is pointless and will only result in constipation.

Water

Two-thirds of the body consists of water and the body loses 1.5 Litres of water a day through the skin, lungs and gut and via the kidneys as urine, ensuring that toxic substances are eliminated from the body(Holford 2005). We also make about a third of a litre of water a day when glucose is “burned” for energy.  So our minimum water intake from food and drink needs to be more than 1 litre a day, with the ideal begin around 2 litres daily. Fruit and vegetables consist of around 90% water- 4 pieces of fruit and four servings of vegetables  can provide a litre of water, leaving 1  litre to be taken as water or diluted juices or herb or fruit teas. Alcohol acts as a diuretic and causes considerable losses of vitamins and minerals so it doesn’t count in this regard.

Should we be eating less?

We need to eat the right number of calories for our level of activity, so that we balance the energy we consume with the energy we use. Although consideration of calorie intake on its own is a simplistic view of weight management (and therefore also health management) if you eat or drink too much, you’ll put on weight. Likewise, if you eat too little for your energy requirements you’ll lose weight. The average man needs around 2,500 calories a day. The average woman needs 2,000 calories. Most adults are eating more calories than they need, and should eat fewer calories.

In fact, controlled, supervised calorie restriction is widely viewed as the most potent dietary means of slowing the aging process (Fontana et al 2004; Colman et al 2009).   Calorie restriction is a dietary regimen that restricts calorie intake, where nutrient dense, low-calorie foods are consumed to supply sufficient quantities of vitamins, minerals and other important nutrients. Generally, a calorie-restriction diet may call for 20 to 30 percent fewer calories than usual. Adult-onset calorie-restriction works best when it is imposed slowly, over two or three years, to allow the body to adjust.

How should we be eating?

We should always eat in a way which helps us maintain steady blood sugar levels. Why? Food is turned into glucose or sugar, which is the fuel that drives all cells and bodily processes. Thus, maintaining a steady supply of glucose to cells is key for optimal mental and physical functioning. However, blood sugar levels must be kept within strict boundaries, since too much is toxic to cells on the one hand, and too little makes us feel tired and lethargic on the other. This balancing process happens through the actions of two hormones. Firstly, insulin stimulates cells to take in glucose when there’s too much of it in the blood- this helps lower high blood sugar levels, but also provides cells with the fuel they need. Secondly, another hormone called glucagon breaks down stored sugar when blood sugar levels are low.

The negative effects of imbalanced blood sugar levels include irritability, poor concentration, fatigue, depression and food cravings- especially for sweet foods or stimulants such as tea, coffee and cigarettes, all of which in turn cause further blood sugar roller coasters.

How you can maintain steady blood sugar levels

1. Eat breakfast. The meaning of the word “breakfast” is literally “breaking the fast”. Blood sugar levels are low after an overnight fast and skipping breakfast will result in an inadequate supply of glucose to the cells. This can make you feel fatigued, moody and affect your concentration.

2. Don’t skip meals. This is for the same reason you shouldn’t skip breakfast- it will lead to low blood sugar.

3. Choose complex carbohydrates. Complex carbohydrates are broken down more slowly into glucose because of their fibre content and therefore provide a steady supply of fuel to brain cells. Complex carbohydrates are found in whole grains, nuts, seeds, legumes, and vegetables.

4. Avoid refined carbohydrates. They convert more quickly into glucose than complex carbohydrates. This causes rapid blood sugar spikes, which is then followed by blood sugar lows because the body keeps blood sugar levels within a narrow range to protect against the potentially toxic effects of sugar on cells. This rapid drop in blood glucose levels (below the optimal reference range) starves the brain of its primary fuel and we experience symptoms such as energy slumps, cravings for sweets and stimulants (tea, coffee, and cigarettes), irritability, mood swings, poor memory, poor concentration and fuzzy thinking.

Refined carbohydrates are found in white pasta/bread/rice (as opposed to their whole grain versions) and anything containing added sugar like cakes, sweets, ice cream etc. Natural sugars are found in fruit and are better sources of simple carbohydrates because they contain protective antioxidants as well as fibre, which slows down the release of fruit sugar into blood and so reduces blood sugar spikes.

5. Avoid stimulants such as coffee, chocolate and nicotine which increase levels of the stress hormones cortisol and adrenaline (Lovallo et al 2006) which sharply spike up blood sugar levels and subsequently leads to an energy slump as described above. Adrenaline and cortisol are “fight-or-flight” hormones, biologically evolved to help survival under stressful situations by breaking down stored sugar to heighten alertness and fuel muscles for emergencies. However, unless the extra sugar released in the blood stream is burned off through a physical response as in the “fight-or-flight” reaction in a genuine emergency, blood sugar levels will remain high. This will trigger a large insulin response and lead to low blood sugar levels because the body keeps blood sugar levels within a narrow range to protect against the potentially toxic effects of sugar. Usually this results in reaching for another cup of coffee or more chocolate and the blood sugar roller coaster starts over. When stimulants are consumed, blood sugar levels remain high because the “fight-or-flight” reaction has been artificially induced rather than through a genuine emergency and requires no physical “fight-or-flight” response which would use up the extra blood sugar and naturally lower blood sugar levels to safe ranges.

6. Make sure you consume protein with each meal and snack – this helps slow down the release of sugar from food into the blood. Choose from chicken and turkey, game, white fish, oily fish (tuna, mackerel, herrings, pilchards, sardines, and salmon), pulses, eggs, yoghurt, cottage cheese, feta, nuts and seeds.

How do you make healthy eating a habit?

  • Don’t try to change everything at once.
  • Set an easy goal you can reach, like having a salad and a piece of fruit each day.
  • Make a long-term goal too, such as having one vegetarian dinner a week.
  • Aim for balance. Most days, eat from each food group-vegetables and fruit, grain products, milk and alternatives, and meat and alternatives. Listen to your body. Eat when you’re hungry. Stop when you feel satisfied.
  • Look for variety. Be adventurous. Choose different foods in each food group. For example, don’t reach for an apple every time you choose a fruit. Eating a variety of foods each day will help you get all the nutrients you need.
  • Practice moderation. Don’t have too much or too little of one thing. All foods, if eaten in moderation, can be part of healthy eating. Even “treats” can be okay.

References

Cancer Research UK (2009) Diet, healthy eating and cancer last accessed 12.12.2011 at http://info.cancerresearchuk.org/healthyliving/dietandhealthyeating/.rs

Choi SW & Friso S (2010) Epigenetics: A New Bridge between Nutrition and Health. Adv Nutr (Bethesda)11 8-16

Colman RJ  Anderson RM Johnson SC (2009) Caloric restriction delays disease onset and mortality in rhesusMonkeys Science 325 5937 201–204

Department of Health (2000) The NHS Plan. London: Department of Health

Fontana L Meyer TE Klein S Holloszy JO (2004) Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans Proc Natl Acad Sci USA 101 6659-6663

Holford P (2005) The New Optimum Nutrition Bible Rev Upd Edition Crossing Press

Lovallo WR  Farag NH  Vincent  AS  Thomas  Wilson T(2006) Cortisol responses to mental stress, exercise, and meals following caffeine intake in men and women Pharmacol Biochem Behav 8 3 3  441–447

World Health Organisation (WHO) (2003) Technical Report Series 916: Diet, Nutrition And The Prevention Of Chronic Diseases last accessed 12.12.2011 at http://whqlibdoc.who.int/trs/who_trs_916.pdf

Copyright secured by Digiprove © 2011 Sylvia Hensher

Nutrition for Optimal Mental Functioning

     Posted on Wed ,07/12/2011 by admin

by London Nutritionist Sylvia Hensher

Research has shown that what we eat and drink influences brain functioning, which in turn can affect our mental state and performance 1. Read on to find out how your dietary habits may be affecting your mind-set and functioning at work.

Healthy and Unhealthy Fats

Omega‑3 Fats

Omega‑3 polyunsaturated fatty acids are found in cold water fish such as salmon, mackerel, halibut as well as in flaxseeds, pumpkin seeds, walnuts, and their oils. They are normal constituents of cell membranes and are essential for optimal brain function. Since the human body is inefficient in synthesising these fats, we are reliant on the dietary sources listed above. It is recommended that girls and women who might have a baby one day and women who are pregnant or breastfeeding should consume at least 1 portion of oily fish weekly and not exceed 2 portions weekly, while boys, men and women who are not planning on having a baby in the future should consume at least 1 portion of oily fish weekly and not exceed 4 portions oily fish weekly (a portion is about 140g).

Dietary deficiency of omega‑3 fatty acids has been associated with increased risk of attention-deficit disorder, dyslexia, dementia, depression, bipolar disorder and schizophrenia2-4.

Why is omega-3 so important for brain health? Research has found that an omega-3 fatty acid called docosahexaenoic acid (DHA) provides nerve cell membranes with “fluidity”- the capacity to transport signals from one nerve cell to another across synapses 5. Synapses are the junctions between nerve cells, and their optimal functioning is central to learning and memory.  DHA also provides “plasticity”- the ability of the brain and nervous system to change/adapt structurally and functionally as a result of environmental input; this is required for learning, memory, and in recovering from brain damage 6.

Saturated and Trans fats

In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, epidemiological studies indicate that diets high in trans and saturated fats adversely affect cognitive performance 7. Trans fats are found in margarine, vegetable shortening, processed foods such as ready-made pies, cakes & cake mixes, biscuits, pizza, crisps, doughnuts, gravy & sauce mixes, artificial creamers and confectionery. Saturated fat is found mostly in meat and dairy products, including butter, as well as some vegetable oils such as coconut and palm oils (tropical oils). The precise mechanism underlying these detrimental cognitive effects induced by high consumption of these fats is not well understood, but it is thought that they negatively affect the fluidity of cell membranes. In addition, it is suggested that they also induce hormonal abnormalities, including the development of insulin resistance (disturbed blood sugar control), and thereby mediate the cognitive deficits associated with high trans and saturated fat consumption 8.

We do need some saturated fats for healthy functioning, but the average man should eat no more than 30g of saturated fat a day and the average woman no more than 20g of saturated fat a day. Trans fats should be kept to an absolute minimum, not exceeding about 5g a day for adults, since unlike saturated fats they have no health benefits whatsoever.

Antioxidants

Oxidative damage

The brain is highly susceptible to oxidative damage because it consumes a large amount of oxygen and thereby generates an abundance of highly reactive molecules known as free radicals 9.   Continue reading »

Copyright secured by Digiprove © 2011 Sylvia Hensher

Mental Acuity & Performance

     Posted on Wed ,07/12/2011 by admin

A Corporate Nutrition article by London Nutritionist Sylvia Hensher

What is Mental Acuity?

Mental acuity measures the sharpness of the human mind and usually considers concentration, memory and understanding, but does not measure intelligence 1. Concentration can be defined as ‘the process by which all thoughts and senses are focused totally upon a selected object or activity to the exclusion of everything else2. Concentration, memory and understanding are interconnected, with the ability to concentrate being key. Take the example of memory lapses, which plague most of us at some point in our lives. For the most part, they can be explained as a consequence of poor concentration. Why? Because if your concentration is poor, then you won’t notice and retain information as much as much as you would if you are concentrating well 3 . It then stands to reason that poor concentration could also impair your ability to understand and carry out tasks at work. While poor concentration and associated impaired cognitive functioning usually isn’t serious, it can however have far-reaching effects; productivity can decline and impair performance, which in turn can lead to stress and mental exhaustion.

Influences on Mental Acuity and Performance

Firstly, motivation to succeed in the task is clearly important, and research shows that when individuals increase effort, they tend to focus more sharply on the task-at-hand4. This underscores the fact that concentration is not a static process, but one that changes over time, and maintaining the intensity and focus of concentration requires effort.

Secondly, emotions can influence our performance through their effects on concentration 5. For example, let’s look at anxiety and excitement. Anxiety is characterised by feelings of nervousness and tension, coupled with negative thoughts about performance. Continue reading »

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Mindless Weight Loss

     Posted on Fri ,07/10/2011 by admin

By London Nutritionist Sylvia Hensher

Introduction

Brian Wansink from Cornell University has spent much of his scientific career trying to understand what influences our food choices. His conclusion is that most of us are unaware of what influences how much we eat. We all think we’re too smart to be tricked by packages, lighting or the size of plates. We might acknowledge that others can be tricked, but not us. Yet every single one of us is influenced by what’s around us when it comes to deciding what and when we will eat.

In other words, we over-eat not because of hunger, but because of family and friends, packages and plates, names and numbers, labels and lights, colours, shapes and smells, cupboards and containers.

Read on to hear about his fascinating findings from decades of research into behaviour and eating patterns.

Brian Wansink on how to lose weight without thinking about it

The average person makes well over 200 decisions about food every day. Breakfast or no breakfast? Bread, bun or bagel? Part or all of it?

Every time we pass a dish of sweets or open up our desk drawer and see a piece of chewing gum, we make a food decision. Yet we can’t really explain most of these 200-plus decisions. Most of us are blissfully unaware of what influences how much we eat. Because although you can eat too much without knowing it, you can also eat less. Because, let’s face it, the best diet is the one you don’t know you’re on…

Strategy 1- Remove The Mindless Margin

Just ten extra calories a day – one stick of gum or three jelly beans – will make you a pound heavier in a year. And 140 calories a day – or one can of soft drink – will make you put on a stone. And you won’t even notice.

Fortunately, the same thing happens in the opposite direction. This is known as the mindless margin: those few extra calories that you can consume – or not consume – every day that you really don’t notice. By cutting out 100 to 200 calories a day, you can lose weight. That can mean not having one of your daily Starbucks. Or not tucking into a packet of crisps when you get in from work.

Cutting out your favourite foods entirely, however, is a bad idea: you’ll just feel deprived. Cutting down on how much you eat of them, on the other hand, is mindlessly do-able.

Simply dish out 20 per cent less than you think you will want before you start to eat. You probably won’t miss it. For fruit and vegetables, though, think 20 per cent more. If you cut down the pasta you eat by 20 per cent, increase the veggies by 20 per cent.

Strategy 2- See All You Eat

When people put their food on a plate, they eat about 14 per cent less. So instead of eating directly out of a package or box, put everything you want to eat on a plate before you start eating – whether it’s a snack, dinner, ice cream or even crisps. Leave the packaging in the kitchen and eat elsewhere. You’ll also eat less if you are able to see what you’ve already eaten.

Strategy 3- Be Your Own Tablescaper

Continue reading »

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Slow Cookers

     Posted on Wed ,21/09/2011 by admin

By London nutritionist Sylvia Hensher

Benefits of Slow Cookers

The advantage of the slow cooker is that it is able to do the cooking without any human intervention. The cooker takes the heat and indirectly applies it to the food so that the food cooked slowly and evenly. As the slow cooker uses low heat, the food is not burned without stirring. Furthermore, the slow cooker is an economical appliance to use for cooking. It uses as little electricity as a 75-watt light bulb and substantially less energy as compared to an electric oven.

The slow cooker means you can go to work all day and come back to enjoy home-cooked food without having to spend time in the cooking process. In the morning before leaving for work you can easily place all the food ingredients in the slow cooker and set it on low. By the time you  come back from work in the evening, a tasty, nutritious, home-cooked dish will be ready.

Tips For Using Slow Cookers

1. Keep it convenient- Make the slow cooker fit your schedule. Prepare a recipe in the morning and let the slow cooker work all day. Or, get everything ready the day before, cover and refrigerate overnight, and wait until morning to start slow cooking.

2. Use fresh ingredients- Avoid using frozen ingredients, especially meat and poultry, which take longer to cook and can disturb the overall timing of a recipe.

3. Stock the crock the right way-For best results, the slow cooker should be half to two-thirds full. When making soups and other dishes that need to simmer, leave a two-inch gap between the food and the top of the slow cooker. Place ingredients that take a long time to cook—root vegetables and large cuts of meat, for example—on the bottom of the slow cooker so they have maximum heat exposure. More delicate items, such as rice, pasta, dairy products, and certain vegetables, should be added during the last hour of cooking.

4. Keep the lid on, stir sparingly-In general, keep the lid securely on the slow cooker to avoid heat loss, which slows down cooking. However, it’s ok to occasionally lift the lid and stir. In fact, if your slow cooker has hot spots, stirring can be helpful.

5. Season later, not sooner- Slow cooking tends to mellow seasoning so be sure to taste your dish to see if you need to add additional salt and pepper at the end of cooking. Better yet, wait until cooking is nearly complete to season your dish. It’s also a good idea to add fresh herbs near the end, as they have a tendency to blacken when cooked for any length of time.

Slow Cooker Recipes

Continue reading »

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Food to boost your mood

     Posted on Wed ,03/08/2011 by admin

by London Nutritionist Sylvia Hensher

Can you alter your mood through your food?

Many people are seeking to take control of their mental health using self-help, and to find approaches to help reduce the need for, or to use alongside prescribed medication. One self-help strategy is to make changes to what we eat, and there is a growing interest in how food and nutrition can affect emotional and mental health. We don’t have the whole story yet, but there are some interesting clues. Food appears to affect our mood by bringing about chemical and physiological changes in our brain structure.

A survey in the UK (1) of 200 people found that 88% of participants reported that dietary changes improved their mental health significantly: 26% said they had seen large improvements in mood swings, 26% in panic attacks, 24% in cravings, 24% in depression, 22% in irritable/aggressive feelings, 19% in concentration/memory difficulties. People also said that cutting down on food “stressors” and increasing the amount of “supporters” they eat had a beneficial effect on their mood. Stressors highlighted included sugar (80%), caffeine (79%), alcohol (55%), chocolate (53%), wheat-containing foods (48%), additives (47%) and dairy (44%). Mood supporters included water (80%), vegetables (78%), fruit (72%), oily fish (52%), nuts and seeds (51%), ‘brown’ (wholegrain) food (50%), fibre (48%) and protein (41%).

In addition, Mind, a charity which helps people take control of their mental health, has received numerous reports of improvements in a wide range of mental health problems by people making dietary changes, including: mood swings, anxiety, panic attacks, cravings or food ‘addictions’, depression (including postnatal depression), irritable or aggressive feelings, concentration, memory difficulties, premenstrual syndrome (PMS), obsessive-compulsive feelings, eating disorders, psychotic episodes, insomnia, fatigue, behavioural and learning disorders, and seasonal affective disorder (SAD) (2).

Which foods can negatively affect mood?

The foods and drinks that most often cause problems are those containing alcohol, sugar, caffeine, chocolate, wheat (such as bread, biscuits, and cakes), dairy products (such as cheese), certain artificial additives (or E numbers) and hydrogenated fats. Other commonly eaten foods, such as yeast, corn, eggs, oranges, soya and tomatoes may also cause symptoms for some people. A qualified nutritionist can help identify suspect culprits.

How can your food boost your mood?

1. Don’t avoid carbohydrates, but choose the right ones-The connection between carbohydrates and mood is all about tryptophan, a non-essential amino acid. As more tryptophan enters the brain, more serotonin is synthesised in the brain, and mood tends to improve (3). Serotonin, known as a mood regulator, is made naturally in the brain from tryptophan with some help from B vitamins. Foods thought to increase serotonin levels in the brain include fish and vitamin D.

There’s a catch though: while tryptophan is found in almost all protein-rich foods, other amino acids are better at passing from the bloodstream into the brain. Thus, by eating more carbohydrates you can help boost your tryptophan levels; carbohydrates seem to help eliminate the competition for tryptophan, so more of it can enter the brain and help boost your mood. However, it’s important to make good carbohydrate choices like whole grains, fruits, vegetables, and legumes, which also support positive mood in other ways by helping to stabilise blood sugar levels and contributing important nutrients and fibre (4).

2. Eat More Omega-3 Fatty Acids-your brain is 60 % fat if you take out all the water. This fatty tissue needs replenishing, but you need to know which fats will nourish your brain the best. Essential fatty acids known as Omega-3 and Omega-6 are intimately involved in brain function and deficiencies or imbalances in brain fats are now known to be associated with numerous mental health problems.

In particular, researchers have noted that omega-3 polyunsaturated fatty acids (found in oily fish, flaxseed, and walnuts) may help protect against depression. This makes sense physiologically, since omega-3s appear to affect neurotransmitter pathways in the brain. Past studies have suggested there may be abnormal metabolism of omega-3 in depression, although some more recent studies have suggested this association may not be as strong as previously thought. Aim for two to three servings of fish per week, of which at least 1 should be oily (5).

Some common symptoms of omega-3 deficiency or omega-3: omega-6 imbalance include:

  • Excessive thirst
  • Chronic fatigue
  • Dry or rough skin
  • Dry hair, loss of hair or dandruff
  • Premenstrual syndrome (PMS) or breast pain
  • Eczema, asthma or joint aches
  • Dyslexia or learning difficulties
  • Hyperactivity
  • Depression or manic depression
  • Schizophrenia

The best foods to feed your brain are:

  • Omega-3: flax seeds (linseeds), hemp seeds, pumpkin seeds, walnuts, salmon, mackerel, herring, sardines, anchovies, eggs.
  • Omega-6: sunflower seeds, sesame seeds, pumpkin seeds.

3. Eat a Balanced Breakfast- eating breakfast regularly can lead to improved mood, along with better memory, more energy throughout the day, and feelings of calmness (6). It seems sensible then to reason that skipping breakfast would do the opposite, leading to irritability, anxiety and fatigue.  So what should you be eating for a good breakfast? Lots of fibre from whole grains, nuts or seeds, as well as legumes (such as baked beans), some lean protein, omega-3 and/or omega-6 fats

4. Follow a Mediterranean Diet- the Mediterranean diet is a balanced, healthy eating pattern that includes plenty of fruits, nuts, vegetables, cereals, legumes, and fish — all of which are important sources of nutrients linked to preventing depression.

In particular, the low levels of the B vitamins folate and B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population (7). These B vitamins help to control “methylation”, a chemical process which goes on throughout the brain and body and helps to turn one neurotransmitter into another.  The brain uses these neurotransmitters to communicate, sending messages from one brain cell to another. Folate is found in Mediterranean diet staples like legumes, nuts, many fruits, and particularly dark green vegetables. B-12 can be found in all lean and low-fat animal products, such as fish and low-fat dairy products.

5. Balance your blood sugar levels- The most common underlying imbalance in many types of mood disorders is fluctuating blood sugar levels. The negative effects of imbalanced blood sugar levels include irritability, poor concentration, fatigue, depression and food cravings- especially for sweet foods or stimulants such as tea, coffee and cigarettes, all of which in turn send your blood sugar levels on a roller coaster. Here are the most common symptoms of blood sugar imbalances:

  • Difficulty concentrating
  • Heart palpitations
  • Fainting, dizziness or trembling
  • Excessive sweating or night sweats
  • Excessive thirst
  • Chronic fatigue
  • Frequent mood swings
  • Forgetfulness or confusion
  • Tendency to depression
  • Anxiety and irritability
  • Feeling weak
  • Aggressive outbursts or crying spells
  • Cravings for sweets or stimulants
  • Drowsiness after meals

A few simple steps you can take to help balance your blood sugar: Continue reading »

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Mood and Performance

     Posted on Wed ,03/08/2011 by admin

A Corporate Nutrition article by London Nutritionist Sylvia Hensher

The power of mood on staff motivation

Research has shown that the mood people bring with them to the workplace at the start of each day, “waking up on the right or wrong side of the bed” influences worker mood throughout the day more powerfully and consistently than any other variable (1). This is not surprising since the boundary between our work and non-work roles is permeable (2). Our mood at the beginning of the day may come from challenges and opportunities we are presented with, positive or negative family experiences before leaving for work, or even the commute into work.

Employees are rarely able to check their emotions at the door, nor are they emotional islands while at work. Whereas start-of-day mood might lead to greater “stickiness” in work mood later in the day, ongoing work interactions can be an important source of positive or negative fluctuations in work mood throughout the day (3). In short, our interactions with others might influence our work mood during the day through the emotional state and mood of others (4).

Consequently, staff with low mood could potentially de-motivate their colleagues by their attitude and lead to underperformance. Conversely, staff with positive mood could help optimise work performance among co-workers.  Thus, the emotions we experience at the start of the day and the emotional state of those we interact with at work can consequently have a profound effect on how we feel and ultimately perform at work.

The effect of mood on work performance-why it matters

Research has found that negative mood can reduce performance outcome; for example, in customer service work settings, it has been shown to reduce the turnover of calls per hour (5).  Workers in a negative mood also need to expend effort to conceal their mood to co-workers and customers (6) which uses up valuable mental and physical resources (7) and could lead to underperformance at work.

On the other hand, positive mood can help employees obtain favourable outcomes at work (8). In particular, research has Continue reading »

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Fatigue & Performance

     Posted on Wed ,03/08/2011 by admin

A Corporate Nutrition article by London Nutritionist Sylvia Hensher

Prevalence of fatigue among the workforce

Fatigue is an everyday experience common among the general working population, with UK prevalence estimates as high as 22% 1 and US prevalence rates ranging as high as 45% 2. Broadly defined as “a feeling of weariness, tiredness or lack of energy,” 3.  Fatigue is best viewed on a continuum with behavioural, emotional and cognitive components 4.

Causes of hazardous fatigue

Fatigue is caused by prolonged periods of physical and/or mental exertion without enough time to rest and recover. By the end of the day, some fatigue is normal but hazardous levels of fatigue can be due to one or more of the following:

  • Feeling stressed for extended periods
  • Excessive workloads
  • Long shifts
  • Working long hours in total over the week or longer periods
  • Working nights
  • Inadequate sleep, particularly over extended periods
    • Iron deficiency anaemia
    • Chronic pain
    • Infections, such as flu
    • Depression
    • Anxiety
    • Cancer
    • Thyroid dysfunction
    • Diabetes
    • Chronic fatigue syndrome (CFS)
    • Lifestyle factors: obesity, insufficient physical activity 5, environmental stressors (eg, personal relationships)
      • Psychosocial work characteristics: job demand, decision latitude, social support, and job strain6

The effects of fatigue on work performance

Employees with fatigue experience more concomitant physical health problems, bodily pain, poorer general health, vitality, and social functioning than workers without fatigue 7. Fatigue has been associated with accidents, injuries 8, and ill-health 9, 10, all of which indirectly impair work performance. Fatigue can also restrict an individual’s ability to compensate physically or mentally for functional impairment from other concurrent health conditions 11. Continue reading »

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Energise Your Diet

     Posted on Thu ,28/07/2011 by admin

by London Nutritionist Sylvia Hensher

One of the most common causes of visiting a healthcare practitioner is the complaint of fatigue. There are different kinds of fatigue. It may be constant, beginning in the morning after a full night’s sleep or it may build up throughout the day. Your nutritional status can and does play a major role in the prevention and treatment of fatigue.  Here are some factors to consider when trying maximising your energy levels throughout the day.

Nutritional causes of low energy

  • Eating refined carbohydrates and sugars: these are found in white bread, rice and pasta, cakes, honey, jam, soda drinks, sweets. These foods are digested quickly and therefore rapidly release sugar (glucose), the main source of fuel for our cells, into the bloodstream. This provokes the release of excess insulin, a hormone which controls blood sugar levels by stimulating cells to take up glucose, as excess glucose is toxic to tissues. Excessive amounts of insulin remove excessive amounts of sugar from the blood, which results in low blood sugar; this can reduce the glucose supply to cells which depend on glucose for energy and therefore reduce our energy levels.
  • Food sensitivities: allergenic foods can act as a stressor on the body and lead to low blood sugar so that cells lack enough sugar (glucose) for optimal functioning, making you feel tired.
  • Nutrient deficiencies such as B and C vitamins, iron, magnesium, zinc and copper which are needed for energy production can lead to low energy
  • Stimulants such as coffee, chocolate and nicotine increase levels of the stress hormones cortisol and adrenaline (1) which sharply spike up blood sugar levels. This causes the release of large amounts of insulin to remove the excess sugar which is not used by the body and subsequently leads to an energy slump.
  • Dehydration- every cell in your body needs water for a myriad of chemical reactions, including the burning of glucose and the breakdown of fat for energy production.

Other causes of low energy

  • Stress leads to a sugar imbalance because it triggers the release of hormones such as adrenaline and cortisol which increase blood sugar levels. This stimulates the release large amounts of the hormone insulin, which removes the excess glucose from the blood, leading to low blood sugar and insufficient energy supply to our cells
  • Anaemia-this refers to a condition in which the blood is deficient in red blood cells or the haemoglobin (iron-containing) portion of red blood cells. The function of red blood cells is to transport oxygen from the lungs to the tissues of the body and help turn fats, carbohydrates and proteins into energy. Thus a lack of red blood cells reduces the amount of oxygen being delivered to tissues and thus energy levels. Iron, vitamins B12 and folic acid are needed to make properly functioning red blood cells, and anaemia may be caused by a shortage of these nutrients.  These nutrient deficiencies may be due to a poor diet, heavy menstrual bleeding, pregnancy or poor nutrient absorption as found in coeliac disease and Crohn’s disease.
  • Poor adrenal functioning-the adrenal glands sit on top of the kidneys and The adrenal glands are situated on top of the kidneys and one of their main jobs is to release hormones which help the body maintain a state of alertness as well as help raise  blood sugar levels when they are low. If the adrenal glands are overworked due to constant uninterrupted stress and poor nutrition, their ability to produce hormones which help maintain steady blood sugar levels can become compromised.
  • Poor thyroid functioning- The thyroid controls energy production, so an underactive thyroid can result in reduced energy production, making us feel tired..

Optimising your energy levels through nutrition and lifestyle Continue reading »

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