Sugar Substitutes

One of the things I am asked about most as a Nutritional Therapist and Health Coach is sugar substitutes. “What can I use instead of sugar ?” I am asked, so here’s the here’s the good, the bad and the ugly low down on some of  those sugar replacements you might think are healthy (and some that definitely aren’t).

Honey

Honey has a lot going for it in some regards. It contains amino acids, electrolytes and antioxidants, and antimicrobial compounds that can support your health. To get these extra benefits, you’ll want to choose a raw (unprocessed) local honey. It may also help relieve allergy symptoms, specifically hay fever, because the bees feast on the local pollen, and taking raw local honey can help you develop natural immunity over time. But, whichever way you cut it, honey is sugar. It may be natural, but sugar it is, and it behaves that way in your body, spiking blood sugar exactly as actual sugar would.

Medjool Dates

Dates are a popular feature of many paleo or natural sugar-free bars, because they are naturally very sweet. They have the highest nutritional benefit of all-natural sweeteners because they also contain minerals like selenium, copper, potassium and magnesium, as well as providing fibre to slow the speed at which the sugars hit your bloodstream. Studies show that they don’t spike your blood sugar levels that much and they’ve been proven to decrease cholesterol and boost bone health, and can help relieve constipation. Stick to 1 or 2 a day so there is no guilt associated with these caramel-like gems.

Maple syrup

It contains antioxidants (24 in fact), which are helpful in the fight against cell-damaging free radicals and inflammation. While studies show maple syrup does not spike your blood sugar levels as much, it is still wise to use sparingly. You’ll want grade A (lighter in flavour) or B (nutritionally better as it’s richer in antioxidants than grade A and with a more intense flavour). Avoid maple flavoured syrups as these are not the same.

Coconut sugar

Coconut sugar has become very trendy of late and brings a lovely caramel flavour to your food. It contains small amounts of iron, zinc, calcium, potassium, and antioxidants, and a fibre known as inulin which  may help reduce the absorption of glucose. It is perfect for baking with and has a lesser impact on your blood sugar levels than regular sugar, but it is still sugar, so use sparingly.

Palmyra Jaggery

You may not even have heard of this, but it’s the crystalized nectar collected from the flower of the Palmyra palm and has a deep, warm caramel flavour. You use it exactly as you would sugar, and often you can reduce the amount needed by up to a half. It’s packed with B vitamins and has a much lower GL than table sugar.

Brown Rice Syrup

This has found its way into ‘healthy’ recipes. It’s made from fermented, cooked rice. It’s not a particularly good option as a sweetener as it’s highly processed, contains very little in the way of nutrition benefits and the effect on blood sugar is almost identical to standard sugar.

Agave Syrup

Agave syrup comes from a cactus, and the syrup is made from the pulp of the leaf. It’s very highly processed and is mainly fructose, which needs to be processed by the liver, causing more stress for an already over-worked organ. Fructose is actually worse for you than glucose. Agave syrup (or nectar) is very similar to the (deservedly) much-demonised high fructose corn syrup, that has contributed greatly to the obesity epidemic in the US. My advice? Do not use it!

Stevia

This is another natural sweetener. There a number of different types of stevia, and ideally you want full, green leaf stevia that is unadulterated with other sweeteners. There are many brands out there that you should avoid because they’re so highly processed, and they also add in other chemicals. Pure stevia will not unbalance your blood sugar levels, thus avoiding an energy rollercoaster. But, a little bit goes a long way, so use sparingly.

Xylitol

Often found in the UK under the brand names Total Sweet or Xyla, xylitol is a sugar alcohol. It’s a little sweeter than sugar, has fewer calories and (the important part) 75% less carbohydrate, so the impact of blood sugar levels is lower than it would be if you were to eat the same amount compared to real sugar. It’s the same stuff used in sugar free chewing gum, thanks to its antibacterial properties. The downside is it is very highly processed, and some people can be sensitive to large amounts and may find their stools a little loose, or they get bloated, if they eat too much. Note as well that it is toxic for dogs.

Artificial sweeteners (like aspartame and saccharin)

People usually resort to artificial sweeteners in a bid to cut calories. This is bad news for a number of reasons, but I’ll mention the two biggies here: Research into some of them shows a correlation with cancer (weak, perhaps, and refuted by the food industry, but personally I’m not taking any chances). Secondly, nutrition science conclusively proves that weight gain/loss has little to do with calories in and out but what happens hormonally inside the body – how much insulin your body makes (insulin being the fat storage hormone that also sabotages fat burning). Recent research shows that these artificial sweeteners can increase blood sugar (and consequently insulin) levels more than normal sugar. So really, what is the point? Thirdly, research shows that ironically, they actually increase hunger. My advice is to stop now.

BUT…

The very best scenario of all is that you wean yourself off sweeteners of any kind as this helps you appreciate and embrace natural sweetness from real food. If you continue to eat sweet things, your taste buds will always want sweet things. That’s because sugar has been shown to have an effect on the brain similar to that of addictive drugs like nicotine, cocaine, heroin, and alcohol. In fact, quickly removing it from your diet can cause withdrawal symptoms, including fatigue, depression, headaches and muscle aches. No wonder it isn’t easy to quit.

If your diet has traditionally been quite high in the white stuff, the first few weeks can be a little tricky as your body (and brain and taste buds) starts to adjust – but bear with it.

 

 

 

Polycystic Ovary Syndrome (PCOS)

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

The Vitamin D Epidemic

By London Nutritionist Sylvia Hensher

How Vitamin D Deficient Is The UK?

A recent survey in the UK showed that more than half of the adult population in the UK has insufficient levels of vitamin D. In the winter and spring about 1 in 6 people has a severe deficiency. It is estimated that about 9 in 10 adults of South Asian origin may be vitamin D-deficient. Most affected people either don’t have any symptoms, or have vague aches and pains, and are unaware of the problem.

Why Do Your Vitamin D Levels Matter?

In addition to the well-known osteoporosis connection, deficiency of this fat-soluble vitamin can be linked to a wide range of health problems, from cancer and cardiovascular disease to cognitive impairment and problems with auto-immunity such as multiple sclerosis and type 1 diabetes. Huge increased research interest in this field is constantly bringing to light new evidence which underscores the enormous importance of vitamin D to human health.

Sources of Vitamin D

What many people don’t realise is that very few foods naturally contain vitamin D. Fortified milk, egg yolks and oily fish are the best sources, but we can’t rely on food to provide with optimal amounts of vitamin D on a daily basis. In fact, the major source (80 – 100%) of vitamin D is actually sunshine. Ultraviolet B (UVB) sunlight rays convert cholesterol in the skin into vitamin D.

That’s right, although cholesterol is often a much maligned substance, our bodies literally could not survive without it! The sunlight has to fall directly on to bare skin (through a window is not enough). To add to the complexity of this issue, age, skin colour, geographic latitude, seasonal variations in sunlight availability and sunscreen use can impact on your body’s ability to produce all the vitamin D it needs. For example, darker skins need more sun to get the same amount of vitamin D as a fair-skinned person and because of geographic location, people in the United Kingdom cannot synthesise vitamin D from November to the end of March.

Why the Vitamin D Epidemic? Continue reading “The Vitamin D Epidemic”

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Food Allergies & Sensitivities

By London Nutritionist Sylvia Hensher

Different Types Of Food Reactions

Type 1 Immune Reactions

The best known and well-studied form of food allergies is called a Type 1 immune reaction, also known as a classical food allergy. Type 1 food allergies occur in approximately only 2-5% of the population, mostly in children and are less frequent in adults.  The reaction is immediate, usually appearing 15 – 30 minutes from the time of exposure to the offending food substance. Usually occurring in people who are genetically predisposed, the immune system begins creating a specific type of antibody called Immunoglobulin E (IgE) to certain foods. One side of the IgE antibody will recognise and bind to the allergic food.  The other side of the antibody is attached to a specialised immune cell called a mast cell which is packed with histamine. Histamine is one of the chemicals that is released in the body as part of an allergic reaction, and which causes the itching, sneezing, wheezing, and swelling typical of allergic symptoms.  Primed for action, the IgE antibody now patiently waits for re-exposure to food allergens.

So, when you eat the allergic food the next time, IgE antibodies hungrily latch onto the food.  Instantaneously, histamine and other allergy-related chemicals are released from the mast cell, quickly bringing on the unwelcome symptoms of stomach cramping, diarrhoea, skin rashes, hives, swelling, wheezing or the most dreaded of all Type 1 reactions, anaphylaxis. Anaphylaxis is a severe, potentially life-threatening allergic reaction which causes your blood pressure to drop suddenly and your airways to narrow, blocking normal breathing. It requires immediate emergency medical attention.

Clinical approach: In Type 1 food reactions, offending foods are completely avoided and nutritional immune and digestive support provided.

Type 3 immune reactions

Type 3 immune reactions are much more commonly involved in food sensitivities than Type 1 reactions.  In fact, 45-60% of the population has been reported as having delayed food allergies.  A delayed food sensitivity also involves the immune system and occurs when your immune system creates an overabundance of antibody Immunoglobulin G (IgG) to a specific food.  The IgG antibodies, instead of attaching to Mast cells, like IgE antibodies in Type 1 allergies, bind directly to the food as it enters the bloodstream, forming food allergens bound to antibodies circulating in the bloodstream.  The allergic symptoms in Type 3 immune reactions are delayed in onset – appearing anywhere from a couple of hours to several days after consuming allergic foods.  This delayed onset makes pinpointing the culprit food difficult. In this instance, laboratory testing may be useful.

Delayed food reactions may occur in any organ or tissue in the body and have been linked to over 100 allergic symptoms and well over 150 different medical diseases.

Clinical approach: In Type 3 immune reactions, it is important to identify food triggers, either through food exclusion tests or laboratory testing (more on this below).Depending on the symptoms,  these foods are then excluded for a period of time, and then reintroduced on a rotational diet to avoid retriggering symptoms. In addition, nutritional immune and digestive support is provided.

Why Has the Incidence of Food Sensitivities Risen? Continue reading “Food Allergies & Sensitivities”

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Curcumin, Pain And Inflammation In Osteoarthritis

By London Nutritionist Sylvia Hensher

What Is Osteoarthritis?

In osteoarthritis, the cartilage that cushions your joints deteriorates and the synovial fluid that keeps your joints lubricated and cushioned is typically reduced as well. It is the most common form of arthritis among the elderly. It’s normally associated with “wear and tear” on your joints, but can also be caused by repetitive stress or acute trauma. The pain is a result of your bones starting to come into contact with each other as cartilage and synovial fluid is reduced.

It causes joint stiffness, pain, inflammation and swelling that can become debilitating. Many patients turn to non-steroidal anti-inflammatories (NSAIDs) and analgesics for pain relief but the regular, chronic use of these types of medications is associated with side effects such as cardiovascular problems, gastrointestinal harm and kidney and/or liver damage. If you are taking an NSAID, you are at approximately three times greater risk for developing serious gastrointestinal side effects than those who aren’t.

What Is Curcumin?

Curcumin is the pigment that gives the curry spice turmeric its yellow-orange color and is the active ingredient in the herb turmeric. Both the ancient Chinese and Indian systems of medicine have recognized curcumin’s beneficial properties for thousands of years, and now modern research is showing it may be one of nature’s most powerful potential healers.

Curcumin is known for its potent anti-inflammatory properties. The compound has been shown to influence more than 700 genes, and it can inhibit both the activity and the synthesis of enzymes such as cyclooxygenase-2 (COX2) and 5-lipooxygenase (5-LOX) that have been implicated in inflammation.

How Can Curcumin Help Osteoarthritis Patients? Continue reading “Curcumin, Pain And Inflammation In Osteoarthritis”

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