I have been enjoying reading dietitian, Ngaire Hobbins' book, Eat to Cheat Dementia. It reinforces the need to eat well as it looks after not only our hearts but also our brains!

We know that inflammation is bad for our brains and exercise and good food can stop this.  Here is my brief summary of the book:

Food

• Eat more antioxidants- put 5-6 colours of food on your plate
• No one food is magical but healthy eating is about eating combinations of good food
• Eating too much, even of healthy food, can cause inflammation

Exercise

• ​When it comes to exercise, "use it or lose it" rings true- keep active!
• Sedentary lives cause inflammation and weak bones and muscles. We know this from people who have spent time in zero gravity
• Plan to exercise or it doesn't happen!
• Try new exercises and activities- your brain likes to learn and be challenged
• Exercise should be a combination of aerobic, resistance, flexibility and balance

Water

• Drink water for your brain. Our sense of thirst declines as we age so drink even if you are not thirsty

If you are over 60 years

• Focus on eating enough protein and keep active to slow muscle loss

My goal in 2020 has been to walk more in the mornings. The dog enjoys it and walking in the morning means it gets done before other distractions take over. January has been a good month for walking for my husband and I (and our miniature Jack Russell, Bella). We have been walking 4 mornings a week, before the routine of busy school terms begins. 
How are you going with your new year's resolutions? The end of January is the time when things can start unravelling! Maybe now is the time to re-consider your goals you set with great enthusiasm when you were on summer holidays on 31 December- were they realistic? 
Remember change is hard but keeping your goals realistic and achievable helps you achieve them in the long term.
For us, it means adjusting our goal to aim for a morning walk from four times a week in January to once a week in school terms (plus the other activities we do like exercise classes and bike riding).
So don't feel guilty about making smaller goals if they are realistic. It is better to achieve something small than giving up altogether because your goals were too hard to achieve.

I have recently had an ulcer on my tongue- ouch! I hadn't realised how important my tongue is to chew- it has been hard to move food around my mouth when eating. I struggle to clear food out from my teeth and to chew food well. I have also noticed it is hard to speak properly with a sore tongue. It made me think of all the aged care residents I see who eat with weak tongue muscles- whether this is due to having had a stroke or dementia.

I have been collecting photos of food from the aged care facilities I work at to show the great food produced to help our residents eat well. Aged care food has had some bad press lately, and for good reason, as some facilities focus more on making profit than caring for residents and sometimes good food is definitely lacking. However the facilities I work in produce quality meals as most of it is cooked fresh on site.

Some meals are not perfect and it is a work in progress. I have been working with my speech pathology colleague, Janice Seton, about making sure our facilities provide food of the correct texture after the new international diet standards were introduced in May this year.

It is a pleasure to work with staff who take pride in the food they produce. I aim to help all staff see that we are working together to help our residents eat well and avoid weight loss.

I have been making my own muesli for a few years now. The family love it- either with yoghurt for a filling snack, or for breakfast. I have always wondered about it's nutritional value so I have analysed my recipe to compare with others.
Here are the results!
​
My muesli per 45 g serve (toasted)
884kJ, 14g fat, 6.6g sugar, 3.7g fibre
Carman's berry bircher muesli (untoasted)
797kJ, 6g fat, 11g sugar, 3.4 g fibre
Arnold's farm toasted full o fruit
820kJ, 5 g fat, 11g sugar, 4 g fibre
Macro organic protein, fruit, nuts & seeds muesli (untoasted)
759kJ, 6 g fat, 2 g sugar, 5.3 g fibre

As you can see the kilojoules or energy is all pretty similar. My muesli is high in fat but it is from good, or unsaturated, fats like seeds, nuts and some oil used for toasting. The sugar is moderate and the fibre is good too.​
I think the key issue here is portion size. Muesli is quite energy dense but small serves like 30-50g (about 1/4 cup) gives you good fats and fibre and a little sugar. I used to think that untoasted muesli is lower in fat and sugar but the numbers above show you really just have to check each label for it's merits.

Toasted Muesli
5 cups rolled oats
1 1/2 cups (200g) sunflower seeds
2 cups (300g) pepitas (pumpkin seeds)
1 1/2 cups (200g) slivered almonds
1 cup shredded coconut
1 cup wheat germ
1 cup dried apricots, chopped
1 heaped tsp ground cinnamon
1/2 tsp allspice
1/2 tsp nutmeg
1/2 cup honey
1/3 cup (80ml) canola oil

METHOD

1. Preheat oven to 160 degrees C. Line 3 baking trays with baking paper
2. Combine oats, sunflower seeds, pepitas, almonds, coconut and wheat germ in a very large bowl.
3. Heat the oil and honey together in a saucepan over low heat until mixed. Don't boil them! Remove from heat and add cinnamon, allspice and nutmeg and stir.
4. Add the oil to the dry mixture and mix well
5. Spread the mixture between the baking trays and bake for 10 minutes. Remove form the oven and stir and place back in the oven for another 10 minutes.
6. Remove from the oven and leave to cool completely. Stir in the apricots and store in an air tight container.
7. Serve with yoghurt, milk and fruit.

The low fodmap diet eases symptoms of irritable bowel syndrome (bloating, constipation and/or diarrhoea). After starting the low fodmap diet, most people feel better. Once symptoms have improved, the next step is to eat foods which challenge people with fodmaps one-by-one so they can work out which foods and how much of it affects them.
I went through this process in August and September.
The order in which I did the challenges are below.
I reacted mainly to lactose so I stick now to lactose free milk and yoghurt. If I have more than 1 piece of bread a day and/or pasta for a meal I have constipation. Large amounts of garlic, onion and stone fruit also cause problems. If I keep eating small amounts though, with a day's break between each, I can manage. 
Please see an Accredited Practising Dietitian about a low fodmap diet. The challenges can be complicated but the process is worthwhile to work out what what to eat to feel well.

To reduce my irritable bowel syndrome (IBS) symptoms I have been living the low fodmap diet.

I started with discussing my issues with my GP and had a coeliac disease blood test before I stopped eating wheat. He approved my trial of the low fodmap diet since I didn't have coeliac disease. If you are not eating wheat you can't be tested for coeliac disease. 

A diagnosis of coeliac disease means a strict gluten free diet for life. A wheat intolerance like the low fodmap diet means eating small amounts of wheat may be OK- these diets are very different and so the coeliac blood test is essential before starting the low fodmap diet.

Fodmaps are sugars in foods which cause bowel problems in sensitive people. High fodmap foods include milk, yoghurt, wheat (bread, wraps, rolls, pasta), onion, garlic, stone fruits, legumes, pears and apples.

Eating less of these foods reduces IBS symptoms (diarrhoea, bloating, constipation) in 75% of people with IBS. The second phase of the low fodmap diet is to challenge what reactions people get to high fodmap foods one by one.

It is important to record everything eaten and drunk and bowel symptoms each day. I have been using the Monash low fodmap app to do this.

Even I made mistakes by not knowing I was eating high fodmap foods. But remember that mistakes are not failures. If you write down your reactions to food you can treat these mistakes as challenges. For example, someone bought me a cappaccino one day and I drank it despite it not being on lactose free milk. I had wind that night and knew the cause! I treated it like a lactose challenge. 

It can be overwhelming when first starting the diet. At first I saw all the foods I couldn't eat but after a few weeks I made use of the foods I could eat. 

There are two low fodmap labelling programs which are pictured below which is a help.

Below are some foods that I have been eating on the low fodmap diet. In my next blog I will go through how my challenges went.

Dietary iron has been on my mind lately having had very low levels last year. Iron is well absorbed from meats especially if they are eaten with a source of vitamin C (like fruits and vegetables). Vegetarians and vegans can meet their iron needs with good planning and help from a dietitian!
Below is my resource I give to clients to help them eat enough iron. You will find how much iron different genders and ages need. The meal plan at the end shows how easy it is to make small changes to your diet to meet your iron needs.

I recently went to a 3D virtual reality seminar on understanding dementia. It was truly eye opening to experience dementia. In the scenario wearing the 3D glasses, we were put in the place of someone waking up and trying to find the toilet in their home during the night. Something so simple turned into a difficult and frustrating experience. There were many things which made it a challenge- the poor light, shadows, clothes and coloured mats on the floor, strange noises, and patterned walls and curtains.

In the second part of the seminar we saw how making a few changes to a home can make living with dementia much easier. These included plain wall colours, night lighting, getting rid of rugs, and putting signs on doors. These changes made it so much easier to find the toilet in the dark!

About dementia
Did you know that dementia is the second leading cause of death in Australia? Every day in Australia, 250 people are diagnosed with dementia. 
Dementia is a broad term describing a loss of memory, intellect, rationality, social skills and physical functioning. There are many different types of dementia and a range of symptoms- everyone with dementia has a different experience.

Some of these symptoms could be:

• tiredness
• losing things
• not recognising familiar faces
• not being able to manage cash
• not being able to make a decision
• not able to use a computer

One man with dementia said "I'm different, but somewhere inside me I'm still here".

Dementia is not a normal consequence of ageing but does increases in incidence as we age. Dementia is a difficult condition to live with as there is a lack of community awareness about it and people experience social isolation as their friends don't know what to say in response to the diagnosis. It means people lose independence and friends, and often an income and work especially in younger people with dementia.

Dementia friendly communities
The "Dementia friendly" initiative is aimed at helping people with dementia thrive in their local community by keeping them independent and with a reason for living.

Being dementia friendly means:

• Having staff who can help customers with paying for items when shopping
• Having clear signage
• People being helpful and friendly
• Acceptance for people with dementia
• Not treating those with dementia as strange or difficult. People with dementia are not trying to be difficult.
• Looking to provide flexible paid opportunities for people with dementia
• Communicating with simple, clear questions
• Being patient waiting for answers
• Being helpful for people who look lost or confused
• Showing dignity, empathy and respect.

A man with dementia said that "Life is good, but not as good as it used to be".

Through this seminar I have learnt that businesses and individuals can become dementia friendly by watching three short videos and earning a certificate and badge to prove it!
​
Check out the dementia friendly website and become a dementia friend like I did.
https://www.dementiafriendly.org.au/

I'll be writing more about diet and dementia in the months ahead so stay tuned!

It has been interesting to visit hospital as a patient, not to mention all the doctor's visits and travel beforehand. As I work in the health area it is a good experience to see things from a patient's perspective. I had laprascopic hysterectomy in March at Wollongong Private Hospital.
Here are my reflections:

• If you think your iron might be low, ask to get it checked. Don't go for months with low iron like I did
• Fasting and clear fluids before surgery is hard to follow
• When channel surfing I discovered Xena, the warrior princess, is still on TV after all these years!
• After surgery it's all about getting the bowels working again- ask the doctors and nurses plenty of questions about what to take and when. Don't assume everything will work when you start eating again. Movichol seemed to be recommended by the staff and worked quite well
• Remember high fibre foods (prunes, wholegrain cereals, lots of fruit and veg) and drinking plenty of water are very important
• Move around as much as you can, when the doctor says it's OK, which is sooner rather than later. I was walking around the hospital 12 hours after the op
• Jigsaw puzzles are a great way to rest!
• True friends come to the fore when you need them
• Consider an IPTAAS application for re-imbursement of travel and accomodation costs if you live in a rural area. An online application doesn't take that long:
• http://www.enable.health.nsw.gov.au/services/iptaas 

The frozen meal sections of our supermarket freezers are full of options! Frozen meals can be an easy way to get a nutritious meal for those who live alone. They are also convenient and people like them for a quick lunch. Then there are fresh prepared meals which is also an expanding market.

When looking at any of these meals there are few things to look for:

• Lots of vegetables (aim for 1-2 cups or fistfuls of vegies per meal)
• Lean protein (about a palm size)
• Less carbs (no more than 1/2 cup of cooked potato, rice or pasta)

Here are some numbers to guide you. 
Aim for:

• Less than 350cals (1500kJ) per meal
• Less than 770mg of sodium per meal (or <2300mg a day or 6g (1 tsp))
• Less than 17g of fat per meal (or <50g of fat a day for weight loss)
• Less than 17g of sugar per meal (or <50g of added sugar (13tsp) a day)

Of course, cooking your own meals will save you money, and probably extra sugar and salt. Cooking in bulk on weekends is a good idea and can provide leftovers which make for cheap, easy and healthier lunch meals.
Scan over the photos below to see points about their taste or nutritional value. If anyone wants more detailed info about these meals, please get in touch and I can send the info through.