My doctor informed me recently that my vitamin D level was quite low. This surprised me as I get outdoors by gardening and walking the dog several times a week, especially in summer. However I do work inside every day which is a risk factor for having low vitamin D levels.  We should have 50nmol/L of vitamin D in our blood at the end of winter (when we are inside more) and we would expect to have 60-70 nmol/L in summer. My level was only 52nmol/L in December, which was why I needed a vitamin D supplement.

Vitamin D helps us absorb calcium from our gut and keeps our bones strong. The main source of vitamin D is sunlight. We need a few minutes of sunlight on our skin most days in summer to get enough vitamin D while avoiding skin damage. In winter, we need 2-3 hours of sunlight a week on our skin to make enough vitamin D.

Low vitamin D levels (which occurs in 30% of Australians) puts us at higher risk of osteoporosis, joint and bone pain, falls and broken bones. 

I went to buy a multi-vitamin supplement but realised some only a small amount of vitamin D. If you need a supplement take 600IU a day (15 ug) and if you are over 70 years then aim for 800IU (20ug) a day.
Nature's Way vita gummies= 2.5ug= 100IU
Centrum Advance= 15 ug vitamin D3= 600IU
Cenovis women's multi= 5ug= 200IU

I have one of these Swisse supplements every night with 1000 IU which should boost my vitamin D level and I will have it checked in a few months.

(1 ug of vitamin D= 40 IU).

​I have just done an eating disorder online course with Inside Out. It was very helpful for me to up-skill in this area to help clients with disordered eating. Here are some myths and facts about eating disorders.
Myths 1- parents do not cause their children to have eating disorders.
There are many factors which contribute to people having an eating disorder. Dieting is the single biggest contributing factor to developing an eating disorder. Other factors are: having high expectations or trouble regulating emotions, anxiety, depression, genetics, focusing on appearance in the family, friends or on social media, and following pursuits focusing on weight (dancing, athletes, actors).
Myth 2- everyone who has an eating disorder is female.
Actually one-third of people with eating disorders are males.
Myth 3- people with eating disorders are seeking attention.
Eating disorders are, in fact, serious mental illnesses. Sometimes people develop an eating disorder as a way of coping with personal challenges or as a way to numb difficult emotions. 
Myth 4- bingeing is a sign of weakness.
Bingeing is not showing weakness but is a natural response to dieting. When we restrict the food we eat, sometimes to the extent of starvation, hunger increases and drives us to eat for survival. The key to recovery from eating disorders is eliminating dieting thoughts and behaviours. Other things to aid recovery include people accepting their own size and shape and not compromising health for appearance.

If you know anyone who needs help see
Butterfly foundation: https://butterfly.org.au/ 
Inside out: https://insideoutinstitute.org.au/
Of course anyone with concerns is welcome to book into see me about these issues.

Reflux is a burning sensation in the  gut or throat caused by acid from the stomach moving up the food pipe (or oesaphagus). It can be very distressing and uncomfortable.
Reflux can be caused by:

• large meals, coffee and alcohol  
• pressure in the stomach from pregnancy, wearing tight clothes, bending and/or overweight
• pressure in the gut from constipation
• anti inflammatory drugs
• coffee, alcohol, fat and smoking can relax the valve at the top of the stomach meaning acid escapes up the oesaphagus

Here are some tips to reduce reflux if it is bothering you:

• Avoid or limit alcohol and caffeine
• Avoid high fat foods like fried food, hot chips, pastries, cakes, biscuits and creamy desserts
• Eat smaller portions at meals
• Don't drink with meals to avoid over filling your stomach
• Have plenty of fibre and water to avoid constipation
• Eat slowly and chew properly
• Sit up straight when eating
• Don't lie down after meals
• Quit smoking
• Use extra pillows in bed
• Ask your doctor about if reflux is a side effect of taking your medications.

The vegan food market has expanded recently. This can be a good thing as people who eat less meat do tend to live longer, healthier lives. 

The vegan diet is for those who avoid eating all animal products due to ethical, animal welfare, environmental and/or health concerns. It can be done well but it takes planning particularly for children, teenagers, older people and athletes. Vegans are at risk of missing out on vitamin B12, iron, zinc and omega 3 fats.

Here are some vegan snacks I have found in Leeton and Griffith, NSW. Remember unprocessed vegan food is the place to start if you are looking for a vegan snack- fruit, vegies, nuts, seeds and legumes. Vegan dips include hommous as pictured here which goes well with vegie sticks.

Processed vegan snacks usually consist bars and balls. They contain dried fruit for sweetness and to stick them together. Then nuts, seeds and coconut are usually added.

Then there are the non dairy milks (see my blog from June 2020) and non dairy yoghurts. Remember to look for 300 mg calcium per 250 ml serve as non dairy milks don't contain any natural calcium. Neither of the vegan yoghurts pictured here (Nakula and Dairy free Yo Pro) contain calcium so they offer no benefit to keeping your bones strong.

​When teaching clients how to read food labels I encourage them to buy food with less than 10% fat and sugar (or less than 10g per 100g). These processed vegan snacks are higher, ranging from 10-40% fat and 15-40% sugar. The lowest in sugar and fat I could find was The Bar Counter blueberry choc fudge bar (black packet) with 20% fat and 19.5% sugar. The Kez's kitchen gluten free naked snack bars have a very high 44% sugar and don't taste that great. Take note though that the fat is mainly the good stuff (unsaturated) and the sugar is mostly natural from dried fruit.

These bars and balls are all good sources of fibre at around 2-3 g per serve (we need 25-30g a day).

Then there are the vegie chips which people assume are healthy because they are made from vegies. These ones have less fat (20%) than regular chips (30-35% fat) but you'd be better off eating steamed or roasted vegies with your dinner than a packet of vegie chips.

So if you are eating vegan foods look go for the unprocessed food if you can.
By the way, I wouldn't recommend the triple berry snackaballs- the salted caramel ones taste better!

In October 2019 the Federal Government made it compulsory for all aged care facilities to report on weight change in their residents. Since then I have been doing a lot of calculations to find the healthy weight range for aged care residents.
It has got me thinking about how arbitrary this all is.
From one number (someone's height) comes an ideal weight range regardless of age, gender, activity or background. It really is a very vague guide which I only use as a baseline measure when deciding what someone's ideal weight is.
This is why I do not use the ideal weight range or a BMI calculation for clients I see in private practice. It is just not helpful for most people. In some cases it is a guide, but is ever only a guide.
In aged care it gives guidance to staff as to whether a resident should be gaining weight to reach the minimum weight desirable for their height. Rarely in aged care do people need to lose weight. If they are losing weight they are usually losing muscle which is not good. Losing muscle can mean more falls and infections which we aim to avoid.
So don't worry about a specific weight you should or should not be. You are more than a number on the scales. 

 Non-dairy milks have become popular for many reasons. They provide a substitute for milk for people who can't cope with the lactose (or sugar) in milk. They are also an options for those who have milk allergies. They have become popular too since the rise of the paleo movement and veganism.
However they also have their drawbacks. They will usually be more expensive, and are usually UHT (long-life). This means they are not as fresh as cow's milk and this in itself gives the milk a different taste. They also lack calcium and some are very low in protein. Below I have pictured a few available and outlined their nutritional qualities.
Overall cow's milk is the cheapest and the healthiest. If you can't tolerate that then soy milk is the closest milk nutritionally to cow's milk.
Calcium
Cow's milk provides valuable calcium for strong bones, particularly for kids, teenagers and post-menopausal women. A non-dairy milk contains no natural calcium. However most have added calcium except for the organic coconut milk and the oat milk seen below. 
Protein
There is very little protein in almond, coconut and rice milk. This means they are not as filling and not as nutritious as cow's, goat's or soy milk.
Sugar
Cow's milk does have natural sugar (3 teaspoons in 250ml) in it but as it is naturally packaged with calcium and protein it is still nutritious and an everyday food. Flavoured milk should be treated with caution as it has much more (added) sugar, like 25-30g per serve or 6-8 teaspoons per glass! Most of the non-dairy milks I looked at had less sugar than cow's milk with the exception of the Vitasoy Rice Milk.
(Remember 1 teaspoon of sugar = 5 grams).
 
per 250ml:
Almond breeze- 200 mg calcium, 1.3 g protein, 0.3 g sugar
So Good Almond-  300 mg calcium, 1.4 g protein, 8.6 g sugar
Organic Coconut-  no calcium, 0.3 g protein, 0.5 g sugar
So Good Almond Coconut- 300 mg calcium, 1.3 g protein, 0.5 g sugar
Vitasoy Soy Milky-    300 mg calcium, 7.5 g protein, 6.3 g sugar
So Good Soy Regular- 400 mg calcium, 8.5 g protein, 5.1 g sugar
Oat Pure Harvest- 6 mg calcium, 4.5 g protein, 9.3 g sugar
Vitasoy Rice Milk- 300 mg calcium, 0.7 g protein, 14.5 g sugar
Living Planet Goats milk- 305 mg calcium, 8.8 g protein, 11.3 g sugar
Cow's milk- 292 mg calcium, 8.2 g protein, 12 g sugar

Since COVID 19 began I have been conducting nutrition clinics from home using the phone or Zoom. I have heeded the NSW Premier's advice to stay home to avoid catching and spreading the corona virus which has had a devastating impact on the health of our world. However nutrition services are deemed to be essential so I have continued providing a valuable service, even if it does look different at the moment.
​The Federal Government has temporarily added dietitians to the health staff who can access Medicare for phone or tele-health from 30 March to 30 September 2020. It is great to be able to allow our clients to access a Medicare rebate after a nutrition consults over the phone or using tele-health.
Corona virus isolation has had different impacts on people. Some are enjoying their extra time to exercise and cook at home more. However other people may be eating more working from home. They now have easy access to food and the structure of eating at set times in a workplace is gone. Gyms are obviously closed at the moment so people need to be creative about looking for other exercise options to avoid weight gain.
There are also positive and negative aspects of phone or tele-health nutrition consults:
Positive aspects of phone or Zoom consults:

• it provides support for clients when other supports are gone (no sport, no family visits, no socialising with friends at hobby or exercise groups)
• it helps clients work on their health goals which may be harder to achieve in isolation
• flexible delivery and timing- most prefer phone consults over Zoom
• staying home works well for those introverts who are happy there
• it provides a focus on clients as the experts in their own lives

Negative aspects of phone or Zoom consults:

• There is no way to show food and plate models of portion sizes over the phone
• I have been sending resources via email or post which means there is a delay in clients looking through them.

I look forward to seeing my clients again in person but until then we all have to make the best of the "new normal". Please call me for an appointment using the phone or tele-health on 0428 323 841.