Management of Cow’s Milk Protein Allergy

Really useful information from an experienced dietitian with first hand experience of a baby with cows milk protein allergy…

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Increasing Vegetable Intake & Using Leftovers: Stir fry

Following the recent media attention on having ten portions of fruit and vegetables a day, here’s a fast recipe that gives you at least 3 portions of vegetables and uses some Sunday dinner leftovers.  The nutritional guidelines haven’t changed, and remain to have ‘at least 5 portions of fruit and veg’… so don’t get hung up on numbers, just eat a little more veg!

To serve 4 in less than 15 minutes:

Ingredients:

Cooked chicken (ours were leftovers from the weekend roast, so I guesstimate 150g)

300g frozen squid rings (defrosted)

2 red peppers (chopped)

1 onion (chopped)

130g baby sweetcorn (halved)

250g chestnut mushrooms (halved)

250g asparagus & tenderstem broccoli (halved)

1 tbsp rapeseed oil

1 tsp Chinese 5 spice powder

200g rice noodles

1 tsp reduced salt soy sauce

1 tsp fish sauce

 

Method:

  1. Heat pan/wok.  In a large bowl, combine chicken and vegetables with oil and Chinese 5 spice powder.  In a separate bowl, cover rice noodles with boiling water.
  2. Cook oiled-spiced chicken and vegetables in pan/wok over a high heat for 5 minutes.  Add defrosted drained squid rings and cook for 3 minutes.  Add drained rice noodles and stir through to combine with soy sauce and fish sauce.
  3. Divide between 4 plates and enjoy!

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Costs:

I had bought fresh veg so this cost me £2.13 per portion (£8.54 total).   If I used frozen veg, I’d save 43%: coming in at £1.22 per portion (£4.88 total). (N.B. I’ve not counted the chicken, oil, spices or sauces.)

Nutritional Value per portion:

352 calories, 24g  protein, 49g carbohydrate, 5g fat

 

Healthy Bones and Osteoporosis

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Osteoporosis

“Osteo” means bone, and “porosis” means porous… so when you have osteoporosis, your bones become thin and weak, and there’s a higher risk of breaking a bone especially if you fall.

Clinical definitions of osteoporosis are based on the measurement of bone mineral density (BMD) from a dual-energy X-ray absorptiometry (DXA) scan. Our bones are constantly being turned over and remodelled, with old bone broken down by osteoclast cells (bone resorption) and replaced by bone building osteoblast cells (bone formation). When bone resorption exceeds the rate of bone formation, bone loss occurs which can lead to osteoporosis.

Skeletal development

Peak Bone Mass (PBM) is the highest level of bone mass that we as individuals can achieve, and we tend to reach PBM at around the age of 20, with about 26% of adult bone being accumulated during our pubertal spurt (girls 11-13 years, boys 13-15 years).  To achieve their maximum PBM, it’s essential to encourage our children and teenagers to drink plenty of milk in order to meet their calcium requirements… or to ensure that they have other sources of calcium in their diet.

This PBM plateaus and remains stable until around the age of 30 years, and then we’ll begin to experience some slight bone loss. When ladies reach menopause, and oestrogen levels fall dramatically, the rate of bone loss increases, but remember that men are not immune to osteoporosis either!  Don’t despair, if like me you’re a little north of 20, we can make lifestyle and dietary choices to help maintain our bone health.

Osteoporosis Risk factors

Women Oestrogen deficiency caused by:

·      early menopause or hysterectomy (age <45 years)

·      loss of periods (>6 months, excluding pregnancy) as result of over-exercising or over-dieting

Men Low levels of male hormone testosterone
Women & Men ·      Previous fragility fracture

·      Close family history of osteoporosis

·      Long term use of oral corticosteroids (for asthma or arthritis)

·      Malabsorption problems (coeliac disease, Crohn’s disease, gastric surgery)

·      Low BMI <19kg/m2

·      Long term immobility

·      Heavy drinking

·      Smoking

Nutritional Factors for Healthy Bones

Calcium: The richest sources of dietary calcium are found in milk and dairy products. A 200ml glass of cow’s milk or 150g yoghurt will provide ~250mg calcium.

Recommended Calcium Intake (ideally from diet)
Female Male
11-18 years 800mg/day 1000mg/day
19-50 years 700mg/day 700mg/day
Breastfeeding mums 1250mg/day n/a
Post menopausal women 1200mg/day n/a
Coeliac disease 1000-1500mg/day 1000-1500mg/day
Osteoporosis 1200mg/day 1200mg/day
Inflammatory Bowel Disease

·      Adults

·      Post menopausal women and men over 55 years

 

1000mg/day

1200mg/day

 

1000mg/day

1200mg/day

Vitamin D: Our richest source of vitamin D is from sunshine, but that disappears in the UK autumn and winter months, which is why we recommend taking a vitamin D supplement between October and March. It is difficult to meet vitamin D requirements through diet alone. See my blog: Vitamin D: the sunshine vitamin

Recommended Vitamin D Supplementation Intake during UK Autumn/Winter
Babies >1 year – adults 10mcg/day

Alcohol: In large amounts, alcohol is toxic to osteoblasts, and reduces bone formation. More reason to stick within the recommended alcohol intakes of not more than 14 units per week, spread over 3 days or more and having at least 2 alcohol free days per week.

The risk of developing osteoporosis can be reduced by:

  • Acquiring optimal peak bone mass
  • Maintaining healthy bones throughout adulthood
  • Reducing the rate of bone loss in later life

Please contact me via my website www.elaineallertondietitian.com if you have any concerns about your current diet. You’d keep a 3-day food/drink diary, which I’d analyse to give individualised dietary advice helping to prevent nutritional deficiencies, or reassurance that you’ve got a balanced diet that’s likely to be meeting all your nutritional requirements.

Do healthy adults need to take vitamin/mineral supplements?

As featured on ITV’s “Save Money: Good Health” series 1, episode 4 with Sian Williams

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During the TV experiment with Sian Williams and our lovely volunteers in Eastbourne on ITV’s “Save Money: Good Health” show, we looked at whether healthy older adults should spend money on vitamin/mineral supplements.

Half our volunteers were already taking a variety of supplements (with strong beliefs that they were needed for good health) whilst the other half did not take any (with equally strong beliefs that they were unnecessary).

What did the pre-experiment blood tests tell us?… Most vitamin/mineral status results were within the normal healthy ranges, however some supplementers had levels higher than the normal healthy ranges. For our short snap-shot study, we asked our original supplementers to stop their supplements and our original non-supplementers to start taking supplements.

After six weeks, we retested bloods again… and found that everyone’s results were in the normal healthy ranges. The pre-experiment high supplemented levels had returned to normal healthy ranges, as the supplements had stopped. As our volunteers were healthy and eating regularly, including a variety of foods, they did not need supplements; their diets were meeting their nutritional requirements.

Food First…

Vitamins, minerals and trace elements are essential nutrients that are needed by your body in small amounts. The amount needed will vary… depending on your age, gender and for women whether you are pregnant or breast-feeding.

We know that the body absorbs nutrients better in food form rather than in tablet/pill supplement form. It’s better to have a “little and often top up dose” achieved by eating a variety of different foods throughout the day, rather than an “all in one dose” capsule.

As some nutrients use the same processing pathways in the body, taking the full day intake in one capsule could lead to competition between the nutrients and therefore you may not absorb the full dose of nutrient.

More Is Not Better…

There are two types of vitamins: fat-soluble (vitamins A, D, E, K) and water-soluble (the B group vitamins, vitamin C).

The body stores fat-soluble vitamins (in our body fat) so excessively high intakes could be harmful, as the body has no pathway to get rid of the excess. Excessive vitamin A supplementation (>1500mcg/d over a prolonged period of time) could result in skin/eye problems, hair loss, bone density loss, joint pain, chronic headaches and liver damage. Pregnant women (or those planning a pregnancy) should not supplement with vitamin A, as high intakes are harmful to embryo and foetus. Excessive vitamin D supplementation (>45mcg/d over a prolonged period of time) could result in bone resorption and demineralisation and irreversible renal/cardiovascular toxicity.

Water-soluble vitamins are not stored in the body, so sources need to be included in your diet every day. Excesses of water-soluble vitamins are unlikely to cause harm, but you will be creating expensive wee!

There is no evidence to show that vitamin C supplements prevent colds in us mere mortals (there is some evidence to show benefits in cold prevention for elite endurance athletes), but be mindful that high doses in excess of 1000mg/day may cause gastrointestinal upset (stomach pain and diarrhoea)… I think I’d rather have a cold!

Double Dosing…

If you’re taking a range of supplements (e.g.: one for heart health, plus another for immune system boosting, plus another for eyesight, plus cod liver oil, plus a one-a-day multivitamin-mineral, etc.), there’s a real risk of double dosing… so read the labels to ensure that you’re not taking amounts in excess of the RNI (reference nutrient intake), particularly for the fat-soluble vitamins (A, D, E, K) that are stored in the body.

An excess of one nutrient can prevent your body absorbing enough of another nutrient; so taking excessive supplements could upset your body’s natural balance. Excessively high doses of folic acid (vitamin B9) could mask a vitamin B12 deficiency.

Most healthy adults who are not planning a pregnancy, pregnant or breast-feeding do not need to take any supplements… with one seasonal exception.

The Exception…

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Current advice in the UK is that we should all consider taking a 10-microgram vitamin D supplement each day, during the autumn/winter months (October to March). This is because there’s not enough sunshine for us to generate vitamin D from the sunlight effect on our exposed skin, and it’s hard to get enough vitamin D from our diets.

Vitamin D is found naturally in oily fish and eggs, and may be added to some yoghurts and spreadable fats. However, you’d need to eat a salmon fillet every day to meet that 10-microgram intake… now I like salmon, but I don’t want to eat it EVERY day!

Buy an own brand supermarket or high street chemist vitamin D3 supplement, as they are cheaper than and absorbed just as effectively as the more expensive options.

Take your vitamin D3 supplement with your main meal, rather than your breakfast… as your main meal is likely to contain more fat which will aid better absorption of the vitamin D.

As they are excluding meat, fish and dairy (food sources of B12), vegans should consider taking a B12 supplement.

Interactions with medications…

Before taking any vitamin/mineral supplements, check that they won’t interact with any prescribed medications… as our GPs are very busy, your pharmacist or dietitian can advise.

Take Home Message…

Most healthy adults (who are not planning a pregnancy, are not pregnant or breastfeeding) can get all the vitamins, minerals and trace elements needed from a varied and balanced diet… without the need for additional supplements.

A balanced diet includes plenty of fruits, vegetables and starchy wholegrain carbohydrates, some protein and dairy, with a little added unsaturated fat.

If you’re concerned that your diet is not varied enough, or if you need nutritional advice about a specific medical condition, make an appointment to see a dietitian. See the link below for more information about my services.

www.elaineallertondietitian.com

Read what some of my dietitian colleagues have to say about supplements:

https://thefoodtreatmentclinic.com/2016/11/22/vitamin-c-supplementation/

 

Slow Cooker Yellow Split Pea Dhal

I know that I said my recipes would take no longer than 30 minutes, and obviously a  slow cooked meal is going to take a lot longer than 30 minutes to cook, but bear with me here… the preparation time is less than 10 minutes and the cooking is done whilst I’m out at work.

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Dhal on the double… ready to table in <5 minutes

Now that autumn has arrived properly, there’s nothing nicer than coming home to the delicious smell of a comforting lightly spiced dhal; knowing I just need to add some rice or naan bread and dinner’ll be on the table in 5 minutes.  The slow cooker meals work well for our family, when everyone needs their meal at a different time of the evening due to work, athletics, rainbows, cubs, scouts, explorers, etc.

This recipe serves 6 and costs less than £1.50 for all 6 portions!  It’s low calorie with less than 200 kcal, provides 30% of your daily protein requirements and over 4g fibre in each serving.

I prepare/mix the ingredients together the night before, pop them into a tupperware and into the fridge overnight.  Then all I need to do in the morning is to pour the mixture into the slow cooker and switch it on… I find that a post-it note reminder on the front door is useful, as dinner is not always the first thing on my mind as I leave the house at 7am.

Slow Cooker Yellow Split Pea Dhal 

Ingredients: 

300g yellow split peas

1 medium onion, chopped

200g tinned tomatoes

thumb sized piece of ginger, grated

2 tsp ground cumin

2 tsp turmeric

2 garlic cloves, crushed

700ml stock (I use a stock cube)

1 red chilli

Method:

Mix all the ingredients together.  Pour into tupperware container.

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Ready to go from fridge to crockpot

Place in fridge overnight.  In the morning, pour the dhal mixture into slow cooker crock pot.  Switch on slow cooker and get on with your day.  Ready to serve 2 adults and 2 ravenous teens in the evening, with enough leftover for 2 lunches next day… all for a total cost <£1.50 for 6 portions.

Here’s the nutritional info bit:

Per serving: Energy: 201kcal, Fat: 1.8g (of which saturates 0.2g), Carbohydrate: 30.3g (of which sugars 3.9g), Fibre: 4.4g, Protein: 13.7g

 

 

 

 

 

Vitamin D: the sunshine vitamin

Hello October!… Time to consider vitamin D supplements for everyone over the age of 1 from now until the end of March. Although it’s sunny in this October picture, the sun zenith angles are now too low in UK for us to synthesise vitamin D through skin exposure to the sun.  Vitamin D is important, as it helps our bodies to absorb calcium, which is vital for strong healthy bones. Unfortunately it’s very difficult to meet vitamin D requirements with diet… you’d need to eat a salmon fillet every day (now I like salmon but I’d soon get bored of it if I was eating it every day!) or you may choose to eat 6 egg yolks a day (again I wouldn’t advise this).

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Have a look at supermarket or high street chemist own brands (looking for vitamin D3 with a daily dose of 10mcg) as these are loads cheaper than the big brand names…your body will absorb the supermarket/chemist own brand just as effectively as the big brand name, and more vitamin D will be absorbed if you have your supplement with your main meal rather than your breakfast. This is because our main meals tend to contain more fat than our breakfast meals.

If you are of Black African, African Caribbean or South Asian descent with dark skin, you may wish to consider supplementing with vitamin D (10mcg/day) all year round, as your skin requires longer sun exposure to synthesis vitamin D.

If you know someone who is elderly, frail and housebound… and therefore not getting much sun exposure, you could suggest that they consider vitamin D supplementation all year round.

Contact me via my website http://www.elaineallertondietitian.com if you’d like your current diet analysed. You’d keep a 3-day food & drink diary, which I’d analyse with the latest computer software. I’d send you a written report, advising you of any possible nutrient deficiencies with suggestions of how to prevent them, or be able to give you piece of mind that you’ve got a balanced diet that’s likely to be meeting all your nutritional requirements.