I received an email from a screenwriter who is writing a script which includes a character with lupus. One of the questions he asked me was: "What can you eat?"
Well that's a big question, isn't it?
What I can eat has changed several times over the years. None of those changes have increased the things I can eat, sadly.
So what can I eat?
Not dairy. It used to just be no lactose, because lactose gives me reflux - nausea and heartburn, sometimes bad enough to be mistaken for heart attack. Now it's no dairy at all, because even lactose-free dairy products are causing severe post-nasal drip. If I eat dairy products, I end up choking on post-nasal drip. Waking up in the middle of the night coughing and choking is most unpleasant. I've decided I don't want to die by drowning on my own secretions. If I did, I could end up as an urban legend like Bloody Mary - you know, you look in the mirror and say three times "Snotty Iris", and my ghost appears and drowns you in snot. So, it's now a no on the dairy.
Not gluten. Gluten upsets my gut - gives me irritable bowel syndrome - wild, unpredictable, swings between constipation and diarrhoea. It's most unpleasant, and can be very embarrassing.
Not much fat or alcohol. Lupus has been messing with my liver for years. My liver enzymes are always off at every blood test. (Sometimes too high, sometimes too low, totally unpredictable.) I need to be gentle on my liver. So I eat low fat food mostly, and limit to alcohol to the occasional glass of wine at Christmas or a birthday.
Low GI carbohydrates. This is the newest thing. My pancreas is struggling, so my blood sugar is now not being properly regulated. Yes, the name for that is diabetes. (Because I didn't have enough health issues already.) So now I have to be aware of the Glycaemic Index of the carbohydrates I eat, and not over-eat carbs in general.
What can I eat? Well, it's complicated, and it gets more complicated all the time.
I'm continuing my project, while I'm feeling especially well, to get my body in the best possible shape to handle the next flare. (Because all lupies know, feeling well is a temporary state and there'll always be another flare at an unknown future time.)
So, step one was exercise. I'm now exercising most days. (Not every day, I won't claim to be that virtuous, but most days.) I either do the the Lupus Exercise video exercise routine, or I go for a walk. Some days, I even manage both. And some days I over-do it and end up going to bed at 3pm. But I am exercising regularly.
Step two was to bring my vegetable intake up to the five serves a day level, recommended in the Australian Guide to Healthy Eating. I've got that under control, again most days. I've done it in the simplest possible way. I buy pre-packed bags of salad, and divide them four ways into containers for lunches with a little meat or boiled eggs, and that's four days lunches. A large stock pot of vegetables, with some canned tomatoes, stock and rice and lentils added makes up a very good vegetable soup - and again I can prepare several days' serves at once. A salad for lunch, and soup with dinner brings up my vegetable intake nicely.
Now, I'm ready to focus on something new. I'm looking at the two and a half milk serves the Guide to Healthy Eating recommends for me. Being lactose intolerant, I don't have regular milk, but use lactose-free milk instead. (That is milk, with lactase enzyme added to break down the lactose.) Non-dairy substitutes are available for people who don't like animal products or can't handle the protein in milk, but it's best to go for calcium-fortified versions dairy substitutes.
At the moment, I have milk with my breakfast cereal. I really need to intentionally have a second serve of milk, cheese or yoghurt at another time of day as well. I'm thinking of a few options: cheese added to my lunch salad, or a warm milk before bed, or perhaps yoghurt and fruit for dessert.
There was a time when I would have created an exciting, varied, menu for my meals throughout the week. I really don't have the energy for that now. It's just easier to have a routine that works for most days, and then I only have to plan occasionally.
So that's my task for the next few days, to intentionally add a little more dairy into my diet.
How about the rest of you lovely lupies out there? When you're able, what do you do to try to improve your health? Do you find it easier to have a routine that's the same most days, or do you like variety?
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The next step in improving my overall health is looking at my diet.
So I have been looking at the Australian Guide to Healthy Eating. The diagram below gives the overview of what a healthy diet should look like.
source: www.eatforhealth.gov.au
The guide gives a breakdown of actual number of serves recommended from each food group, for people on the basis of sex and age.
Looking at it, there are a lot of changes I need to make. The biggest will be to get five serves of vegetables into my diet each day. But a few weeks ago, getting exercise into every day seemed a major challenge, so I'll do this the same way - work up to it. I'm going to look for ways to include more vegetables in my diet day by day, until it eventually becomes a habit.
Once I get that under control, I'll start looking at how well I balance the other food groups.
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Do you want help to sort out fact from fiction when it comes to nutrition and health?
Dieticians at Monash University are running a free on-line nutrition course, called "Food as Medicine."
It's a course designed for anyone with an interest in food, nutrition and health, and run by actual, qualified dieticians, not someone who is trying to market the latest "superfood" or supplement.
It starts this coming Monday, so if you're going to sign up, be quick.
Further information: http://www.med.monash.edu.au/scs/nutrition-dietetics/short-courses/food-as-med.html
If you're like me, you really want healthy home-cooked meals. You just don't have enough energy to cook them.
This minestrone is one of my favourite quick-fix-meals. It takes very little effort, but is still healthy and tasty.
The first thing to remember is you need a big saucepan. The second thing to remember is there's no set amounts of things. You can put in as much or as little of each ingredient as you like.
Ingredients:
Canned four-bean mix or five bean mix, drained and rinsed. (It's important to rinse. The liquid they're canned in tastes bad and can give you a tummy pain.)
A peeled and chopped up onion (this is the most work in the whole recipe, so leave it our if you're really short on energy.)
A can of crushed tomatoes.
Some tomato paste.
Vegetable stock powder or cubes or the more expensive liquid stuff if you think it's any better.
Frozen mixed vegetables - the ones cut into small pieces.
Pasta (I use gluten free) or rice.
Herbs: I used garlic, black pepper, basil, oregano, chives and parsley.
Some dried red lentils, washed.
Water.
Put it all in the pot, bring to the boil and simmer for 10 to 15 minutes until the pasta or rice is tender. (If you use whole grain rice, it might take 20 minutes.)
It means I can now send the government my poo, and not get in trouble for it.
I don't know how you feel about politics, but I often think having a pile of poo in Parliament House would not be much different to what we have. So I'm eager to contribute my fair share to the pile.
But apart from the delight in knowing that one can give the government poo, there's a serious side to this rite of passage.
Australians 50 and over get a request from the government to provide a sample of our poo, to test for bowel cancer. I know lupus is quite enough and I don't need any cancers as well, but bowel cancer is very common among Australians. (That probably says we eat too much junk food and too little fibre.)
My test pack arrived today.
It seems a fairly simple process. Use the special paper to catch poo, a sample pick thing to pick it up and put it in a dated sealed test tube. Refrigerate it, and repeat with another set of collection equipment a day or so later. Then put both samples, with a form giving my personal details, in the addressed envelope and send it away.
Clearly, it's not the most dignified of things to do. On the other hand, if it catches bowel cancer early, it might saves some of the very many indignities of bowel cancer treatment. And all it will cost me is a bit of time, and a bit of politics, er, I mean, poo.
Those of us taking steriods often struggle to lose weight (or even to stop gaining weight), let's revisit the basics of weight control with an expert in the field of food. The following post, by Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle has been republished from The Conversation. See the original version here: https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496
Health Check: six tips for losing weight without fad diets
Clare Collins, University of Newcastle
Monday - start diet. Tuesday - break diet! Wednesday - plan to start again next Monday.
If this is you, it’s probably time to get off the diet roller coaster and make some bigger changes to the way you eat, drink and think about food.
Here are six tips to help you get started.
1. Improve your diet quality score
When trying to lose weight, it might be tempting to quit carbs, dairy or another food group altogether.
But to stay healthy, you need to meet your requirements for important nutrients like iron, zinc, calcium, vitamins B and C, folate and fibre. These nutrients are essential for metabolism, growth, repair and fighting disease.
Our review of diet quality indexes used to rate the healthiness of eating habits found that eating nutritious foods was associated with lower weight gain over time.
Improving your diet quality means eating more fruit and vegetables, lean meats, poultry, fish, eggs, tofu, nuts and seeds, legumes, dried beans, wholegrains and dairy (mostly reduced fat).
Rate your diet quality and get brief feedback using our online Healthy Eating Quiz www.healthyeatingquiz.com.au.
2. Mum was right - eat your veggies
Fruit and veg are high in fibre, vitamins and phytonutrients, but low in total kilojoules. So eating more can help you manage your weight.
A study of more than 130,000 adults found that those who increased their intake of fruit and vegetables over four years lost weight. For each extra daily serve of vegetables, there was a weight loss of 110 grams over the four years. It was 240 grams for fruit. Small, but it all adds up.
Not all vegetables are equal.Michigan Municipal League/Flickr, CC BY-NC-ND
Drilling down to specific fruit and veg gets interesting. Increasing cauliflower intake was associated with a four-year weight reduction of about 620 grams, with smaller reductions for capsicum (350g), green leafy vegetables (230g) and carrots (180g). The reduction was 620g for blueberries and 500g for apple or pears.
It was not good news all round, though. Corn was associated with a weight gain of 920g, peas 510g and mashed, baked or boiled potatoes 330g.
3. Limit your portion size
If you are served larger portions of food and drinks, you eat more and consume more kilojoules. That sounds obvious, yet everybody gets caught out when offered big portions - even when you’re determined to stop when you’re full.
Research shows offering larger portions leads adults and children to consume an extra 600 to 950 kilojoules (150-230 calories). This is enough to account for a weight gain of more than seven kilograms a year, if the kilojoules aren’t compensated for by doing more exercise or eating less later.
4. Watch what you drink
A can of softdrink contains about 600 kilojoules (150 calories). It takes 30-45 minutes to walk those kilojoules off, depending on your size and speed.
Children and adolescents who usually drink a lot sugary drinks are 55% more likely to be overweight.
Switch to lower sugar versions, water or diet drinks. A meta-analysis of intervention studies (ranging from ten weeks to eight months) found that adults who switched had a weight reduction of about 800 grams.
5. Cue food
Our world constantly cues us to eat and drink. Think food ads, vending machines and chocolate bars when trying to pay for petrol or groceries. Food cues trigger cravings, prompt eating, predict weight gain and are hard to resist. They can make you feel hungry even if you are not.
Ditch the oily popcorn and take your own snacks.rpb1001/Flickr, CC BY-NC
Try to minimise the time you spend in highly cued food environments. Avoid food courts, take a list when you go to the supermarket and take your own snacks to places where highly palatable food is advertised, like the movies.
This will reduce autopilot eating, which sabotages your willpower.
6. Resist temptation
A treatment for food cue reactivity is called exposure therapy. With the help of a psychologist or health professional, you expose yourself to the sight and smell of favourite foods in locations that commonly trigger overeating, like eating chocolate when watching TV. But, rather than eat the chocolate, you only have a taste without eating it.
Over time, and with persistence, cravings for chocolate reduce, even when cues such as TV ads or people eating chocolate in front of you are present.
You can also draw on your brain’s own self-management skills to resist temptation, but it takes conscious practice. Try this food cue acronym, RROAR (remind, resist, organised alternative, remember and/or reward), to train your brain to resist temptation on autopilot.
When you feel yourself pulled by cues to eat or drink:
Remind yourself that you are the boss of you, not a food cue.
Resist the tempting food or drink initially by turning your back on the cue. (This gives you time to think about next steps.)
Have a pre-Organised Alternative behaviour to use against food cues. Grab a drink of water, walk around the block, check your phone messages, read, take a walk in the opposite direction. Diversion works.
Remember what your big-picture goal is. Do you want to eat better to help you feel better, reduce medications, lower blood pressure, improve diabetes control or manage your weight?
You can add another R for Reward. Financial incentives help change behaviour. Each time you complete your organised alternative behaviour put $1 in a jar. When it builds up, spend it on something you really want.
Swap to small plates to reduce your portion sizes.Robert S. Donovan/Flickr, CC BY-NC
You need a plan
The journey off the diet roller coaster needs a cunning plan. Here’s how you can put it all together.
Start by assessing your diet quality using the Healthy Eating Quiz.
Next, plan weekly meals, drinks and snacks. Write a grocery list and buy extra fruit and vegetables.
Swap to small plates, cups and serving utensils. You’ll serve and eat less without thinking.
Aim for half your plate covered with vegetables and salad, one-quarter lean protein (trimmed meat, chicken, fish, legumes) and one-quarter grains or starchy vegetables (potato, peas, corn).
Change your food environment to avoid constant prompts to eat.
Minimise the places you allow yourself to eat and drink to reduce food cue exposure (not in front of TV or computer, at a desk, or in the car).
Keep food out of sight (unless it is fruit and vegetables). Store in opaque containers.
Remove workplace food displays, such as food fundraisers.
Plan driving and walking routes that do not take you past fast-food outlets or vending machines.
Prerecord TV shows and fast-forward food ads.
Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle
This article was originally published on The Conversation. Read the original article.
Pre-cut vegetables, with tomato, chick pea patties and
salad dressing.
I struggle at times to eat properly. I get to the end of the day, and I just don't have the energy to
prepare a meal.
I'm trying something new - a way to make preparing a meal much easier.
I'm pre-cutting my vegetables.
For the past couple of weeks, I've set aside a day (the day after grocery day) to do two things - to bake something as "treats" for the week, such as biscuits or cupcakes, and to put a week's worth of vegetables through the shredder attachment on the Kenwood Chef.
The idea is that I save energy by only cleaning up my Kenwood Chef once a week, and by reducing the amount of preparation for meals throughout the week.
What I've shredded is a mix of cabbage, carrot, onion, capsicum and celery. Left dry and in a sealed container in the fridge, this will easily last all week.
It's a good mix, because it's versatile.
Used with a mayonaise style dressing, it's a coleslaw.
Cooked with some lean beef mince, canned tomatoes, a couple of herbs and some olives, it's a bolognese.
Cooked with some lean meat strips and soy sauce, it's a stirfry to go over rice.
Add some tomato and possibly a lettuce leaf or a slice or two of cucumber, along with a fat-free salad dressing, it's a basic salad to have with just about anything. (In the picture I have chick pea patties: a can of chickpeas, drained in a colander and then washed under running water, mashed. Mixed with some garlic sesame seeds and whatever herbs I feel like. Then formed into patties and cooked in a pan that's been sprayed with canola oil spray.)
Add canned beans, canned tomato, herbs and stock (or tomato paste), it can make a minestrone-style soup.
The effect of preparing my vegetables in advance has been that I've made myself healthy meals now for a week and a half. I've been looking forward to meals again, rather than just eating whatever is easiest or not bothering to eat.
That little bit of saved effort in preparation and clean-up really has made a huge difference for me. Between meals I mostly have fresh fruit, but I also have small treats I have baked so I don't feel any need or even want of any other "junk food".
People sometimes ask if I think everyone with lupus should be on a gluten-free and lactose-free diet.
My answer is that lupus is different for everyone. If you have the same gut symptoms as me, it's worth checking with your doctor whether you need to restrict gluten and lactose.
So what are these symptoms? Usually I just say I have reflux and irritable bowel. If you don't really what those things mean, I guess it doesn't mean a lot.
Here's in detail what is going on (for me, it could be different for other people):
Lactose is the sugar that occurs naturally in milk. (Most things that end in -ose are sugars.)
When I have lactose I get reflux. Sometimes that's just an uneasy feeling in my chest. Sometimes it feels like hunger, and makes me desperate to eat endless amounts. Reflux also takes away my ability to realise I'm full, so I just keep bingeing.
That's mild reflux. If I've had a lot of lactose, I get a more severe reflux. That is just an incredible pain in the middle of my chest. A couple of times, I've found myself on an electrocardiograph machine, because a doctor really wasn't sure if it was reflux or heart attack. Once, I ended up in an emergency department bed, being fed a mix of a local anaesthetic and mylanta, through a long straw so the anaesthetic got to my gut without making my mouth numb.
Gluten is the protein found in wheat (including spelt), oats, rye and barley.
When I have gluten I get irritable bowel syndrome. For me, this causes diarrhea, which is urgent and frequent, and comes with lots of blood. If it's really bad, I pour blood between the loose bowel motions as well. This all comes with either severe cramping pains, or ominous volcanic rumblings accompanied by bursts of toxic gasses.
Recently, my doctor told me it was OK to try a little lactose and gluten again, to see if I have built up some tolerance over my years of not eating them. Now, I can have a very little without a problem, but that very little is exceeded quickly.
At home, I still cook my lactose free and gluten free diet. When I'm out, I allow myself small amounts. And sometimes, when I'm enjoying time with family or friends, I go past my limit, deciding that the enjoyment of the moment is worth the consequences.
So do I recommend lupies (or anyone else for that matter) go gluten-free and lactose free? Well, no, unless they actually need to.
As regular readers know, I struggle with my weight.
I know I'm not the only lupie with this problem. Sometimes, prednisone just makes me ravenous. I can't stop eating. That's the reason for my failed attempt to wean off it. (OK, I have discovered what a wimp I am - I just can't take the pain I suffer if I take less steroid.)
Then there's other times, such as the past few days, when I can't eat. I can't tell you why it happens. I just don't know the cause. I know that some of the books I have read have said that lupus can cause anorexia. I know that some of my medications have anorexia listed as side effects. When I'm 30kg overweight that I can't say I could be considered anorexic in any way, shape, or form.
But I have times, when the thought of food revolts me, and when I force myself to eat, my stomach objects in no uncertain terms. For half the week, I've been trying to force myself to eat. I'm almost at the stage of giving in and just buying a can of Ensure powder to sustain me until I get past this stage.
It's always passed before, either in days or a week or two at the longest.
What I'd like is a half-way point. I would love to be able to eat the way healthy people eat - to have enough, and know when to stop. That's the dream.
One of the risks of long-term prednisone usage, is that it can reduce bone density.
I'm glad my rheumatologist has been monitoring my Vitamin D ever since I started taking steroids. I've been taking Vitamin D supplements the whole time, and regular blood tests have been used to make sure I'm taking the right amount of supplement.
I've heard that there's more than one way to do a bone density test, mine was basically an xray. I was asked to lie on a table, with my legs raised on a block and an xray machine passed over my torso. My feet were then put flat on the table, toes pointed inwards and the xray machine passed over again. The test was non-intrusive, and over in a couple of minutes.
Despite my normal bone density result, my GP and I have discussed, and are now beginning, weaning me off my steroids. This isn't because of any harm the steroids are doing, but to make it easier for me to lose weight.
I weigh about 90kg at the moment, and my healthy weight range is about 55-60kg. My rheumatologist wants me to lose the excess, because excess weight adds so much extra stress to my joints.
It's very hard to lose weight while taking steroids. So I'm going to very slowly come off them. Each fortnight, my dose will reduce by .5mg/day. Hopefully, my other medications, and time on the tens machine will keep keep my lupus symptoms in check. I might end up having to deal with a little extra pain, but hopefully that will be the worst result. And if I can lose the weight, that will help with my pain levels long-term.
It's a tough time to try to lose weight. This month I have my birthday, World Lupus Day, Mothers' Day and my daughter's wedding. That's a lot of eating out, but if I'm careful, and with the steroids being reduced, I should still manage to lose some weight.
The Federal Government's Swap It, Don't Stop It campaign is one which aims to help us become more healthy, by substituting healthier foods and activities for things we ordinarily do. I was thinking about that and the Go For 2 and 5 campaign to get us eating two serves of fruit and five of vegetables each day.
This led me to thinking about ways to have nice, healthy snacks which feature fruit and vegetables. Can we really enjoy our food and still eat healthy? Yes we can.
Here's some of the ideas I came up with in a quick brainstorming session:
A slice of fruit bread toast (I use gluten free) topped with sliced banana, a half teaspoon of honey and a sprinkle of cinnamon.
Cut a peach in half and remove the seed. Cook in a non-stick frypan, to heat through. Serve topped with two teaspoons of flaked almonds and half a teaspoon of honey.
Cut a tomato in half. Top each half with a little low-fat cheese and your favourite herbs. Cook in microwave until cheese is melted and tomato heated through.
Cut carrot and celery sticks and serve with hommus for a dip.
For something a little more dressed up, (if you have an afternoon tea), cut a sheet of puff pastry into quarters. In the middle of each piece, place a thick slice of tomato, a thin slice of onion, a little capsicum, a couple of slices of olive, and a fresh basil leaf. Add a little shaved parmesan, and bake in a moderate oven until pastry is puffed and crisp.
Fill mushroom cups with bread crumbs, herbs, the finely diced stems of the mushrooms, a small amount of margarine and low-fat cheese, and bake in a moderate oven.
Microwave a potato in its jacket, and top with baked beans, or light sour cream and chives.
Freeze some pieces of fruit (eg banana, grape, berries) and eat like an ice block. (You can even put paddle pop sticks in the fruit before freezing.
Blend berries or banana with skim milk and yoghurt to make a smoothie.
Traffic light skewers. Thread skewers with pieces of watermelon, rockmelon and honey-dew melon. A really yummy snack to serve. (You can serve with a dip made of light Greek-style yoghurt mixed with a little honey.)
I post gluten free and lactose free recipes on this site, and sometimes people ask what being gluten free does for my lupus, and whether I think it would help them.
Second question first. I have no idea if it would help you. If you have symptoms similar to mine, it might be worth talking to your doctor about trying it.
Now the first question, how does it help me?
All my life I've struggled with reflux and Irritable Bowel Syndrome. (When I was diagnosed with lupus, my rheumatologist told me "reflux" and "Irritable Bowel" were terms that actually mean "we have no idea what's causing this.")
Reflux upsets the top bit of the digestive system. Stomach acids get into the oesophagus, causing nausea, pain (at times so intense, I've been rushed to hospital with a suspected heart attack), and a constant feeling that I'm hungry, leading to binge eating.
One of the things which has contributed to my reflux is lactose intolerance. My body doesn't make sufficient lactase enzyme, so I can't digest lactose (the natural sugar in milk.)
Giving up lactose helped to settle reflux. It hasn't stopped it all together. I still take medication for it, and sometimes it still bothers me. But without lactose, it's not so bad.
I haven't had to give up dairy products. It's now possible to buy milk and cream that have had lactase enzyme added to them to break down the lactose. Yoghurts and cheeses already are made with enzymes that break down the lactose in the process of converting milk to yoghurt or cheese.
Further down the digestive system, Irritable Bowel Syndrome causes bloating, flatulence, alternating constipation and diarrhea, very unpleasant. I've struggled with it my whole life, but it has been getting steadily worse. A year or two ago, my GP suggested I try going gluten free to see if it made a difference. It made a huge difference, almost immediately.
Reflux and IBS are just something that goes with lupus for a number of us (but not everyone, because lupus has so many variations that no two of us seem to have exactly the same issues.) For me, cutting lactose and gluten from my diet has helped me to manage these very symptoms.
I can't guarantee it would work for everyone. But I post recipes now and then because, I know that some other lupies have found it helps them as well.
The following article has been republished from The Conversation.
It's a reminder for people with lupus, and other conditions that compromise our immune systems, that we have to be careful of things other people don't worry about. Public health authorities may publish lists for pregnant women about the foods they need to avoid, but how many autoimmune patients are given copies of these lists?
Understanding the recent listeria-linked cheese recall
By Tom Ross, University of Tasmania
Soft cheeses made by Jindi were recently recalled in Victoria, after they were linked to the deaths of three adults, a miscarriage, and a score of other cases of “listeriosis”. The case is a reminder of the need for public health authorities to be vigilant about educating at-risk people about this disease and for the food industry to minimise the risk from contaminated food.
Deadly disease
Listeriosis is almost always acquired by eating contaminated foods. While listeria monocytogenes are quite common in the environment (and at low levels in many fresh foods), the disease itself is rare. There are about 60 reported cases a year in Australia, and that rate is similar to other developed nations, although it’s possible that as many cases again go undetected.
If detected early enough, infections can be treated successfully with antibiotics. Despite being uncommon, listeriosis is very serious and will be fatal for 20% to 30% of infected people. This statistic is repeated in the current outbreak, which has seen four deaths out of about 20 cases.
Listeria monocytogenes is harmless to most people, even when ingested at high levels. Many of us will have the bacteria in our guts at some time and they usually pass through without harming us. People at high risk are those with reduced immune function, such as those on drugs to stop rejection of an organ transplant, or to control an autoimmune disease, such as lupus, those receiving anti-cancer treatments, the aged, those with diabetes, liver or kidney disease, and the unborn or very young babies.
Indeed, a person with liver cancer is nearly 1000 times more likely to get listeriosis than a healthy young adult, while pregnant women and their foetuses are at about 100 times greater risk. Virtually every person who gets listeriosis has some underlying condition that predisposes them to infection.
If people susceptible to listeriosis ingest a large amount of listeria, some may cross from the intestine into the cells of the body, where they can “hide” from the immune system. They then increase in number, moving from cell to cell, and spreading to susceptible sites in the body, where they cause damage to host cells. This results in disease symptoms. The most common sites of overt infection and damage are the central nervous system and the uterus of pregnant women and foetuses.
Mitigating risk
Health authorities have produced information pamphlets for pregnant women to alert them to the risk from eating certain foods, while also giving advice about alternative foods to meet nutritional needs. Such advice is equally relevant to people with reduced immunity.
Since listeriosis was first recognised in the 1980s as a food-borne disease capable of causing outbreaks with deadly consequences, research has shown how best to reduce the risk. Listeria is common in nature, preferring moist habitats where there’s decaying organic matter, such as rotting vegetation. Unusually among bacteria that can cause human infection, it can grow at refrigeration temperatures and tolerates quite salty conditions. As such, it can grow in foods that have traditionally relied on added salt and chilling to extend shelf life.
Some of these foods allow listeria to grow to dangerous levels, albeit slowly. Foods most at risk of transmitting listeriosis are those that have a long shelf life but that still require refrigeration, such as “ready-to-eat” processed meats (for example ham, cold meats and paté), cheeses (particularly soft, surface-ripened cheeses, such as Brie, or Camembert), smoked fish and other lightly preserved seafood, and some types of pre-prepared salads.
Listeria’s lifestyle means it likes to set up house in food factories, because they often have nooks and crannies that are cool, remain wet and have traces of food to sustain populations of the bacteria. For the food industry, understanding that lifestyle has led to increased vigilance and steps to prevent listeria from becoming established factories, to detect it if it has, and to prevent if from contaminating foods.
This increased vigilance has also meant that potential problems are more reliably detected before contaminated foods are released or people become ill. Foods are also sometimes recalled to minimise risk to consumers.
Tom Ross receives funding from Meat and Livestock Australia, and NZ Ministry of Primary Industries.
This article was originally published at The Conversation.
Read the original article.
Additional Information
Since the link to this post was posted on the Sometimes, it is Lupus Facebook page, there have been a couple of questions about where to find lists of food which people with chronic illnesses should avoid. There are some links below to Queensland Health Fact sheets about food safety. Because of our compromised immune systems, we're best to assume that anything that could be harmful to a developing foetus (whose immune system isn't fully developed) could also be harmful to us.
Sometimes, the only way to achieve something is to set a definite goal - not just, I will do better at something, but that I will do something I can measure to know I've achieved it and set a time limit.
awesomeanimals.cheezburger.com
Once I moved, and realised I could at last afford my rent, and not keep getting further into debt, I looked at my finances. I have a plan now to be out of debt by the end of 2016. That's without missing out on anything I really need, and starting to save to cover anything unexpected.
To do that, I've had to sacrifice some things that I know I can live without, for example, I've dropped the hospital cover from my health insurance, and now only have extras cover. If I need hospital care, I will go to the public system. Throughout my adult life, whenever I have had enough income, I have private health insurance, otherwise I have counted on the public system. To me, it's an ethical choice, if I can afford a private hospital, I'll leave a space free in the public system for someone who really needs it, but when I can't afford the private system, I don't feel guilty about taking my place in the public system. I've been a patient in both, and have to say I've actually found the public system far superior.
I'm also saving money by simply spending more time at home, eating all my meals here, inviting friends here for coffee instead of meeting them out, and not using the car as much.
How not to lose weight - failblog.org
There's another goal I needed to set, and absolutely must achieve. With continual reminders from my doctors about my weight, and now not needing to escape my home to get out of the heat constantly, I can start to address the basics of food and exercise. It's time to set the weight goal as well. I will be a healthy weight (for me, that's the range between 52kg to 62kg) by the end of 2016. Again, that's enough time to allow for some setbacks, lupus flares, etc.
My plan is quite simple. I need to go back to calorieking.com.au and follow the program carefully. I need to make sure I know what I'm eating and how much, and that I'm doing sufficient exercise. Because the flat is cooler and more comfortable, I'm able to spend the time in the kitchen to cook healthy meals.
I've started to exercise, with a daily walk around the block with my old dog. (Calorie King also counts housework as exercise, so that also contributes.)
Three years seems like a long time, but with both of these goals, the only way to achieve them is the long, slow, way. And the time to get started is right now.
There are times when I'm tempted to go out for "fast food", because I'm just too tired to cook. In fact, "fast food" is usually slow - it takes time and energy to get there, wait in line, get home. It's faster, cheaper, and healthier to throw together a quick meal at home.
Here's one of the fastest, easiest recipes ever. Fast Minestrone
400g can diced tomatoes
125g can tomato paste
1 litre water
1 can four bean mix or five bean mix - drained and rinsed
1 tablespoon vegetable stock powder
2 cups mixed chopped vegetables (suitable vegetables include potato, carrot, celery, green beans, onion, capsicum, sweet potato, peas.) Frozen mixed diced vegetables are OK.
Half cup basmati rice
Put all ingredients into a saucepan and bring to the boil. Reduce heat, cover and simmer 15 minutes.
Serves 4.
Recipe is gluten free, lactose free, vegan friendly, low GI, low fat, high fibre.
High fibre foods and mono-unsaturated fats lower LDL.
Well, it's weight loss group tonight, and we have a question that came up at last week's meeting: Does eating rolled oats actually lower your cholesterol?
The short answer is "yes".
The longer answer is as follows.
Cholesterol is a kind of fat that your body needs. It's present in all the cells of your body. It helps make hormones, and control metabolism.
But like the salt we talked about last week, we need far less than most Australians actually have. According to the Heart Foundation, 51% of us suffer from high blood cholesterol.
When we are concerned about high cholesterol, we usually concerned about high levels of LDL (Low Density Lippoprotien) which carries cholesterol to the cells and can block arteries. The other kind of cholesterol, known to be the "good" kind is HDL (High Density Lippoprotien) which takes cholesterol out of the body.
To lower LDL, we need to eat a healthy diet.
There are foods that can help lower LDL, and one of them is yes, rolled oats. It helps because it contains soluble fibre - and all foods with soluble fibre help to lower cholesterol. So that's rolled oats, barley, legumes, fresh fruit and vegetables. The fibre that helps us feel full and keeps the digestive system functioning well, also helps lower cholesterol.
Eating monounsaturated fats, such as the omega three fats in fish, olive oil and the fats in nuts and avocados also helps to lower LDL.
The "bad fats" the saturated fats in animal products will increase LDL. So another way to reduce cholesterol is to take the skin off chicken, remove the visible fat from meats, and where possible avoid the hidden fats in things like cakes, biscuits, and fried foods. And, of course, we need to opt for low fat varieties of dairy products.
Exercise also helps reduce LDL, so adding exercise into the daily routine can help.
In summary, to lower cholesterol
Eat lots of whole grains
Eat legumes/pulses
Eat fish
Eat olive oil, avocados, and other mono-unsaturated fats
Eats lots of fresh fruit
Eat lots of fresh vegetables
Take visible fat off meat
Eat skim or low-fat dairy foods
Avoid deep fried foods
Avoid cakes, pastries, etc
Avoid fatty meats
Have some exercise daily
References:
Better Health Channel: Cholesterol http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cholesterol_explained
CSIRO: The Facts About Cholesterol Levels http://www.csiro.au/en/Outcomes/Health-and-Wellbeing/Prevention/CholesterolFacts.aspx
Harvard Health Publications: 11 Foods That Lower Cholesterol http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2009/October/11-foods-that-lower-cholesterol
Heart Foundation: Fats and Cholesterol http://www.heartfoundation.org.au/healthy-eating/fats/Pages/cholesterol.aspx
Mayo Clinic: Cholesterol Top 5 Foods to Lower Your Numbers http://www.mayoclinic.com/health/cholesterol/CL00002
One of the questions that comes up at Thursday night weight loss group quite often is the question of how much salt we actually need, and how much is too much?
So what have I been able to find out?
Firstly, we don't need salt, as such. We need a small amount of sodium, most of which we habitually eat as salt (sodium chloride). About 90% of our sodium intake is in the form of salt, so for our purposes, watching our salt intake, is a good way to keep our sodium from getting out of hand.
The amount Australians eat, is far more than we actually need. Most of us are eating around 10 grams of salt a day.
The upper safe limit (according to the National Health and Medical Research Council - NHMRC) is 2300 milligrams (2.3 grams) of sodium per day. That equates to about 6 grams or 1 1/2 teaspoons of salt. That is the maximum amount of sodium it is safe for an adult to eat (from all sources - not just what we add when cooking or at the table). Interestingly, this is the amount used for the % of Recommended Daily Intake used on boxes of cereal and other products.
The amount the NHMRC recommends as a target amount for people to eat is, not surprisingly, a long way below that upper limit. It sets a target of 1600 milligrams (1.6 grams) per day for people who are older, overweight, have high blood pressure, or want to maintain a healthy blood pressure across the lifespan. I expect that people wanting to care for their blood pressure should include everyone. That 1.6 grams of sodium equates to 4 grams of salt (a teaspoon full).
An "adequate intake" the minimum to give us all that we need is about 460 to 920 milligrams (0.4 to 0.9 grams) of sodium. That's about 1.15 to 2.3 grams of salt. (So unless you are eating less than half a teaspoon of salt from all sources each day, you are not in danger of having too little.)
So, all up, our salt from all sources should be no more than a teaspoonful in a day, or 1600mg of sodium, and having a little less than that will not hurt us.
Given that the average Australian eats more than twice that amount, we need to look at how to reduce our sodium intake.
Here are some tips:
Cook at home, instead of going out. Take-away food has lots of salt, and you only have to watch an episode of Master Chef to see how much chefs love salt. Cook without adding salt.
Use fresh ingredients wherever possible - virtually all packaged food products have some form of salt added. Fresh fruits and vegetables do contain sodium - but nowhere near as much as you will find in packaged foods.
When you must buy packaged food, choose foods that have less than 120mg of sodium per 100g of food.
Use herbs and spices to add flavour to food, rather than fats and salts.
Remember the reason people like food that tastes of salt is just because of habit - habits can be changed.
Steam, grill, stir-fry, or microwave food. Don't boil food in water, because flavour is lost (along with some nutrition), and it is tempting to replace the lost flavour with salt.
And now, the big question: why bother? What does eating too much salt do to our bodies? Excess salt is linked to:
High blood pressure
Kidney problems/ kidney stones
Oedema (swelling, fluid retention.)
Some Cancers
Osteoporosis (sodium encourages the body to excrete calcium)
There are also dangers from too little sodium, but it is very unlikely that people in Australia are going to suffer from this, because of the way salt is introduced into almost all our foods. (It's possible to die from both too much and too little sodium.)
References:
Better Health Channel: Salt http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Salt
Food Standards Australia: How Much Salt and Sodium are We Eating - More Information http://www.foodstandards.gov.au/scienceandeducation/factsheets/factsheets/howmuchsaltareweeating/howmuchsaltandsodium4551.cfm
Healthshare: How Much Sodium/Salt Should We Consume Per Day? http://www.healthshare.com.au/questions/42121-how-much-sodium-salt-should-we-consume-per-day
Mayo Clinic Nutrition and Eating: Sodium: How to Tame Your Salt Habit Now http://www.mayoclinic.com/health/sodium/NU00284
Nutrition Australia: Salt and Hypertension http://www.nutritionaustralia.org/national/frequently-asked-questions/salt-and-hypertension
I haven't posted about Weight Loss Group for a while, because we've been working our way through the National Dietary Guidelines. That's taken several weeks of just continuing on the same thing.
If you've never read it, it's a good explanation of how to have a healthy, balanced diet.
So here's two examples of breakfast cereals. (There's no point in comparing foods of different types - we're looking for different things in different types of foods.
Cereal A:
Cereal B
I'll actually take the boxes to the meeting to for people to look at tonight - but reading the information panel, is really all you need.
The ingredients are ordered from greatest to least. So 93% of this is Corn. The other 7% is a mix of sugar and salt. Glucose is a form of sugar. (Point to note, anything ingredient ending in -ose is sugar.)
So mostly this cereal is just corn, with added sugar and salt for flavour. There's no artificial additives. There's also no added vitamins or minerals, and no ingredients high in fibre.
Cereal B: Rice Flour (66%), Maize (Corn) Flour, Psyllium (6%), Sugar, Apple Juice Concentrate (4%), Salt, Rice Bran Extract, Vitamins (Niacin, Thiamine, Fiboflavin, Folate).
There's a lot more ingredients in this. It still has two kinds of sugar (fruit juices are another way to include sugar, without calling it "sugar"). It also has salt, although we'll see later that it is much less salt than the other cereal. It has psyllium and rice bran extract, which both provide natural fibre.
It doesn't have artificial colours or flavours, but it does have added B group vitamins and folate (which is important to help the body absorb iron).
The Nutrition Information Panels
It's interesting to note, that each pack has three columns on the nutrition information panel.
Cereal A: has average quantity per serving, % of daily intake per serving, and average quantity per 100g.
The first thing to do here is ignore the middle column. This is % of daily intake for someone on an 8700kj per day diet. If you check your recommended intake on Calorie King you'll find that is very much more than recommended for women, especially women trying to lose weight.
Cereal B: has average quantity per serving, average per serve with 1/2 cup skim milk (the way you actually eat it) and average per 100g.
Comparing the two: You will notice that a serve of Cereal A is 483kj and a serve of Cereal B is 796kj, which makes it appear that Cereal B has more energy than Cereal A. This is just an appearance. If you look closer, you notice that a serve of B is 50g, while a serve of A is only 30g. For a fair comparison, we need to look at the average per 100g column of both - this is the one that is the same.
Serving sizes are set by the company making and marketing the product. They can be manipulated to make the product look better (ie by having a small serving size). This is a trick you'll see on a lot of products in the supermarket. A number of packages that look like single serves will actually have two "serves" according to the nutrition information panel. Be aware of the risk that you may be tricked.
For an accurate comparison of two foods of the same type, we need to line up the information in the 100g column side by side.
Cereal A Cereal B
Energy per 100g 1610kj 1590kj
Protein per 100g 7.5g 6.7g
Fat total per 100g <1g 1.3g
Saturated fat per 100g <1g .4g
Carbohydrate total per 100g 86.0g 84.0g
Sugars 7.5g 9.3g
Dietary Fibre per 100g 1.5g 7.1g
Sodium (salt) per 100g 400mg120mg
What are we looking for when we look for healthy food?
We want the lower energy because we're trying to lose weight - Cereal B wins here, but not by a lot.
We want lower saturated fat - they're both quite low.
We want low sugar (but only because sugar is energy dense and increases the energy in food.) Cereal A wins here. Remember, the glycaemic index is far more important than whether the carbohydrate is sugar or starch, but neither of these cereals are marked with their GI.
We want high fibre. Fibre helps us feel full, and helps keep our bodies functioning effectively. Cereal B wins this by a long way.
And we want low salt, because although we all need a small amount of salt, most people eat far more than is healthy. Cereal B wins this one as well.
From comparing the two, I'd go with Cereal B for preference.
Now to serve it
We use the 100g (100ml for liquids) column of the nutrition information panel to compare products so we have a fair comparison.
When it comes to our actual serving, and recording it on Calorie King, it's time to use the actual serving size set - or to set your own serving size, but measure it, and tell Calorie King how much you've actually eaten.
You don't necessarily have to weigh and measure food every day, but doing it from time to time to ensure you still have a fairly good idea of what a serving size is, will make a huge difference to your weight loss. No matter how hard we work at checking that we are buying the very best food, if we are not actually paying attention to our portion sizes, we'll end up eating far more energy than our bodies can handle.
Note:
Our weight loss group uses calorieking.com.au which is a free site, or the Calorie King books which can be purchased fairly cheaply from most newsagents as the base for our program.
I'm desperate to have my cholesterol down before it's re-tested in three months time. To that end, I'm making sure I eat my five serves of vegetables and two of fruit every day.
If you're not sure about that, a serve of vegetables is usually about a cup of raw vegetables or half a cup of cooked vegetables. (This doesn't include things like potato or sweet potato, which contain so much carbohydrate that they're classed with grain food like rice, pasta or bread.) So I'm having two and a half cups of vegetables each at lunch and dinner. This is very filling.
A serve of fruit is generally just a piece of fruit like an apple or an orange or small banana, or a couple of smaller pieces of fruit like strawberries or kiwifruit. I'm making sure I eat some fruit each at breakfast and afternoon tea time. (This means I am back to eating afternoon tea, even though I can't have domperidone then - so my tummy does complain a bit. I just can't get down the sheer volume of food I need to eat in three meals a day.)
Of course, there are other food groups I must eat to get my day's nutrition: protein foods, carbohydrates, and dairy foods, as well as a small amount of healthy fats. I'm struggling to eat the bare minimum of these after the fruit and vegetables are accounted for.
That is causing me a problem. Tracking my eating on calorieking.com.au, I'm finding that I'm just not eating my energy requirements for the day. I'm eating so much food that's very low energy-density, I'm not able to eat much of anything else. I just don't feel I can fit it in!
In theory, I ought to lose tons of weight. So far, that's not showing up on the scale. But that has been an issue all along for me. My body seems very determined to hold on to its fat reserves in case Australia's struck with a sudden famine.
I received an email from a screenwriter who is writing a script which includes a character with lupus. One of the questions he asked me was: "What can you eat?"
