Mostrando entradas con la etiqueta Dieta. Mostrar todas las entradas
Mostrando entradas con la etiqueta Dieta. Mostrar todas las entradas

lunes, 3 de febrero de 2020

Bolognesa de soja texturizada

Receta para 2:

  • 80gr de soja texturizada 
  • 1 lata de 400ml de tomate natural triturado
  • un puñado de tomate seco
  • 1 chorrito de vino tinto
  • cebolla
  • ajo
  • Aceite de oliva virgen extra
  • Remojamos la soja en un recipiente con el tomate y vamos removiendo para que vaya absorbiendo el líquido.
  • Rehogamos la cebolla en el aceite de oliva y cuando esté pochada añadimos el ajo
  • A fuego medio, le añadimos el tomate y medio vaso de vino tinto. Removemos y echamos los tomates. 
  • Lo he dejado en el crockpot 3 horas cocinándose a potencia lenta. Pero si lo haces en una olla normal, déjalo a potencia baja, y ve removiendo durane media hora. Ya sabes que soja no necesita cocinarse. 
  • Por otra parte, haz los espguetis de boniato y cuando vayas a comer, mézclalos con tu salsa durante 10min, no más, para que no se queden blanditos. 

miércoles, 4 de diciembre de 2019

España: El País Más Sano del Mundo. ¿Hasta Cuando?

A principios de 2019 España fue nombrado el país más sano del mundo, sí, ¡en serio! (1) Si la imagen de este país ahora mismo es la de un país sano, donde todo el mundo come bien y vive hasta 100 años, el futuro no es tan atractivo. Hace un mes, la organización World Obesity (traducido como Obesidad Mundial) lanzó su atlas global de obesidad infantil (2), en el cual lista información sobre los porcentajes de obesidad en niños y niñas de 5 a 9 años y 10 a 19 años. También se listan los datos de porcentaje de mujeres que fuman y los porcentajes de adolescentes que no hacen suficiente actividad física.
En el 2013 en la Asamblea de Salud Mundial (World Health Assembly), 193 países acordaron que los niveles de obesidad infantil en el año 2025 no deberían superar de los niveles del 2010 – 2012. Pero, por desgracia, el documento de este año nos informa de que 80% de esos países tienen una probabilidad de cumplir ese reto por debajo de 10% y, ningún país tiene una probabilidad por encima de 50% de cumplirlo. En otras palabras, hace 6 años el mundo acordó frenar el crecimiento de obesidad infantil y, lo más probable, es que nadie lo consiga.

Los datos de España son los siguientes

% de niños con la edad 5-9 con obesidad en 2016
% de niñas con la edad 5-9 con obesidad en 2016
% de niños con la edad 10-19 con obesidad en 2016
% de niñas con la edad 10-19 con obesidad en 2016
% de niños adolescentes que no hacen suficiente actividad física en 2010
% de niñas adolescentes que no hacen suficiente actividad física en 2010
% de mujeres con obesidad en 2016
Estimación de % de mujeres fumadoras en 2020

Los colores no son así como un homenaje a la bandera de España, si no que representan números altos (rojo) y números medio-altos (amarillo).
Con estos datos de la situación actual, World Obesity asigna cada país una puntuación de riesgo (CHO Risk) que cuantifica el riesgo de cada niño y niña de tener obesidad. La puntuación máxima es 11 y España tiene 7.5, un riesgo alto según World Obesity.

Además de un reportaje de la situación actual, hay unas predicciones para el año 2030.

Predicción 2030 % de niños y niñas de 5-9 con obesidad
Predicción 2030 % de niños y niñas 10-19 con obesidad
Predicción 2030 numero de niños y niñas 5-9 con obesidad
Predicción 2030 numero de niños y niñas de 10-19 con obesidad

Con las predicciones de 2030, World Obesity le da a cada país una probabilidad de cumplir el objetivo de que los niveles de obesidad infantil en 2025 no sean más altos que en 2010-2012. España tiene una probabilidad de cumplir este objetivo de solo 18%.
En resumen, mientras que los niveles de obesidad infantil en España no son los más altos en el mundo, sí que son demasiados altos, y es muy probable que vayan a aumentar en los próximos 10 años. Un niño/a nacido hoy en España tiene una probabilidad del 68% de ser obeso/a. Otra estadística alarmante es la del porcentaje de niño/as que no hacen suficiente actividad física, especialmente las niñas. La actividad física es mucho más que una forma de controlar el peso corporal. Los beneficios son muchos y es imprescindible que encontremos una forma para aumentar los niveles de actividad física.   
En fin, decimos que España es el país mas sano del mundo, pero ¿no sería más correcto decir que España, en realidad, es el país menos insano?


miércoles, 13 de noviembre de 2019

Has the Game Really Changed?

You know a nutrition documentary is making a big splash when your friends start texting you to ask for your opinion. As most nutritionist/dietitians will agree, generally, your friend's interest in nutritional science will end at what is going to help them look good on the beach that summer or make them stronger/faster in their chosen sport.
 We had originally planned to give the documentary The Game Changers a miss, not because we have anything against vegetarianism or veganism, or to use the new trendy term "being plant based", in fact, quite the opposite. We often promote on our social media "meat free" days and are constantly badgering our patients to reduce their animal products in favour of vegetables and legumes. No, we didn't want to watch the movie because we suspected it would be a series of anecdotes passed off as "proof" that a plant based lifestyle is the ONLY way, and that if you don't convert right now you are evil and you will die when you're 50, if you're lucky.
 However, when a friend is asking your professional opinion you can't reply "sorry mate, I couldn't be bothered to watch it", and then be expected to be taken seriously at a later date.
 Before we get stuck in, I would like to point out that this review will not be an in-depth look at the studies and evidence that were put forward during the documentary. That has already been done quite extensively and so there's not much point in repeating ourselves. Further more, most people, who only have a passing interest in nutrition, are not going to want to hear all about research and statistical analysis. It is our job as nutritionists/dietitians to take that information and put it into "normal" language.
 With that in mind, if you do in fact want to look at the science in a more in-depth way, I would recommend going to Asker Jeukendrup's site where you will find a great critique of the evidence featured in the documentary.
 This review will be more of an overview of the documentary as a piece of film and the reason why, as someone who works in sport nutrition, I found it so infuriating.

The documentary taken purely at face value is brilliant. It is entertaining, emotive, thought provoking and motivational. It is really well shot and the narrator's journey from injury to recovery is fascinating. The athletes featured are all really interesting and to choose sports such as Strongman or American football, as opposed to Yoga, the stereotypical domain of the "whimpy vegan", was a very clever move from the directors of the film. And to top it all off, Arnie is in the movie! Who doesn't love Arnie???

 Where the wheels started to come off was when the coaches and Drs said things like "sport nutritionists say we have to eat meat" or "sport nutritionists say we need protein for energy". I was immediately confused because both of those statements were totally false. Anyone with even the most basic knowledge of nutrition would know that protein is not our primary energy source. And nor I, nor any nutritionist I know, have ever told anyone that they must eat meat.
 As the movie progressed it started to appear that it was advocates of the plant based lifestyle Vs sports nutrition of 30+ years ago. It didn't surprise me in the slightest when Arnie, a 72 year old man, described how he thought that he had to eat meat to hit his protein targets. Let's not forget that his pro bodybuliding career was from 1968 to 1980. You would hope science had moved on a fair bit in 40 years.
 The film makers then reveal that carbohydrate from plants and not protein from animals is the main fuel source for athletic performance as if they have just revealed the biggest kept secret in human history. Again, this puzzled me because this was nothing new, a quick browse through any sport nutrition literature would tell you exactly the same. But the film makers don't mention up to date sport nutrition. Instead they quote some German bloke from the 19th century who said vegetarians could never be athletes. A shocking statement yes, but also one that has nothing to do with modern sport nutrition. Pick any topic in science and compare it to what people thought 200 years ago and yes it's interesting and quite probably shocking but it has little to do with science in the 21st century.
 And then if going back 200 years wasn't enough, we do the inevitable trip back 100,000 years to our Paleo ancestors. And guess what? Turns out we didn't eat that much meat after all.
 It is fairly logical that when we had to spend time and energy to catch, kill and butcher our meat instead of just going down the shops, we wouldn't have eaten that much of it. Instead we relied more on fruits, vegetables and nuts for our energy source. That doesn't mean we didn't eat any meat at all. If we never ate meat we wouldn't have evolved the ability to eat meat. Next time you're down the park have a chew on some grass and see what happens. That is what happens when you eat something you're not supposed to.
 Apart from having little if anything to do with modern humans, no one in the sport nutrition world, at least nobody credible, is saying that human beings are carnivores.
 This leads nicely to the next point which, as infuriating as I find it, I must admit, this film is not the only one guilty of this. The constant comparison between a human and either the lion or gorilla to make a point about what we should or shouldn't eat is plainly ridiculous! You may as well compare us to trees and suggest we just stand in the sun all day. We are humans, not lions, not dogs, not gorillas, not sharks. We have all evolved on very different paths and so making comparisons is just a waste of time.

Moving away from the attack on outdated nutritional science onto the athletes themselves and things are not much better. This is probably the part of the movie that shocked me the most. No, not the fact we see plant based athletes exist, because again, we all knew that. What really shocked me was how appalling most of the diets of the featured (non-plant based) pro athletes were. I couldn't believe it when one of those pro American footballers was describing how his diet basically consisted of KFC. Or when the Titans guys were saying their pre-game meal was mountains of steak. As mentioned before, a big dollop of protein pre game is neither what is needed nor what is recommended, so I was totally flabbergasted that a sport as rich as American football had such poor sport nutrition support. Its not surprising at all that once you take somebody off a junk food diet they feel better. Hardly groundbreaking stuff that one.
 We see the same story with the firefighters, who were mostly overweight and pretty unhealthy looking, they were taken off their dreadful diets and shock horror, they felt better. 
Returning to steak, we got a little snap shot of everybody's favourite pantomime villain, Connor Mcgregor, and how his pre fight diet of 3 steaks a day backfired (who saw that coming?) and his plant based opponent, Nate Diaz, had more energy in the tank and eventually beat him. While it is not directly mentioned, it is heavily implied that because Diaz is plant based he won that fight. Again, what the standout message for me here was not Diaz being plant based but how Mcgregor was allowed or advised to eat nothing but steak before a fight. Yes, it sounds good in the press conference but in reality it is not going to help you much when your muscles are screaming for energy and you've hindered their ability to utilise glycogen through going low-carb. If McGregor had a sport nutritionist for that fight, something I doubt, I hope he fired him/her afterwards.
 Then we move on to Dotsie Bausch, the Olympic track cyclist, and we are told how she went through a transformation after leaving meat out of her diet. We see images of her smashing it in the gym and speeding round the track, whilst she describes how proud she felt "stood on the podium with a medal round her neck" at the 2012 Olympics. Now, to the majority of the viewers of this documentary they will probably think that she came away as Olympic champion. The choice of words and the editing of the clips from the race certainly gave that impression. I remember as I was watching the movie I was thinking "hang on a minute USA didn't win the women's team pursuit in 2012". I know next to nothing about American football, and little more about MMA but cycling is my sport, so I knew something fishy was going off here. I paused the movie and double checked online for the result, and sure enough, USA were beaten in the final by Britain (1). By quite a margin as well, nearly 5 seconds. I'm not for one second saying Bausch didn't win because she was plant based, I'm saying the omission of the fact her medal was silver, still an unbelievable achievement, was a very strange decision by the film makers, especially after the song and dance they made about Diaz beating McGregor.. A silver medal at the Olympic games is something to be very proud of and a clear demonstration that yes you can be plant based and get to the very top. There was no need to edit it in such fashion to lead you to falsely believe she won. Of course they will argue they never said she won, but they didn't say she came second either.
 They also heavily imply that the sudden turn around of the Titans' fortunes is down to a load of their players moving to a plant based diet. At the risk of sounding like a stuck record, I would argue it is probably more to do with them moving away from a junk food diet.
An important point to remember whenever elite athletes are concerned, there is always an elephant in the room when it comes to their diet and/or training plans which renders their comparison to mere mortals like us utterly pointless. I'm sure you know what I mean, but if you don't have a quick read about about else Arine was taking bucket loads of, spoiler alert, it wasn't soy.

Putting to one side the smoke and mirrors of the movie makers, these stories of athletes are nothing more than anecdotes. They are the movie equivalent of "this worked for me so it must work for you", which, as powerful as these anecdotes are, and watching a vegan athlete lift 550kg is certainly powerful, they are nothing more than a demonstration that in those cases those particular athletes can achieve amazing feats whilst being plant based. That's it. Nothing more. They are not proof that every athlete on Earth should become a plant based one.
This is where I was really disappointed with the film. I felt like the film makers were more interested in attacking the Low-Carb (LCHF) movement and the American meat industry rather than putting together a really great, scientifically sound documentary. If instead of attacking the sport nutrition sector with 30 year old data they invited some of the top sport nutrition minds on the movie, such as Asker Jeukendrup or Louise Burke or even my old lecturer Nigel Mitchel, a sports nutritionist for EF cycling team and (wait for it) a vegan, they would have got a more up to date view that wouldn't have altered greatly an important message from the film, eat more plants! But instead, they decided to go full conspiracy theory and started comparing meat to tobacco with the end result of not only ruffling the feathers of most sport nutritionists worldwide, but also damaging the value of the documentary. What I can never understand about these nutrition zealots is, if their chosen diet or lifestyle is unquestionably "the right way", why don't they just let the science speak for itself instead of resorting to dodgy tactics? for example, it's funny how the film mentions "industry sponsored science" but fails to mention the director is a major share holder in a vegetable protein supplement company. I'm sure they just forgot.
 If as a consequence of this movie people reduce their meat intake and increase their vegetable intake then fantastic! There's very little argument to be had when it comes to the fact that we eat too much meat and not enough veg. But that doesn't mean we all have to go full vegan! Even the guest Drs on the film say "predominantly plant based", which is a fancy way of saying balanced diet. This evangelical approach that food documentaries are currently taking is exhausting. It was the same with the low-carb movies, it's the same with the vegan ones and I'm sure it will be same with the fasting ones. Be it with our food or our politics, we appear to be living in a time where we must be A or B, black or white, yes or no, fat or thin. We slap a label on ourselves and we won't even entertain the idea of taking a bit from column A and a bit from column B. All that these documentaries achieve with their cherry picked, one sided science is to create further mistrust and confusion between the general public and the nutritional science industry, which, in turn, leaves the door open for the real con artists and quaks, of which there are plenty.

So finally, has the "game" really changed thanks to this film? The answer is a resounding NO I'm afraid. The film did not show us anything that wasn't already known in the current world of sport nutrition. We know plant based athletes can make it to the very top, we know a diet of red meat is not good for athletic performance (or health) and we know most of the developed world eats too much meat. Their decisions to portray sport nutrition as an outdated meat obsessed cartel, to cherry pick data and stretch the truth with clever editing has utterly diminished the credibility of the film, which I think is a great shame.
The one ray of hope from this film is that many athletes still eat like teenage boys and so we sport nutritionists are still very much in need.


viernes, 25 de octubre de 2019

Dietas bajas en carbohidratos y altas en grasa en deportes de resistencia: un repaso a la evidencia

No es sencillo informarse sobre las dietas bajas en carbohidratos y no perderse en un montón de anécdotas o peor, encontrarte en medio de una pelea de Twitter. Hay pocos temas en el mundo de la nutrición que causen tanto revuelo.

Mi interés personal en las dietas bajas en carbohidratos y altas en grasa (LCHF) se debe a su aplicación en deportes de resistencia.

Sería un sueño hecho realidad el poder utilizar las más de 100.000 kcal de grasa que están almacenadas en nuestro cuerpo. Pero como casi con todo lo relacionado con la nutrición, no es tan simple como nos gustaría.

Antes de que examinemos la evidencia, quiero aclarar que no estoy hablando sobre “LCHF” y composición corporal o sensibilidad a la insulina, sino solo examinando si una dieta baja en carbohidratos y alta en grasa te hace un mejor corredor, ciclista o triatleta.

En este post voy a resumir un artículo de Louise Burke que se llama “Re-examining High-Fat Diets for Sports Performance: Did We Call the "Nail in the Coffin" Too Soon?". El artículo original es en inglés, te recomiendo que lo leas. Lo puedes encontrar aquí. Abajo he traducido los puntos claves.

Es globalmente aceptado que una dieta LCHF de corta duración (menos de 3 días) es perjudicial para el rendimiento debido al agotamiento de glucógeno de los músculos y del hígado, y que no se produce un aumento de oxidación de grasa. Sin embargo, existen resultados interesantes si se sigue una dieta LCHF durante mucho tiempo.

Después de un repaso extenso de los artículos existentes desde 1980 hasta 2006, los resultados claves del autor son:

  • Seguir una dieta LCHF sin cetosis puede causar adaptaciones claves en los músculos en tan solo 5 días. Esto incluye un aumento de triglicéridos intramusculares y de la actividad de la enzima lipasa hormono sensible (LHS) que moviliza los triglicéridos de los músculos y el tejido adiposo. Con estas adaptaciones el/la atleta puede aumentar su oxidación de grasa. 
  • Estas adaptaciones persistirían a pesar de realizar 1-3 días de carga de carbohidratos. Aunque la velocidad de utilización de grasa sería menor en comparación con una dieta LCHF, sería más alta que con una dieta alta en carbohidratos.
  • La exposición crónica a una dieta LCHF causa una regulación a la baja en la utilización de los carbohidratos, específicamente del glucógeno de los músculos, durante ejercicio. Esta regulación a la baja persiste durante el ejercicio de alta intensidad, incluso en estudios con una dieta LCHF seguido por una carga de carbohidratos.
  • A pesar del aumento en la capacidad de utilizar esta fuente de combustible, las estrategias de LCHF no han dado lugar a una mejora del rendimiento en deportes de resistencia. Las mejoras se han limitado a estudios con protocolos de ejercicio sub-máximo, que no son un fiel reflejo de los deporte de resistencia.
  • Es posible que las estrategias LCHF puedan perjudicar rendimiento, específicamente deportes que tienen intervalos cortos de esfuerzas de alta intensidad. Esto es probablemente debido a una disfunción en la utilización del glucógeno por parte del músculo.

La autora escribió que debido al reciente aumento de popularidad de las dietas LCHF, había vuelto a examinar la evidencia disponible. Sin embargo no pudo encontrar estudios recientes que justificaran la avalancha de popularidad. De hecho sólo encontró dos estudios con atletas, desde 2006, y ninguno mostró una mejora del rendimiento. Sin embargo lo que sí que mostraron fue un pequeño pero favorable cambio en la composición del cuerpo debido a una reducción de grasa corporal.

La autora afirma que la mayor parte del apoyo a las dietas LCHF se encuentra en los medios de comunicación social, como por ejemplo, Twitter. También que en general está relacionado con atletas que no son de elite y que son historias de tipo anecdótico.
La conclusión de la autora es que en lugar de un “pensamiento en blanco y negro”, los investigadores y profesionales deberían moverse hacia protocolos individualizados cuando trabajen con atletas.

Mis pensamientos

Creo que Louise Burke ha escrito un artículo muy interesante y lleno de sentido; estoy de acuerdo con que deberíamos mantener una actitud más flexible y que el dogma no ayuda a nadie.

En el pasado se pensaba que las dietas altas en carbohidratos eran la única dieta que se podía seguir si querías participar en los deportes de resistencia. Ahora, sin embargo, parece que algunos se han ido al extremo opuesto y defienden que sólo se debe seguir una dieta LCHF.
Personalmente veo los beneficios de limitar de vez en cuando la ingesta de carbohidratos, especialmente si quieres reducir la grasa corporal. Pero lo cierto es que la evidencia demuestra que si quieres rendir bien en un ejercicio de alta intensidad, seguir una dieta crónicamente baja en carbohidratos sería perjudicial.

Si quieres que te ayude a planificar tu entrenamiento deportivo, escríbeme a

miércoles, 10 de abril de 2019

Probióticos: ¿sí o no?

El acceso a y uso de probióticos está cada vez más extendido. No solo se venden como suplementos en las farmacias, si no que también lo vemos anunciado en variedad de productos como yogures, té kombucha, miso, kéfir, etc.
Imagen de Bruno Glätsch en Pixabay 

Para aquellos que no sepan de lo que estoy hablando, los probióticos son microorganismos vivos que pueden, potencialmente, aportar beneficios para la salud de aquellos que los consumen (1). Según la Organización Mundial de Gastroenterología, estrictamente hablando, solo se les debería llamar probióticos a aquellos productos que han demostrado, en estudios, producir este efecto beneficioso. 

En general, se supone que al introducir especies de bacterias beneficiosas para el organismo, nos podríamos beneficiar de, por ejemplo, menor incidencia de diarrea tras el uso de antibióticos, ya que éstos matarían tanto a las bacterias dañinas como a las "buenas" que tenemos en el intestino. Sobre el papel tiene sentido, pero en la realidad no ha habido tanto éxito aplicándolo. Por ejemplo, hay estudios (2) que no han encontrado un efecto consistente tras el consumo de yogur para prevenir la diarrea asociada al consumo de antibióticos, e incluso este estudio (3) mostró cómo algunas personas suplementadas con probióticos presentaban un retraso en la recuperación de la flora intestinal tras el uso de antibióticos, comparados con aquellos que tomaron un placebo. Curiosamente, lo que sí que demostró tener un efecto positivo fue el transplante fecal autólogo, que es básicamente la reintroducción de las heces del paciente en sí mismo. 

También se ha sugerido que los probióticos estimulan, modulan y regulan la respuesta inmunitaria del huésped (4) y que podrían jugar un papel importante en la regulación de la inflamación en enfermedades inflamatorias intestinales (5). Incluso jugaría un papel importante en la dermatitis atópica (6).

Sin embargo, existen varios "problemillas" con los probióticos. Para empezar, al ser un suplemento alimentario, no está regulado de la misma manera que los medicamentos, con lo que podría contener especies de bacterias que "no nos interesan" y que podrían ser dañinas (7). También ha habido casos en los que los efectos asociados a estos "suplementos" o probióticos no han podido demostrarse cuando se le ha pedido a la compañía en cuestión que presente los hallazgos o las pruebas que demuestran que en realidad sí que se produce un efecto beneficioso. Este es el caso del Activia de Danone o del L.Casei (8). Básicamente le vinieron a decir a Danone que hasta que no pruebe que el activia te regula el tránsito intestinal y que el Actimel te protege de resfriados (por los probióticos que contiene), pues que no puede decir que sus productos te curan nada de nada. También existe el problema de que el probiótico tiene que atravesar en estómago, con sus ácidos gástricos correspondientes, con lo que las cepas tienen que estar protegidas de tal manera que consigan llegar al intestino. Y luego, una vez allí, tienen que sobrevivir y colonizarlo. 

Y la realidad es que, ahora mismo, no hay suficientes estudios que garanticen que a nivel poblacional sea beneficioso el uso indiscriminado de probióticos. De hecho, hace tan solo unos días, se ha presentado en la reunión anual del American Association for Cancer Research, un abstract que mostraba como en pacientes con melanoma, tomar suplementos probióticos se asociaba con una posibilidad 70% menor de respuesta al tratamiento de inmunoterapia contra ciertos tipos de cáncer. 

La flora intestinal es muy personal, y cada uno tenemos diferentes microorganismos que pueden responder de manera distinta a la suplementación con probióticos. Sí que es un área que promete y que creo que va a tener mucha importancia en los próximos años, aunque los datos parecen apuntar a que los probióticos deberán ser diseñados de forma personal, y que no va a ser algo de que "un probiótico nos vale a todos para todo". También los transplantes fecales (que ya se realizan en España) están cobrando más importancia, ya que en vez de introducir un número limitado de especies, estamos introduciendo un ecosistema completo. 

También mencionar que aunque sí que se ha demostrado su eficacia en casos aislados (9),  existe mucha publicidad dudosa al respecto, como el Probiota Histaminx, cuyos estudios asociados a la eficacia no he conseguido encontrar, cepas de probióticos de farmacia como Lactibiane, que tampoco tiene estudios para demostrar la eficacia (en su estudio no consiguieron probar eficacia en aliviar los síntomas del Intestino Irritable (10): Lactibiane Référence was not superior to the placebo in relieving symptoms of IBS (42.6 % vs 42.3 % improvement).

Muchos de estos probióticos parece que podrían tener efecto. Sin embargo nos hemos liado a crear productos con probióticos sin todavía entender completamente el mecanismo de actuación ni tampoco la complejidad del microbioma intestinal.

Lo cierto es que se necesitan muchos más estudios para conocer qué bacterias, qué cepas dentro de esas bacterias, en qué cantidades, durante cuando tiempo y para qué condiciones/enfermedades los deberíamos tomar. Y, aunque el consejo general solía ser "bueno, tómatelo, daño no te va a hacer y a lo mejor te va bien", cada vez hay más evidencia disponible de que no es cierto y sí podría tener un efecto nocivo.

Parece que además de probióticos y prebióticos hay un tercero que se ha unido a la fiesta, los postbioticos, pero ya hablaremos de ellos más adelante. 


lunes, 8 de abril de 2019

Thin Privilege: An Update

After another lively debate on Facebook regarding this topic I spent most of the other night thinking about it and my reaction to it. 
Is this where I suddenly repent and accept my thin privilege? No, it isn't. I still don't like the term, the concept and everything it entails and here is why.
When I read the original article and the comments associated with it it made me angry because deep down I didn't think I was getting any kind of privilege for being thin. Yes as a man, and although I really didn't want to bring race into it, a white man, I fully acknowledge the society we live in has been constructed in my favour. I accept that, and if it will change anything, which I doubt it will, I acknowledge that privilege. 

The comments I received mostly seemed to indicate that I was denying that "weight bias" "body diversity" "Sizeism" and so on existed, which was not the case. What I didn't like was first the assumption that people are "naturally thin", and that my life is easy because I am thin, You have no idea about my life just as I don't about yours, any assumption based on appearance is wrong. 
This point didn't seem to be accepted and I continued to receive anecdotes about people's lives and how they struggle with discrimination, which, at the risk of sounding like a stuck record I didn't deny existed.

After being directed towards research around weight bias and wages, a couple of points jumped out at me and made me rethink why I am reacting this way. 
In an article in the Journal of Applied Psychology (1) it was demonstrated that thinner women get paid more, not surprising, but the opposite was true for men. In fact, larger men get paid more up until the point of obesity. And a quote lifted from an article on Forbes (2) based on the study said. "Skinny men, indeed, are often regarded as nervous, sneaky, afraid, sad, weak, and sick, where men of well-proportioned build are associated with traits such as having lots of friends, being happy, polite, helpful, brave, smart, and neat." 

So is this really "Fat Vs Thin"? Or is it just another example of different rules for men and women?

I started thinking through my experiences in work and the times I've had to say "yes I do eat" or "no I am not addicted to heroin", did me being a thin man (as opposed to just thin) have something to do with this? 
Or the times I felt I wasn't taken seriously in staff meetings. I had always assumed it was because I was one of the youngest in the room (sadly no longer the case) but maybe it was because I was thin? 
While I can still find clothes that fit me in most shops I have noticed that I have had to drop down a size from M to S with no major change in body weight. It appears that provisions are being made to spare men's feelings by simply shifting everything up one size which is not happening for women. So is this really "thin privilege" or just plain old sexism? 
Is it possible that as a man "thin privilege" doesn't extend to me? Or at least not as much as it does for women? 

Rethinking where I stand on this topic I still reject the term thin privilege because I think it diverts away from the real issue which is what society expects of women. It looks like as a man I can put on a few kilos and not suffer any negative consequences, up to a point, whereas women cannot. And to me that is sexism not thin privilege. 

1.  2011 Jan;96(1):95-112. doi: 10.1037/a0020860.

viernes, 5 de abril de 2019

No, we don’t need to talk about thin privilege

 Update: I have modified slightly my opinion on the term thin privilege which can be read here

This is an opinion piece by Wayne Bradley and does not reflect anybody else's views associated with this blog.

Recently I found myself in a debate with fellow nutritionists and dietitians on the Build Up Dietitians Facebook page regarding the concept of thin privilege. Thin privilege is as follows, we “thin” people live in a world where we don’t experience the stigma and prejudices that overweight people experience. We can find clothes easily, we don’t get stared at when we eat in public and so on. 

Ok, so far so good, nobody would argue with that fact. But I have several issues with labelling it “thin privilege”, firstly the word privilege and the tone of the articles I have read regarding this topic indicate that being thin, or “skinny” which gets thrown around lightly but no-one will dare say fat, is something that has been gifted to us, we haven’t earned it and we should thank our lucky stars that we’re in this position. 
Most people, especially those in the health & nutrition industry know only too well how hard maintaining/losing weight is and to hint that normal weight people are somehow blessed or “privileged” is quite insulting, but sadly nothing new. Now of course because I said I eat well and do a lot of exercise that also means I think every large person is bone idle and just eats pizzas all day long! No, it doesn’t! It means making ANY assumption about a person’s body shape is wrong. 

I feel very proud of myself when I see those scales going down, or when I get up 8am on a Sunday to go riding even though the sun is shining and I’d much rather have a few beers with my wife and friends. To suggest I should somehow feel privileged for that completely undermines the hard work and effort I (or anyone) does to maintain their healthy lifestyle. That doesn’t make me unaware of the battles large people go through, in fact, what I do with my life has nothing to do with what my patients do with theirs, which leads me on to my second issue.  

My second issue is also to do with the term “thin privilege”. It is a nonsense term and completely unnecessary. When our patients come to visit us, they will discuss with us the problems they face, not only with their food choices but with self -esteem, health issues and so on. We will listen to them and if we do not share the same problems we will use empathy to understand them and guide our patients through their journey. 
We already have the word, it is empathy, we do not need a new Insta-trendy, buzzword. If as a healthcare professional you are unable to empathise with your patients then may I suggest a career change? Politics perhaps. 

To repeat a previous point, what I do with my life has no bearing on my patient's lives and has no place in a consultation. They are there to talk about their lives not mine. If the boot was on the other foot and my coach was "acknowledging" their superior athletic ability or shall we say "athletic privilege", I would feel extremely patronised and would probably sever ties with that coach very quickly. 

Perhaps I am being too pedantic around terminologies and the use of words. However, I worry that we are going down a particular path where we will not be able to openly discuss weight, obesity and its related health problems. Body size and shape should not be attributed to attractiveness, I will vigorously defend that there is not one "perfect" type of body in terms of what is "hot" or "sexy". We all have our own tastes and that is what makes the human race so amazing! However, obesity is not healthy, it just isn't. Many co-morbidities exist with obesity, we all know it and not discussing them does not make them go away. 

Saying "you're fat therefore ugly" is disgusting and should be stamped out immediately. But saying "you are overweight and need to make a change to improve your life" is not the same thing and should be what we are saying, but I fear we are becoming too scared of being labelled as "fat shamers". 

To repeat, I acknowledge that larger people have a tough time in regards to the society we live in, but as nutritionists/dietitians we are there to help them and we owe it to them to be honest. What use is saying "yeah I know I'm thin and my life is easier than yours"? 

During the debate, the topic of the genetic influence on body weight continued to appear, while it was beside my original point I will address it here.Yes genetics plays a large role in a person's size. The size of that role varies. However, does that mean we all just give up and say "its the genetics"? Because if that is the case then dietetics is dead!! I don't believe that is the case, some of us have been dealt a good hand in genetics, some haven't. That doesn't mean we can't make the best with what we've got. We can still strive to be the best version of ourselves and I strongly believe that externalising ourselves to the genetically thin and fat does us all a huge disservice. 

Wayne Bradley BSc (hons) MSc PG cert

viernes, 4 de enero de 2019

Pasó la Navidad... y nos hemos pasado

Ya ha pasado la parte más complicada de las fiestas y solo nos quedan los Reyes. 

Después de las principales comidas y cenas, estos días nos hemos dado cuenta de que han pasado factura. Nos sentimos hinchados, empachados, incómodos, indigestos; sentimos que hemos puesto algo de peso y hemos bebido más de la cuenta.

Muchos tendréis la tentación de parar por la farmacia y llevaros uno de esos productos detox que te ayudan a limpiarte por dentro tras los excesos navidadeños. Pero recordad lo que hablábamos aquí sobre las dietas detox: "No existe ningún tipo de evidencia científica que pruebe la eficacia de las dietas depurativas. Nuestro cuerpo ya tiene maneras (mediante nuestro hígado, riñón y piel) de deshacerse de las toxinas y elementos que nuestro cuerpo no necesita". Vale la pena volver a leerse este otro post que escribimos después del verano sobre las dietas depurativas y otros tipos de dietas son más efectivas que una de zumos. 

En fín, entonces, ¿qué hacemos? Nos hemos saltado nuestra rutina y ¡nos encontramos mal! Lo más efectivo es volver a nuestra alimentación habitual y escuchar lo que nos pide el cuerpo. Si no tenemos tanta hambre como antes de las fiestas, no hace falta que nos forcemos a comer las 5 comidas al día que solíamos antes del 24-D ni tampoco las mismas cantidades. 

¿Cuál es la clave? Incluir verdura en todas las comidas: nos aporta un montón de vitaminas y minerales que probablemente hayamos descuidado durante las fiestas y además es rica en fibra, que nos ayudará a ir al baño e ir regulando nuestro sistema intestinal (que puede haber variado y situarse en estreñimiento o diarrea).

Muy importante: no caer en el truco de los zumos. Los zumos, ya sean naturales o comerciales, son ricos en azúcares (algo que ya hemos tomado de sobra durante las navidades); así que mejor, la fruta entera, que nos haga masticar y sacie más y por más tiempo. Y para beber, ¡agua!

¿Qué más puedes hacer? Retomar la actividad física. En las fiestas probablemente nos hemos movido menos y si solíamos ir al gimnasio, seguro que no hemos ido tan a menudo. Empezar a movernos y a sudar nos ayudará a activar nuestro cuerpo, nos subirá el ánimo y ayudará a quemar un extra de calorías. Si no te gusta ir al gimnasio, prueba a hacer actividades en casa, youtube está lleno de ideas: zumba, yoga, tablas de ejercicios, abdominales, salsa. Busca una actividad que te motive e inclúyela en tu rutina semanal al menos 3 veces a las semana 20min para luego llegar a 5 veces a la semana 30min (ya sabes que la actidad física recomendada es de al menos 150 min a la semana).

Y sobre todo, ¡no te desanimes! Si te has pasado, te has pasado, ya está. No hay nada que hacerle; ahora vuelve a tu rutina de siempre y verás como empiezas a sentirte mejor en 3-4 días.

Si quieres saber que ejercicios serían más apropiado para tí o quieres empezar el año alimentándote mejor, no dudes en pedir una cita escribiéndonos a 

Para conocer más sobre los servicios que ofrecemos visita: 

lunes, 15 de octubre de 2018

Diagnosis of IBS: Breath Tests

One of the many frustrating aspects of irritable bowel syndrome (IBS) is it can appear quite vague and “un-scientific” when it comes to getting a diagnosis. In today’s modern world we expect diseases to be diagnosed rapidly and efficiently, we go to the Drs, they take some blood and a few days later we have our results. With IBS on the other hand, its lots of questionnaires, symptom diaries and trial and error.
One area that does appear, on the face of it, to offer a clear yes/no answer are breath tests. But how useful are breath tests when it comes to an IBS diagnosis?

What are breath tests?

Breath tests are used to determine whether you absorb or malabsorb a particular sugar. The tests offered are usually for lactose, fructose, sorbitol and mannitol. The patient will be given a dose of one the above sugars and then the amount of hydrogen and/or methane is measured in the patient’s breath. The understanding is that any of the sugars that are not absorbed are fermented by intestinal bacteria which produce the gases hydrogen and methane. The gases are carried in the bloodstream to the lungs where they are exhaled. A cut off point is established and if the amount of exhaled gas is above that point then the patient is diagnosed as “intolerant” to that sugar.
For an individual that suspects they may have IBS these tests appear very attractive because all of the mentioned sugars are associated with the condition plus the tests promise a quick and clear result.


Sadly here comes the but. While lactose intolerance is a recognised condition and the breath test to determine it well established, the same cannot be said for fructose, sorbitol and mannitol. One issue is the lack of standardisation of the test, different centres have different cut-off points so your diagnosis may be different depending on the centre’s cut-off point not the amount of hydrogen you produced in your test.
Focussing on fructose for a second, we all have a limited capacity to absorb fructose. That means that at a large enough dose every single one of us will malabsorb fructose. A study from way back in 1986 found that 8 out 10 healthy subjects malabsrobed a 50g dose of fructose, whereas only 1 out of the 10 malabsorbed the 15g dose (1). Another study in 2014 found similar results, in a group of 16 healthy (non IBS) participants, a 40g dose of fructose was shown to distend the small bowel with water and cause IBS type symptoms even though they were not IBS sufferers (2).
This means that depending on what dose they give you could be wrongly labelled as intolerant to fructose or even given a false IBS diagnosis. What has been shown is that some people are more sensitive than others to a single dose of fructose but to label them intolerant is probably an exaggeration.
In conclusion, while the idea of a quick test and diagnosis is very attractive, especially in a condition such as IBS where patients are usually desperate for a straight answer. The lack of standardisation of the tests and the fact that we all could be diagnosed as fructose “intolerant” at the right dose means that sadly breath tests are not a reliable way to get an IBS diagnosis.


1.  J J Rumessen and E Gudmand-Høyer, 1986. Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides.Gut. 27 (10) 1161-1168

2.  Murray, K et al. 2014. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. American Journal of Gastroenterology. 109 (1) 109-110

martes, 26 de junio de 2018

10 consejos de cara al verano

Estrenando mayo, y con calorcito, ya nos empiezan a bombardear con productos para cuidar la figura; desde cremas reductoras hasta tés diuréticos, pastilla come-grasas y, sobre todo, batidos detox. 

Pero no caigas en la tentación. Si quieres estar list@ para el verano, un zumo detox no te va a ayudar, sino más bien lo contrario. Los zumos detox están llenos de azúcar (los de las frutas, que sí, son naturales, pero azúcares al fin y al cabo) y, aunque en un principio te ayuden a perder algo de líquido (ese kilo-dos kilos que vemos que baja en la primeras semanas), pronto te estancarás y recuperarás el peso perdido en cuanto dejes el batido. Son tan bonitos, tan verdes, tan de dieta...¡pero no! Haznos caso, mejor tómate las espinacas y el pepino de la forma tradicionar, es decir, masticando, que ya verás como no te cabe tanto!!

Por eso hoy hemos preparado 10 consejos para ayudarte a llegar a ese peso que te gustaría (o al menos a acercarte al él) antes de que te cojas vacaciones y te vayas a la playa. ¿Preparad@? Toma nota:
  1. Cámbiate a productos integrales: te saciarán más y te proporcionarán energía durante más tiempo. Además, se absorben más lentamente que los carbohidratos refinados y producirás menos insulina para metabolizarlos, lo que te ayudará a no acumular más grasa. 
  2. Elimina alimentos superfluos: se acabaron las galletas para desayunar o picar de la caja de bombones en la oficina. Se acabó el tomar un pincho de tortilla a media mañana con el café. Y si sales a tomar algo, mantente alejad@ de las patatas fritas y el mix de frutos secos. Y de los refrescos con azúcar! ¿¿¿Sabías que una cocacola tiene casi 40gr de azúcar??? Planifica tus comida y tus snacks incluyendo alimentos nutritivos y saciantes: tostada integral con aguacate, yogur con nueces o semillas de sésamo, fruta, un puñado de frutos secos, pan integral con requesón, etc.
  3. Deshazte del azúcar añadido: cada vez está más claro que el exceso de azúcar produce un aumento de grasa corporal (es decir, que no solo " la grasa produce grasa"). Quítatelo de los yogures, pan de molde, salsas, pan del desayuno, pavo, café. 
  4. Elimina el alcohol. Sí, sabemos que no quieres oír esto, pero cuando pases un par de semanas sin alcohol te darás cuenta de como te deshinchas. Piensa que es un sacrificio temporal y necesario. Esto no significa que renuncies a tu vida social, si no que sustituyas tu caña o vino por agua, nestea sin azúcar, o refrescos light. 
  5. Pon verdura en todas tus comidas. Como mínimo, 200gr de verduras en cada comida y cena. Las verduras te van a saciar porque contienen fibra, además de un montón de vitaminas y minerales. ¡Deben estar presentes en TODAS tus comidas!
  6. Bebe agua. Muchas veces pensamos que tenemos hambre cuando en realidad es sed y terminamos comiendo más de la cuenta. Si estás liada en el trabajo, ten una botella de 500ml cerca de la mesa y asegúrate de que te la bebes para el final de la mañana. 
  7. Camina. Todos los días, al menos 30-45 minutos sin parar, a un paso acelarado, con la espalda recta y los hombros hacia atrás. La postura es tan importante como el andar en sí, no la descuides. Irse a caminar parece algo muy sencillo, pero, si lo piensas ¿a que hay días que no has andado ni siquiera 30 minutos seguidos? Y no: "no tengo tiempo" no es una excusa válida. Si fuera fácil, lo habrías hecho hace tiempo , ¿verdad?
  8. Cardio y tonificacion: has estado desde el verano pasado sin hacer demasiado ejercicio y necesitas tonificar. No es solo perder esa grasa que nos molesta, si no que tengamos una musculatura debajo. Si no estás apuntad@ a un gimnasio, plantéatelo. Si no, trae el gimnasio a casa. En Youtube podrás encontrar mil vídeos con ejercicios, tanto cardio como de fortalecimiento para hacer en casa. Proponte encontrar tiempo 3 días a la semana y ¡pónte en forma! Enseguida verás los resultados. 
  9. Planifica tu menú semanal: si te sientas el domingo y planificas lo que vas a comer y cenar durante la semana, ahorrarás tiempo en tu día a día. No tendrás que abrir la nevera y preguntarte qué puedes cocinar hoy para no tener que tirar ese puerro que te mira como mustio. Tener un menú semanal te ayudará también a hacer la compra, con lo que no tendrás que visitar el súper a diario porque se te ha olvidado alguna cosilla.
  10.  Sigue estos consejos durante todo el año.  De esta manera, te ahorrarás quebraderos de cabeza cuando veas que empieza el calorcito y saques la ropa del verano pasado para ver si te cabe. 
Si necesitas asesoramiento y te gustaría pedir una cita, estemos encantados de atenderte y ayudarte con estos cambios. No dudes en ponerte en contacto con nosotros en 

lunes, 25 de junio de 2018

Gluten Sensitivity: Does it really exist?

In previous articles we have explained the difference between coeliac disease, wheat allergy and a third condition known as Non-Coeliac Gluten Sensitivity (NCGS). To briefly recap, as the name suggests, NCGS appears to be a condition where people who are neither coeliac nor allergic to wheat still report symptoms of bloating, loose stools etc. when consuming gluten containing foods. The mechanisms behind the condition are unclear, the immune system doesn’t appear to be involved but some researchers have suggested that NCGS may be a step along the path towards coeliac disease (1). Whilst we were completing the Monash FODMAP course another possible explanation was put forward to explain why people who have no immunological response to gluten still report gastrointestinal issues when eating gluten containing foods. What was interesting was that the explanation called into question the very existence of the condition of NCGS.
In recent years gluten free eating has become very popular and lots of pseudo-conditions are attributed to gluten. Although NCGS isn’t what we would call a pseudo-condition it has been proposed that it might be part of IBS and the culprit isn’t gluten after all. 

Fructans are chains of varying length of the sugar fructose, they are universally malabsorbed because we do not have the required enzyme in our body to break the chains into smaller fructose units. This leads to the fructans passing to the large intestine where they are fermented by the resident bacteria. This fermentation and the resulting gas production is usually well tolerated by non-IBS people but people with IBS tend to be highly sensitive to the fermentation of fructans and experience painful bloating and bowel distention. Foods that contain fructans are vegetables such as onion and garlic and of course wheat.
Monash University state that there is a lack of evidence that has managed to separate the effects of gluten from fructans so it is unclear which food component they are reacting to. Therefore, they do not recognise NCGS as a condition in itself and propose that people who report problems with gluten may in fact be IBS sufferers reacting to the fructans in wheat (2).
Now, this all sounds well and good, people can now relax and realise they weren’t sensitive to gluten after all. However, the problem lies in the practicality of it all. Finding a food that contains gluten but no fructans is virtually impossible, the only one we have found so far is sourdough bread or “masa madre” as it’s known here in Spain. During the fermentation process of sourdough bread, microorganisms such as Lactobacilli feed on the fructans and reduce their content in the finished product. The end result is that people who previously thought they were gluten-sensitive could enjoy sourdough bread, providing coeliac disease has been correctly excluded.

In conclusion, it appears that there is a lack of strong evidence to declare that NCGS is a condition in itself and people who report symptoms may be in fact IBS sufferers who are particularly sensitive to fructans. Aside from wheat, people who suspect they may fall into this category also need to keep in mind, onion, garlic, leeks and chickpeas.
For any more information on IBS or the Low FODMAP diet please get in touch via

1. Francavilla MD, et al. 2014, Clinical, Serologic and Histologic Features of Gluten Sensitivity in Children. The Journal of Paediatrics; 164: 463-7