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.

But…..

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.

References

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

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 info@gabinetederueda.es 

La homeopatía sale cara

Desde hoy estamos colaborando con Build Up Dietitians, una red global de dietistas que incluye tanto dietistas americanos como británicos, australianos, etc. que intentan compartir nutrición basada en la evidencia.

Como vamos a estar compartiendo y escribiendo posts para ellos, iremos dejando los enlaces por aquí para que los podáis leer en su página de FB, abierta a todos los públicos No necesitáis tener una cuenta en FB para acceder.

Nuestro primer post va sobre la homeopatía (que es distinto a la suplementación con plantas medicinales, no lo confundamos). Vale la pena investigar un poco nuestra Ley del Medicamento en España, los decretos están disponibles online aquí. 

Link al post

Parece que la FDA va a endurecer la legislación relativa a los productos homeopáticos, especialmente para aquellos que son publicitados para tratar enfermedades graves. En España, según la Ley del Medicamento, para venderse no tienen que demostrar que son efectivos sino que son inocuos. Sí, lo has leído bien. Deben ser inocuos, lo cual no es difícil ya que, según la ley, deben estar disueltos en 1 parte del sustrato madre por cada 10 000.
“A veces el peligro de los productos homeopáticos es que las personas que los toman dejan de tomar aquellos medicamentos que han sido estudiados y que son, en realidad, seguros y efectivos.”

https://tonic.vice.com/…/evmm…/are-homeopathic-remedies-safe

¿Cómo se regula la homepopatía en tu país? (LR)

El gran error que tienes que evitar en Enero

Aquí estamos otra vez: un año nuevo, hace frío y nos sentimos gordos y feos porque hemos comido y bebido demasiado en Navidad. Internet está lleno de artículos, consejos y curas milagrosas para perder grasa, ganar músculo y arreglar todo.

No vamos a añadir nada a estas listas de curas pero te vamos a ofrecer un único consejo para tener en cuenta si quieres empezar una dieta o un régimen de ejercicio.

Si estás en dieta no empieces un bloque de entrenamiento duro o alta intensidad  

Es un error que comete mucha gente y (en nuestra humilde opinión) la principal razón por la que la mayoría de los “quiero ponerme en forma” fallan en febrero. Mucha gente ha pasado las Navidades bebiendo, comiendo y no haciendo casi nada de ejercicio,  y cuando llega al año nuevo empiezan una dieta muy estricta y se castigan en el gimnasio, todo a la vez. Normalmente estas rutinas tan duras ocasionan lesiones y enfermedades y no se pueden mantener más allá de unas semanas. 
 

Como hemos dicho anteriormente, tu nutrición tiene que estar adaptada a tu plan de ejercicio, es decir, si vas a empezar una rutina muy dura, tu cuerpo necesita los nutrientes necesarios para proporcionarte energía y hacer las adaptaciones necesarias, como aumentar el tejido muscular. Si tu cuerpo no tiene suficiente energía porque estás siguiendo una dieta muy estricta, no podrás hacer los ejercicios bien porque no tienes sustento y eso aumentará el riesgo de lesiones; tu sistema inmunitario tampoco podrá funcionar de manera óptima y te pondrás enferm@.  

Si quieres empezar una dieta, aquí tienes algunos puntos clave

• Asegúrate de que mantienes una ingesta adecuada de proteína: 1,5 – 2g/kg de peso corporal 
• Haz ejercicio de esfuerzo para mantener la masa muscular pero recuerda, nada de alta intensidad
•  Si haces ejercicio de resistencia, que no sean de larga duración (más de una hora) o de alta intensidad (mayor que zona 3 - pulsaciones/vatios). 

Cuando hayas llegado a tu peso objetivo puedes aumentar la intensidad y empezar a entrenar más duro, pero siempre adaptando tu dieta a ello.

The number one mistake to avoid when you start your January fitness regime

 Here we are again, its January, it’s cold and miserable and we all feel fat and ugly! After overindulging over the Christmas period we are all determined to get back in shape. 
The internet is currently awash with detox plans and miracle regimes to get everyone thin, fit and strong. 
We’re not going to add to the list but we are going to offer you a piece of advice that you should always take into account when deciding if you going to try to lose weight.

Do not start a block of hard training if you are dieting

This is a mistake people make over and over again and (in our opinion) why many “I must get fit” New Year’s resolutions fail around mid to late February. 

People will have spent most of December drinking and eating and probably not doing much exercise, and when January arrives they go on a strict diet and flog themselves in the gym. 

The usual result is they become either sick or injured and then the new regime falls by the wayside. 

As we have said previously you have to match your nutrition to your training needs. If you are going to start a very hard exercise regime, depriving your body of the necessary nutrients to provide energy and make the adaptations will result in, at best poor training sessions and at worst, getting sick and/or injured.

If you want to go on a diet some key points to remember are

• Make sure you maintain an adequate intake of protein, 1.5-2g/kg of bodyweight
• Make sure you do resistance training in the gym to maintain muscle mass (remember nothing crazy)
• Keep any cardio work to a moderate intensity and duration

Once you have reached you goal weight you can start to increase the intensity of you fitness regime.

For any more questions regarding diet and exercise email info@gabinetederueda.es 

An Introduction to Periodised Nutrition

If you regularly read articles about training or subscribe to any of the millions of training magazines, you will almost certainly be familiar with the term “periodised training”. Basically, it means instead of doing the same thing day in day out, you plan your training sessions to ensure you reach your optimal state of fitness for your given sport at the right time. As with most ideas regarding training it has been tweaked over the years and now we have versions such as, inverse periodisation, block periodisation so on and so on, but the idea remains the same, plan your training.

When people ask me how much carbs/protein/fat they should eat I always answer, “it depends on your training”. Initially they think I have given them a rather vague and unhelpful answer, but once I explain that their nutrition should match their training and go into detail they understand why I gave that answer.

This is the concept of periodised nutrition, depending on the type/duration/intensity of your training regime determines what you should eat. This is one of my main arguments against the LCHF craze, if during your training regime you have any periods of high intensity training or races, then chronically following a low carb diet will not be of much help. Of course, the opposite is true. If you are not doing any kind of intense or long duration training then a high carbohydrate diet is not necessary.

A good example would be somebody training for an Ironman, whilst the event is still several months away and they are wanting to optimise their fat utilisation capacity, they will most likely be doing sessions of fasted training or sessions of fairly low intensity. At this point, I would recommend a diet low in carbs with higher fat. Once they got nearer to race day and the intensity of training increased, I would increase the amount of carbohydrate in their diet. And of course, for the event itself, ensuring they take on plenty of carbohydrate will be vital.

In summary, your diet should provide fuel for your training and your recovery, the more intense your training is the more you will need carbohydrate in your diet.

Over the next few months we will be looking in-depth at different strategies of periodised nutrition, but in the meantime any questions or comments leave below or contact www.gabinetederueda.es

Amino Acidos Ramificados: ¿Merecen la pena?

Los aminoácidos ramificados (también conocidos como BCAAs) son uno de los suplementos más populares, quizá más que la creatina. Siempre se ha dicho que los BCAAs son imprescindibles para los aficionados de entrenamiento de fuerza y resistencia, porque al parecer los BCAAs provocan un estado de anabolismo o impiden un estado de catabolismo.

Mientras la creatina tiene décadas de apoyo científico, ¿podemos decir lo mismo sobre los BCAAs?

En este post resumimos el artículo de Robert Wolfe de la publicación Journal of the International Society of Sports Nutrition. Te dejamos el original aquí (en inglés), te recomendamos que leas, aquí abajo tienes los puntos claves. 

Antes de que empecemos a repasar la evidencia, vamos a repasar brevemente qué son los aminoácidos. Hay en total 20 aminoácidos, 9 son esenciales y 11 no esenciales. Esencial quiere decir que nuestro cuerpo no los puede construir y tenemos que obtenerlos través de la dieta. De los 9 aminoácidos esenciales (AAE) 3 de ellos se llaman los amino ácidos ramificados o “branched chain” (BCAAs) son: leucina, isoleucina y valina. Las proteínas musculares están en un estado continuo de rotación, es decir, que siempre hay síntesis de proteínas musculares (SPM) y descomposición de proteínas musculares (DPM). Hay un estado de anabolismo cuando hay más síntesis que descomposición, y cuando pasa lo contrario lo llamamos estado de catabolismo. Se puede alcanzar un estado de anabolismo al aumentar SPM o al inhibir DPM, pero para la SPM hacen falta todos los aminoácidos.

La evidencia

• En los estudios que demuestran un efecto positivo de la SPM los sujetos son ratas. Los estudios de músculos en ratas tienen casi ninguna relación con los estudios de músculos de los humanos.
• En estos estudios, los BCAAs que les dieron a las ratas fue por la vía intravenosa, no vía oral, un método poco práctico en realidad.
• En los estudios con sujetos humanos, también les dieron los BCAA por la vía intravenosa, pero esta vez hubo una disminución de la SPM.
• En los estudios de humanos hubo también una disminución de descomposición (DPM) pero los sujetos se quedaron en un estado de catabolismo.  

Actualmente la evidencia sugiere que los BCAAs solos (sin otras proteínas, carbohidratos etc.) reducen la rotación de las proteínas musculares (síntesis y descomposición). El autor nos advierte que una reducción en la rotación de las proteínas musculares puede tener un efecto negativo en el esfuerzo del músculo debido a una reducción en la construcción de nuevas fibras musculares.

La evidencia actual indica que los BCAA (particularmente leucina) aumentan la señal de SPM, sin embargo, una señal más potente no significa más SPM si todos los AAE no están presente. Es como intentar arrancar un coche sin combustible.

Para conseguir la SPM necesitamos todos los aminoácidos. Después de una comida con proteínas, nuestro cuerpo puede utilizar los AAE de la comida, pero entre comidas, en el estado post-absortivo, la única fuente de AAE es a partir de la descomposición de las proteínas musculares, por eso la proteína del músculo está siempre en un estado de rotación.

Si tomamos una dosis de BCAA muy grande sí reducimos DPM, pero eso significa que estamos reduciendo la cantidad disponible de AAE, por lo que como resultado también reducimos la SPM.

El lado bueno (más o menos)

Con una señal de SPM aumentada gracias a los BCAA puede que, en combinación con una comida rica en proteína, el efecto de la proteína resulte aumentado. Un estudio ha demostrado que una dosis de 5g de BCAA en combinación con 6.25g de proteína de suero tenían el mismo efecto en la SPM que 25g de proteína de suero solo.  

Aunque esto es interesante, si pensamos en el precio de los BCAA en comparación con el precio de proteína de suero o mejor todavía, COMIDA, ¿merecen la pena los BCAA? Recuerda que más no es necesariamente mejor, si añades más BCAA a tu batido de proteínas no significa aún más SPM.

Otro punto a recordar, como decimos en nuestro blog de BCAA e inmunidad, es que los BCAA compiten por el mismo sitio de absorción y normalmente el aminoácido en mayor cantidad (casi siempre leucina) es absorbido a costa de los otros dos. 

Conclusión

No solo hay una falta de evidencia que demuestra un efecto anabólico de los BCAA solos. El autor concluye que sin la presencia de una fuente de AAE (a través la comida o de la DPM), no es posible para los BCAA aumentar la síntesis de las proteínas de musculares. Nuestro consejo es: olvídate de los BCAA y asegúrate de que tu dieta tiene una buena cantidad de proteínas de fuentes animales y vegetales.     

Si quieres saber más sobre nutrición deportiva visita nuestra web. www.gabinetederueda.es   

BCAAs: Are they really worth it?

Branched chain amino acids (BCAAs) are in some way the creatine of the 21^st century, what I mean by that is, that they have become the “go to” supplement for every gym goer. Strength and endurance enthusiasts alike are sold the idea that BCAAs are an essential component of their nutrition regime because they supposedly induce an anabolic/avoid a catabolic state in humans.

Whereas creatine now has decades of convincing research behind it, can we really say the same about BCAAs?

This post will summarise the recent review by Robert Wolfe in the Journal of the International Society of Sports Nutrition. I strongly recommend that you read the full paper (link here) after you have read the main points below.

First, a quick recap on amino acids. There are 20 amino acids in total, 9 are essential and 11 are non-essential. The term “essential” means that the body cannot synthesise these amino acids so we must obtain them from food. Of the 9 essential amino acids (EEAs) 3 of these are called the branched chain amino acids (BCAAs) these are, leucine, isoleucine and valine. 

Muscle protein is in a continued state of turnover, meaning proteins are constantly being broken down and synthesised (built up). The term anabolic state refers to when muscle protein synthesis (MPS) is greater than muscle protein breakdown (MPB), in other words, our muscle tissue is being built up as opposed to being broken down. When muscle protein breakdown is greater than synthesis this is known as a catabolic state. The anabolic state can be achieved by either increasing muscle protein synthesis or by reducing muscle protein breakdown. For MPS to be greater than MPB all 20 amino acids must be present.

We are sold BCAAs under the premise that they stimulate muscle protein synthesis and so we can avoid the dreaded catabolic state. But what does the actual evidence say?

The Evidence 

• The studies that show an increase in MPS after ingestion BCAAs were conducted on rats. Muscle protein studies on rats have little if any relevance to humans.
• These studies also administered the BCAAs intravenously as opposed to orally
• Studies on humans, (who also administered the BCAAs intravenously), actually showed a decrease in MPS
• The human studies also demonstrated a decrease in muscle protein breakdown but overall net effect was that the subjects remained in a catabolic state. 

When all the evidence is considered, it appears that taking BCAAs alone reduces protein turnover (synthesis and breakdown). The author points out that this may have a negative effect on muscle strength due to a reduction in new muscle fibre construction.

Current evidence suggests that BCAAs (in particular leucine) increase the “signal” for MPS, however an increased signal will not lead to increased MPS if the other EAAs are not available. Think of it as turning the key in the ignition, without fuel the engine won’t start.

In order for MPS to occur all amino acids must be available. After a meal containing sufficient protein, MPS is achievable because the EAAs will be taken from the ingested food. However, in the post-absorptive state (in between meals) the only source of EEAs is from the breakdown of muscle protein. This is why muscle is in a constant state of turn over.

If we take a huge dose of BCAAs we reduce MPB, however, by reducing MPB we reduce the amount of EEAs available for MPS so in turn, both MPS and MPB are reduced.

The Good News (kind of) 

With an increase in anabolic signalling through BCAAs, it appears that it can increase the effect of a protein meal. One study demonstrated that 5g of BCAAs added to 6.25g of whey protein had the same effect on MPS as 25g of whey protein alone.

While this may seem interesting, when you weigh up the cost of BCAAs against the cost of whey protein or (shock horror) real food, are they really worth it? Remember the golden rule, more is not always better, so adding even more BCAAs to your shake will not have a greater effect on MPS.

Another point to remember is, as we mentioned in our amino acids and immune system post, the BCAAs compete for the same site of absorption so when taken in a large dose the amino acid in the greatest concentration (usually leucine) will be absorbed at the expense of the others. 

Conclusion 

Not only is there a lack firm evidence to demonstrate an anabolic effect of taking BCAAs alone, the author concludes that without a supply of essential amino acids (either through food or muscle protein breakdown) it is not possible for BCAAs alone to increase muscle protein synthesis. Our advice as always is ensure you have a diet rich in high quality protein before starting to consider supplements. 

For more info please see www.gabinetederueda.es 

Energy Bar Recipe

Finding an energy bar that tastes good and is not full of rubbish has always been a huge challenge. I'm sure that I am not the only person who has ordered a large batch of energy bars for a cycling or training trip and then during a long ride as you unwrap probably the 20th bar you think "God! I am sick of this flavour!"

Taste fatigue is detrimental to both moral and performance. It may sound obvious but if don't like the flavour of something or you are sick to death of it, you will not eat it, which eventually leads to your performance suffering through lack of energy.

The finished article. 

Through years of trying several different brands of energy bars I have found that I really want them to taste like actual food and not a bunch of chemicals and flavourings. Eventually I decided to experiment with making my own bars.

The advantages of making your own bars are, you know exactly what is going into them, you can experiment with several flavours without having to buy lots of different types of bar, and generally speaking the cost of the ingredients will be cheaper than buying a box of energy bars from a well known brand.
I have always found that the energy bars you buy are very sweet so after 2 or 3  I get really sick of the flavour, especially if I am on a very long ride where I will be taking gels and sports drinks as well. By the end of the ride I am dying for something savoury!
With this recipe I have tried to find the right balance between carbohydrate for energy but not being too sweet. The great thing is that the recipe is pretty flexible so you can add or take away ingredients as you pplease to suit your taste preference. The only 3 ingredients that are essential are oil, oats and honey. This is the recipe to the bars I am currently taking out with me.

Ingredients:
100mls oil. (I use sunflower oil just for the fact it doesn't really taste of anything, I have tried both coconut and olive oil and find the flavour overpowers the rest of the ingredients.)
225g of oats
210mls Honey (The reason I put mls here instead of grams is that I use a protein powder scoop to measure my honey, 210 mls is 3 big scoops or around 300g. Yes that is a lot of honey but these are energy bars for long days in the saddle.) 

The ingredients above form the base of the bars and should be included in whatever batch you make. With the following you can be pretty flexible and change depending on your preferences.

40g Almonds (chopped)
10-12 Dates (chopped) 
2-3 tablespoons of peanut butter (this takes a bit of the sweetness away from the honey and dates, make sure you use a brand of peanut butter that isn't full of palm oil and sugar. I use bulkpowders 100% peanut butter.)
30g 100% cocoa grated or in powder (again this takes the edge off the sweetness and gives the bars a nice chocolate hint)

Here is a picture of all the ingredients. 

Melted Honey

Method 

• Preheat oven to 180C 
• Place the oil in a saucepan and put on a low-medium heat (my electric hob is numbered 1-6 and I usually use 3) 
• Add the honey and stir continuously until it has melted
• Add the peanut butter and also stir until melted 
• Once the both the peanut butter and honey have melted you can start to add your other ingredients and give them a good stir so they are totally covered by the mixture
• Now you can start adding the oats. Add them a small amount at a time and make sure you keep stirring to get all the oats covered in the mixture. As you add more oats it will start to get thick and difficult to stir. At this point also add the cocoa. 
• Transfer the mixture into a cake tin and place in the preheated oven for between 15-18 mins depending on how gooey you want your flapjacks. I usually take them out around 15 minutes.
• Leave to cool. This may sound obvious but if you try and cut the flapjacks now they will just fall apart, I usually leave them overnight. 
• Cut them up into sizes of your preference, I have recently started to cut them into smaller pieces as I have found it easier to eat in one go as opposed to taking a bite then putting it back in your pocket whist moving.

Adding the almonds and dates into the mixture  

Adding the oats 

Nutritional Info if you divide the finished block into 8 bars each bar contains 

• Kcals 324
• Carbohydrates 59g 
• Sugar 36g
• Fat 6g
• Protein 6g  

For long endurance events, the magic number in terms of carbohydrate is 60g/hr which means one of these bars an hour should do the trick in meeting your carb needs. 

If you try this recipe please let us know in the comments section how you get on, or you make any tweaks 

http://gabinetederueda.es/ 

Macronutrients, Exercise and Immunology Part 2: Lipids

As was discussed part 1, exercise can depress the function of the immune system. Supplementing with carbohydrate during exercise has been shown to blunt this response therefore the immune system can function better than if no supplementation had taken place. In this post, we will be looking at the role of fatty acids in exercise and immune function.

As with carbohydrate, the main role of fatty acids is a source of energy. As well as energy, certain fatty acids are involved in inflammation and immune responses. A dialogue that is probably very familiar to all of us is that Omega-6 fatty acids are pro-inflammatory and Omega-3 anti-inflammatory and that our modern diet has too much Omega-6 and not enough Omega-3. Just a quick google search of either Omega-3 or 6 will result in many nutrition “experts” giving advice on how to improve the ratio of the fatty acids in the diet. 

The Omega-6 linoleic acid is termed an essential fatty acid because, as with essential amino acids, it cannot be synthesised by the body and therefore must be obtained through the diet. Nuts, seeds and vegetable oils are rich sources of linoleic acid¹. Once in the body, linoleic acid can be converted to another Omega-6 fatty acid arachidonic acid, this fatty acid is a pre-cursor to inflammatory mediators known as prostaglandins and leukotrienes. These two mediators are involved in inflammatory (and allergic) reactions, hence the belief that a diet rich in Omega-6 can lead to problems associated with chronic inflammation. Despite their role in inflammation, the authors of the exercise and immunology review² state that currently there is no strong evidence to support the claims that altering your Omega-6 intake will affect inflammation. In terms of the role of Omega-6 in exercise and the immune system, the same authors state that there is very little research in this area.

Moving on to the Omega-3 fatty acids EPA and DHA, the anti-inflammatory actions of these fatty acids, taken as either a fish oil supplement or as oily fish, are well documented. EPA and DHA can be easily assimilated into cell membranes at the expense of the Omega-6 arachidonic acid, which of course leads to less production of the prostaglandins and leukotrienes. They are also involved in the production of mediators that resolve inflammation, enhance immune function and regulate key signalling events within immune cells such as T-cells and B-cells.

Unlike with Omega-6, the role of Omega-3 within exercise is a well-researched topic. However, (there is always a however) it is difficult to draw any firm conclusions from the published research. A large difference in doses used, (1g – 4g/day), the populations studied (untrained or elite athletes) and length of time of the studies (one week to several months) have made it difficult to say with confidence that Xg of Omega-3 taken per day will help you decrease exercise induced immunodepression. Supplementing with Omega-3 appears to decrease post exercise muscle soreness and exercise induced inflammation in untrained individuals but the evidence in trained and elite individuals is less convincing. The conclusion of the authors of the Exercise and Immunology Review is that more research is needed in this area.

So, what conclusions if any can we draw from this information? Regardless of its role in exercise Omega-3 fatty acids have numerous health benefits, so I would recommend that our diet has sufficient Omega-3 in it, either by ensuring we eat 1-2 portions of oily fish per week, or if you do not eat fish, take a fish oil supplement. At this moment in time I would avoid taking large doses of Omega-3 either before or during exercise until there is stronger evidence supporting the claim that it has a beneficial effect in this area. 

If you want any more information on diet, exercise and the immune system please get in touch via wayne@gabinetederueda.es 
 

References

1. http://nutritiondata.self.com/foods-000141000000000000000-w.html   
2. Berman S et al. (2017) Immunonutrition and Exercise Consensus Statement. Exercise and Immunology Review: Vol 23