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

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.
2. https://www.forbes.com/sites/freekvermeulen/2011/03/22/the-price-of-obesity-how-your-salary-depends-on-your-weight/#29a06bbb3d9a

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 it's 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, 26 de octubre de 2018

Por qué no debes estresarte con la compra

Hoy os traemos un artículo muy interesante que hemos leído aquí. Está escrito por la dietista registrada Rebecca Scritchfield. El link al artículo original lo tenéis justo encima, os dejo aquí un resumen extenso en español.

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Todos hemos experimentado alguna vez el ser cuestionados o avergonzados por nuestras elecciones en comida "No te vas a comer eso, ¿verdad?" o "Creo que comer de esta manera es lo correcto", como hubiera una forma incorrecta de comer. Como dietista registrada, me encanta ayudar a las personas a disipar esas presiones sociales poco saludables. 

En una conversación reciente, una amiga mía estaba llorando por lo mucho que había subido el precio de su carro de la compra: "Sé que es 'mejor' comer alimentos orgánicos, ¡pero no puedo continuar gastanto tanto!". He escuchado estas preocupaciones de la boca de amigos, familiares y clientes durante muchos años, ¡y ni siquiera es cierto! Los cultivos orgánicos no son más nutritivos (1), ni siquiera están libres de pesticidas. Lo que importa más para tu salud es que obtengas suficientes (2) frutas y verduras, no de dónde vienen ni cómo se empaquetan. El sufrimiento de mi amiga nace de un dilema social: la moralización de los alimentos. 

Cuando la comida adquiere un valor moral, se llena de prejuicios: la comida no solo es mala, la gente que la come también es mala.Los prejuicios asociados a los alimentos pueden crear un temor tan fuerte a lo que comemos que una persona arriesga su salud física y emocional. Se ha demostrado que el estrés crónico que pueden causar estas situaciones (3) está asociado con mala salud, probablemente más que los mismos alimentos que las personas sienten vergüenza de comer.  

En lugar de preocuparnos por lo que los demás piensan de nosotros, ¿qué pasaría si seguimos un enfoque diferente, basado en hechos que nos permitieron tomar las decisiones que más nos convengan? Por ejemplo, el tema de los OGM es un tema que a menudo influye en las opiniones de los que nos rodean. Siempre que me preguntan sobre los OGM, lo primero que hago es aclarar qué son exactamente los OGM. A día de hoy todavía existe mucha confusión sobre lo que realmente son e incluso en la literatura científica me he encontrado con innumerables descripciones que se contradicen. 

Para simplificar las cosas, aquí está mi definición: los OGM representan un método de producción de semillas que lo hace más eficiente, preciso y seguro para potenciar los rasgos beneficiosos en los cultivos que los humanos han estado modificando durante siglos. Los OGM y los métodos de agricultura sostenible que habilitan los cultivos OGM son muy interesantes. Como madre de dos niñas, me importa mucho la buena nutrición y el bienestar de mi familia y más allá de mi interés profesional, quería verificar los hechos por mí misma. Una vez revisé la información que ofrecen fuentes como la Asociación Médica Americana, la Unión Europea y la Academia Nacional de Ciencia, llegué a la misma conclusión que prácticamente todas las instituciones científicas y médicas: que los cultivos cultivados con OGM son igualmente nutritivos que los convencionales u orgánicos. 

Éste es solo un ejemplo de cómo tener acceso a la información puede ser útil para tomar decisiones que se ajusten a las necesidades y preferencias de tu familia. Además, los agricultores que eligen los métodos de cultivo de OGM pueden usar menos pesticidas ¡la agricultura transgénica ha reducido el uso de pesticidas en un 37% a nivel mundial! (4)

Sin embargo, muchas personas aún creen que no pueden comer de manera saludable y sostenible si compran alimentos cultivados con métodos de OGM. Cuando hablo con los clientes acerca de esto, se sorprenden al escuchar que, además de producir cultivos nutritivos, la OGM puede ser beneficiosa para el medio ambiente.  Comer de acuerdo con los estándares actuales de pureza en los alimentos puede agotar la cuenta bancaria de cualquier persona. 

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Aunque los cultivos GMO aún no estén extendidos en Europa y los alimentos transgénicos no hayan llegado a nuestros supermercados tal cual (sí que tenemos trazas o pequeños porcentajes de materias primas OGM en alimentos envasados), no dudo que veremos ese día dentro de pocos años. Y eso no debe asustarnos.
 
1. https://www.youtube.com/watch?v=k9p2jXhYRCk&feature=youtu.be
2. http://www.safefruitsandveggies.com/
3. https://www.apa.org/helpcenter/stress.aspx
4. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111629

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.


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





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 info@gabinetederueda.es

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

2. https://www.monashfodmap.com/blog/the-truth-behind-non-celiac-gluten/ 



jueves, 17 de mayo de 2018

Vitamina D y su relación con las caídas en ancianos

Hoy vamos a hablar de un estudio caso-control llamado Vitamin D and the Mechanisms, Circumstances and Consequences of Falls in Older Adults: A Case-Control Study.

Aunque obviamente hace falta más de un estudio para establecer conclusiones, me parece interesante las observaciones que han hecho, que se acercan mucho a las que ya comentábamos hace un par de año por aquí. 

En este estudio cogieron a 216 pacientes del ala de geriatría de un hospital y tras observar que no había diferencias en los niveles basales de vitamina D y de ajustar por factores de confusión llegaron a dos conclusiones:
  1. La deficiencia de vitamina D estaba asociada con caídas en los ancianos.
  2. Los ancianos que presentaban deficiencia de vitamina D tenían mayor prevalencia de hipotensión ortostática, lo que sugeriría que la vitamina D puede influir en las condiciones que predisponen a las caídas en lugar de la caída en sí misma.
Aún queda mucho que investigar, pero parece que la vitamina D está involucrada en numerosos procesos metabólicos (justo acabo de leer un estudio sobre su deficiencia y suplementación en quemados, pero eso ya para otra vez) y que su deficiencia es cada vez más común.

miércoles, 16 de mayo de 2018

¡Terminamos el curso de FODMAP de la universidad Monash!


Grandes noticias!! Hemos terminado la especialización del manejo del síndrome de intestino irritable (SII) tras completar el curso de la universidad Monash titulado “La Dieta Baja en FODMAP para Síndrome de Intestino Irritable”. 

La Universidad de Monash es el pionero en el manejo y tratamiento de SII con una dieta baja en carbohidratos rápidamente fermentables que se llaman “FODMAP”. Tras completar este curso podemos ofrecer un tratamiento basado en evidencia científica para personas que tienen problemas como dolor abdominal, gases e hinchazón. 



Si quieres saber más sobre la dieta FODMAP haz clic aquí o si crees que esta dieta te ayudaría escribanos en info@gabinetederueda.es