Nutrition and Breastfeeding Articles

Drinks may be flowing in December, are you worried about overdoing it? Try these tips:

• Space them out: Alternate alcohol with water or bubbly water, to reduce overall alcohol and keep you hydrated.
• Pouring at home? Know your serves: 100mls wine & sparkling, 30mls spirits, 285mls beer (less than a stubby), 425mls light beer, 285mls cider.
• Limit cocktails, they are very high in sugar and contain multiple standard drinks.
• Be the nominated driver: If you have lots of parties, can you go alcohol free for some?
• Try zero alcohol options: a great alternative to alcohol. Check the labels before buying as remember they may also be high in sugar and added chemicals. We found these good options:
• Dash peach infused sparkling water
•  Polka botanical non-alcoholic spirit
• Iced tea homemade e.g. with a teabag and sparkling water

I’m breastfeeding, can I drink alcohol?
The safest option whilst pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

By Emma McShane, Dietitian & Nicole Bando, APD, IBCLC
​

1.      Balance
When life gets a little crazy busy, aim to be prepared for the weeks with meal prepping. Try double batch cooking and freezing. Keep canned or frozen foods handy, such as vegetables, eggs, baked beans & wholegrain bread for quick and healthy meals. If you can, take some time for yourself to do something you love.                                                                                                                                            
2.      Don’t restrict yourself
Though there may be more treats around than usual, it’s important not to restrict yourself before or after social occasions, by skipping meals. Stick to fresh whole foods where possible, with loads of fruits and vegetables, and remember this season is a small part of the year, so enjoy it and listen to your body. 
 
3.      Find time to move
Movement is so important for both your physical and mental health. Small steps count, so even 10-15 minutes of activity is a great start, try gradually building up to 30 minutes a day.  Switch off by playing a podcast or your favourite music.
 
4.      Listen to your hunger cues
It’s easy to overeat when food is plentiful. Tune into your hunger & fullness signals by taking your time. Remember it takes 20-30 minutes after eating for these signals to occur. Eat with awareness; choose foods you really feel like, to avoid mindless grazing.
 
5.      Perspective
Don’t let a day, a week, or even a month derail your overall health and wellbeing. It’s a small part of the year and whilst it’s important to make healthful choices and keep moving, it is also ok to indulge sometimes. If you can give yourself permission to enjoy, and tune into your body's messages, it can help to avoid unhelpful guilt. Aim to keep routine and structure where possible.

By Emma McShane, Dietitian & Nicole Bando, APD, IBCLC
​​

Eggs: how many is too many?
Eggs are a great source of nutrition, including protein, iron, choline, Vitamin D, B12, and selenium. Eggs contain heart healthy monounsaturated fats and also some saturated fat (which can increase cholesterol in excess). Include up to seven eggs a week, this won’t increase risk of heart disease. Those at increased risk of heart disease can eat up to six eggs per week.
 
How often should I eat fish?
Research supports including 2-3 portions of fish per week.  Try to choose sustainably sourced fish and limit high mercury options, such as shark, swordfish, barramundi, orange roughy and ling. Low mercury fish include salmon, mackerel, tuna, sardines and shellfish.
Fish are a great source of omega-3 fatty acids (unsaturated fats – known as good fats!) which contributes to brain health and development and reduces risk of heart disease.
Protein, selenium, zinc, iodine, and vitamins A and D are other important nutrients in fish.
 
Vegetables: what’s 5 a day?
We may have all heard that adults need five serves of vegetables a day. To help figure this out, a serve of vegetables is ½ cup of cooked vegetables, canned or cooked legumes, or 1 cup of green leafy vegetables or chopped salad. To achieve this, aim to include half a plate of vegetables at lunch and dinner.
 
Did you know that toddlers need 2-3 serves per day, increasing to 5 serves by aged 9? A great way to increase vegetable intake, is to offer them 2-3 times per day, for important nutrients, including potassium, fibre, Vitamins C & A. Eat from the rainbow by choosing lots of different coloured vegetables. If 5 a day feels a bit tricky, start small and try to add some chopped carrot or cucumber to your morning snack. Frozen, canned and fresh are all great options.

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC), October 2022
​​

​If you are planning a party for children who have food allergies, it can seem overwhelming to know where to start. Follow these steps for safe and yummy party food. A food allergy is when a person’s immune system reacts to the protein in a food, causing symptoms such as hives, rashes or in more severe cases swelling of the mouth and throat (anaphylaxis).  Find out which allergens you need to exclude and take it from there. The key allergens are: peanuts, dairy, wheat, egg & fish.

1. Have a plan: Find out the symptoms of the child’s food allergy. Who will be supervising them? What is their allergy/anaphylaxis plan? Make sure they have their epi-pen & you or a supervising adult knows how to use it. Call an ambulance if the child demonstrates signs of an allergic reaction.
2. Know your key allergens and read the ingredients list. It is Australian law that processed foods must be clearly labelled to include allergens using their common names (e.g. egg or milk) so that they can be easily recognised. Allergens are often shown in bold in the ingredients list. There is also a ‘contains’ section that has a summary list of the allergens present in that food. Check food labels every time you buy the product, as ingredients and processes can change. 
3. What about ‘may contain traces of?’ This means that there is a potential cross-contamination risk.  It may be best to avoid these foods for safety reasons.
4. Food preparation and cross contamination: When the tiniest amount of an allergen comes into contact with another food (e.g. crumbs from wheat bread are on the bread board used to prepare gluten-free bread) it can be enough to cause an allergic reaction. Set up the food preparation area in a clean environment away from other foods being prepared. Use only clean (using hot, soapy water) equipment when preparing food. Make sure that your hands are cleaned prior to preparing and serving as well and that any products used haven’t been exposed to allergens (e.g. margarine previously used for wheat containing bread). 
5. So what party foods can I serve? Choose fresh over processed foods, it is easier to avoid multiple food allergens this way. Have fun with fruit, e.g. fruit skewers or try our simple allergy-friendly popsicle recipe: Blend 500ml of plant-based milk, 1 tb of maple syrup and your choice of 300g frozen fruit. Pour mixture into moulds, add an icy-pole stick & freeze until solid. Also try gluten-free pizza bases with vegetables (either without cheese or with vegan cheese), tofu and vegetable skewers, mini beef burgers with gluten free rolls, 100% corn chips & avocado dip, popcorn (over 3 years), rice crackers & dried fruit.  Consider party bags that are food free and perhaps involve craft, such as colouring.
6. What about the cake? Check out this allergy free birthday cake recipe! https://www.allergicprincess.com/egg-free-dairy-free-nut-free-cake/ - if looking for a wheat/gluten free option, swap out the plain flour for gluten-free flour.

 
References:

1. What is allergy? - Australasian Society of Clinical Immunology and Allergy (ASCIA) [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/patients/about-allergy/what-is-allergy
2. Avoiding Cross-Contact [Internet]. FoodAllergy.org. 2022 [cited 9 July 2022]. Available from: https://www.foodallergy.org/resources/avoiding-cross-contact
3.  [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_general_info_2019.pdf

 
 By Emma McShane, Dietitian, edited by Nicole Bando, Dietitian & LC, August 2022
​

A well-balanced diet with a variety of plant foods can help to ensure your immune system is functioning properly. If a diet is nutritious, there may be no need for dietary supplements.
 
The three nutrients important to maintain a healthy immune system is zinc, vitamin C and vitamin D. Zinc can be found in food sources such as lean meat, fish, nuts, seeds, and legumes. Vitamin C is found in oranges, strawberries, tomatoes, broccoli, and kiwi fruit and Vitamin D is gained from the sun, eggs, liver, and oily fish. Other nutrients of importance are selenium, iron, and protein. Check out my latest blog posts on Zinc and Vitamin C for more information.
 
A hearty, nutritious soup such as chicken soup with large amounts of vegetables or a red lentil soup, or a pumpkin soup may help increase your immunity and help with relieving some of the symptoms of a common cold. The anti-inflammatory properties of whole ingredients, including vegetables, may reduce symptoms associated with upper respiratory tract infections.  Please see my latest blog posts, for hearty, nutritious, and tasty soup recipes.
 
Fermented foods promote the growth of good bugs in our gut, which help with immunity and digestion. Examples of fermented foods to include in your diet are sauerkraut, kombucha (if less than 5g of sugar per 100g), and kefir.
 
To protect your immune system, it is recommended to reduce those foods that provide a limited amount of nutrients, such as ultra-processed foods high in saturated and trans-fat, high sugar foods, and excess alcohol. Social distancing, mask wearing, hand washing & staying home if you have symptoms are all first line defences against illness.
 
SM post 1: What do I eat to improve my immunity this flu season?
A well-balanced diet with a variety of plant foods can help to ensure your immune system is functioning properly. If a diet is nutritious, there may be no need for dietary supplements.
The three nutrients important to maintain a healthy immune system is zinc, vitamin C and vitamin D. Try out hearty soups full of vegetables and fermented foods this flu season to improve your immunity!
 
SM post 2: What foods potentially affect my immunity?
To protect your immune system, it is recommended to reduce those foods that provide a limited amount of nutrients, such as ultra-processed foods high in saturated and trans-fat, high sugar foods, and excess alcohol. Try swapping some of these foods in your diet for foods from the five core food groups, especially vegetables to improve your immunity. Are you eating a rainbow of fresh food? Social distancing, mask wearing, hand washing & staying home if you have symptoms are all first line defences against illness
 
References:
Nutrition Fact Sheet. Food and your immune system. Baker Heart and Diabetes Institute. Available from: https://baker.edu.au/-/media/documents/fact-sheets/baker-institute_food-your-immune-system.pdf. Accessed on 26 June 2022. 
 
TH. Chan. The Nutrition Source. 2020. Nutrition and Immunity [online]. Harvard, School of Public Health. Available at h https://www.hsph.harvard.edu/nutritionsource/zinc/ [accessed 26 June 2022].
 
​By Emma McShane, Dietitian. Edited by Nicole Bando (APD, IBCLC. July 2022

​Echinacea is a plant that is widely used to treat the common cold. There are nine known species that are all native to North America. The most common species used in dietary supplements are Echinacea purpurea or Echinacea angustifolia. Echinacea available for purchase can vary greatly due to different types, preparation, and parts of the plant being used. 
 
Many studies have investigated effects of Echinacea, with varying outcomes and no clear understanding that Echinachea helps to prevent a cold. However, studies have shown that some preparations of Echinacea purpurea can help to shorten the duration & severity of the common cold. This may be effective in adults, but not in children.
 
It is recommended that Echinacea preparations shouldn’t be consumed for longer than 8 weeks. At this stage, no harmful side effects are known, but the evidence for long-term use is still very limited. 
 
It is important to know that products of Echinacea on the market differ greatly. If taking Echinacea, look for Echinacea purpurea as an alcoholic extract, or pressed juice. Overall, the evidence is inconclusive & more studies are needed to determine if echinacea prevents or reduces the effect of the common cold. 
 

References:
Sachin A Shah, Stephen Sander, C Michael White, Mike Rinaldi, Craig I Coleman, Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis,The Lancet Infectious Diseases, Volume 7, Issue 7, 2007, Pages 473-480, https://doi.org/10.1016/S1473-3099(07)70160-3.
 
Linde K, Barrett B, Bauer R, Melchart D, Woelkart K. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000530. DOI: 10.1002/14651858.CD000530.pub2. Accessed 26 June 2022.
 
National Center for complementary and integrative health. Echinacea. NIH. 2020. Available at: https://www.nccih.nih.gov/health/echinacea. Accessed on 26 June 2022.
 
By Emma McShane, Dietitian. Edited by Nicole Bando, APD, IBCLC, July 2022

Zinc is an important mineral involved in making new cells and enzymes to help your body fight infection. It also helps use to digest nutrients such as carbohydrates, fat, and protein in food and is vital in wound healing. Does supplementation help treat or prevent a cold? Which foods should you eat?
 
Good food sources of zinc are:
-      Meat
-      Shellfish
-      Dairy foods such as cheese
-      Bread – fortified with zinc
-      Cereal products – with added zinc
-      Nuts, seeds
 
Studies show that zinc may help to prevent or reduce the length of a cold (not COVID specific), though more research is needed. If you are vegetarian or vegan, you may need a supplementation as zinc is found mostly in animal products. The fibre in plant foods, such as legumes, can reduce the absorption of zinc. Supplements are not needed unless your diet is low in the above foods, or you are diagnosed with a zinc deficiency. Too much zinc can affect the absorption of other minerals, such as iron and copper, so it’s important to seek professional advice before supplementing. Include a good range of lean meats, fish, low fat dairy, wholegrains, nuts & seeds to meet your needs.

References:
Penny M, E: Zinc Supplementation in Public Health. Ann Nutr Metab 2013;62(suppl 1):31-42. doi: 10.1159/000348263
 
Wolfgang Maret, Harold H. Sandstead, Zinc requirements and the risks and benefits of zinc supplementation, Journal of Trace Elements in Medicine and Biology, Volume 20, Issue 1, 2006, Pages 3-18 ,https://doi.org/10.1016/j.jtemb.2006.01.006.
 
Office of Dietary Supplements. Zinc Factsheet for Health Professionals [online]. National Institutes of Health. 2021. Available at: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/ [accessed 26 June 2022].
 
TH. Chan. The Nutrition Source. 2020. Zinc [online]. Harvard, School of Public Health. Available at h https://www.hsph.harvard.edu/nutritionsource/zinc/ [accessed 26 June 2022].
By Emma McShane, Dietitian, (Edited by Nicole Bando (APD, IBCLC),) July 2022

A balanced, nutritious lunchbox is important to support the growth and development of children. Food is fuel, that children need to learn, concentrate, thrive, play, and grow. A balanced lunchbox can help promote performance (academic, physical, emotional), as well as body image, mood and environmental sustainability. It also helps your child to learn to manage their hunger & fullness cues, a wonderful habit to take through life.
 
When providing food to children, it is up to the parent to provide:

1. The right types of food
2. Regular meals and snacks.

 
However, it is up to the child to decide:

1. What to eat
2. How much to eat

It can take up to 1-15 times for a child to accept new food, which may seem like a lot, however the lunchbox provides the perfect opportunity to introduce new foods. Role modelling and positive food environments play a key role in children trying and accepting new foods, so the school environment can have a positive effect on your child’s eating. To save time, pack lunches the night before, you can even use dinner leftovers packed into a thermos.
 
Choose an option from boxes 1-4 to create a balanced lunch box.

See below for 3 days of lunchboxes:
Also see our great resources on simple snack swaps and soy/dairy-free alternatives.

By Emma McShane, Dietitian & Nicole Bando, Dietitian, May 2022

By Emma McShane & Nicole Bando, March 2022
 
Some people need to remove dairy and soy products from their diet due to a food allergy or intolerance. As these foods contain vital nutrients, including protein and calcium; important for the health of our bones and muscles, dairy and soy should be replaced with nutritious substitutes. This easy to follow guide provides simple swaps to help you enjoy the foods you love and get the nutrients you need.
 
*Please note that this resource is a guide only. Always check the ingredient labels of foods, medications and supplements for allergens, as ingredients may change.  This resource displays food products labelled as dairy-free (DF*) or soy-free (SF*) or both. Products ‘may contain traces’ of either soy or dairy, please consult with your allergist or dietitian for guidance. Please note that plant based milks may not meet the growth needs of young children, seek advice from a dietitian. Daily calcium requirements vary according to age and gender.

Are you breastfeeding and avoiding soy/dairy? See this article for more about how to meet your dietary needs.
See here for more about breastfeeding & nutrition.

For further label reading advice, see: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf
This does not substitute individual dietary and medical advice. 

By Emma McShane & Nicole Bando
​
New mothers need quick, convenient, and nutritious snacks and meals (see ideas & sample meal plan, below).
Choose carbohydrate foods that provide a slow, sustained release of energy, such as wholegrains e.g. wholemeal bread with seeds, oats, fruit, dairy, and starchy vegetables, such as sweet potato. These foods manage appetite and help to avoid sugar crashes. Avoid large quantities of high sugar, high-fat foods; these provide a quick release of energy, followed by a crash in blood sugar and energy levels, which can increase feelings of hunger and impact mood levels. Of course, the occasional chocolate or treat is OK.
 
Include a couple of pieces of fruit, and vegetables at least twice per day, dairy/dairy alternatives three times each day, lean meats (or alternatives), and healthy fats e.g. omega 3 & 6 fatty acids (from fish, nuts, etc.) three times each day.
For more information about the nutritional needs of breastfeeding mums, see these articles: Breastfeeding & Nutrition: www.nicolebando.com/blog/nutrition-during-breastfeedi and Weight loss after baby and special diets/situations: www.nicolebando.com/blog/weight-loss-after-baby-and-special-dietssituations
 
EASY IDEAS:
Meals:

• Omelettes loaded with frozen vegetables and cheese.
• Stir-fries with frozen vegetables and rice noodles.
• Pita bread with vegetables and low fat cheese as a cheats pizza
• BBQ chicken in wraps with salad mix.
• Meals that can be eaten hot or hold such as frittata, zucchini slice
• Serve grain foods like rice, pasta, quinoa or couscous with main-meals such as stir-fries, curries and casseroles.
• Buy meat and vegetables already diced

 
Snacks:
●      Boiled eggs
●      Individual serves of yoghurt
●      Cut-up vegetable sticks and fruit
●      Nuts & seeds
●      Canned fish, canned beans and lentils

• Leftovers – on their own or in a toasted sandwich
• Cheese and crackers

Download my easy list, below:
​

By Emma McShane & Nicole Bando
​
WEIGHT LOSS AFTER PREGNANCY
There is a lot of pressure from society on women to ‘bounce back' to their pre-pregnancy weight, however, this is not realistic nor recommended. Some of the weight gained during pregnancy is used to fuel breastfeeding, which is why breastfeeding can help a woman gradually return to her pre-pregnancy weight. Weight loss is recommended at the rate of around 2kg loss per month, as this does not affect breast milk production. It takes 9 months to grow a baby, so it is expected to take 9-12 months to return to pre-pregnancy weight. It helps to be patient, realistic and kind to the incredible body capable of growing a child. Restricting eating can affect not only a mother’s health but can reduce milk supply and impact a woman’s bone health. 
 
Aim to be intuitive with eating (e.g. listen to hunger cues), choose whole foods from the core food groups and avoid too many high sugar and high fat treat foods to help weight loss to occur gradually. See these posts on a woman's special needs whilst breastfeeding: www.nicolebando.com/blog/nutrition-during-breastfeedi and www.nicolebando.com/blog/meal-snack-ideas-for-new-parents
 
Gentle exercise has been shown in multiple studies to effectively help with post pregnancy weight loss. Exercise can help to boost overall health and wellbeing too. It is important to let the body recover after birth, and when ready, commence gentle exercise to strengthen your bones and muscles, improve sleep and stress levels, help to lose weight, and improve mental wellbeing.
 
SPECIAL DIETS/SITUATIONS:
 
VEGAN & VEGETARIAN DIETS:
Mothers who are vegan or vegetarian are at high risk of nutrient deficiencies, in particular; protein, iron, calcium, Vitamin B12, and omega-3 fatty acids. These nutrients can mostly be obtained from plant-based products, except for Vitamin B12, which is mainly found in animal products. In some cases, a blood test to check levels, and a B12 supplement may be required.
 
INTOLERANCES/ALLERGIES:
Some babies may have intolerances or allergies to proteins present in their mother’s breast milk. The most common allergies are cow’s milk, soy, eggs, peanuts, and tree nuts. Avoidance of the particular protein in the mother’s diet may be needed. However, each mother and baby duo is different, so seek medical advice from a doctor and dietitian before excluding food group(s). If a mother needs to exclude a particular protein, the nutrients from that food will need to be replaced with alternative foods (e.g. alternatives to cow’s milk for adequate calcium).
 
 
CLOSE PREGNANCIES & MULTIPLE BABIES:
Mothers who have close pregnancies are at higher risk of nutrient deficiencies, as the nutrient reserves in the body may not have been fully replenished before the next pregnancy. Iron is at most risk of deficiency, as the body may not have had time to fully replenish the stores lost during pregnancy. Supplementation of this nutrient, as well as calcium, magnesium, zinc, and essential fatty acids may be needed but it is important to seek support and guidance from a dietitian who can accurately assess your dietary intake and blood levels of these nutrients. Women who have had multiples (e.g. twins) have greater demands for nutrition and need an additional 2000kJ in energy, per baby, as well as increased vitamin and mineral needs.
 
BARIATRIC (WEIGHT LOSS) SURGERY:
There have been multiple studies that have investigated the impact of bariatric surgery on breastfeeding. People who have had bariatric surgery may be at greater risk of nutrient deficiencies, as the surgery can change how nutrients are absorbed, so it is important to check levels of vitamins and minerals before, or at the start of pregnancy, to see if supplementation is needed.  A study investigating the composition of breastmilk, comparing nourished mothers who had undergone weight-loss surgery and those that had not, found there was no significant difference in nutrient composition between the two. This, however, takes into account that it is important to still consume a balanced diet. As some bariatric surgeries may result in ongoing complications e.g. reflux or reduced food consumption or absorption, which all may affect nutrient intake, it is important to seek support from a dietitian.
 
PREMATURE OR LOW BIRTH WEIGHT BABIES:
Breastfeeding is important in babies who are premature or of low body weight as breastfeeding can reduce the risk of the baby developing medical complications. The production of milk components starts in pregnant women before 22 weeks of pregnancy, so even with very premature babies, most mothers can produce colostrum. Breastfeeding may be difficult if a baby is in the neonatal intensive care unit, requiring some mothers to express breastmilk. There are multiple barriers for both mother and baby to overcome when breastfeeding a premature, or low birth weight baby, such as a delayed or traumatic start to breastfeeding, and maternal stress. Recent studies however have shown that there is a higher rate of breastmilk feeding amongst very low birth weight infants, often due to mothers recognising the fragile health of their baby and the benefits of breastfeeding.
 
Good nutrition at this time is vital to cope with the energy demands of expressing and or breastfeeding, to maintain supply and provide energy to cope during a stressful time, and to replete nutrient stores used during pregnancy. Follow the general nutrition advice set out above. If you have experienced a bumpy start to breastfeeding, seek guidance from a lactation consultant.
 
NAUSEA & VOMITING IN PREGNANCY:
Some women experience severe nausea/vomiting during pregnancy that can affect the quality and quantity of food consumed. It is important during this time to eat high-energy and protein foods such as eggs, dairy, and meats/meat alternatives. Try having cold foods, as hot foods and their smells can exacerbate nausea. If nausea/vomiting continues, seek advice from a doctor and dietitian to see if supplementation of specific nutrients is needed. A woman who has experienced severe nausea and vomiting in pregnancy may be at greater risk of vitamin and mineral deficiencies and will need extra help to replenish her stores. 

By Emma McShane & Nicole Bando 

Nutrition whilst breastfeeding is vital to optimise the health of both mother and baby. New motherhood is a very busy time, and many women put their own health last.  A woman’s remarkable body will produce the live, biodynamic, complete food that is breastmilk that evolves with her baby’s growing needs. Milk production is robust and will only be affected in very extreme circumstances. The average woman produces 750mls of breastmilk per day, from 1-6 months. Fat stores accumulated during pregnancy are used to fuel milk production when baby arrives, though this does not cover all of the energy needed to produce breastmilk. Some elements of breastmilk are impacted by a woman’s diet and those that follow a vegetarian or vegan diet, are at greater risk of vitamin and mineral deficiencies.
 
DID YOU KNOW?

• Adequate nutrition can help with coping with a new baby and the adjustment to motherhood, mood, and energy levels. Restrictive eating during breastfeeding can impact mood, milk supply, overall coping, and bone health.

• Certain nutrients in breastmilk, such as lactose and protein are fairly constant, however the fat content of breastmilk changes according to how empty the breast is. The types of fatty acids and quantities of iodine and Vitamin B12 are also affected by the mother’s diet.

• A mother’s varied diet exposes baby to different flavours and tastes, which will help baby to accept a wider range of solid foods, including fruit and vegetables.

• Regular nutritious meals and snacks are important to nourish both mother, and baby. There is no need to aim for dietary perfection.

 
ENERGY:
An extra 2000kJ per day is needed for a breastfeeding mother, though this can change depending on individual needs. This is equivalent to a serving of spaghetti Bolognese with cheese (1 cup pasta and ½ cup sauce), or a bowl of porridge with apple, yoghurt, and nuts (½ cup uncooked oats, made with 1 cup of milk, 1 apple and a handful of nuts) or a combination of snacks throughout the day, such as yoghurt (¾ cup), popcorn (small packet/1 cup), crumpets, and peanut butter (1 crumpet with 1 tb of nut butter). Studies show that not eating enough can directly impact milk supply and composition, so a wholesome diet is vital to fuel both mother and baby.
 
FLUID:
Breastmilk production requires fluid, so a breastfeeding woman requires more fluid than usual. The amount depends on various factors such as weather conditions, activity levels, and the food eaten. Be guided by your body, and ensure you’re drinking water consistently throughout the day.
 
CAFFEINE:
Caffeine transfers directly into breastmilk, so avoid large quantities of caffeinated drinks when breastfeeding. 1% of caffeine enters breastmilk and peaks an hour after consumption. A newborn baby can take up to 160 hours to process caffeine, however by 6 months that drops to 2-3 hours, so an older baby is able to better tolerate caffeine. A morning latte or a few cups of tea across the day might not cause any issue, but observe baby; a mother may consider changing to a decaffeinated tea or coffee if she notices that her baby is very wakeful after her morning coffee. A moderate amount of caffeine a day, such as two cups of coffee (latte or espresso), three cups of instant coffee or four cups of tea is usually fine. Remember that sources of caffeine include: cola, chocolate, tea, guarana, and energy drinks.
 
Caffeine can also affect the let-down (the milk ejection reflex) and worsen nipple vasospasm (occurs when blood vessels tighten and spasm, causing nipple pain).
 
ALCOHOL
The safest option while pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

MIXED FEEDING:
Any amount of breastfeeding increases a woman’s dietary requirements, however given the wide variation in breast milk production when mixed feeding, it can be difficult to estimate. A woman should use her appetite as a guide and may require additional foods from the core groups. A dietitian can help to guide this.

DO CERTAIN FOODS INCREASE BREASTMILK PRODUCTION?
Oats: Many women wonder if oats or lactation cookies help with milk supply, however, there is no clear evidence to support this.
Fenugreek: There is poor quality and limited evidence to suggest that fenugreek increases milk supply.
Breastfeeding with good attachment, flexibly and frequently is the best way to protect milk supply.

IMPORTANT NUTRIENTS:

Emma McShane, Dietitian

References:    

1. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Breakfast Cereals. Australian Government: Department of Health, 2013. (Available from: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~breakfast-cereals, accessed September 3, 2021).
2. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Savoury Snack Foods. Australian Government: Department of Health, 2013. (Available from:https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~savoury-snack-foods, accessed September 3, 2021).
3. Queensland Health. Sodium. The State of Queensland (Department of Health), 2021. (Available from:  https://www.healthier.qld.gov.au/guide/sodium/, accessed September 3, 2021).
4. Coles. Food products. Coles Supermarket, 2021. (Available from: https://www.coles.com.au/, accessed August 22 - September 3, 2021).
5. Woolworths. Food products. Woolworths Supermarket, 2021. (Available from: https://www.woolworths.com.au/, accessed August 22- September 3, 2021).
6. Tong, T., Rangan, A., & Gemming, L.  Evaluating the Nutritional Content of Children's Breakfast Cereals in Australia. 2018. Children (Basel, Switzerland), 5(7), 84. https://doi.org/10.3390/children5070084

Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children's dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.

2) When should I worry about my toddler's eating?
Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:

• exhibiting extreme fussy eating behaviours and mealtimes are very difficult
• lethargic and lacks energy for daily activities
• appears unwell

• gagging or vomiting often, or has problems with chewing or swallowing
• eating a very limited variety of foods and missing out on entire food groups
• unable to drink from a cup from around 16 months
• rejecting whole food groups or groups of foods of a similar texture
• not growing or developing as expected

 
3) How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits. 
The below strategies can help manage fussy eating behaviours:
     Parents use a consistent approach with all strategies
     Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
     Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
     Minimise distractions: eat at table, away from television, devices or toys.
     The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
     Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
     Keep meal times to a reasonable time limit and develop a routine around meals.
     A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
     Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
     Children love helping and can assist with shopping for the family’s food and simple meal preparation.
     Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
     Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
     Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
     Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.
4) Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.  

By Nicole Bando, Dietitian & Lactation Consultant, November 2019

I’ll start by saying that I’m all for encouraging people to eat healthier food. There is absolute scientific consensus that we cannot sustain a future population of 10 billion people with our current diet and food production methods. An urgent, systematic review of how we produce, transport and eat food is required. Game Changers rightly touched on the global impact of current food production. However, should you obtain nutrition information from a Netflix documentary? I’d say no, and here is why:

Let’s talk ‘plant-based’:
The term ‘plant-based diet’ is new and what does it mean? Game Changers did not make this clear. If I took my dietitian hat off, the main message I received was to eat lots of vegetables and maybe some beans, absolutely no meat and I’d be good to go. But the reality is far more complex than that. It is true that a vegetarian or vegan diet confers many health benefits (lower risk of heart disease, stroke, diabetes, lower body weight). However, this diet must be carefully planned or serious deficiencies from lack of key nutrients such as iron, Vitamin B12, zinc, iodine and omega-3 fatty acids can develop.

The long-term consequences of deficiencies include anaemia, osteoporosis (brittle bones), loss of nerve function, depression and long-term cognitive impairment. At vital times such as pregnancy and breastfeeding, inadequate omega-3 fatty acids (found in fish, chia, flaxseeds, walnuts, microalgae) can impact a baby’s brain development. Serious stuff, no?

Athletes have far greater requirements than the general population, and risk inadequate iron, energy and protein intakes. This impairs recovery, increase injury risk and has long-term health consequences. The female athlete is risk of consequences including irregular periods, infertility, osteoporosis and a host of cardiovascular and mental health side effects.

None of these risks were mentioned, which is why it’s best to seek advice from a trained health professional, rather than Hollywood. I will give kudos to Game Changers for using some pretty good party tricks, such as finding the strongest man in the world who only eats plants to move some heavy stuff, measuring nocturnal erections of college students and centrifuging blood after a meat vs vegetarian meal. All very convincing, but a little lacking in scientific depth.

It's a little extreme to compare the meat industry to the tobacco industry. Whilst the science does tell us that a diet heavy in processed meats can increase the risk of certain cancers, meat isn’t out to get us. I’m confused, aren’t we the ones hunting down the animals and putting them on our plates? My issue is the demonising of one food. Our health crisis is related to myriad factors, including added sugars, salt, overall saturated fat, caloric intake and lack of enough of the good stuff, mainly fruits, vegetables and whole grains. Even that is oversimplifying matters.

The bottom line?

• If this documentary made you consider changing your diet to eat more plant foods and reduce meat, processed foods and sugar, awesome.
• The Eat Lancet Commission gathered 37 of the world’s leading scientists produced a global document that addresses the environmental and health crisis we face as a planet, with food as the driver for change.
• It is ok to keep some meat on your plate, try to reduce total to 300g per week. Include dairy, eggs and fish.
• Base your diet on plant-based foods: nuts, legumes, fruit, vegetables, whole grains
• Include good fats
• Reduce added sugars
• And please, seek advice from a university qualified nutrition professional if you are considering a vegetarian or vegan diet, especially if you are in a vulnerable category (pregnancy, breastfeeding, child, adolescent or athlete).
• For some hard-hitting evidence-based information, explore this: www.eatforum.org
• And a documentary that is right on the money? 2040 by Damon Gameau: www.whatsyour2040.com

As part of planning for a glowing pregnancy, have you considered your diet? It's true that supplementation with key nutrients is important, but a nutritionally complete diet during pregnancy and breastfeeding helps to lay the vital foundations for a healthy mother, foetus and eventually, a thriving family. This is important to reduce the risks of chronic disease later in life, in both the mother and child.

New research is emerging that nutrition plays an important role in the pre- conception period and can also affect fertility. Despite having more information at our fingertips than ever before, as a population our diet has never been worse. We are constantly bombarded with myriad information about nutrition and it is little wonder that we are confused about what to eat.

The latest data from the Australian Health Survey shows that less than 7% of Australians are eating enough vegetables and that a significant portion of our daily calories (35%) comes from discretionary items. These are foods that are not essential to a healthy diet and are high in refined sugar, fat and alcohol. Yet, we have heard the argument that the Australian Dietary Guidelines (ADG’s) don’t work, and this is simply because we are not following them. The ADG’s aren’t designed to be a ‘one-size-fits-all’ approach. They are evidence-based and provide us with a brilliant framework for living a healthy lifestyle without the merry-go-round of fad diets, or the latest buzz in superfoods. Perhaps they just need to sound a little more glamorous.

All foods are fabulous in their own right and there are many ways that the guidelines can be tailored by a dietitian to fit in with a range of lifestyles, cultures, taste preferences and life stages to suit the individual; sounds a little bespoke, doesn’t it?
​
Boosting vegetable intake by 1-2 serves (half to one cup) per day has many health benefits and can be done relatively easily. For example: 

• Add canned legumes to salads, soups and slow-cooked meals during winter. Legumes are super food powerhouses, replete with fibre, iron and protein. They are low in fat, have a low glycaemic index and on top of these great benefits, are cheap.
• Try one new recipe a week and add in an extra vegetable that isn’t on the list of ingredients. 
• Snack on cut-up vegetables and dips such as hummus or tzatziki (food safety is an important consideration in pregnancy, avoid dips containing raw egg). 
• Try avocado with tomato on wholegrain toast for breakfast, for a brilliant source of mono- unsaturated fatty acids, lycopene, vitamin C, fibre and beta-carotene. Boost iron and folate with a scattering of basil leaves. 
• Add a handful of spinach or rocket to any meal for a boost of folate, iron, vitamin C and fibre 
• Avoid pre-cut vegetables and ensure all fresh produce is washed to avoid listeriosis

To plan for a healthy pregnancy and make sense of the nutrition information, come and visit me at NEST Elsternwick for personalised advice on how to make the best start for you and your family.

​Happy Winter everyone...with June 1st upon us, what do you need to know about oats – steel cut vs rolled vs instant or quick? All oats have the same nutritional profile, they are rich in fibre, beta-glucan (helps to keep cholesterol in check). They are often marketed to increase breast milk supply, however there is no evidence to support this claim, though oats are a great source of energy for breastfeeding women, therefore great to include as part of a balanced diet.

1. Steel cut oats are the least processed, they are unrolled then cut into pieces, they take the longest to cook; 20 minutes once simmering. Fashionable in recent years, there is negligible difference to rolled oats nutritionally, though they cost a lot more. They have a slightly lower glycaemic index than rolled oats.
2. Rolled oats have been steamed, rolled and dried. They take approximately 5 minutes to cook once bought to a simmer. They have a low glycaemic index, so will keep you full longer.
3. Quick oats have been rolled, steamed and ground into smaller pieces. They have just as much nutrition as their less processed relatives, but your digestive system doesn’t have to work as hard; so they may not keep you feeling as full for as long, meaning the glycaemic index is higher.
4. Instant oats: another step along the processing chain, these have been cut further and have additives, such as sugar, emulsifiers, milk products and sweeteners. They are lower in fibre and higher in sugar.

The bottom line? If choosing microwave oats, opt for a plain or high fibre option (e.g. Uncle Toby’s Original sachets, Carman’s Natural 5 Grain & Super Seed ). Steel oats are of negligible added benefit, so my advice is if you have time, choose plain rolled oats. Whichever oats you choose, add your own toppings such as fruit, yoghurt, nuts and seeds to sustain you for longer.

Calcium is an essential nutrient for building healthy bones and teeth. The majority of our body’s store (99%) is found in the skeleton. The major source of calcium in our diet is dairy; though it is present in other foods too. Many parents report that their toddlers drink milk before bedtime and worry that stopping it will upset the bedtime routine. Parents are often concerned that their child isn’t eating enough during the day, especially if dealing with a fussy or selective eater.

There are many good reasons to change the evening milk routine. The evening bottle of milk may fill your child up and affect their appetites, which may contribute to fussy eating. Drinking milk out of a bottle or after teeth brushing can contribute to dental caries. Dairy contains 10 essential nutrients, including protein for growth, zinc for immunity and vitamin B12; essential to nerve cell function. However, it does not contain iron, so children who drink large quantities of milk are at risk of iron deficiency, as milk may replace other foods in their diet. Also other nutrients in milk can interfere with the absorption of iron, when consumed in excessive quantities.

So how much calcium does your child need? 1-3 year olds require 500mg per day, this increases to 700mg at 4-8 years. 1 serve of dairy provides 250mg of calcium, so a toddler needs two serves per day. See the list below to check your child’s diet for adequate calcium.

1 serve of dairy = 250mg calcium:
250ml milk
2 slices cheese – 40g
½ cup evaporated milk
½ cup ricotta cheese
¾ cup yoghurt
1 cup calcium fortified grain or nut milk
Other sources include:
100g almonds
60g sardines
½ cup canned salmon with bones
100g firm tofu – may differ between brands

Whilst your child adapts to the change, it may be a good time to alter the evening routine. Offer a small amount of milk at the end of the evening meal in a cup if concerned that dairy needs have not been met during the day. Perhaps a feeding chair can become the story chair, or moved out of the room if no longer needed. Offer full fat dairy at other times of day, for example – milk in cereal, yoghurt with fruit or cheese and biscuits as a snack, to easily meet the daily requirements.  Breastmilk continues to be a source of calcium and other nutrients for breastfed toddlers.

A word on toddler formulae - these are not required for healthy children. Beyond 12 months, children should be eating the same foods as the rest of the family. Formula may take up valuable stomach space and prevent a child from accepting a variety of solid foods. Offer foods from all groups, including adequate dairy; and though toddlers may not eat consistently from day to day, this will help to ensure that your child's growth needs are met. If you feel uncertain, see a paediatric dietitian for thorough assessment of your child's diet.
Fussy eating is a normal stage of toddlerhood that usually passes. A healthy child will never go hungry. As parents, offer a variety of fruit, vegetables, meat or alternatives and whole grains over the day to help your child get used to different tastes and textures. Their intake will vary day to day. If your child is a very fussy eater, is not growing well or you feel concerned about lack of variety, see your NEST GP and our Women’s and Infant Health Dietitian and Lactation Consultant, Nicole Bando.

References
1. Osteoporosis Australia www.osteoporosis.org.au (accessed 18/10/17)
2. National Health and Medical Research Council. Eat for Health Australian Dietary Guidelines Summary. Canberra: Commonwealth of Australia, 2013. (Available from: https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55a_australian_dietary_guidelines_summary_book.pdf, accessed 18th October 2017).

Thanks to Victoria Hobbs, Deakin University for data collection.

It’s time to examine a snack that has been trending for some time; the bliss ball. Are they actually a healthy snack and what sort of marketing tricks to the companies use to lure us in? I look at kilojoules/calories per serve, as well as fibre, sugar and protein per 100g. What are the top 3 ingredients – do they contain sugar, do they contribute nutrients? A good guideline for a snack is generally 300-600kJ, depending on your nutrition goals.
Let's compare products:

1. Special K protein bliss bites: 420kJ/serve, moderate fibre, low sugar and a good source of protein (from milk). The fats and protein may improve satiety.
​
2. Carmen’s Bliss Balls : ~312kJ/serve (similar calories to an apple), 6-10g fibre/100g, high sugar 39-47g/100g across the range. A source of refined sugar, the primary ingredient is dates. Contain nuts, so a valuable source of protein. However, will 1 bliss ball fill you up? Consider how many you need in order to feel full and note if they take you through until the next meal.

3. Creative Gourmet Super Balls (fridge section): 525kJ/serve (equivalent to 1.5 apples), moderate fibre 6g/100g (2.1g per serve, an apple delivers up to 3-5g), high sugar 24.5g (mainly from dates as the first ingredient), good source of protein (whey), though also high in saturated fat from coconut cream.

4. I Quit Sugar’ Superfood protein ball mix:
This product is so directly misleading. Initially appears to be a good contender for a healthy snack: it is high in fibre, low in total sugars (<3g/100g) and 486kJ per serve. Its main claim to fame is being fructose free.
However, THIS DOES NOT INCLUDE the ingredients that must be added to the mixture to actually make the protein balls. Once the rice malt syrup, coconut oil and coconut are added, these protein balls lose the ‘no sugar’ kudos and increase to 640kJ/serve, refined sugars increase to ~25g/100g and they are a source of saturated fat from all of that coconut. This is marketing genius at its best. Not much better than a muesli bar and so very misleading.
Note: I have checked to see if I can locate this product and it is temporarily unavailable. Check other mixes such as these to see if the nutrition information panel reflects ALL ingredients, or dry portion only.

5. Bounce Peanut bliss balls:
A high energy snack with 880kJ/serve, they are low fibre, high sugar, despite being a good protein source – (derived from ~30% nuts). The second listed ingredient is brown rice syrup. This is OK as an occasional snack if you are very active, but may not fill you up for long and could contribute to weight gain over time.

6. Bounce Cacao raspberry balls:
High energy at 710kJ per ball, high sugar and moderate fibre. A better choice than the peanut ones, but not by much.
My verdict? Choose the top 2 products, stick to the serving size. Enjoy occasionally and observe if they fill you up enough to last until the next meal. They are similar in nutritional profile to muesli bars. Alternatives such as fruit, low fat dairy, nuts, seeds and grains provide more benefit nutritionally.

Why not make your own bliss balls at home to enjoy occasionally? This way you can reduce the serving size and choose the ingredients that will be healthiest. I like this recipe from shift nutrition:
https://shiftnutrition.com.au/recipe/chocolate-peanut-butter-bliss-balls/ (~300kJ/serve)

DISCLAIMER: I RECEIVE NO FINANCIAL BENEFIT FROM REVIEWING THESE PRODUCTS, THIS IS AN INDEPENDENT PRODUCT REVIEW BASED ON MY PROFESSIONAL OPINION. I HAVE REVIEWED A SMALL RANGE OF AVAILABLE SUPERMARKET PRODUCTS, THIS IS NOT AN EXHAUSTIVE COMPARISON.

​Many of you have asked for my opinion on the ketogenic diet, here is my summary, based on current evidence.
What it is:
A very high fat, low carbohydrate diet, initially devised in the 1920's to treat severe seizures in epilepsy.
Gained popularity for weight loss in recent years.
•Breakdown: 70% fat, 10-20% protein, 5-10% carbohydrate. Looks like this:
Breakfast: 2 eggs, 1/3 avocado Lunch: salad with low carb veg, 100g meat, 1 boiled egg, 30g cheese, Dinner: 150g meat + low carb vegies, snacks: low carb protein bar, nuts, cheese, chopped veg, berries.
•Studies show short-term improvements health markers
•Benefits: fuller for longer due to fat content, ketones suppress appetite, fat loss instead of muscle
•Disadvantages: sustainability, social occasions, restriction severe, satisfaction, expensive

What is ketosis?
Glucose is the main source of energy for the body, from carbohydrates. Brain uses 120g glucose per day 
When the body is deprived, alternative fuel is produced =‘ketones’
During fasting – body removes glucose from the liver and breaks down muscle (glycogen) to release glucose
Once this depletes glucose stores, (3-4 days), insulin decreases and body uses fat as primary fuel.
Liver produces ketone bodies from fat.
Ketones accumulate in the blood = ketosis 
•Symptoms of ketosis: hunger, fatigue, low mood, irritability, constipation, headache, ‘brain fog’, nausea, vomiting, reduced exercise tolerance 
Safety:
•Unclear long-term risks, risk to heart health with high saturated fat diet (risk of high cholesterol)
•Kidney stones, osteoporosis, uric acid (gout), nutrient deficiencies, gut health
•Unsafe in certain medical conditions and times of growth: pregnancy, breastfeeding, children, adolescents

So what is the bottom line?
•Option if difficulty losing weight other methods
•If individual can stick to it and meet nutritional requirements
•Consult GP and Dietitian before commencing 
•Dietitian can guide reintroduction of carbohydrates to enable long-term weight maintenance
•Good option is a modified carbohydrate diet – easier to stick with in the long-term
- Weight regain a risk after following a restrictive diet