Nutrition and Breastfeeding Articles

By Nicole Bando, APD & IBCLC, 17th September 2019

Water is vital for all of our body's basic functions, such as carrying nutrients to cells, regulating body temperature and ensuring healthy bowel motions. I am often asked, how much fluid do children need?
The answer depends on their age, body weight and other factors, such as illness, environment & physical activity levels. My advice is based on a healthy population.

0-6 month old babies need 150mls of fluid per kg per day. Many parents of breastfed babies worry that they can’t quantify how much milk their baby is receiving. There are many ways to tell if a baby is well hydrated, remember that what goes in must come out.
 
At least 5 heavy wet nappies and multiple soft stools per day are a good indicator that baby is well hydrated. Please note that after about 6 weeks, a breastfed baby poo only once per day. it is also normal for a breastfed baby to last 7-10 days without a bowel motion, this is quite normal if baby is otherwise gaining weight and well. Bottle fed babies may only poo once every 2 or 3 days.

Baby’s skin tone, colouring and alertness is also a good indicator of hydration. Diarrhoea or vomiting increase fluid requirements and increase risk of dehydration at any age, which can be life threatening in children. If your child ever becomes listless, has a depressed fontanelle (soft area on baby’s forehead prior to the bones closing), won’t drink breast milk or formula or becomes unresponsive, seek emergency medical attention.
 
Both breastfed and formula fed babies are likely to need extra feeds offered in hot weather. A formula fed baby may need additional sterile water, it is best to discuss this with your GP. Breastfed babies do not require additional water, and instead may be offered extra breastfeeds.  
 
Children 6-12 months require 120mls fluid per kilogram per day (e.g. a 9kg baby requires just over 1000mls per day). This includes water consumed from sippy cups, breastmilk, formula, as well as water found in foods.

Basic fluid requirements per day beyond 12 months (+fluid from diet) are listed below:
1-3 years: 1000mls
4-8 years:1200mls
9-13 years: Boys 1600mls, Girls 1400mls
4-18 years: Boys 1900mls, Girls 1600mls
 
Fluid is defined as anything liquid at room temperature (milk, jelly, yoghurt, custard), it also comes from high water content foods, such as fruit and vegetables. These are difficult to quantify, but they do count towards total fluid intake (in adults up to 20% of total intake). Beyond 12 months, cow's milk (or alternative) and water are the best drinks for children. Specialised toddler formulae are not required in healthy children. Juices, diet and sugary soft drinks are not recommended to be part of a child's diet. Many schools now only allow water in the classroom and children are encouraged to drink throughout the day.

If your child is straining, passing hard pellet like stools, or passing urine that is dark and offensive, this can be a sign of inadequate hydration, which can contribute to constipation and other medical concerns. See your GP if you have any concerns and seek help from a Paediatric Dietitian for specialised dietary help if you feel constipation or diet may be an issue.

https://www.betterhealth.vic.gov.au/health/healthyliving/hot-weather-and-child-safety
https://kellymom.com/hot-topics/newborn-nursing/
https://www.breastfeeding.asn.au/blog/simonecasey/breastfed-babies-and-poo

Nicole Bando, APD, IBCLC
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It’s a privilege to be allowed to glimpse into a person’s life, family, thoughts and vulnerabilities. When discussing weight, health and body image, these aspects are so closely intertwined, that to really understand someone’s dietary choices, you must first understand them. Celebrations, eating out and socialising are a part of our lives and learning how to manage these occasions makes a big difference to your everyday health. Though it can be tricky to make informed choices at times of temptation and plenty, we can learn how to integrate these parts of our lives to create a balanced approach. 

I read an article by The Age columnist, Jessica Irvine on the weekend, which really spoke to me of this concept. It highlighted how in every possible way, we live in a modern society of excess; of consumerism, objects, stuff, and of course, food. There is so much choice and availability all the time, that it can start to feel like our only choice is to consume.

So there’s the clincher; choice. I don’t want to be reductionist about health and weight management. I understand the complexities; the psychological, medical, genetic, environmental and physical factors associated with health decisions. However, if we focus on our choices in a given situation and how we can learn to make better ones, we start seeing longer term shifts in health outcomes such as weight, blood pressure, blood sugar levels, and importantly, how we feel about ourselves. It’s a good time to consider how to live and derive pleasure from special occasions, without jeopardising what is of utmost importance; our own precious health. This is possible, even when three course meals are on offer for days in a row.

1. Forward plan: List every occasion over the next week and be strategic with meals and snacks on those days. Is it a big lunch you are feeling concerned about? Have a good breakfast – oats with berries and yoghurt, or eggs on multigrain with tomato and do something active (go for a walk or gym class). In other words, set yourself up to make healthy, informed and sound decisions.

2. Consider what will be on offer: if going out, check the menu in advance and make the best decision you can. If at someone's home, you may have an idea of the fare. When you arrive, scope out what is available decide what you would really love to eat. Please, enjoy it. By allowing yourself to do so and letting go of dieting ‘rules’, such as ‘no bread or pasta or dessert,’ you will immediately make better choices. This doesn’t mean lose all barometer of fullness and go crazy; it means – give yourself the permission to taste, nourish and celebrate, whilst listening and ultimately respecting your body. Take a plate and load up on salads or vegetables, choose a small amount of the available protein (chicken, meat, fish) and similar size of carbohydrate (pasta, potato, rice). Try to avoid mindless snacking on dip & cheese platters and save room for the main event. If there is a cheese you love, take a small piece with crackers, taste and enjoy it.

3. Save room for your favourite dessert (mine is my mum’s chocolate cake). Avoid going back for seconds by eating slowly, check in on how you are feeling. Enjoy a glass of wine if it makes you happy. Move away from the table when done; a family board game or walk around the block might be a welcome distraction.

4. If you feel uncomfortably full, or have over indulged, avoid the guilt and negative self talk and instead reset at the next meal. Choose to eat lighter – a salad, or some toast and please do not punish yourself. Food is not tied into moral worth, eating too much does not make a person ‘good’ or ‘bad’, it makes them human. Learning from these times can help us approach the next occasion differently. The ability to reset helps us shift towards a healthy lifestyle approach; it gets easier as time goes on.

5. Perspective: One meal in isolation is not going to have a long-term impact, it is when the splurge meals carry on for days or weeks that the impact is greater. 

6. Realistic expectations: Make healthy choices most of the time, plan regular exercise opportunities and be organised with fresh, seasonal meal ideas and snacks. These are the best steps towards health.

I would love the privilege to help you glow, grow or nurture and develop a healthier relationship with food. My approach is tailored to each individual’s situation. I am available for consults at NEST Family Clinic and booking details can be found at www.nestfc.com.au

Data collection by Victoria Hobbs, Deakin University

Disclaimer – I receive no remuneration from reviewing these brands; this is an unbiased, professional opinion based on a selection, and is not a definitive list.

How many times have you stood in the breakfast cereal aisle overwhelmed by the sheer number of options? So many people say they are confused about what to eat. I am often seen juggling multiple boxes of cereal, analysing the nutrition information in order to give the best advice to my clients, and make sense of it myself. Cereals can provide valuable nutrients such as fibre, vitamins and carbohydrates; though many contain little nutrition and an undesirable amount of sugar and salt. The complex interplay of the ingredients in your cereal could either fuel your performance, or leave you feeling hungry and fatigued early in the day.

Today, I have ranked a range of popular fruit and nut cereals according to their nutritional profiles (fibre, sugar, whole grain content and sodium), to remove the guess work and make healthier = easier. Where does your daily cereal fit into the list and is it time to make a switch?

Best choices
As a general guide, choose cereals that are:

• Greater than 50% wholegrains – specified on the ingredients list
• Greater than 10g fibre/100g
• Less than 400mg sodium/100g
• 15g sugar/100g – slightly higher is OK if dried fruit included. Note that dried fruit and fruit may contribute to overall sugar content, this is different to refined sugar.
• Choose untoasted over toasted muesli varieties

Avoid cereals that list sugar, or a variant within the first 3 ingredients (e.g. glucose, dextrose, honey, golden syrup, coconut sugar, barley malt, rice syrup, etc.). Beware health claims – if it sounds too good to be true, it generally is.

So with all of this in mind, the best choices include:

1. Be Natural Cashew, Almond, Hazelnut & Coconut: the winner with high fibre, 17.1g, low sugar: 12g, and low sodium: 195mg. Top 3 ingredients: wholegrain cereals, nuts, rice – all valuable sources of nutrition.
2. Be Natural Pink Lady Apple & Flame Raisin: Dried fruit raise the sugar content, but still a good choice – low salt 210mg, high fibre 14.1g, high whole grains, sugars moderate 17.1g –(wholegrain cereals, rice, fruit).
3. Morning Sun Natural Style Peach & Pecan Muesli: Great muesli choice, high fibre 11.1g, low salt 18mg and sugar 14.4g from dried fruit is considered low-moderate (Wholegrain oats, dried fruit, wheat bran)
4. Morning Sun Natural Style Apricot & Almond Muesli: Similar to above. Fibre 10.3g, sugars 15.1g, sodium 19mg (wholegrain rolled oats, dried fruits, wheat bran)
5. Lowan Fruit & Nut Natural Muesli: competes with Morning Sun, a great choice. High fibre 9.7g, moderate sugars 15.5g (from dried fruit), sodium 36mg (Wholegrain oats, dried fruits, wheat bran straws)
6. Uncle Toby’s Natural Style Swiss Blend Muesli: untoasted, high fibre 10.2g, low salt 14mg, sugar 16.3g – from dried fruit and fruit pieces as 2nd, 3rd ingredients (Rolled Oats (72%),  Dried Fruits (16%) [Sultanas (8%))

The next list shows moderate choices – less fibre and/or more sugar. Choose sometimes

1. Uncle Toby’s O&G Bircher Muesli Cranberry, Almond & Quinoa:moderate fibre 8.1g, low sugar 11.4g, low sodium 11mg, untoasted (Rolled oats, dried fruit, almonds). Add some bran to boost fibre content
2. Carman’s Natural Bircher Museli: Lower fibre 7.9g, moderate sugar 16g, though than other options. Low sodium 7mg. Top 3 ingredients look good (Wholegrain oats, fruit, nuts). Add bran, LSA, fruit to boost fibre content.
3. Kellogg’s Special K Fruit & Nut: Moderate fibre 8.1g, high sugar 19.6g, moderate sodium 310mg (Rice, wholegrains, fruit). Better choices above
4. Uncle Toby’s Plus Fibre Apple and Sultanas: It’s a trade-off, with high fibre 17.9g, but higher sugar content 23.3g, (wholegrain cereals, dried fruit – contributing to high sugar content, wheat bran), low sodium. Either mix this with wholegrain/bran flakes, or choose a different option and add a small amount of your own dried fruit to keep sugars down.
5. Table of Plenty Macadamia, Cranberry & Coconut Muesli:despite high fibre 10.4g, low sodium 15mg, moderate sugar 17.3g, derived from dried fruit and golden syrup as 2nd, 3rdingredients – not a satisfying choice.
6. Carman’s Classic Fruit & Nut Muesli: toasted muesli, moderate fibre 8.7g, moderate sugars 15g (despite first ingredient wholegrain oats, with golden syrup in the top 3, this is higher in refined sugars. Choose an untoasted muesli with more nuts and less added sugar.

Lastly, many of these may sound healthy, but are not the best choices for breakfast…high sugar, low fibre, low nutrient contribution and not the best way to start the day.

1. All Bran Honey Almond: Sounds healthier than it is with All Bran in the title. High fibre 16.1g, but also very high sugar content 23.9g (Wholegrain wheat, wheat bran, sugar), moderate salt 315mg.
2. Uncle Toby’s Oat Crisp Honey & Macadamia Cereal: Toasted, high sugar 22g – 2nd ingredient Wholegrain cereals, sugar, macadamias), fibre moderate 8g.
3. Kellogg’s Just Right Cereal: Not really just right, with high sugar 28.7g, note ingredients (Wholegrain cereals, sultanas, sugar), low salt 30mg, high fibre 10.2g. Better choices above
4. Arnold’s Farm Toasted muesli clusters: Sugar high 19.5g – added as second ingredient (Wholegrain Rolled Oats, Glucose, Oat Bran), steer clear, fibre 8.2g, low sodium 30mg.

For individual advice to optimise your nutrition to fuel your day, come and see Nicole at:
NEST Family Clinic, 289 Kooyong Road, Elsternwick VIC 3185,

It can be challenging encouraging children to eat different foods, but with persistence and consistency, children will try new things, allowing them to reach their growth and learning potential.
Hover over each lunch box photo for details of what is inside. Remember that even small changes are positive, so try simple swaps such as:
-  Swap a processed snack for a piece of fruit 
- If vegetables are no longer sent, start by sending a single vegetable stick or slice each day, knowing that acceptance takes time and one day it may be tasted or eaten.
- Swap a less nutritious snack for something better e.g chips for popcorn, or a muesli bar for Vita Weats and cheese.
- or banana bread for a regular sized piece of raisin bread with cream cheese.
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Thank you kindly to Victoria Hobbs for data collection.
Please note that our product review is unbiased, we receive no remuneration or commercial endorsement.

Rice crackers take up almost half a supermarket aisle and have become a daily snack in many diets; children love them. Are they are a healthy choice and how often should they be eaten? Let me cut through the marketing hype to help you make an informed decision at the supermarket. 

Plain rice crackers – (Coles, ALDI, Sakata, Peckish)
Let’s take a peek at the nutrition information panel. Remember that ingredients are listed from most to least. The top 3 are rice flour, vegetable oil and salt. Refined white rice flour contains little of nutritional benefit and negligible fibre – which is not listed on some of the nutrition information panels; this is generally telling of the quality of a product derived from a grain, as it should be a valuable source of fibre. This tells us that the grain has been highly refined. In other cases, fibre is listed as less than 1g/100g – that’s negligible. (Note that a high fibre food is greater than 10g/100g).

Rice crackers have a high glycaemic index; they are rapidly digested and cause a spike in blood sugar levels, closely followed by a crash. A subsequent drop in energy levels and surge in hunger results, usually soon after eating. The lack of fibre means they are not satisfying, making it is easy to eat above and beyond the portion size. Energy, sodium (salt) and fat content are similar between brands. They qualify as a moderate to high salt food. Read on for a healthier alternative.

Flavoured rice crackers – vegetable, cheese, BBQ, sour cream and chives (Coles, ALDI, Sakata, Peckish)
This line contains a similar quantity of refined rice flour, with the next ingredients either soy sauce or cheese powder; for seaweed and cheese or pizza flavours. The sweet carrot option lists rice flour, rice bran oil and 3% carrot – that’s not a source of vegetables, and merely a marketing gimmick. The seaweed crackers are extremely high in sodium, with Sakata clocking in a hefty 971mg/100g and Coles 690mg/100g. Thirsty? (A high sodium food is classified as greater than 400mg/100g).
Energy content is similar across products; Peckish sour cream and chives contain the greatest kilojoules, though are significantly lower in sodium than the other flavoured options. Cheese, when listed is in the form of powder; which offers no nutritional benefit.

What about Healtheries Kidscare Rice Wheels?
This product is located in the health food section, a marketing ploy to lull shoppers into a false sense of security. It is targeted at parents wanting to do the best by their kids. The nutrition claims on their website (see example, below) are questionable.

• ‘Scrummy, bite-sized, crunchy rice snacks that are ideal for healthy school lunches’

The product contains negligible nutrition, fibre and a significant amount of sodium 705mg/100g. There is not much difference in kilojoules between a packet of these and a snack-sized packet of potato chips, despite the difference in fat content. In fact some brands of chips have less salt. At least they don’t fill too much valuable tummy space in growing children, though if eaten regularly they are taking the place of more nutritious foods.
These, along with flavoured rice crackers in general are definitely classified as an occasional food, similar to potato chips.

Wholegrain, seeded and brown rice crackers
These varieties have more nutritional clout than the rest of the range, with Sakata Wholegrain Original Rice crackers the best of the options we reviewed. They are a high fibre biscuit with 9.4g/100g and moderate sodium (just).
The Coles brand brown rice and seed/grain options are lower in sodium and a better choice than their plain white rice counterparts; though are still classified as low fibre.

The verdict
The wholegrain options take the prize (Sakata specifically). When choosing rice crackers, opt for the brown rice or wholegrain varieties, reduced salt if possible. Note the suggested portion size of 10-13 crackers. Whether opting for plain or wholegrain varieties, serve with protein such as low fat cheese, tzatziki, hummous and chopped vegetables for a balanced and satisfying snack that will keep blood sugar levels more stable.

It’s OK to enjoy the other options occasionally, but a highly refined food shouldn’t feature daily in anyone’s lunch box. They are definitely the white bread equivalent of biscuits and easy to over consume, which can contribute to weight gain over time. The salt content can also contribute to high blood pressure over time.

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.
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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