The Power of a Plant-Based Diet for a Healthy Gut

by Anna Debenham & Alex Parker, The Biting Truth

Tired of diets promising health wonders and miracle cures that fail to eventuate? It’s time to say goodbye to the era of ‘low-everything’ diets and make room for the plant-based lifestyle!

There is growing evidence of the powers of plant-based diets (i.e. high in fibre, vitamins and minerals) on the health of your gut and your whole body, as well as reducing our risk of developing Type 2 Diabetes and Cardiovascular Disease by 20-25% ^1-6. Following a diet that looks after your gut is imperative. After all, it’s where your food enters your body! Your gut helps you absorb nutrients, keep your immune system strong and prevent certain cancers. As well as your gut health, dietary fibre has profound impacts on your mood, fatigue, stress, mental health, weight and skin.

6 out of 10 Aussies are not eating enough fibre, so most of us could benefit from adding a little more to our diet! If you are worried that this might mean giving up meat, poultry, fish and dairy foods, then rest assured you don’t have to become vegetarian or vegan to reap the benefits of a plant-based diet!

Sounds like a winner? Let’s introduce you to this golden way of eating:

What is a plant-based diet?

A plant-based diet is one that focuses on including a variety of foods that are loaded with fibre - think fruits, vegetables, legumes, whole grains, nuts and seeds. Getting enough fibre is important, but eating a combination of different types of fibre is just as essential for good digestive health.

• Soluble fibre: helps lower cholesterol and slow digestion. Eat more legumes, oats, barley, nuts, fruits and veggies. 
• Insoluble fibre: promotes regular bowel movements. Eat more whole grains, nuts, seeds, fruits and veggies.
• Resistant starch: act as food for our healthy gut bacteria (potentially the most important type). Eat more legumes (lentils, beans), whole grains, potatoes and firm bananas.

Good Sources of Dietary Fibre

Legumes (chickpeas, red kidney beans, four bean mix, lentils):

Legumes contain a type of fibre called ‘prebiotic fibre’, which feed our good gut bacteria and produce short chain fatty acids. Prebiotic fibre nourishes your intestinal cells and helps to push along the all-important fibre through your gut. Legumes may cause you to feel gassy, or bloated, but this is completely normal (did you know men fart on average 12 times a day and women 7 times). Start introducing legumes in small portions and gradually increase over the next few weeks (and remember to drink plenty of water to help push things along!). This way, you let your gut bacteria gradually adjust to your high(er)-fibre diet without any surprising changes in your bowel habits.

Grains (, oats, barley, rye, whole grain bread, brown rice, bran):

Cutting carbs has been shown to upset gut flora, so the paleo diet is out and grains are back in! In particular, fibre from grain foods has been shown to benefit our overall health, as they contain polysaccharides which provide bulk and absorb water to promote normal bowel movements. Many grains are also a good source of resistant starch (remember this is the food for our gut bacteria).

Fruits and veg:

Fruit and vegetables contain simple sugars which draw water into the gut to assist movement of fibre and prevent constipation. Rather than building your meals around protein try building them around your vegetables. Then add your grains and or legumes, top with crunchy nuts or seeds and finally add your meat, dairy, fish or eggs.

Are you getting enough?

A high fibre diet should give you a score of 4 or 5 on the Bristol Stool Chart. If yours is less than 4 then you may need more fibre in your diet.

6 Ways to Boost Your Fibre

1. In your next spag bol or lasagna, swap 50% minced meat for 50% lentils, or for black beans in your beef patties and meatballs.
2. Mix up your grains. Wheat is the most commonly eaten grain, but have you tried quinoa, spelt, teff, barley, rye, amaranth, buckwheat, bulgur, millet or sorghum? These will keep things interesting in your plant-based routine.
3. Choose whole grain breads and cereals instead of refined varieties.
4. Fill half your plate with non-starchy veggies.
5. Enjoy a handful of nuts and seeds as a snack.
6. Enjoy a potato salad for a dose of resistant starch

Summary

We are huge advocates of plant-based eating, as it encourages you to eat loads of fruits, vegetables, whole grains, legumes, nuts and seeds – all while still allowing for meats and other animal products. Following a plant based diet that is high in fibre is associated with improved digestive health as well as other health benefits. The type of fibre matters, which is why it’s important to enjoy variety (soluble, insoluble, resistant).

References

1.McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of Geriatric Cardiology : JGC. 2017;14(5):342-54.

2.Medina-RemÓn A, Kirwan R, Lamuela-Raventós RM, Estruch R. Dietary Patterns and the Risk of Obesity, Type 2 Diabetes Mellitus, Cardiovascular Diseases, Asthma, and Mental Health Problems. Critical reviews in food science and nutrition. 2016:00-.

3.Shang X, Scott D, Hodge AM, English DR, Giles GG, Ebeling PR, et al. Dietary protein intake and risk of type 2 diabetes: results from the Melbourne Collaborative Cohort Study and a meta-analysis of prospective studies. The American journal of clinical nutrition. 2016.

4.Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics. 2016;116(12):1970-80.

5.Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical reviews in food science and nutrition. 2017;57(17):3640-9.

6.Harland J, Garton L. An update of the evidence relating to plant-based diets and cardiovascular disease, type 2 diabetes and overweight. Nutrition Bulletin. 2016;41(4):323-38.

12 Ways to Enjoy Grains & Legumes this Festive Season!

Along with the festive season comes the rush to fit in last minute jobs for the year, plus never-ending social catch ups. Not to mention the main event come Christmas Day!

To keep you feeling full of energy and armed with some delicious foodie ideas for the holidays, we’ve put together our list of 12 ways with grains & legumes this festive season.

1. Summer smoothies for breakfast: The jury is out over whether it really is the ‘most important meal,’ but there’s no doubt a healthy breakfast can set you up for a day of healthier eating. For warmer mornings, smoothies make the perfect quick and easy option. Give this Blueberry & Cashew Smoothie a try – by throwing one Weet-Bix in the blender you can get a third of your whole grain Daily Target Intake!

2. Easy lunches: Busy days mean little time to stop and put together a healthy lunch, so having a nutritious option pre-made and ready to go is the best way to nourish your body with little effort. Making a double-serve of dinner for leftovers is a smart move, as is meal-prepping when you have a bit of spare time. Made with eggs, wholemeal pasta, and veggies, this Pasta &Vegetable Frittata is packed with protein and fibre to keep you going through the afternoon. Perfect for lunchboxes too!

3. Get your bake on: Christmas time is synonymous with baking, so once you’ve whipped up the usual festive treats, try something a little different, like these Super Lentil Bites. Made with a mix of lentils and nuts, these little treats are packed with healthy fats and fibre and taste great. Better yet, they’ll be ready to eat in just 10 minutes!

4. Pimp your sandwich: So much more than a school lunchbox staple! The humble sandwich is the ideal way to enjoy leftovers from big barbecues or lunches. Think ham off the bone or roast turkey slices with leftover salads, sandwiched between your favourite whole grain bread. Or try this delicious classic – egg lettuce!

5. Different desserts: You’ve heard of hummus, but how about dessert hummus? Although it might sound crazy, this sweet tasting dip is trending, and thanks to social media, finding recipe inspiration is only a few clicks away. All you need is a base of drained, rinsed chickpeas and a few other ingredients blended in the food processor. With options like chocolate chip peanut butter, snickerdoodle, chocolate, and apple pie, you’ll almost forget you’re still getting a serve of legumes in! Try cutting up a selection of fruit for dipping.

6. Summer BBQs: Whether you’re hosting, or heading to a BBQ as a guest, coming up with a crowd-pleasing side-dish can be tricky. Give this Fresh Lentil, Mango & Quinoa Salad a try and watch it disappear!

7. Meat-free meals: Whether you’re mixing up the weekly menu with more plant-based meals, or are expecting vegetarian guests for lunch, there are endless options for meat-free recipes. Try experimenting with tofu, nuts and seeds, legumes like lentils or chickpeas, and different cheeses like haloumi and feta. A winner for summer BBQs are these Stuffed Capsicums, made with chickpeas, brown rice, pine nuts, and goats cheese or feta.

8. Make friends with salad: If  ever there’s a time to experiment with salads, it’s summer, when the temperature rises and your tastebuds crave fresh, crunchy meals. To make a really satisfying salad, there are a few elements to consider. First, start with a grainy base, like ½ cup cooked rice, quinoa, or freekeh. Next, add a mix of salad leaves and any other veggies you have on hand, as well as a protein source, like boiled eggs, nuts, your favourite cheese, tinned tuna, leftover roast chicken, or some legumes like cannellini or black beans. Finally, drizzle on a tasty dressing (a vinaigrette of olive oil, balsamic vinegar and mustard is a fail-safe), and you’re done! Or try out this fibre rich salad with freekah, lentils and feta!

9. Foodie gift ideas: There’s nothing nicer than giving, or receiving handmade gifts. Whip up a big batch of festive spice granola or muesli and divide into jars finished off with a red ribbon – perfect for small last minute gifts. Use our base granola recipe and get creative with your flavours by trying a mix of different spices and nuts to mix it up!

10. School holiday snacks: Along with the Christmas holidays comes the long summer break for school kids. For days at home, keep a supply of cut-up fruit and veggies in the fridge, ready to pull out and serve with hummus or tzatziki dip when hunger calls. When you’re out on the go, use a cooler bag stocked with whole grain crackers and cheese, or snap-lock bags of air-popped popcorn. They’re always popular, plus around three crackers and ½ cup of popcorn offers one third of their Daily Target Intake for whole grains! Why not try this bright pink beetroot hummus for a twist on traditional varieties the kids will love.

11. Road trip snacks: For many of us, summer holidays mean long road trips – the perfect excuse for preparing a selection of delicious car snacks! And as the weather warms up, food safety is an important consideration, so keep your snacks to shelf-stable options that won’t spoil out of the fridge. Think snack or muesli bars, or make your own trail mix using different nuts, seeds and dried fruit combos! If you’re feeling adventurous why not try roasting your own chickpeas…

12. Healthy nibbles: No party platter is complete without at least one dip for veggie sticks and crackers, and the choice most of us agree on is hummus. But rather than grabbing some from the shops, impress your friends with a homemade version. You’ll be surprised at just how simple it is –this Classic Hummus has just 6 ingredients, and all you’ll need to whip it up is 10 minutes and a food processor!

However you incorporate grains and legumes into your diet this festive season, make sure you have fun with your food and enjoy a happy holiday!

  

Grains & legumes: what's trending in 2018?

As another year draws to a close, we’ve been looking at key trends for 2018 – so what’s influencing innovation and driving consumer behaviour for the year to come?

“A key trend is a genuine growth opportunity. It’s a set of changes in consumer beliefs and behaviours, leading to a change in a market. It’s something on which a company can base its strategy to increase sales of existing products or create new products, to boost market share and profitability.”

In the first of a series of trends reports, we’ve taken a look at two of 2018’s top trends (with more to come) and the opportunities they present for industry innovation!

Number 1: Plant Based

Plant based is one of the biggest trends right now and this wide reaching category is having an effect on nearly every other foodie trend out there. In 2017, plant based was the second biggest trend, having a considerable impact on innovation and product development. And during 2018, the lifestyle shift that’s driving plant based is the rise of the inclusive Flexitarian diet, not so much an increase in the number of people adopting a vegan diet as many people think. A Flexitarian is defined as.... ‘a person who has a primarily vegetarian diet but occasionally eats meat and/or fish.’ 

Emerging research is also helping to drive the prevalence of plant based eating with more and more evidence pointing to the many health benefits of eating mostly plant based, including up to a 25% lower risk of developing cardiovascular disease and type 2 diabetes and a lower frequency of obesity (1). Protein has a part to play here too with many consumers increasingly looking for alternatives to meat. In 2017, a massive 43% of Australians are strongly influenced by protein claims on pack (2).

As a result, consumer demand, changing eating patterns and technological advances are pushing innovation. Legumes are now appearing in all sorts of traditional foods, including breakfast cereals, snack bars and pasta as well as new development with smoothies, savoury snacks and bliss balls. Whole grains feature here too, due to their many health benefits and links with the benefits of increased fibre consumption, cereal fibre in particular. Both categories are driving innovation here.

So what's new within this space?

Plant based meat alternatives - Gold & Green Foods latest product combines oats and beans to create their plant based meat alternative – Pulled Oats...

A focus on plant protein - The Lupin Company’s Lupin Flakes are highly versatile and can be used in baking, added to breakfast cereals or porridge or used in plant based patties to add plant protein, texture and additional nutrients...

Reformulation to up the veggie/legume content of many traditionally grain based foods - the bread market too is seeing diversification with Finnish bakery Fazer adding vegetable and legume purees to breads to create new and innovative offerings...

Plant based is an exciting trend that's set to drive strategy within food for at least the next 5 years.

Number 2: Snackification

The next big trend for 2018, continuing on from 2017 and previous years, is the rise of the snack market. The younger generation is driving most of the growth within this trend, with millennials primarily looking to snack to tide them over between meals and increasingly replacing traditional sit down meals with a snack or two. And with 56% of us eating at least one snack every day (3), consumer demand is higher than it's ever been and is set to continue to grow. This change in the way we’re snacking, from between meal and on-the-go snacks to keep you going until your next meal to whole meals based on a selection of snacks, has prompted a change in consumer demand, with many of us now looking for healthy snacks instead of typically indulgent snack foods that have dominated this category in the past. This shift has ensured both whole grains and legumes are now featuring prominently within the many innovative new offerings available.

Opportunities here are plenty, but where's the biggest potential gain?

Creation of premium products - we’re increasingly willing to pay a premium for a great tasting snack that caters to our lifestyle and fulfils a genuine need. Good Thins crackers are a prime example with a range of different options for all (premium) tastes...

Ever more innovative offerings - Regrained Cereal Bars use leftover grains from the beer brewing process to create whole grain snacks...

There are no limits on innovation - perhaps the biggest opportunity of all within this space - from meat to dairy to veggies, any category is open for disruption. Health and often a focus on protein drives new development, take Biena’s new chickpea snack for example, which combines a typically savoury food with chocolate to create an unusual but delicious snack option...

Manufacturers and retailers will continue to experiment with new trends to fulfill consumer demand and as we become more adventurous with our food and more of us become food explorers, the opportunities for ever more exciting options continues to grow.

To find out more about the fascinating rise of the snack market, read our article here.


References

1. Harland J, Garton L. An update of the evidence relating to plant-based diets and cardiovascular disease, type 2 diabetes and overweight. Nutrition Bulletin. 2016;41(4):323-38.
2. GLNC. 2017. Consumption & Attitudinal Study. 2017. Unpublished.
3. Choosi. Modern Foods Trend Report. 2017.

Forget activated almonds, this year it’s all about sprouted grains!

Last year the Washington Post predicted ‘sprouted everything’ would be a major food trend for 2017 (1). And based on the steadily growing range of sprouted grain products on supermarket shelves in Australia, this trend is here to stay in 2018. But what exactly is a sprouted grain, and does it boost the already impressive nutrient profile of a whole grain? Read on for a summary of the evidence:

But first, what exactly is a sprouted grain?

There is currently no regulated definition for a sprouted grain, but it’s commonly agreed that it is a whole grain that has been soaked in water, and has started the germination process. So put simply, it has ‘sprouted’ a new shoot, and is in the transition phase between a seed, and a new plant.

How do they differ nutritionally to regular grains?

While the evidence around sprouted grains is still emerging, sprouting grains may boost their nutritional value.

The idea is, once they have started sprouting, the grain uses up some of its own starch as energy to grow, which then makes it easier for us to digest. Likewise, germination is said to boost the availability of vitamins and minerals, increase the grain’s antioxidant levels, and reduce phytates - which inhibit the absorption of minerals like zinc, calcium, and iron, meaning we can absorb more of the good stuff. But, given that there is no standard definition for the process, it’s reasonable to assume that variation may exist between products (2,3,4).

Additionally, as sprouted grains need all parts of the grain intact to germinate, they are always a whole grain, as opposed to refined. This is important, as we know whole grains are brimming with health benefits, being richer in protein, fibre, vitamins, minerals, and phytochemicals than their refined counterparts. So whether or not sprouted grains have additional benefits, those eating them will be reaping the benefits of including whole grains – so it may be a win-win!

What does the research say?

A scan of the literature brings up a small pool of studies – few of which relate to humans. Early findings suggest sprouted grains may reduce risk and assist with the management of chronic diseases like diabetes, cardiovascular disease, cancer, fatty liver disease and depression. However, it’s unclear whether eating sprouted products offers additional benefit beyond simply consuming more whole grains, - supported by the evidence as reducing risk of chronic disease and improving diet quality (5).

Where can we find them?

As well as being used in place of grains in home cooking or on trendy café menus, sprouted grains are making their way into a range of commercially available foods. They’re still a niche product, but are growing in popularity in the USA, so it’s no surprise Australia is following suit. We’re seeing sprouted grains appear in cereals and granolas, breads, flours, bars, grain-based drinks, even corn chips!

Can I make them myself?

You can. And on the upside, it’s cheaper than buying pre-sprouted grains, but it can be time consuming and fiddly.

D.I.Y sprouted grains:

1.      Rinse grains and place in a jar

2.      Soak the grains in water for 12 to 24 hours. They will expand as they absorb water, so it’s important that grains are completely submerged

3.      Use a sieve with small holes to drain the water completely from the jar, leaving the grains

4.      Rinse your grains twice a day and leave to drain

5.      Depending on the temperature, humidity and type of grain, sprouting should start to occur within three to seven days

6.      When you are happy with the level of sprouting, dry completely in a low oven or dehydrator and refrigerate for 3 days.

Once prepared, they can be used in the same way that you would ordinarily use grains – such as sprouted brown rice in a stir fry, or sprouted quinoa in a salad.      

Note: it’s important to be aware of food safety when it comes to sprouted grains. As they are prepared under moist, humid conditions, sprouted grains also offer an ideal condition for harmful bacteria to grow, so they can pose a risk for food poisoning. As such, the USA’s Food and Drug Administration (FDA) suggest children, elderly people, pregnant women, and those with weakened immune systems should avoid eating sprouted grains.

Are they worth the extra effort/money?

Since the evidence is still emerging, it’s too early to confidently recommend sprouting your grains for the health benefits. But, given sprouted grains offer an interesting and tasty way to enjoy whole grains, there’s nothing to be lost from giving them, and the interesting sprouted grain products on the market a go. Watch this space!

References
1. The Washington Post, Plant proteins, healthy fats and more 2017 food trends. Accessed 16/11/2017 from: https://www.washingtonpost.com/lifestyle/wellness/checking-the-crystal-ball-for-2017-food-trends/2016/12/07/ead326ac-ac2a-11e6-8b45-f8e493f06fcd_story.html?utm_term=.e07c0af6033e
2. Chavan JK, Kadam SS, Beuchat LR. Nutritional improvement of cereals by sprouting. Critical reviews in food science and nutrition. 1989;28(5):401-37.
3. Jaenke R, Barzi F, McMahon E, Webster J, Brimecombe J. Consumer acceptance of reformulated food products: A systematic review and meta-analysis of salt-reduced foods. Critical reviews in food science and nutrition. 2017;57(16):3357-72.
4. Mbithi S, Van Camp J, Rodriguez R, Huyghebaert A. Effects of sprouting on nutrient and antinutrient composition of kidney beans (Phaseolus vulgaris var. Rose coco). European Food Research and Technology. 2001;212(2):188-91.
5. Lorenz K. Cereal sprouts: composition, nutritive value, food applications. Critical reviews in food science and nutrition. 1980;13(4):353-85.

Grains are back: new research shows fewer Australians are avoiding grains!

After years of going against the grain, promising new research from the Grains and Legumes Nutrition Council (GLNC) has found fewer Australians are limiting grain foods, and more of us are enjoying legumes.

The triennial Consumption Study found 47 per cent of Australians limit grains, significantly less than the 60 per cent recorded in 2014 (1). While the persistence of Paleo, low carb, and gluten free diets are likely still pushing the trend of grain-avoidance, these results suggest the wide-spread fear of grains is slowing – and that’s great news for Aussies’ health.

The evidence for grains and health is strong, and continues to develop. Grains like wheat, oats, rice, barley, and rye are nutrition powerhouses, boasting more than 26 nutrients and phytonutrients that help to protect us against chronic disease and arm us with good health. In fact, an in-depth review of more than 300 studies found whole grains and high fibre foods to be the most protective against diet related diseases of all food groups – even more so than fruit and vegetables (2)!

And the evidence around legumes (think chickpeas, lentils, kidney beans) is equally exciting, with every additional 20g eaten daily (around a tablespoon) reducing risk of early death by 7-8 per cent (3).

Overall, we’re not a country of big legume-eaters, but it’s encouraging to see a greater proportion of Australians are including them in 2017 - 28 per cent, up from 24 per cent in 2014 which continues the upward trend of consumption. This was likely fuelled by the United Nations naming 2016 the International Year of Pulses, which saw celebrity chefs showcase legumes’ versatility and simplicity to prepare, through a whole range of different recipes.

The study also picked up on some interesting trends around the grain and legume foods Australians are eating. The percentage of people eating porridge, for example, has doubled between 2014-2017, while fewer people are choosing wheat breakfast biscuits. The way we eat is evolving too, with snacking on the rise.  Bars for example, were previously eaten as part of a meal at lunch or breakfast, but this year’s results showed they are more commonly eaten as a morning or afternoon snack. We’re also eating more alternative breads like flat breads and wraps.

The GLNC 2017 Consumption Study revealed a number of
encouraging trends in the grains and legumes categories

So how can you reap the wonderful benefits grains and legumes offer? It’s as simple as adding half a cup of legumes, or an extra serve of whole grain foods to your day! Try subbing half the mince in your Bolognese with lentils, or adding a handful of oats to your morning smoothie.

Check out the infographic below to find out what a serve of grains really means, and for more foodie inspiration, check out the recipe section of our website.

References

1. GLNC. Australian Consumption & Attitudes Study. 2017.
2. Fardet A, Boirie Y. Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews. Nutrition reviews. 2014;72(12):741-62.

3. Darmadi-Blackberry I, Wahlqvist ML, Kouris-Blazos A, Steen B, Lukito W, Horie Y, et al. Legumes: the most important dietary predictor of survival in older people of different ethnicities. Asia Pacific journal of clinical nutrition. 2004;13(2):217-20.

Plant Foods Offer An Unexpected Protein Hit

Grain foods, including bread, can contribute a surprising amount of plant-based protein to our daily requirements.

While young Aussies are forking out on pricey supplements in a bid to build muscle and cut weight, new evidence has revealed an unexpected source of protein: the humble loaf of bread.

The new findings, from the Grains & Legumes Nutrition Council’s (GLNC) annual food category audit, revealed that close to one in every five loaves of wholemeal/whole grain bread assessed was considered a ‘good source’ of protein¹, boasting at least 10g per serve – the same amount found in a glass of milk or two boiled eggs.

Even white bread, often shunned as nutritionally inferior, came out on top with protein content; almost three quarters (73 per cent) of white sliced loaves were a ‘source’ of protein, with at least 5g per serve.

Felicity Curtain, Accredited Practising Dietitian and Nutrition Manager for GLNC, said this brings perspective to our nation’s protein fixation.

‘Australians are protein-obsessed, with at least 10 per cent of adults over 15 using sports supplements², but most of us can easily reach our daily needs through a range of whole foods, including bread!’

Curtain said grain foods like wheat, rye, barley and oats are naturally rich in plant-based protein, on top of other nutrients like vitamins, minerals, dietary fibre and phytochemicals.

‘When combined with other good quality protein foods like meat, eggs, dairy foods or legumes, grains will get you well on your way to meeting your protein needs.’

While individual needs vary based on age, gender, body size and activity level, protein requirements range from between 0.75-1g of protein per kilogram of body weight; around 50g per day for a 65 kilogram woman.

So forget protein shakes, try these post-exercise alternatives that offer at least 15g protein per serve:

· Two slices of whole grain toast with nut butter and sliced banana
· A bowl of whole grain cereal with Greek yoghurt and berries
· A delicious smoothie made with milk, yoghurt, fruit and rolled oats
· A whole grain roll filled with lean ham, cheese and salad
· Whole grain crackers with cheese and hummus

Visit the GLNC Website for recipes, factsheets and up-to-date information on the latest evidence around grains and legumes.

References

1. GLNC. 2017 Bread Audit. Unpublished.
2. https://www.foodstandards.gov.au/publications/Documents/Sports%20Foods%20Quant%20Report.pdf  

Australians Are Falling Short on Cereal Fibre

by Eden Barrett,  Accredited Practising Dietitian and PhD candidate from the University of Wollongong 

When we think about the benefits of fibre, we typically think about its role in digestive health and staying regular. While this is certainly one of fibre’s great benefits, there are many more you may be less familiar with. For example, did you know that a diet high in fibre has also been found to protect against heart disease, type 2 diabetes and some cancers (1,2,3). Additionally, fibre helps you to feel full eating fewer calories, which may explain why higher intakes of fibre are also associated with lower body weight (4).

What is particularly interesting is that these associations are often found to be strongest with high intakes of cereal fibre specifically (3,5,6,7), meaning the fibre that comes specifically from grain foods such as breads, pasta, rice and breakfast cereals.

To understand how much cereal fibre Australians are currently eating, we recently conducted some research with the University of Wollongong to develop a database of more than 1,900 foods containing cereal fibre, expanding on the current AUSNUT 2011-13 food composition database. This database allowed us to estimate how much cereal fibre Australians are getting through the foods they eat. In addition, we were also able to determine the main foods which were contributing to cereal fibre intake as well as how the amount of cereal fibre a person is eating may be related to their likelihood of meeting daily total fibre targets.

On average, Australian adults ate 6.4g of cereal fibre each day, while Australian children and adolescents ate 6.2g each day (8). This is the equivalent of about 2-3 slices of whole grain bread or 1 cup of wholemeal pasta. The main food items contributing cereal fibre within the Australian diets were:

• Breads and bread rolls (29% of adult intake and 27% of child intake)
• Ready to eat breakfast cereals and porridge (29% of adult intake and 22% of child intake)
• Cereal-based mixed dishes (e.g. spaghetti bolognaise or risotto) (13% of adult intake and 16% of child intake).

Australians who ate the most cereal fibre were not only eating more cereal foods in general but were also choosing higher-fibre varieties, such as whole grain breads and breakfast cereals, porridge, whole wheat pasta and bran-based products.

Interestingly, those who ate the most cereal fibre also ate the most total dietary fibre and were more likely to meet the recommended daily target for dietary fibre (30g/day for men and 25g/day for women):

• Men with diets highest in cereal fibre were 4.4 times more likely to meet the recommended target for total dietary fibre.
• Women with diets highest in cereal fibre were 3.1 times more likely to meet the target for total fibre.

With that in mind, how much cereal fibre should you be eating, and how can you increase your intake? Within Australia, there is no guideline on how much cereal fibre to eat. However, the Australian Dietary Guidelines suggest adults should aim for four to six serves of grain foods each day and we should aim to choose whole grain, high-fibre options at least half of the time.

While different grains differ in the amount of fibre they provide, opting for whole grain cereal foods is a good way to increase your cereal fibre intake. Importantly, whole grain foods also contain other important nutrients such as magnesium and iron, as well as many B vitamins (thiamin, riboflavin, niacin and folate).

There are many ways to add whole grains in to your diet at every meal or snack. Here are just a few simple ideas to get you started:

• Use wholemeal or whole grain bread for your sandwich at lunch
• Go for plain popcorn or whole grain crackers as a high fibre snack
• Try porridge in the colder months or muesli in Summer as an easy breakfast option
• Give wholemeal pita breads a go for healthy homemade pizzas
• Substitute regular flour for oat flour when baking muffins or making pancakes
• Try wholemeal pasta or brown rice to boost the fibre content of your favourite family dinners

And remember, even small changes can have big benefits for your health. Just starting with one of these simple swaps to a higher fibre, whole grain option will help to boost your cereal fibre intake and contribute to a healthier you!

References

1 Yao, B. D., H. Fang, W. H. Xu, Y. J. Yan, H. L. Xu, Y. N. Liu, M. Mo, H. Zhang and Y. P. Zhao (2014). "Dietary fiber intake and risk of type 2 diabetes: a dose-response analysis of prospective studies." European Journal of Epidemiology 29(2): 79-88.

2 Wu, Y. H., Y. F. Qian, Y. W. Pan, P. W. Li, J. Yang, X. H. Ye and G. Xu (2015). "Association between dietary fiber intake and risk of coronary heart disease: A meta-analysis." Clinical Nutrition 34(4): 603-611.

3. Aune, D., D. S. Chan, R. Lau, R. Vieira, D. C. Greenwood, E. Kampman and T. Norat (2011). "Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies." BMJ 343: d6617.

4 Du, H., H. C. van der A Dl Fau - Boshuizen, N. G. Boshuizen Hc Fau - Forouhi, N. J. Forouhi Ng Fau - Wareham, J. Wareham Nj Fau - Halkjaer, A. Halkjaer J Fau - Tjonneland, K. Tjonneland A Fau - Overvad, M. U. Overvad K Fau - Jakobsen, H. Jakobsen Mu Fau - Boeing, B. Boeing H Fau - Buijsse, G. Buijsse B Fau - Masala, D. Masala G Fau - Palli, T. I. A. Palli D Fau - Sorensen, W. H. M. Sorensen Ti Fau - Saris, E. J. M. Saris Wh Fau - Feskens and E. J. Feskens "Dietary fiber and subsequent changes in body weight and waist circumference in European men and women." (1938-3207 (Electronic)).

5 Hajishafiee, M., P. Saneei, S. Benisi-Kohansal and A. Esmaillzadeh (2016). "Cereal fibre intake and risk of mortality from all causes, CVD, cancer and inflammatory diseases: a systematic review and meta-analysis of prospective cohort studies." Br J Nutr 116(2): 343-352.

6. Schulze, M. B., M. Schulz, C. Heidemann, A. Schienkiewitz, K. Hoffmann and H. Boeing (2007). "Fiber and magnesium intake and incidence of type 2 diabetes - A prospective study and meta-analysis." Archives of Internal Medicine 167(9): 956-965.

7. Koh-Banerjee, M. F., M. Franz, L. Sampson, S. Liu, D. R. Jacobs, Jr., D. Spiegelman, W. C. Willett and E. Rimm (2004). "Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men." Am J Clin Nutr 80(5): 1237-1245.

8. Barrett, E. M, Probst, Y. C & Beck, E. J (2017). “Creation of a database for the estimation of cereal fibre intake”. Submitted to Journal of Food Composition and Analysis.

Declaration of Lupin as an Allergen

A year on from their initial announcement, Food Standards Australia New Zealand (FSANZ) have reminded food businesses that from 26 May 2018, lupin must be declared as a potential allergen on food packaging.


This amendment to the Food Standards Code means that it is now mandatory for lupin to be declared when it is present as an ingredient, compound ingredient, additive or processing aid.


Lupin is a type of legume (like kidney beans or lentils), available in various formats, including flakes, flour and whole beans and used in a range of grain foods like bread, breakfast cereal or pasta. The decision to identify lupin as an allergen on food packaging will make it easier for people with a lupin allergy to identify and avoid foods containing lupin and enjoy those that are lupin free.

There has been a 12 month transition period allowed for the food industry to update product information and declarations. All products, new and existing, will be required to comply with this requirement. Read more about the change in labeling requirements here.

Increasing Legume Intake Among Australians

by Courtney Rose-Davis, APD, PhD Candidate

These days, we’re seeing more and more research suggesting that legumes possess significant health benefits, different to that of other food groups. Studies suggest that consuming legumes 4 times per week, compared to only once, reduces risk of coronary heart disease [1,2]. When legumes are added to our diet, levels of total and LDL cholesterol are lowered [3]. Legumes, including chickpeas, lentils, kidney, fava and black beans, amongst others, are a key feature of the Mediterranean diet, which is predominantly eaten by people living coastally in Southern Europe [4]. This balanced diet has been proven to lower our risk of heart disease and diabetes. Although just one part of this dietary pattern, legumes provide important nutrients including protein, fibre and other minerals, especially as the Mediterranean diet is low in meat. In terms of health benefits, one study showed that the Mediterranean diet would only be 90% as effective if legumes were excluded [5]. 

In Australia the story is very different, where adults eat very few legumes. Data from the most recent National Nutrition Survey suggests legume intake is only 20 g/week for males, and 16 g/week for females [6]. The health benefits of following a Mediterranean diet with legumes could be enormous; however this previously hadn’t been well studied. So we conducted a research trial where older Australians (aged >64 years) were asked to follow a Mediterranean diet for 6 months. Around 80 participants were asked to consume at least 3 servings of legumes per week, at a serving size of 75 g or half a cup (225 g/week). Three servings of legumes were provided to participants as canned legumes, to make this easier for them. The participants had their diets analysed before they commenced the study and median legume intake was 0 grams/week, meaning at least half the study participants were eating no legumes at all. The average intake however was 140g/week, which was quite high compared with national data, however still less than half the amount needed to provide health benefits.

Surprisingly, over the course of the study, legume intake increased to an average of 340g/week, with the median increasing from 0 to 231 g/week. Anecdotally, participants said they found legumes not only tasty, but versatile and useful when making filling lunches and salads. Recipes and instructions to incorporate legumes were provided, such as making legume patties and dips, adding legumes to soups, casseroles and salads and even replacing some meat with legumes.

It’s difficult to say with certainty which of these factors contributed to the legume increase, however, it appears that with some instruction and encouragement, older Australians could greatly increase their intake and enjoy legumes more often. The easy provision of legumes might have played a large role, although participants clearly went and bought their own on top of our provisions suggesting that participants genuinely enjoyed this part of their diet. It's most likely that several factors contributed, including providing them for free, provision of innovative recipes, additional suggestions on how to incorporate them in their daily diet, but most importantly - the enjoyment factor. Legume intake likely promoted the intake of other healthful dietary components too, like olive oil and vegetables, as these are often consumed together.

The potential health benefits of such a change are exciting! Legumes on their own have been associated with considerable health benefits, and even more so when being consumed as part of the Mediterranean diet. Our encouraging results suggest that given the right resources, such as recipe inspiration and handy tips, most people can become a legume fan. Here are our easy tips to help you enjoy legumes more frequently:

- If using canned legumes, make sure you rinse them well before using – this can help reduce the sodium content by up to 40%.

- If using dried legumes, soak and cook in large batches and freeze in individual portions for quick and easy additions to midweek meals.

- Use lentils or black beans as a substitute for mincemeat – mix into patties, meatballs, spaghetti bolognaise and taco mince.

- Add to salads for a filling protein and fibre hit.

- Add to soups and casseroles to bulk out.

- Mix in with pasta dishes - this works especially well with lentils and chickpeas.

- Make nachos with kidney beans or black beans.

- Add mixed legumes to tomato, onion and canned fish and drizzle with olive oil  and lemon juice for a delicious, Mediterranean salad.

 References

1.         Bazzano, L.A.; He, J.; Ogden, L.; Loria, C.M.; Vupputuri, S.; Myers, L.; Whelton, P.K. Legume consumption and risk of coronary heart disease in US men and women. Arch. Intern. Med. 2001, 161, 2573-2578. DOI:

2.         Afshin, A.; Micha, R.; Khatibzadeh, S.; Mozaffarian, D. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am. J. Clin. Nutr. 2014, 100, 278-288. DOI: 10.3945/ajcn.113.076901.

3.         Bazzano, L.; Thompson, A.; Tees, M.; Nguyen, C.; Winham, D. Non-soy legume consumption lowers choletserol levels: a meta-analysis of randomized controlled trials. Nutr. Metab. Cardiovasc. Dis. 2011, 21, 94-103. DOI: 10.1016/j.numecd.2009.08.012.

4.         Trichopoulou, A.; Lagiou, P. Healthy traditional Mediterranean diet: An expression of culture, history, and lifestyle. Nutr. Rev. 1997, 55, 383-389. DOI: none.

5.         Trichopoulou, A.; Bamia, C.; Trichopoulos, D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009, 338, 26-29. DOI: 10.1136/bmj.b2337.

6.         Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12 - Australia. Table 5.1 Mean daily food intake (grams). Statistics, A.B.o., Ed. Australian Bureau of Statistics: Canberra, ACT, Australia.

What’s trending in grains?

By Alexandra Locke

After a 30% drop in grains consumption in 2014 (1) and plenty of talk about the benefits of the paleo, diet, the dangers of gluten and the plus side to cutting carbs, we’re now seeing a shift in media perspective,  with a much  more positive outlook for grains overall! With the right conditions, it’s high time to start promoting the benefits of grains again and get consumers back on board.

But where do the opportunities lie? There are three key trends where we see grains leading the charge in innovation…

Digestive Wellness

More than ever before, consumers are paying attention to how a specific food can make them feel, so they’re consciously looking for the benefits that certain foods can provide. What’s more, they want to feel assured that they’re promoting their digestive health and overall wellness when making food choices – these consumers will pay a premium for products which taste good and offer functional digestive benefits.

And this is where grains, whole grains specifically, come in – whole grains exhibit an impressive nutritional profile, providing dietary fibre, protein and are a healthy source of carbohydrate , also contributing nutrients like magnesium, folate and iron to our diets. Fibre intake is directly related to our digestive health so the opportunities for whole grain innovation in this category are big!

Good Carbs, Bad Carbs

Over the past year or so we've increasingly seen consumers understanding that there are ‘good’ and ‘bad’ carbs, with an emphasis on the importance of choosing the most healthful carbohydrate format. Both the media and consumers are becoming more aware that carbohydrates are essential as part of a healthy balanced diet, focusing on crowding out refined and processed carbohydrates by increasing intake of whole grains, wholemeal bread and pseudo-grains, as well as eating more ‘alternative’ forms of carbohydrates, think sweet potato toasts and zucchini noodles.

With ‘healthier’ forms of traditionally carbohydrate heavy foods now on the rise, we’re seeing significant movement towards alternatives such as ancient grains, legumes flours and even substitution of flour with pureed veg! But again, with consumer awareness of whole grains on the rise, grains can still play a significant part in the healthful innovation of this category.

Snackification

And finally, the rise of snackification is promoting massive innovation. The Australian snacking market is now worth more than $2 billion and climbing fast (2) and Australians are now snacking four times as much as 10 years ago.

And it would appear that anything goes with this trend, any food can be engineered to be thought of as a snack, any time of day is open to snackification and there are no limits on product development - almost any ingredient that can be dried, pureed, shaped, extruded or frozen is open to innovation. Whilst grains traditionally dominated this category, we’re still seeing big opportunities for grain foods moving forward. More food than ever is being consumed on-the-go, especially at breakfast and manufacturers are innovating with grains to make healthy choices more convenient for today’s busy lifestyles.

Whilst these trends clearly present big opportunities for manufacturers and retailers, there are also significant opportunities for those at the very beginning of the supply chain – for the growers and the farmers.

These mega-trends have paved the way for several smaller trends within the grains space…

Ancient Grains 

Quinoa is now found on nearly every trendy café menu in some form or another with this group of grains being seen as untainted and intrinsically healthy. Perhaps their alternative title of pseudo-grains has helped with the allure, but this presents opportunities for diversification on farm and many young farmers are doing just that. And perhaps fonio is the next big ancient grain?

Back to Basics with Oats 

This humble grain has seen a huge resurgence in popularity in recent years and manufacturers have already taken advantage of this opportunity. Now’s the time for growers to reap the rewards of increased demand for this crop and add value in the form of exclusivity… think single origin oats, exotic flavours and on-the-go formats.

Provenance 

Consumers want to connect with their food more than ever, so now is the time for growers to tell their story. With social media at our fingertips and whole communities of consumers ready and waiting, the desire to understand where our food comes from is strong. And consumers are actively seeking out those products with a story behind them.

Now is the time to connect with consumers, tell them the story of how their product got from farm to store and enrich them with the knowledge of understanding where their food comes from. We can’t leave it just to the marketers and manufacturers to promote this category anymore – we all need to be involved with spreading the story and helping to bring back the belief in grains!

References

1. GLNC. 2017. Consumption & Attitudes Study. Unpublished.

2. Innova Market Insights Report. 2016

An Ingrained Truth: Pre-Exercise Fuelling & Post-Exercise Recovery Foods for Performance

By Toni L Franklin

Accredited Practising Dietitian, Dietitians Association of Australia, Provisional Sports Dietitian, Sport Dietitians Australia

The desire to seek out new or peculiar foods to add to our arsenal of table talk, or ‘foodstagram’ posts, is born out of natural human curiosity. But is there any grain of truth in the notion that we should be seeking out exclusive ancient grains to fuel our exercise training and performances?

Fuelling our bodies before exercise and restoring nutrition after exercise is a fundamental component of Sport Nutrition. Why?

Before exercise, the carbohydrate in food tops up our liver and muscle glycogen stores, especially if we are training first thing in the morning after an overnight fast. Eating before exercise also helps to avoid that niggling hungry feeling and help us get the most out of our training. Taking care to eat foods that don’t cause gastrointestinal upset should also be at the forefront of your food choices (1,2). After exercise, food helps you refuel in preparation for subsequent exercise sessions, promotes muscle repair and growth, boosts adaptation that occurs as a result of training and supports your immune function (3,4). The combination of appropriate nutritious foods and exercise works synergistically to help you achieve your goals.

Traditional and ancient grains battle it out on the playing field. Which is best?

Grains are a nutritious source of carbohydrate, fibre and micronutrients. A good comparison of the nutrient composition of different grains is found in the article “What’s all the fuss about trendy grains?” Grains also contain some protein, a fact that is commonly overlooked. Previous studies have investigated animal protein sources with a high amount of an amino acid called leucine and found around 20g stimulates muscle protein synthesis during recovery from exercise. However, we have recently seen an increasing interest in investigating plant sources of protein to support muscle protein synthesis, perhaps through fortification of leucine or by combining plant based proteins such as grains with complementary amino acid profiles (5).

So do both the hipster ancient grains and the traditional grandparent grains provide appropriate fuel for exercise? 

 The answer is yes. However, at this point, it’s important to reveal another essential principle of sports nutrition - using familiar foods with a known tolerance is always encouraged for key training sessions or competition. Most runners would not wear a brand new, untested pair of running shoes for a marathon race unless they are invincible to injury, blisters and indifferent about performance. If an ancient grain buckwheat, quinoa and chia acai bowl is what you normally eat and tolerate before exercise, go forth and conquer. But a good old-fashioned porridge or some whole grain toast with banana and honey is equally effective and possibly more tolerable on the gut if this is what you are used to eating. There is also something to be said about the nostalgic calming effect that familiar foods can have on settling rattled nerves before a big event. The crux of the matter is that a varied diet remains central to a healthy lifestyle. Both traditional and ancient grains should be friends not foes and there is no grain more ‘superior’ than another.

Key points for fuelling and recovery 

- Have your pre-exercise meal 3-4 hours before exercise if you struggle with gastrointestinal discomfort during exercise. This is more crucial for higher intensity weight bearing sports such as footy and running or sports where your stomach will be jostled about, such as gymnastics or boxing. If you are having a smaller snack this can be eaten 1 or 2 hours before the event.

- Good pre-exercise meals or snacks include: eggs and tomato on rye toast, a whole grain sandwich or wrap with some lean protein and salad, wholemeal raisin toast or oats with yoghurt and fruit.

- Try to have some post-exercise recovery nutrition with a combination of carbohydrates and protein as soon as possible after your event.

- Good recovery nutrition meals or snacks include: whole grain crackers and cheese or nut butter, wholemeal pasta and vegetable salad, tabbouleh, wholemeal spaghetti and meatballs, homemade muesli bar with oats or dried fruit and seeds.

And if you’re ever unsure about what’s best for YOU, contact an Accredited Sports Dietitian for your tailored nutrition plan to help you be your best.

Toni Franklin is a Dietitian with a background in clinical and sport nutrition. For more information about how you can use nutrition to improve your sport performance, please contact a member of Sport Dietitians Australia (SDA), Australia’s peak professional body and credible source of sport nutrition information. Visit www.sportsdietitians.com.au for more information.


References

1. SDA Sports Dietitians Australia. Factsheets: Eating & Drinking before exercise. Retrieved from: https://www.sportsdietitians.com.au/factsheets/fuelling-recovery/eating-drinking-sport/

2. Australian Sports Commission (2009). Eating before exercise. Retrieved from: http://www.ausport.gov.au/ais/sports_nutrition/fact_sheets/eating_before_exercise

3. SDA Sports Dietitians Australia. Factsheets: Recovery Nutrition. Retrieved from: https://www.sportsdietitians.com.au/factsheets/fuelling-recovery/recovery-nutrition/

4. Australian Sports Commission (2009). Recovery nutrition. Retrieved from: http://www.ausport.gov.au/ais/sports_nutrition/fact_sheets/recovery_nutrition

5. Witard, O.C., Wardle, S.L., Macnaughton, L.S., Hodgson, A.B., Tipton, K.D. (2016). Protein considerations for optimising skeletal muscle mass in healthy young and older adults. Nutrients, 23;8(181) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848650/

Carbohydrates & Fertility: An Update On the Latest Research

By Melanie McGrice, AdvAPD

One in six Australian couples struggle to conceive [i] and the psychological, physical and emotional impacts of infertility can be overwhelming.  As one woman struggling with fertility recently wrote on her Instagram feed “I am angry.  Angry at my friends and family who managed to have children easily, angry at the doctor who told me that I had nothing to worry about, and mostly, angry at myself for all of the croissants that I’ve eaten over the years.” 

Pre-conception weight is one of the major risk factors for fertility outcomes and it is well accepted that weight loss improves fertility in overweight and obese women [ii]. In fact, research suggests that women who have a body mass index (BMI) greater than 30kg/m2 often have natural menstrual cycle disruptions at a rate of almost three times higher than women of a healthy weight [ii]. 

Although research shows that low carbohydrate diets are no better for long term weight loss than other energy restricted diets (and in fact, may be worse as they are often more difficult to ensure nutritional integrity, and are often more difficult to maintain), low carbohydrate diets are a popular choice for rapid weight loss [iii].  Considering the urgent weight loss requirements for many women (particularly in their late 30’s and early 40’s) wanting to conceive, we wanted to investigate the impact of low carbohydrate diets for conception.

Overall, the research shows that lower carbohydrate diets have a positive effect on reproductive hormones, ovulation rates and pregnancy rates than standard diets in women who are overweight or obese. However, before adopting a low carbohydrate diet there’s a few important factors to keep in mind….

1.      Firstly, the research does not yet confirm how low in carbohydrates the diet should be.  Our research was based on diets which were less than 45% carbohydrates so that we could include Very Low Energy Diet studies (also known as intensive phase meal replacements where all meals are replaced with meal replacements).  However, although lower than usual, 45% carbohydrates is not ketogenic for most people.

2    There’s one small prospective study which used meal replacements (which didn’t meet the criteria for inclusion into our systematic review), that actually reduced the number of eggs available for fertilisation [iv]!  This provides a warning that low carbohydrate diets are not suitable for everyone wanting to optimise their fertility.  One possible alternative may be a low carbohydrate diet for short term weight loss, followed by a period of slight weight regain.  This practice, known as “flushing” is often used to improve the fertility of farm animals [v]. A pattern of a period of weight loss, followed by a period of weight regain has also been found to demonstrate a positive impact on reproduction in women [v].  

      Consequently, I believe that a low carbohydrate diet should only be utilised for a short period of time to optimise menstrual cyclicity and fertility hormones, followed by a period of renourishment.

3.      Furthermore, optimal nutrition is essential in the lead up to pregnancy. Wholegrains are some of the best sources of key fertility nutrients such as iodine and folate.  Women following a low carbohydrate diet without meeting all their nutritional requirements could do more harm than good, so it’s essential to seek expert advice from an Accredited Practising Dietitian when considering a change in diet at any life stage. 

      The takeouts here are that low carbohydrate diets are clearly not suitable for everyone looking to lose weight in order to increase their fertility. However, a low carbohydrate diet may be a suitable option for some women who would benefit from losing weight prior to conception. As such it's important to always seek expert advice from a qualified nutrition professional, before embarking on any dietary changes.

To see the review or for further information, go to www.melaniemcgrice.com.au/research

References

[i] http://www.health.gov.au/internet/publications/publishing.nsf/Content/womens-health-policy-toc~womens-health-policy-experiences~womens-health-policy-experiences-reproductive~womens-health-policy-experiences-reproductive-maternal~womens-health-policy-experiences-reproductive-maternal-fert

[ii] Sim, K.A.; Partridge, S.R.; Sainsbury, A. Does weight loss in overweight or obese women improve fertility treatment outcomes? A systematic review. Obes. Rev. 2014, 15, 839–850.

[iii] http://ajcn.nutrition.org/content/90/1/23.short

[iv] Tsagareli, V.; Noakes, M.; Norman, R.J. Effect of a very-low-calorie diet on in vitro fertilization outcomes. Fertil. Steril. 2006, 86, 227–229.

[v] Butler, S.T. Nutritional management to optimize fertility of dairy cows in pasture-based systems. Animal 2014, 8, 15–26.