Our Nutritionist and Dietician Rosie answers a selection of your recent questions below. If you have any other questions you can email firstname.lastname@example.org and we'll get them answered at the next Q&A with Rosie.
Q1 I think I have a mild intolerance to food (possibly dairy). I suffer from eczema and bad skin sometimes. What is the best way to find out what could be causing it? I find it hard to be very systematic about removing one food group alone in order to check for sure.
The best way to find out if an allergy is causing a skin problem is to speak with your GP and if necessary discuss being referred to a registered dietitian or allergy clinic. The NHS state that skin problems such as eczema can be triggered by a range of things other than food such as: genetics, the environment, irritants and hormonal changes.
Allergy UK say the Gold Standard, and only way, to ascertain which foods cause adverse reactions, is by accurately recording the times and duration of all symptoms, illness or stress, as well as everything you eat and drink. This record, should be continued for 2-3 weeks and should represent your normal diet. Ideally, it should be analysed by a registered dietitian, as they will be able to advise you on alternative foods so that you still are able to follow a healthy well balanced diet. More information and support can be found via Allergy UK here.
Q2 Out of the dairy free milk alternatives, which are the better ones to have?
In the UK, we are lucky to have a wide choice of dairy free milk alternatives. The most common are: almond, rice, coconut, hazelnut, hemp, oat, soy and quinoa. There is not really a clear winner from a health perspective so advice is to experiment, enjoy a variety and think which would work best for what you’re using it for e.g. poured over cereal, in a cup of tea or during baking.
Importantly, it’s best to choose a dairy milk alternative that has been fortified with calcium and vitamin D to keep bones strong. These will tend to have about 120mg calcium and 75µg vitamin D per 100ml which is about 15% of the recommended daily allowance (RDA). Look out for this highlighted on the front of the packet. Since organic products are unable to be fortified (unless instructed to by law), shop-bought organic, or homemade versions will not contain anywhere near as much (or any) calcium or vitamin D.
Sweetened vs unsweetened
If possible, choose unsweetened options as sweetened milk alternatives will contain added sugar or juice. For example sweetened soy milk can contain ~3g sugars per 100 ml compared to unsweetened which can contain ~0.1g per 100ml.
Protein: Interestingly, milk alternatives can contain far less protein compared to cow’s milk. Cow’s milk contains >3g protein per 100ml whilst milk alternatives can contain as little as <0.1ml per 100ml. An example of this is hemp milk which is typically known to be a good source of plant-based protein, but contains almost nil protein per 100ml when made into a milk! Soy contains about~3g protein per 100ml, almond contains ~ 0.5g per 100ml and oat milk contains ~
Beta-glucans: With the recommendation that 3g of beta glucans are consumed daily for cholesterol reduction, several oat-based milks are suitably rich in this special fibre to contribute towards the recommended amount. Simply having porridge made with water for breakfast and a glass of oat milk later in the day would add up to 3 g of beta glucans!
Omega 3: Note that although hemp milk does contain omega 3, this is plant-based omega 3. Evidence suggests this will not provide the same health benefits related to omega 3 from oily fish.
A good all-rounder
Though there are many great milk alternatives to choose from, a popular, neutral tasting ‘all-rounder’ would be this one by Oatly containing: 1g protein/100ml, beneficial beta-glucans, no added sugar and being fortified with calcium (15% RDA) and vitamin D (30% RDA). Note this milk contains low levels gluten, but there are other brands producing oat milk made from uncontaminated oats which are suitable for coaliacs.
Q3 What is the best sugar alternative as everyone says different things? I don’t use agave as have read bad things about that but I do use honey quite a lot.
The key, as with so many things, is moderation. There's strong evidence to suggest we need to decrease our added sugar consumption, and this includes sugars such as honey, maple syrup, date syrup, coconut sugar and agave. It’s important to remember all these sugars contain a range of sugar molecules and it’s not helpful to look at just one health outcome. Some people may say “X is lower in glucose so won’t raise my blood sugar”, but what about the other sugar molecules it contains (e.g. fructose) which may have other effects on the body? We therefore need to think of the food as a whole and at the end of the day, sugar is sugar!
Though some sugar alternatives do contain more nutrients than refined table sugar, since we should be keeping all sugars to a minimum anyway, these levels of nutrients are insignificant sources for humans and arguably therefore not really a reason to choose one over the other.
The best option? The World Health Organisation advises to keep added sugars to a minimum overall (< 12 tsp, or even better <6 tsp per day). When you do use them, choose the one which will best complement what you’re cooking. If using table sugar means your cookies will be crunchy rather than soggy, use it! But also remember you can satisfy a sweet tooth using wholefoods. Grilling pineapples and peaches caramelises the sugars for a rich, delicious sweetness, or baked apples with a sprinkling of cinnamon are fantastic too.
Q4 Is there a big difference between omega-3 in oily fish compared with other foods like walnuts, chia or flaxseeds?
Chia seeds, flax seeds and walnuts are all incredibly nutritious for many reasons. They contains protein, fibre and a range of vitamins and minerals. They are however often advertised with claims promoting their high omega 3- fatty acid content.
Omega-3 fats are called essential because our body can’t make them. We need to get them from food to maintain good health. Though oily fish is well known for containing omega-3s, they do turn up in some plant foods. In fact, chia seeds biggest claim is that they are the most concentrated source of omega-3!
However, plant-sourced omega-3 is different to fish oil omega-3. Oily fish contains the omega-3 fatty acids called DHA and EPA. Both of these are easily used by our body to support heart heath, cell activity and brain, eye or skin structure. Current guidelines therefore state to eat two portions of fish per week, one of which should be oily.
Plant sources of omega-3 are a bit different. They are abundant in another omega-3 fatty acid called ALA. The problem is ALA is it’s of no real use to us directly. Although it can be converted into DHA and EPA by our body, this is a slow and inefficient process. So although chia seeds, walnuts or flax seeds may ‘contain more omega-3 than salmon’, it’s does not contain the important DHA or EPA.
If you are vegetarian or vegan, the British Dietetic Association recommends maximizing the conversion of ALA to DHA and EPA in the following ways:
- Replace saturated fats with unsaturated fats
- Limit vegetable oils high in linoleic acid (omega-6 fatty acid) such as safflower, sunflower and corn oil.
- Focus on plant foods that do contain ALA
- If you don’t eat fish, consider a supplement made from algae derived from DHA, eat sea vegetables and foods fortified with DHA.
It’s also important to remember that although the omega-3 content may not be so useful for our body, chia seeds, walnuts and flaxseeds are ‘whole foods’. This means they contain a range of beneficial nutrients, so are still extremely healthy foods to include in a varied diet.
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