Understanding Lactose A lactose-free diet is becoming an increasingly common eating pattern for many, with lactose-free and plant-based alternatives to regular dairy products gaining popularity and becoming more readily available. This raises the question: should everyone be restricting or completely eliminating lactose from their diets? The internet is brimming with questions surrounding if, when and by whom lactose should be avoided. There is also confusion as to whether lactose is only present in dairy products? And, furthermore, how to find out if someone is lactose intolerant? Many people who are not able to digest lactose have no symptoms at all, whilst others experience very uncomfortable symptoms. It is therefore helpful to know how to recognise a lactose intolerance and how to manage it.  What is lactose? Lactose is a natural, large sugar molecule made up of glucose and galactose, that is mainly found in milk from mammals. Lactose represents approximately 6% of the carbohydrates consumed in Western diets and, although we often only associate lactose with dairy products, this sugar is also commonly used in a wide range of products, including: baked goods, breakfast cereals, drinks and even processed meat.  Lactose in whey has become the focus of attention more recently, as studies have shown that it serves not only as a source of energy, but also as a key player in facilitating the absorption of calcium, phosphate, manganese and magnesium. In addition, when undergoing fermentation in the gut, lactose contributes to the development of healthy gut bacteria, which are important for immune health. Sometimes lactose is falsely blamed for gut complaints – so it is important to note that by eliminating lactose-containing products  from the diet without having to, we could miss out on the health-promoting components that lactose provides. This is also why those that are lactose intolerant should try to avoid completely eliminating lactose-containing products but to simply reduce lactose consumption, or opt for equally nutritious alternatives. Lactose intolerance explained Lactase is the enzyme that plays a fundamental role during lactose digestion, which takes place in the small intestine. More specifically, this enzyme is responsible for splitting lactose into glucose and galactose, allowing its absorption by the intestinal cells. Around 70% of the population worldwide has lactase deficiency . Without the lactase enzyme, the undigested lactose becomes subject to bacterial fermentation, which leads to lactose malabsorption.  There are three types of lactose intolerance: congenital, primary, and secondary lactose intolerance. Congenital lactose intolerance is very rare, with symptoms that can appear shortly after birth and may last throughout the entire lifespan. In this case, it is crucial to recognise the intolerance early in infancy, to avoid the risk of dehydration and subsequent life-threatening consequences. Primary lactose intolerance occurs more frequently and is caused by a decrease in the lactase enzyme after the age of 2. Lastly, secondary lactose intolerance is linked to reduced lactase activity due to diseases such as infections, food allergy, celiac disease, Crohn’s disease, or radiation/chemotherapy-induced enteritis. In this case, the symptoms may disappear only once the primary disease is treated. Depending on the origin of the condition, doctors may suggest different kinds of treatments. As mentioned, not everyone suffers from gut complaints due to the malabsorption of lactose.  However, if after ingesting it in high quantities you are experiencing symptoms such as abdominal pain, bloating, flatulence, diarrhea and headaches, there is a higher chance that could be caused by lactose intolerance. There is no standard timeframe for lactose digestion; it may take 12 hours, 24 hours, or even 72 hours to fully eliminate the lactose-containing food. However, studies indicate that the symptoms could peak 5-10 hours after the consumption of lactose. In order to confirm the diagnosis of lactose intolerance, clinical tests such as the hydrogen breath test, a genetic test or a small intestinal biopsy can be performed. Among the three, the least invasive and most cost-effective procedure is the hydrogen breath test, which is generally used to detect gastrointestinal disorders. The hydrogen breath test detects traces of hydrogen on the breath following milk consumption, which is indicative of lactose malabsorption in the gut – and therefore lactose intolerance. Lactose intolerance vs cow’s milk allergy Lactose intolerance can often be confused with cow’s milk allergy, which may then lead to unnecessary dietary restrictions. Therefore, it is important to know what the major differences between a lactose intolerance and a cow’s milk allergy are. As discussed, lactose intolerance results from a reduced ability to digest lactose, which is a sugar. On the other hand, cow’s milk allergy is caused by an immune-mediated reaction to the proteins contained in milk. While lactose intolerance causes milder symptoms, cow’s milk allergy can affect the respiratory system and cause more aggressive reactions (e.g. signs of anaphylaxis), even after cow’s milk proteins are consumed in microscopic amounts. Whereas for lactose intolerance it may only be required simply to reduce lactose intake, for a cow’s milk allergy it is necessary to strictly eliminate cow’s milk from the diet altogether.  Managing lactose intolerance There is no specific treatment for lactose intolerance, as it depends largely on the origin of the condition. The main principle is to either reduce lactose consumption or increase lactase enzymes available to digest it.  If you suffer from lactose intolerance, the following tips can help: Consume no more than 10-15g of lactose per meal (this is equal to 240ml cow’s milk). In case of non-congenital lactase deficiency, most people can tolerate this amount throughout the day Consume lactose-containing foods together with other food, as this will help to dilute the lactose content.  Only consume lactose-containing products at every other meal, as this gives the gut more time to process the lactose in the meantime.  Consume more lactose-free dairy products or plant-based alternatives. Some lactose-free milk and cheeses are produced by adding lactase enzyme to milk, which predigests the lactose. Generally, these products are widely tolerated but they do tend to have a sweeter taste compared to regular dairy products.  Increase the presence of lactase in the small intestine. By doing that, symptoms significantly reduce because of proper breakdown of lactose. This can be achieved with the consumption of lactase in the form of tablets or drops. Moreover, this can really allow a non-restricted diet, which is also a benefit to take into consideration. In addition to that, lactase drops can even be added to breast milk to ensure that infants obtain all necessary nutrients.  For patients with congenital lactose intolerance, the safest option is typically adherence to a completely lactose-free diet. When on a strict lactose-free diet, a person must carefully check all food labels not only on dairy products but also on non-dairy foods such as bread or processed meat. It is also important to ensure a balanced diet with no nutritional deficiencies. Impact of a lactose-free diet Overall, a lactose intolerance is not harmful for most, but it can be a cause of discomfort in the long term if not managed. Lactase supplements can really help to provide freedom with foods, but these are more often seen as an occasional option rather than a long term solution. It is generally up to the individual how to best balance food choices and quality of life. For both congenital and non-congenital lactose intolerant individuals, opting for a diet in which lactose-based products are limited or, in extreme cases, completely eliminated is the main approach to management.  For anyone living with lactose intolerance who is looking for healthy and tasty lactose-free recipe inspiration, Swapmeals provides a great resource for delicious and nutritious meals!  Disclaimer This information does not serve as dietary advice and is not a replacement for medical guidance. It is always recommended to consult a dietitian when you suffer from congenital and non-congenital lactose intolerance. References  Di Costanzo, M., & Berni Canani, R. (2018). Lactose Intolerance: Common Misunderstandings.  (4), 30-37.  https://doi.org/10.1159/000493669 Facioni, M. S., Raspini, B., Pivari, F., Dogliotti, E., & Cena, H. (2020). Nutritional management of lactose intolerance: the importance of diet and food labeling.  (1), 260.  https://doi.org/10.1186/s12967-020-02429-2 Lomer, M. C. E., Parkes, G. C., & Sanderson, J. D. (2008). Review article: lactose intolerance in clinical practice – myths and realities.  (2), 93-103.  https://doi.org/10.1111/j.1365-2036.2007.03557.x Parker, A. M., & Watson, R. R. (2017). Chapter 16 – Lactose Intolerance. In R. R. Watson, R. J. Collier, & V. R. Preedy (Eds.),  (pp. 205-211): Academic Press. https://doi.org/10.1016/B978-0-12-809762-5.00016-4 Rana, S. V., & Malik, A. (2014). Hydrogen breath tests in gastrointestinal diseases.  (4), 398-405. https://doi.org/10.1007/s12291-014-0426-4 Swagerty Jr, D. L., Walling, A., & Klein, R. M. (2002). Lactose intolerance.  (9), 1845. Xiao, Y., Chen, Q., Guang, C., Zhang, W., & Mu, W. (2019). An overview on biological production of functional lactose derivatives.  (9), 3683-3691.  https://doi.org/10.1007/s00253-019-09755-6

Intermittent fasting explained Wouldn't it be perfect if a diet is not focused on food products and calories, but that it is more about when to eat something? Intermittent fasting is a way of eating that focuses more on the time frame when something is eaten instead of what is eaten. In this diet, periods of eating alternate with periods of fasting (this means no food or less than 25% of the energy requirement). Naturally, people already do this during their sleep. With intermittent fasting, the fasting period is extended. The three most popular ways to do this are: Fasting a couple of days per week (1-3 days), for 24 hours and eating normally the other days. Fasting every other day. Fasting takes place every other day for 24 hours. Fasting for a fixed number of hours per day. This is the most common variant and involves several consecutive hours of fasting per day. The hours can vary from a 16 to 20 hours fasting window with a 4 to 8 hour eating period. In daily life, this can, for example, be achieved by eating from noon until 8:00 pm, outside of which is the fasting period. This is also called time restricted fasting, where the time between noon and 8:00 pm is called the eating window.   During the fasting period, it is possible to consume low-energy drinks such as water, coffee, and tea without added sugar or milk. What are the claims surrounding intermittent fasting? A quick search on the internet shows many different statements about intermittent fasting. Probably the most popular one is that it causes weight loss. In addition, intermittent fasting is said to improve insulin sensitivity, and increase the production of human growth hormone (HGH)]. There are also claims that intermittent fasting reduces the risk of type 2 diabetes, cancer, and Alzheimer’s disease. Moreover, it is beneficial to heart health because of a reduction in LDL cholesterol.  So does the science behind intermittent fasting actually support these claims? The vast majority of studies have examined the impact of intermittent fasting on weight loss and the short term results appear to be similar to an energy restricted diet. There is some evidence that more muscle mass is lost using intermittent fasting. Several studies also show a beneficial health effect, whereby intermittent fasting may reduce total- and LDL cholesterol, triglycerides, and blood pressure which can reduce the risk of cardiovascular diseases. In addition, beneficial effects are seen on fasting blood glucose levels, HbA1c, and insulin, all of which play a role in diabetes. That all may sound very nice, but there are some comments to be made. The beneficial effects of intermittent fasting are comparable to those of normal weight loss. This may mean that the effect is not necessarily related to intermittent fasting per se, but to the result of weight loss because of a lower energy intake. Moreover, high-quality studies are lacking in some respects.  Apart from health effects, several studies show that intermittent fasting can reduce appetite. This can further contribute to reducing calorie intake, and thereby weight loss. Who should try intermittent fasting? Intermittent fasting is not for everyone, but it can be a good tool for weight loss. However, because it is more an eating habit than a diet, it is important to know how to still consume enough nutrients. There are also some limitations – for example, it can be difficult to apply intermittent fasting in social life. Moreover, it is less suitable for people who are underweight or have a past with eating disorders, as well as those with diabetes (type 1 or 2). In case of intensive sports, research is inconclusive. However, it is more likely that intermittent fasting has a neutral or negative effect on performance rather than a positive effect. Conclusion Intermittent fasting is a tool that can be used for weight loss. The health effects that result from this are most likely due to weight loss. By using intermittent fasting you lose as much weight as with a normal calorie restricted diet. It is important to make sure that you still get enough nutrients when applying intermittent fasting. Please refer to your dietitian if you want to try it out. Within Noory, it is currently possible to indicate the number of meals you want to eat per day. This can be set to three, these meals can be eaten within an eight-hour eating window for time restricted fasting. Using Noory like this will provide you with a sufficient amount of energy, and is therefore not suitable to lose weight. If that is something you prefer, it is advised to also select the energy restricted diet option, to ensure a calorie restriction. References Cleveland Clinic. (2019). Intermittent Fasting: 4 Different Types Explained . Consulted on 25 May 2021, from: ttps:// health.clevelandclinic.org/intermittent-fasting-4-different-types-explained/   Healthline. (2019). 10 Evidence-Based Health Benefits of Intermittent Fasting. Consulted on 25 May 2021, from: https://www.healthline.com/nutrition/10-health-benefits-of-intermittent-fasting   Diet doctor. (n.d.). Intermittent fasting for beginners. Consulted on 25 May 2021, from:  https://www.dietdoctor.com/intermittent-fasting   Harris, L., Hamilton, S., Azevedo, L. B., Olajide, J., De Brún, C., Waller, G., … & Ells, L. (2018). Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Evidence Synthesis , 16 (2), 507-547. Roman, Y. M., Dominguez, M. C., Easow, T. M., Pasupuleti, V., White, C. M., & Hernandez, A. V. (2019). Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials. International Journal of Obesity , 43 (10), 2017-2027. Meng, H., Zhu, L., Kord-Varkaneh, H., Santos, H. O., Tinsley, G. M., & Fu, P. (2020). Effects of intermittent fasting and energy-restricted diets on lipid profile: a systematic review and meta-analysis. Nutrition , 77 , 110801. Santos, H. O., & Macedo, R. C. (2018). Impact of intermittent fasting on the lipid profile: assessment associated with diet and weight loss. Clinical nutrition ESPEN , 24 , 14-21. Dong, T. A., Sandesara, P. B., Dhindsa, D. S., Mehta, A., Arneson, L. C., Dollar, A. L., … & Sperling, L. S. (2020). Intermittent fasting: a heart healthy dietary pattern?. The American journal of medicine , 133 (8), 901-907. Cho, Y., Hong, N., Kim, K. W., Lee, M., Lee, Y. H., Lee, Y. H., … & Lee, B. W. (2019). The effectiveness of intermittent fasting to reduce body mass index and glucose metabolism: a systematic review and meta-analysis. Journal of clinical medicine , 8 (10), 1645. Nowosad, K., & Sujka, M. (2021). Effect of Various Types of Intermittent Fasting (IF) on Weight Loss and Improvement of Diabetic Parameters in Human. Current Nutrition Reports , 1-9. Barnosky, A. R., Hoddy, K. K., Unterman, T. G., & Varady, K. A. (2014). Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research , 164 (4), 302-311. Varady, K. A. (2014). Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research , 164 (4), 302-311. Ravussin, E., Beyl, R. A., Poggiogalle, E., Hsia, D. S., & Peterson, C. M. (2019). Early time‐restricted feeding reduces appetite and increases fat oxidation but does not affect energy expenditure in humans. Obesity , 27 (8), 1244-1254. Gaeini, Z., Mirmiran, P., & Bahadoran, Z. (2021). Effects of Ramadan intermittent fasting on leptin and adiponectin: a systematic review and meta-analysis. Hormones , 1-10. Correia, J. M., Santos, I., Pezarat-Correia, P., Minderico, C., & Mendonca, G. V. (2020). Effects of intermittent fasting on specific exercise performance outcomes: A systematic review including meta-analysis. Nutrients , 12 (5). Levy, E., & Chu, T. (2019). Intermittent fasting and its effects on athletic performance: a review. Current sports medicine reports , 18 (7), 266-269.

Reducing salt intake: use a pinch of creativity Salt is a mineral that is essential to our bodies for many different functions – including the absorption and excretion of fluids, nervous system function and muscle contraction. However, too much salt intake can lead to negative health outcomes – including hypertension and a higher risk of cardiovascular and kidney diseases. Therefore it is important to stay within the recommendations. Salt intake recommendations Healthy adults are advised to consume a maximum of 6 grams of salt (2.4 grams of sodium) per day. There are also a number of groups who should be extra careful with salt intake due to being at higher risk of issues. This includes people with high blood pressure, individuals with excessive weight or obesity, and the older population.  It can be difficult to determine exactly how much salt you consume on a daily basis. Our salt intake does not only come from the pinch of salt we may add to a dish, but also from processed foods such as ready-made soups, sauces, and meals. Food producers often add a lot of salt to these products, so eating these foods often can really contribute to excess intake. In addition, baked goods, dairy products and deli foods also often contain salt. Take a simple sandwich for example, if you were to have two slices of bread, with a slice of pre-cut cheese, a slice of cold cut meat and some hummus spread, you would be consuming around 2 grams of salt in one sandwich. This is already one third of your daily requirement and shows just how easily our salt intake can accumulate throughout the day. Tips to reduce salt Whilst a completely salt-free diet is not necessary nor advised, you can reduce your overall intake by making some small adjustments in daily food choices. Here are some great tips that you can already do to lower your salt intake and improve your health: Reduce your intake of cold cuts  Do you eat deli meats regularly? Make a smarter choice by opting for cooked meat instead of smoked meat, because smoked cold cuts contain more salt. Swap your pre-cut cheese by slicing your own, having smaller slices or choose for a dairy spread instead. You could also swap cold cuts for a boiled egg with garden herbs every now and then. Reduce your intake of ready-made and processed products If you have the time and desire, make your own sauces and dishes instead of buying pre-made – this way you can control how much salt is added. Pasta sauce from a jar, for example, can contain up to 2.5 grams of salt per portion. A homemade, fresh pasta sauce with fresh herbs and spices and without added table salt will contain much less salt. Similarly, most ready-made meals contain more salt than is typically added in a homemade dish, so simply by preparing your own meals you will be able to reduce your overall salt intake. Check out our overview at the bottom of this article to get inspired. Pay attention to the food labels when you are doing your grocery shopping The amount of salt can vary between different food brands within one product category. Compare the amount of salt to help make the best choice. Sometimes a food label does not note the amount of salt. In that case you can base your decision on the amount of sodium that might be noted instead. Top tip: 1 gram of salt is equal to 0.4 grams of sodium. Add more herbs and spices to enhance flavour Adding extra flavour by means of herbs and spices reduces the need for additional salt. You can get creative and try new flavours – or even grow your own herbs to further inspire you. Combine different kinds of herbs and spices and discover along the way what you like best.  Try potassium salt  If you really miss the taste of salt and the alternatives in this article are not sufficient for you to reduce your salt intake, then potassium salt might be an option for you. Potassium salt contains less sodium and can be used as a replacement for table salt. However, potassium salt is not suitable for everyone. People that use ACE inhibitors, diuretics and/or have kidney problems have to be cautious. They are at risk to create too high potassium levels in their blood. Do you have doubts about using potassium salt? Please consult a dietitian or a doctor. Give yourself some time to get used to the flavour of low salt dishes. If you have been eating salty meals for a long time, your taste buds are used to that. That is why it might take a bit of time to get to appreciate a meal without or with lower salt.  References: De Nederlandse Hartstichting. (z.d.). Zout eten . Hartstichting. Retrieved on October 4, 2021, from https://www.hartstichting.nl/gezond-leven/gezond-eten/zout-eten?gclid=CjwKCAjwzOqKBhAWEiwArQGwaD6sHxyS-eYEDsSrIfyMaNOFHsj60en7S72–C4Ds2EEf-KeFfgOHxoCN-UQAvD_BwE RIVM. (2016). Inname natrium. Voedselconsumptiepeiling. Retrieved on October 4, 2021, from https://www.wateetnederland.nl/resultaten/vitamines-en-mineralen/inname/natrium Voedingscentrum. (z.d.). Zout en natrium . Retrieved on October 4, 2021, from https://www.voedingscentrum.nl/encyclopedie/zout-en-natrium.aspx De Nederlandse Hartstichting. (2020). Zoutwijzer . Hartstichting. Retrieved on October 4, 2021, from https://www.hartstichting.nl/getmedia/4a1e5c3c-43bf-46b9-9e31-1330275d8543/pv154_zoutwijzer_2020.pdf

Eating healthy on a budget Eating a varied and healthy diet every day can cost a lot of money, right? Whether you are cooking just for yourself, your partner or a family – before you know it, your budget is spent. Due to rising inflation, the prices of groceries have gone through the roof. In particular, healthy products seem to get less affordable by the day. When the expenses keep rising while the spending limit stays mostly the same, it isn’t surprising that people feel limited in choosing healthy products in the supermarket. Especially when a lot of unhealthy products seem more affordable. A hamburger is simply often cheaper than a quinoa burger, for example.  It can seem really out of reach to be able to cook a healthy meal every day, but we can assure you that it is achievable. Based on three pillars – buying, cooking and preserving – Swapmeals guides you through the possibilities to live a healthy life whilst staying within budget. Buying Preparing healthy meals starts with buying healthy products. While doing the groceries, here are some tips to save money: Buy fruits and vegetables which are in season. These are mostly more affordable for the consumer, because when in season they are more readily available and can be sourced more locally. Respecting seasonality isn’t just beneficial for your budget, it also contributes to sustainability and often means you are getting more nutrient-rich produce. Think beyond the supermarket. Making a visit to the local market can turn out to be surprisingly beneficial. Especially at the end of the day, when unsold products are often offered with a discount. By buying these, some food waste is also prevented; win-win! Fill your pantry. Keep an eye out for special offers and fill up the kitchen cabinets with long lasting products like rice, pasta and nuts for a better price. Also, let the freezer function as a pantry. Deep-frozen fruits and vegetables are often more affordable than fresh ones. Another plus: they get frozen right after harvesting, which means they are packed full of nutrition – affordable ánd healthy. Cooking After buying the groceries, preparing the meal is the next step. With these smart cooking tips, money can be saved: Be aware of how much needs to be prepared. It sometimes can be difficult to estimate how much there is needed from certain products. Spinach shrinks as soon as it is heated, while pasta and rice increase in size. For that reason, one could make a wrong estimation. The result would be an unintended meal surplus. Food waste can be prevented easily by taking into account the number of table companions and the portion sizes. There are several tools and tricks for that, so not everything has to be weighed precisely on a kitchen scale. There are for example rice and pasta measuring cups, which – by the use of stripes – indicate how much is needed per person. Spaghetti measuring tools help with choosing the right portion by the use of indicating circles, which get bigger per person. Also, check the product packaging. When a dish for two people is going to be prepared and the package says the product contains four portions, simply use half of the product.  Replace meat products with other protein sources. Meat products are often expensive so by replacing meat more often, your meals can become more budget friendly. Ready-made meat replacements are often equally – if not more – expensive than meat products, so choosing these isn’t going to provide a solution. However, legumes and eggs cán provide a cost effective and nutrient rich solution. Legumes include beans and lentils and are not only cheaper sources of protein, but they also  contain more fibres than meat products and are more beneficial for the environment. Similarly, eggs are full of vitamins, minerals and of course protein.  Preserving In line with buying products and preparing meals, money can also be saved with smart preservation:  Well begun is half done. In case of preservation, it is convenient to have freezer bags and containers that can be used as airtight, food safe storage. Bag clips are also handy to secure bread bags or pasta packages ensuring they are airtight.  Reuse leftovers. Prepared too much? Be sure to avoid food waste and freeze the leftover portions. Or be a little creative and create a new meal with your leftovers the next day. Enjoy your leftover pasta for lunch or serve it with a soup or salad to create a new dinner dish.  Buy family packages and divide them into multiple smaller packages. Buying in bulk is often cheaper than buying smaller packages. A bulk package of meat or vegetables can be divided into smaller portions and stored in the freezer for later use. Larger portions of bread can also be frozen in smaller portions – perfect for toasting straight from the freezer. Just be sure to always check before freezing any product, that it is indeed freezable.  Check and understand expiry dates. In the UK, there are two types of expiration dates: the ‘use-by’ date and the ‘best before’ date. Both have a different meaning and it’s important to be aware of that. ‘Use-by’ is related to food safety. Products with a use-by expiration date can only be used until that specified date, and must be discarded thereafter because these products can be extremely taintable. The ‘Best before’ date is related to food quality. Products with a best before (BBE) date can be safe to eat after the expiration date, but the quality might not be optimal. In this case, you can use sensory cues – look, smell and taste – to examine if a product is edible. Being aware of the difference between the two expiration dates can reduce food waste and also unnecessary spending. Healthy and varied eating doesn’t have to be expensive. With a little bit of creativity, a lot of money can be saved when buying, cooking and preserving food. References 1. UK Inflation Rate . (2022). Inflation Rate and Consumer Price Index. Retrieved April 1, 2022, from https://www.rateinflation.com/inflation-rate/uk-inflation-rate/ 2. Smith, J. (2022, 3 maart). UK consumer spending set to fall amid cost of living crunch . ING Think. April 1, 2022, from https://think.ing.com/articles/uk-consumer-spending-set-to-fall-amid-cost-of-living-crunch 3. Voedingscentrum. (z.d. -a). Wat zijn de seizoensgroenten? En welk seizoensfruit is er? Retrieved February 4, 2022, https://www.voedingscentrum.nl/nl/service/vraag-en-antwoord/gezonde-voeding-en-voedingsstoffen/wat-zijn-de-seizoensgroenten-in-de-verschillende-jaargetijden-en-welk-seizoensfruit-is-er.aspx 4. Li, L., Pegg, R. B., Eitenmiller, R. R., Chun, J. Y., & Kerrihard, A. L. (2017). Selected nutrient analyses of fresh, fresh-stored, and frozen fruits and vegetables. Journal of Food Composition and Analysis , 59 , 8–17. https://doi.org/10.1016/j.jfca.2017.02.002 5. Lentils, raw Nutrition Facts & Calories . (z.d.). Nutrition Data. Retrieved February 4, 2022, from https://nutritiondata.self.com/facts/legumes-and-legume-products/4337/2 6. Sabaté, J., & Soret, S. (2014). Sustainability of plant-based diets: back to the future. The American Journal of Clinical Nutrition , 100 (suppl_1), 476S-482S. https://doi.org/10.3945/ajcn.113.071522 7. Egg, duck, whole, fresh, raw Nutrition Facts & Calories . (z.d.). Nutrition Data. Retrieved February 4, 2022, from https://nutritiondata.self.com/facts/dairy-and-egg-products/126/2 8. Best before and use-by dates . (2021, 19 maart). Food Standards Agency. Retrieved April 1, 2022, from https://www.food.gov.uk/safety-hygiene/best-before-and-use-by-dates

The Power of Protein: how protein can help with weight management Protein is a crucial part of our diet, but did you know that this key nutrient also plays an important role in weight management? It not only helps to preserve lean muscle and give you better energy but also keeps you feeling fuller for longer. Protein also supports your metabolic health in a variety of ways. In this article, we’ll explore how protein works in your body and how it can help you reach and maintain your weight goals.  The functions of Protein When you eat protein, your body breaks it down into molecules called amino acids, which are often referred to as ‘the building blocks of life’. These amino acids are then used by your body to perform various functions, including: Tissue repair Protein is essential for building and repairing muscle, bones, skin and hair tissues. The toned physique you can acquire after exercising regularly over a longer period is a result of this tissue repair function. Immune support Protein is what antibodies are made out of. Antibodies help your immune system fight illnesses and infections, keeping you healthy and strong.  Enzyme and hormone production All enzymes are made out of amino acids. Enzymes are essential for various chemical reactions in the body, especially for your metabolism. A lot of hormones are also made out of amino acids, including insulin, leptin, and ghrelin. These hormones regulate the feeling of being hungry and full. This is why eating protein is important in helping you not to overeat, which ultimately will help manage your weight.  Sources of Protein: Fueling Your Body with Nutrient-Rich Foods A balanced diet is key to a healthy lifestyle. Most foods contain some amount of protein, which comes from two different sources: animal and plant-based protein.   Animal protein comes from animal sources and is easiest for our bodies to digest. It can be found in meat, fish, eggs, and dairy. This type of protein is a complete protein, meaning it contains all the essential amino acids our body needs. Plant protein comes from plant sources and is harder for our bodies to digest than animal protein.  Plant protein can be found in legumes, nuts, seeds and certain grains. This type of protein is incomplete, meaning it may lack one or more essential amino acids. However, by eating a variety of plant-based proteins, you can still get all of the amino acids your body needs. Plant proteins are also packed with fibre, vitamins, and minerals, which are beneficial for overall health. What sources of protein to incorporate is up to you and depends on personal preferences, dietary needs, and health goals. In the two tables below, you can find some examples of protein sources. Table 1: Examples of animal protein sources Food product Portion size Amount of protein Turkey breast 1 piece (120g) 31 g Chicken breast 1 piece (100g) 30,9 g Cod 1 piece (120g) 25,8 g Tuna (canned in water) 100g 24,9 g Salmon 1 piece (120g) 24,2 g Lean ground beef 1 portion (100g) 20 g Shrimp 1 portion (100g) 15 g Low-fat quark 1 bowl (150g) 12,8 g Cheese 1 pre-cut slice (30g) 9,6 g Low-fat yoghurt 1 bowl (150g) 6,3 g Chicken egg 1 egg (50g) 6,2 g Semi-skimmed milk 1 glass (150g) 5,1 g Table 2: Examples of plant protein sources Food product Portion size Amount of protein Tofu 1 slice (75g) 8,7 g Edamame beans 1 serving spoon (60g) 7,2 g Lentils 1 serving spoon (60g) 5,3 g Peanut butter (100% peanuts) For one slice of bread (20g) 5,3 g Kidney beans 1 serving spoon (60g) 5,0 g Chickpeas 1 serving spoon (60g) 4,6 g Whole grain bread 1 slice (35g) 3,9 g Whole grain pasta 1 serving spoon (60g) 3,4 g Oatmeal 1 serving (20g) 2,6 g Broccoli 1 serving spoon (50g) 2 g Protein and Long-term Weight Management Including enough protein into your diet can help you to maintain your weight goals long term. By eating your recommended amount of protein, you preserve lean muscle mass, which helps you maintain your metabolism and prevent weight (re)gain over time.  How much protein should you eat? On average, adults need around 0.75 grams of protein per kilogram of body weight. So as a general estimate, if you weigh 70kg your daily protein requirement is around 52.5g (70 x 0.75). However, other factors such as age, gender, activity levels and dietary needs can also influence your protein requirements – so always consult with a healthcare professional if you are unsure.  Protein can help you reach your weight goals in several ways:  It makes you feel satiated more than carbohydrates or fats, helping you feel full longer which can help with reducing your overall calorie intake A higher protein intake can also help reduce cravings and late-night snacking by stabilising blood sugar levels.  Digesting protein requires more energy compared to fats and carbohydrates which can lead to an increased basal metabolic rate (BMR). Your BMR is the amount of calories you burn in ‘rest’ – performing the most basic tasks needed to keep you alive, like breathing.  Importantly, during weight loss or management, maintaining muscle mass is crucial as it needs more energy than fat. How to reach your protein needs So now you know where to find great sources of protein, but how can you incorporate more protein into your diet? Here are some practical tips to help you: Start your day with protein: Some great breakfast proteins include eggs, low-fat (natural) yoghurt or quark with some nuts and seeds, or whole-grain toast topped  with lean meats (such as chicken or turkey breast) or cottage cheese as a vegetarian option.    Choose protein-rich snacks: opt for snacks like a handful of nuts, whole-grain crackers with reduced-fat cheese, or edamame beans   Replace refined grains with whole grains to increase protein. Additionally, whole grains have a higher amount of fibre which, like protein, also contributes to satiety.   Incorporate protein in every meal: aim to have a source of protein such as lean meat, fish, legumes, or dairy with each meal. A balanced meal consists of a healthy amount of protein, carbohydrates and fats.    Incorporating a variety of protein-rich foods into your meals and snacks can help you reach your weight management goals while enjoying delicious and satisfying meals!  Protein and Exercise Protein plays a critical role in enhancing muscle recovery and building muscles after exercise. When you work out, your muscles get tiny tears, and protein helps repair and rebuild them, making them stronger. Eating protein after exercising gives your body the amino acids needed to do this. Getting enough protein also helps you to improve your endurance, making your workouts more effective. Here are some practical tips to improve your fitness outcomes to effectively manage your weight: Pre-workout Protein: Consume a small protein-rich snack 30-60 minutes before exercising to fuel your body during your workout. Mind that the snack isn’t too rich in fats, this can make your stomach upset during the workout. Good snacks to prepare you for a workout could be a bowl of low-fat quark with some fruit, a slice of whole-grain bread accompanied by a boiled egg, or a banana topped with peanut butter.    Post-workout Protein: Have a protein-rich meal or snack within 30 minutes to 2 hours after exercising for optimal recovery. Check out some of our recipe suggestions below, and more on Swapmeals.   Hydration: drink plenty of water, as hydration is crucial for muscle function and recovery, and protein metabolism. Aim to drink at least 1-2 litres of water each day.   Consistency: try to spread out your protein intake throughout the day rather than consuming a large amount in one meal.  Are you looking for some recipe inspiration to increase your protein intake? Sign up with Noory and enjoy a wide variety of recipes suited to your needs!  References: Gezondheidsraad. (2015).  Richtlijnen Goede Voeding 2015 (Nr. 2015/24). Accessed 09-04-24 https://www.gezondheidsraad.nl/documenten/adviezen/2015/11/04/richtlijnen-goede-voeding-2015 Gezondheidsraad. (2021). Voedingsnormen voor eiwitten – referentiewaarden voor de innname van eiwitten (Nr.2021/10). Accessed 17-05-2024 https://www.gezondheidsraad.nl/documenten/adviezen/2021/03/02/voedingsnormen-voor-eiwitten Korek, E., Krauss, H., Gibas-Dorna, M., Kupsz, J., Piatek, M., & Piatek, J. (2013). Fasting and postprandial levels of ghrelin, leptin and insulin in lean, obese and anorexic subjects. Przeglad gastroenterologiczny, 8(6), 383-389. https://doi.org/10.5114/pg.2013.39922   Leidy, H.J., Clifton, P., Astrup, A., Wycherley, T. P., Westerterp-Plantenga, M. S., Luscombe-Marsh, N. D., Woods, S. C., & Mattes, R. D. (2015). The Role of Protein in Weight Loss and Maintenance. The American Journal Of Clinical Nutrition, 101(6), 1320-1329. https://doi.org/10,3945/ajcn.114.084038 Voedingscentrum. (n.d.). Eiwitten. Accessed 15-04-24 https://www.voedingscentrum.nl/nl/service/vraag-en-antwoord/gezonde-voeding-en-voedingsstoffen/hoeveel-eiwit-zit-erin/magere-yoghurt.aspx

Navigating Nutrition: Your Guide to Eating Well During Cancer Treatment When faced with a cancer diagnosis, the journey ahead can be challenging, and maintaining a healthy diet often takes a back seat. However, what you eat during this time can play a significant role in managing treatment side effects, preventing weight loss, and supporting your overall well-being. In this article/post, we’ll explore the vital aspects of nutrition throughout your cancer treatment, providing you with valuable insights and practical tips to help you make informed choices on the path to recovery.  The Importance of Good Nutrition During Cancer Treatment Good nutrition during cancer treatment serves multiple purposes, such as reducing the risk of infection, preventing weight loss, alleviating treatment side effects, promoting a quicker recovery, and enhancing your overall well-being. In general, a healthy diet should contain:  Proteins : Incorporate protein-rich foods, such as eggs, legumes, lean meat, and nuts into your diet. A protein-rich diet is often recommended for cancer patients. Fats : Choose healthy fats, particularly monounsaturated and polyunsaturated fats which can be found in foods such as olive oil, avocado, nuts, and seafood. Carbohydrates: Source your carbohydrates from fruits, vegetables, potatoes, and whole-grain bread. Vitamins and Minerals : A balanced diet usually provides the vitamins and minerals you need. However, if cancer treatments make it challenging to eat a variety of foods, talk to your healthcare provider about potential supplements. Antioxidants : Fruits and vegetables are rich in antioxidants, which can promote your health. Hydration: Stay adequately hydrated with water, as it’s essential to your overall well-being. Note that during cancer treatment, it’s advisable to limit alcohol consumption, as it can interfere with your medications. Remember that the path to better nutrition during cancer treatment is unique for every patient. Individual dietary needs will vary, so be open to exploring what works best for you. Managing side effects Cancer treatments often come with a range of side effects that can pose challenges to maintaining a healthy diet. These side effects can vary depending on the specific treatment you receive, making it important to adapt your approach to nutrition accordingly. Take surgery, for example, which is a common cancer treatment. Following surgery, your body requires additional nutrients to support recovery and bolster your immune system. Additionally, various treatments may lead to a set of shared side effects, including: Loss or Change of Taste: You might find that your sense of taste has shifted. In this case, consider avoiding red meat, using plastic utensils instead of metal ones, and enhancing flavours with a variety of spices. Loss of Smell : With a decreased sense of smell, it’s essential to focus on other aspects of food, such as texture and appearance, to make your meals more appealing. Loss of Appetite: When your appetite declines, concentrate on consuming high-protein, high-calorie foods. You can replace regular meals with nutritious milkshakes, eat your most substantial meal when you feel your best during the day, and try light exercises to stimulate your appetite. Dry Mouth: To ease dry mouth, choose soft, moist foods and drink plenty of water. Nausea and Vomiting: When dealing with nausea and vomiting, opt for smaller portions of soft, easy-to-digest meals. Consider replacing meals with nourishing soups or shakes, and eat foods that are at room temperature. Constipation and Diarrhoea: Managing bowel irregularities may require alterations to your diet. Consult with your healthcare team to find suitable dietary solutions. Inability to Absorb Nutrients : This can be a challenge. Focus on eating high-protein, high-calorie soft foods, and consider meal replacements like milkshakes if necessary. Physical Inability to Eat: Physical limitations might require you to consume smaller meals more frequently. Food Safety Finally, it’s crucial to prioritise food safety during your cancer treatment. Your immune system is weakened during this time, making you more susceptible to infections.  Follow these guidelines to keep your food safe: Wash your hands thoroughly before cooking. Rinse fruits and vegetables meticulously. Prevent cross-contamination by keeping raw and cooked foods separate. Avoid foods that are typically consumed raw. Store foods appropriately in the fridge or freezer. Defrost meals in the refrigerator or microwave, and ensure they are thoroughly heated before consumption. By focusing on your nutrition during cancer treatment and working closely with your healthcare team, you can improve your overall well-being and help your body navigate this challenging journey with resilience. References American Cancer Society. (n.d.). Benefits of Good Nutrition During Cancer Treatment . Accessed 05-07-23 https://www.cancer.org/cancer/survivorship/coping/nutrition/benefits.html American Cancer Society. (n.d.). Eating Well During Treatment. Accessed 05-07-23 https://www.cancer.org/cancer/survivorship/coping/nutrition/once-treatment-starts.html American Cancer Society. (n.d.). Food Safety During Cancer Treatment. Accessed 05-07-23 https://www.cancer.org/cancer/survivorship/coping/nutrition/weak-immune-system.html   City of Hope. (n.d.). Nutrition for cancer patients: How to fuel your body for the fight. Accessed 05-07-23 https://www.cancercenter.com/community/blog/2021/02/nutrition-for-cancer-patients National Cancer Institute. (2022, December 9). Nutrition in Cancer Care . Accessed 04-07-23 https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq#:~:text=Eat%20foods%20that%20are%20high,desserts%2C%20and%20fried%20foods )

Understanding food allergies and intolerances We all know someone with a food allergy or intolerance, but what is the precise distinction between the two? Food allergies and intolerances may seem similar, but they have different causes and trigger different responses in the body. A food allergy is caused by the immune system and can lead to a severe reaction to the allergenic food. Food intolerance results in a much less severe reaction, as the immune system is not involved. Nevertheless, food intolerances can also be very unpleasant. Food allergies During an allergic reaction to food, antibodies (proteins that can bind to foreign substances in the body) bind to proteins in the food that cause an allergy (allergens). These antibodies then bind to certain immune cells. This activates the immune cell to release histamine, which causes the symptoms of food allergy. The only solution to prevent symptoms is to avoid the foods that you are allergic to. Common symptoms of a food allergy include: Dizziness Prickling sensation in the mouth  Problems swallowing Red and itchy skin Swollen face, mouth or elsewhere Vomiting Anaphylaxis The immune system response to the food allergen is usually quick, but can also start up to two hours after eating. The most severe response is anaphylaxis, in which someone experiences a decrease in blood pressure and constricted air flow caused by histamine. Someone in anaphylactic shock needs treatment with epinephrine immediately to open up the airways and increase the heart rate.  Food allergies can be diagnosed by either a skin-prick test or a blood test. For a skin-prick test, the allergen is pricked into the skin. If someone is allergic, a reaction will appear on the skin. In the blood test, the amount of antibody against food allergens is measured in the blood. If someone is allergic to a certain food, the amount of antibodies against that food is higher. In a food challenge, the food will be given by a medical professional, to determine if any symptoms appear.  The likelihood of outgrowing a food allergy varies between foods. Children are most likely to grow out of egg, milk and wheat allergies, but are less likely to outgrow peanut and soy allergies, and very few outgrow fish, tree nut, molluscs or shellfish allergies. Common food allergens include: Celery  Eggs Fish Gluten containing wheat Lupine Milk Molluscs  Mustard Peanuts Sesame Shellfish Soy Sulphite Tree nuts These foods are legally required to be mentioned on the labels of food products, so allergens can be avoided.  Food intolerances Unlike food allergies, food intolerances are not caused by an immune system reaction. If you have a food intolerance, your body cannot properly digest a food, or part of a food. This is mainly caused by non-functional enzymes, but can also be caused by active ingredients in food – such as histamine.  Common symptoms of a food intolerance include: Bloating  Diarrhoea Stomach ache Rashes Headache Although food intolerances do not cause severe symptoms like anaphylaxis, they can certainly result in discomfort, therefore foods causing intolerances should be avoided. As food intolerances do not involve the immune system, the response is not as rapid. Symptoms can appear immediately after eating, but can also take up to 24 hours to present.  Food intolerances are usually diagnosed by excluding the food from the diet for a few weeks, and determining if your symptoms improve. This can be done by an exclusion diet, such as the FODMAP diet, where many foods are excluded from the diet, and later gradually re-introduced. By tracking the symptoms, the foods causing an intolerance can be identified. Lactose intolerance can be diagnosed by a breath test, which measures hydrogen produced by bacteria in the gastrointestinal system. Unlike food allergies, food intolerances are usually lifelong and cannot be outgrown.  Foods and food components that commonly cause a food intolerance include:  Alcohol Certain fruits Eggs Food or flavour additives Lactose Salicylate Sulphite Wine (histamine) Conclusion In general, food allergies are caused by the immune system, with rapid reactions after eating. It is sometimes possible to outgrow an allergy. In contrast, food intolerances are mainly caused by non-functional enzymes. The reactions often develop more slowly and lead to discomfort. It is virtually impossible to outgrow a food intolerance. Both allergy and intolerance symptoms can only be avoided by avoiding the foods that cause them. References Bda. (n.d.). Food Allergy and Food Intolerance Testing. British Dietetic Association (BDA). Accessed 16-05-23 https://www.bda.uk.com/resource/food-allergy-intolerance-testing.html#:~:text=Blood%20tests,can%20organise%20this%20blood%20test . Diagnosing Food Allergy. (2022, September 14). NIH: National Institute of Allergy and Infectious Diseases. Accessed 16-05-23. https://www.niaid.nih.gov/diseases-conditions/diagnosing-food-allergy#:~:text=The%20most%20frequently%20used%20food,prick%20after%20about%2015%20minutes . Gargano, D., Appanna, R., Santonicola, A., De Bartolomeis, F., Stellato, C., Cianferoni, A., … & Iovino, P. (2021). Food allergy and intolerance: A narrative review on nutritional concerns. Nutrients, 13(5), 1638. https://doi.org/10.3390/nu13051638 Lomer, M. C. (2015). The aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Alimentary pharmacology & therapeutics , 41 (3), 262-275. https://doi-org.ezproxy.library.wur.nl/10.1111/apt.13041 Lopez, C. M. (2023, January 31). Food Allergies. StatPearls – NCBI Bookshelf. Accessed 15-05-23 https://www.ncbi.nlm.nih.gov/books/NBK482187/#:~:text=Food%20allergy%20is%20defined%20as,aspects%20of%20a%20person’s%20life NHS (2022, November 28). Food intolerance. nhs.uk. Accessed 15-05-23 https://www.nhs.uk/conditions/food-intolerance/#:~:text=A%20food%20intolerance%20is%20when,can%20make%20you%20feel%20unwell NHS. (n.d.). Food allergies. Accessed 15-05-23 https://www.nhsinform.scot/illnesses-and-conditions/nutritional/food-allergy#symptoms-of-a-food-allergy Ortolani, C., & Pastorello, E. A. (2006). Food allergies and food intolerances. Best Practice & Research Clinical Gastroenterology , 20 (3), 467-483. https://doi.org/10.1016/j.bpg.2005.11.010 Prv, C. (2023, April 28). Allergenen. NVWA. Accessed 15-05-23 https://www.nvwa.nl/onderwerpen/allergenen#:~:text=De%2014%20allergenen%20waar%20u,%2C%20sesamzaad%2C%20sulfiet%20en%20lupine Savage, J., Sicherer, S., & Wood, R. (2016). The natural history of food allergy. The Journal of Allergy and Clinical Immunology: In Practice, 4(2), 196-203. https://doi.org/10.1016/j.jaip.2015.11.024

Vegetarian diets explained Vegan, flexitarian, lacto-vegetarian, all very popular terms nowadays. But what actually are the options if you want to consume a plant-based diet? And more importantly, what are the points of attention when following such a diet? In this blog post we explain the ins and outs of a vegetarian diet.  What does a vegetarian diet look like and what are the points of attention? People that follow a vegetarian diet don’t consume meat. Besides that, there are no strict rules and it can differ per person what a vegetarian diet looks like. A person can choose to consume eggs and dairy, but no fish. This is called a lacto-ovo-vegetarian diet. Others might choose to consume both eggs and dairy products as well as fish. This is called a pescetarian diet.  Since vegetarians choose not to consume meat, it is of high importance to replace the essential nutrients that are naturally present in meat. These are protein, iron, and vitamin B1 and B12.  What is protein and what are important food sources? Proteins are, like carbohydrates and fats, essential nutrients for the human body. Proteins are built of amino acids. Amino acids are important building blocks for our body. They are needed for the construction and maintenance of all of our body cells, including our muscles. Proteins can be either animal- or plant-based, and they are particularly abundant in meat, fish, egg, dairy, bread, grain products, legumes and nuts. For vegetarians, a big part of their protein intake comes from plant-based sources. The amino acids in plant-based proteins are less optimal for the human body compared to animal-based proteins, and are sometimes harder to digest. A higher protein intake will solve this problem. An adult needs on average 0.83 grams protein per kilogram of bodyweight. However, a vegetarian has a protein requirement which is 1.2 times higher.   Table 1: Vegetarian protein sources Food product Portion size Amount of protein Low-fat quark 1 bowl (150g) 12,8 g Cheese 1 pre-cut slice (30g) 9,6 g Low-fat yogurt 1 bowl (150g) 6,3 g Chicken egg 1 egg (50g) 6,2 g Unsalted nuts 1 handful (25g) 5,4 g Lentils 1 serving spoon (60g) 5,3 g Semi-skimmed milk 1 glass (150ml) 5,1 g Kidney beans 1 serving spoon (60g) 5 g Chickpeas 1 serving spoon (60g) 4,6 g Whole grain bread 1 slice (35g) 3,9 g Whole grain pasta 1 serving spoon (60g) 3,4 g Oatmeal 1 serving (20g) 2,6 g Broccoli 1 serving spoon (50g) 2 g What is iron and what are important food sources? Iron is an important mineral for the formation of hemoglobin, which is an essential element of red blood cells. Red blood cells transport oxygen through the body. Iron can be present in our diet in two forms: heme iron and non-heme iron. Heme iron is only found in animal products, whereas non-heme iron is found in both animal and plant products. The absorption of heme iron in our body is more efficient than the absorption of non-heme iron.  The absorption of non-heme iron can be improved by including products rich in vitamin C – like fruits and vegetables – in the meal. Well-known plant-based sources of iron include bread, whole grain products, legumes, nuts and leafy green vegetables. The recommended daily intake of iron is 11 mg per day for women over the age of 50, and for men. The recommended daily intake for women aged between 16 and 50 years is 16 mg per day. Table 2: Vegetarian iron sources Food product Portion size Amount of iron Unsalted nuts 1 handful (25g) 1,7 mg Lentils 1 serving spoon (60g) 1,7 mg Chicken egg 1 eeg (50g) 1,2 mg Spinach 1 serving spoon (50g) 1,2 mg Kidney beans 1 serving spoon (60g) 1,2 mg Chickpeas 1 serving spoon (60g) 1,1 mg Whole grain pasta 1 serving spoon (60g) 1,0 mg Oatmeal 1 serving (20g) 0,8 mg Whole grain bread 1 slice (35g) 0,7 mg Kale 1 serving spoon (50g) 0,5 mg Potatoes 1 serving spoon (100g) 0,5 mg What is vitamin B1 and what are important food sources? Vitamin B1 (thiamine) plays an important role in the provision of energy of the body since it helps cells to change carbohydrates into energy. Besides, vitamin B1 is important for proper functioning of the heart muscle, nervous system and the brain. Vitamin B1 is particularly present in meat products, milk and milk products, bread, grain products, potatoes and vegetables. Adult men require between 0.9 and 1.2 mg vitamin B1 per day. Adult women are advised to have a daily intake between 0.7 and 0.8 mg vitamin B1.  Table 3: Vegetarian sources of vitamin B1 Food product Portion size Amount vit. B1 Potatoes 1 serving spoon (100g) 0,06 mg Semi-skimmed milk 1 glass (150ml) 0,06 mg Low-fat yoghurt 1 bowl (150g) 0,05 mg Whole grain pasta 1 serving spoon (60g) 0,05 mg Whole grain bread 1 slice (35g) 0,04 mg Vegetables, general 1 serving spoon (50g) 0,03 mg How does a vegetarian meet the requirements for the intake of vitamin B12? The human body needs vitamin B12 (cobalamin) for the formation of red blood cells and a proper functioning of the nervous system. Vitamin B12 is only found in animal products. Vegetarians are therefore dependent on the consumption of eggs, cheese and milk products for their intake of vitamin B12. Men and women aged above 14 years have a recommended daily intake for vitamin B12 of 2.8 mcg per day.  Table 4: Vegetarian sources of vitamin B12 Food product Portion size Amount vit. B12 Low-fat quark 1 bowl (150g) 1,1 mg Chicken egg 1 egg (50g) 0,8 mg Cheese 1 pre-cut slice (30g) 0,7 mg Semi-skimmed milk 1 glass (150ml) 0,7 mg Low-fat yogurt 1 bowl (150g) 0,6 mg Conclusion Eating (more) plant-based is not the same for everyone. Different types of vegetarian diets exist in which the points of attention regarding nutrients differ as well. By choosing the right food products, eating (more) plant-based can be implemented in a responsible way without possible deficiencies.  References Postma-Smeets, A., & Van Dooren, C. (2018, November). Vegetarisch en veganistisch eten. Consulted on 31 March from Voedingscentrum: https://www.voedingscentrum.nl/Assets/Uploads/voedingscentrum/Documents/Ontwerp_Vegetarisch%20en%20veganistisch%20eten_defLR_2018.pdf Voedingscentrum. (nd). Vegetarisch, veganistisch en flexitarisch eten . Consulted on 31 March from Voedingscentrum: https://www.voedingscentrum.nl/encyclopedie/vegetarisme-veganisme.aspx Voedingscentrum. (nd). Eiwitten . Consulted on 31 March from Voedingscentrum: https://www.voedingscentrum.nl/encyclopedie/eiwitten.aspx Gezondheidsraad. (2021). Voedingsnormen voor eiwitten. Den Haag: Gezondheidsraad. Rijksinstituut voor Volksgezondheid en Milieu. (2019). Nederlands Voedingsstoffenbestand (NEVO) . Consulted on 31 March from Nevo-online: https://nevo-online.rivm.nl/ Rijksinstituut voor Volksgezondheid. (2020). Portie-online . Consulted on 31 March from Portie-online: https://portie-online.rivm.nl/ Gezondheidsraad. (2018). Voedingsnormen voor vitamines en mineralen voor volwassenen . Consulted on 31 March from Gezondheidsraad: https://www.gezondheidsraad.nl/documenten/adviezen/2018/09/18/gezondheidsraad-herziet-voedingsnormen-voor-volwassenen Voedingscentrum. (nd). Thiamine (vitamine B1) . Consulted on 31 March from Voedingscentrum: https://www.voedingscentrum.nl/encyclopedie/vitamine-b1.aspx#blok1 Voedingscentrum. (nd). Vitamine B12 (cobalamine) . Consulted on 31 March from Voedingscentrum: https://www.voedingscentrum.nl/encyclopedie/vitamine-b12.aspx

Understanding Gluten Between all of the sensational headlines, food fads and plethora of gluten-free products that have emerged in recent years, gluten has had a tough ride when it comes to how it is perceived by the general population. It has come under scrutiny for being the sole cause of many health issues. With so much information to wade through, it can be difficult to understand what role gluten actually plays in our diets. Do we indeed need to avoid it in order to be healthier? The simple answer is, no. Gluten is not inherently unhealthy, and the majority of people do not need to cut out gluten in order to enjoy good health. However, there is a spectrum of gluten-related conditions in which gluten can have problematic consequences, and avoidance of gluten may be beneficial. What is gluten? Gluten refers to a family of proteins that are naturally present in different grains, including: wheat, rye and barley. Gluten acts like a binding agent and provides structure and elasticity. It is what gives dough its elasticity and ensures that it can rise well and form that perfect loaf of bread, or delicious crust on a pizza. For most people, gluten is not something to be feared or avoided. In fact, gluten provides nutritious benefits. Gluten is a source of protein and is often found in food products that are rich in fibre. Sufficient intake of protein and fibre are needed for the body to maintain good health. Besides, gluten can also act as a prebiotic, helping the good bacteria in the gut to grow.    Whereas gluten is a healthy addition to the diet for most, there is a spectrum of gluten-related conditions, in which gluten can lead to or worsen gut symptoms. These include coeliac disease, Non-Coeliac Gluten Sensitivity (NCGS), wheat allergy, gluten ataxia, dermatitis herpetiformis, and Irritable Bowel Syndrome (IBS). You may have heard the terms gluten allergy or gluten intolerance being used to describe conditions in which someone cannot tolerate gluten. However, gluten-related disorders is a more accepted umbrella term for describing these conditions.  Coeliac Disease explained Coeliac disease is neither an allergy, nor an intolerance; it is actually an autoimmune disorder. This means that the body’s immune system mistakenly identifies gluten as a foreign invader and attacks its own healthy cells in response. This reaction leads to inflammation and damage in the small intestine, which over time results in malabsorption of nutrients.    An important fact to note is that coeliac disease is a chronic condition that affects only around 1% of the global population and is managed by a lifelong strictly gluten-free diet.    It is not possible to know whether or not you have coeliac disease unless it has been medically diagnosed. It can be easy to misdiagnose yourself based on symptoms alone, as there are many overlapping symptoms between different conditions. Most common symptoms include diarrhoea, abdominal pain, bloating, fatigue and unintended weight loss. But other symptoms like headaches, eczema or anaemia may be experienced as well. It is important to note that many of  these symptoms could also be due to a number of different causes, including irritable bowel syndrome (IBS), age-related changes, and even stress. So it is important that the root cause of symptoms is determined with the guidance of a qualified health practitioner. Firstly, a blood test can help to determine if your blood contains antibodies against your own intestinal cells, indicating the possibility of coeliac disease. A blood test is not conclusive, so a biopsy of your small intestine is needed in order to confirm a diagnosis of coeliac disease. If you have a family history of coeliac disease, the risk of developing this condition is increased. If coeliac disease and wheat allergy have been excluded as a possible cause for the symptoms, it could be that you suffer from other gut related issues. Non-Coeliac Gluten Sensitivity (NCGS) explained Coeliac disease is possibly the most well known gluten-related condition, but gut symptoms could be caused by any of the other conditions as well (NCGS, wheat allergy, gluten ataxia, dermatitis herpetiformis, IBS). Of all the conditions, it is NCGS that shares the most similarity with coeliac disease in terms of its presentation.    NCGS is a syndrome for which the exact cause is not yet fully understood, but which is characterised by gut and other physiological symptoms as a direct result of gluten consumption. In contrast to coeliac disease, in NCGS there is no physical damage caused to the intestinal lining, and it is not yet clear whether it is even necessary to follow a strictly gluten-free lifelong diet. But those who suffer from NCGS can experience improvement of symptoms when gluten is removed from the diet. Gluten in foods For those diagnosed with coeliac disease, it is crucial to follow a strictly gluten-free diet permanently. This means that any product containing gluten (even in trace amounts) should be excluded from the diet. It is also important to avoid any cross-contamination by ensuring that gluten-free products do not come in contact with gluten.   Gluten is often present in different grain products such as bread, pasta, couscous, crackers and pastries. It is also often found in flour, bread-crumbs and binding agents. Products such as soups, sauces, processed meat products and meat alternatives may also contain gluten. To avoid missing out on all of the other nutrients in these foods, it is helpful to replace them with gluten-free alternatives. Nowadays there is an abundance of gluten-free products readily available, which makes life a lot easier for those with coeliac disease or NCGS.   Luckily it is not all bad news when it comes to grains. Some grain products are naturally gluten-free and can be enjoyed safely. These include millet, quinoa and buckwheat. Oats are more of a grey area, as although they are technically free from gluten they are typically grown and processed through methods that cause cross-contamination with gluten. Most brands of oats will not be gluten-free unless it is clearly specified, so be sure to always check the packaging.   Most importantly, a gluten-free diet can still consist of a wide variety of fresh fruits and vegetables, rice, legumes, tofu, tempeh, eggs, as well as unprocessed meat, fish, dairy and nuts. For processed and canned foods it is always important to check the label to ensure safety. The impact of a gluten-free diet It is important to emphasise that for those people who do not fall under the spectrum on gluten-related conditions, it is not beneficial to follow a gluten-free diet. In fact, it could potentially be harmful, since it can lead to nutritional deficiencies if the diet is not implemented correctly. Products that contain gluten often also contain whole grains, fibre and beneficial micronutrients. These nutrients are important to maintain health and can reduce the risk of developing diseases such as heart disease or diabetes. Therefore, it is only recommended to follow a gluten-free diet when it is medically indicated.   A gluten free diet has a noticeable and immediate beneficial impact on those who suffer from coeliac disease. Gut symptoms such as abdominal pain, diarrhoea, and bloating improve significantly within the first couple of weeks of transitioning to a gluten free diet. Moreover, the small intestine can fully restore again over time when there is no consumption of gluten. This takes between three months to two years.  All in all, gluten in itself is not a harmful or unhealthy nutrient. For most people gluten remains a perfectly healthy addition to the diet as gluten, and the products containing gluten, have several beneficial nutritional aspects. They are a source of protein, are often rich in fibre and contain other important nutrients that are part of a healthy diet. Disclaimer This information does not serve as dietary advice and is not a replacement for medical guidance. It is always recommended to consult a dietitian if you suffer from coeliac disease or NCGS. References  NHS. (2019b). Food intolerance . Retrieved May 11, 2022, from https://www.nhs.uk/conditions/food-intolerance/ NHS. (2019a). Coeliac disease . Retrieved May 11, 2022, from https://www.nhs.uk/conditions/coeliac-disease/ Dutch Nutrition Centre. (n.d.-a). Coeliac disease (gluten intolerance) . Retrieved May 9, 2022, from https://www.voedingscentrum.nl/encyclopedie/coeliakie.aspx Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., Kelly, C. P., Ahuja, V., & Makharia, G. K. (2018). Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology , 16 (6), 823-836.e2. https://doi.org/10.1016/j.cgh.2017.06.037 Catassi, C., Bai, J. C., Bonaz, B., Bouma, G., Calabrò, A., Carroccio, A., Castillejo, G., Ciacci, C., Cristofori, F., Dolinsek, J., Francavilla, R., Elli, L., Green, P., Holtmeier, W., Koehler, P., Koletzko, S., Meinhold, C., Sanders, D., Schumann, M., … Fasano, A. (2013). Non-celiac gluten sensitivity: The new frontier of gluten related disorders. Nutrients , 5 (10), 3839–3853. https://doi.org/10.3390/nu5103839 Rampertab, S. D., Pooran, N., Brar, P., Singh, P., & Green, P. H. R. (2006). Trends in the presentation of celiac disease. American Journal of Medicine , 119 (4), 9–14. https://doi.org/10.1016/j.amjmed.2005.08.044 Dutch Nutrition Centre. (n.d.-b). Gluten and the gluten-free diet . Retrieved May 9, 2022, from https://www.voedingscentrum.nl/encyclopedie/gluten-en-het-glutenvrij-dieet.aspx Caio, G., Lungaro, L., Segata, N., Guarino, M., Zoli, G., Volta, U., & Giorgio, R. De. (2020). Effect of Gluten-Free Diet on Gut Microbiota Composition in Patients with Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients , 12 (6), 1–23. Kupfer, S. S. (2012). Pathophysiology of Celiac Disease. Gastrointestinal Endoscopy Clinics of NA , 22 (4), 639–660. https://doi.org/10.1016/j.giec.2012.07.003 Hörnell, A., Murray, J. A., & Clearman, B. (2005). Effects of a gluten-free diet on gastrointestinal symptoms in celiac disease [3] (multiple letters). American Journal of Clinical Nutrition , 81 (6), 1452–1453. https://doi.org/10.1093/ajcn/81.6.1452 Johns Hopkins Medicine. (n.d.). Gluten-Free Diet: Is It Right for Me? Retrieved May 12, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/celiac-disease/what-is-a-glutenfree-diet https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/ Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PHR, Hadjivassiliou M, Kaukinen K, Rostami K, Sanders DS, Schumann M, et al. Spectrum of gluten-related disorders: Consensus on new nomenclature and classification. BMC Med. 2012;10.

The benefits and the principles of the Mediterranean diet There are many definitions of what a Mediterranean diet is or what it should look like. The overall concept was developed to represent the typical dietary patterns that inhabitants of the countries around the Mediterranean sea, most of all Crete, Greece and the South of Italy, used to have in the early 1960s. The ‘Mediterranean diet’ actually embodies the concept of an economical diet that was followed by poor rural societies.    Over the course of the last 40 years, the Mediterranean diet has been broadly and largely studied. Numerous studies have shown that the Mediterranean diet can help with weight loss and the prevention of strokes, heart attacks, type 2 diabetes, obesity, metabolic syndrome, some types of cancer, and premature death.     The principles of the Mediterranean diet, as shown in the picture below, recommend an eating pattern rich in whole grain unprocessed products, all types of fruit, vegetables, nuts and legumes, lean protein sources like eggs, fish, meat and dairy products and generous consumption of extra virgin olive oil. Nutritionally, this leads to a diet high in fibre, omega-3 polyunsaturated and monounsaturated fats intake which may help to reduce inflammation and improve lipid profile.  The 10 main principles of the Mediterranean diet: 1- Use Olive Oil as the main source of added fat Olive oil, especially extra virgin olive oil, is the cornerstone of the Mediterranean diet. It provides a rich source of vitamin E, beta-carotenes, polyphenols and unsaturated fatty acids. For this reason, it helps to prevent cardiovascular diseases. It is important to note that extra virgin olive oil is best enjoyed cold and not heated up for the most benefit. Through the centuries, olive oil has represented a real treasure in the Mediterranean Diet and it continues to do so owing to its unique taste and aroma and nutritional benefits. 2- Eat plenty of fruits, vegetables, legumes and nuts Fruit and vegetables are rich in all kinds of nutrients such as vitamins, minerals and fibres. They also provide us with a large amount of water. Thanks to their elevated content of antioxidants, they can contribute to preventing cardiovascular disease and certain cancers. The traditional Mediterranean diet emphasises seasonal fruit and vegetables, preferably fresh from the land. Common fruits in the Mediterranean diet include oranges and pomegranates, berries, figs, grapes and orange-coloured fruits such as apricots, peaches, nectarines and melons. Common vegetables include different types of lettuce, tomato, eggplant, cucumber, radish, garlic, onion and spinach.    With regards to legumes and nuts, they are an important source of protein, fibre, vitamins, minerals, trace elements and unsaturated fatty acids. Common legumes in the Mediterranean diet are chickpeas, lentils and beans. The most common nuts are pistachio, almond, peanuts, hazelnuts and walnuts.   3- Grain products should be a part of your everyday diet  Daily consumption of pasta, rice and whole grain products guarantees an adequate intake of carbohydrates and, consequently, an important amount of energy for daily activities. This mainly concerns whole grains products. They are a source of fibre, iron, zinc, manganese, magnesium, copper, vitamin B1, vitamin B6, selenium and riboflavin.  4- Locally sourced fresh foods that have undergone minimal processing are best. The Mediterranean diet takes seasonality into consideration due to the higher nutrient content and improved flavour of in-season foods. In general – the fresher the produce, the better it is in terms of flavour and nutritional benefits.   5- Consume dairy products on a daily basis.   Daily consumption of dairy products – especially yoghurt and cheese – is important for a good intake of proteins, minerals and vitamins. Furthermore, fermented dairy products, thanks to their content of live microorganisms, are associated with improved balance and health of the intestinal microflora. 6- Consume red meat in moderation and ideally as part of stews and other recipes. Meat is a source of proteins and iron. However, its content of animal fat, although variable according to the type of meat, is considerable. Since an excessive intake of animal fat is not healthy, red and processed meat should be consumed as little as possible and, if possible, as a part of other dishes. Lean meat should be preferred and whenever possible consumed as part of a meal based on grains and vegetables.    7- Consume fish abundantly and eggs in moderation Fish, especially fatty (dark meat) fish, is a good source of long-chain unsaturated fatty acids, which are known to protect against cardiovascular disease. It is recommended to consume fatty fish at least once or twice a week. Typical examples include sardines, mackerel, mussels, octopus, oysters, salmon, sea bass, shrimp and tuna. Similarly, eggs are an important source of high quality proteins, fat and many vitamins and minerals. Eggs are considered a very complete food item and consuming them 3-4 times a week provides a good vegetarian alternative to fish and meat.   8- Fresh fruit should be your everyday dessert – sweets, cakes and dairy desserts should only be consumed occasionally.  Fresh fruit should be consumed over sweets, cakes, pastries, cookies and candies both for snacks and desserts. Sweets and cakes should be consumed only occasionally because of their high content of sugar and saturated fats. Fruit is a much more nutritious alternative that brings unique colours and flavours to our diet.   9- Water is the best choice of beverage in the Mediterranean Diet. Water is fundamental for good hydration and therefore it has been placed among the basis of the Mediterranean Pyramid. Fresh water and herbal infusions without added sugar should be consumed daily. Red wine is a traditional element of the Mediterranean Diet, however, it is important to include this only in moderation and as part of a meal in a balanced diet.   10- Be physically active every day.  Being physically active is just as important as eating well. Regular physical activity, adequate rest and conviviality are the three key elements from which to start building a balanced and healthy lifestyle. References: Trichopoulou, A. Martínez-González, M. A. Tong, T. Y. Forouhi, N. G. Khandelwal, S. Prabhakaran, D. Mozaffarian, D. & de Lorgeril, M. (2014). Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC medicine, 12 , 112. https://doi.org/10.1186/1741-7015-12-112    Davis, C. Bryan, J. Hodgson, J. & Murphy, K. (2015). Definition of the Mediterranean Diet; a Literature Review. Nutrients , 7 (11), 9139–9153. https://doi.org/10.3390/nu7115459 Schwingshackl, L.  Morze, J. Hoffmann, G. (2020). Mediterranean diet and health status: active ingredients and pharmacological mechanisms . British Journal of Pharmacology. 177:1241 –1257 Mediterranean Diet Foundation (n.d.) Consulted on 20 May 2021, from: https://dietamediterranea.com/en/nutrition/ –