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ORDINATION

This blog is about gut flora, good bacteria, scientific research, and anti-inflammatory food. It’s a prescription for anyone who wishes to eat their way to a healthier life. It’s impossible to overdose on this course of treatment.

Erik Hemmingsson

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Från Nickel till godishink

På många sätt är hälsan i Sverige god jämfört med våra europeiska grannar. Vi har fortfarande en relativt god förväntad livslängd, och har historiskt sett någorlunda framgångsrikt bekämpat spriten och rökningen. Dessutom har vi fortfarande en sjukvård i världsklass, som på många sätt är juvelen i den svenska välfärden, även om den visar tydliga tecken till att börja gå på knäna. 

Men folkhälsan befinner sig i konstant rörelse, nya utmaningar dyker upp när de gamla försvinner. Vi har inte längre råd att blunda för ett antal olika ohälsofaktorer som borde åtgärdats för länge sedan, t ex en sjunkande medellivslängd för individer med låg utbildning (varför detta inte diskuteras mer i media och inom politiken begriper jag inte). Maten och det vi äter är naturligtvis en av de mest slående exempel vi har på en utveckling som gått åt helt fel håll. 

När jag var liten på 70-talet så delade jag och mina syskon upp läsken på julafton med tumstock för att det skulle bli rättvist, och på bio kunde man lyxa till det med en Nickel eller tablettask från automaten. Numera ser det som bekant inte ut så längre. Det tålmodiga kioskbiträdet, som med tång fyllde de prickiga godispåsarna är försvunnet sedan länge. Nu har barnen egna skopor som de fyller påsarna med, där ett hekto inte ens räcker för att täcka botten på påsen. 

Eftersom många av våra smakpreferenser och andra hälsofaktorer som tarmfloran grundläggs i barndomen är det extremt viktigt att vi hjälper alla barn att äta näringsrik och nyttig mat. Jag har svårt att tänka mig bättre samhällsinvesteringar än att satsa på barnens hälsa och livsstil. 

Eftersom mat- och sockerindustrin till synes är helt oförmögen till självreglering, så är det upp till oss konsumenter att sluta köpa deras produkter, men också till våra politiker att visa att de vill göra det lättare för människor att leva mer hälsosamt. Är det t ex rimligt att vi har samma moms på godiset och läsken, som på frukt och grönt? Här kan vi faktiskt lära oss något av det folkhälsoarbete som gjordes för att minska alkoholintaget och rökandet. 

Den vanligaste invändningen mot statlig involvering brukar vara av karaktären nanny-state, och det kan jag till viss del förstå. Vi ska inte ha en stat som detaljstyr vad vi äter, och människor måste ta eget ansvar naturligtvis. Men varför inte göra det lite lättare? Övervikt/fetma och dess hälsomässiga konsekvenser beräknas kosta 70 miljarder per år, så det är inga småpengar vi pratar om. 

Vi ska också tänka på att förekomsten av fetma har tredubblats de senaste 40-50 åren, samtidigt som typ-2 diabetes blivit fyra gånger vanligare, vilket sammanfaller väldigt väl med den gradvisa invasionen av processad och näringsfattig skräpmat. Och det finns nu mer och mer forskning som talar för att kvaliteten på det vi äter spelar en betydande roll även när det gäller vår mentala hälsa, sannolikt även för våra barn. Och vad kan vara viktigare än att våra barn mår bra, och ges en optimal start i livet? Absolut ingenting. 

För dig som vill läsa mer:

Juul F, Hemmingsson E. Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010. Public Health Nutr. 2015 Dec;18(17):3096-107.

Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Ruusunen A, Jacka FN. Dietary recommendations for the prevention of depression. Nutr Neurosci. 2017 Apr;20(3):161-171.

Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019 May 29;365:l1949.

Erik Hemmingsson är överviktsforskare (docent) på GIH i Stockholm och författare till Slutbantat: förstå din kropp och få en vikt som håller livet ut (Bonnier Fakta, dec 2018). Åsikterna i krönikan är skribentens egna.

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FÖLJ OSS I VÅRA ANDRA HEM:

Recipes, Therese Elgquist

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Tofu scramble med ångade rotsaker, grön ärthummus, sallad och mandeldressing

Dagen då jag kom på att tofu scramble var en av mina favoriträtter serverade jag den ganska exakt så här. Tofu scramble smakar gott, är busenkelt att slänga ihop, går snabbt och kan serveras på såväl ett rågbröd till brunchen som i en lunch- eller middagsbowl tillsammans med grönsaker. Eller varför inte i en matig wrap? Hur som så vill den mer än gärna serveras med en mandeldressing.

När jag tillagar rotsaker med tunna och fina skal (tänk morötter och palsternackor) så låter jag alltid skalet vara kvar. Det smakar mer och ger god textur samtidigt som det är väldigt näringsrikt. Dessutom är det urtrist att skala.

Byt gärna ut rotsakerna mot de råvaror i säsong som du har hemma. Nu kan du passa på att lägga med lite sparris och andra tidiga primörer, och ju närmare sommaren vi kommer kan du istället välja trädgårdsbönor och vackra tomater i olika färger.

Tofu scramble med ångade rotsaker, grön ärthummus, sallad och mandeldressing
(4 portioner )

500 gram fast ekologisk naturell tofu
1 gul lök
1 vitlöksklyfta
1 tsk malen gurkmeja
1 msk näringsjäst / b-jäst
2 msk valfri osötad plantdryck (exempelvis soja eller havre)
1 näve färsk persilja, hackad
salt och nymalen svartpeppar

Grön ärthummus:
250 gram frysta gröna ärtor, tinade
1 vitlöksklyfta, finriven
1 msk ljus tahini
1 stor näve färska örter, eller 2 msk färska frysta örter, exempelvis basilika eller persilja
1/2-1 tsk malen spiskummin
1 msk äppelcidervinäger
salt och nymalen svartpeppar

Mandeldressing:
1/2 dl mandelsmör
1 dl vatten
1 tsk äppelcidervinäger
1/2 tsk ingefära, riven
salt och nymalen svartpeppar

Till servering:
blandsallad
krasse
fröknäcke

Skala och skär löken i båtar, och skala och finhacka vitlöken. Fräs lök och vitlök i en stekpanna i en skvätt vatten tills de mjuknar. Häll av tofun och smula ner i stekpannan, och fräs under omrörning på medelvärme tills allt blir varmt. Vänd ner gurkmeja, näringsjäst och din valfria plantdryck och fräs i ytterligare ett par minuter under omrörning, tills allt får en härlig färg och tofun en lätt yta. Ta bort från plattan och vänd ner persiljan. Smaka av med salt och peppar.

Skrubba rotsakerna och skär i mindre bitar. Ånga i ca 5-7 minuter, tills de mjuknat men fortfarande har en inre kärna. Mixa ihop ingredienserna till ärtröran i en matberedare. Smaka av med salt och peppar.

Mixa ihop ingredienserna till mandeldressingen tills den blir krämig. Tillsätt mer vatten för en lösare dressing. Smaka av med salt och peppar.

Fördela tofu scramblen och rotsakerna i fyra skålar. Toppa med grön ärthummus, blandsallad och krasse, och ringla över mandeldressing. Servera gärna med ett fröknäcke (det här är en av mina favoriter) eller en bit rågbröd vid sidan av. Smaklig spis!

Följ gärna Therese Elgquist på på Instagram @plantbasedbythess, eller fortsätt inspireras på Therese hemsida plantbasedbythess.com. Ta också en titt i hennes böcker The new green salad och The new green protein.

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Food Pharmacy

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PCOS, Insulin Resistance and Vitamin D (part 1)

A few episodes ago on our Swedish podcast we talked about PCOS with Jenny Koos, a sexual health advisor and Holistic Reproductive Health Practitioner. During the episode we promised that Jenny would appear here on the blog as our very own expert on PCOS and today it is finally time.

– Jenny, tell us. What is PCOS exactly?

Polycystic ovary syndrome, PCO-S, is part or a precursor to a metabolic syndrome including diabetes, obesity and cardiovascular problems. The name has been on the verge of changing for several years to “metabolic reproductive syndrome”, or “Anovulatory Androgen excess”, because “PCOS” is misleading. Explained here:

“[The name PCOS] is a distraction, an impediment to progress,”… “It causes confusion and is a barrier to effective education and communication. It focuses on… polycystic ovarian morphology, which is neither necessary nor sufficient to diagnose the condition. ”(NIH panel, 2012)

– What are the symptoms?

Women with PCOS have an excess of androgens (“male” sex hormones), which can express themselves as an irregular menstrual cycle, acne, increased hairiness according to a “male” pattern, thinning of the scalp, or obesity around the waist. In the long run, it is linked to a higher risk of diabetes and gestational diabetes, cardiovascular disease, high blood pressure and uterine cancer.

However, the syndrome is more complex than singular external symptoms, but conventional medical treatment focuses on suppressing the symptoms, e.g. by completely shutting down the ovulation and causing regular withdrawal bleeding. The problem with PCOS, however, is not that you do not bleed, but you do not ovulate.

– Yeah, we are aware of the issue with ovulation. We have many friends with PCOS who have had problems with irregular periods and difficulty getting pregnant. How common is it with PCOS?

It is estimated that up to 18 percent of women of childbearing age have PCOS, and of course that number isn’t’ including unknown cases. It is a metabolic syndrome, a endemic disease based on diet and lifestyle and is not about arduous ovaries. Read more here, here and here.

– Breakdown for us what it is that’s happening in the body?

In a normal menstrual cycle, the growing follicle (egg shell) actually produces androgens, that is, “male” hormones. However, this androgen in the follicle should then convert to estrogen, and a peak of high estrogen is necessary for the brain to drive the ovulation using the hormone LH. The problem with PCOS is that the follicles stay idling.

The hormone LH from the brain at PCOS is elevated for longer periods than normal – because the brain wants to ovulate, which for various reasons cannot be completed. This can make ovulation tests difficult to read.

When the levels of LH are elevated, the conversion to androgens such as testosterone and dihydrotestosterone increases, giving rise to acne and hirsutism (increased male-type body hair). Even stress is a major contributing factor, as androgens can also be overproduced from the adrenal glands.

– What’s the relationship between androgen excess and ovulation?

Essentially, androgen excess, accumulated from various sources, affects the regulation of the menstruation cycle from the brain, resulting in a vicious circle where the weakened ovulation ends up preventing itself.

In addition, from the “half-mature” follicles (growing eggs that have not come to the end spurt), the hormone AMH is released. Women with PCOS have therefore increased AMH. They also have low SHBG, a transport protein that normally binds free testosterone and makes it inaccessible.

– That’s a lot to keep track of, but so interesting. How is the diagnosis determined?

Well, there is a lot to think about. One or more ultrasounds that show on PCO do not equal that you have PCO-S. Diagnosis cannot be given just by ultrasound!

PCO stands for polycystic ovaries, and means many small semi-mature follicles in the ovaries without any particular one leading or appearing to be ovulating. This phenomenon is known as “the pearl band” when seen on ultrasound. However, the pearl band in itself says nothing about WHY your follicles go and go but don’t come to the party. It may have other things to do than PCOS: puberty, hypothyroidism (underactive thyroid), nutritional deficiency, stress, high prolactin, or some medications.

PCO alone can thus occur during an extended menstrual cycle, during stress, or after recently discontinued use of endocrine disrupting contraceptives, and is therefore, in certain circumstances, “normal”.

According to the AE-PCOS Society, diagnosis can only be made if the person meets all three of these criteria:

  • Irregular cycles and/or PCO
  • Excess of androgens such as testosterone, androstenedione and DHEAS – or symptoms of the same in the form of acne, increased hairs (hirsutism) or obesity (especially around the waist)
  • Do not have any other reason to overproduce androgens, eg congenital adrenal hyperplasia

Thus, if you have been diagnosed with PCOS based solely on an ultrasound, without having taken blood samples, the doctor has not done his job. You could be able to ovulate a few weeks afterwards and thus not have the careless diagnosis anymore!

If you do not have a period for a couple of months it does not necessarily mean PCOS. You may instead have suffered from hypothalamus syndrome, which is not at the ovarian level but means that the brain closed down the menstrual cycle due to malnutrition or overtraining.

Knowing WHY your menstruation cycles are irregular, why it is difficult to ovulate, is absolutely crucial for which treatment will work for you!

– But if a woman finally gets the diagnosis, what does she need to know to alleviate the symptoms? For example, are there different types of PCOS?

Lara Briden refers to 4-5 different types of PCOS, which I think is a helpful approach to finding the drugs that actually work for the individual.

The first and foremost is the insulin-resistant variant. Of women with PCOS, 30% have been shown to have impaired glucose tolerance, another 7.5% have diabetes, and one need not be overweight to have blood sugar problems. Insulin resistance means that you cannot use insulin, which usually means increased production. Insulin resistance does not have to mean obesity or diabetes, but can definitely lead to it.

The insulin resistance factor is the reason why type 2 diabetes is a future risk for those who suffer from PCOS – at ground level it is essentially the same problem. And given that many of us are raised on frosted flakes, instant noodles and candy it’s maybe not so strange that PCOS is increasing.

Hyperinsulinemia affects the growing follicles locally and drives a testosterone production, instead of the estrogen that should actually dominate. High insulin also raises LH from the brain, further increasing the production of androgens in the ovaries. High insulin also lowers SHBG, which means more free testosterone.

A bit more progressive doctors use Metformin, a diabetes medicine, for PCOS. Often, however, the focus is often solely on lowering the androgens, which does not overcome the underlying problem.

– You mentioned PCOS stems from diet and lifestyle, and now you mention the link to insulin resistance and blood sugar levels. Does this mean that women with PCOS should think about what they eat?

Yes, you can definitely greatly reduce your sugar intake and make your insulin receptors more sensitive so the insulin doesn’t shout at them. Low Carb Diets is proven effective, but I would not recommend removing carbohydrate/starch completely, because you need them to be able to ovulate. Eat well and balanced during the day and avoid sugar-roller coasters, even if they consist of raw nutrition balls. Sleep helps, magnesium helps, inositol is an option.

– We’ve heard that vitamin D plays a roll here too, is this true?

Yes, vitamin D is a prerequisite for you to ovulate properly and there is plenty of research on how it is involved in PCOS. For example, it has been shown to induce ovulation in women with PCOS, as it optimizes follicle growth (the growing follicle has receptors for vitamin D), as well as lowers AMH and testosterone. Vitamin D deficiency is associated with insulin resistance, difficulty in ovulating, hyperandrogenism, overweight and so on. In this study, up to 85% of women with PCOS had low levels of vitamin D in their blood.

– Thanks, Jenny! We’ll continue with the rest of the PCOS issues on Thursday. Ciao!

Photo: Jenny Koos.

Jenny Koos is a Holistic Reproductive Health Practitioner, but also known as Vulverine, the pussy whisperer, or simply a holistic-minded sexual health advisor. You can find her on facebook and instagram.

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Recipes, Therese Elgquist

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Vegelicious Green Smoothie Bowl

During the spring and summer I tend to eat more smoothie bowls for breakfast (and lunch and dinner). The nice thing about smoothie bowls is that you can blend up virtually anything (well… almost), so don’t be afraid to go outside the frozen-banana-berry-and-acai powder box.

I like to mix as much vegetables as possible since it gives a fulfilling breakfast filled with nutrients. In this particular smoothie I just threw in a bunch of greens and vegetables that I had at home, including my new favorite – chlorella. It gives a really nice color and has mega benefits!

Pause for a second of reflection on the topic of avocados. You have, as myself, likely become aware of the debates on, avocado water use and non-sustainable production as of recent. It is, among other things, regarding the fact that the hip crops are grown in such extreme quantities (as this gives the most yields) that the soils become overloaded.

Despite this, I have not completely stopped eating avocados. I do, however, make the occasions more rare and avoid buying if I do not find organic and grown “near” me or at least the continent I find myself on. Instead of making a point of eating an avocado every day, it is now a luxury that is saved for special occasions. Most recently, avocados ended up in this smoothie, and oh so delicious it was!

Vegelicious Green Smoothie Bowl
(1 bowl)

¼ – ½  fennel
1 handful fresh spinach, or about 4 cubes frozen
1 stalk of celery
½ inch (1cm) fresh ginger
1 tablespoon freshly squeezed lemon juice
½  avocado
1 large handful raspberries
2 fresh dates, pitted
1 – 1½  teaspoons of chlorella water to taste

Topping:
granola or roasted seeds and/or nuts
hemp seeds
coconut pieces
dried berries or fruits, such as inca berries and apricots
fresh mint

Throw everything down in a powerful blender and mix until it becomes completely smooth. Add a little water at a time until you get a consistency that you like. Are you going to drink it on the road? Pour in more water for a looser smoothie or less water for a smoothie that is best eaten with spoon. Top with optional nummies!

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