Nicole's latest diary entries
Getting Active - so much more than calories

Activity more than just calories burned

Studies have shown that it's energy balanced healthy eating combined with activity that provides the best results for weight, but more importantly for health. 


The current government guidelines in the UK are to have  a minimum of 150minutes a week of heart rate raising activity, along with 2 days of strength building activity for the core muscle groups. That works out at 30mins on 5 days and two days of weight resistance. However  studies have shown results for double this - an hour a day five days a week and 2 days muscle strengthening. 

Labelling with activity equivalents needed to burn the calories in that food package aims to tie the two together. 

Through obsessive Focus on details of calories  is not the aim.  

It may be motivational to use this for the treat foods like a 400 calorie cake bake and full fat latte from a coffee shop coming to over 700kcal  may make you think twice when you think that's over two hours of walking or an hour and a half jog. 

Activity is much more than weight maintenance. There are deeper fast acting effects acting from the moment you start that means even if you don't see the results on weight there is much more going on, with just a few here on this list below...

  • Body tone and shape
  • Muscle strength and posture,  improving endurance to daily tasks. 
  • Builds bone  - fracture risk reduce 
  • Energy levels increased
  • Mood improved
  • Heart health
  • Hormone balance and insulin sensitivity improved. 

Many patients I see get despondent when they increase activity but see no results on weight. Remember muscle weighs more than fat, so body tone and shape are improved despite what the scales show. 

I have seen a patient recently who came in with a weight gain but he showed me a body scan he had done, showing he had gained a stone in muscle with a major reduction in body fat - and he felt so well. 

Do something every day. Anything you enjoy that gets you up and moving. 

Rough guide to calories burned in one hour for a 70kg person:

  • Dancing ballroom 200kcal
  • Brisk walk 3.5mph – 300kcal
  • Aerobics – low impact – 400kcal
  • Cycling 12mph – 500kcal
  • Running 5mph 600kcal
  • Swimming fast – 700kcal
Being overweight the new normal?

 Being overweight the new normal?

Today England's chief medical officer said that being overweight is increasingly being seen as normal with the rising levels of overweight and obesity. However normal doesn't equal healthy. 

Figures for overweight and obesity have been increasing over the decades, now with nearly 62% of adults and 28% of children as either overweight or obese (figures DoH March 2013 policy document Reducing Obesity and Improving Diet)

Tackling the problem starts with people realising they need to take action. With research  showing half of men, a third of women and over three quarters of parents do not realise they have an issue in this area - this may be where we need to begin. 

So how do you know if you have to take action? Some will say it's obvious. However will you realise you are overweight if everyone around you looks just like you? 

Start with some basics:

Take notice if your clothes are getting tighter. 

Take your waist measure - if it's over 80cm/31.5" as a woman, or over 94cm/37" as a man you are creaping into higher risk. If it's over 88cm for a woman or 102cm for a man - then you are in the high risk category for poor health. 

Look at your BMI - with caution! This has to be taken with some understanding of what it means. It can be a poor indicator for those who have a lot of muscle tissue, the elderly and those of different ethnic groups such as Asians, as well as for children. For all these groups the BMI figures don't stand alone and need careful interpretation. There are BMI calculators online to get your levels. 

Take action as soon as you see things creaping up. At this stage it's a lot easier to make small changes that make a difference early on without much effort.This keeps you on basic healthy eating and exercise without any drastic action. 

Caffeine in pregnancy linked to lower birth weight babies?

Caffeine in pregnancy and birth weight of babies

A study from Sweden looked at the intake of caffeine of about 57000 women, from all sources including coffee, tea, cola, chocolate, desserts and energy drinks and found that there was a correlation between the level of intake and the birth weight of the baby. 

Small for age birth weight of the baby is linked to future health problems. The study looked at low birth weights at 2.5kg or less. Average healthy birth weights are typically 3.6kg.  
For every 100mg of caffeine from any source they found a reduction by approximately 20-30g of weight of the baby (note these figures are small). They also found coffee, not other sources was association with longer pregnancy duration. 
The associations were found to be independent of smoking - another factor known to affect the health of the baby - so even for those that didn't smoke they saw the lowering of baby weight by caffeine intake. 
Caffeine in pregnancy report:
The UK currently sets a limit of 200mg intake of caffeine during pregnancy. 
Caffeine contents: Fresh coffee 140mg, instant coffee 100mg, tea 75mg, plain chocolate 50g bar: 50mg, Cola 40mg. So a cup of coffee and a bar of chocolate, or two teas and a cola adds up to the daily limit.
It is important to note that studies like this that just look at an association can not prove that caffeine caused the smaller birth weight. It could be a chance finding with no connection to caffeine at all,  or it could be that there are other behavioral factors that just happened to be linked to intake of these foods, or that there is some other compound in foods tested other than caffeine giving this result, rather than the caffeine alone. It's simply not possible at this stage to take it further than this without more evidence. 
For now we can take this as another reason to keep to a healthy diet without any area being excessive. These figures were for daily continuos intake throughout pregnancy, it is highly unlikely that having a little more on one day is going to make a significant difference. 
In conclusion, this is not a reason to panic about moderate intake within the guideline figures. And take a look at the NHS choices website for all the dos and don'ts on pregnancy and what foods to avoid.


Reducing salt. Cheese focus

Reducing salt

Once again salt is in the news for high levels in processed foods. This time Cheese hits the headlines as being third of the top three salt contributors to the UK diet, with bread and processed meats such as bacon and ham taking the top two. 

A survey carried out by Consensus Action on Salt and Health (CASH), found that  cheese contain more salt than seawater and higher levels than in some obvious foods such as crisps. The focus is on manufacturers to keep a check on salt and reduce where they can since 75% of our total salt intake is typically from food bought outside the home.

Manufacturers add salt to products for technical reasons and for food safety, so some is needed in there to do the job needed. However where it can be reduced without affecting these issues it should be addressed. 

Sodium that is found in salt has important functions in the body, but we don't need much. Too much is linked to raised blood pressure, stroke, cardiovascular disease, stomach cancers and kidney problems. 

Keeping it down is easy when making your own foods as you control what you put in. Using lemon, chilli, black pepper, herbs, spices, ginger are all alternatives that have benefits too. 


Report compares light to standard products
Light or standard

A Which report found that there was little difference in calories between products labelled light and standard. 
To have the word light  it must contain at least 30% less fat than the standard version.
The best way to compare products is to see how much they give you per 100g, see how much your portion is going to give and if that amount is something you are concerned about. 
For example chocolate digestives were found to have just 8kcal less in energy than the standard version. This is a treat food and having just one or two, these small differences in calories wont make a difference. So the verdict on this one is to go by whichever you like the taste of. 
For cheese the lighter one has about 40% less fat, which has resulted in the protein and calcium going up - a good choice. 
For the yogurts you will need to compare per 100g too see how much sugar, fat and calories they have and then see how much that adds up to for your portion. Sometimes the lighter product may have more calories and sugar just because you are having a double size portion.


Rapid weight loss with the Naso-gastric Tube Diet

 This is one way to get weight loss. Clinics in the United States and now starting here in the UK are offering a radical form of weight loss.  A naso-gastric tube, normally used to feed critically malnourished patients to help weight gain is being used for weight loss. Patients are fitted with the tube for 10 day periods where they are fed just 130kcal of protein based feed, putting the body into a ketotic state, giving rapid weight loss.


Diets less than 800kcal are termed very low calorie diets. They typically use liquid drinks and should be supervised by a medical team and only for patients with significant weight to loose, with a BMI greater than 30kg/m2. Key issues with these diets is that risks of problems are increased if there is underlying heart disease, or if they are used for long periods severed vitamin and mineral deficiencies may occur, and increased risk of gall stones and most typically, muscle loss.

Muscle loss is a key concern as loss impacts key muscles affecting lung function, heart muscles and mobility muscles, with an impact on the immune system and infections. But even more relevant to weight loss, any drops in muscle tissue lead to drops in the metabolic rate of the body, a measure of the turnover of chemical reactions in the body, which means the body does not need as much food calories in and weight loss slows down. This is one reason why people who return to eating normal amounts of food rapidly put weight back on. This weight rebound is common after following a radical diet plan.

The recommendation for any VLCD use is to keep protein intake adequate to help minimize the inevitable muscle loss, typically 1g protein for every kilogram ideal body weight for height.


This addition to the rapid weight loss arena uses the VLCD but delivers it through a tube through the nose rather than by drinking shakes or special meals. Use of an NG tube is a medical intervention and thus requires medical supervision as it is not without risks.

The feed may be a protein feed without carbohydrates, putting the body into a state of ketosis. This means that instead of burning carbohydrates, which the brain and nervous system need, the liver uses fat to make energy, converting it to ketoacids for the body to use.

Low carbohydrate diets such as the Atkins diet have been around for some time. They are also found to have a particularly high weight rebound when the diet is stopped, meaning that people regain weight rapidly afterwards, possibly exceeding the weight they started at.


For a weight loss plan to work it must have three key components:

Effective – achieving the loss that is needed.

Sustainable – you must be able to keep it up in the long term, which means it’s got to be practical and enjoyable.

Healthy – it must provide all your body needs in terms of vitamins, minerals and nutrients for long term health.

A quick fix plan without an effective follow on will not fit these conditions and the weight will come back on quickly.

If you’ve money to spend on expensive interventions, a personal trainer along with a good enjoyable healthy and calculated food plan will give you results that should last you a lot longer than the quick fix. 

BBC Breakfast Organic verses conventional produce

The facts about organic food

A new campaign starts out this week to raise awareness of organic food. So what's the difference between organic and conventional produce and what are you paying for? Here's what we know so far...


The Food Standard Agency commissioned research to look at differences using studies from 1958 to 2009. No significant differences were found for levels of vitamins and minerals when the best quality studies were assessed, with the exception of nitrogen and phosphorus, which aren't thought to have an impact on health at the levels found. No differences in health were found from eating organic or conventional produce, though in this case the number of studies was limited.

Weather organic or conventional produce, nutrient levels are far more effected by many other factors such as types of soil, weather conditions, storage type, length of storage and transport, crop variety and how the animal is fed. Consider these if nutrient levels are your priority. 


Both organic and conventional produce are under the same safety regulations. So no difference here


Lower levels of pesticide residues have been found in organic, but all pesticides are tested for safe limits before being accepted for use and both conventional and organic are monitored to ensure levels are below the safety limits set. Therefore levels in conventional produce and organic should both be below safe limits. 


Organic food has traditionally been more expensive, but the gap is reducing. The latest price check found less than £5 difference on the total of a range of items purchased over a week. 


Organic food has plus points. It represents high standards in all areas. It has a high focus on the environment, sustainability, soil care using crop rotation, natural manuring methods for fertilisers, strict rules on which pesticides can be used and how, no genetic modification allowed, high animal welfare standards. All standards are governed by EU law for minimum standards, with a monitoring body to ensure these standards are met. You may be getting standards well above these minimums. Ultimately, you are paying for quality in all these areas. 


Consumer choice is important, so you choose what's important to you. If the environment is your priority then consider organic, but be aware of all issues such as where the food is produced, are air miles and pollution involved from shipping long distances? 

MY OPINION: I'm all for organic farming and protection of our planet. Best of all for the environment and for fresh produce has to be growing your own wherever you can, but obviously that isn't possible for all. If cost or availability is an issue I'd rather you focus on having a healthy balance of food, quality lean cuts of meat and fish with lots of fruit and vegetables of any type, organic or standard. The facts are, the benefits of a vegetable and plant based diet is protective for health no matter which one you choose. 


BBC Breakfast Panorama discussion: Children's Ready Meals

 BBC Breakfast interview with Nick Coffer

Supermarket salads not always the healthy choice!

Some pre-packed salads have been found to have more fat and calories than eating a burger and fries or 6 crème eggs. A study by the consumer organisation Which? looked at a variety of supermarket off the self salads, taking a close look at the small print on the labels.

A 300g small prawn salad  sold in Morrisons topped the league packing in 855calories and 66.3g of fat.  That’s nearly all the fat for one day in the guideline daily amounts for a woman and more calories than in a  McDonald’s Big Mac and medium fries (820Kcals and 40g fat).  

Marks and Spencer’s pasta with tomato and basil chicken salad  came second for calories at 760Kcals and 46g of fat, with mayonnaise being the second highest ingredient at 27% of the meal.  Most of the fat from salads is due to the amount of high fat dressings, mayonnaise or oils used.

Asda’s Chicken Caesar Pasta Salad contained 683Kcals and 41g of fat, the same amount of fat as in 6 Cadbury’s crème eggs.  

When choosing salads pick from ones where you can see lots of colourful salad vegetables rather than just pasta or rice. Also look for those with salad dressing on the side so you can just add the little you need and drastically reduce the fat and calorie content.

A caution on cheese if you are watching the pounds and keep portions small. It’s a great source of calcium but it is also high in fat. Beans and pulses are another protein option and work well in salads.

As with anything shop bought, read the labels if you want to keep a check on what you are eating. The information is there, but it might be very small and misleading, often needing you to calculate the amount in the portion size you will be having.

Have a look at the salad trial we conducted to see what the public made of these salads:



Alcohol - health boost or risk?

The department of health recently carried out research showing beer drinkers having five pints a week loaded up the same calories as having hundreds of high fat cakes and doughnuts in a year.  A similar picture emerges for other alcoholic drinks including wine, spirits, cider and liquor. 

For a long time alcohol has been noted for heart protective qualities when taken in moderation in heart disease and this is still the case. However it has also been found to raise blood pressure and raise levels of triglyceride fats in the blood, so contrary to popular belief it may not be ideal for all cases. For women even a glass a day has been linked to an increase in breast cancer and there are other cancers that alcohol may raise the risk of such as mouth and stomach. 

But looking at the more immediate health factors, many do not realise that alcohol contains more calories weight for weight than the food components of protein and carbohydrate. In fact it contains nearly double and a little less than fat.

That means that alcohol adds up the calorie count in your day very quickly. 

But it's not only the calories in alcohol that can lead to weight gain but the effect alcohol has on our body function. 

In the first instance alcohol causes a drop in blood sugar levels as it suppresses the function of the liver and its release of glycogen stores so hunger cravings go up, making you much more likely to eat excessive amounts or to go for unhealthy snacks that are at hand.

Over a longer period of time and excess use the blood sugar mechanisms may be effected permanently with a high blood sugar hyperglycaemic state leading to insulin resistance, which is linked to many healthy conditions, notably heart disease, weight gain and obesity, cancer and diabetes.

Alcohol is a diuretic, leading to dehydration and thirst, so we tend to drink more alcohol and compound the situation. 

Finally, even though alcohol is a dense source of calories, it does not compensate for food in the same way. It does not contain all the nutrients of food and it doesn't keep you full as food does. Drinks, whatever they be, do not trigger the bodies satiety mechanisms, the signals that tell your body it is full. That means that when you drink you don't feel full in the same way you do with food and within a short time, even though you may have had more calories than a whole meal, you soon feel hungry. 

My advice: you don't need to avoid alcohol if you enjoy it, but have just a glass with a meal occasionally rather than daily and keep a large glass of water near by to combat dehydration.

If you go out socially regularly then the same applies. Keep to one glass and make it last and get used to being able to go out without having alcohol at all in social situations so that you are not tied to it when you want to be alcohol free.

A better swap for these days would be a glass of orange juice to sip slowly, a virgin mary and a glass of mineral water - giving you plenty of fluid with added vitamins and minerals too.

If you are drinking look out for small 120ml glasses of wine rather than the more common large 175ml glasses, mix with sparkling mineral water if you wish but take care with mixers as the alcohol may then not be noticed and there is a tendency to drink up quicker; a bloody mary cocktail which has lemon, lime and tomato juice to boost the nutrient count rather than creamy cocktails; half a pint of beer or lager rather than pints. 

Calorie counts:

1 pint lager: 230Kcals   Low alchohol lager: 57Kcals

1 pint bitter: 190Kcals

1 pint cider: 240Kals

1 shot/25ml spirit: 50 Kcals

1 bottle alcopops: 200Kcals

1 SMALL glass 120ml wine: 80-100Kcals...  Sauvignon blanc 80Kcals; Chablis 85Kcals, Chardonnay/Burgundy white 90kcals; Rose/Burgundy red/Beaujolais/Bordeaux 95Kcals; Chianti/Sangiovese 100Kcals; Madiera/Muscatel 160Kcals

But typically many wine glasses are now 175ml or larger! 130Kcals per glass 300Kcals in half a bottle wine

1 glass 50ml sherry: 70Kcals


1 glass 250ml glass tonic water: 83Kcals

1 glass 250ml cola: 105Kcals

1 glass 250ml lemonade: 53Kcals

1 glass 200ml orange juice: 72 Kcals

1 shot 25ml  lime cordial: 28Kcals

Tax on chocolate?

 A GP recently put forward a recommendation to put an increased tax on chocolate with the aim of curbing consumption of one of the nation's favorite treats. The proposal set before GPs in Scotland was defeated by just two votes, much to the relief of chocolate lovers.  But what is the basis for this debate?

Current figures on obesity show the UK is steadily following the US. Figures for 2007 put just under a quarter of all adults as obese and just under half as overweight. A quarter of children are overweight with 14% of under 11's obese. (Foresight Report 2007). Heart disease, diabetes, cancers, blood pressure, strokes and many other related conditions all rise as these figures climb. The UK is near the top in the world obesity rankings. 

Chocolate, once a special treat, is now part of the daily diet of many. It's often reported to be good for health, confusing health messages further.

The truth is chocolate is a high fat and high sugar food. Even high quality, high cocoa chocolate has 40% fat and 30% sugar. But as with everything, it will also provide some good things too. The cocoa bean is a rich source of antioxidants in the form of catechins and phenols that do have some protective effects. 

On balance I would say the bad outweighs any good if you are having the large quantities needed to give the positive effects seen in studies. With obesity figures rising and heart disease still in full focus, bringing chocolate, along with all the other treat foods, back into occasional rather than daily intake is the way to go.

Once or twice a week, a couple of small squares rather than bars at a time, is unlikely to cause problems and it still remains the enjoyable pleasure it should be.

Maybe taxation won't work, but this story at least highlights a need to look at all avenues to help us help ourselves and give us another kick at eating everything in balance. 



January Detoxes?

No I don’t believe in these. They are everywhere and I don’t believe that they are the way to boost your health.

Your main detoxing organ is the liver. It has various chemical pathways to break down both the toxins formed as by products of metabolism of your body and toxins from what you put into your body. These chemical pathways do need vitamins and minerals to do the job, but we get all of these in the foods we are eating and in a form that is likely to help the body to do even this job better.

This way you’ll be eating lots of natural fibres too without realising it. These fibres speed up the movement of food in your gut, binding toxins too and helping to carry them out the body.

Drop the detox pills and packages. Just give your body what it needs and cut out what it doesn’t. You’ll soon be on your way to a fitter, slimmer, healthier you.

What to cut out:

After the festive season take a break on the treat foods and alcohol, and of course cut out smoking. So that’s chocolate, sweets, puddings, crisps, chips, fried foods, all the processed ready foods, cocktails, wine, beer and spirits. All these foods are either high calorie or put an extra load on the liver which has to break down the toxins we put in us.

What to put back in:

Fresh food! Get back to all the fresh fruit and vegetables bursting with nutrients, freshly chopped up and put into meals and eaten as snacks and dessert. Onions (a great liver detox food), sweet peppers (packed with vitamin C), the detoxifying cruciferous vegetables broccoli, cabbage, cauliflower, watercress, the high fibre beans and pulses and other good quality lean proteins including fish and chicken. These foods are packed full of nutrients that help the liver do its job.

Get Cooking!

Cook up fresh meals again, breakfast of oats or cereal topped with fruit and low fat plain yoghurt, sandwiches with lots of fresh salad ingredients and lean proteins, dinners of hearty winter bean and vegetable soups or fish, chicken with steamed vegetables, wholegrain pasta, brown basmati rice or sweet potato. For dessert or snacks, drop the crisps and chocolate and have your choice of fresh fruit - apples, oranges, clementines, grapes, mangos, fresh lychees – the list goes on and they are all good.

Get exercising again

Regular is more important than the one off heavy sessions that can’t be sustained. . If it doesn’t fit in it won’t happen. So find something that fits in with your weekly routine, be it at the gym, weight training at home, in studio classes, swimming, running, cycling, dancing, work-out videos in the front lounge. Just do something, anything, each day, so you haven’t sat around all day on any one day. Aim to get an hour of heart raising activity a day, or build up to that starting with 30 mins a day. That may sound a lot to fit in, but it could be as simple as taking a lunch break to walk or parking the car further than normal and have a 20 minute walk at a fast pace in one direction and 20 minutes back.

Get to sleep at the right time

After all the long late nights staying up over the festive season and long lie ins, it is important to get the body back into a good sleep routine. This is the time the body recovers and renews. The sleep cycle is programmed into our bodies and erratic bed times and routines can affect the quality of sleep and so also the recovery and energizing processes taking place at this time. So get your routine going again so your body is ready to wind down at the same time each night and get you started up and set up the with fresh energy for the new day .