Can you please tell us a little bit about yourself and your career?
I have been a dietitian for around 15 years now and my passion is fertility, pregnancy and women’s health. It’s what we call ‘early life nutrition’ and I’m particularly passionate about that because I have come to learn that what a woman eats in the lead up to pregnancy, during pregnancy and then what we feed our babies during the first couple of years of life—that period of time is often called the first 1,000 days—and that has a humungous impact upon the genetics of our babies, which goes on to impact their future health.
The research is currently suggesting that the next generation is actually going to have shorter lifespans than we will because of the fact that women just aren’t eating healthily enough during this period of time now. It’s such an important period of life. My main focuses are fertility, pregnancy and then helping new mums.
Can you tell us a little bit about your systematic review on the effect of low-carb diets on fertility hormones and outcomes in overweight and obese women?
Part of what I’m interested in is helping women to become pregnant and we know that when women are overweight or obese, that has a humungous impact upon their ability to become pregnant.
The research is very clear that losing weight helps to improve a woman’s fertility. We also know that losing weight before becoming pregnant helps to reduce the risk of future childhood obesity. I think it’s a really important area.
Why I chose to look at low-carbohydrate diets is because low-carbohydrate diets are well-known for fast weight loss, which is often advised against. But when you’re talking about fertility, often women need to lose weight quite quickly. So, I wanted to do a systematic review to find out how the fast weight loss of a low-carbohydrate diet impacts fertility. Is it a good thing or a bad thing for this clientele?
Our research found that it seems to be a good thing, but I’m really interested to go on and to do more research because I have some theories around how low the carbohydrates should be and also how long we should be doing a low-carbohydrate diet for. I don’t think it should be for very long— I think it should be a very short burst of weight loss to help with fertility.
As an estimation, how long do you think people should be on low-carbohydrate diets?
It’s probably more about not doing it too close to when a woman actually conceives. It’s about doing the weight loss early enough so that a woman is well-nourished again and bringing those carbohydrates back into her diet again before she actually conceives as opposed to doing a low-carbohydrate diet long-term.
Is there a downside to doing a low-carbohydrate diet just after the time of conception?
That’s not really clear in the research yet just because the research hasn’t been done. But reading between the lines, yes, I do believe there is a downside and that it can actually decrease a woman’s fertility doing a low-carb diet too close to her becoming pregnant, or that she actually doesn’t become pregnant because it can impact upon egg health. That’s why I think it’s best to do a low-carb diet early on and get some quick weight loss and then bring those carbohydrates back into the diet again.
Can you include artificial sweeteners in the low-carb diet? Is it as effective?
You certainly can, it’s not going to impact upon getting into ketosis or on the number of carbohydrates that you’re consuming. Personally, I’m not a big fan of artificial sweeteners. I know that the research is very divided, but there was another paper that came out this week suggesting that artificial sweeteners can impact weight gain in the long term. I would much rather people avoid sweeteners and avoid sugar altogether rather than using diet products to lose weight.
Once a woman is pregnant, how much weight should she gain?
Unfortunately, not enough women know the answer. The answer is that it actually depends upon your conception weight.
For somebody who has a healthy BMI of 18.5–25, the recommendations are 11.5–16kg. But for women who are overweight or obese, which is a high proportion of women—one in three women of childbearing age are overweight or obese, their BMIs determines how much weight they should be gaining.
The higher their BMI, the less weight they need to gain throughout pregnancy because we need to remember that, at the end of the day, babies are only born at usually around 3.5kg. Although we need to put on some extra weight to thicken our uterus and we put on some fluid stores, at the end of the day, a lot of what we’re actually putting on is fat stores so that we can breastfeed.
We do need to do that, but if a woman is very overweight, she certainly doesn’t need to be putting on those additional fat stores. Some women, if they have quite a high BMI, may not need to gain any weight at all.
Is it safe for a woman with a really high BMI to lose a little bit of weight during pregnancy?
If they’re doing in under the guidance of an accredited practising dietitian and they’re getting regular ultrasounds of their baby to make sure that their baby is growing well. Obviously, it’s very important to meet their nutrition requirements, but if their baby is growing at the right pact and they’re having a very nutritious diet, then yes, you can lose weight during pregnancy—you just want to be very closely monitored.
Do you have any opinion on whether Australia should have a sugar tax?
I think it’s a positive thing to have a sugar tax, but I think that there need to be some caveats around it. I really think that if we do a sugar tax than the money needs to be directed towards other beneficial things like subsidising the cost of fresh fruit and vegetables for low-income families or something along those lines because I don’t think that a sugar tax alone is going to solve the obesity crisis.
What I really think the tax should go towards is providing women who are pregnant or thinking about becoming pregnant with Medicare rebates for seeing a dietitian because it’s such an important time for impacting the health of the next generation.
If we really want to reduce childhood obesity and future obesity levels, I think it’s about educating women before they become pregnant and during pregnancy. I don’t think to do a sugar tax itself is going to change much, but I think it’s what we can redirect that money to that will have a bigger impact.
In regard to the Flexi Diet by CSIRO, the 5:2 Diet and intermittent fasting in general—do you think it’s easier for some people to stick to that style of eating rather than daily calorie restriction? Would you ever use that approach with someone looking to fall pregnant?
I have had a good look at the research on intermittent fasting. Although the research tends to show that in the long term, people don’t necessarily lose more weight than going on a calorie-controlled diet, they don’t tend to lose less either.
My opinion on flexi diets and intermittent fasting is that it depends on the individual. You have to look at people’s individual goals and their individual lifestyles. For some people, I think that intermittent fasting can work quite well. Sometimes I use it as a first measure, but often I would use it after putting somebody onto a stricter weight loss diet and then move them onto some intermittent fasting for long term weight maintenance.
My short answer is yes, it does have a place, but it’s not for everyone and that’s where people really need to do a nutrition assessment with their accredited practising dietitian and work out what’s going to be best.
What do you do differently from other dietitians that specifically satisfies clients so much that they keep coming back?
I guess one of the big things is that I’ve got experience. I’ve been seeing clients in private practice for around 15 years now, first of all as a sole trader and then I moved onto owning a business and employing dietitians.
Now, we’ve actually moved onto licensing out the Nutrition Plus brand to experienced dietitians. I think part of it is about the experience, but another big part of it is actually just about passion.
To me, dietetics is not just a job, it is a passion and I am really moved to help my clients and make a difference. For me, it’s not just about a 30-minute or a 60-minute consultation, but I really look at how I can make a difference in their life.
I think all those little things make a big difference. It might be just about really listening to each and every client and hearing their own unique story. It might be about giving them a free book or it might be about putting in some time to do some research about their particular rare medical condition. It might be about following up with their doctor or their psychologist or something along those lines.
I really have a work ethic to try and go over and above for every client that I see and treat everybody as a unique individual instead of doing a cookie-cutter approach. I listen to every person and try and do my best to make a difference in their life.
Is there anything you would like to add to wrap up the interview?
I have a book called the Pregnancy Weight Plan. It discusses how weight impacts upon our fertility and then goes in-depth through the three trimesters of pregnancy and breastfeeding.
There’s meal plans and exercise plans in there for each step of the journey, and a lot of calculations so women can work out how much weight they should be aiming for during their pregnancy.
It’s a great resource that dietitians can use with their clients in their clinics, or people can use themselves to be able to work out what they should be eating and how much weight they should be gaining throughout pregnancy.
I’ve had lots of great feedback about it—people find it just very easy to read and a very practical resource, so that’s been really nice.