Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Super excited today to have someone to talk to. And indeed, I have Dr. Rebecca Long, who is an accredited practicing dietitian with a special interest in sports, but also cardiometabolic. And in fact, Rebecca is also co-founder of Heartful Flavours. which I'll let her tell us more about later on. Welcome, Rebecca. Thank you for joining me. Hi, Warrick. How are you? Thanks for having me today. Delighted to have you. And I'm well, thank you. So, look, let's wind back the clock a little. And, well, we all have a journey or a story. How did you end up in dietetics? Thanks for the question. Well, basically, I love food all throughout my life. And because of the love of food, I started studying a Bachelor of Food Science at the University of New South Wales. And at that time, I actually worked as a medical receptionist as a university student. That's where I saw firsthand the importance of taking care of our bodies. So combining food and health naturally, it was just nutrition, and then I did a Master of Nutrition and Dietetics at the University of Sydney. And following from that, immediately, I saw patients one-on-one in practice. I also worked in various areas of dietetics, including community health programs, supermarket nutrition research, also outpatient hospital. And then all along, I kept seeing the same issues that pop up, like high blood pressure, high cholesterol, high blood sugars, abdominal adiposity. Like, why do they keep coming together? So then that led me to pursue a doctor of philosophy of diet and cardiometabolic health at the University of Sydney. So to this day, I still see clients one-on-one and also recently founded Heartful Flavors, for flavors that put your health first, which we'll talk a bit more about later. Yeah. I'll certainly look forward to coming back to Heartful Flavours presently. But you said you love food yourself. Just a quick one. Did you have anyone in the family who was medical so that you sort of lent that way or was this somewhat serendipitous? And part two of the question, what are the sort of foods that you really loved that were in the back of your mind as you were thinking about becoming a dietician and helping others? Good question. Thinking about in terms of like what brought me into it, I think it was really my interest in food. Like I just like eating different foods. I found food products really fascinating. And when I went to the supermarket, it was like my library. that's how I felt um and in terms of having a medical background like I didn't think about it too much in terms of family history and things like that but I do like in my family like people have had diabetes they've had heart disease they've had high blood pressure whether it's the genetic or lifestyle you know it probably could be more of a lifestyle thing um in that sense because It's not like there's no familial hypercholesterolemia from what I can see. It's not like where audio cholesterol is above six, like not like that. And I'm fine, which is good. But, yeah, people in the family have been affected by it, but it does affect lots of people anyway. Like when I looked at the statistics, like two in three have abnormal blood lipids in Australia, which is ridiculous, but that's what is happening at the moment, yeah. Yeah, no question. It is, look, one in four people die from heart disease. And so this is a non-trivial situation and really anything to the good could make enormous differences and inroads, not just for individuals, but communities, if we can adopt sensible eating patterns. I'm really in awe of you undertaking a PhD. For those who don't know, PhD means that Rebecca is a true doctorate. Congratulations, because the study, the journey to do that is significant. They do not award PhDs for a trivial effort. It's normally a major effort of research. So congratulations for doing that. But I'm super interested that your PhD was in cardiometabolic health. And of course, I'm in exactly the same... wheelhouses you in that regard, because I see exactly the same people you described. I see people with cardiovascular disease who have dyslipidemia, abnormal cholesterol levels. They have that central adiposity or weight around their tummy. Their triglycerides are up. Their sugars may be elevated. They may be diabetic or pre-diabetic. So tell me if there was... two or three main points that came from your PhD and your understanding about cardiometabolic health, what would they be, Rebecca? Yeah, I think that comes, I think, before we discuss it, and so people know, they're going to define what they are. So firstly, with cardiometabolic health, I think it was a term that was first coined in 1999, just those risk factors that you just mentioned, like blood sugars, adult adiposity. blood pressure all of that those risk factors that are predictive of cardiometabolic disease which includes like heart disease and diabetes so that's how that term was coined and then in terms of my research I also looked at diet but in terms of diet like you can always analyze single nutrients or whether you analyze a whole diet overall and that's more and more where the research is going where we analyze that whole entire diet so a dietary pattern is actually defined by like the frequency proportion of you know foods in that diet and a combination of all those foods and nutrients and the synergistic effects within that and how that impacts on our any effects that they have and the impacts on our health risks um so on top of that in my phd i actually looked at frailty as well so there's another outcome and that's due of healthy aging like i remember reading this paper and it was one of the Actually, another investigator in the study that I was doing, and he was part of this paper as well, and he's really renowned in the space of frailty and older adults. He's Professor David Le Couture. And one of the papers kind of talked about aging and like different conditions. And when you age, like aging of single conditions is like, say, one condition. So a chronic condition, aging of multiple organs and tissues, then you've got multiple morbidity. And then as you progress along the age, you know, as you age and then you got. aging of like multiple almost all conditions i'm sorry all um organs um is where you develop frailty so it's just like a line like that which i found really interesting look it's a fascinating space we'll touch on frailty briefly but before we do cardiometabolic for those who are listening really pertains to the heart as you said and When we talk about metabolic, we're mostly talking about diabetes and pre-diabetes and we're talking about the consequences of that. Rebecca, when you find someone with pre-diabetes, I know my general recommendation is for those individuals to reduce their carbohydrate consumption. And my belief behind that is if you reduce the carbohydrates, then you reduce... the insulin response that those people have. And many of those people are insulin resistant, meaning that when they consume sugar, they have a fairly brisk insulin response. And my understanding and belief is that insulin probably underpins some of the negative outcomes we see in metabolic syndrome, which increase in adiposity which we use adiposity instead of fat for those wondering what adiposity means and central adiposity just means a fat tummy uh we also think that insulin i believe probably drives inflammation as well and is certainly linked to triglycerides which of their own um are often seen in conjunction with low htl so there's this total body picture including the high blood pressure that you mentioned so i often aimed towards getting those blood sugars down by reducing carbohydrate consumption. What's your first step in that sort of arena? Yeah. So particularly, yes, if they have high blood sugar levels, like a lot of times I'll look at their diet and see, you know, how their carbohydrate distribution is. So typically when you see a dietician, if that is that, it will be carbohydrate control. So not necessarily cutting out everything with carbohydrates. That's not the point. It's more about... knowing the portions and how much to have like for example um like breakfast lunch and dinners um you could be aiming say between 30 to 45 grams of carbohydrate just to split it up and maybe maximum 60 grams um and then mid meals you might do zero to say oh 50 zero to 30 grams depending on what you consume as a snack whether there is carbohydrate there so it might be zero it might be something um you know i just jump in there rebecca were you saying um 30 or 40 grams per meal, breakfast, lunch or dinner, or 30 or 40 grams per day broken up into those three because they're... yeah i just missed that yeah that's okay um actually at each one like i would say that's maximal like usually even if i've seen people with that and they say they have high blood sugars and then they do that the father recommendation when they you know they do their blood test a few months later there will be improvements yeah um and you can also test like whether the carbohydrate you had enough is is excessive but because um you know they they have guidelines where for example two hours um from once you start consuming meal from two hours you can test it and see what your blood sugar levels are at yeah yeah and we'll talk about this a little bit more and uh what i would really like to do is we've we've probably done 10 or 15 minutes even without trying so what i'd like to do is tease out a little bit more on this cardiometabolic dietary discussion talk a bit about cutting those carbs a little more and then if you're open to it perhaps bring you back for a second interview to talk about that frailty diet and to talk about heartful flavors how does that sound yeah yeah we'll see what you've been in all right let's let's come back to the reduced carbohydrate eating regime when you're talking to your clients or patients are you making a significant distinction between types of carbohydrate? Are all carbohydrates basically the same? And from my understanding, even if you've got brown grainy bread, the body still breaks it down to simple sugars to absorb it. You may have increased fiber, it may take longer to digest, but it still breaks down to sugar versus a tablespoon of table sugar. they still break down to the same things. How do you make those distinctions for your patients and how does that fit in with your discussion? Yeah, so firstly, you can talk about the amounts of it and then you can also go to types of carbohydrate or you can go into like the low glycemic index and high glycemic index, which is kind of what you kind of touched on, like where you have a... A high glycemic index, basically, for example, if you have white rice, like you'll increase the peak of your blood sugar levels faster and it will drop down faster. And that means the energy lasts you for shorter. But what you want is probably like, say, like a low GI rice, like basmati rice and basmati brown rice. It can increase the blood sugar slower. So the peak is lower and also it lasts longer. So the energy lasts you longer. Another example. I'll jump in there briefly. Just for those listening, glycemic index, just as. rebecca alluded to is a way we measure how quickly that particular food raises the blood sugar level in an individual and exactly as rebecca said the high glycemic index foods are the ones that really pump up the sugar levels very quickly and the low glycemic foods are the ones that release their sugar very slowly, the far more complicated carbohydrates and some of those more complicated carbohydrates releasing that sugar slower may well have less impact on insulin. Perhaps that's some of the thinking behind it, Rebecca. Yeah, and I guess with whole grains as well, like that's where it comes in where we term it whole grains versus refined grains. And if you look at dietary patterns overall, most of them would always be recommending whole grains. None of them would be going for refined grains. And in addition to what you're saying, of course, obviously, if it's just the sugar itself, like which is mostly what you can find in the processed foods and snacks, like obviously those will be high glycemic index and affecting you in that way. But we do try to look at the foods overall and obviously in a healthy dietary pattern. We always limit the discretionary food, which is like high in fat, salt and sugar and those kind of processed foods. Yeah. Well, I think those other foods in particular, the protein. um the fats we're gonna i'm gonna wrap up here and we'll come back and we'll talk about those proteins and fats because they tie into frailty and i think we're pretty well on the same page when we see cardiometabolic patients we want them to reduce their carbohydrate consumption overall we want to reduce that insulin exposure but um how about we wrap it up here and i invite you back for another occasion where we talk about the protein and the fat, particularly for that frailty and for the heart. Is that okay with you? Yeah, definitely with healthy dietary patterns overall, not just reducing carbohydrate consumption. It's just if it is excessive, then it's a point that we can make. But it's more about focus on the food groups that we have, and we can definitely talk about that more in the next session we have coming up. Thank you so much. That sounds great. Is there anything else you want to add about cardiometabolic? dietary advice or any of your one or two of your special hints or tips that you would really just like to share before we wrap up um i i definitely can and i hope it doesn't take too long but i think the listeners will will love this um so basically like in dietary patterns overall like the most best diets for like heart health, metabolic health, from what we can see and know from all the different studies. You'll have the Mediterranean diet. You'll have the DASH diet. You have the portfolio diet. You also have, like for example, the Nordic diet, where there's more research there, increasing research. The DASH diet, sorry, stands for the dietary approaches to stop hypertension. All of these diets would always have vegetables, fruits, whole grains, legumes, nuts and seeds. That's in all of them. Okay. And then most of them, also all of them will always limit the discretionary food, like the high fat, salt and sugar processed foods. There's minimal red meat and most of them also recommend the fatty fish and all of that together. would make sure if you're eating that, naturally your diet will be low in saturated fat, low in sodium, low in glycemic index and also high in potassium. So those are all the nutrient characteristics of that. Yeah, a real call out to whole foods, nutritious foods and steering away from particularly excess animal product and saturated fat. So very sensible advice there. Thank you. Rebecca, I'm going to wrap it up there. I'd really like to thank you for sharing today. Thanks, Laurie. Thanks for having me. For those listening, I'm sure you've got as much out of this as me. Absolute delight to speak with Dr. Rebecca Lung. Thank you again for joining me. I look forward to the chance to speak again. For anyone listening, if you've got any queries or questions, please drop me a note at drWarrickbishop.online. and open to any questions or suggestions for future podcasts. I'd be super grateful if you enjoy these podcasts, if you share them with someone else as well. For now, though, I am going to wish you the very best and I hope you live as well as possible for as long as possible. Take care and bye for now.
