G'day, it's Warwick Bishop here and welcome to my podcast and videocast station today. Super excited to have Dr. Rebecca Loong back for a second time. Hi, Rebecca, how are you? Very good, thank you. Thanks for having me, Warwick. Absolute pleasure. For those who missed the first part, I strongly recommend you go back and listen to it. But in the meantime, I'll let you know that Rebecca is a qualified and practicing dietitian. She's done a PhD in cardiometabolic health, and she's an accredited sports dietitian as well, so very well credentialed. She's also co-founder of Heartful Flavours, and we're going to talk about Heartful Flavours in just a little while. If you missed the first podcast, you will find it interesting. We talk about a heart... and metabolic healthy diet. And we talked really about reducing carbohydrates and how they tie in with insulin. What I'd really like to dive in on are the other macronutrients. And I'm going to really tease Rebecca out on fats and protein and the sort of things we need to be aware of as we age and the nutrients we need to be getting on board to promote healthy aging. Rebecca, I'm going to open that up for you as you're speaking with your clients or patients around a healthy aging diet. Where do you start and what are some of the absolute priorities that you want to get across to these individuals? Thanks. So with, you know, what's good for healthy aging is also healthy, you know, good for your heart. So it comes together like we know. I mean, when I looked into the research. If you have frailty, it increases the risk of, like you have a higher risk of the major adverse cardiovascular events by two to five times. And if you have frailty, it increases the risk of developing the cardiovascular disease about two times. So they're quite interrelated, but we don't know which one comes first, okay? It could be a bi-directional relationship there. But yeah, so, you know, in the research I've done, it's similar to a healthy dietary pattern for your heart. What we found particularly now was like the vegetables, legumes and seafood dietary pattern was associated with increased, sorry, reduced prevalence of frailty. But that was also, that's not just a cross-sectional analysis, but there's also different longitudinal analyses of other cohort studies that showed similar. In terms of diet and frailty in trials, there isn't that many directly on a whole dietary pattern on trials. I think there are some maybe underway, but it's also because when we get older, it's hard to, I guess, for older adults to have a long-term, you know, a long trial. That's, I guess, a limitation that's quite expensive to conduct. I'll jump in there a little, Rebecca. I guess when we're talking frailty, and to be honest, I don't even have a formal definition. I suspect, I'm sure the World Health Organization have a formal definition, and you may know it, but from a pragmatic perspective, one thinks of frailty as loss of condition, loss of muscle mass, loss of functional capacity. And I guess as we think, and certainly the people listening, maybe in the same boat, as we think of that, we think, well, it's probably muscles and muscle deterioration that is a significant player in that space. And if we're thinking about muscles, how do we look after our muscles from a dietary perspective? And again, I'm not a dietician, but one can't help but think that protein and protein consumption is really central to that. How would you describe that? How would you see that? How would you discuss it with your clients? Yeah, thanks. So I guess firstly to find out what frailty is, you know, there's different criterias, but basically it is like a deficits of physiological, physical and mental function. And there's different criteria, which is exactly similar to what you said. Like one of the three criteria, there's five criterias in there, which is like weight loss, weakness, slowness. So like when you do a six metre walk test, how fast are you? Exhaustion. um and a low activity so like you know less exercise that you do another criteria can be like the rockwood criteria or rockwood criteria uh which is looking at the accumulation of deficits um and conditions and disability so i wouldn't say there's a solid definition but there's different definitions there and it all talks similar of similar things of of these kind of um inadequate or less function right and how in terms of yes muscle so that comes into the grip shrimp when they do a grip shrimp test like and I used to work in our outpatient hospital clinic and that was called like the strong program at Balmain and they've opened another one at Concord and that one's typically for diet and exercise they're helping people prevent frailty helping they get stronger so they do shrimp training and yeah we provide a protein supplements uh after their shrimp training sessions okay so usually after you do any sort of shrimp training you want protein during you know before during or after um uh at least 20 or 30 grams um to help with uh the muscle synthesis rate that increases um during training yeah so when when we're talking about uh protein consumption really what we're talking about is people eating the the proteins that then get broken down to amino acids, which are the building blocks for proteins that the body, once they've absorbed them and digested them, then use those building blocks to rebuild the proteins that we actually want for ourselves. So what sort of amount of protein should people be eating? How do they know? Is it a piece of fish a day? Is it a chicken breast? Is it a steak? What does it look like for a person to know that their portions, the amount of protein they're eating is appropriate? And look, while I'm asking this, it moves as well as it changes a little bit because as people get older, my understanding is they probably need a little bit more protein. Is that correct? Yeah, so some of the research is showing older adults require high amounts of the protein. So even in the nutrient reference values, I'm pretty sure it's already higher right now for older adults. And then what they're looking at is probably one point now with newer evidence, probably 1.2 to 1.6 grams of protein per kilogram body weight, which is like it's higher than maybe the previous. They maybe thought it was 0.9 grams per kilogram body. Okay. Yeah, so it is higher. And in terms of when you're asking the amounts, you can use, like sometimes we recommend people using apps. I'm not saying you have to track your food forever, but it's a good way to understand the portions and how much protein come from that and different other nutrients that come from different foods, right? Yeah. So when, if you look at the kind of dietary guidelines, protein meat alternatives uh group provides protein but also the dairy fruit group generally obviously there's still other amounts of protein little amounts in like your grains as well but uh meat alternatives fruit group what does that include um so for example your chicken your legumes um your fish uh your nuts and seeds are in there as well um and then you also have the dairy, dairy alternatives food group that also provides protein. So also, sorry, eggs are in the meat alternatives food group. Like, for example, a serve can be, for example, two or two serves of two eggs, which makes a serve all the alternatives. But that would once seven grams of protein. Yeah. How much in an egg? About seven grams. Seven grams of protein. Yeah, on one egg. Yeah. Okay. Okay. So you could probably do two eggs there and then that's what I'll say, you know, maybe around 15 grams and then you might have some sort of carbohydrate on the side and other things to make up to at least the 20 grams, right, at a meal. And then even dairy, like a server dairy, for example, like 10 grams of yogurt, which is about three quarters of a cup. I always ask people to use their fist, okay? It's approximately one cup. Depending how big your fist is. So you always have that with you. You can always use it to estimate it. So free cause of a cup, 200 grams, yogurt is about 10 grams of protein. And a cup of milk is about 10 grams of protein as well. So it really helps. And actually when we get older, so the meat autosis serves in the dietary guidelines is around similar, around two and a half to two serves. But when we get older, the dairy is the one that actually increases. Also increasing the... calcium intake, right, because of the increased risk of osteoporosis, but also increases of protein. Yeah, right. So from the usually you want two and a half serves of dairy or alternatives. And when you get older, it can increase to four serves for men and three and a half serves for men. Okay. Well, that's important to know. And, of course, dairy ties in with bone health as well. Excellent. I'm going to. throw this out there just so that those who are listening can get a what what does this look like sort of picture in their mind my so if we go for say an older or an older person trying to get the right amount of protein let's say they are aiming for 1.5 grams per kilogram if that individual was say a bit like me, about 60 years of age and about 60 kilos, I'm a little shade over 60 these days, but that would calculate to 1.5 times 60 is 90 grams of protein I need to get a day. Yep. And 90 grams of protein, my understanding is if you take cooked meat, whether it's chicken or steak, then 100 grams of that cooked meat. yields about 30 grams of protein and it's a little bit lower in the uncooked is that that's approximately right yeah like roughly 100 grams of any cooked kind of protein sources um like fish um uh chicken and beef i'm not saying i'm promoting red meat at all i'm not um but that is uh yeah roughly about 30 grams of protein um but yeah that would mean that Just so that 90 grams that I'm trying to obtain looks like 300 grams of that cooked fish, chicken or meat, which is quite a lot. And I just want to flag that. I mean, obviously you might have yogurt, you might have some milk, you might have other bits and pieces, but putting those completely aside, just that's quite a lot. And you'd need to spread that over the day because that's quite a lot for most people I would have thought to eat, for example, as an evening meal. A 300-gram piece of fish, chicken or steak is fairly sizable, I would have thought. Yeah, and you definitely won't do that. You're not going to have that all at once. And plus, as you said, it does come from the other sources, and that's why it's good if people do, if they really want to track it, they can track it in an app. There's a free app called the Easy Diet Diary app, and it's based on the Australian Food Database. So generally... Just say that one again for us, Rebecca, in case someone's listening and they're trying to write it down. Say it nice and slow. Easy Diet Diary. Yeah. So that's one of the apps. And, yeah, using the Australian Food Database, you can even scan, you know, the barcodes and show up the food product. So 90 grams. Actually, that's not too hard to meet. 90 grams is quite easy. If you think about it, if you're eating good breakfast, like even having, like, the right serve of grains, like, say, a bit of cereal or oats in the morning, that's maybe around five grams or so of protein. Then you add in, like, a cup of milk because that's already 10 grams. You can add some nuts. and seeds in there, they'll make around at least 20 to 25 grams, right? Okay. So that's, you know, 20, 25 grams from that. And then you got your main, maybe your lunch and your dinners where you don't necessarily have to hit the 30 grams straight away just from the protein source. It can be around 30 grams. Then you make it up with the other carbohydrate or grain component and other foods that will be a tiny bit. So you can at least get 25, 25 again. So you're on 75 already, right? That's 50 with only 40 to get at the end of the day. So we're now talking 200 grams of something, 150 grams of protein source, whether it's your fish or your chicken or beef. So, yeah, that's far more attainable, isn't it? Yeah, so there's different serve sizes, like for what equates to serve in a meal alternative food group. But yes, so like if I get 25 grams of what we talked about at breakfast, the cereal and milk and nuts and seeds, and then you've got your lunch, which is some sort of protein, you know, with... you know, maybe probably not the 100 grams. It could be depending on different serves. It can be 100 grams of fish or 80 grams of chicken or 65 grams of red meat. They'll probably give you at least 20 grams just from that. Okay. And then you add on a grain sauce. Here it's a 25. You do a similar for dinner. That's 25. So we're at 75, right? Doing maths. And then you have your meat meals. And what happened to, you know, your three and a half serves of dairy? Yeah. That would definitely go over 90, right? Beautiful. Yeah. Beautiful. What sort of advice do you give people around protein supplements? Do you support them or rather see people eat whole food? I'm guessing whole food makes more sense, but do you have many people ask about supplements and supplementing with protein? Yeah, I think it depends on the scenario and context and what the person aims to achieve and, you know, the overall, you know, what they're doing. But generally, I would always recommend whole foods because... A supplement is if they take an isolate, they only got that one thing, you got protein. If you take a whole food, you have all these other vitamins and minerals with it. Like, for example, in the dairy, you have calcium as well. It's not just the protein. And that's what's been associated with reducing risk of chronic conditions, right? With protein supplements, if they somehow can't get enough from their diet, they can use it. Or if they feel like they... Yeah, it might be easier to drink if they don't have a big appetite to eat a lot of food, right? So they can definitely do that if they want to, like after training, or they can just have it from Whole Foods as well. Okay, so the... The take home I really want people to get from this and what I'm learning is as you age, you need to really pay attention to your protein intake because I understand you lose some of your efficiency in absorption and then utilization of protein. So you may even need more as you age to keep frailty at bay and that you can match and meet those needs through sensible, mixed dietary. foods through the course of the day. So you're not trying to knock back all your protein in one meal. You're stretching it over the course of the day. And dairy sounds like it works very well in there from what you say, Rebecca. Yes, I think it helps. It helps a lot. um and if you feel like you're gonna you know juggle all this yourself you don't have to you can always see a dietitian um like as a prevention check basically like a lot of times even with high blood sugars or things like that i can see it before it happens and then it happens and then they come and i told you not to or or i i you know gave this advice and you know and then they know and that's okay but people learn and You know, hopefully they can control it over time. But, yeah, see somebody even at different life stages as you go through your life because your dietary requirements will change. Cool. Now, just a couple of words on what your recommendations are with regard to saturated fat and cholesterol when you're talking to your heart-healthy, metabolic, healthy, aging, antifraal clients or patients. Yeah, so the recommendation is still there to limit saturated fat intake. Mostly, firstly, you would always look at if they're having excessive discretionary food, so, you know, high fat, high salt, high sugar. and high fat in terms of high saturated fat, like the biscuits and pastries and cakes that can somehow slip in. Like you can have it on occasions, but if you know that occasion's coming up, then you can save it for that occasion and try to make sure it's not an everyday thing. And they can also use the app to track that as well. There is a guideline, the dietary guidelines, where we want the saturated fat intake to be less than 10% of the overall energy intake. So for example, if you're... you know limited six out your energy intake 6 000 kilojoules a day then you want 600 kilojoules from saturated fat which uh 37 grams uh sorry 37 kilojoules per gram saturated fat so you just do 600 divided by 37 which for example it's going to do that quickly is about 16 grams of saturated fat a day yeah yeah yeah so they can track that and like they know what contributes to saturated fat like i'm not going to say limit your fatty fish no they will be more the other sources yeah what kind of foods they are well um so i'll just jump in here certainly uh saturated fats um are important for blood cholesterol levels so as you're probably aware and some of our listeners will find this really interesting when people eat cholesterol that cholesterol doesn't necessarily raise the blood measured cholesterol because our bodies make cholesterol and there's a frustration when people try and improve their cholesterol levels through diet alone they'll often reduce their cholesterol and foods like eggs or prawns that they perceive as high cholesterol they'll stop eating those well the frustration is that the body has a set point for cholesterol and this is genetically determined so look to your parents to blame them for wherever your cholesterol is the Frustration is if you eat less cholesterol, your body makes more cholesterol and therefore your cholesterol levels don't change that much. And conversely, actually, if you eat more cholesterol, your body makes less cholesterol. And again, it doesn't move so much. So exactly as you were talking about, Rebecca, it's saturated fats, consumption and increased consumption of saturated fats that are then absorbed drive cholesterol levels up. reducing saturated fats help bring cholesterol levels down so not exactly what you'd imagine what you're eating isn't changing uh directly what's occurring in the bloodstream it's an indirect and it's saturated fats that have more of an impact in natural fact so i'm i can see the home stretch but before we get uh to the finish line rebecca i'd really like you to tell me about heartful flavors i know you are the co-founder but Tell me what the business is about. Tell me how you became interested in it and tell the listeners a little bit about why it might be helpful for them and how they could find out more about it. Yeah, so Heartful Flavours, well, I grew up loving cultural foods. And like I understand with the knowledge as a dietician, the average sodium intake is double the recommended upper limit in Australia, like at 3,600 milligrams per day. And global is probably around 4,000 milligrams per day. But to reduce the risk of chronic disease, it's less than 1,500 to 2,300 milligrams per day. So excess sodium intake has been actually attributed to 1.9 million deaths and 45 million disability-adjusted life years globally. So it is a really, really big issue. And we just don't want a lifespan as long. We also want a health span, so living healthily without disability. So it's important for that. And we know there's a relationship between sodium and blood pressure, obviously kidney issues and other things as well. how do you create healthy cultural meals or particularly asian meals without salt fish sauce soy sauce oyster sauce like what is the solution and you know from that background i Like knowing that knowledge, I subconsciously just reduced having it and limited my favorite cultural meals to sometimes. And it was really hard to watch family, friends and clients consume meals that were high in Zoom, often unbalanced in nutrition. So I thought, you know, it's so integral as a part of our culture. And I felt like I was losing a vital part of my cultural identity if I couldn't find a solution. So I thought, look, I have the knowledge. I've got food science background. I have dietetics. I'm in this area of heart health. Why can't I make it happen? So together with some Food Science University friends, we thought of doing these flavours. So we only use herbs, spices, yeast, fruit and vegetables, and that mimics the flavour of those Asian meals. So I'm really happy with it. And we did a pilot launch in September last year and it's been going well. And at the back of pack, there's actually nutritionally balanced recipes. So one pack makes four meals and those nutritionally balanced recipes help you meet like two and a half serves of veggies, one serve of meal alternatives, 1.5 to two serves of grains. So it helps you with meal prepping. You don't have to calculate it all yourself. It's done for you. And it's also in alignment with the Mediterranean and DASH dietary patterns. They're actually right here behind me. So it's a good solution because as a dietitian, we know there's, you know, barriers between advice and implementation. If you're like... you know, confidently you can say health professionals can take this and be like, hey, you can use this. It'll be a healthy flavour. There's no outer salt, no outer sugar. It has a five health star rating. That's our first in the category. And you can use it and follow the backup pack recipe. That's all you need to do. And it's ready in less than 30 minutes. Some of them, you can just add hot water. It makes the sauce instantly and also the broth. And you just need to add the protein veggies. That's it. Wow. Rebecca, what a great initiative. What a really... wonderful reason and drive to do it, to hold on to your own cultural heritage and identity. I'm really actually very impressed by that. And in fact, I'm going to have to buy some myself. I haven't tried them yet, but where would I get them? And where would people listening get them from to have a go? Because what a great idea, getting rid of the salt and the sugar out of some of these beautiful flavours. for this group of predominantly Asian meals that you're describing sounds just a tremendous initiative. So good on you. Well done for doing that. Yeah, thank you. Like it's hard because in the food products, in the food industry, there's salt always added. How do our taste buds learn to adapt to none of that if it's always there? It's really hard. It increases our salt taste threshold, but we want to reduce that so less amount of salt can taste the same. You know, you can taste it with less amount of salt. So it's also teaching people about taste bud adaptation. You can find it on our website. So we do nationwide, actually international delivery as well at www.heartfulflavours.com. So heartful as in heart and then F-E-L, heartful. flavors.com. We also are stocked in some stores in New South Wales and Victoria and also in South Australia. But hopefully we'll get more stockers. So we've, yeah, been going well. And we actually last week got announced that we received the award, the winner award for the Dietitians Australia's President's Award for Innovation. So I'll go to the conference next week for that. Congratulations. That's absolutely fantastic. Look, I'm going to wrap it up. We've had a wonderful sharing around dietary aspects for heart health, longevity, frailty. It's been an absolute delight sharing with you. Thank you so much for joining me. Thanks, Warwick. I also thought that we can put a special code for your listeners for Heartful Flavours. I'll let you know that you can probably put that in the notes. Okay. Sounds fantastic. We would love to do that. For now, again, thank you so much for sharing. Those Heartful Flavours recipes just sound like the bee's knees, so anyone listening, go and give them a try. But those listening, thank you so much for tuning in, and I'm sure you learned as much as I did. I am going to wish you the very best. I hope you live as well as possible for as long as possible, and take care. Goodbye for now.
