Live healthY with Optimal Nutrition

Live healthY with Optimal Nutrition

31. August 2023

Like every year, the 45th European Society for Nutrition and Metabolism Congress (ESPEN) gathers prominent experts from all over the world to present the most important science and latest findings around clinical nutrition and metabolism, this time in Lyon, France.

Live healthY with Optimal Nutrition is the guiding thread for this year.

The ESPEN 2023 program offers a great opportunity for physicians, dietitians, pharmacists, nutritionists, scientists, nurses, and everyone involved in the field of nutrition and metabolism to meet and discuss cutting-edge science, stimulate new collaborations and consolidate existing close partnerships.

Dr. Katarina Melzer, for the 13th time in a row, chairs, moderates and teaches the LLL module on Physical Activity and Health.

Come and join us!

Time: 10th of September from 9 to 13h.

See you soon in Lyon, France

LLL Courses

 

What are the LLL Courses?

The ESPEN Leonardo da Vinci Life Long Learning Project is an ESPEN – EU global effort to improve daily practice in Clinical Nutrition and Metabolism and develop quality care in nutrition by means of an innovative educational initiative.

What are the main objectives?

To improve the knowledge, competence and skills of health professionals and students in Clinical Nutrition and Metabolism while providing CME credits and European certification for medical doctors. The courses are open not only to medical doctors. Pharmacists, dieticians and nurses can attend.

The duration of each course is 4 hours.

Paying courses are to be reserved upon registration to the Congress (cf. online registration form) and are open for all nutritional caregivers (medical doctors, pharmacists, dietitians and nurses).

The LLL Live Courses (4 hours each) are linked with the Educational Programme and are open to all the Congress participants. However, participants wishing to take the LLL case discussions and do the test that follows the corresponding educational session must register specifically for the latter.

Further information on the Final Exam, the pre-requisites and the application process is available here.


Why we overeat and under-exercise

Why we overeat and under-exercise

13. July 2023.

As metabolic disorders become a major concern, let us try to understand the barely seen underlying reasons. We can easily blame genetics or our work life for the metabolic disorders we suffer with but what about the stored trauma, stress, and loneliness? Learn why we eat the way we eat and create unhealthy relationships with our food. This episode with Dr. Katarina Melzer would have you pause and compel you to take a look at what is the real issue.

00:00         Intro

02:00          No country today has successfully realized the growth of obesity.

03:12           How obesity is not an issue of prejudice or fashion but a scientific reality?

08:10          Nutrition actionable.

09:20          Becoming more aware of the psychosocial factor impacting our health.

10:40          The way we eat as a coping mechanism.

15:00          Our addiction to food is actually our addiction to the dopamine response.

19:15           Changing our relationship with food:  from a coping mechanism to energy input and energy output.

22:07          Why suicidal rates have increased over 30% in the last few years.

23:27          How is our modern society characterized by a chronic imbalance between energy intake and expenditure?

27:00          How much exercising it takes to create a balance in our current energy intake and expenditure?

28:40          How much do we need to exercise regularly for bodyweight regulation?

30:00          Abundance of exercise for abundance of food.

35:10          Why do we need to work on regulating energy balance?

36:45          The quality of our relationships and the degree of loneliness, happiness and satisfaction are somewhere connected to over-eating and under-exercising.

42:50          Where do we go from here?

Thank you The Settle or BBETTER Podcast for the invitation!


The forces behind our unhealthy habits

The forces behind our unhealthy habits

25. March 2023.

Why would we push ourselves to ask for help in our quest for understanding the reasons behind our self-destructive behavior? Why would we choose to discuss the forces that drive our unhealthy habits? Isn’t it more comfortable to stay in our own psychic bubble that shields us from reality, and keeps us from confronting our personal trauma that would only unleash emotional storms we might not be able to handle?

Yes, staying in that bubble of denial seems more comfortable. Why? Because the reality we would suddenly expose ourselves to is too scary. The bubble serves as a safe capsule, keeping us from feeling the full range of grief and pain from negative life experiences and trauma which we all, at some point, lived through.

As a child, have you ever been judged? Not understood for who you are? Verbally, physically or in any other way abused? Harshly disciplined? If not obeying, bitterly punished? Not accepted exactly the way you are? Have you ever witnessed the suffering of your parents and faulted yourself for it? Or punitively self-blamed for not being able to help?

Most of us have. Many times, even without realizing that these overwhelming experiences can be traumatizing. In fact, trauma is part of life. It is unavoidable. Understanding that we are living through experiences that can leave traumatic effects on us is not always obvious. As the neurologist Robert Scaer defined it, trauma can be “any negative life event that occurs to us in a state of relative helplessness”.

In these situations, we coped as well as we could. In doing so, we constantly betrayed ourselves for love and acceptance. We allowed others to treat us in a way that made us feel unworthy or unaccepted, severing our connection to our authentic Self. Could we have changed anything at that point? Nothing. We were young, dependent, utterly vulnerable and helpless. Trauma creates the fundamental belief that we must betray who we are in order to survive. The experience brought us nothing but self-limiting beliefs.

When a parent figure denied our reality, they were unconsciously teaching us to reject our intuition, our “gut feeling”. The more we learned to distrust ourselves, the deeper our intuitive voice withdrew becoming harder and harder to hear. This resulted in lost intuition, and internal conflict. We learned that our judgement cannot be trusted and looked to others to shape our reality. The emotional immaturity due to unresolved trauma kept us unfulfilled, outside our emotions, trapped in our inability to connect with others and ourselves, and emotionally immature for challenges the world brings along.

How should we, then, deal with persistent stressors in our lives? How should we approach problems in our current relationships? How to manage unsatisfaction with our current job or with the way our boss treats us? How to deal with inequalities related to social status, gender, unemployment, racism or discrimination that each of us felt at some point? Where to find strength to carry on when we feel unhappy, lonely, unseen and unknown? To whom to reach out for a helping hand?

Can we change something, especially now?

Certainly. What we fear is not the future, but the past. We can develop genuine self-esteem, not based on others’ valuations and approbation, but rooted in authentic self-acceptance. That may, of course, evoke the grief of letting go of who we thought we were and who the world that shaped us wanted us to be. But it certainly denotes a sense of liberation, an invitation to live a richer, more authentic and healthier life.

Unfortunately, most of us seek the truth only once we recognize that the cost of not doing so has become too high. Running from ourselves and from what makes us feel not at “ease”, brings us to the state of being dis- eased or ob-e(a)sed, indulging in self- destructive behavior, be it in too much food (or too little), alcohol, sweets, drugs, internet or shopping. This desire for the quick fixes, emblematic of the Western culture in many ways, comes from the understandable want to end the increasing discomfort of living with our wounds.

The state could be a wake-up call, serving as a signpost that an otherwise healthy person is heading in the wrong direction and should ask for the help and support they need.

Dr. Katarina Melzer

Be balanced, be free!

Equiliberty


Food for Body and Soul - part III. No "Free Lunch"

Food for Body and Soul - part III.

No "Free Lunch"

23. February 2023.

Having said all that in “Food for Body and Soul” part I and part II (see previous two blogs), we can conclude that, by and large, obesity, overweight and related chronic diseases result primarily from a prolonged disbalance between energy input and energy output. If that is the case, there are two ways to regulate the outcome: You can either reduce the energy intake, or you can increase the energy output. Everything else is hocus pocus. Once we have understood this, and once we have adapted our behavior accordingly, we can then still talk about fine tuning of more sophisticated physiological factors that can influence energy intake and output, but which really should not be of primary concern for our discussion here.

But if it really is as simple as that, why are we not doing it? Well, I said it was SIMPLE, but not that it was EASY! It is simple, because you don’t need to be an expert to understand that every calorie you eat must go somewhere, and that it must either be burned as fuel for your metabolism and exercise, or stored as fat in those places you hate to look at in the mirror. Nor do you need a PhD to understand that “junk food” is just that: “junk” and that, therefore, it probably is not good for you. Because, after all, your entire body is nothing else than a compilation of cells made from all the food you have eaten, and it does not take rocket science to realize you cannot build and maintain a healthy body from nothing but processed sugar, fats and artificial additives.

So the hard part is not to understand the truth, the hard part is to adapt our behavior to the truth. Being ordinary humans, we all tend to look for magic diets, “scientific” doctrines and quick solutions that will allow us to fool ourselves, just as long as we can stick to our old bad habits. But why are we like that?

Where do we get it wrong?

One of the main problems, I think, is that we live under the illusion of a “credit mentality” leading us to believe that we can get joy and happiness without taking full responsibility for our lives. In reality, you can do whatever you want, but pay day always comes. In life: there (really) is no “free lunch”!

In practice, this means that there is no cheap food. If you think that good quality food, organic products and fresh fruit and vegetables are too expensive, wait until you see the health costs of a lifetime of junk food, from the medical bills of your doctor to the pain, discomfort and disability caused by a deprived and neglected body. The same applies to physical activity, taking time for yourself, buying and preparing healthy food instead of having a quick stop for junk food somewhere. The truth is that, whatever you do, you WILL end up paying the full price, either now at the grocery store, or later at the hospital, but then with a hefty interest depending on how long you have been postponing “pay day”.

Most importantly, we have to become aware of what we are trying to nourish when we eat – our body or our soul? Because, as we already discussed, if calories are our only source of nourishment, we will stay hungry for the rest of our lives. Hungry, exhausted, and too tired to move. Tired not because we have done too much, but because we have done too little of what sparks a light in us.

And while obesity and overeating are still defined by some medical practitioners “as a normal physiological response to an abnormal environment”, other nutritionist and/or psychologist are less ambiguous, conceptualizing both obesity and overeating as a form of a “addiction” to food, similar to addictions to excessive shopping, drinking, smoking, Internet, work, drugs, sex, etc.

For example, Gabor Maté, a brilliant physician specialized in the field of substance dependence and psychology, clearly categorized overeating as addictive. He says that if you want to understand addiction you cannot look at what is wrong with addiction, you have to look what is right about it, what the persons get from the addiction that otherwise they do not have. And, what addicts are getting is relief from pain, a sense of peace, a sense of control, a sense of protection (maybe through some additional layers of fat tissues as layers defending them from the outside world). Unfortunately, whatever “substance” we are addicted to can only temporarily relieve the painful symptoms of what is missing in our lives, but cannot remove the source of the problem. So the question is not “why the addiction?”, but “why the pain?”

Addiction always aims to forget, not to be ourselves for a few hours, to avoid the discomfort of being in our own skin, to escape from our own mind, so some people are destroying themselves with work, others with drugs, shopping or food. It is all about trying to fill an inner emptiness from the outside.

And if you want to understand why people are in pain, you cannot look at their genetics only, but must look at their lives. Because many people that are in pain have been abused in some manner: physically abused, or maybe sexually abused, neglected, abandoned or emotionally hurt, exposed to an environment that did not give them the love and acceptance. As a consequence, they did not develop brain chemicals such as dopamines (motivational component of reward-motivating behavior) or endorphins (chemicals to relieve pain or stress), so now they seek to fill this hole with all kinds of things from the outside.

In order to feel loved, understood and accepted, we suppress our own needs and start living someone else’s life, seeking acceptance of others, a sense of being “needed” (through work achievements), filling this emptiness of something we needed, but never got. But the truth about addiction is that it never works, because any inner emptiness we are trying to fill in this way will remain a hole without a bottom.

Maintening or restoring health means getting in touch with our own self, our body and emotions and honoring who we are. What about being honest about what is lacking in our lives emotionally, and deciding not to try to suppress these needs with junk food and senseless entertainment, but to actually look for activities and relationships that stimulate our mind and nourish our soul?

Changing our habits towards a healthier, balanced and more fulfilled life can be scary, because it may go far beyond our menu of foods and drink. But remember, everything comes at a price and, in the long run, the costs of staying in an unhealthy place are always higher than the potential costs of changing your habits. All changes are hard at first, messy in the middle, and gorgeous at the end. If it is not hard at first, it is not the real change! A bird sitting on a tree is never afraid that the branch could be breaking because its trust it is not in the branch, but in its own wings. Until you spread your own wings, you have no idea how high and far you can fly.

Take the leap and you may discover wings you never knew you had.

Dr. Katarina Melzer

Be balanced, be free!

Equiliberty


Food for Body and Soul - part II. Whome to blame for current obesity epidemic?

Food for Body and Soul - part II.

Whome to blame for current obesity epidemic? The environment or ourselves?

19. January 2023.

The current obesity epidemic is the result of multiple, complex and interacting dynamics, which have progressively converged to produce lasting changes in people’s lifestyles.

Overproduction of food

First comes overproduction of food. In order to increase quantity of food, more and more crops are grown using chemical fertilizers. These industrial grown crops grow more quickly, but this also gives them less time to accumulate important nutrients. Industrial crops also develop smaller and shallower root systems than organically grown plants and, therefore, have less access to soil minerals than deeply rooted plants. In addition, organically grown crops contain more phytochemicals, which defend plants against pest and diseases, and many of which have important antioxidant, anti-inflammatory, and other beneficial effects for humans.

Because plants growing on organic farms are not sprayed with synthetic pesticides, they are forced to defend themselves and, therefore, produce between 10-50% more of these valuable secondary compounds than conventionally grown plants. Thus, our quantitative overproduction of food has come at a significant cost to its quality. An analysis of British government data found that, from the 1930s to the 1980s, there have been “marked reductions” of 7 minerals in 20 fruits and 20 vegetables¹. In result, already in 1991, you had to eat three apples to get the same iron content supplied by one apple in 1940; and the iron content of meat products declined by an average of 54%.

Food transportation and storage

In addition, due to long time spent in transport and storage, most fruit and vegetables are picked green and ripened artificially. Produce picked early does not develop sunlight-related nutrients such as anthocyanins and polyphenols—compounds that give fruit their color and flavor, and which protect humans against DNA damage, brain cell deterioration and cancer. For example, blackberries picked “green” contain 74 mg of anthocyanins, compared to 317 mg in ripe ones – more than four times less. Apples and apricots have no vitamin C when picked green, but significant concentrations of the vitamin when picked half or fully ripe².

Food technology

The industrial production of food also brought along major changes in food production technologies. Today, ingredients are being dehydrated to prevent them from spoiling, but this makes them more energy dense. Moreover, in order to make products more palatable, whole wheat is turned into white flour, and brown rice into white rice, thus eliminating 50-96 % of the fiber, vitamin and mineral content². Then, enormous amounts of sugar or fat are added to make products tastier, thus further increasing the energy content of already energy dense foods. Finally, our food gets seasoned with tons of additives and preservatives – not in order to ensure the longest and healthiest life for the customers, but the longest shelf-life for the products in an air-conditioned, blind-story supermarket.

Ultra-processed food

This is what in the food industry we call “ultra-processed food” or, in full, “low-quality energy dense food, high in free-sugars, sodium and fats, and low in protein, fiber, minerals and vitamins, that contain little to no whole food” – for our convenience, we may also just call it “junk food”. The list of such ultra-processed junk food is long, perhaps much longer than most of us would spontaneously think. It ranges from usual suspects such as carbonated drinks, chocolate, candies, cakes, biscuits, pastries, desserts and ice-cream, and powdered and packaged “instant” soups, to sweetened breakfast cereals, packaged breads with emulsifiers, ready to eat pasta and pizza dishes, noodles, margarine, spreads, pastries, energy bars, energy drinks, poultry and fish nuggets and sticks, sausages, burgers, hot dogs, and includes even purportedly “healthy” foods, such as sweetened and flavored yogurts, milk-based drinks and fruit juices.

As a result of overproduction, the availability of calories per person worldwide increased by approximately 500 kcal/day. Roughly 15% of these calories stem from sugars, another 15% from added fat, some 50% from (mostly refined) grains; and the remaining 8% from fruits and vegetables – all of which supplies lots of energy but very little of anything else.

Ultra-processed foods are convenient (durable, ready-to-eat, drink or heat), attractive (hyper-palatable) and profitable (low-cost ingredients) and increasingly displace foods that humans have been eating throughout their evolutionary history. Currently, the percentage of calories of an average diet that comes from ultra-processed food is about 30% in Spain, 50% in Canada, 60% in the US, and even 80% in Germany. But the food industry did not stop here. In order to deliberately encourage over-consumption, they started to supersize their food and beverages because, as research has shown, people presented with large portion sizes tend to “overdose”, i.e. they end up eating unintentionally up to 30% more than they would otherwise eat³.

As far as our nutrition is concerned, the major health problems we currently observe are primarily rooted in excessive caloric, salt, and saturated fat intakes. At the same time, we have inadequate intakes of vitamin and antioxidant-rich fruits and vegetables, and fiber. A diet based on quantity rather than quality has brought a new creature onto the world stage: a human being that manages not only to be overfed, but also to be malnourished, two characteristics seldom found simultaneously in the same body in the long natural history of our species.

Is Health Care the Answer?

Without any doubt, we are the most comfortable generation that ever lived on this planet, sacrificing our health, well-being and productivity for short-sighted benefits of ease and convenience. Even when we start to feel the consequences of our self-destructive behavior, we usually start blaming the scale, the shrinking laundry, the kids, and the weather, soothing our emotional discomfort with intensified compensatory eating, excessive drinking or smoking. Once we realize that passive worrying and blaming our circumstances is not going to solve the problem, most of us already give up and turn to the health care industry for salvation.

Unfortunately, just like the food industry, the health care industry does not keep us healthy. We are running a system of “sick care”, not “health” care. The medical system has perfected the art of keeping us alive after the modern lifestyle has made us sick, because the only contact we get with the medical system is once we are already sick. And the medical system certainly has little or no interest in shrinking its own customer base. In fact, its purpose is to turn obesity and related diseases into business opportunities: diet pills, heart bypass surgery, insulin pumps, bariatric surgeries. So let’s get real: just like any other industry, the health care industry prioritizes profit over people, prescription over education, and treatment over prevention.

Ultimately, however, our life, our health, our happiness and our satisfaction are our responsibility, and cannot be found in the magic boxes sold by the food industry, nor in the magic treatments offered by the health care industry, but only in the magic of our own resolve and self-discipline.

For the absolute majority of us, our health and our productivity is what we choose it to be. As long as we keep blaming others and try to outsource our responsibility, we will be good customers but unhappy people, seeing ourselves as victims unable to respond to the challenges of living a healthy life in our modern world. Because, in essence, “respons-ability” means the “ability to respond”. Without it, we are predestined to fail. We may have all the right arguments and excuses but, deep inside, we will always know we have just chosen the path of least resistance, deluding ourselves that we are actually comfortable being increasingly uncomfortable.

Is Natural Body Self-Regulation the Answer?

Ok, we may say, but doesn’t the body simply self-regulate and adapt food intake to its actual needs? In fact, the body’s natural energy balance regulation has long been my main research interest. Indeed, as my research at the Swiss Federal Institute for Sports has shown, prolonged increase in energy expenditure due to exercise is automatically followed by an equivalent increase in caloric intake. For example, during the Tour de France, a 22-day cycling race of up to 4000 km, cyclists expend 4-5 times their basal metabolic rate, around 7500 kcal, which corresponds to about 20 hours of jogging!

So, in order to retain their body weight, they have to increase their energy intake. This self-regulation happens naturally, but only when we increase our physical activity level to around 2 (i.e. two times our basal metabolic rate) which corresponds to approximately 2-3 hours of moderate to vigorous physical activity per day. Unfortunately, it does not work in the other direction in sedentary lifestyles. When a person does no physical work, the body will not recognize that it is being overfed and will not compensate the absence of activity with a reduction of food intake. Why?

Historically, of course, this was an important survival mechanism. Our hunter-gatherer ancestors would use every opportunity to feast and build up reserves of fat against future famine. But what represents a useful adaptation in an environment of food scarcity and unpredictability, is simply a disaster in an environment of abundant junk food, where the “feast” never ends. Since our DNA has not changed much in the past 50’000 years, our bodies frantically keep storing fat reserves for times of famine that never come. At some point, of course, the body starts being oversaturated with the stored energy that is not being used for muscle activity. Sugars, fats and cholesterol accumulate in our organs and blood and start to cause dysregulation of our hormonal and metabolic system, diabetes, or cardiovascular diseases. Overall, if we want to avoid obesity and chronic diseases, we cannot rely on the body to self-regulate, but we must adapt our energy output to our energy intake, or vice versa. For  most of us, this means 2-3 hours of physical activity every single day.

Is “Superfood” the Answer?

No generation before us worried more about health consequences of their food choices, and no generation before us suffered from as many diet-related health problems. We are an unhealthy generation obsessed with healthy eating! The self-help market is full of gurus, athletes and celebrities promoting contradictory and confusing nutritional doctrines, many of which have little or no basis in science, but offer empty promises of overnight success, health, and happiness ever after.

For example, Reese Witherspoon promotes a “Baby Food Diet”, which involves eating 14 jars of baby food per day, with the option of adding in one actual low-calorie meal. Should you do it? No. The jars of baby food are 80 calories. Eat 14 and you end up with roughly 1000 calories each day plus one real meal. So long as the meal you allow yourself is about 400 calories — think a small piece of grilled fish or lean meat and some sautéed veggies — you’ll definitely lose weight. But it will be because you’re not eating enough calories to maintain your weight, not because mushed-up fruit is a miracle diet product.

Christina Aguilera ate foods of a different color for every day of the week. Day one starts with white, which is followed by red, green, orange, purple, yellow, and, on the seventh day, all of the colors. I am not going to discuss the scientific merits of this colorful diet here, except to point out that, if you choose to go for this one, you can just eat as much gummi bears and m&m’s as you want, as long as you switch the color each day. I’ll let you do the math on the calories yourself.

Another diet virtually impossible to ignore is the “gluten-free” diet, which is promoted by celebrities for weight loss, and by athletes for improved performance. Gluten is a high molecular weight protein found in grains, including wheat, barley and rye. But while celebrities including Novak Djokovic, Gwyneth Paltrow, Miley Cyrus, and Victoria Beckham all reported to suffer from gluten sensitivity, 50% of Americans buy gluten-free food for reasons other than gluten sensitivity, believing that is generally healthier. As a result, Between 2004 and 2011, the market for gluten-free products grew at an annual rate of 28%, with sales estimated to reach $2.6 billion in 2012 and $6.6 billion in 2017.

Then there is the “low-carb ketogenic diet”, of course: high in fat, low on evidence. Normally, the body’s main source of energy is blood sugar, which comes from carbohydrates. In the absence of blood sugar (that is restricted to 20-50 g on this diet), we start breaking down stored fat into molecules called “ketone bodies” until we start eating carbohydrates again. Because it lacks carbohydrates, which normally account for at least 50% of our diet, a ketogenic diet is rich in proteins and fats and typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables (very low carb vegetables such as cauliflower and leafy greens), but very few fruits and vegetables, with unknown consequences in the long-term. The diet is heavy on usually uncontrolled sources of red meat and other fatty, processed, and salty foods that are notoriously unhealthy.

Of course, the list of “superfoods” and magical diets could continue endlessly. In nutritional science, however, the term “superfood” does not even exist. In fact, the recommended science-based healthy reference diet largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils, and includes a low to moderate amount of seafood and poultry, and no or a low quantity of red meat, processed meat, added sugar, refined grains, and starchy vegetables. It really is as simple as that! Obviously, within these broad recommendations, plenty of variations are possible to suit personal preferences, and there really is no sound scientific basis for being more specific – variety is an important part of avoiding one-sided diets.

Even science-based research reporting adverse health effects of specific unprocessed foods should be taken with caution, particularly when the physical activity level of the evaluated persons was not adequately taken into account. Studies showed that such negative effects of particular ingredients tend to be insignificant for persons with sufficient levels of physical activity.

 

….to be continued (in Food for Body and Soul – part III).

 

Dr. Katarina Melzer

Be balanced, be free!

Equiliberty

 

References:

  1. Mayer Anne-Marie. British Food Journal. 1997; 99(6): 207 – 211.
  2. Brian Halweil. Critical Issue Report. Still No Free Lunch: Nutrient levels in U.S. food supply eroded by pursuit of high yields. The Organic Center. September 2007
  3. Pollan M. The Omnivore’s dilemma: a natural history of four meals. Pinguin Random House, 2016.


Food for Body and Soul - part I. Food - a Matter of Life or Death

Food for Body and Soul - part I.

Food - a Matter of Life or Death

12. December 2022.

Let us go a little bit back in time. Ever since we have come down from the trees, hording in social groups of hunters and gatherers and started taking meals together somewhere in a cave, eating has been as much about culture as it has been about biological necessity. Therefore, food is not only about physical survival, but also about pleasure, about community, about family, friends and spirituality, about our relationship with the natural world and with each other, and about experiencing our own identity.

This also means that our eating habits are quite complex. There are many reasons for eating other than nourishing your body, and so it is not surprising that, very often, we eat without being hungry, or we don’t eat despite being hungry, or we eat something our body does not need or want, or that is not even good for us.

I am sure you will agree with me that we may be the most comfortable and abundant generation in human history, but we certainly are not the most healthy, happy and satisfied humans who ever lived on this planet. Our modern, speedy, stressful but effortless life, free from physical exertion, and abundant in food, has come with a high price tag.

Not everything looks bad at first sight

In the last 70 years, on a global scale, life expectancy increased by more than 20 years¹. Medical practitioners and scientists would be proud to attribute these results to improved medical care, guidelines and recommendations. But let us not celebrate too early. The truth is that, out of the 20 years that we live longer than some 70 years ago, we spend a whole decade in poor health, under medications, in disease or disability¹!!!

In the last few decades (1990-2017) neonatal disorders and so-called “infectious” or “communicable” diseases (such as tuberculosis, influenza, malaria, and sexually transmitted diseases), which had long been the primary causes for increased mortality and morbidity have seen a sharp decrease worldwide (40%)¹. At the same time, however, some new diseases emerged, which our great-grand mothers and fathers probably did not even know existed. Contrary to infectious diseases, which can spread and kill quickly and cause mortal pandemics, the newly emerging diseases degrade your health slowly but surely, until you die! These so-called “chronic” diseases are now responsible for 80% of disabilities worldwide, namely cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and mental illnesses².

But what is interesting is that the majority of these diseases are the effects of nothing else but what we eat and drink (alcohol and tobacco included), how much we exercise and how we respond to stress³. As simple as that!!!

Our health today

We know that, today, 70% of Americans are overweight, and 40% obese. As you may have guessed, only 20% are meeting current physical activity guidelines and, of course, they eat excessively, with as much as 60% of calories coming from ultra-processed, so-called “junk food”. As a consequence, no less than 70% of Americans aged 45-64 years and 90% of those aged >=65 years are on some sort of prescription drugs, with 9000 $ of personal health care expenses every single year! Every third (30%) dies of a heart disease, every fifth (20%) due to cancer, and every sixth (15%) due to diabetes. And that is not all: the most dire projections point to almost 90% of Americans being overweight or obese by 2030 – that’s just a decade away!

Now you may think this is an American anomaly, but it is not. Today, even in Europe, already more than 50% are overweight or obese (13% obese). While some countries are resisting the obesity trends (like Italy (7%), Sweden 10% (Austria, Czech Republic, Poland, Hungary), France 12%, Spain 14%), Serbia (21.9%) and Croatia (21.5%) are becoming some of the leaders in this game. Interestingly, the prevalence of overweight and obesity remains the highest even among migrants from former Yugoslavia living in other countries. For example, in Switzerland, where the overall prevalence of overweight and obesity is one of the lowest in Europe, migrants from former Yugoslavia have a 5 times higher chance of being overweight and obese compared to migrants of any other European country.

The truth is that, every single year, food is responsible for killing almost 700’000 in America, and 11 million worldwide! Compare that to approximately 100’000 people being killed every year by all wars taken together. As you can see, the most deadly weapons ever used by humanity are not firearms, bombs or even nuclear weapons, but simply our forks and knives!

 

Dr. Katarina Melzer

Be balanced, be free!

Equiliberty

 

References:


Food as an emotional substitute

Food as an emotional substitute

18. November 2022.

People can be addicted to food, alcohol, nicotine, drugs, shopping, work, gambling, smartphones, internet, sex tapes, video games, extreme sports…. – anything that can temporarily suppress negative emotions and, therefore, give us a sense of peace, control, and calmness.

If a healthy person is addicted to overeating, the solution generally is not just to abstain from food, but to understand why overconsumption of food is taking place at first place.

Food can become a substitute, when we lack emotional nourishment. When we feel that we do not exercise real power over our lives, we move towards whatever offers us a sense of safety and protection (even if that protection comes in the form of extra fat depots surrounding our body). When obesity becomes an emotional armor, major weight loss can be perceived as sexually or physically threatening, despite its objective health benefits.

But why are we seeking emotional protection?

From the moment we are born, we have an innate need to connect with others. If the bond provided by our parents, caregivers and surroundings is strong, safe, stable and protective, we are naturally able to trust and connect with ourselves and others in healthy ways. However, if we are neglected and isolated, and do not experience secure attachment, we tend to struggle with trust issues. Later in life, we are usually unable to bond, and will constantly seek for relief from our feelings of lack of acceptance, connection and protection.

How many of us compensate for our perceived lack of value by becoming work-a-holics? How many of us for our sense of being unwanted by becoming sex-a-holics? How often do we suppress our true selves and become people pleasers, in order to cover feelings of not being accepted and valued for exactly who we are?

And so, a self-destructive cycle is triggered: by suppressing our feelings, we become de-pressed. Under extreme tension and with no one to share it with, we tend to become hyper-tensive. Living life with a lack of “ease” makes many of us “ob-esed” and “dis-eased”.

Food as an emotional substitute

You get my point: overeating, just as any other addiction, is not a problem itself, it is only a marker for other, pre-existing problems. It is a coping mechanism that attempts to suppress the emotional discomfort we experience, generally because of unresolved trauma suffered earlier in life.

Developing healthy interpersonal connections as part of our recovery and healing is not easy. Overcoming our lack of trust and connection, often rooted in early life experience, requires self-awareness, forgiveness, and patience. In order to truly heal and learn to trust and connect with our surroundings, we first have to create a sense of safety, trust and connection within ourselves. For this, we have to make peace with our past, accept the reality of our present, and then harness our power to shape a future that honors our bodies, our souls and the truly miraculous beings we are.


Energy Balance Regulation Course by Dr. Katarina Melzer - this time in Vienna, Austria

Energy Balance Regulation Course by Dr. Katarina Melzer- Vienna, Austria

3. September 2022.

This year, like every hear, it is a great feeling to be back at ESPEN (European Society for Clinical Nutrition and Metabolism) for chairing, moderating and teaching the LLL module on Nutrition and Physical Activity, this time in Vienna, Austria.

Module:

Physical Activity and Health: Energy balance regulation – Katarina Melzer

Learning objectives

  • Define physical activity, exercise, physical fitness and physical fitness components, as well as intensity, volume, duration and frequency of physical activity.
  • Present current physical activity recommendations for healthy subjects.
  • Discuss the factors influencing the energy balance equation.
  • Describe energy content and energy conversion factors of food.
  • Discuss the factors influencing energy expenditure during resting state.
  • Clarify the difference between resting and basal metabolic rate.
  • Question the widespread application of a “metabolic equivalent (MET)” value to all individuals and population subgroups.
  • Describe anaerobic and aerobic pathways for energy production during physical activity.
  • Explain the influence of exercise intensity, duration and mode on substrate utilization.
  • Explain the influence of training, diet and gender on substrate utilization during exercise.
  • Present latest findings on the effects of physical inactivity and activity on ad libitum energy intake and its impact on energy balance regulation.
  • Clarify the effects of energy imbalance on body weight and composition.
  • Briefly discuss other factors influencing energy balance regulation.

See you next year in Lyon!!!

Dr. Katarina Melzer


The first meal of the day can make all the difference!

The first meal of the day can make all the difference!

15. June 2022.

Thanks to TV channel Prva Srpska Televizija for having me on the program for fun time chatting about health and nutrition and exchanging recipes!

The first meal of the day can make all the difference, especially when it is nutritious, natural and filling!!!

I never skip breakfast due to its numerous health benefits (decreased risk of obesity¹, high blood pressure, high cholesterol and diabetes², improved cognitive function, memory, concentration, alertness and mood³).

I start my day with a bowl of all-natural Greek yogurt with fresh fruits, flavored with garam masala spice and sprinkled with 1 tablespoon of my favorite home-made muesli/müsli rich in fiber, protein, vitamins, minerals and antioxidants. It gives me loads of energy and helps my body perform at its best.

Here is my one and only homemade muesli recipe:

200 gr hazelnuts (roughly chopped)

100 gr pistachios (roughly chopped)

200 gr almond pins (slivered almonds)

100 gr sliced almonds

100 gr sesame seeds

200 gr coconut strips

100 gr sunflower seeds

100 gr flex seeds

100 gr dried fruits (for ex. cranberry, apricot)

1 tbsp=90 kcal

Roast all ingredients (except dry fruits) in the oven (130 C) for 20-25 min (mixing them from time to time). Take them out of the oven. Add the dried fruits. Voila!!!

The muesli can be kept in an airtight container for several days.

Tips to build a healthy breakfast:

  • Always use a homemade muesli. Avoid prepared muesli (bought in supermarkets) as they are rich in additives, fats and added sugars.
  • If you roast nuts yourself, keep the temperature relatively low (not higher than 130-140 C). Roasting nuts at high temperatures may damage their healthy fat, reduce their nutrient content and lead to the formation of a harmful substance called acrylamide.

Dr. Katarina Melzer

 

References:

  1. Obes Res Clin Pract. 2020; 14 (1):1-8.
  2. Public Health Nutr. 2015; 18(16):3013-9.
  3. Nutritional Neuroscience, 25:6, 1250-1264.

…..

(Translation in Serbian)

Hvala Prvoj Srpskoj Televiziji na pozivu da učestvujem u emisiji! Evo šta smo pripremali!

Sladak jogurt sa voćem i muslijemSastojci za musli:200 gr lešnika100 gr pistaća200 gr badema u sitnom komadu100 gr badema u listu100 gr sesama200 gr kokosovih listića100 gr suncokretovog zrna100 gr lanenog semena100 gr suvih brusnica

Priprema:Lešnike i pistaće sa mašinom za seckanje ili ručno grubo usitniti na manje komade. Dodati ih mešavini ostalih sastojaka (izuzev suvih brusnica). Mešavinu ravnomerno rasporediti po plehu. Pleh ubaciti u zagrejenu rernu i peći 20-25 minuta na 130 stepeni. Izvaditi pleh iz rerne i ostaviti musli da se prohladi. Dodati brusnice ohlađenom musliju.  Savet: Posle 5 minuta pečenja dobro promešati da bi semenje podjednako porumenelo sa svih strana. Musli servirati sa grčkim jogurtom zaslađen sirupom od javora, i začinjeno garam masala začinom.


What do we know about Muesli?

What do we know about Muesli?

15. May 2022.

In the beginning, Muesli was quite different – its name, its image, its purpose, its consumers, and even its recipe!

Developed by Swiss doctor Maximilian-Max Bircher-Benner as Apfeldiätspeise (Apple Diet Meal) in 1900s, Muesli was never a breakfast idea, nor a quick snack swallowed in a hurry between appointments. Muesli was intended as a starter to every meal: breakfast, lunch and dinner!!! For some enthusiasts, later, it became a Schweizer Znacht, a Swiss dinner. But breakfast? Never!!

Unlike most of the pre-packaged Muslis sold in supermarkets nowadays, the original main ingredients of the Apfeldiätspeise (Apple Diet Meal) were, as the name indicates, apples and not cereals: 200 grams of freshly grated apples with just one level tablespoon of well ground oats (soaked in 3 tablespoons of water and 1 tablespoon of milk), a tablespoon of finely grated nuts, and the juice of half a lemon!¹

The word Müsli (Muesli) is the diminutive form of the word Mus in Swiss German, which means purée, as the focus in the original recipe was on the freshly grated apples (very similar to an apple purée) and not, as we might think, on the soaked oats.

The history of Muesli

But how did Muesli find its way from its creator – Swiss doctor Bircher, to the breakfast table of nearly everyone all around the globe?

Upon finalizing his medical studies at the University of Zurich, Bircher opened a general practice in Zurich’s industrial quarter. During the first year, however, Bircher developed jaundice, which weakened his immune system. Conventional remedies proved unsuccessful, and he decided to rely on his self-treatment, most notably a diet of raw fruit and vegetables. The meals, which were particularly rich in raw apples, worked astonishingly well, and he soon cured himself fully.

Convinced of the healing power of raw fruit and vegetables, Bircher immersed himself in the study of the effects of raw food on the body, and conducted numerous nutritional experiments with fresh fruit and vegetables. Following the successful treatment of a woman with chronic stomach problems using a similar diet rich in raw apples, he finally developed a recipe that has become a classic around the globe, Muesli or Birchermuesli.

At that time, industrially-processed flour, sugar, and spirits, as well as the increasing consumption of meat started to characterize modern society’s eating habits, and raw vegetables and fresh fruit were considered to be worthless side dishes, indigestible as well as a source of infection due to their quick spoilage. Bircher argued against this view. He believed that raw foods were, instead, most nutritious because they contain direct energy from the Sun, and that food processing deprives foods of their nutritional content and destroys their “vital substance”. Bircher’s peers in the mainstream medical establishment dismissed his views as unscientific and branded him a quack who “crossed over the border of science”.

In 1904, Bircher opened his “Vital Force” sanatorium (Lebendige Kraft) in the prestigious hills above Lake Zurich, a little way down from the noble Dolder Grand Hotel, to serve as a “clinic for inner illnesses and health problems of body and soul.”  The sanatorium treatment included a nutritious diet (where fifty percent of the daily intake consisted of raw unfired fruits, nuts and tastefully prepared vegetables made up into salads, dressed with olive oil and lemon-juice, and seasoned with aromatic herbs), physical activities (walking in the forest, gardening) and methods of healing and psychotherapy. The patients were advised to write a diary and express their feelings. Bircher-Benner was convinced that people should pattern their lives as closely as possible to nature, and that only harmony between the body, soul and spirit could lead to health and vitality.

His holistic approach worked, and the sanatorium became one of the most renowned places for healthy living in early 20th century Europe. A growing number of celebrities and wealthy people stayed there, including violinist Yehudi Menuhin and politicians like Sir Stafford Cripps, Habib Bourgiba and Golda Meir, and German literate and Nobel Prize laureate Thomas Mann, among others.

The original recipe

A typical meal at the sanatorium would be:

– a starter of Apfeldiätspeise (Apple Diet Meal) i.e. Muesli (apple purée), served fresh, at the beginning of every meal, before anything else;

– a main course of a raw vegetable platter, consisting of chopped leaves and grated roots;

– a small cooked dish, often vegetarian but not always;

– a dessert.

When cooking had to happen, he allowed steaming (rather than boiling) or slow cooking over low heat. He avoided prescribing drugs wherever possible.

 

Muesli was prepared as follows²:

Apples: 2-3 small apples or 1 large one. Do not take away the skin, core, or pips.

Nuts: 1 tablespoon of walnuts, hazelnuts or almonds.

Rolled Oats³: 1 tablespoon previously soaked in 3 tablespoons of water for 12 hours.

Lemon Juice: The juice of half a lemon.

Milk and honey or sweet condensed milk: One tablespoon. (The Swiss health reformer knew that the use of industrially processedmilk went against the grain of his basic argument. Yet he adopted it for reasons of hygiene).

Preparation

Mix milk, honey and juice of lemon with soaked rolled oats. Grate the apples including the skin, core, and pips vigorously. Stir it continually to prevent apples from getting brown in contact with the air. Sprinkle the mixture with the grated nuts or almonds.

Bircher is said to have taken inspiration for his recipe during a hike in the Alps, when a dairymaid had served him the dish. Alpine shepherds had apparently eaten the apple purée with some oats and nuts for hundreds of years.  Bircher thus revived an old custom, using the four ingredients of fruit, nuts, milk and oat flakes – a healthy combination that has been passed down through the ages.

Fast forward to present time, seeing people starting every single meal with the bowl full of graded fresh apples seem unrealistic. Living in harmony with nature and with one another appears to be too idealistic. Prioritizing people’s own health and well-being seems to be regarded as a naive fairy tale told by the health visionaries of the last century. Present modern time brought along something different, something that Bircher would have never imagined coming: speedy, stressful and effortless life, free from physical exertion, deprived of contact with nature and human connection, and abundant in everything but not raw foods.

Fresh fruit and vegetables are downsized to 5% of daily consumption, while instant processed foods loaded with added sugars, bad fats and additives are continuing to be oversized in any other possible way: in quantity, variety, affordability, advertising and even in serving sizes. Even Muesli become popular only when its cereal and sugar content was increased!!!

As a consequence, 70% of Americans are currently overweight, 40% obese, with only 20% of them meeting current physical activity guidelines. It thus comes as no surprise that 70% of Americans aged 45-64 years and 90% of those aged >=65 years are on some sort of prescription drugs, with 9000 $ of personal health care expenses every single year! Every third person (30%) dies of a heart disease, every fifth (20%) due to cancer, and every sixth (15%) due to diabetes. And that is not all: the most dire projections point to almost 90% of Americans being overweight or obese by 2030 – which is less than a decade away!

In reality, people are dealing with increased levels of chronic illness that are now responsible for 80% of disabilities worldwide, in a society that trades quality for quantity, equality for inequality, connection for separation, closeness for loneliness, in an environment where our sense of unity is under assault, largely forgotten or unrecognized; in a world proclaimed the loneliest that has ever existed. Especially now, after two years of COVID pandemic, one of the biggest lessons we should have learned is to recognize the indispensability of human connection. Health is not just a physical thing, it is a mental and social thing.

Doctor Bircher was convinced that only harmony between the body, soul and spirit could lead to health and vitality. Let us be wise, and follow his advice!

References:

  1. Meyer-Renschhausen E, Wirz A. Dietetics, health reform and social order: vegetarianism as a moral physiology. The example of Maximilian Bircher-Benner (1867-1939). Med Hist. 1999;43(3):323-341.
  2. Wolff, E. A new way of living: Maximilian Bircher-Benner (1867-1939). Karger Gazette. 2010; (71):11-12.
  3. Klose C, Arendt EK. Proteins in oats; their synthesis and changes during germination: a review. Crit Rev Food Sci Nutr. 2012;52(7):629-39.

 

Dr. Katarina Melzer


Health in a lonely world

When we look at the world today from the perspective of health, what do we see?

10. October 2021.

We see people who are dealing with increasing levels of illness, from obesity-related chronic disorders, to depression and anxiety. We see people fighting stress in a society that trades equality for inequality, connection for separation, closeness for loneliness; in an environment where our sense of unity is under assault, largely forgotten or unrecognized; in a world proclaimed the loneliest that has ever existed.

That world of false stardom teaches us to suppress our feelings, so we tend to become de-pressed. Under extreme tension and with no one to share it with, we tend to become hyper-tensive. Living life with a lack of ease made many us ob-esed, and dis-eased. Chronically.

Now, whom to turn to for an advice or a helping hand, in a world where our authenticity is lost in the name of progress, and with the constant message “you are not enough”?

The crucial problem in dealing with obesity is not only to learn what people should eat, but also to learn why people overeat. In as much it is necessary to learn how food energy is stored and utilized, it is equally necessary to understand what motivates us to start or stop eating. We cannot separate body from mind, physiology from emotions. Only when we have this fundamental understanding will those who practice nutrition be able to do more than offer calorie guides and suggest willpower for prevention of obesity.

You are enough!

 

Dr. Katarina Melzer

Be balanced, be free!

Equiliberty


Live virtual congress on Clinical Nutrition and Metabolism 2021

In light of the current situation related to the coronavirus (COVID-19) pandemic, the European Society for Clinical Nutrition and Metabolism (ESPEN) has decided to embrace a second, fully virtual format for the 2021 Congress.

A selection of updated and enhanced Life Long Learning Courses (LLL)  will be held virtually from 7-12 September. This year’s main objective is to improve the knowledge, competence, and skills of healthcare professionals and students in Clinical Nutrition and Metabolism. The courses are open to all healthcare providers, including doctors, pharmacists, dieticians, and nurses.

Session 12: Nutrition and Physical activity

Moderator: K. Melzer (CH)

 

14:00 – 14:30   Module 37.1.    Energy Balance Regulation: Effects of Exercise on ad libitum Food Intake

Speaker: K. Melzer (CH)

 

14:30 – 15:00   Module 37.2.    Physical Activity in Chronic Diseases

Speaker: J. Mareschal (CH)

 

15:00 – 15:30   Module 37.3.    Nutrition for Endurance and Strength Sports

Speaker: N. Rotovnic (SI)

 

15:30 – 16:00   Module 37.4     Fluid, Electrolyte Balance and Ergogenic Aids

Speaker: B. Knap (SI)

 

16:00 – 16:50    Q & A, Case discussions

 

17:00 – 18:00    Feedback & Test


The Science of Nutrition Webinar

The Science of Nutrition Webinar

5. October 2020

The Science of Nutrition Webinar – Book your seat!

17 Oct 2020, Nutrition Course Webinar, Amman, Jordan


Journée genevoise de nutrition clinique

Journée genevoise de nutrition clinique

1. September 2020

32e Journée genevoise de nutrition clinique.

23 Sept 2020, Nutrition and Sport, Moderator: Dr Katarina Melzer

For more information, please visit SSNC/GESKES.

Come and join us!

Katarina Melzer


Nutrition and Physical Activity Webinar - Join Us!

Nutrition and Physical Activity Webinar - Join Us!

25. August 2020.

This year, we are celebrating the 10th Anniversary of the Life Long Learning (LLL) Module in Sport and Nutrition at the ESPEN Congress. Since its first roll-out in 2010, interest has continued to grow with more and more attendances every year.

As Chairperson and Director, I would like to warmly thank all those countless colleagues and friends, who have helped to shape and deliver the module throughout these years. Without them, we would not be where we are today.

At the same time, I also would like to warmly welcome our new lecturers, whose expertise and experience will contribute decisively to the module’s continued growth and success in the future.

This year’s module, newly updated and renamed “Nutrition and Physical Activity”, will address four key topics:

Physical activity and health: energy balance regulation.

Physical activity and chronic diseases.

Nutrition for endurance and strength sports.

Fluids, electrolyte balance and sports supplements.

Join us!

ESPEN 2020 Virtual Congress

www.espencongress.com

Dr. Katarina Melzer