Orthorexia, What Is It and What are Orthorexia's Indicators? "Sequential Eating", Does It Have Any Benefits? Which Supplements Can Best Combat a Cold or Flu?

then overeating later. The quest to be healthy can become an obsession, and on today's episode, we discussed the presentation of all thorexia and the signs that trying to be healthy may have gone a little bit too far. Hi, I'm Susie Burrow and on Leah Lord and as two of us traders leading dieticians who specialize in evidence based nutrition, we bring you the Nutrition Couch podcast, a bi weekly chat on everything that is new in the world of food,

diets and nutrition, as well as authorexia. Today we look at a new way of eating called sequential eating, which actually has some evidence to back it for the right person. And our listener question is all about colds and flu season and what are the supplements we can try to help you recover quickly if you've been sick. But first of all, Yat, I know you've been a little bit sleep deprived because baby Meya is getting some teeth. How is that going?

It's just a nasty cold that's going around. Everyone at the moment just seems to have some sort of cold or flu or bug or you know, COVID's still out there as well, So there's just been a lot of sickness around like this. So we've had that in the household plus meters, had some teeth, and she's just been a little bit out of sorts lately. So the last couple of nights, you know, she's barely done an hour

one to two hour blocks. Nor she'll do a good three four five hour block and then we'll get up feeder, she'll do another two three hours feet and then she might go back down for an hour or so and a good day.

we're in this together. She's she's cut her first two bottom teeth, so I think the tea things sort of stopped now at the moment, I think it's more just she's just I don't know a little bit out of thoughts unsettled. She might have picked up a little bug or a little virus. I'm not really sure what's going on.

one of a better term hell with young children. But my advice to everybody and all the parents out there listening. I can't even remember the time. All I remember is just a haze. I couldn't tell you when teething was or when it was bad, other than there were some really bad times and there were some times it were fine. But for some reason you just seem to forget it all. So that's the good news. You'll get through and you won't remember how bad it is. So everyone has their

turn with it and you'll come through. And you know, like I said, mother, the boys now they're so tired at school, have very little drama with them, so you'll be right. Hang in there, hang in there.

If anything, I probably am a bit jaded. But last night I was scrolling Twitter at a time I really shouldn't have been, and I saw this reference to a new passion of eating called food sequencing, And I have never heard of this before, And when I took a little deep dive, apparently it's out there and there's a couple of key articles on it when was published on The Conversation, which is quite a reputable online evidence based publication.

And to put it in the most basic of terms, it is we wouldn't call it food combining because that's separate altogether. But it's basically looking at the macronutrient or breakdown of the foods we eat. So, for example, saying a meal will have a mix of protein rich foods, carbohydrate rich foods, low energy density foods, so salads and vegetables,

and then things like your start sheet carbohydrates. And the theory is for people who are more sensitive to fluctuations in glucose levels, so perhaps those with hyperglycemia or insulin resistance or pre diabetes, people who really suffer from that peak and then the drop where they get really craving

and times overeat. The argument is if you eat what we would call the low energy density foods first, so salads or soup, follow that with the protein rich foods I say, the chicken or the meat or the dairy part of the meal, and then finish with any starchy carbohydrates, that any peak in glucose levels will be flattened and leave you less prone to energy fluctuations and cravings, which

is better for glucose regulation long term. Now, as I said, it's not that it's new science as such, because we know roughly that that is the way scientifically food will break down. You know, a few food combine or have protein with carbohydrate, it will help to control glucose levels. But this is the first time I've seen it referred to as a movement around going out of your way to.

at it, which to me was really quite surprising. So in one study they were looking at participants consuming a way protein based shake thirty minutes before a meal that had potato in it with the goal of slowing gastric emptying and helping bloo glucose levels be controlled. And there was evidence to show this really did help reduce glucose spikes and the experience of that. So I thought, how interesting, because, as I said, in all the years I've worked in practice,

I've never heard it. And I thought, well, it's really quite novel and really interesting, and I don't know if I'll try it with clients or not, but I thought it was certainly worthy of a discussion, particularly for people who really struggle with those highs and lows through the afternoon, suggestive of perhaps some insulin issues or crimium deficiency, which can absolutely be associated with hyperglycemia, which is where you get really lo glucose levels and feel almost shaky.

that beneficial. Because there was another small study that tested five different meal sequences. So you know, some participants ate the carbs first, some participants ate the protein first, some participants ate the veggies first, and they all had to eat their meal within fifteen minutes, so the timing of

the meal was factored in as well. And of those five different meal sequences, none of those sequences actually made a difference to the overall spike in blood glue coase levels, whether they their veggies first, their meat first, their rice first. So I thought that was interesting. So there's not a

whole amount of evidence behind it. But if you are somebody who really does struggle with those big spikes in their glucose levels or struggles to get their blood glucose readings, you know more stable, it probably is something that's worth a trial. It's definitely not going to hurt you. But I do feel like sensible nutrition goes hand in hand.

Like if you're someone who has diabetes or is pre diabetic, if you're sitting at a restaurant waiting field meal and sipping on a soft drink or you're sipping on a juice, of course that's going to hinder you know, your blood sugar levels. But if you're someone who you've ordered a really lovely healthy salad and it's got some kinoi in it, and it's got some chicken in it, and it's got some avocado in it, I think just eating that meal

as a whole meal is probably absolutely okay. I think it really comes down to the amount of foods that we're eating as well. For having a huge bowl of creamy pasta, yeah, maybe it may be beneficial to have a salad first, or have I don't know, some Greek yoga or a protein hit before that to really reduce the overall spike of the those glue coase levels. So although there's not a whole I guess amount of research behind it, it is a kind of a cool novel concept.

You know, there are definitely probably some listeners out there, SUSI that do struggle with their sugar level. So I do think it's something that if we've got the time, I mean, I think it probably shouldn't take you know, any more time to eat your meal in a different sequence. To me, it probably wouldn't add much to the over experience of a meal. I really like to mix things up. I like to sort of have the flavors going all

through to together. I wouldn't like to just eat my chicken first and then my potato, then my salads or whatever, you know, whatever sequence first. I prefer to eat things all together. But I do think it's worth a try at home. It's not going to cause any harm and it's not going to you know, be negative, I don't think for anyone out there. So I think it's well worth a trial for alysis at home who do struggle with you know, highs and lows in terms of their sugars.

not dissimilar. But what we do know from volumetrics eating is that including a low energy density food before the meal or at the start of the meal, whether it's a broth type soup or a salad or even a plate of vegetables, is that you lead up to one hundred calories less per meal basically because it occupies some of the stomach and fills you up a little bit, same as drinking glass of water before a meal. So

it's a little bit of an extension of that. But I think as a novel aspect, particularly for people who really struggle through the afternoon, so those who are at really high risk of type two diabetes or no they have that real low feeling, it's probably worth a little play. It won't hurt. But as I said, I wouldn't be mucking around with shakes and things. All I would do is say start the meal with some sort of low

salad or bulk. You know, have then your protein and then you know, have any of the carbohydrate more towards the end to give that digestion and just see the effect. And if you find it works for you, it's a strategy that they're won't hurt and if it works fantastic. You know, it's not using any strange supplements, so it's really just you know, having a little look at physiology

and seeing how we digest food. And I think it also encourages people to really look at the makeup of their meal because the feedback I'm giving every daily and is where are your salad? Where's your vegetables? Because the meals are inevitably too much protein, too much carbohydrate. You know, people will have a big serve of chicken or a realasmably big serve of meat and then rice or noodles

in far excess of what should be there. Whereas I think if we take the focus back to a salad or veggies or soup to start as a bit of an entree, it's good for your nutrition in general. And then whether you eat the protein or the carb straight after each other, I don't think it'll make a massive difference. But I think just loading up with that bulk and that volume that we all need is a good strategy for all of us, and we could all benefit from

having more veggies in general. And then you know, if you want to take it to the extreme if you do want, you know, we wouldn't be encouraging people to have mashed potato anyway. We'd certainly want a potato in a jacket as the recommendation. It comes down to a little bit of carbohydrate quality and portion size that you know. Certainly, I think that there's a bit of fun in it, and if it works for you, it's certainly something to have a look at, and metabolically there would be some

evidence to support it. So yeah, I was quite interested, and I think we'll see a few articles on this coming through now because we're like something new in the tight space and I've never heard of that before. So you heard it here first on the Nutrition Couch podcast food sequencing and the association with glucose control. So let us know your thoughts if you've tried it and if it works for you.

I really do think have the meal that you're going to eat and maybe try to sequence out the different parts of that that you're going to have at a different timing, or you know, have one portion first, the next portion after, versus.

more necessarily in our diet. So it's a novel little concept, and it will be interesting to see if our listeners can provide us with any feedback if anyone's given it a go. But moving on to our client case study of the week, So Susie, this is I would say a condition that we've both seen more and more frequently within our clinics, particularly in our younger population, particularly in our females. So it's the concept of or the clinical

condition that we would call orthorexia nevosa. By definition, so, orthorexia nervosa is basically a disordered eating pattern that's characterized by the need or the obsession to eat completely clean and completely pure foods to the point that that individual or that person then becomes quite obsessive with this way of eating in this way of life. So orthorexia nervosa is commonly associated with and also social isolation. So if you were looking to have an exact definition, authorexia is

an obsession with eating healthy foods. Basically, that's probably the easiest definition, and it is now a diagnosed medical condition because you know, years ago, Susie, we had eating disorders that were anorexia oversia, we had bolimia. We never had a type of eating or a style of eating that really was focused on restriction and really focused around healthy foods.

I see my doctor? Should I see a dietician? These are maybe some red flags or some signs that things may have gone a little bit too far despite the best intentions. We I don't think anybody sets out to have an eating disorder, right, but it sort of just develops naturally over time. And for those of us with more of that perfectionist personality type and really like we're obsessed with being healthier, we fear unhealthy foods. I think

that's sort of the first red flag. So the number one sort of sign that you're healthy eating may have gone a bit too far is that you skip social occasions. So you're saying, no, I can't come to dinner, No, sorry, I can't eat out breakfast because you fear having to eat food that you haven't prepared yourself, or you bring all of your food to a social occasion, so you go to someone's birthday and you take your food in a top work container so you can eat that. Second sign,

your skin is really dull. It's breaking out, your hair's bawling out, basically, sort of like vitamin and nutrient deficiencies. Number three, if you're a female, if you've lost your period or it's very irregular, or if it used to be regular and now it's really a regular, or there's just changes within your period of cycle all you've lost it all together. Number four is you're constantly tied or you're constantly feeling very cold. Number five you've got recurrent

injuries or sicknesses. Number six, you only have a very limited range of foods that are quote unquote safe or you're able to eat. Number seven, you never ever have cake, chocolate, an alcoholic drink, or.

Sign Number nine is that people are constantly commenting on how thin you look or how much weight that you've lost recently. And number ten is that you're not happy with your body no matter what you do, no matter how much you weigh, no matter how much you eat or how much you exercise, You've always constantly feeling like you can do more, you should do more, you should

look differently. So those are sort of ten signs that maybe things have gone a little bit too far and there's a little bit of this obsession with health that may have gone towards more of an unhelpful place.

eating behavior and exercise behavior. So a classic presentation would be a typically young, sort of twenty thirty year old female who is slim and fit and healthy but wants to be slimmer, wants to lose that final two to

three kilos, which is debatable if it's there. They're already training, often multiple sessions a day, so this is often my goal, well not often because I don't want to put everybody in that group, but these are goals who perhaps will do a CrossFit early five am every day and then come and train again in the afternoon, plus doing their steps, and then on a really tight calorie restriction, so eating eight hundred one thousand calories, so chronically calorie deprived and

not ticking the box, and a number of their key nutrients.

and perfectionistic characteristics and anxiety in many cases. So it's more it's a slippery slope, isn't it, Because sometimes we start with healthy eating behavior and then we think more is better. And as we've discussed before, it's not a competition. You can't win the prize for being the healthiest eater. And even if you do, even if you tick the box on the healthiest eating, it doesn't guarantee any outcome. You know, the physiology and the body is a lot

more complicated than that, so it's a complex issue. Certainly, in many cases, I would say it's not only a dietary presentation. Often the referral is going back to GPS or psychologists to work on the underlying driver, which is often some psychology or anxiety or stress or trauma that's driving that more obsessive behavior. So certainly alone not a nutrition problem, but I think it also can present with teenage girls who start to eat healthy and become more

and more obsessed moving through those school years. So they are all little markers for parents listening with teenage girls who sort of tend to be a bit obsessive, become very body conscious, going to the gym more and more frequently, because yeah, it's a slippery slope to full blown eating disorder and becoming quite clinically underweight and doing damage to the body and resulting in things like stress factors as a result of chronically localcium intake and impacts on metabolic

rate because of chronically low So there are a few signs of it, and it does absolutely present, and you can really benefit from some nutrition therapy around hitting baseline calorie requirements and nutrient targets as a minimum, not overtraining

and underfuel, which is common. You know, if I'm seeing someone doing more than a couple of hours of intense exercise and they're not elite athletes, I'd be sort of questioning the driver for that, and certainly looking at things like the bloods and nutrient deficiencies, things like B twelve iron, zinc can all be impacted thyroid long term, and of course mood. You know, we know that mental health issues

are so prevalent. We know that its getting to the right practitioner and the right support around it, which we've spoken about before.

You know, inevitably well can lead to eating disorders and they very serious, so you know, worth of a discussion, particularly for as I see most commonly that the overtrainers and underfuelers.

always want to find those healthy eruptions. But when it comes to soul foods, when it comes to a celebration, when it comes to eating at at a restaurant, if places use palm oil, if places use sugar in cake, if people you know, want to have a glass of champagne with their dinner, all those things are absolutely okay in you know, small amounts or in moderate portion sizes.

So it's not to say that if we go to a restaurant and we ask, you know what type of oil the chef uses and we say, well, I'm not eating that.

So that's probably a big one for me where I've had a few clients who have absolutely black or white with different ingredients in different nutrients in the foods and iolutely won't eat this. And fair enough, if there's an ethical or a personal view of it, you know, say you might be plant based, so you might be vegan, that's absolutely okay. That's you know, a whole other area in it stuff. If you don't want to eat animal products,

that's absolutely okay. But if you're avoiding an ingredient and avoiding it something in a food because you just feel that it's completely unhealthy, there's just a fine line between that, isn't There susa a fine line between you know, wanting to choose better products and then being almost fearful of

eating certain ingredients. Of course, we're not saying you should eat soft foods regularly all of the time, but it's absolutely okay to have some you know, white refined sugar in a birthday cake if it's somebody's birthday it's a bit of a celebration or something like that. So I really think that obsessiveness around the ingredient list and very black or white in terms of the foods that you

will and won't eat is a big sign. And the other one is really, I mean, the most common sign of orthorex here, I think Susie is that it negatively affects your life. So it's causing you, you know, more stress, more anxiety. It's socially isolating you. You've got your friends and your family really worried about you, asking lots of questions, are you doing okay? Perhaps they're suggesting that you should talk to somebody. I think really the biggest sign is

that it's negatively impacting your life in some way. If you're canceling plans with your family, or you running late to work because you had to spend an extra you know, twenty minutes out on your run, those sorts of things are negatively impacting your life, and I really do think that it's time to take a step back and sort of go and chat to a professional. And probably the top line professional when it comes to something like orthorexia

would be a psychologist. So absolutely that's the first point of call we'd recommend, although you know, having a chat to your dietician or having a chat to your doctor of course is a good idea as well, but for I think the majority of people suffering from orthorexia, it really would be a psychologist that is able to help them probably the most.

You know, it's probably twenty percent in accuracy, So people who are really focused on those numbers and thinking, oh, I eight five more grams of carb today, when really it's probably an error margin anyway for any food that's

in there. So that's another warning sign for me. When people obsessively calorie count with no end in sight for no other reason than just to feel in control, that can be a sign that, you know, focusing a little bit too much, and it particularly getting into headspaced hunger rather than what your body is telling you and overriding things like fatigue and training regardless and ignoring sort of physiological signs and then cognitively controlling things. So yeah, I

think there might sort of risk groups. It's the young women and then also the girls' teenage girls who go through sometimes that focus on what they're eating and doing exercise wise, so it can be a real concern for parents. All right, Ley and Well for our final segment of

their show. Another pertinent topic at the moment given that everyone we know is sick, because we do get a lot of questions around supplements, and naturally we are dietitians, so we love natural food supplements because we always think that they're best. But when we do take a look at the evidence around cold and flu, there is a handful of supplements with some evidence behind them to support

either improvements in immune function or reduction in symptoms. So, off the top of my head, you know, the ones we were asked about was more magnesium. Now, whilst there's some evidence to show that there's about ten to fifteen percent of Australians who have a low intake of magnesium, and magnesium is a nutrient found in leafy green veggies, nuts and seeds, whole grains, and often people are relatively low because of high requirements and low intake of fresh food.

There is some evidence for concentrated garlic supplementation. Now, obviously it's ideal to have the garlic in natural form, but may not always be overly palatable to down a few cloves of garlic each day, so if you prefer to take it in a supplementary form. It's been used for many years as an anti bacterial and anti microbial supplement and so indeed shows improving in immune function. The same for olive leaf extract as a high level antioxide. There

is some evidence for that. Echinata is another one. There is a little bit of evidence to help reduce the duration of a cold, as is the case with vitamin C. So vitamin C at high doses won't stop you getting the cold, but it can slightly reduce the.

routinely supplement. Rather, I would be interested in making sure people get enough dietary intake of zinc from lean red meat and whole grains and nuts regularly, rather than encouraging zinc supplementation without warranting it. But in the cases of garlic olivelea extract echination and vitamin C, I wouldn't be concerned about supplementing those because there's really no concern about overdosing in the same way that you would be concerned

about something like zinc or iron. So yeah, if you don't mind popping a few pills, there is a little bit of evidence. Do I take any of them? No, I don't take any supplements because I'm just not a supplement person. But if some people like them and want to, these are the ones that you could potentially spend your money on. With a little bit of evidence behind them, as opposed to the ones that we normally see, which

are spriaked all the time. So what are the ones we see like the greens, powders, and you know a lot of those I think are just money makers. I certainly wouldn't be encouraging those. I'd much rather someone has a veggie juice. But if you want to pop a couple of garlic tablets won't hurt you. So that's where the evidence sits. What do you suggest for people when they're warding off the colds and flu?

So whatever my clients go, oh yeah, and I feel like I'm coming down with something, I'm going to start taking some vitamin C supplement. As a hold up, let's just take a kiwi fruit a it can count as a bit of a snack. We're getting in a bit of a fruit serve. There's some soluble fiber in there. Like, we're getting way more benefits than just popping some vitamin CE tablets. And it's a lot more cost effective as well.

So queufruits where it's at. If you struggle with things like constipation, lead the skin on, you can actually.

So where the research really does sit with zinc is that zinc lozenges and it's really important to have the lozenge of form so it coats the mouth because a lot of the bacteria starts in the mouth, So you really don't want to just be taking a supplement. You want something to hope the mouth. So lozenge is what a lot of the research has really been studied with, and it can actually help to decrease the duration and

the severity of a cold. But of course the amount is very very important, So a lot of the research really focuses on about seventy five milligrams a day of zinc in lazow form. It's a hell of a lot of zinc, and actually finding a supplement or a brand that has that amount in it is basically non existent, like you're going to have to take two through four tablets of something. So this is definitely something that we would only really recommend for healthy adults.

impact if you already day in. It really needs to be on day one that you first develop those symptoms, and then I generally recommend my clients take it as sort of anywhere between three to seven days, and we cut it off after that. Zinc's not something that I

would recommend, particularly such a high dose of it. I wouldn't recommend just taking it in order to try and prevent something, you know, like I have a lot of clients who say, oh, well, I've got a big presentation coming up at work, I'm just going to take some supplements to make sure I don't get sick. A high dose amount of zinc isn't something that I'd be recommending you take as a preventative zink because where the research really does show assis that does help to prevent and

decrease the duration and the severity of a cold. So the research is really around that seventy five milligrams a day, So a lot of brands you're going to need multiple tablets or multiple lozenges of that. I'm just looking at one of the systematic reviews I've pulled up Susie, and there were five trials included in this with a total

daily zinc dose of more than seventy five milligrams. There were no sorry, five trials that had a total daily dose of less than seventy five milligrams, and all five trials found zero effect in terms of the zinc and reducing the duration and severity of a cold. But once we increase the dose over seventy five milligrams a day, there was a forty two percent reduction in the duration of a cold. So that's you know, for a lot

of people, that's really a significant impact. So it is something well worth trialing, but I think it has to be for a very very short period of time and only really in the healthy adult population. I definitely wouldn't be giving this to children or teens or anything like that because it is such a high dose.

You know, mixed veggie and a little bit of fruit. That's one of the best ways to get a good dose of vitamin see nutrients without Yeah, I just maybe I'm too tired. I wouldn't pay all that money. But you're right, olive leaf extract does have some evidence towards it, so interesting that you take.