Meet the ADSA President!

We sat down and had a chat with the new ADSA President, Christine Taljaard-Krugell, who has taken over from Nicole Lubasinski, following her relocation to the UK.

Christine brings along a wealth of experience as the general manager of the African Nutrition Leadership Programme. “With ADSA turning 30 this year, I am truly humbled for the opportunity to contribute in my new role as ADSA president.”

 Why did you become a Registered Dietitian?

My sister had DM type 1 from a young age. The way that her disease impacted not only her own life but also our family’s as a whole made me realize just how big the potential impact of optimal nutrition can be. I have the utmost respect and deepest empathy for any family who is faced with chronic illness. It was only later in life, in my fourth year that I was exposed to what I now enjoy the most, public health nutrition related research.

What do you enjoy most about the work you do? What are the most satisfying moments?

Being a researcher I love the diversity that my work brings. Research is challenging in the sense that you have to invest for a very long period of time before you get the reward. It is when one’s research is usable, when it reaches the target audience that I think the satisfying moments emerge. I am also very privileged to have been involved in the African Nutrition Leadership Programme for the past 6 years. Investing in individuals in the field of nutrition, and to experience the change within such a person, must be some of the most satisfying things one can do.

What has been your career highlight?

In 2016 I was chosen by the International Agency for Research in Cancer to partake in their “50 for 50” initiative to be held in Lyon, France. The initiative entailed that 50 young leaders from around the world were selected to participate in their initiative called “Empowering future cancer research leaders”. It was an absolute wonderful opportunity where I have met great mentors and made new colleagues and friends.

What are the major nutrition-related health issues that South Africa is faced with?

South Africa remains to be utterly complex. South African households are faced with significant challenges that include high levels of poverty, unequal distribution of income and wealth and inequality in health outcomes. In addition to the above malnutrition, including both under and over nutrition prevail. While one fifth of households do not have enough money to buy food for the household till the end of the month, two thirds of women are either overweight or obese. Dietitians needs to provide a health service to the population that is evidence informed as well as attainable.

What are the positive side to the relative dark picture painted above?

Malnutrition is preventable. In the words of Lawrence Haddad, the executive director of the Global Alliance for Improved Nutrition (GAIN):

Despite the challenges, malnutrition is not inevitable, where leaders in government, civil society, academia and business are committed… anything is possible.

How do you see a nutrition champion?

The nutrition champions in my life are men and women who have an inextinguishable passion for their work. They invest unlimited time, resources and knowledge into young (nutrition/dietetic) professionals. They have the highest work ethic that they choose to stand by.

How do you cope after a day of nutrition disaster and bad eating choices?

I think a good routine (even if a bit boring) helps in preventing a day of total nutrition disaster. However, if that day happens, I hope it was in good company, under the blue sky and enjoyed with friends and family.

What is your favourite dish and your favourite treat food?

I have to stick to my Dad’s braaivleis and for my favourite treat food it has to be Clover Vanilla Milk.

 

More about Christine

Christine Taljaard-Krugell is a registered dietitian and currently a part-time researcher and lecturere at the Centre of Excellence for Nutrition at the North-West University, Potchefstroom Campus.  She holds a PhD in Nutrition and a MSc in Dietetics with her research area being Public Health Nutrition.  She is the general manager of the African Nutrition Leadership Programme (www.africanutritionleadership.org) and the Editor and founding member of The Leader  the official newsletter of the African Nutrition Leadership Programme which is published quarterly.

Her research career started with clinical trials investigating the effect of a multi-micronutrient fortified beverage on cognitive growth in primary school children.  Since 2014 she has been actively involved in the South African Breast Cancer study.  This population based case-control study of breast cancer aims to clarify the role of body size, diet and physical activity in the African female population. In 2016 she was invited as part of the prestigious “50 for 50 initiative” where the International Agency for Research on Cancer (IARC) identified 50 future cancer research leaders from low-and middle income countries to attend a specialised workshop entitled Fostering Leadership in Cancer Research. 

Christine has an interest in evidence informed decision making and was the project lead for the South African leg of the EVIDENT (Evidence informed decision making for nutrition and health) project.  This multi-country project included other African countries such as Benin, Morocco, Ghana and Ethiopie.  The aim of the South African study was to document decision-making processes for public health nutrition programming.


Weight loss – a journey, not a destination

Today we meet Debbie de Coning who after many years of trying to improve her health and loose weight unsuccessfully, reached out to registered dietitian Monique Piderit.

She shares her journey with us, as well as some great tips for anyone embarking on a journey to better health:

Why did you decide to see a dietitian?

I had been on a quest to improve my overall health for many years and as a result had developed an interest in nutrition and healthy eating. I had already eliminated several food groups in my efforts to reduce inflammation, sinus and increase my energy levels. I had cut out sugar and refined carbs; wheat; as well as dairy – and while I did feel some benefits from significantly reducing all these – my energy levels remained low and the weight refused to move.

I had got to the point where I felt there must be a missing link somewhere and that if I could find out what it was, I was sure that I would be able to lose weight. I had tried so many approaches – and even although my health improved – the weight did not budge. Quite simply, I was tired of all the guesswork.

I kept researching, and after reading about DNAlysis, decided that I was going to invest in my health and get my weight sorted out once and for all.

Tell us about your journey with the dietitian?

I put a request out on Facebook asking for recommendations of dietitians who worked with DNAlysis. Someone tagged Monique in that post, and Monique reached out and offered to assist me on my weight loss journey.

What I really loved about working with Monique was the holistic way in which she approached this ‘project’. While we waited for the DNAlysis results, we had an in-depth consultation about relationships with food, family and friends. We also spoke about lifestyle. She found out which foods I liked and which I didn’t. We did a comprehensive set of blood tests and adjusted my supplement intake. By the time we had the DNAlysis results, we had a sound scientific platform from which to work.

The test showed that my body does not metabolize fat well. So, I went onto a low-fat eating plan. When I received my eating plan from Monique, it was scientifically worked out. There was nothing on it that I didn’t like and so it all felt pretty normal and do-able.

I now knew, that if I put something fat (good or bad) into my mouth, it wasn’t going anywhere anytime soon! I drastically reduced my red meat and chicken intake. I had to learn to use different sources of protein that were lower in fat, and had to make decisions to cut back on foods though they were healthy fats, such as peanut butter, almonds and avocados, and watch portions. No more guesswork: we had an informed strategy. Having the scientific knowledge has really helped me to rationalise making the right choices.

I really recommend working with a dietitian. Healthy living and good nutrition is a science. You need someone with the knowledge and skills to assist you, and it’s a real plus to find someone who is your champion as well.

 Tell us about your results / successes? 

In a relatively short time (8 months) and with what felt like minimal effort I lost 20kg. My waist and hips reduced by 14cm each. I also reduced my insulin by half and reduced my cholesterol count. My energy levels have also increased.

I went to see a biokineticist to get the appropriate exercises to tone and strengthen my muscles. My fitness is the next leg of the journey that I need to work on. Before losing weight, I wouldn’t have been able to complete even half of the exercises, but after the weight loss, I was able to complete all the sets of repetitions, albeit slowly.

When I first picked up the 2 x 2kg weights, I could hardly lift the 4kg. It was a shock to realise that I had been carrying five times that weight all day and every day. No wonder I had no energy!

What was the hardest part of the journey? 

Being a people pleaser, it was often hard for me to say no when being offered well-intentioned albeit wrong food choices. I had to become firm in making decisions to decline food without being apologetic and feeling the need to explain myself to others. Drinking enough water is always a challenge. And of course, who wants to offend a Lindt chocolate on offer?

What are the top three tips you can share?

  1. Be pedantic about portion sizes. Have a good food scale and measuring cups to make sure you stick to your portion sizes. If it’s 80g of chicken, then it’s 80g and not 95 or 100g. Also, split portions to allow for variety and texture. Instead of a full starch portion of mealies, have half mealies and half couscous. This helps to make food interesting with a variety of colour and texture. The minute food becomes boring, you are sabotaging yourself and feel hard done by.
  2. Embrace the new normal. I only told a few people about my weight loss journey while I was in the trenches, those I knew would support me. I did not want people watching me, watching what I was eating and passing judgement. There will always be pessimists and naysayers. Limit your exposure to them. It was a personal journey and I just wanted to get on with it. Sometimes the downside of setting a goal is thinking that when you’ve reached it the journey is over. Embracing the new normal means exactly that. When you’ve reach your goal weight, your healthy lifestyle continues.
  3. Celebrate a range of milestones. It’s not just about the weight. Celebrate reducing your insulin or centimetres lost. I celebrated cleansing my wardrobe and adopting a minimalistic capsule wardrobe approach. It’s not about buying things to reward yourself necessarily. You are making a conscious lifestyle change, so why do you need to be rewarded for that? Celebrate mindshifts and lifestyle choices. They are rewards in themselves.

What the dietitian says 

Monique says: “A key lesson is how Debbie approached this change in her life as a journey and not a destination. Right from the beginning, she chose to embrace the process of change by eating healthier, controlling portions, and making better food choices every day and at every meal, consciously avoiding dieting and the deprivation that it entails. Debbie’s dedication to her health is a great inspiration to other women. I am so proud of you, Debbie!”

To find a registered dietitian in your area, visit the ADSA website!


Why Breastfeeding is the Foundation of Life

 

This  year’s World Breastfeeding campaign celebrates breastfeeding as the foundation of life for the good health of mothers and children. Co-ordinated by the World Alliance for Breastfeeding Action (WABA), the campaign identifies breastfeeding as an essential strategy to prevent malnutrition in all its forms, combat inequality, crises and poverty – all major issues in many South African communities.

ADSA (Associations for Dietetics in South Africa) spokesperson and Registered Dietitian Mbali Mapholi, points out how important it is that women in South African communities – where hunger, poverty and inequality are rife; where crises such as fires, floods and social unrest are frequent – realise that breastfeeding their babies can provide many vitals benefits.

“Breastfeeding provides babies with the best source of highest quality nutrition possible, at the very small cost of just ensuring that the mother’s nutritional needs are met,” says Mbali. “Malnutrition is the third highest cause of infant death in South Africa, and breastfeeding can prevent malnutrition in all its forms. Breastfeeding also provides complete food security for infants, even in times of crisis.”

 Breastfeeding saves you time

  • Breastmilk is always available
  • Breastfeeding requires no preparation

Breastfeeding saves you money

  • No need to buy infant formula
  • No need to buy bottles, teats and sterilising products
  • No need to use electricity

Breastfeeding boosts your baby’s health. A breastfed baby is likely to get sick less often. This means there are fewer clinic visits, and fewer days off absent for Mom.

  • Lower risk of death
  • Lower risk of diarrhoea
  • Lower risk of chest infections
  • Lower risk of ear infections
  • Lower risk of overweight and obesity

Breastfeeding boosts mom’s health

  • Lower risk of breast cancer
  • Lower risk of ovarian cancer
  • Lower risk of high blood pressure

“There are so many incredible advantages to breastfeeding,” says Mbali, who is currently breastfeeding her 14-week old twins. “Moms need to feel confident that it is the natural, perfect food for their infants under six months; and it continues to be a vital source of nutrition as a baby grows into a toddler and their immune systems continue to develop. Some Moms may need to return to work, but because breastmilk is best for baby, they should consider expressing and storing their milk so their children continue to receive the benefits for longer.”

Tips for expressing breastmilk

  • Allow 20 to 40 minutes of relaxed private time
  • Gently massage and squeeze around the nipple area and your milk will start to flow
  • Collect your breastmilk in a wide-rimmed container that has been sterilised with boiling water
  • Transfer the breastmilk to sealable bottles, food containers or food bags that have been sterilised with boiling water. You can even get pre-sterilised, resealable food bags.
  • Breastmilk can be safely stored in the fridge for one to two days or in the freezer for up to six months
  • If you are expressing and storing a lot of breastmilk, date the storage containers so you can keep track of the milk that needs to be used first

“World Breastfeeding Week reminds us that breastfeeding is a universal solution that gives everyone a fair start in life and lays the foundation for good health and survival of children and women”, concludes Mbali. “Moms need to be fully supported by their families, friends and employers because breastfeeding is a major strategy to fight poverty and boost food security in our communities, and we hope to see a significant increase in breastfeeding across South African communities.”

For information on World Breastfeeding Week 2018 visit www.worldbreastfeedingweek.org


BREASTFEEDING, NOT JUST BEST FOR BABY, BUT BEST FOR SA!

Today is the start of the 2018 World Breastfeeding Week, which runs from the 1st to the 7th of August. This year the emphasis is on breastfeeding as ‘the foundation of life’ and highlighting the advantages of improving breastfeeding for communities and countries. The campaign, co-ordinated by the World Alliance for Breastfeeding Action (WABA), identifies breastfeeding as an essential strategy to combat the impacts of inequality, crises and poverty – all major issues across South Africa. Yet, we remain one of the countries with the lowest rates of breastfeeding in the world.

In an attempt to turn this around, South African organisations, which promote and support breastfeeding, such as ADSA (Association for Dietetics in South Africa) are driving conversations around the 2018 World Breastfeeding Week themes. On the individual level, breastfeeding significantly boosts the health of children and mothers, while saving family income. Amplified at the country level, breastfeeding contributes to breaking the cycle of poverty, reduces the burden of health costs by preventing all forms of malnutrition and ensures food security for babies and young children in times of crisis. It is a universal solution that gives everyone a fair start in life and lays the foundation for good health and survival of children and women.

Optimal infant nutrition is defined by the World Health Organisation (WHO), as exclusive breastfeeding for the first six months of life, and continued breastfeeding until the age of two years and beyond, whilst complementary foods are introduced. One of the key Sustainable Development Goals of the United Nations is that by 2025 at least 50% of infants aged 0-6 months in every country will be exclusively breastfed. At just 32% currently, South Africa has a long way to go in the next seven years if we are to reach this goal.

ADSA spokesperson, Registered Dietitian/Nutritionist, lecturer and researcher at Stellenbosch University, Associate Professor Lisanne du Plessis, explains that breastmilk and breastfeeding are referred to as ‘the economic choice’ because mothers produce custom-made breastmilk for their children at no additional expense to their households. She points out that the high costs of not breastfeeding include the impacts on nutrition, healthcare and the environment. It is essential that the barriers to mothers providing their children with the most natural, nutritious and health-boosting free option need to be overcome. Lisanne points out that: “On average, 20 kilogrammes of formula is needed to feed a baby for the first six months of life. At an average price of R190 per kilogramme, the formula bill adds up to almost R4000. Add to this, the cost of bottles and teats as well as fuel to boil water and clean utensils, and families face a staggering expense of thousands of rands to feed their babies.”

There are also substantial environmental costs associated with not breastfeeding. According to the widely cited Lancet Breastfeeding series, breastmilk is ‘a natural, renewable food that is environmentally safe’. It is produced and delivered to the consumer without fuel inputs, pollution, packaging or waste. By contrast, breastmilk substitutes have a substantial ecological footprint, which includes agricultural production, manufacturing, packaging and transport just to get to the consumer. In the home, it requires water, fuel and cleaning agents for daily preparation and use. A host of pollutants and significant waste are generated along the way. It is estimated that more than 4000 litres of water is needed to produce just 1 kilogramme of infant formula. “It is clear that from the household to the country level, breastfeeding can significantly reduce costs and contribute to breaking the poverty cycle,” Lisanne concludes.

A nation of breastfeeding mothers can also reduce the burden of their country’s healthcare costs. Registered Dietitian and ADSA spokesperson, Chantell Witten, who is also a researcher at North West University says, “It is well-proven that breastfeeding reduces disease risk. Breastfeeding substantially protects infants against death, diarrhoea, chest and ear infections. Breastfeeding also helps to prevent malnutrition in all its forms. It protects against overweight, obesity, diabetes as well as the various health consequences of under-nutrition. For mothers, breastfeeding reduces the risk of breast and ovarian cancers, and of high blood pressure.” As pointed out by Chantell, infants who are not exclusively breastfed; who are given food earlier than age six months and who are not following a varied diet, are at higher risk of malnutrition and death. Globally, if higher rates of optimal breastfeeding were practiced, 823 000 annual deaths in children under the age of five years and 20 000 deaths from breast cancer could be averted.

The third key message of the 2018 World Breastfeeding Week is concerned with the role of breastfeeding in a world of upheaval. Breastfeeding has the power to ensure food security for infants and children in times of crisis. This is highly relevant to disadvantaged communities in South Africa, which bear the brunt of disasters such as fires and floods, but are also increasingly thrown into crisis due to protest action.

University of the Western Cape lecturer, Registered Dietitian and ADSA spokesperson, Catherine Pereira points out that breastfeeding provides complete food security for babies up to six months of age. “Furthermore, from 6-24 months, breastmilk still provides a substantial contribution to a child’s nutrient and energy needs. Breastmilk is accessible, sufficient, safe and nutritious and it is therefore quite clear that breastfeeding can contribute directly to ensuring food security during emergencies.”

Catherine emphasizes the need for us to think carefully about the ways in which we respond and give help as a crisis unfolds: “When it comes to making sure that babies are fed in a crisis, for many people, the first thought is to donate infant formula. Infant formula is expensive, and so there’s an assumption that it is something valuable that could help. Unfortunately, this is not the case. Rather, providing support to mothers to continue breastfeeding, especially during a crisis, is a much more important priority. The WHO and UNICEF have issued a very recent brief on breastfeeding during a crisis which includes suggestions consistent with what has been mentioned by Catherine.

In addition to this, many women struggle to continue breastfeeding when they return to work and research shows that breastfeeding rates go down when women go back to work. It is therefore important for South Africa to focus on improving comprehensive maternity protection for women, which is defined by the International Labour Organisation (ILO) as: health protection in the workplace, a minimum period of maternity leave, some form of cash and medical benefits while on maternity leave, job security, non-discrimination and support to breastfeed or express milk upon return to work.

In South Africa, we have a far way to go to support breastfeeding mothers in the workplace. Current law indicates that women should receive four months of maternity leave, however paid leave is not mandatory (although government departments and some companies do provide paid leave). It would be very important for all stakeholders to advocate for longer maternity leave (up to 6 months) and that paid leave is mandatory. Non-standard employees (employees placed by temporary employment services, employees on temporary or fixed-term contracts and part-time employees such as domestic workers or farm workers) are a particularly vulnerable group. This group of women often have to claim pay for their maternity leave from the Unemployment Insurance Fund (UIF) and this can be an extremely time-consuming and complex process for some women.

Once back at work, women should be informed that they are entitled to two 30-minute breaks during their work day to breastfeed or express breastmilk until their infant is six months old. This enables mothers to return to work and earn an income whilst still providing their infants breastmilk, the best feeding option. All stakeholders should work together in an attempt to improve the support of women to be able to continue breastfeeding when they return to work.

It’s clear that South Africa has much to gain in turning around its low rates of exclusive breastfeeding and actively striving to reach the 2025 target of 50% of mothers’ breastfeeding exclusively for the first six months of life. Developing a national culture that supports the truism that ‘breast is best’ can have far-reaching positive impacts for our children, mothers and country.

For information on World Breastfeeding Week 2018 visit www.worldbreastfeedingweek.org