Meet the dietitian: Blog series

Chat Leave a comment November 23, 2020 nutritionadsa

By Darinka Theron:

I was born in Port Elizabeth (also known as the friendly city). I have lived in Port Elizabeth, Cape Town, Cradock, Beaufort West and Knysna. The last 9 years I have worked in the government sector at 7 hospitals and 39 health clinics in two of South Africa’s most beautiful provinces. I love meeting people from different cultures and learning new things in life. I have gained experience in various areas of being a dietitian, from enteral home feeding, vegetable gardens, therapeutic nutrition, food service management and private practice consultations.
During my high school years, I loved learning about biology and the body’s functions. I still remember my first biology terms like osmosis, amoeba, chloroplast, extracellular matrix etc. I became a dietitian because I have always loved the feeling I get when I walk into any hospital environment and I knew I wanted to help people and make a difference in the community and world! If I didn’t study dietetics, I would have studied any degree working in the hospital environment. Through my younger years I have wanted to be a dentist, occupational therapist, dermatologist, pharmacist etc… and the list continues.
I’m a Matie at heart. I studied at Stellenbosch University for 4 years while I stayed in Huis Francie and Meerhoff residences. My favourite modules included anatomy, physiology and therapeutic nutrition. I am currently busy with my master’s degree in Therapeutic Nutrition. I find ICU nutrition, perioperative nutrition and gastrointestinal nutrition fascinating.
At the moment I work at Knysna Provincial Hospital as part of the Eden District in the Garden Route. I work in the hospital wards as well as at the surrounding clinics.
My main responsibilities include: nutrition support treatment and counselling, growth monitoring, nutrition therapeutic programme management, MBFI management, malnutrition control, nutrition education, promotion and advocacy, and food service management.

A day in my work life consists of:
A big cup of coffee in the morning (without sugar!) > ward: nutritional screening or some mornings a meeting > clinic visits: 10-30 patients a day  administration (emails, etc.) > patient nutrition counselling and education/In-service training as needed.

I enjoy seeing patients’ results, growth, change in behaviour and knowledge, and helping to make a difference in people’s lives. I am thankful for the patients who give positive feedback or a small gift to show their appreciation. I also enjoy organizing Health Days, World Breastfeeding Week and Nutrition Week. My career highlights include helping Murraysburg hospital get the Mother & Baby Health Initiative accreditation, helping Knysna Provincial Hospital food service unit achieve silver status, helping Cradock health clinics with their vegetable gardens and celebrating World Breastfeeding Week yearly… Breast is truly the best!

Generally being a dietitian has many challenges. Challenging aspects of being a government dietitian includes time management, high workload (especially at the clinics), language barriers, less resources, poverty and poor social circumstances and the community’s lack of knowledge on proper nutrition. During my career I have also found that some health care workers are uninformed about what nutrition really can do for a patient’s health and wellbeing.
When I’m not being a dietitian, ‘Event planner’ should have been my second name. I love doing theme parties, including the food and décor. Party themes I have done include Mexican, Asian, kindergarten and Halloween themed parties. I also love dancing; I did Ballet, Modern, Horton and Contemporary Dancing for 13 years. Dancing teaches a person determination, discipline, teamwork and never giving up in life.
Favourite foods, mmm… nothing like avocado and scrambled eggs on rye toast with a cup of filter coffee or rooibos tea, yes please! I also enjoy eating a variety of colourful fruit and vegetables daily. When I have time to dine out, I always choose between steak, sushi, pizza or a creamy pasta dish. I believe in having a balance in my diet and enjoying different foods.

The things that people should stop saying when they meet a dietitian: “Do these pills/shakes work for weight-loss?” or “Do you only eat salad and fruit?” & “Please don’t look at what I’m eating right now.”
I’m sure other dietitians know what I’m talking about.

WHAT YOU NEED TO KNOW ABOUT MANAGING DIABETES IN THE FAMILY

Chat 1 Comment November 11, 2020 nutritionadsa

As the rates of Type 2 diabetes continue to rise in South Africa, more and more South African families are meeting the challenges of living with the condition.  A diagnosis of diabetes in the family is a life-changing event, but it is important to remember that diabetes can be managed.  If you, or a family member has been diagnosed with diabetes, the first step is for you to completely understand the condition and how it impacts the body.  You are empowered to take charge of the condition by diabetes education.  So if you feel that you don’t fully understand diabetes, you must ask your local clinic or a community dietitian or a healthcare practitioner to give you more information and help you understand the condition fully.

Diabetes can be managed by medication combined with healthy eating, exercise and monitoring your blood sugar.  Registered dietitian and Association for Dietetics in South Africa (ADSA) spokesperson, Neo Mongoegi says, “You need to understand the symptoms of high blood sugars, which is hyperglycaemia, and the symptoms of low blood sugars, which is hypoglycaemia.  You also need to understand the impact that food has on blood sugar levels.  This awareness enables you to identify any symptoms and then manage them.” Neo is the Head of the Dietetics department at Chris Hani Baragwanath Hospital.  She explains, “It is important to know that diabetes is a manageable condition and not a death sentence.  However, it is a progressive disease and has to be managed properly through a lifestyle change and compliance to medication.  This lifestyle change is essential, and it involves the whole family, not just the person who has been diagnosed. We know that compliance with your healthier lifestyle and new medication routine is improved when the whole family adopts healthy eating and exercise habits.”

Type 2 diabetes disproportionately effects people living in lower income communities where making the necessary lifestyle changes can be challenging due to harder access to healthcare services and diabetes education.  Sometimes, access to fresh fruit and vegetables is less easy, and in neighbourhoods with high crime and less recreational space it can be more challenging to develop sustainable exercise habits.  No matter the challenges you face, it is important to know that solutions can still be found. This is the advice from another registered dietitian and ADSA spokesperson, Carla Boshoff who works in low income rural communities.  She says, “Some small lifestyle changes can be made immediately.  Don’t start with what you don’t have, but with what you do have available.  Start adding less sugar to foods and drinks, and work towards avoiding it completely.  Swop sugary cold drinks for water.  Stop adding unnecessary fats or spreads to food and start eating a smaller portion of the carbohydrates that form part of your current daily diet.  Start harvesting seeds from available vegetables like tomatoes, pumpkins and peppers, and start planting.  Invest in planting spinach, whether you have a garden, an old bucket or old car tyres, so that you always have access to green leafy vegetables.  Many people discover that they love food gardening and that there’s great satisfaction in growing your own healthy food.  Ask your neighbours and friends to share the costs of seeds with you, and you can all start planting.  Join others in community food gardening so that you can share resources, trade vegetables and even sell some for extra income.”

These are Carla’s top 6 tips for people affected by diabetes who live in low-income communities:

• Enjoy a variety of fresh, wholesome food and ensure a variety of vegetables form part of your everyday meal plan
• Ensure that you enjoy a healthy breakfast and never skip a meal which is very important when taking medication for diabetes
• Choose foods and drinks with little or no sugar.  Drink lots of clean, safe water
• Work with what you have and focus on portion control. A healthy diet doesn’t need to be expensive and even the smallest changes such as adhering to portion sizes can make a difference.  If there is a dietitian or nutrition expert in your area, consult with them for an eating plan that suits you and your family
• Follow up at your local clinic to have your blood sugar levels monitored and take your medication as prescribed
• Invite your friends or loved ones to join you in exercise to make it more enjoyable and take a brisk walk at least two or three times a week. Get gardening – this is not only good exercise by working physically in the garden; it contributes to food production, improves food security; helps you eat a variety of fresh and wholesome food every day. Food gardening is also encouragement, and setting a good example for your children and the children of the community. Perhaps you can also get involved in local food gardening projects at your hospital, clinic or school – and if there is no such project, then start one!

Raising awareness of diabetes is not only important to help people living with diabetes and their families, but also to help prevent diabetes in your community. November is Diabetes Month in South Africa, and World Diabetes Day is on the 14^th of November 2020.  Neo concludes, “There are dietitians at most hospitals and local clinics that can assist you.  If the doctor does not refer you to a dietitian, you can still refer yourself to the dietitian at your local clinic or nearest public hospital.  If you are struggling with accepting your diagnosis, there are also social workers at local health facilities for counselling after diagnosis.”

You can also find a dietitian in your area by visiting https://www.adsa.org.za/find-a-registered-dietitian.

Meet the dietitian: Natasha de Almeida

Chat Leave a comment November 9, 2020 nutritionadsa

Hi everyone! My name is Natasha de Almeida, I am a 26-year-old Registered Dietitian from Johannesburg, and I absolutely love food. I spend a lot of my time eating, or thinking about eating, or cooking food, or watching people cook food on TV. Food brings people together, when we’re happy or sad, and there are so many different cuisines to enjoy from all around the world.

My food journey has been a bumpy one. I went from being an incredibly fussy child, teenager and young adult to someone who tries to taste and enjoy different types of foods. Before all of this, the look of ANY vegetable got me shifting uncomfortably in my chair. If there were vegetables on the menu for supper, I’d try to switch plates with my sister while my parents weren’t looking. Anything to avoid the absolute torture that it was to eat a single pea. That has changed now, but one thing that has always been with me is my sweet tooth. Anything chocolate and I’ll be happy. If I could cover everything in bar-one sauce, trust me, I would. 

I studied Dietetics at the University of Pretoria. A health-related degree appealed to me as it would allow me to help people improve their lives. I’ve always wanted to help anyone or anything, and when I was younger, it was animals. I aspired to be a veterinarian, that is until a 7-year-old me shadowed one performing surgery on a dog. I left that room with a face toned deep purple and a broken dream. Though now, if I look back, I might have studied veterinary science if I hadn’t studied dietetics.

I am half-Mozambican and grew up there, where my whole school, pre-school through to high school, had seven hundred students. So, going from that to a giant, seven-campus university with tens of thousands of students was intimidating to say the least. My university years were incredibly challenging but also rewarding in many ways. When starting at university they recommend that you partake in the ‘three pillars of university life’: academics, social events, and exercise. So that’s what I tried to do, even though it seemed pretty unrealistic at times. Balancing all three was not easy, but I managed to make good friends, pass my degree timeously, and become a first team varsity soccer player in those four years.

I think I only truly realised that health was important to me during my studies.  When I started learning about nutrition and health, I was able to reflect, and think about how many lives are affected by nutrition related problems, which I feel like I was very ignorant about before. Studying dietetics opened my eyes to how nutrition can truly affect your health, and that there is more to my interests than just a love of food.

Last year, I completed my one year of community service at a community clinic. Throughout the year I learned a lot about myself and the dietetic profession. I experienced the triumphs and the pitfalls of working as a dietitian. The most challenging aspect of the job being a lack of resources, both in the environment in which we work, and those of the individuals we counsel. The highlight of my job so far has been helping the most disadvantaged improve, even in the smallest of ways, such as helping a child with severe cerebral palsy gain that little bit of weight. My career has just begun, there is much room for growth and experience, and I look forward to many more highlights and learning curves. At the moment, in between completing short courses to improve my knowledge, I am slowly looking at starting my own practice. I also have a keen interest in clinical dietetics and look forward to getting back into a hospital setting.

Being a dietitian comes with many stereotypes, and since I qualified, I have noticed a few misconceptions that people have about the profession, the worst being that we are incredibly judgemental about what others eat. It is sad to hear a friend try to defend their eating when you sit down with them at the dinner table. We do not watch your every bite and dissect every meal you eat. When you season your food, we don’t picture little salt monsters dancing in circles above your head, chanting and waving blood pressure cuffs in the air. We are just like you in that we enjoy food as well, and it is okay to have preferences or dislikes. Some people do not know this about me, but I have texture issues when it comes to certain foods, one example being strawberries. I love the smell, taste and look of them, but I can’t eat them because of their texture. This is something my friends and family joke about with me on a regular basis! We are all different.

Another frustration is the immediate mention of a meal plan when the word ‘dietitian’ pops up in conversation. Yes, we can definitely help you with weight management, but there is so much more that dietitians can do. A dietitian may have helped your uncle with diabetes control his blood sugar by educating him about carbohydrates and insulin use. They may have helped your premature baby gain weight while in the NICU through careful calculation of their nutrient requirements, and they may have analysed that very menu that you choose from at your favourite restaurant. There’s so much more!

One last thing that I do not like hearing as a dietitian, is the idea that eating healthy involves a boring diet that gets rid of your favourite foods.  There are so many ways to make a healthy diet enjoyable, including using some of your favourite foods, but in different ways and amounts. Everything in moderation.  

With all that being said, the biggest thing I look forward to is helping people from all walks of life, educating those in need, and myself in the process. I am proud to be a Dietitian.

Blueberry Breakfast Bars

Chat 1 Comment November 6, 2020 nutritionadsa

This month’s wonderful and nutritious Nutrition Confidence breakfast recipe was formulated by registered dietitian, Julie Perks. See how creatively Julie combined these ingredients for a delicious “on the run” breakfast but also an ideal snack.

As much as I wanted to create a lovely crunchy breakfast bar, I kept making granola as nothing was sticking together so in the interest of ensuring success, I created this version which is both delicious and healthy and utterly fool proof! These can be made with store (and freezer) ingredients. They are then perfect to keep in the fridge or freezer for a quick breakfast on the run. Ideally obviously we would prefer you to be mindful of your meals and not eat “on the run” but also, we know life happens and these then help to ensure you don’t skip breakfast. Ideally enjoyed with some plain yoghurt for added protein where possible.

Serves 8

Ingredients:

• 1 ¾ cup rolled oats (210g)
• 2 TBSP ground flaxseed (10g)
• 1 TBSP cinnamon (7g)
• ½ tsp nutmeg (1g)
• ½ tsp ginger (1g)
• ½ tsp salt (2.5g)
• ½ cup mixed unsalted nuts (70g)
• ¼ cup pumpkin seeds (35g)
• ¼ cup honey
• 1 ¼ cup milk
• 2 cups blueberries (245g)

Instructions:

1. Preheat the oven to 180 degrees Celsius.
2. Mix the dry ingredients (oats, flaxseed, spices, salt, nuts, pumpkin seeds) in a large mixing
   bowl.
3. Then add in the honey and milk and mix well.
4. Allow to soak for 10-15 minutes.
5. Line a 20 x 20cm baking dish with baking paper (I used 2 pieces of baking paper going in
   opposing directions so it made it easier to remove after it has cooled).
6. Stir in the blueberries and pour into the baking dish.
7. Cook in the oven for 40 – 50 minutes until set.
8. Allow to cool completely then cut into 8 bars.

EXTRA: You can make this bar vegan by swapping the milk for plant based milk of your choice (soya milk will be most aligned with the protein content as shown in the nutritional analysis) and then substituting the honey for maple syrup or rice malt syrup.

Nutrition Information: Per serving
Energy: 1100 kJ Protein: 7,5g Carbohydrate: 34,7g of which, total sugars: 2,7g Fat: 11,6g, unsaturated fats 9,23g, Saturated fats 2,4g, Fibre: 5,4g Sodium: 171mg
*note, if you chose to cut into squares to make it a snack portion, then make 16 squares and it will halve the nutritional analysis.