PROTECTING BREASTFEEDING IS A SHARED RESPONSIBILITY

Breastfeeding is the recommended ideal, a natural and sustainable food for the healthy growth and development of infants and young children. Yet, South Africa’s breastfeeding rates, at all ages, are low. The recommendation for infants 0 –  six months is exclusive breastfeeding (feeding breastmilk only).  The rate of exclusive breastfeeding in the first six months of life was reported at just 32% at the last  national survey in 2016.  While that figure falls far short of the World Health Organisation (WHO) global target of 50% by 2025,  it signals a slight  improvement over the past years for the country. 

The effort to improve breastfeeding rates has shifted from focusing on mostly mothers and health care workers, to look across our society and identify all the contact points with mothers and ways that mothers may be discouraged and or even persuaded to give up on breastfeeding their babies.  This has  led to efforts to include all sectors throughout the healthcare system,  the non-profit and community-based organisations,  workplace settings and families to unite in protecting breastfeeding and  creating a culture where the whole society  fully supports breastfeeding mums.

We often don’t realise that we may be discouraging breastfeeding and may have little idea of the health impacts on both mothers and babies if exclusive breastfeeding for the first six months of life doesn’t happen.  It’s quite another thing though, to answer a call to become a protector of breastfeeding.   How do we do this?  It starts with understanding the barriers to breastfeeding that many mothers face.  Breastfeeding education in South Africa is insufficient and there is often not enough skilled healthcare support for new mothers to help them overcome early challenges.  The answer to any sign of a struggle is too often a recommendation to abandon breastfeeding and switch to infant formula products.  In a upper-middle income country, this is a move that not only compromises the health of mom and baby but adds a significant household expense impacting on the entire family. 

However, the challenges of breastfeeding exclusively for six months, and ongoing breastfeeding on demand are not limited to our healthcare facilities and services.  Key to successful breastfeeding is that moms are empowered to feed their babies anytime and anywhere, which means they need broad-based support across society.  Dr Chantell Witten, a Registered Dietitian and spokesperson for ADSA, (The Association for Dietetics in South Africa), points out that moms can face significant roadblocks to breastfeeding their babies even when this delicate process went well for them after the birth of their baby.  She says, “Given the many stressors on households, sometimes mothers find themselves in hostile home environments and social circles negative towards breastfeeding. Often influential women in their lives second-guess them or encourage that they feed other foods before their baby is six months old.  The need to earn and return to work, puts pressure on moms to give up on breastfeeding.  That’s why protecting breastfeeding needs to be a “whole of society”  effort to ensure that we have work and social environments that are breastfeeding-friendly.”

In essence, what we all have to remember is the simple truism that ‘breastfeeding is best’ – for both babies and moms.  The straightforward health benefits are all the reasons we need to become protectors of breastfeeding. Breastfeeding from birth supports the healthy development of babies and plays an important role in prevention of all forms of childhood malnutrition including undernutrition, obesity and micronutrient deficiencies. Breast milk contains antibodies which help protect against many childhood illnesses. The risk of breast and ovarian cancers can also be reduced in women who breastfeed.

Professor Lisanne du Plessis, a fellow ADSA spokesperson and Registered Dietitian and Nutritionist, makes it easy to understand how we can be a protector of breastfeeding:

  • Partners can help mothers with the domestic workload as well as the caring of the baby. Getting hands-on with baby bathing, burping, talking, singing and playing is a great support.  Doing grocery shopping, helping with food preparation and cleaning of the house creates a supportive environment. Raising children was never supposed to be a one-woman job and partners have a major impact on creating a home environment conducive to breastfeeding for optimum mom and baby health.
  • Family and friends should be cheerleaders for breastfeeding. It makes such a difference to encourage mothers on their journey to provide their babies with the best nutrition.  Be aware of supporting breastfeeding moms anytime and anywhere.  Even if you didn’t have a positive breastfeeding experience with your baby, make sure you fully encourage the new moms in your social circle.
  • Workplace support can make a real difference when it comes to maintaining breastfeeding after the end of maternity leave.  In South Africa, we have few workplace policies that are designed to create an enabling environment to support breastfeeding mothers, and you can be part of ensuring this happens in your company.  Breastfeeding moms who have returned to work are entitled to two 30- minute breaks to express breastmilk. A private room and refrigeration facilities for safely storing their breastmilk can provide further support.
  • SA society needs to be aware of attitudes that discourage breastfeeding, and even shame breastfeeding mothers.  Breastfeeding is perfectly natural and should be normalised and championed across SA communities.  Do your part to support, promote and protect breastfeeding as a national asset. It makes sense for us to ensure that our breastfeeding moms feel valued for the great choice they are making.

World Breastfeeding Week runs from 1 to 7 August 2021.  In the midst of the global pandemic with our heightened awareness of the importance of health and robust immunity, it is vital to remember that breastmilk is the optimum food for our babies.  Nothing compares, it is priceless.  Let’s support and encourage moms in those critical hours after birth, continue the support for the first six months of the baby’s life and also over the longer term as they strive to do their best for their children.


OPTIMISING HEALTHY EATING HABITS

There’s nothing quite like a (hopefully) once-in-a-lifetime experience of a global pandemic to focus our attention on the status of our health, and the preventative benefits of a healthy lifestyle.  As rolling lockdowns have restricted our movements and options, and tightened our belts, we’ve had little choice but to adapt our shopping and exercise habits; and shift our cooking and eating patterns to meet the moment.  Now, in the midst of a third wave, many South Africans across economic spectrums are thinking more about how and what we eat; and wondering if our eating habits can help to protect our health in the face of COVID.


As Registered Dietitian and President of ADSA, (The Association for Dietetics in South Africa), Maria van der Merwe points out when it comes to preventative health, nutrition plays a bigger role than just immune support. “Good nutrition is essential for optimal health across our lifespans.  Meeting our changing nutritional needs from infancy through childhood and the teen years, through our adulthood into older age can not only help to increase resilience but helps us to manage our weight, prevent nutritional deficiencies and the development of a range of chronic health conditions.  If we do become ill, a balanced diet can help us fight acute health problems and aid in our recovery.”

So, how is the pandemic shaping our views and habits when it comes to daily eating?

Registered Dietitian, Dr. Nazeeia Sayed says, “Many South Africans are feeling the economic impacts of the pandemic such as rising food prices and reduced household incomes threatening their household’s food security.  With tighter budgets, you can still find affordable, healthy foods and achieve balanced meals.  Focusing on increasing your family’s intake of seasonal veg and fruits, whole-grain options like oats, as well as shifting to more plant protein sources such as beans and lentils in place of meat, will save money.  Healthy eating is within reach.  For instance, traditional foods such as samp and beans, or dahl and rice are tasty, affordable meals that can be supercharged with some extra veg or a salad.”

Many middle-income South Africans have increased their focus on nutritional supplements and so-called ‘functional foods’.  Nazeeia points out that, “With vitamins and minerals flying off the shelves, it’s important to note that’s there’s no scientific evidence that any particular food or nutritional supplement or diet that can prevent COVID or any other infections. Your best move is to stick with the healthy eating guidelines and ensure your family is enjoying a variety of foods every day.”

But what are functional foods?

Maria explains, “Also known as nutraceuticals, functional foods contain particular ingredients that offer health benefits that extend beyond their nutritional value. For example, these ingredients may protect against disease, prevent nutrient deficiencies, and promote proper growth and development. Some examples of functional foods include products enriched with vitamins, minerals, probiotics, or fibre; with each of these ingredients having a specific function. However, by their nature, nutrient-rich whole-foods like fruits, vegetables, nuts, seeds, and wholegrains can also be considered functional foods. For instance, whole-grains like oats and barley contain a type of fibre called beta glucan, which has been shown to reduce inflammation, enhance immune function, and improve heart health. Similarly, fruits and vegetables are packed with antioxidants, which are beneficial compounds that help protect against disease.  So, increasing your family’s access to functional foods in an affordable way is as simple as including more fresh vegetables and fruit, legumes and whole-grains in our daily meals.”


Should we make more home-cooking a keeper in this COVID world?

Most South Africans have cooked more at home over the past 18 months than ever before.  Nazeeia says, “Home cooking is great for many different reasons! If you involve the family, especially your children, it is a time to learn more about the food you eat – where it comes from and what it contains.  Home cooking inspires us to try new recipes, talk about healthy eating, and explore different global cuisines.  This is important modelling for the younger generation and assists in them establishing better eating habits that can last a lifetime. Many of us have access to the internet and you can learn to cook from watching videos, even if you have not done so before.”


Maria agrees, “Cooking at home, from scratch, allows us to use unprocessed or minimally processed foods – foods in their natural state – as the basis of our meals. When we cook our own meals, we can determine how much fat, salt and sugar, if any, are added during meal preparation. Unprocessed foods are more often than not, affordable ‘functional foods’ – nutrient dense and good sources of vitamins, minerals and fibre.”

What are the top dietitian tips for getting more preventative nutrition benefits on a tighter budget?

  • Focus on eating a variety of affordable foods so that you consume a wider spectrum of beneficial nutrients
  • Prioritise unprocessed foods, including seasonal vegetables and fruits, wholegrains, dried beans and lentils
  • Eat less take-out meals which are often high in salt and fats, and allocate this budget to whole-foods you can prepare at home
  • Replace drinks with added sugar including sodas, fruit, sports and energy drinks with lots of clean, safe water – you will be amazed at how much you will save on your food budget
  • Reduce your meat intake by focusing on more plant-based eating.  Inexpensive dried beans and lentils are tasty replacements in meat dishes, or they can be added as an extra ingredient to stretch out your meat-based meals
  • If meat options are becoming too expensive, shift to other more affordable animal-based protein sources such as eggs, maas and yoghurt
  • Plan your meals and plan your food shopping.  Look out for price specials and discounts.  Collaborate with your family, friends and neighbours so that you can collectively shop for cheaper bulk buying options. 
  • Grow your own – start a home or community veggie garden and increase your daily access to easy-to-grow veg such as spinach, kale and traditional greens such as marog, as well as onions, beans, beetroot, carrots and tomatoes

The Importance Of Nutrition In Fighting Cancer

As many of us know all too well, a cancer diagnosis for you or a loved one is a sea change. While day-to-day life goes on, cancer symptoms and the ongoing effects of treatments usher in a myriad of adjustments.  Typically, our food preferences and eating habits are deeply entrenched, and therefore, getting optimally supportive nutrition can be challenging, but it is vitally important. 

As a Registered Dietitian and spokesperson for ADSA, (The Association for Dietetics in South Africa), Omy Naidoo points out, “Cancer propels the body into a catabolic state where both muscle mass and fat are breaking down, therefore the nutritional needs of cancer patients increases.  To meet this, there needs to be a careful focus on protein, calorie, and vitamin intake. 

Unfortunately, this need for increased nutrition comes at a time when it’s highly common to experience a general loss of appetite and the side effects of treatment that can seriously impair a patient’s interest in eating.  This makes a focus on nutrition a critical part of a patient’s cancer journey.”

Revealing a cancer diagnosis in your circle often opens the floodgates to well-meaning nutritional advice that can lead to going down unhelpful ‘rabbit-holes’.  There’s a mass of information and promotion around ‘alternative’ or ‘natural’ cancer nutritional support, even cancer ‘nutritional cures’.  This can be overwhelming, confusing, and frustrating during a vulnerable time.  It is important to note that there is currently no scientific evidence that any particular food, food supplement, or diet can cure cancer.

Cancer patients in both the private and the public healthcare systems do have access to the support of a dietitian, who is the only health professional that has specifically qualified in evidence-based nutrition.  If you’re feeling uncertain about what you or your loved one should be eating and drinking, it’s time to ask your doctor to help bring a dietitian onboard.  It’s important to discuss any natural remedy you want to introduce with your doctor or dietitian to ensure that there are no unintended interactions with the treatment you are undergoing.

While nutritional support for cancer patients focuses on avoiding malnutrition, some foods are allies, and some are to be avoided.  Another ADSA spokesperson, Registered Dietitian, Faaizah Laher puts it in a nutshell:

Foods to avoid during cancer treatment and recovery:
  • Avoid or limit alcohol
  • Avoid or limit highly refined, highly processed foods
  • Limit foods high in sugar, including sweets, cakes and sugary drinks
  • Limit foods that are high in salt
  • Limit foods that are high in animal fats
  • Avoid or limit cured meats such as bacon, ham and sausages
Focus instead on
  • Eating lots of fresh vegetables and fruits every day
  • Enjoying lean animal protein such as chicken breast and fish
  • Including more plant-based foods high in protein such as beans, lentils, peas, chickpeas, quinoa and soy-based foods
  • Choosing whole-grain options such as brown bread, brown rice and wholewheat pasta
  • Increasing your intake of nuts and seeds
  • Focusing on sources of healthy fats such as olive oil, avocados and fatty fish like sardines
Tips for bypassing the typical nutritional roadblocks

Omy Naidoo says, “Cancer patients undergoing treatment often experience a severe loss of appetite, nausea, vomiting, diarrhea, as well as dysgeusia which is taste alterations. Very often these patients need high protein, vitamin-containing supplements which they drink 2-3 times per day.  Some patients need tailored diets to help them get through spells of nausea and vomiting, and this is exactly how your dietitian can help you.

It’s important to remember that cancer patients need more nutrition, however, they typically end up taking in much less than usual due to these symptoms. The nett effect of this is that patients can lose muscle mass and become malnourished. This is precisely what you want to avoid as malnutrition then becomes an independent risk factor for poorer outcomes.” 

If you or a loved one are dealing with these challenges, then you need to reset your daily nutritional regime:

  • Focus on smaller, lighter meals eaten more frequently than the standard three meals a day
  • Experiment with healthy snack foods that are always on hand such as wholewheat crackers, nuts, seeds, fruits and vegetables
  • Try out delicious nutrient-rich smoothies
  • Add nuts and seeds to yoghurt, cereals, smoothies, and even casseroles
  • Make frozen lolly treats from fresh fruit juices, fruit, yoghurt and smoothies
  • Use nutritional supplements prescribed by your health professional

Most important is to remember that combatting malnutrition is your goal.  Take action and get professional nutritional advice to help the cancer patient maintain their weight as best as possible.

Healthy nutrition also reduces your risk of cancer

While some risk factors for cancer cannot be changed, research shows that 30 to 50% of major cancers can be prevented by following a healthy lifestyle. Faaizah Laher says, “While there is no guaranteed way to prevent cancer, a healthy lifestyle can help reduce your risk of developing many cancers and positively support treatment and recovery if you are diagnosed with cancer.

Think of eating the colours of a rainbow and lots of variety of nutritious foods (such as fruits and vegetables, whole grains, nuts, seeds, and legumes). Along with healthy eating, an active lifestyle and maintaining a healthy weight play important roles in reducing risk and boosting your resilience.”


NEW TO MOTHERHOOD IN COVID-19 TIMES

The six weeks after childbirth, known as the post-partum period, is a vulnerable time for women and their infants.  The impacts of the ongoing pandemic have only heightened concerns that new mothers in South Africa are able to access the care and resources they need as they step into motherhood. It’s not unusual for the need for post-partum follow-ups to extend for four to six months, especially in cases where there are physical and emotional issues and health complications.  In South Africa, primary health care provides free services to pregnant and lactating mothers, as well as children under six years.  Given the severe economic impact of the global pandemic, this access to post-partum care has become particularly important to the country’s new mothers.

As with pregnancy, nutrition is a particular focus of post-partum care.  New mothers need the support to recover from the rigours of pregnancy and childbirth so that they can cope well with the different challenges presented by infant care.  Exclusive breastfeeding, which means providing only breastmilk to the exclusion of water, tea, juice or food, from birth for the first six months of life, is crucial and requires ongoing support within the family and through community and healthcare connections. 

According to ADSA (The Association for Dietetics in South Africa) spokesperson, Professor Lisanne du Plessis breastfeeding is not only the best source of food for babies; it is also a major cost saver for food-insecure families and a major immune support for vulnerable children.  Therefore, we have to make sure during this COVID-19 time that our new moms are healthy and well-nourished. She says, “Mothers should try and eat a healthy balance of fresh, whole foods including carbohydrates from unrefined, whole grain starches; proteins from meat, eggs, fish, chicken, beans and legumes; healthy fats; fruit and vegetables as well as dairy that

supplies vitamins and minerals. They should try to avoid fast foods and other ultra-processed foods that are high in salt, sugar, preservatives, and unhealthy fats.  It is interesting to note that breastfeeding moms need around 500 additional calories daily, which equates to an extra snack such as a wholewheat bread sandwich with cheese or peanut butter; one to two glasses of milk, and an extra vegetable plus a fruit.  What is most important is a focus on fresh and whole foods.  New moms who are battling currently with household food insecurity need to raise this issue with their primary health care providers and get connected to a community-based or non-profit initiative which supports families through food parcel or other food security programmes. 

When it comes to nutrition, post-partum care and breastfeeding, some of the same pregnancy restrictions should continue.  Prof du Plessis says, “Limit coffee drinking to just one cup a day, avoid other drinks and snacks that contain caffeine, and keep avoiding cigarettes and alcohol.”

An issue for many new moms is managing the weight they gained through pregnancy.  Another Registered Dietitian and ADSA spokesperson, Cath Day says, “Don’t rush it. Don’t worry about how much you weigh for at least the first six weeks after the birth of your baby. During this time, concentrate on eating fresh and minimally processed food.  Focus on your support system and on getting enough rest. Once you have healed from childbirth and established a good breastmilk supply, you can begin to think about getting your body back. Go slow, do what you can, and be kind to yourself.  If you are not back to your pre-pregnancy weight by six months, then you can start looking at your diet and exercise regime.  Remember, it took you 9 months to gain the extra weight, so give yourself enough time.”

As disruptive as the pandemic has been, and how it has shaped many women’s experience of pregnancy, childbirth, and new motherhood, what’s important to remember is that COVID-19 has not changed the essentials of bringing a new life into the world.  Moms need the same as they always have.  They need support and encouragement from their families and friends.  They need access to good, fresh foods.  They need easy access to quality healthcare and professional support when needed.  Day says, “There is currently no evidence to suggest that pregnant women and new mothers need to adapt their nutrition specifically in response to COVID-19. Pregnant mothers and new mothers should concentrate on eating a healthy and well-balanced diet made up of minimally processed and fresh foods such as wholegrains, legumes, nuts and seeds, plenty of fruit and vegetables, lean proteins, and plant-based oils. Combat stress with a healthy, balanced diet along with enough sleep and exercise.  Consider stress management techniques such as walking, deep breathing, meditation, yoga or Pilates. It is really important that if mothers require nutrition and food support, there are various government, non-government and community-based programmes providing food parcels and other social relief.”

Prof du Plessis adds: “Although everyone is encouraged to stay at home with COVID-19 regulations in place, it is important that new mothers continue to go for their check-ups and take their babies for routine immunizations and follow-up clinic visits, according to the schedule in the Road to Health booklet.  During these visits, mothers should ask questions about their health and their children’s growth, health, and nutrition.  They should also request breastfeeding support if they are experiencing challenges to their goal of breastfeeding exclusively for the first six months.  The pandemic has not changed the essentials of life, and post-partum maternal and infant health remains a high priority in our country.”


FESTIVE SEASON & FOOD IN A PANDEMIC YEAR

We’ve had a year like no other, and while the shadow of the pandemic still looms over the world, South Africans can breathe a sigh of some relief, that it is, at least, the summer holiday season.  A good dose of festive cheer has rarely felt so crucial.  The pandemic will inevitably mute our celebrations in various ways.  Some of us are feeling the effects of the economic impacts and will have to scale down or forego the treats and luxuries.  Others, especially those with vulnerable loved ones, will opt for smaller, home-based gatherings and would rather skip the holiday crowds this year.  However we choose to make the most that we can of the festive season, our hearts will be pulled towards those struggling to put food on the table this December, as well as those who have an empty chair at their family table.

If a global pandemic can have a silver lining it is that it has immersed us far more than usual in home life.  We’ve had more concentrated time with our loved ones and closest friends, and that’s heightened our appreciation of the really important things in our life.  As families, we’ve cooked more together, and shared more meals.  Food is at the centre of our social lives, and the festive season brings with it particular food traditions and long-established favourite holiday food habits.  This brings challenges to starting up or maintaining healthy eating, and to how we can still enjoy special food occasions on tighter budgets this year.

Three registered dietitians, all spokespeople for ADSA (Association for Dietetics in South Africa) share their advice for a happy, healthy 2020 holiday season for all South Africans:

Omy Naidoo, registered dietitian from KZN on beating the budget:

  • Opt for much more cooking in rather than eating out; the savings are significant, especially when it comes to larger families
  • Add beans, peas and lentils to dishes for a punch of affordable, quality protein so that you can use less meat 
  • Include more vegetables at every meal to ensure you get a boost of vitamins and minerals without breaking the budget.  Start your own summer veggie garden at home
  • Cook large meals from inexpensive ingredients, and use your leftovers over the following days 
  • Every meal doesn’t have to have meat which can be swopped out for beans, legumes, eggs or canned fish, which are all cheap, nutritious and delicious sources of protein

Zitandile Mfono, registered dietitian from Eastern Cape on healthy balance:

  • Every day and every meal won’t be the same, and you should strive for balance over time.  For instance, a sweet treat at lunch can be balanced by plenty of vegetables at dinner
  • Plan ahead for your ‘must-have’ favourite celebration meals; make the shopping list for those ingredients and then stick to it.  Because you will enjoy getting what you most want out of festive eating, you won’t miss those less healthy extras you slipped into your trolley
  • Put the tips for healthier alternatives into action so that you can reduce sugar and saturated fats at most meal times
  • Have fun with family workouts and long family walks to balance out the long hours sitting down to bigger meals
  • Balance is also about the mind; so enjoy your festive meals and holiday time with your loved ones.  Despite the difficulties of this year, we are still going to be thankful for the festive cheer

Rosanne Lombard, registered dietitian from Gauteng on keeping it simple:

  • Don’t overcomplicate your nutrition.  Try not to restrict yourself and deprive yourself of treats as this tends to lead to a binge.  If you can eat the healthier foods most of the time, in portion-controlled amounts, then it is okay to enjoy festive season treats
  • Fill at least half your plate with vegetables and salad for an easy way to control your portions
  • Drink lots and lots of water, and limit alcohol, which is expensive. This is an easy way to save money and keep healthy
  • Make simple breakfasts like oat, banana and egg flapjacks, high fibre cereal cereal and yoghurt, poached eggs and toast and delicious smoothies.  For lunches, you can do snack platters with crudité veggies, homemade wraps and filled brown or seeded rolls with a big salad. All of these ideas are super easy and affordable, plus healthy too 
  • Buy fewer treats and energy-dense snacks. We tend to stock-pile these items during the festive season, and because we have them, we eat them. Rather don’t have them in the house. If you really want a treat every now and then, then you can rather go and buy one treat such as an ice cream at the beach or a slice of cake with a friend

A last word from Zitandile:

“It’s the giving season and the holidays are a time to make extra or pack your leftovers to share with neighbours, friends or your local shelter. In these tough economic times, sharing food can prevent food waste and bring festive cheer to someone else.”



WHAT YOU NEED TO KNOW ABOUT MANAGING DIABETES IN THE FAMILY

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 14th 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.


BREASTFEEDING & COVID-19: BUSTING THE MYTHS

We’ve had an overload of fake news over the past pandemic months.  One of the most damaging falsehoods to emerge has been that COVID-19 + moms can transmit the virus through breastmilk to their little ones, and should stop breastfeeding.    Spokesperson for ADSA (The Association for Dietetics in South Africa), Andiswa Ngqaka, a registered dietitian says, “There are anecdotes from various countries indicating that this misinformation is causing moms to avoid breastfeeding during the pandemic. While some may see infant formula as a ‘safer alternative’ during this time, this is not the case. Breastmilk is the safest and most nutritious food for babies, and COVID-19 does not change that.”

 

There is no evidence of COVID-19 transmission through breastmilk

As the medical profession’s foremost experts in nutrition, registered dietitians are constantly keeping up to date with the latest scientific evidence. Worldwide, there is currently no evidence that breastfed babies have been infected by mothers who have tested positive to COVID-19. Andiswa explains, “The WHO cites one study where there was a detection of non-infectious COVID-19 viral RNA in breastmilk, and this is definitely not the same thing as finding viable and infective virus.  Therefore, there is unanimous agreement across international health organisations that moms can have complete peace of mind breastfeeding their children through the pandemic, even if they are COVID-19 + or suspect they might be infected.  The benefits of skin-to-skin contact with your baby and breastfeeding as normal are overwhelmingly immune-boosting and protective of your baby’s health.”

Lisanne du Plessis, Associate Professor at Stellenbosch University and ADSA spokesperson, gives her top 5 tips for breastfeeding moms during the pandemic:

  1. Mothers should breastfeed on demand, whenever baby wants to breastfeed, day and night.
  2. Breastfeed exclusively for 6 months. Breastmilk provides all the food and water that babies need during this time. Breastmilk also protects babies against sickness or infection.
  3. Do not give any other food or liquids to babies, not even water, during the first 6 months of life. Even during very hot weather, breastmilk will satisfy babies’ thirst.
  4. Giving babies under 6 months anything other than breastmilk will cause them to suckle less, will reduce the amount of breastmilk that a mother produces and may make babies sick.
  5. Practice hygienic measures to protect moms and babies against COVID-19 and other harmful bacteria and viruses in our environments.

 

Breastfeeding is food security for babies

Breastfeeding from birth supports the healthy development of babies and plays an important role in prevention of all forms of childhood malnutrition including wasting, stunting, obesity and underweight and micronutrient deficiencies.  Breastmilk protects against many infections including COVID-19. At a time when many South African families are facing serious food shortages, breastmilk provides complete food security for babies under 6 months, and boosts nutrition and health for other young ones.  Breastfeeding saves on the food budget, making more money available to feed the family.  When it comes to food, you can’t get anything safer, more convenient and more economical than breastmilk. “It would make good sense to see a boost in breastfeeding across South Africa at this time,” says Lisanne.

 

 

What precautions should a COVID-19 + mom take?
The WHO provides the following breastfeeding guidelines if you suspect or know you have COVID-19:

  • Wash hands frequently with soap and water for at least 20 seconds or use alcohol-based hand rub and especially before touching the baby;
  • Wear a medical mask during any contact with the baby, including while feeding;
  • Sneeze or cough into a tissue. Then dispose of it immediately and wash hands for at least 20 seconds again;
  • Routinely clean and disinfect surfaces that you have touched.

It is vital that partners, family and friends support breastfeeding moms who may be COVID-19 infected.  They need to understand that there is no evidence that the virus is transmitted through breastmilk, and that by continuing breastfeeding, the mother is doing the best she can do to protect her baby from COVID-19.

 

What should happen if you’re just too ill to breastfeed?
Andiswa says, “If you’re too ill to breastfeed, try to express your milk for your baby and give it with a clean cup or spoon and cup. Expressing breastmilk is important to sustain your milk production so that you can carry on breastfeeding when you recover.  If you can’t express your breastmilk, you can consider donor human milk.  Wet nursing is another option if culturally acceptable to you.  Your last option would be to provide a breastmilk substitute. Reunite with your baby as soon as your recover. Get support if you need help re-lactating and bonding with your baby.”

 

 

Get Messages for Mothers – M4M

A global pandemic is certainly not the easiest time to be a new mom and the mom of young children.  Mothering babies and small children is often an isolating experience at the best of times, so now, with social distancing and staying-at-home, you may need to make some extra efforts to ensure you are well-supported at this critical parenting time. Grow Great, a campaign to prevent stunting by 2030, partnered with other NGOs Embrace, ilifa labantwana and the Perinatal Mental Health Project, to launch Messages4Mothers, a new digital platform to connect with South African moms during the pandemic. Messages for Mothers can be accessed at M4M or you can connect with Grow Great on social media @GrowGreatza on both Twitter and Facebook.  Grow Great Communications Specialist, Duduzile Mkhize says, “Some of the biggest concerns for mothers are around how they can safely continue to breastfeed their children while dealing with COVID-19.  Some mothers are essential workers and they worry about how they can continue to keep their families safe. Mothers of small children worry about taking them for immunisations as they fear clinics might not be safe. Pregnant mothers who have to go for checks ups also worry about this. COVID-19 lockdown has caused a lot of anxiety for many people, so many mothers ask questions about how to cope with anxiety and depression.”

 

You’re not alone

On a daily basis, the M4M platform provides accurate and reliable information for mothers by answering frequently asked questions. These questions are gathered from social media platforms of all the partners and the Grow Great WhatsApp groups and campaigns. You will find reliable updated COVID-19 information as well as support for breastfeeding and practical advice for coping with the challenges of motherhood during the pandemic.

 

World Breastfeeding Week takes place from Saturday, 1st August to Friday, 7th August. The local 2020 campaign theme is Support breastfeeding for a healthier South Africa.  The Department of Health and its partners, including ADSA, appeal to the country to fully support and encourage breastfeeding mothers who are protecting their babies against many infections, including COVID-19.  Through breastfeeding on demand, mothers also protect their baby’s vital source of immune-boosting breastmilk and help their babies thrive through close mother-and-child contact.

 

Breastfeeding pamphlet

Breastfeeding Q&A Booklet


SOUTH AFRICA’S SUPERHERO DIETITIANS

Superheroes are dedicated to making the world a better place and protecting the public. They stand up to threats and use their superpowers to ensure people’s well-being and safety.  As COVID-19 has spread across the world, we have seen dietitians at the frontlines of the health response supervising life-sustaining nutrition in hospitals and care homes.  Many have also been working remotely, helping patients manage their health and nutrition under lockdown.  Those in public health have been contributing their expertise to emergency food relief efforts as South Africa faces a sharp crisis in food security.  These are just some of the vital roles that registered dietitians play across a range of fields.

 

“The need for latest nutrition knowledge and science-based advice is far more widespread than most people realise,” says Logesh Govender, registered dietitian and council member of SASPEN, the South African Society for Parenteral and Enteral Nutrition.  “There is considerable dietetic diversity, from food product innovation in the corporate sector to patient care in government hospitals; from the policy level of public health disease prevention to practically improving nutritional access in communities.  Food is a basic essential of life, and the need for expert nutrition-related services impacts every one of us.”

 

At a time, when most countries around the world are emerging from hard COVID-19 lockdowns, the health of our families has come sharply into focus on a daily basis.  With the closure of food takeaways and restaurants and confinement to our homes, many of us are experiencing changes to our habits and relationships with food.  “For the individual and the family, the community and the country, we are experiencing a unique opportunity to examine our thoughts, beliefs and actions around food,” says Association for Dietetics in South Africa (ADSA) President, Christine Taljaard-Krugell. “If there is good that can emerge from this global crisis, it is to see where we can use science-based evidence and advice to make positive changes that will improve our lives now, and once the threat of COVID-19 has subsided.  When it comes to nutrition knowledge, it is our dietitians who are the superheroes that can lead the way in recommending sustainable changes to ensure healthier lifestyles.”

 

 

These South African Dietetic Superheroes represent their colleagues in diverse and critical health sectors:

 

Dietetic Superhero in ICU/COVID-19, Anna-Lena Du Toit is currently the dietitian responsible for the nutritional management of patients in the intestinal failure unit, colo-rectal surgery, hepatobiliary surgery, upper gastro-intestinal surgery and surgical ICU at Groote Schuur hospital. In light of the pandemic she has been re-assigned to a 12-bed COVID-19 ICU unit as well as two COVID-19 wards. She also works part-time at UCT Private Academic hospital with mostly surgical in-patients.  Anna-Lena serves as the scientific secretary and president-elect of SASPEN.

Your Superpower:  To be a valued member of the multi-disciplinary healthcare team I think is the most vital tool if you want to influence patient care and ensure that your patients receive optimal nutrition support. Your relationship with the various players in the team have a direct impact on the nutritional management of your patient. Building relationships with various members of the team ensures early referral of patients for nutritional input all the way through to nursing staff valuing your input and ensuring accurate delivery of the nutrition prescription.  Regular training and education within the multi-disciplinary team ensures their buy-in into the important role nutrition plays and ultimately translates into better nutrition for your patient. Being up to date and able to translate evidence into practice ensures that you are regarded as the expert in your field and gives you the opportunity to advocate for your patient.

When patients are in hospital and unable to eat by themselves the dietitian has the super power to still ensure that patients receive all the nutrition they need for their various conditions. This is achieved either through feeding the patient directly into the stomach or by feeding into the veins. This requires the use of very specific nutritional products that should only be prescribed and used under supervision of a registered dietitian.

Is there a positive health lesson we can take out of our experience of COVID-19?  What a time to be alive! In my 13 years in clinical dietetics, I have not seen protocols and plans being put in place as quickly as it has been happening in the past three months. The innovation, drive and commitment on all levels that has gone into ensuring safe working conditions and optimal facilities for patient care has been phenomenal. In the community, the way in which people have adapted to a ‘new normal’ and the realisation of what is truly important in our lives has been incredible. It has been positive to see the amount of good that there is in this world, and how willing people are to help and give.  If we can come out of this pandemic and continue doing these things we can truly change the world.

Dietetic Superhero in breastfeeding advocacy, Chantal Whitten recently completed her PhD at the North West University and is currently a lecturer at the University of the Free State.   Chantell serves as the Nutrition Lead for the coalition network the South African Civil Society for Women’s, Adolescents’ and Children’s Health, and as a member of the National Department of Health  Ministerial Committee for the Morbidity and Mortality of Children under 5 years.
Winning the challenge:  For all my years of experience in the field of breastfeeding, my greatest moment of contribution was in facilitating the legislating of Regulations R991, which are the regulations that control the marketing of breastmilk substitutes.  These latest regulations protect breastfeeding for generations to come and help to foster a supportive environment for mothers to choose breastfeeding without undue pressure from the infant formula industry.
Is there a positive health lesson we can take out of our experience of COVID-19?  We know that mothers who are breastfeeding through the pandemic have less stress trying to source food for their young infants and children, while mothers who are not breastfeeding have an additional burden to find food for their young children.  We can now see first-hand the protection that breastfeeding offers both children and mothers during a time of crisis.  This will remain important as we enter an economic depression.  For children, food security starts at the breast.

Dietetic Superhero in reducing obesity, Kelly Francis serves on the executive committee of ADSA where she is currently assisting with a COVID-19 hunger relief campaign and a strategy to support the prevention and reduction of obesity in South Africa.   She has a passion for nutrition education and the prevention of nutrition-related diseases and her special areas of interest include obesity.

Greatest challenge:  The culture of dieting is the greatest threat to winning the battle against obesity. Many people are resistant to long term lifestyle and behaviour modification and would rather be very restrictive for short bursts of time than work at developing a healthy and mindful relationship with food. Not only is this not a sustainable treatment for obesity, but the family’s opportunity to develop a healthy relationship with food is ultimately disrupted by family members following a different diet.

As a Dietetic Superhero what one sweeping change would you like to see that would improve nutrition and health in SA?  I would like to see that no nutritious food goes to waste in South Africa, especially ‘ugly’ vegetables not accepted by retailers. I feel that there is much room for work in this particular area of safe food waste to improve access to nutrient-dense food.

Dietetic Superhero in public health, Lenore Spies has more than 35 years’ experience in the public health sector.  She is currently a Senior Technical Advisor in Nutrition for the Maternal, Adolescent and Child Health Institute. Lenore is an expert in nutrition leadership, strategy and policy development, and she is passionate about mentoring the next generation of nutrition leaders.

Greatest challenge:  The single greatest challenge in public health nutrition is the underestimation of the contribution that dietitians and nutritionists can make to the public health agenda. You are always having to explain and motivate the contribution that dietitians and nutritionists can make. We can do so much more. We need to move to a place where the expertise of public health nutritionists is an integral part of any public health agenda item. In the current COVID-19 context, with hunger and malnutrition as well as hospitalizations and quarantine, we should be central to the discussions. I was very impressed with the
Governor of New York, the hardest hit state in USA, when he specifically listed Public Health Personnel and Dietitians and Nutritionists as essential front line workers.
Your Superpower:  Over the years, I have worked relentlessly to develop my leadership and
advocacy skills to the extent that I am often consulted on my views and opinions. I have become particularly adept at being able to navigate the balance between the political and social contexts, take a high level view of its relevance and translating that to the nutrition policy environment.

Dietetic Superhero in public health, Gilbert Tshitaudzi is a Nutrition Specialist at the UNICEF South Africa Country Office.  He has many years’ experience in the public health sector and has specialised in infant and young child nutrition, clinical nutrition, HIV and nutrition programming.  Gilbert served for four years as a board member of the Professional Board for Dietetics and Nutrition of the HPCSA (Health Professions Council of South Africa).

Winning the challenge:  My contributions have been in advocating for public health nutrition interventions through public health policies, nutrition-specific, nutrition-sensitive policies and strategies. Having advocated for the mainstreaming of nutrition into HIV/AIDS care when South Africa started with ARV rollout is one of the major contributions I have made in the nutrition landscape in South Africa.

Is there a positive health lesson we can take out of our experience of COVID-19? COVID-19 could be a springboard for our healthcare system in South Africa in strengthening our public health interventions, with prevention of diseases as a cornerstone. It is also an opportunity to bring all South Africans around to one health system for all in order to deal with the inequalities that have been highlighted by this pandemic. This is an opportunity to interrogate our food systems and play a meaningful role as a profession in those debates.

 

Dietetic Superhero in private practice, Monique Piderit serves private practice patients through Nutritional Solutions in Bryanston, Johannesburg and consults to corporate and food industry clients.  She is currently a PhD Dietetics candidate at the University of Pretoria.

Greatest challenge:  Dietitians are dedicated to sharing evidenced-based nutrition information and advice.  Today, everyone has vast amounts of information, and misinformation, at their fingertips.  There are high levels of consumer confusion which, unfortunately, can lead to distrust of professionals. This confusion may be fuelled by non-experts like bloggers, influencers, health coaches, and the like, who often have large social media followings vulnerable to misinformation. It’s particularly challenging when such non-experts create fear-mongering related to healthy eating and nutrition.

Winning the challenge:  The best for me is when a patient, who starts out resistant, reluctant and unwilling to change, realises the huge power that they hold in improving their nutritional status. It’s fascinating to watch this transformation to one of confidence and positivity as they choose to take control of their health and turn it all around. Actually, my patients and clients are the real superheroes. I am just their sidekick!

 

ADSA  has joined forces with SASPEN in the upcoming celebration of Dietitian’s Week, which runs from 1 to 5 June 2020, focussing on #WhatDietitiansDo.

 

Dietitian’s Week highlights the diverse and important roles that these science-based nutrition experts play in our health care system.


Good Nutrition, a priority during COVID-19

The global pandemic has stripped daily life down to the essentials, and we find ourselves under lockdown restrictions with our thoughts and actions around food set in a very different context to anything we have known before.  As it grows ever clearer that the threat of COVID-19 will be with us for quite some time and restrictions will be ongoing, optimising our family’s health now is top of mind for many.  Generally, South African families are now home together for an extended period of time.  There’s more opportunity to shift into healthy habits like cooking nutritious meals together, making healthy snacks and drinks available in the home and being physically active as a family on a daily basis.

“If it’s not already a focus of family life, this is actually an ideal time to prioritise nutrition and health,” says Retha Harmse, a Registered Dietitian and spokesperson for ADSA (Association for Dietetics in South Africa). “As lockdown restriction levels fluctuate; we will have more freedom of movement, but also more risks of contracting COVID-19.  Eating a balanced diet plays an important role in maintaining health and supporting the immune system, as well as all the body’s vital systems.”

 

A balanced diet is the best immune support

The media, especially social media, are rife at the moment with information-sharing about COVID-19, and there’s a lot of ‘advice’ and recommendations that are not evidence-based.  A feature of the COVID-19 fake news has been the touting of various foods, medicinally-used plants or nutritional supplements as ‘immune-boosters’, treatments or even ‘cures’.  Retha says, “Of course, everyone would like to minimise their risk for contracting COVID-19, however, there is no simple quick fix to boost our immune system to guarantee that we won’t be infected. Simply put, you cannot ‘boost’ your immune system through diet, and no specific food or supplement will prevent you contracting COVID-19. Good hygiene practice and social distancing remains the best means of avoiding infection.”

There are many nutrients involved with the normal functioning of the immune system.  This is why maintaining a healthy balanced diet made up of different foods that provide a spectrum of nutrients that include copper, folate, iron, selenium, zinc and vitamins A, B6, B12, C and D is the very best way to support immune function. “In addition to a healthy balanced diet, a general healthy lifestyle is also important to support your immune system,” says Retha, “This means not smoking, exercising regularly, getting adequate sleep and very importantly, minimizing stress, which is very intense at this time.”

 

 

 

How do we achieve a balanced diet for optimum immune support?

A well-balanced, healthy diet will provide you with all the nutrients you require to support immune functioning. Retha suggests going back to the basics of good nutrition.  Here, she takes the South African Food Based Dietary Guidelines and shows where you can make some creative adjustments to fit the lockdown restrictions you might experience:

  1. Enjoy a variety of foods – Although certain foods might be a bit harder to come by, don’t fall in the trap of eating only certain foods. Variety also means including foods from two or more food groups at each meal.
  2. Be active – Regular, moderate exercise is very beneficial for getting outdoors (if you can), stress relief and improved immune function. Try some of these lockdown ideas:
    – You don’t need big spaces for cardiovascular exercise – running up and down stairs is great; as is skipping, and skipping ropes are inexpensive cardio tools
    – download exercise apps for daily workouts
    – Similarly, there are many physical activity videos, including dance, martial arts and yoga, available on YouTube and other websites
    – If you have a closed in garden or courtyard-type space, play physical games such as handball, bat and ball, mini-cricket or mini-soccer as a family or couple, combining fun, bonding and exercise
  3. Make starchy foods part of most meals – Choose whole grain, unrefined foods to add more fibre, vitamins and minerals to your diet. Good options to choose are whole-wheat pasta, multigrain provitas or cracker breads, brown rice and bulgur wheat. Combine whole grains with other tasty, nutritious foods in mixed dishes.
  4. Eat plenty of vegetables and fruit every day– This can be challenging while we are under lockdown and want to avoid frequent shopping. Here are some tips:
    – Choose fresh, whole fruit that is naturally longer lasting such as apples, pineapple and citrus fruits
    – Eat fruits as snacks and desserts. Add sliced fruit or dried fruit to your cereal, muesli or yoghurt
    – As some fresh vegetables don’t last long, blanche or cook them on the day of purchase and then freeze for later use
    – Root and bulb veg options such as carrots and turnips, onions, garlic and ginger are longer lasting
    – Frozen and canned vegetables are also good options
  5. Eat dry beans, split peas, lentils and soya regularly – Dried legumes are not only good substitutes for meat, fish, eggs or cheese, but can also be used as affordable ‘meat extenders’ to make meals go further. If you use canned legumes rinse them well after they have been drained to reduce the sodium content.
  • Mash and heat up tinned cannelloni beans as the creamy base for a pasta sauce.
  • Save on your budget and make your own humus from canned chickpeas.
  • Peanut butter can be used as a sandwich filling and can be stirred into porridge. ​
  1. Have milk, maas or yoghurt every day – Maas and yoghurt will last longer in the fridge than fresh milk. For more long-term milk options buy long-life milk, skim milk powder or evaporated milk.  Fresh dairy products can also be frozen.  Eat yoghurt, with added fruit, as a snack between meals instead of a packet of chips as this contributes to the day’s nutrient intake and does not contain excess fat and salt.
  2. Fish, chicken, lean meat or eggs can be eaten daily
  • Stock up on tinned fish options such as tuna, pilchards, sardines
  • Quiches and omelettes are an easy and tasty way to use up vegetables that might spoil soon
  1. Drink lots of clean, safe water – This is perhaps the easiest time to get into the habit of drinking enough water because you are confined to one space. If water is readily available during the day, it increases consumption. Keep a water bottle on hand or a jug nearby.
  2. Use fats sparingly – Choose vegetable oils rather than hard fats, and always use only a little, as fats are high in energy but provide relatively few nutrients.

Even for those who are still earning under the lockdown restrictions, the economic downturn is going to have an impact on the vast majority of South African households.  Retha emphasises the importance of getting your household food budget under control, as this can relieve some stress.  “Prioritise nutrient-dense foods that you know your family enjoys, and limit your purchases of treats, drinks and snacks that are high in calories but low in nutrients,” she says. “Meal planning, and keeping dishes simple yet nutritious, helps to reduce your food waste and gives you the peace of mind that you’re doing the best you can so that your family can maintain their health.  Always remember that the best ways to stay safe are through regular, proper washing of hands, social distancing and limiting movement outside of your home.”


Dietitian Tips for COVID-19 Food Shopping and Preparation

No take-away foods.  No home deliveries. No hot counter meals.  No restaurant fare.  For now, and the foreseeable future, COVID-19 has us all cooking from home, 7 days a week. Lockdown rules and the need for social distancing also mean that we need to do our best to reduce the amount of times we are leaving home for essential food shopping. But mindless panic buying and frightened hoarding aren’t actually going to help when it comes to ensuring we’ve got balanced, nutrient-dense foods at home that will help to support our families’ immune systems.

Here’s some advice from Registered Dietitians and ADSA (Association for Dietetics in South Africa) spokespeople, Jessica Byrne and Retha Harmse:

First, get organised – Take note of what you already have at home. Many of us will now have time on our hands to make an inventory, tidy up and declutter our storage spaces.  Look at the use-by dates of foods in your pantry and freezer and discard anything that is no longer safe to eat or won’t be eaten, recycling whatever you can. Make a proper assessment of your food storage spaces, so that you can be sure not to buy more than you can properly and safely store.  “Aim to use your fridge and freezer space optimally; for instance, fresh produce such as whole butternuts, potatoes, sweet potatoes, onions, garlic and tomatoes should rather be stored in a cool, dry place,” Retha says.

Plan your meals – Keep in mind easy recipes using a variety of simple ingredients; and focus on healthy, nutrient-dense foods. Lockdown is not the best time to get experimental with your family meals, even if you do have more time for cooking.  Jessica says, “Rather prioritise the foods you know your family enjoys and will eat so that you can minimise food waste and make the best use of your resources.”  Plan for opportunities to cook in bulk soon after you shop so that you can freeze for later, especially when it comes to meals that require perishable ingredients.

Make your shopping list – Maybe it’s not something you usually do – but a list can really help to keep you on track when you’re under the stress of lockdown shopping.

 

Young black mom running errands at the supermarket smiling at camera

 

Here are some foods to consider:

  • Grains: Aim for higher fibre grains such as brown rice, barley, bulgur wheat, oats, whole-wheat pasta, whole-wheat noodles, high fibre crackers, quinoa and cous cous. Whole-wheat wraps can be stored in the freezer to extend their shelf-life.
  • Fruit: Fresh fruit for a week or two – choose fruits that last longer such as apples, pears, unripe bananas and citrus fruits. If you have the freezer space, you can also look for frozen fruits.  If you include dried fruits and canned fruits, these should only be eaten in small amounts.
  • Vegetables: Quite a lot of the fresh vegetables that you buy such as spinach, peppers, brinjals and marrows will have to be consumed or used for home-prepared frozen meals in the first few days after you shop. However, you should also shop for fresh produce that lasts longer, such as potatoes, sweet potatoes, onions, carrots and other root vegetables, whole butternut, gem squash, ginger and garlic. Frozen and canned vegetables can be stored to use once the fresh items have been used up.
  • Dairy and protein sources: These include canned fish such as salmon, tuna or sardines; canned or dried beans, lentils, chickpeas or split peas; nuts and seeds, including nut butters; eggs; cottage cheese; yoghurt or maas, and long-life milk. Store chicken pieces in the freezer, and lean mince which can be turned into bolognaise sauce and then, portioned and frozen.
  • Herbs and spices: Having a range of herbs and spices on hand provides more variety in your meals and can help boost the flavour of foods without needing to add extra salt.

 

Retha adds: “In case you do fall ill, it is worth having a few easy to cook and prepare foods in the house on standby. Frozen soups, microwavable rice and frozen ready meals are easy options that you can keep in stock in reasonable quantities if you don’t have the energy to prepare more complex recipes. Just remember that  canned foods are high in salt, so be sure to drain and rinse before using to remove the extra salt.”

 

Stocking up well during the nationwide lockdown is all about thinking clearly and planning well as there is no need to panic buy and stockpile foods. “Our President has confirmed that food stores will remain open during the lockdown, and we are seeing this happening all over South Africa,” points out Jessica. “We all need to act sensibly and to exercise restraint when it comes to the bulk purchasing of foods at supermarkets, as panic buying places greater strain on the poorest and most vulnerable members of our community.”


Nutrition for Women – should it be different?

When it comes to the basics of healthy eating, there’s no doubt that what’s good for the goose is also good for the gander.  No matter your gender, you can’t go wrong with eating a variety of healthy foods including lots of fresh vegetables and fruit; legumes and pulses, nuts and seeds; lean proteins and dairy; healthy fats and wholegrains.  Combine those healthy eating guidelines with regular physical activity plus the awareness that we require less calories than men, and women can do a lot to safeguard their health.  Inevitably though, finely etched into the fabric of women’s lives are the details of our difference, and we do have some unique needs when it comes to certain micronutrients, which shift in focus during our changing life stages.

 

Maryke Bronkhorst, a Registered Dietitian and spokesperson for ADSA (Association for Dietetics in South Africa) points out that our reproductive years represent the major portion of our lives. “Women and girls of reproductive age, who are not pregnant or breastfeeding, should strive for optimal nutritional status for their own health and for the health of any future children,” Maryke says.  “Good nutrition during the reproductive years helps set the foundation for health in years to come. It helps ensure proper growth during adolescence, adequate nutrient stores for a healthy pregnancy, and a good nutritional status to help maintain bone health during the menopausal and postmenopausal time of life. Many women’s health issues are related to the hormonal shifts in oestrogen and progesterone associated with the menstrual cycle. These include higher risk of anaemia, weakened bones, and osteoporosis. Malnutrition, as either under- or over-nutrition, can also have adverse effects on women’s health and fertility.”

 

Top tips for your reproductive years are:

  • Achieve and maintain a healthy body weight. Underweight is related to poor nutritional status; heart irregularities; osteoporosis; amenorrhea (absent menstruation); and infertility in women. Obesity is associated with increased risk of chronic disease and obesity-related anovulation (ovulation does not occur during the menstrual cycle) which affects fertility
  • Consume a healthy, balanced diet. Women should enjoy a variety of foods across all food groups. Include wholegrains, plenty of vegetables and fruit, healthy fats, dairy and lean protein sources. Limit processed foods, salt, saturated and trans-fats, refined carbohydrates and sugar. Remember that supplementation cannot compensate for an unhealthy or unbalanced diet
  • Exercise regularly. Research shows that women are less physically active than men.  Find sports and activities that get you moving that you enjoy and try to ensure a minimum of three hours of physical activity every week
  • Avoid harmful substances including tobacco and vaping products, alcohol, recreational drugs and environmental toxins
  • Include iron-rich protein food in your diet like lean meat, eggs and fish or plant sources such as spinach, beans and lentils, and eat these in combination with Vitamin C rich foods to help improve iron absorption. Iron deficiency is one of the most common nutrient deficiencies that results from losing more iron than one takes in. Menstruation depletes a woman’s iron stores. Iron deficiency reduces the ability to complete any work, lowering productivity and performance. We know that worldwide, women do more unpaid work in the household than men. If you are diagnosed with iron deficiency anaemia, make sure to take your iron supplement daily as prescribed.

 

Multiracial females with different size and ethnicity stand together and smile. 

 

What about pregnancy?

This incredibly special time in a women’s life can become a minefield when it comes to everyone’s opinions about pregnancy do’s and don’ts.  What is critical for pregnant women is to turn a blind eye to old wives’ tales and the latest fads and to rather follow professional, evidenced-based nutritional advice.

Pregnant women and breastfeeding moms do have important nutritional requirements that support both their health and the health of their precious baby.  Maryke highlights the importance of healthy weight gain: “Ideally, a healthy weight should be achieved prior to conception but, of course, this can only be worked on in the case of planned pregnancy. What mums-to-be need to understand is that obese pregnant women have increased rates of pregnancy related hypertension, gestational diabetes, large babies, C-section, perinatal morbidity and mortality. Conversely, underweight pregnant women have greater risks when it comes to preterm delivery, low birth weight, and foetal growth restrictions. Healthy weight gain during pregnancy is important for the health of both the mother and the foetus, and it has a positive impact both during and after pregnancy. However, weight loss during pregnancy should be avoided.”

 

Top tips for pregnancy and breastfeeding are:

  • Focus on the basics of a healthy, balanced diet every day
  • Avoid harmful substances including tobacco and vaping products, alcohol, recreational drugs and environmental toxins
  • Reduce your caffeine intake to no more than 200mg or two coffees daily and remember caffeine is also present in teas, hot chocolate and sodas
  • Exercise up to 30 minutes daily as approved by your health care professional
  • Take prenatal supplements as prescribed by your health care professional
  • Avoid certain foods to prevent the chance of foodborne illness such as soft cheeses, sushi and deli meats. Also, avoid fish that may contain high levels of mercury such as albacore tuna, swordfish, tilefish and king mackerel. And limit excessive liver consumption.

 

During and after menopause

While the basics of a healthy, balanced diet stay the same, your post-reproductive years herald some slight changes in your healthy eating regime.  Maryke notes that a common concern for women during and post- menopause is ‘unexplained’ weight gain, especially around the abdomen. “This is attributed to many factors, “she says, “such as changes in hormones affecting metabolism; the loss of lean body mass which is part of the ageing process; reduced basal metabolic rate; lifestyle changes and changes in physical activity.”  It is important to note that your calorie requirements are reduced post-menopause due to a natural metabolic ‘slow down’. Focus on consuming nutrient-dense foods in smaller portions, cutting down on processed foods and foods that are high in fat and sugar, as well as maintaining (or increasing) regular physical activity.  Due to the cessation of menstruation, iron requirements are reduced.

 

Top Nutritional Tips:

  • Consume a healthy, balanced diet – Menopausal women should also consider including more plant-based foods in their diet
  • Be physically active – During and post-menopause, women should engage in regular physical activities that they enjoy – this should include aerobic, resistance, and weight bearing exercises that are protective of bone, heart and emotional health
  • Manage your weight – As we age, excessive weight gain is a risk factor for other health conditions. If you find yourself struggling to maintain a healthy weight, get the help of a registered dietitian, who will take all aspects of your lifestyle into account to assist you in reaching a healthy weight
  • Protect your heart health – Menopausal women often experience changes in blood lipid levels (for example raised cholesterol levels), therefore it is important to include healthy fats in your diet. The focus should be on plant-based sources of unsaturated fats, such as nuts and seeds and their oils, avocado, and especially sources of omega-3, such as sardines, pilchards or salmon. Limit saturated and trans-fats.
  • Include phytoestrogens in your diet – These plant-based oestrogens may mimic the oestrogen produced in the body. Some studies show that the intake of soy may help to manage menopausal symptoms such as hot flashes. Sources include soy, soymilk, tofu, tempeh, and soybeans
  • Avoid fad diets- These are unsustainable in the long-term; they often don’t meet your nutrient requirements, and they can adversely affect metabolism

 

Maintaining a healthy weight for a lifetime

From girlhood through to old age, we benefit greatly from maintaining a healthy weight.  Another ADSA spokesperson and Registered Dietitian, Nathalie Mat makes the point that South African women tend to weigh more than our male counterparts, which puts us at greater risk of a number of health conditions including Type 2 diabetes, cancer and high blood pressure.  “One of the key identified reasons is physical inactivity, says Nathalie.  “South African women tend to exercise less than men do and this increases the likelihood that they will gain weight.”  Nathalie also warns against unregulated portion size, especially when eating out: “Chefs have no idea whether the food they are dishing up in the kitchen is going to a woman or a man.  As women, we need to be acutely aware that the portions we are eating when out are most probably more food than we need. This means we need to stop eating when we have had enough, instead of eating mindlessly until we finish the plate.”


SPRING CLEANING YOUR LIFESTYLE

 

Finally!  It’s time to emerge from the heft and sluggishness of Winter, and tune into the bright, clean energy of Spring.  It is the season for clearing out the old and slow and kicking up our heels to livelier, sunnier rhythms.  Springtime brings the perfect opportunities to reboot our immune systems after the cold-and-flu blues; use the extra daylight hours to boost our Vitamin D and swop stodgy comfort food for the juicy buoyancy of the new season’s bounty.

There are many potential benefits to responding to the effervescent energy of Spring; however, specialist healthcare professionals such as Registered Dietitian and ADSA (The Association for Dietetics in South Africa) spokesperson, Retha Harmse cautions against getting caught up in making lifestyle changes that are too sweeping.  “Trying to make too many changes, or really big changes overnight doesn’t always stick,” she says.  “A great approach to the new season is to just aim to be the better person than you were the day before.  When you begin with small steps, it is far easier for the changes you make to improve your health and well-being to be sustainable.”

 

Go with the season

Keeping your focus on the in-season fruit and vegetables is an easy way to usher in small daily changes that can make a big difference.  Swopping out soups and stews for fresh and delicious salads and plant-based bowls helps you to increase both the amount and variety of fruit and veg you eat. Jade Seeliger, also a Registered Dietitian and ADSA spokesperson points out that Spring produce can have a restorative effect on the body.  “After a long, cold winter, our immune systems take a knock and many of us turn to antibiotics to help us recover.  Antibiotics wipe out both the bad and good microbiota living in our gut.  Certain fruit and vegetables are known as prebiotics provide food for your gut bacteria and help them to flourish once more.  Prebiotic-containing fruit and vegetables in season in Spring include artichokes, apples and asparagus.”  Keep your attention also on the versatile cruciferous veg such as broccoli and cauliflower; and stock up on the Spring avocados, tomatoes and berries.

 

Experience an awakening

Much of our less than healthy eating is rooted in being on auto-pilot when it comes to choosing what we eat and how we eat it.  Spring invites us to wake up to our habits, and there’s no better way to do this than by exercising our mindfulness.

“Mindful eating is an ancient, mindfulness-based practice with profound implications and applications for resolving problematic eating behaviours and troubled relationships with food,” says Retha. “It also fosters the development of self-care practices that support optimal health.

Here are five ideas to you get started with mindful eating:

  • Start with a favourite: Choose a favourite food or a dish you really enjoy and have eaten often.
  • Sense it: Observe the look, touch, texture, and smell. Appreciate the appearance and scent of your food and begin to perceive any sensations happening in your body, particularly stomach and mouth.
  • Observe before you chew: Once you take a bite, observe the sensation of food in your mouth without chewing. Carefully think about the taste of the food.
  • Go slow and think: Chew slowly and pause briefly. Think about the location of the food in your mouth, as well as the taste and texture. Concentrate on how the taste and texture change as you continue chewing.
  • Pause: Before you swallow, pay attention to the urge to swallow. Do so consciously and notice the sensation of the food travelling down the oesophagus to the stomach. Pay attention to any physical sensation.”

 

Lighten up!

More sunshine and warmth, new green shoots and coloured blossoms all give Spring its quintessential lightness that lifts the spirits and invigorates the body.  It’s an ideal time to choose a few new habits that feel good.  Jade suggests:

Cut the Cuppa’s! – “Caffeine has always created a buzz, and cappuccinos are always a perennial favourite.  Unfortunately, when it comes to kilojoules, these milky drinks come at a cost.  A ‘short’, ‘tall’ or ‘grande’ cappuccino is approximately 500, 700 and 900 kilojoules respectively (based on low-fat milk and no sugar), which are kilojoule equivalents to 1.7, 2.7 and 3.7 slices of bread.” If you find it too difficult to cut out your daily caffeine-fix, replace your cappuccino with an Americano or filter coffee with a splash of milk, which will help reduce the energy to approximately 150 kilojoules per serving.

Eat your water – “Thankfully, this does not mean crunching away on ice cubes to help shut down the hunger, rather pile your plate high with vegetables and salad.   Most vegetables are between 90 – 95% water, this paired with fibre, vitamins, minerals and anti-oxidants makes them the perfect accompaniment for every meal.  Try to ensure that at least half of your plate is vegetables and/or salad and that they represent all colours of the rainbow, from purple eggplants, yellow peppers, red radishes, orange butternut to green spinach.”

Bring back balance – “Extremes have always held so much appeal, from fasting to carb-free to fat-full to fun-less.  Diets seem to be a collection of short-term restrictions that never reach the pot of gold at the end of that ‘goal weight’ rainbow.  When it comes to meals and snacks, and eating in general, it is worth bringing back some balance which will help you to not only achieving those health goals but also being happy at the same time.”

 

Get an energy boost

Take inspiration from all the joys of Spring to boost both your physical and mental well-being.

Get outside and get more Vitamin D – Find your Instagram moments outside.  Nature has a calming effect on us and spending time outdoors is so good for that extra Vitamin D. Embrace walks in the park and picnics; think about taking up gardening, especially growing your own salad leaves and edible flowers, Spring veg and herbs.

Find the ways to make healthy fun – Spring offers an opportunity of starting a-fresh; it’s worth using this new season to approach your health journey differently.  Embark on a healthy cooking class or actually use the recipe books that adorn your shelves; ditch the gym if you don’t like it and find a new exercise you actually enjoy.  Make health your new wellness goal, not deprivation and dieting, which is often the case leading up to summer holidays

Spring clean your sleep – Our bodies and minds need enough sleep to recover and be sharp for the next day. Sleep hygiene refers to your pre- and bedtime habits that help you to get the rest you really need.  Ensure that you remove distractions close to bedtime to fully wind down and fall asleep quicker and more easily.