NEW NutritionConfidence recipe: Fish en Papillote

“Many people do not know how to cook fish or dislike making their entire kitchen smell like fish. Cooking fish en papillote (in a baking paper parcel) is an easy way around both these issues”, says Nathalie Mat, registered dietitian and creator of our latest NutritionConfidence recipe.

The fish used in this recipe is hake, a fish on the SASSI green list. You are welcome to use any other fish in the recipe. Choosing a SASSI green listed fish will ensure that your heart-healthy dish is also one that is healthier for the planet.

If you have “vegetable resistant” children, get them involved in packing their own parcels. They can choose more of the vegetable they prefer and limit the ones that they do not like. Involving children in cooking improves familiarity with foods and increases the likelihood that these foods will be eaten.

Ingredients per parcel

½ a yellow pepper

2 baby marrows

150-200 g hake fillet

1 slice of lemon

Black pepper to taste

Herbed dressing

30 g fresh parsley

10 g fresh basil leaves

1 tbsp capers

4 tbsp olive oil

Juice of ½ – 1 lemon (to taste)

Black pepper to taste

Method

  1. Heat the oven to 200˚C
  2. Fold baking paper to make a large square and then cut the folded paper like you did in school to make a rounded heart shape. Cutting a shape like this increases the amount of food you can easily seal into the parcel.
  3. Chop the pepper into batons; trim and quarter the marrows.
  4. The vegetables will form a bed on which we will place the fish. Open the baking paper and near the centre fold, make a layer of peppers. Top with a layer of marrows. Finally, place the fish on the marrows.
  5. Season the fish and place the lemon slice on top of the fish. To close the parcel, close the heart shape. With the edges lying together, start at the top of the heart, making small overlapping folds the whole way around to the bottom of the heart. Be sure to fold the bottom of the heart securely so that the parcel does not open in the oven.
  6. Place the parcel in the oven for 15-20 minutes. If the hake fillet is 2cm or thicker leave it in the oven closer to 20 minutes. If you have a thinner fillet the fish will be ready after 15 minutes. If you are not sure, this steaming method is a gentle way of cooking fish, leaving it up to 20 minutes should not be a problem. With practice, you will become more confident with this way of cooking.
  7. For the herbed dressing: put all the ingredients (start with the juice of ½ a lemon) and blend until nearly smooth. Check for acidity, add more lemon juice if needed and season to taste. Blend one last time.
  8. Serve by letting everyone empty their parcels onto their plates. Top the fish with 2-3 teaspoons of herbed dressing. This dish is delicious served with boiled baby potatoes or herbed whole-wheat couscous and a green salad.

The herbed dressing is delicious dotted onto the fish before cooking but it does lose its vibrant green colour when cooked.

 

Nutritional information per parcel (175g fish) with 3 teaspoons herbed dressing:

Energy: 1308 kJ; Protein: 37.2 g; Carbohydrates: 6.9 g; Fat: 14.1 g; Sodium: 268 g

 


Meet the new ADSA President!

We chatted to Nicole Lubasinski, the new ADSA President (July 2017 to June 2019), to find out about her plans for ADSA and why she became a dietitian, what she loves about her work and what the challenges are:

As the new President, what are you looking foward to achieving?

I am looking forward to playing a role in unifying the profession, continuing to build a great Association for all our fellow dietians and to achieving ADSA’s vision – to represent and develop the dietetic profession to contribute towards achieving optimal nutrition for all South Africans.

Why did you become a Registered Dietitian?

This is a complicated question for me to answer as there were many factors in play. Food is a key part in our daily lives, as with most young girls weight and food were an intricate part of my life growing up. I wanted to be able to understand our relationship with food better and to hopefully help other people come to terms with it too.

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

I think it’s similar for most dietitians. We tend to be the patients last resort for many patients and the “ah ha” moment that happens when people realise achieving a healthy balanced lifestyle doesn’t have to be restrictive or stringent. And that dietitians can often work in favourite foods to limit the sense of deprivation.

What has been your career highlight?

I think the achievement that sticks out the most is receiving my IOC diploma in Sports Nutrition in Switzerland. The reason being is I completed my final assignment whilst in hospital after delivering my little girl & she happened to be breastfeeding at the time of submission.

What are the most challenging aspects of your career?

Being the last resort, people have preconceived ideas about what a dietitian is or does. Automatically people judge you for your appearance and food choice, or feel you will judge them for theirs.

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

Everything in moderation. Add in an extra few KMs or reps in my work out session. Life happens and its ok. We tend to be pretty hard on ourselves and I think that needs to change.

What are the three things that you think people should stop saying when they meet a dietitian?

  • “Oh goodness, I better not eat this in front of you then”
  • “So what’s the best way to lose weight”
  • “Oh really, I would of thought dietitians needed to look a certain way”

What should clients look out for when deciding which dietitian to work with?

Someone you can relate to. A patient relationship with a dietitian is more than “just tell me what to eat”. The ups and downs that come with changing a lifestyle or dealing with a health condition can be emotional, it’s good to have someone in your corner who will motivate you in a way that works for you.

What is your favourite dish and your favourite treat food?

Oh wow, just about anything my mom cooks. But my all-time overly decadent high day and holiday meal is grown up Mac and Cheese. One of our wonderful ADSA chefs needs to tailor this to be more nutritionally balanced

 

 


Why breastfeeding and work can, and should, go together

Returning to work after maternity leave rates as one of the top reasons why mothers stop breastfeeding their babies before they should. The 2017 World Breastfeeding Week runs from the 1st to the 7th of August with the aim of uniting all sectors of society in the protection, promotion and support of breastfeeding. The campaign, co-ordinated by the World Alliance for Breastfeeding Action (WABA), identifies four critical focus areas, one of which is women’s productivity and work.

ADSA_Breastfeeding ImageWorking SA mums are entitled to a minimum of four consecutive months of maternity leave. Many take at least one month of that leave prior to the birth, and then make their return to work when their infants are just around three months old. However, exclusive breastfeeding of an infant from birth to six months is what is recommended as optimal nutrition by the World Health Organisation. Therefore, the only way that working new mums can meet these important health standards is if they can breastfeed or express breast milk for some months at their workplaces.

 

The benefits of creating workplaces that are friendly to nursing mums go beyond just the physical welfare of our new generations. Cath Day, registered dietitian and spokesperson for ADSA (The Association for Dietetics in South Africa) points out: “There is a vast body of scientific research that has shown that breastfeeding, as exclusive nutrition in the first six months and then as a supplementary food for two years and beyond, also protects and benefits the physical health of the mother; while impacting positively on her emotional well-being as she forms the essential bond with her new child. It is clearly in the interests of the employers of child-bearing women to protect, promote and support them during the times when they are breastfeeding because companies need their employees to be healthy and optimally productive.”

ADSA recommends that businesses formalise their support of breastfeeding in the policies, standards and practices of their employee wellness programmes.

So what can businesses do practically to protect and support the nursing mums on their workforce?

  • Uphold the Law – Corporates must recognise and facilitate the legal rights of SA breastfeeding mothers enshrined in the Basic Conditions of Employment Act. Up until their babies are six months old, working mums are entitled to two, paid 30-minute breaks every work day for breastfeeding or expressing milk.
  • Know and promote the benefits of breastfeeding – “It helps to have employers who are knowledgeable about why breastfeeding is so important and a commitment to protecting, supporting and promoting breastfeeding in the workplace,” says Cath Day. “As part of the employee wellness programme, registered dietitians can be engaged to make presentations to all staff on the advantages of a breastfeeding-friendly work environment and how to make it happen in your company. The straightforward facts and the inarguable science go a long way to reducing the discomforts and stigmas people might attach to breastfeeding.”
  • Provide the place – Nowadays it is widely regarded as completely unacceptable for breastfeeding mums to have to lock themselves in a public toilet, or their car, to breastfeed or express milk at work because they have nowhere else to go. Many companies realise that a breastfeeding-friendly workplace means providing a secure and comfortable space for working mums to spend their 30-minute breastfeeding breaks. Preferably, this private room should have a door that locks, comfortable seating, plug points for breast pumps and a refrigerator for the safe storage of breast milk.
  • Be flexible and adaptable – Part-time, flexi-time or temporary work-from-home plans can be very effective solutions for breastfeeding mums, and should especially be employed by companies who provide no proper facilities for the legal breastfeeding breaks in their workplace.
  • Offer child-care facilities – A number of progressive companies with a clear focus on employee engagement provide workplace child care facilities for the babies and small children of their employees. This is ideal for breastfeeding mums as they can more easily and quickly breastfeed their infants and need to express less milk.

ADSA spokesperson Zelda Ackerman, whose areas of expertise include baby and child feeding, urges new working mums to know their rights and to get the support that they need from their bosses and colleagues so that going back to work doesn’t become a barrier to the continued breastfeeding of their infant. “It is really important for South Africa as a country to transform to a culture of being breastfeeding-friendly in every environment,” she says, “We have to consider the potential health burdens of being a country with exceptionally low rates of breastfeeding, and turn this trend around. From the family home to the work environment to society at large, breastfeeding mothers need support.”

Zelda’s top tips for breastfeeding mums returning to work include: 

  • Before your return to work, give yourself enough time to get to grips with finding the pump that works best for you and regularly expressing milk – and give your baby enough time to get used to expressed breast milk. Time and practice will help you both to establish this as a stress-free routine before the big change up ahead.
  • Also, ahead of time, build up a stock of breast milk at home – it can be refrigerated and frozen. Stored breast milk should always be dated, and you retain more nutritional quality if you refrigerate it immediately after you have expressed.
  • On your return to work, have straightforward conversations with your bosses and/or team members, as necessary, so that they are clear about your breastfeeding goals and needs. Be clear about your legal right to two, paid 30 minute breastfeeding breaks each working day, and establish with them how this is going to work best for you and what accommodations you will need.
  • If you encounter resistance or lack of support in your workplace, get help rather than give up breastfeeding. Other working mothers in your workplace and HR personnel may help to raise awareness of the importance of your continued breastfeeding. External sources of help can include breastfeeding support organisations and registered dietitians.
  • You can reduce discomfort from engorgement and pace your two breastfeeding breaks optimally at work if you arrange your workday mornings so that you give your baby a good feed that ends just before you leave for work; and then breastfeed your baby again as soon as you get home. Co-ordinate this well with your baby’s caregiver so that they don’t feed the expressed breast milk just before you get home. If you are breastfeeding a baby older than six months of age, make sure your caregiver doesn’t provide late afternoon snacks so that your child is ready for a good breastfeed when you get home from work.
  • Be patient and resilient. Our modern world doesn’t necessarily make breastfeeding easy, natural and stress-free. But it is as important as it has ever been to both you and your baby. The science is clear, the more you can; the better for you, your baby and our society at large.

‘I feel healthier, fitter and more energetic!’

We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved. This week we chat to Adrienne Bewsher, who started seeing Registered Dietitian Monique Piderit following a general health check-up which highlighted concerns around her weight and fitness. Here is her story ….

ADSA_AdrienneBewsher

Tell us about your journey with the dietitian

Just before my 45th birthday late last year, as part of a Women’s Development programme at work, I had a general health check-up and the results highlighted that I was both overweight and totally unfit! I knew I had to do something about that, so, in November 2016, I decided to visit a dietitian, Monique Piderit at Nutritional Solutions, and have a DNA Diet test done. I received the results of my DNA Diet test and the best eating plan for my body was a low-fat diet. Monique put together a very practical eating plan for me which was so easy to follow and apply to my lifestyle. I also had full range of blood tests done to understand my overall health – my overall Cholesterol and LDL-Cholesterol were high, whilst my Vitamin D levels were low.

Working with Monique, we set realistic weight loss goals which are achievable and keep me motivated.

Tell us about your results

Since November 2016 I continue to have regular “weigh-ins” with Monique which help to keep me on track and teach me more about healthy nutrition. I am so thrilled that I have lost over 10% (8kgs) of my body weight in 8 months, plus my Cholesterol levels have dropped to low risk levels.

To improve my fitness, I decided to take up running. As a full-time working Mom of 5 year old twins, I needed to find a form of exercise that would fit into my time constraints

and my lifestyle. I started off using an App that taught me to run 5kms in 8 weeks (although it took me more like 12 weeks to complete the programme!). Then in May this year I discovered “Catch Me If You Can” (CMIYC) – a running community exclusively for women in South Africa. CMIYC motivates women at various stages of their running journeys to get out and run together. They have various locations throughout the country, with Team Leaders in different areas who setup running dates throughout the week. Apart from getting fit, there are the added benefits of safety in numbers, tremendous support, motivation and friendship from the other women. I am proud to say that I have completed several 5km and 10km races and have entered my first half-marathon in November this year!

At 45, I now feel healthier, fitter and more energetic than I have for at least the past 10 years.

What was the hardest part of the journey?

My biggest challenge has been sticking to eating healthy during holidays like Christmas and Easter. When I do “de-rail” I am gentle but firm on myself and get back to healthy eating as quickly as possible. Just because I had a “cheat” meal doesn’t mean that I write off the entire day or weekend, but rather get back on track again the very next meal.

What are the top three tips you can share?

Banish the word “diet” from your vocabulary. For me, it comes with such negative connotations and makes me feel immediately hungry! Rather think of yourself as following a healthy lifestyle, as it will benefit so much more than just your weight.

Find a form of exercise that works for you. I do not have the time to drive to gym to do a workout, but road running works for me. If you can, persuade a buddy to join you for your workouts – you will feel far more guilty cancelling on them.

Set yourself goals. I am extremely target driven and by implementing achievable goals, both from a weight-loss and exercise point of view, I am getting there one step at a time. Celebrate when you achieve those goals – you deserve it!

What the dietitian says

I met Adrienne just before her 45th birthday. From day one, her motivation levels were high and her energy to make a change for her health and wellbeing was so strong. I think that’s why Adrienne has done so well (and continues to do so) – it became less about weight and more about health.

Adrienne joined a social running team called Catch Me if You Can which consists of like-minded ladies. She started with short 5km runs, progressing up to doing 10km running events. Running is a great way to boost energy levels, improve sleep, and help with weight loss, and Adrienne soon got addicted to that well-known runners high. Last I saw her, she told me she signed up for her first half-marathon in November. I am so proud of her for being so steadfast in her decision to be health. Who knows, maybe next we’ll be talking running nutrition as she trains for Comrades. Adrienne is a great example of how weight loss is just a by-product of choosing a healthy lifestyle first and foremost.


NEW Recipe: Lettuce & Pea Soup

Our latest NutritionConfidence recipe is from the authors of Food for Sensitive Tummies, registered dietitians Cath Day and Gabi Steenkamp. A perfect winter warmer Lettuce & Pea Soup.

We love this recipe because it is a really smart way of including green leaves into your eating routine during the cold winter months! A great starter for a dinner party.

 The dietitians say:

  • This delicious soup contains a whopping 4 vegetable servings, making it a really healthy meal and gets you very close to your 5 a day quota.
  • In addition, it is high in fibre, making it the perfect meal for helping sensitive tummies keep regular. The fibre comes from the peas, chickpeas and the lettuce.
  • The benefits of increasing your fibre intake for gut health is well documented – healthy gut = happy you!

INGREDIENTS (Serves 4)

5 ml         butter (1t)

5 ml         olive oil (1t)

3 leeks    well washed and sliced with the green tops

1 ml         dried crushed garlic (¼ t)

2.5 ml     salt (½ t)

1              head of butter lettuce, finely sliced

250 g      frozen peas (1½ c)

1.25 L     boiling water (5 c)

15 ml      chicken flavour or vegetable stock powder (1 T)

125 g      tinned chickpeas (½ x 410 g tin, drained)

125 ml    chopped parsley (½ c)

METHOD

  1. Melt the butter and olive oil together.
  2. Add the leeks and crushed garlic and salt.
  3. Sauté over medium heat for 3 minutes until soft.
  4. Add the sliced lettuce and the peas.
  5. Add boiling water and stock powder.
  6. Boil for 5 minutes uncovered.
  7. Add the chickpeas and heat through.
  8. Add the parsley and liquidize until the soup is smooth.
  9. Reheat before serving.
  10. Optional: serve with one slice of bread with avocado as a topping, per serving (½ avocado is equivalent to 2 fats)

NUTRIENTS PER serving (200 ml of soup)

Energy                                   740 kJ

Protein                                   6.7 g

Carbohydrates                     28.0 g

Total sugars                         6.2 g

Added sugar                        0.0 g

Total Fat                                3.1 g

Saturated fat                         0.8 g

Fibre                                      6.4 g

Sodium                                 773 mg

One serving is equivalent to ½ carbohydrate, 1 protein and 4 vegetables.

FOOD FOR SENSITIVE TUMMIES

Do you suffer from winds, burping, cramps, heartburn, constipation and/or diarrhoea as well as bloating? Then the book, “Food for Sensitive Tummies” is for you! Having a sensitive tummy or super sensitive tummy (irritable bowel syndrome) can be one of the most debilitating health issues to deal with. In Food for Sensitive Tummies, Gabi Steenkamp and Cath Day show you how you can cut down on the ingredients and food that cause you problems and still prepare a whole range of recipes that are simple, affordable and delicious to eat. Their recipes also feed your gut microbiome with nourishing food substances important for maintaining health. From fresh and healthy breakfast ideas, to wholesome mains such as Butternut, Aubergine and Rocket Lasagne, cooking for sensitive tummies has never been so easyL 

Food for Sensitive Tummies can be ordered directly from the authors via this page or via email (info@catherineday.co.za or info@gabisteenkamp.co.za).


Dietitians urge South Africans to ‘Eat Fact Not Fiction’

Nutrition advice promising all sorts, from weight loss to healthier living and even cures for diseases, spread like wildfire across social media. In the era of ‘alternative facts’ and post-truth, ‘the latest, greatest nutrition advice’ from dubious sources can unfortunately tempt many away from accepted dietary guidelines and recommendations based on years of evidence.

‘Evidence and Expertise’ is the theme of Dietitian’s Week 2017, highlighting the important role of dietitians who are able to interpret nutrition science and dietary guidelines in order to customise nutrition advice for each individual. This is vital because from weight loss to a disease like diabetes, there is no ‘one size fits all’ best eating plan. Dietitians happen to be health professionals trained and qualified to do this.

Dietitians and Evidence

In the course of earning their degrees in the science of dietetics, dietitians are specifically taught the skills required to interpret scientific evidence. In order to maintain their professional registration with the Health Professions Council of South Africa (HPCSA), all practising SA dietitians also have to undertake ongoing studies that ensure they keep up with the latest knowledge provided by new and emerging evidence, in accordance with the Continuing Professional Development (CPD) programme. This means they have the latest evidence-based food, health and disease expertise at their fingertips – and you won’t find a registered dietitian in the country basing any recommendations on the long outdated food pyramid.

Dietitians and the Food-Based Dietary Guidelines

The country’s broad strokes dietary guidelines, on which public health messages are based, and which were developed according to the process recommended by the Food and Agricultural Organisation of the United Nations (FAO), have also evolved over the years, featuring a notable shift from the emphasis on nutrients to the focus on actual foods, which by nature contain a variety of nutrients. ADSA, the Association for Dietetics in South Africa, provides further clarity on the guidelines with its statement on the Optimal Nutrition for South Africans. The latest visual Food Guide from the Department of Health provides a very different picture from older models such as the Food Pyramid and represents the latest FAO recommendations.

Dietitians and Patients

But the reality remains that diet is highly personal. What we eat is rooted in our culture and tradition, shaped by affordability and accessibility, and inextricably intertwined with highly variable lifestyle factors such as weight, physical activity, emotional connection to food and our consumption of non-food substances, as well as various physiological differences and genetics.

“This is where the dietitian comes to the fore,” says ADSA President and Registered Dietitian, Maryke Gallagher. “If you take a disease such as diabetes, which is a prevalent lifestyle disease in the country, and is a condition that can be managed through diet, each patient needs a tailor-made plan and focused support to make their individualised diet work towards their well-being and health. When the situation demands change around something as fundamental to life as food, then broad strokes are not necessarily sustainable solutions.”

Dietitians and Sustainability

The role that the dietitian can play in helping the communities in which they work to secure healthy food systems that are good for both people and the planet is an emerging responsibility in the profession. Dietitans are increasingly involved in facets of our modern food systems including agriculture and alternative food production methods, natural resources and ecosystems, social justice and community health issues, as well as developing food policy and food systems research that takes sustainability into account.

Dietitians and Diseases

Some may associate dietitians with merely giving advice and support to someone who wants to lose weight, but dietitians work across a range of industries. They are also experts in providing nutritional advice with regard to serious diseases and conditions such as diabetes, heart disease, hypertension, liver disease, kidney disease, cancers, HIV/AIDS, TB, throat, stomach and intestinal disorders, as well as food allergies and intolerances, eating disorders, sports nutrition and life-stage nutrition (including the protection, promotion and support of breastfeeding as the best start in life). Apart from dietitians in private practice, they work in hospitals and communities, academia and industries. In addition to consulting with patients, dietitians are also involved in research, nutrition training and development of provincial and national policies.

Dietitians and Malnutrition

In South Africa, where the health issues that arise from the obesity epidemic stand side by side with those resulting from undernutrition, our dietitians’ work literally spans from one extreme to another. The South African Society for Parenteral and Enteral Nutrition (SASPEN), a supporter of Dietitian’s Week, highlights the essential role the dietitian plays in providing nutritional support to promote optimal nutrition to people in hospitals, where malnutrition is a common cause of the exacerbation of disease, delayed healing and prolonged hospital stays.

The Dietitian and You

It’s clear, that as a country, our need for dietitians is multi-fold, which explains why there’s a lot more than just dietary guidelines on the mind of a registered dietitian. In consultation, your dietitian is going to be taking in many factors unique to you to work towards helping you make optimal food choices. This includes your age and gender; your genetics, body size and body image; your environment, culture, spiritual beliefs and family life; physical activity level, mental well-being and general abilities; your work life and patterns; your budget; food preferences, eating tastes and cooking skills; as well as your existing health conditions and prescribed meds.

In the hopes of steering us clear of the latest trumped up ‘diets’ and promoting a return to genuine expertise and evidence, dietitians countrywide are suggesting that we ‘Eat Facts Not Fiction’.

In collaboration with the British Dietetics Association, Dietitian’s Week is held in SA from 12th to 16th June, with the 2017 theme ‘Evidence and Expertise’.

To find a dietitian in your area, please visit the ADSA website.

 


Turnip Tagliatelle with Chicken & Herb Sauce

Registered Dietitian and food blogger Cheryl Meyer, from Dish & Delite, kicks off our new series of NutritionConfidence recipes with a delicious ‘Turnip Tagliatelle with Chicken & Herb Sauce’. As always, the focus is on real food that is healthy and delicious, encouraging local, close-to-home ingredients.

We love this recipe because turnips are easy to spiralize and make lovely veggie noodles. When raw, they can tend to have a sharp distinct taste, warming them softens the flavour and makes for a perfect veggie noodle base for your dish.

Cheryl says: “Veggie noodles are a great way to the boost the vegetable component of a meal and plain yoghurt serves as a nutritious alternative in this twist on classic creamy carbonara.”

INGREDIENTS

(serves 4)

4 medium turnips

4 teaspoons olive oil, divided

4 chicken breasts, cubed (approx. 125 g each – 500 g)

4 leeks

250 g mushrooms

2 teaspoons crushed garlic

½ cup plain yoghurt

2 large eggs

30 ml fresh chopped parsley

¼ cup grated parmesan cheese

Salt and pepper, to season

METHOD

  1. Heat 2 teaspoons olive oil in a non-stick pan and cook the cubed chicken pieces. Set the cooked chicken aside.
  2. Slice the mushrooms and leeks.
  3. Heat the other 2 teaspoons of olive oil and soften the mushrooms and leeks. Just before cooked, add the garlic for the last 2 minutes. Remove and combine with the chicken.
  4. Peel turnips and cut the ends off flatly and evenly. Spiralize them to tagliatelle thickness (blade C on the inspiralizer).
  5. Boil turnip noodles for 2-3 minutes.
  6. In a small bowl or jug whisk the egg, yoghurt and parsley together well. Season with salt and pepper.
  7. When the turnip noodles are done, drain them, return them to the pot off the heat, pour in the egg mixture and toss until evenly coated (the warmth of the cooked noodles cooks the egg but it is important to do this off the heat, otherwise the egg will scramble when you add it, and we don’t want that).
  8. Serve the noodles topped with the chicken, leek & mushroom mixture and garnish with grated parmesan cheese.

 

Nutrition Information: Per serving

Energy: 1487 kJ Protein: 38.7 g Carbohydrate: 25.7 g Of which, total sugars: 11.0 g Fat: 14.8 g Fibre: 4.7 g Sodium: 303 mg

 

To find a dietitian in your area, visit http://www.adsa.org.za

 


Statement on the outcome of the HPCSA inquiry into the conduct of Professor Tim Noakes

The Association for Dietetics in South Africa’s (ADSA) former president Ms Claire Julsing-Strydom submitted a complaint about Professor Tim Noakes to the Health Professions Council of South Africa (HPCSA) in 2014 on behalf of ADSA regarding, what it considered, unconventional infant nutrition advice.

The complaint

The complaint was lodged after Professor Noakes advised a mom via Twitter to “ween” (sic) her baby on to a low carbohydrate, high fat diet. ADSA believed, at the time, that the advice:

  1. was not based on current scientific evidence;
  2. contradicted international and local guidelines for complementary feeding adopted by organisations like the World Health Organisation;
  3. could negatively affect a baby’s health, growth and development; and
  4. was provided via Twitter without an examination or consideration of the baby’s health or age and therefore nutritional needs. ADSA also considered it risky if other moms on Twitter took the same advice.

Professor Noakes did not advise the mom to continue with breastfeeding, which undermined its importance. For these reasons, ADSA considered the advice unconventional and requested the HPCSA to investigate further.

The HPCSA charge and inquiry

The HPCSA is a statutory body established to regulate registered healthcare practitioners and protect the public. The HPCSA considered the complaint and decided to hold an inquiry into what it considered “unprofessional conduct” that was “not in accordance with the norms and standards of your profession” and that Noakes “provided unconventional advice on breastfeeding on social networks (tweet/s).”

ADSA has lodged other complaints to the HPCSA to adjudicate in the past. Most cases are resolved mutually without the need for a detailed inquiry. It was never ADSA’s intention for this matter to span over 3 years and to progress to a hearing. The HPCSA follows a specific disciplinary process for all complaints. This case has gone through all the necessary steps and couldn’t be resolved or concluded in the preliminary inquiry phase. The HPCSA has autonomy on the type of inquiry it wished to institute and ADSA has co-operated fully with their decision.

The formal hearings began in June 2015 and continued in November that year. The inquiry continued in February and October 2016. The hearings have now been concluded and the HPCSA has issued its verdict.

ADSA’s concern

ADSA was concerned, when lodging the complaint in 2014, that a strict low carbohydrate, high fat diet for babies would not meet all the nutritional needs of a growing child. Current scientific evidence does not support an extreme low carbohydrate, high fat diet for babies. When foods rich in carbohydrates such as whole grains and legumes are avoided and other carbohydrate food sources such as dairy, fruits and vegetables are restricted, the diet can become deficient in certain essential nutrients, such as vitamin C, B1, B3, B6, folate, magnesium and fibre. Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies can compromise growth, and cognitive and physical development. Restrictive diets for babies with medical conditions should only be followed under strict medical supervision with monitoring by suitably trained and registered healthcare professionals.

Dietary guidelines for feeding babies are developed by organisations such as the World Health Organisation and the United Nations Children’s Fund (UNICEF), based on a strong body of evidence. In South Africa, the Department of Health has adopted these recommendations. We also have Paediatric Food Based Dietary Guidelines backed by technical support papers published in 2013. This is a widely accepted scientific approach to child nutrition. The risks of experimenting with a baby’s development are immense and the long-term effect of low carbohydrate, high fat diets for babies is currently unknown. ADSA believed that the advice provided by Professor Noakes was against accepted common practice. The concern for the health of babies was ADSA’s primary interest when ADSA lodged this complaint.

The use of social media for professional purposes does pose interesting questions, especially for dietitians and other health care practitioners. While social media may be appropriate for generic public health messages such as how to reduce salt or sugar consumption in diets, social media may not be advisable for providing specific individualised, clinical nutritional advice to vulnerable groups such as babies, where little is known about their health and medical history. ADSA does recognise that social media provides significant opportunities for public health information and for use by health care professionals. However, clear guidelines are required to guide and regulate patient interaction outlining the use and limits of social media by health practitioners.

“ADSA accepts the verdict and we are relieved that the hearing has finally been concluded. We welcome the precedent this case provides on what we considered unconventional advice. The case also sets a precedent about the use and limits of social media by health professionals. For ADSA this hearing was never about winning or losing, or standing for or against Professor Noakes. It was about protecting the health of babies and future adults,” said Maryke Gallagher, President of ADSA.

“We will study the verdict in detail and decide what implications this case has for ADSA and dietitians. We also call on the HPCSA to provide guidelines for health professionals’ use of social media in their practice,” said Gallagher.

ADSA and its members will continue to provide dietary advice that is evidence-based and in line with guidelines provided by the national Department of Health and international bodies such as the World Health Organisation. A scientific and rigorous process is used to develop international and local dietary guidelines, and the outcome of the inquiry does not mean that these guidelines will now change. ADSA will consider new approaches and practices based on scientific evidence that has been adopted by credible health organisations.

About sponsorship and big foods

“Many dietitians and members of ADSA have been worried about the allegations made during the course of this inquiry that dietitians are unfairly favouring big food companies because they sponsor the organisation. ADSA wants to assure those concerned that we will never compromise ADSA’s independence as a result of corporate sponsorship. ADSA is a registered not-for-profit organisation (NPO) and relies in part on fundraising to sustain its work. In 2016, we received 63% of income from members. Our sponsorship policy is clear on non-influence by sponsors. We do not endorse any brand, product or retail chain. There is no conspiracy between big foods and dietitians to sell unhealthy food to South Africans. A healthy population through well balanced diets is what we strive for,” said Gallagher.

It is very unfortunate that the professionalism and integrity of a number of nutrition scientists in South Africa has been unfairly questioned during this inquiry. It is ADSA’s hope that the reputation of nutrition professionals and dietitians as nutrition experts will be restored. Despite the negative sentiment, ADSA believed it had a responsibility to enquire about an issue that had such significant consequences for dietitians and other health professionals.

On Tim Noakes

“We respect Professor Tim Noakes for his work as a sports scientist. He is a well respected A-rated scientist and is respected in academic circles. His work is pioneering and he has always tested conventional thinking. But, we have differed with Professor Noakes on this issue. We have no personal gripe with Professor Noakes. Our concern has always been about the health of babies,” said Gallagher.

This hearing has been rather divisive with strong views expressed on both sides. The debate has raised significant awareness about the importance of nutrition, which is positive. Health, wellness and nutrition should concern everybody. But, South Africans have also been confused by the ebb and flow of this divisive nutrition debate and the inconsistent nutritional advice provided over many years. That is unfortunate.

“I’m pleased this is over and we can now focus on other urgent nutrition challenges we have in South Africa,” concluded Gallagher.

Useful links:

ADSA’s position on infant nutrition:

Infant Nutrition Statement

Comprehensive Q&A:

Q&A

ADSA’s sponsorship policy:

ADSA Sponsorship Policy

Tim Noakes tweet: 

ADSA_Noakes Tweet

  1. The HPCSA charge:

“guilty of unprofessional conduct or conduct which, when regard is had to your profession is unprofessional, in that during the period between January 2014 and February 2014 you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding on social networks (tweet/s).”


Is a Career as a Dietitian for You?

Dietetics, the field of nutrition, health and the application of science-based nutrition knowledge offers a variety of distinctive career opportunities that goes beyond the usual view of the dietitian as someone who simply helps others lose weight. If you have interests in health, food, healthy lifestyle and science, you may well find your niche in this growing profession.

“A dietitian is a registered healthcare professional who is qualified to assess, diagnose and treat nutritional problems, as well as to advise on preventative nutritional strategies,” says Maryke Gallagher, registered dietitian and President of ADSA, the Association for Dietetics in South Africa. In South Africa, the minimum qualification for a dietitian is a four-year BSc degree and one-year of community service. To practice dietetics in the country, one must be registered with the Health Professions Council of South Africa (HPCSA). A registered dietitian is, therefore, a recognised expert in evidenced-based nutrition. This scientific expertise is vital in today’s world where there is an abundance of unscientific health and nutrition information, as well as a plethora of fad diets and nutrition gimmicks.

While dietitians are certainly the ‘go-to’ people for those battling with overweight and obesity, there is a lot more to the career than just sharing weight reduction and management expertise. What we eat has significant impacts on many other diseases and health conditions. Whether therapeutic nutrition or preventative nutrition, dietitians promote good health and wellbeing for all. There is much scope to tailor a career in dietetics to your personal passions. You may be interested in focusing on children’s health, maternal health, food allergies or eating disorders, or on some of the many medical conditions that require a dietitian’s management such as diabetes, heart disease, HIV/AIDS and intestinal disorders. In addition, when it comes to sports, nutrition also impacts on performance, and dietitians may often play integral roles on the teams managing high performance sportspeople.

Without doubt, there is a high need for registered dietitians in South Africa. While infectious disease such as HIV/AIDS and TB continue to be prevalent in South Africa, non-communicable diseases like heart disease, strokes, cancers and diabetes are actually the main causes of deaths (1). Yet up to 80% of heart disease, stroke and type 2 diabetes and over a third of cancers could be prevented by adopting a healthy lifestyle, such as eating a healthy diet, keeping physically active and avoiding tobacco products (2).   South Africa is ranked the most obese country in sub-Saharan Africa(3). Alarmingly, two out of three women and almost one in three men are overweight or obese, and almost 1 in 4 children aged 2-14 years are overweight or obese in South Africa(4). On the opposite side of the coin, chronic under-nutrition is also prevalent with 1 in 4 children aged 0-3 years suffering from stunting, a condition where a child grows to be small for their age due to poor nutrition(4). There is also a high incidence of micronutrient deficiencies, particularly vitamin A and iron, in South African children and women of reproductive age(4). South Africa has high levels of food insecurity with around 1 in 4 food-insecure South Africans experiencing hunger and a further 1 in 4 at risk of hunger(4).

Dietitians may work in a variety of settings with different areas of focus:

Private practice – like other health professionals, dietitians can set themselves up to consult privately with patients who need advice on nutrition therapy and support to make healthy eating a lifestyle change.

Hospitals – known as clinical dietitians, these practitioners primarily work in hospitals consulting with patients who are referred to them by doctors or other healthcare professionals. Their role in a patient care team is to assess and individualise nutrition therapy (whether an appropriate special diet, tube feed or intravenous feed) as an integral part of recovery or palliative care.

Community – these dietitians may be employed in the public sector, or by NGOs or community-based organisations. Their focus is generally on the promotion, protection and support of breastfeeding; growth monitoring and the prevention of malnutrition; nutrition promotion and education; promotion of healthy lifestyles to address non- communicable diseases; prevention and treatment of vitamin and mineral deficiencies; and addressing food insecurity issues.

Institution-based – dietitians also work in food service management providing healthy and specialised diets to people living in institutions such as senior homes, school hostels, welfare care centres, prisons and health care facilities. Their work includes planning, costing and developing menus; controlling implementing, evaluating and overseeing food service systems; and managing special dietary requirements.

Industry/Corporate – there are varied roles for dietitians in the food, retail, healthcare and pharmaceutical industries. They may advise on current food labelling legislation, nutrition regulations and the nutritional analysis of food items; be involved in product development; share latest developments and trends in nutrition; participate in nutrition-related marketing activities; lead corporate wellness programmes and conduct literature reviews.

Research/Academia – dietitians employed by educational institutions are involved in continuously providing new evidence-based nutrition information through on-going research and teaching and are responsible for the training of new nutrition professionals. 

Media/Publishing – in the Information Age, there is opportunity for dietitians, who have important knowledge to share, to generate expert content providing nutrition advice, latest evidenced-based nutrition news and views, commentary on nutrition issues and inspiration for healthy eating.

Do you have what it takes?

Maryke advises that a career in dietetics will suit those who:

  • are interested in food and health
  • enjoy and have a flair for Science
  • would be fulfilled by a caring, helping profession
  • are lifelong learners who are attentive to the on-going developments in Science
  • are able to translate scientific knowledge into practical advice
  • are comfortable in the role of the expert and like sharing knowledge with others
  • have strong inter- and intrapersonal skills
  • have a positive attitude and the ability to motivate others
  • have empathy, understanding and tact

 

 

References
  1. Mortality and causes of death in South Africa, 2014: Findings from death notification / Statistics South Africa. Pretoria: Statistics South Africa, 2015
  2. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011
  3. World Health Organisation. 2015. Global Health Observatory Data Repository. Accessed June 2015. http://apps.who.int/gho/data/node.main.
  4. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, et al. South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: Health Sciences Research Council, 2013.

 ABOUT ADSA

ADSA, the Association for Dietetics in South Africa is one of the country’s professional organisations for registered dietitians.  It is a registered non-profit organisation served by qualified volunteers. The Association represents, and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans.  Through its network of ten branches ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA). Visit: http://www.adsa.org.za

 


ADSA News for Private Practising Dietitians

One of the ADSA Executive Committee portfolios takes care of the needs of Private Practising Dietitians (PPDs) in South Africa. There have been some important developments in the private practice dietetics space due to the work of the ADSA PPD portfolio. Please read all of the information below if you run a private practice.

Practice cost survey

ADSA and the Hospital Dietitians Interest Group (HDIG) have been engaging with Healthman, a healthcare consultancy, to improve dietetic billing since 2016. The rates at which private practicing dietitians are remunerated have not been based on real-life practice costs. The following survey will help change this and you have a chance to be part of it!

We need as many dietitians in private practice as possible to answer the following survey. Please send this link onto non-ADSA members in private practice to help us reach as many dietitians as possible.

Important: all results are independently collated by Healthman and no dietitian will see the survey data.

Completed entries will be entered into a lucky draw for a R1000 Pick ‘n Pay voucher.

After this initial survey, we will need a minimum of forty practices to submit their financials to help assess if dietitians are fairly remunerated considering the cost of running a practice. The weekly mailer will include further information.

Please click the following link to answer the survey: Dietetics Practice Profile Survey 2017

The survey will take about 10-20 minutes to complete.

Professional Indemnity Insurance

The public are protected by the Consumer Protection Act which covers all services, including those provided by a dietitian. If a patient suffers harm or loss due to negligence, they are entitled by this act to sue the service provider – and this may include you as a dietitian.

Professional indemnity insurance is highly recommended for any private practising healthcare practitioner. ADSA has negotiated excellent rates for professional indemnity cover for dietitians. Please log onto the member section of the ADSA website and look under the PPD section (http://www.adsa.org.za/Members/PPD.aspx) to get the latest forms to apply for cover for the year.

Clarity on billing practices

Dietitians use time-based billing. As part of the consultation with Healthman last year, the descriptors were updated and sent to medical funders. Please click here: Dietitians Coding Structure 2017 to download the up-to-date billing codes. Changes to codes include re-inserting the term “planning” into the descriptors (which had been removed in 2006) and adding to the rules and modifiers. Please take the time to read through these. Previously there was confusion around whether or not a dietitian could charge for time spent planning without the patient (non-contact medical nutrition planning). This change now means that a dietitian can charge for non-contact medical nutrition therapy. This amount is capped at 50% of the total time claimed.

Update on Discovery Vitality benefits

Many dietitians have asked questions around changes in the Discovery Vitality programme. Please click here for a letter from Craig Nossel, head of the Vitality programme, explaining why the changes have been made. Letter from Craig Nossel

Some practical information with regards to the new changes:

  • To claim points, Vitality members must submit their statement from the dietitian to the medical aid and points will be automatically allocated.
  • If the person is not a member of the Discovery Health Medical Scheme, they can email their statement to: claimsvitalitypoints@discovery.co.za and points will reflect automatically.
  • The dietitian no longer needs to enter anthropometry in the same way she/he did for the Vitality Nutrition Assessment.
  • 1000 points will be awarded for seeing a dietitian per year.
  • The appointment must be at least 30 minutes long.
  • If a dietitian is working at a wellness day and the company covers the cost of the assessment, a zero-cost statement with the Vitality member’s information can be used to claim points.
  • The Vitality Weight Loss rewards programme is yet to be launched – dietitians will be made aware of what is happening before the programme launches.

ADSA and the Discovery Vitality team regularly meet to discuss developments.

As always, if you have any questions or concerns you would like us to raise, you are welcome to contact Nathalie Mat: adsappdqueries@gmail.com.

 


Salty South Africa – are we doing better after salt legislation?

Despite South Africa passing world-leading legislation to reduce salt intake, too many South Africans eat too much salt, putting themselves at risk of heart disease and strokes. Today is the start of  Salt Awareness Week which runs from 20-26 March.

 

ADSA_Salt week banner

Salt – a forgotten killer

Excess salt intake directly increases blood pressure in most people, and exacerbates high blood pressure in people who already have this condition. “High blood pressure is not only caused by high salt intake, and factors such as genetics, obesity, fruit and vegetable intake, stress, smoking and a lack of exercise all contribute. However, reducing salt intake is a safe, affordable and effective strategy to reduce high blood pressure or avoid developing high blood pressure” says Prof Naidoo, CEO of the Heart and Stroke Foundation South Africa (HSFSA).

The World Health Organization (WHO) reports that it’s African region has the highest prevalence of high blood pressure globally. People of African origin are more prone to salt sensitivity, and excess salt is consumed through both liberal addition of salt to meals and as salt hidden in many processed foods. In South Africa, the prevalence of high blood pressure ranges from 30% to as high as 80% in adults over the age of 50 years (1) .

A world-leader in salt reduction

South Africa is ahead of the pack with ground-breaking legislation to limit the salt content of certain foods. June 2016 marked the implementation of these regulations that have reduced salt in commonly consumed foods such as breads, breakfast cereals, and processed meats. So far legislation has been hugely successful with most manufacturers complying, and some products have reduced salt content by 30 to 40%.

What can the food industry do?

During World Salt Awareness Week, WASH and the HSFSA are calling on manufacturers to put less salt in our food, and challenge everyone to read food labels and choose the lower salt options – it’s as easy as that! Salt legislation will reduce salt intake by approximately 0.85 grams per person per day, depending on the individual’s food choices. One study estimated that this level of salt reduction will result in 7 400 fewer cardiovascular deaths and 4 300 fewer non-fatal strokes every year in South Africa (2) .

The WHO recommends that total salt intake should not exceed one teaspoon a day, an amount equal to 5 grams. The average South African eats roughly 8.5 grams of salt per day (range of 6 – 11 grams), with some people eating significantly more than this (3) . Salt legislation is a good start, but it is inadequate to curb excess salt intake.

How do we eat so much salt?

“Salt intake is not easy to measure and is hidden in almost everything we eat, even sweet foods. When adding extra salt in cooking or at the table, all the pinches, shakes and grinds of salt add more salt than we actually need. One take-out meal can triple our salt limit for one day. Even something as simple as a cheese and ham sandwich can provide 2.5 grams of salt, already half the daily limit” says Gabriel Eksteen, Dietitian and Exercise Physiologist at the foundation.

Do YOU eat too much salt?

The Heart and Stroke Foundation SA launched an online salt calculator in 2015 in partnership with Unilever South Africa. This is the easiest way to see how much salt you eat, and which are the main salty culprits in your diet. The calculator has been carefully updated to improve accuracy and to reflect changes after salt legislation. Test your salt intake at www.saltcalculator.co.za . You may be surprised where your salt comes from!

How to reduce salt intake

Total salt intake includes what is already in the food, and what people add to food while preparing or eating the food. Choose foods wisely, keeping an eye out for food products with the Heart Mark logo and eat salty foods less often. How much salt is added at home is completely in the individual’s hands. When using salty ingredients like stock cubes, soy sauce or chicken spice as part of cooking, don’t add any further salt. Taste food while cooking and at the table, and think twice before adding more salt!

ADSA_Change your salty ways

Get tested

One in every two South Africans with high blood pressure remain unaware of their condition. This prevents effective care and increases the risk of heart diseases and strokes. The HSFSA recommends that all adults test their blood pressure at least once every year. The public can get their blood pressure measured for free from 17 March until 9 April at all Dis-Chem pharmacies nationwide.

The next step forward

South African salt legislation will further reduce the salt levels of certain foods by 2019. Yet many foods are excluded from legislation, including fast foods. The HSFSA call on the fast food industry to clearly display the salt content of their meals, and to start reducing the salt content of their offerings. Graham MacGregor, Professor of Cardiovascular Medicine at The Wolfson Institute of Preventive Medicine and Chairman of WASH comments: “Salt damages our health. Salt reduction is the simplest and most cost effective measure to prevent thousands of unnecessary deaths from stroke and heart attacks every year. It is not just down to the individuals; manufactures must stop adding salt to our foods. During World Salt Awareness Week you can do something great for your health by eating less salt“.

 

1) Lloyd-Sherlock P, et al. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control.
Int J Epidemiol. 2014 Feb;43(1):116-28. doi: 10.1093/ije/dyt215
2) Bertram et al. Reducing the sodium content of high-salt foods: Effect on cardiovascular disease in South Africa. S Afr Med J
2012;102(9):743-745. DOI:10.7196/SAMJ.5832
3) Wentzel-Viljoen et al. “Use salt and foods high in salt sparingly”: a food-based dietary guideline for South Africa. South African Journal of Clinical Nutrition 2013; 26(3): S105-S113

Meet registered dietitian, Thembekile Dlamini

We chat to registered dietitian and ADSA spokesperson, Thembekile Dlamini to find outADSA_Spokesperson_Thembekile why she became a dietitian and what she loves most about her work. Thembekile works at the Free State Department of Health, is busy doing her PhD in Public Health and has a special interest in paediatric nutrition.

Why did you become a Registered Dietitian?

Saving lives has always been my first priority but I didn’t want to do it in the usual and obvious ways that society dictates. I saw a need to communicate the science of nutrition especially for the benefit of the black community. I thought if I understood healthy eating in any context, I would then be able to disseminate information correctly and with sensitivity to cultural preferences. That way I knew I would make a difference and save lives through nutrition.

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

I am mostly based in the paediatric ward, doing both inpatients and outpatients. When I meet a helpless soul in the ward admitted for whatever condition, just knowing that I will make a difference in their life makes my life and work enjoyable.

Most satisfying moments: every time my little patients get well and are discharged and I know I made a huge difference on their journey to getting better.

What has been your career highlight?

I have a couple of those:

  • When mortality rates of a hospital dropped within 3 months of my arrival in the facility.
  • When my child health and nutrition research paper got an award for best poster presentation in 2015 in the whole province.
  • Getting a Gold award for saving cost of service delivery in the province through my hard work.

What are the most challenging aspects of your career?

Working with the most disadvantaged communities which cannot afford even the basic foods. Counseling them becomes a challenge because they always highlight their affordability challenges.

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

I have a few of those but when they happen, I drink lots of water and morning exercise.

What are the three things that you think people should stop saying when they meet a dietitian?

  • Please give me a diet
  • I want to loose weight
  • Give me a list of the right foods to eat

What should clients look out for when deciding which dietitian to work with?

  • Dietitian must be registered with the Health Professions Council of South Africa
  • Dietitian must have a practice number and/or have a facility practice number
  • Must be easily accessible
  • Must be reliable
  • Must have a love for people
  • Must provide quality services

What is your favourite dish and your favourite treat food?

Pap and Masonja (Mopani worms) in tomato sauce!

I love Rum ‘n Raisin ice cream. A bowl of that is the perfect treat!


Expert Tips for a Healthier Lifestyle

February is national Healthy Lifestyles Awareness Month, with Healthy Lifestyles Awareness Day being celebrated on 22nd February. The National Department of Health encourages all South Africans to live healthier lifestyles, through promoting healthy eating, regular physical activity, avoiding tobacco products, and drinking alcohol in moderation, if at all. But can improving our lifestyles have much of an impact on our health? According to the World Health Organization, the good news is that leading a healthy lifestyle can help to prevent 80% of premature deaths from heart disease and strokes and 60% of premature deaths due to cancer *.

A panel of health and wellness professionals, including dietitians, a psychologist, a sleep expert and a yoga instructor, give us their top tips on healthy eating, aiming to achieve balance, improving sleep and learning to relax to make our lifestyles healthier:

How to Get Healthy Eating Right

To transform poor eating habits into healthy ones, Raeesa Seedat, Registered Dietitian and ADSA spokesperson, says:

  1. Start your day well: Eat breakfast! – Breakfast is linked to improved nutrient intakes, as well as improved concentration and alertness. Studies show that skipping breakfast is associated with increased stress, anxiety, depression, fatigue and tiredness.
  2. Avoid temptation – The sight and smell of food is often enough to tempt us. Avoid keeping tempting but unhealthy foods around the house and avoid the treat aisles in the supermarket.
  3. Shop smart – To avoid impulsive buying, plan your shopping with a budget and a list of what you need to buy and stick to it! If you don’t buy unhealthy foods, you won’t eat them.
  4. Motivate yourself – Research shows that habits that don’t serve us can be overcome with good intentions. For example, having a conscious intention to eat healthier snacks helps to override a habit of making poor food choices.
  5. Do not starve yourself – One of the most common triggers for unhealthy snacking is hunger. Eat smaller, more frequent meals. Do not get to the point where you are so hungry you could wolf down anything you get your hands on. Carry healthy snacks such as fruit, plain unsalted nuts or a tub of low fat yoghurt to work or school to snack on.

What small changes can we make to our daily eating that will help us move towards a healthier lifestyle? Kezia Kent, Registered Dietitian and ADSA spokesperson says:

  1. Hydrate: Increase your daily water intake – being well-hydrated is important for overall health. Herbs such as mint, chopped fruit and lemon slices can all be used to make water more interesting. Remember that store-bought flavoured waters often have added sugar and should therefore be avoided.
  2. Eat regularly through the day by trying to eat every 2-3 hours – Eating healthy snacks between main meals helps to maintain a healthy metabolism and can help to control portions at main meals. Your first meal or snack of the day should be within 90 minutes after waking up. Never skip meals.
  3. Only eat until you feel satisfied – If you begin to feel uncomfortable or too full, then you’ve already eaten too much. If you still feel hungry after a meal, have some fresh vegetables with fat-free salad dressing.
  4. Avoid eating while doing something else – eating while driving, watching TV, being on an electronic device or working prevents most people from actually realising what and how much they are putting into their bodies. Focusing on your food enables you to be aware of what your body wants and needs. Many also find they enjoy their food more and are more satisfied with what they have eaten.
  5. Be active every day – it can be a considerable boost to your overall health to prioritize daily physical activity.   Even a short walk is better than nothing.

How to practice balance in your life

Raydene Naidoo, Psychologist from the South African College of Applied Psychology (SACAP) recommends:

  • Focus on yourself from time to time and pamper yourself. You can’t expect others to nurture you if you can’t nurture yourself.
  • Learn to say no without feeling guilty. Having reasonable boundaries is healthy, and it helps you to regulate how much you take on.
  • Take time to nurture your relationships, especially with your loved ones.
  • You are only human and you’re not always going to get the balance right. Rome was not built in a day. Allow yourself a cheat day but within moderation.
  • Get a good night’s rest as often as you can, naps count too.
  • Set SMART goals for yourself. Specific, measurable, attainable, realistic and time specific.

How to improve our sleep

Sleep is central to all body functions. By the time you are 30 years old, you have already slept for about 10 years. The basis of good sleep is to maintain good sleep hygiene. Dr Kevin Rosman from the Morningside Sleep Centre has this advice:

The sleep environment – the bed must be comfortable enough, the room quiet enough, dark enough, cool enough, and secure enough. Complete absence of sound would be the best, but is generally not possible. Second-best is a continuous quiet hum. Television is generally a bad idea. Sometimes double lining of the curtains may be necessary to keep the room dark enough. We sleep better at night when the environment is cool. If you have an air conditioner, for example, set the temperature to that which is comfortable for the “cooler” partner, and let the other simply add a blanket.

Winding down the brain – before going to sleep, one needs to give the brain a chance to wind down. Allocate between 30 and 60 minutes for this. Going to bed directly after working or after exercise can cause difficulty getting to sleep. Caffeine and alcohol can affect sleep, and sufficient time should be allowed after the consumption of these before getting into bed.

Regular sleep habits – because the body works on a number of different cycles, we sleep best at our usual bedtime. Getting up at the same time every day is also helpful.

How to relax more

An important part of a healthy lifestyle is stress reduction and stress management. Lexi Ryman, Co-Founder of Wild Thing Yoga & Body Conditioning, says “Taking time to switch off and quiet your mind is so important for so many reasons; for example, having your nose to the grindstone all the time limits our perspective, meaning we might not achieve our full potential.”

The practice of mindfulness underpins activities such as yoga and meditation. “Yoga is a form of moving meditation where your movement is guided by your own breath,” Lexi says “It is a complete and total mind-body-spirit overhaul and the benefits of practicing yoga range from the physical benefits of increased flexibility and strength right through to mental and emotional wellbeing.”

To practice mindfulness, start small. “Set your alarm clock for 10 minutes earlier in the mornings. Find somewhere quiet, with a comfortable seat. Close your eyes, and focus on your breath – allowing it to move freely in and out of your nose. Start with 5 minutes and see how you go from there. If you really aren’t a morning person, try it in the evenings. Tonight, instead of your usual routine of flicking on the TV when you get home, take a few moments, find a quiet space, no technology on or around you and just breathe. Find a way of moving your body that feels good in your body. Try out different exercise or yoga classes, until you find an environment that’s comfortable to you.”

To find a registered dietitian in your area who can assist you with a healthy lifestyle plan, visit www.adsa.org.za. 

* Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011

The facts about ADSA

Have you ever wondered who ADSA is or why you should become a member? Read on to find out more about what ADSA does and how you can get involved.

The Association for Dietetics in South Africa, or ADSA, is the professional organisaadsa_what-dietitians-do-boxtion for registered dietitians, and has been committed to serving the interests of dietitians in South Africa for the past 29 years. The Association is made up of a variety of members, from registered dietitians and nutritionists, to community service and student dietitians, international, retired and honorary members.

ADSA’s VISION: To represent and develop the dietetic profession to contribute towards achieving optimal nutrition for all South Africans.

ADSA’s MISSION: As the registered professionals in the field of dietetics and nutrition we support and promote the continued growth of the profession of dietetics in South Africa.

ADSA is a registered not-for-profit organisation (NPO) and unlike counterparts abroad, it is mainly driven by passionate and dedicated volunteers, most of whom are not remunerated for their time and services. The Executive (national) and Branch (provincial) Committee members serve for a 2-year term. Here are some of the many functions and activities the various portfolios are responsible for.

  • President: directs, manages and guides the Association, oversees all its activities on a strategic level and builds strategic partnerships
  • Communications: coordinates all internal communication with members, via the weekly bulletin and quarterly newsletters, managing ADSA’s website, and ADSA’s inputs into other scientific journals or newsletters, as well as co-ordinating a mentorship programme and bursary fund and being a member of the biannual national nutrition congress organising committee
  • Public Relations: handles all aspects related to public relations, including planning and implementing nutrition and health-related awareness days, formulating and publicising statements based on evidence, acting as the official contact person for input into media content, monitoring of nutrition information communicated to the public and creating content to promote the profession in the public space, assisted by a team of spokespeople
  • Sponsorship: recruits and manages suitable sponsors in line with ADSA’s updated rigorous sponsorship policy
  • Representation: coordinates ADSA representatives on eight different official scientific or government groups or committees, as well as other interest groups, and manages the submission of comments to government on nutrition-related draft legislation
  • Private Practicing Dietitians (PPDs): manages all professional issues relating PPDs, including the PPD database, addressing billing practices and providing assistance to PPDs on issues they may experience in private practice
  • Continuous Professional Development (CPD): manages the accreditation of CPD events and online activities to create opportunities for continued education and upskilling of dietitians. Each year the 10 ADSA branches across the country are encouraged to host one CPD event per quarter and there has been on average 3 to 4 CPD-accredited events per branch per year. This portfolio also provides dietitians with access to latest scientific evidence, guidelines and resources through PEN.
  • Membership: manages membership applications and coordinates member benefits. Liaises with members and non-members to establish needs to enhance membership benefits.
  • Public Sector: establishes a support network and line of communication between dietitians in the public sector and ADSA, and communicates relevant developments, such as employer/labour negotiations to ADSA members
  • Branch Liaison: acts as the communication link between ADSA branch chairpersons and the national Executive Committee to ensure consistency in operations
  • Secretary: assists with organisational tasks for the Executive Committee, such as taking meeting minutes and record keeping
  • Chief Operating Officer: part-time employed dietitian to assist with public relations, attend meetings on behalf of ADSA, and assist with other executive portfolios as and when required

The ADSA Executive and Branch Committee portfolio holders strive to meet the needs of the members they serve, by being in constant communication with members. This means that ADSA policy and strategic direction is continuously evolving to meet the changing needs of nutrition professionals in South Africa. Recent significant changes include an updated sponsorship policy, that includes a stricter process of selection and is based on international standards, as well as a review of membership benefits to determine the most appropriate fee structure. ADSA’s Constitution was also recently reviewed and updated to reflect the growth of the nutrition profession.

If you are a registered dietitian, nutritionist with a recognised nutrition degree, community service or student dietitian, we invite you to join us today. As your professional organisation, the more members we have, the stronger our collective voice, and the more we can do to achieve our vision and mission to grow the profession and to promote the nutritional well-being of our country.

To find out more about the benefits of joining ADSA or to find a registered dietitian in your area, visit http://www.adsa.org.za.


The Low Down on South Africa’s Sugar Tax

The Minister of Finance announced in the February 2016 National Budget a decision to introduce a tax on sugar-sweetened beverages (SSBs), with effect from 1 April 2017, to help reduce excessive sugar intake by South Africans. The Association for Dietetics in South Africa (ADSA) welcomes this step as one part of the solution to address the obesity problem and improve the health of South Africans.

How much sugar do South Africans really consume?

When you think of sugar-sweetened beverages, the first thing that comes to mind is the regular fizzy drink, but the term encompasses far more than that. SSBs are beverages containing added sweeteners that provide energy (‘calories’ or kilojoules) such as sucrose, high-fructose corn syrup or fruit-juice concentrates. This includes carbonated drinks (fizzy soft drinks and energy drinks), non-carbonated drinks (sports drinks, iced teas, vitamin water drinks and juice concentrates), sweetened milk drinks and sweetened fruit juices. And many of us do not realise just how much sugar is found in these drinks. For example, a 330 ml bottle of iced tea has a little over 6 teaspoons of sugar!

ADSA is concerned that the intake of added sugars (sugars added to foods and drinks during processing by the food manufacturing companies, cook or consumer) is increasing in South Africa, both in adults and children. Some estimate that children typically consume approximately 40-60 g/day of added sugar, possibly rising to as much as 100 g/day in adolescents. High intakes of added sugar, particularly as SSBs, has been shown to lead to weight gain and cause dental caries. The added sugar in these drinks makes them high in energy (kilojoules). Because these drinks don’t make us feel full in the same way that eating food does, most of us don’t reduce our food intake to compensate, making it easy to consume too many kilojoules. Over time, these extra kilojoules can cause one to become overweight, putting us at risk for diabetes, heart disease and certain cancers. Obesity is already a massive problem in South Africa, with 2 in 3 women and 1 in 3 men being overweight or obese, as well as almost 1 in 4 children.

What is ADSA’s recommendation for sugar intake?

ADSA supports the recommendations by the World Health Organization (WHO) and the South African Food-Based Dietary Guidelines that we need to reduce the intake of beverages and foods that contain added sugars, such as sugar-sweetened beverages, sweetened yoghurts, frozen desserts, some breakfast cereals, ready-to-use sauces, cereal bars, health, savoury and sweet biscuits, baked products, canned or packaged fruit products, sweets and chocolates. The WHO advises reducing the intake of free sugars found in foods and beverages (including added sugars, but excluding sugars naturally present in fresh fruits, vegetables and milk) to less than 10% of total energy (kilojoule) intake for the day (i.e. 50 g of sugar, which is approximately 12 teaspoons per day), with a conditional recommendation to further reduce intake to 5% of total energy (approximately 6 teaspoons per day) for additional health benefits. The South African Food-Based Dietary Guidelines also advise to ‘use sugar and foods and drinks high in sugar sparingly’. To put this into perspective, a 500 ml bottle of a carbonated drink will provide your maximum sugar allowance for an entire day!

The sugar tax – is it a good idea?

The proposed tax on SSBs will mean roughly a 20% tax will be added on to sugary drinks, which is intended to decrease the purchase and consumption of SSBs. Encouragingly, in Mexico, a sugar tax has reduced sugary drink sales by 12% in the first year. The sugar tax is likely to affect shelf prices, but will also motivate manufacturers to reduce the amount of sugar added to their products.

ADSA welcomes the proposed tax on SSBs, but acknowledges that the sugar tax is only part of the solution to address the growing obesity problem. Just as taxing tobacco does not reduce or stop smoking by all people, taxing SSBs will not reduce or stop all purchasing and consumption of SSBs and reduce obesity on its own. Obesity is a complex condition, and sugar is not the only cause. There is a need for multiple interventions across a variety of different sectors to address unhealthy diets and lifestyles and have an impact on the obesity epidemic. ADSA recommends that revenue generated from the tax should go towards health promoting interventions, such as subsidies to reduce the costs of fruits and vegetables, education around healthy choices and creating an enabling environment to make those healthier choices easier.

In addition to reducing the consumption of SSBs to prevent obesity and promote long-term health, ADSA continues to recommend a healthy diet which includes whole grains, fruit, vegetables, nuts, legumes, healthy oils, proteins such as lean meats and seafood, and a reduced intake of processed meats and salt, accompanied by regular physical activity.

ADSA’s detailed Position Statement on the Proposed Taxation of Sugar-Sweetened Beverages, with references, can be accessed here: http://www.adsa.org.za/Portals/14/Documents/2016/Nov/ADSA%20Position%20Statement%20on%20Sugar%20Tax_Final_28%20Nov%202016.pdf

 


10 Healthy Ways to Survive the Festive Season Eating Frenzy

Every year the festive season arrives and all our healthy eating plans go out of the window. There is no doubt that time to relax and enjoy ourselves is important to our well-being, but we tend to over-indulge in rich foods, sweet treats and alcohol. At the same time, we are cutting back on regular physical activity and staying up too late, too often.

This is not to say that we shouldn’t allow ourselves to indulge a little, but allow for eating in moderation and maintaining a varied diet. Ditching your weight loss or weight management plans, or letting go of your health conscious habits over the festive season stresses both body and mind. Of course, you want to enjoy yourself, and it’s certainly not the time to feel deprived, but you can avoid the holidays becoming an extended binge by using strategies to moderate the inevitable excesses.

We asked a team of registered dietitians from ADSA (Association for Dietetics in South Africa) to give us their top tips on how to balance holiday fun with staying healthy, and here’s what they have to say:

Surviving holiday parties: Don’t attend a party on an empty stomach – grab a small healthy snack before you go. When you get there, don’t rush to eat – socialize and settle into the festivities before you eat and keep your socializing away from the buffet table or appetizer trays – to help limit nibbling. (Cheryl Meyer)

Eat mindfully: The buffet table is an invitation to eat all you can, so first survey what is available, choose the foods you really want to eat, and then move away. Eat slowly, focusing on enjoying the taste and smell of each bite. (Jessica Byrne)

Eat what you love, leave what you like. Be picky – don’t deny indulges, but only eat treats that you really love – avoid “wasting” calories on non-favourites. Think quality rather than quantity. (Cheryl Meyer)

Make water your MVP (most valuable player) this holiday season:  Jazz it up with lemon, cucumber or even fruit cubes like watermelon ice cubes, adding an element of holiday indulgence to plain water. Also try plain fruit or herbal tea for a change.  Water and tea can help fill you up preventing holiday overeating or even overindulging in alcohol or fizzy drinks, both loaded with calories/ energy. (Hlanzeka Mpanza)

Balance less healthy meals with healthy ones: Choose only one less healthy item or meal per day.  For example: one day an English breakfast, the next day an ice cream and the next day a take away, but not all three on one day. Ensure the other meals are healthy by eating lots of fresh vegetables and fruit. (Zelda Ackerman)

Be a snack smuggler: Travelling, shopping and lack of routine during the holidays can lead to skipping meals, or grabbing that seemingly convenient fast food. To keep your appetite in check, never leave home without a snack. Fruit makes a refreshing and no fuss snack, and a small packet of unsalted nuts can easily fit in your handbag for when the hunger hits. (Jessica Byrne)

Avoid after-dinner nibbles and snacks: Those chocolates and biscuits that come out after an indulgent lunch or dinner are unnecessary calories and will probably only make you feel more uncomfortably full. (Lila Bruk)

Have your cake and eat it too: If you do have one of the many sweet treats on offer, keep your portion size as small as possible and choose the healthiest of what you can find. For example, generally fruit-based cakes and desserts are better choices, so an apple tart would be a better option than a chocolate cake, especially if you don’t eat all the pastry. (Lila Bruk)

Start your day with a wholesome breakfast: Have a low GI breakfast such as oats, wholegrain cereal or wholewheat toast with avocado or eggs. This will not only keep you satisfied, your sugar levels stable and hunger pains at bay, but will also prevent you from snacking on sugary treats that are empty calories with little nutrients. (Lucinda Lourens)

Get moving with friends and family: Spend quality time with friends and family these holidays, but instead of catching up over coffee and cake, make the most of the warm weather and plan to do something where you can be active together. Meet for a walk on the beach or get a group together and go for a hike. Go for a swim, or get the whole family involved in a post-lunch stroll around the neighbourhood. (Jessica Byrne)

This ADSA NutritionConfidence recipe, created by Chef Vanessa Marx, is perfect for keeping your health on track this holiday, while still indulging in delicious festive food: “Grilled Ostrich Fillet with Egyptian Dukkah and Cucumber Raita”.

Ostrich is a truly South African and healthy alternative for the braai this festive season! The raita bursts with flavour while being low in sugar and fat. Ostrich meat is a great alternative to other ‘red meat’ sources. Classified as a ‘white meat’ due to its fat content, it’s low in fat (even lower than some chicken cuts) and saturated fat; but also a good source of biologically available iron. This makes a great pairing with the “Spinach, Beetroot and Pomegranate Salad”.


CHICKEN SKEWERS, DIPS & SEED FLATBREAD

We love this recipe – it makes a delicious starter for summer entertaining. Making your own dips and marinade rather than using store-bought varieties gives you more control and means you know exactly which ingredients have gone into those dishes.

Not only are the chickpeas in the hummus rich in slowly-digested starch and fibre, helping to control blood sugar levels, but they are also a great source of plant-based protein, vitamins and minerals.

Using whole-wheat flour and oat flour in the flatbread adds healthy fibre, lowering the glycaemic index and aiding in blood sugar control. Because this is still a carbohydrate-containing food, people with diabetes should enjoy the flatbread in appropriate portions.

Homemade chicken skewers are a great lean protein option, and this protein further lowers the glycaemic index of the meal.

RECIPE (Serves 4 as a main or 8 as a starter/snacks)

Chicken skewers

600 g free-range chicken breast

2 lemons

1 Tbsp wholegrain mustard

salt & black pepper

30 g chopped oregano

8 sosatie sticks (you can cut them in half if you want smaller ones for snacks)

 TO MAKE IT

  • Cut the chicken breasts into cubes, about the size of an ice cube
  • Put the chicken in a mixing bowl, and add the zest and juice of the lemons, mustard, and chopped oregano, then season with salt and pepper.
  • Leave the chicken to marinade in the juices for an hour or so
  • Skewer the cubes of chicken onto the sticks
  • Put a pan onto a medium/high heat and add some canola oil
  • When the pan is hot, add your chicken skewers, and allow them to cook on the first side for about 2 or 3 minutes before turning them. Cook the other side for another 2 or 3 minutes and then check between the pieces of chicken to see that the flesh is white, and no longer translucent. You want the chicken to be cooked all the way through, but not dry. Remove from the pan and set aside until you are ready to serve.

Hummus

1 can chickpeas, drained

125 ml Extra virgin olive oil

Juice of 1 fresh lemon

salt & pepper

5 ml tahini

1 garlic clove, peeled

1 Tbsp toasted sesame seeds

 TO MAKE IT

  • Put the chickpeas, oil, lemon juice, garlic, tahini into a blender or food processor, and season with salt & pepper.
  • Blend together until smooth
  • Scrape the hummus from the jug with a spatula into a serving bowl
  • Top the hummus with toasted sesame seeds and drizzle with olive oil

Tzatziki

1 cup plain yoghurt

Juice of 1/2 a lemon

15 g fresh mint

salt & pepper

1/2 a cucumber

TO MAKE IT

  • Grate the cucumber into a bowl, and squeeze off the excess water
  • Add the yoghurt, lemon juice, mint, and season with salt & pepper and put into a serving bowl

 Tomato Pesto

100 g sun-dried tomatoes in oil

30 g roasted plain almonds

10 g fresh parsley, chopped

TO MAKE IT

  • Roughly chop the tomatoes
  • Put the sundried tomatoes with the oil into a blender
  • Add the roasted almonds & chopped parsley
  • Pulse the blender to combine the ingredients into a chunky pesto
  • Scrape from the blender into a serving bowl

Seed flatbread

100 g whole-wheat flour

100 g oat flour

150 g cake flour

100 g plain yoghurt

250 g water (lukewarm)

1 sachet yeast

2 tsp salt

50 g mixed seeds: sesame, flax, sunflower, poppy, pumpkin

TO MAKE IT

  • In a large mixing bowl, add the flours, yeast, salt and seeds and mix together
  • Mix together the water and yoghurt
  • Make a well in the middle of the dry mixture and gradually add the yoghurt/water mixture little by little and mix together to form a dough.
  • Stop adding liquid once the dough comes together, or add extra if you find the dough to be too sticky.
  • Knead the dough together to form an elastic ball of dough.
  • Separate the dough into golf ball sized balls
  • Put a griddle pan onto a medium high heat
  • Dust a clean working surface with a little flour, and roll each dough ball into a flat bread (about 3mm thick).
  • Place the flatbreads onto the hot griddle and allow to cook until a little golden and firm on the first side, and then repeat on the other side.

TO SERVE

On a large board or platter, place the flatbreads and drizzle with a little olive oil. Place your bowls of dips and you chicken skewers onto the platter and sprinkle with fresh herbs

 

 


What your dietitian wants you to know about diabetes

There were 2.28 million cases of diabetes in South Africa in 2015 according to the International Diabetes Foundation and around 1.21 million people with undiagnosed diabetes. Considering these numbers it remains vitally important to continue educating South Africans about diabetes and to address the myths that are often associated with this lifestyle disease.

Nasreen Jaffer, Registered Dietitian and ADSA (Association for Dietetics in South Africa) spokesperson has a special interest in diabetes. She debunks some of the myths surrounding diabetes and nutrition:

People with diabetes have to follow a special diet or have to eat special diabetic foods.

People with diabetes do not have to follow a ‘special’ diet. People with diabetes need to make the same healthy eating choices as everyone else. Healthy eating choices include vegetables and fruit; whole grains; fish, lean meats and poultry; dairy products; seeds, nuts, legumes and plant oils. Everyone needs to limit fatty red meats, processed meats, salt and foods high in salt, and foods and beverages with added sugar.

There are foods that should be avoided completely.

The answer, is ‘no’. Moderation is key, the minute you’ve banned a certain food entirely, you’re likely to start craving it intensely. Your health and weight are more affected by what you do daily than what you eat once or twice a week, so if you’re in the mood for a piece of cake once in a while, buy a small one and share. If you deprive yourself of something you’re craving, it’s just a matter of time until your binge on it and sabotage your motivation. However, crisps, chocolates, and sweets are high in saturated and trans fat, while sugar-sweetened beverages like soft drinks, iced tea and energy drinks contain a large amount of sugar, so these have to be limited.

 If I am diabetic, my diet is going to be more expensive.

It is not necessary to buy expensive foods marketed to diabetics. Healthy eating can be economical, and is often cheaper than buying unhealthy treats. Buying seasonal fresh fruit and vegetables is cheaper than buying fruit juices and sugar-sweetened beverages. If you replace sweets, chocolates, crisps, puddings and cakes with fruits, yoghurt and salads as your snacks and desserts, you’ll find you will save money. Legumes, such as lentils and beans, are cheaper alternatives to red meat, while providing numerous health benefits.

Eating too much sugar causes diabetes.

Too much sugar does not necessarily cause diabetes, but because foods and drinks with added sugar are often energy-dense (high in kilojoules), consuming too much of these on a regular basis can lead to weight gain. This can put us at risk for type 2 diabetes. Sugar-sweetened beverages seem to have the strongest link to type 2 diabetes. ‘Sugar’ doesn’t only refer to the sugar added to tea and coffee, but also includes sugar and sweetened products added when cooking and at the table. Look out for hidden sugars in pre-prepared and processed foods, like some breakfast cereals, sweetened drinks, dairy products, sauces and sweet treats. People with diabetes should limit or avoid adding sugar as it can have a negative effect on blood sugar levels.

 People with diabetes cannot eat carbohydrates.

No, this is not true. While all foods that contain carbohydrates will affect your blood sugar levels, people with diabetes can still eat carbohydrate foods. There are healthy types of carbohydrates that you do want to include in your eating plan, and the type or quality of carbohydrate foods is important. Therefore, for optimal blood glucose control it is important to control the quantity, and distribute carbohydrate foods equally throughout the day. For example, choose wholegrain or high-fibre carbohydrate foods as they don’t increase blood sugar as quickly as refined grains, and make sure that each meal is balanced, containing not only carbohydrate foods, but also protein or dairy, non-starchy vegetables or healthy fats.

People with diabetes should restrict their fruit intake.

Because fruit contains natural sugars, too much fruit can contribute to an increase in blood glucose levels. However, eating fruit also adds fibre, and essential vitamins and minerals to the diet, so while people with diabetes should not eat excessive amounts of fruit, fruit should not be completely eliminated. Portion control is important, and people with diabetes should choose whole fruit rather than fruit juice. It is recommended that you consult your dietitian to calculate the amount of fruit that you should include in your daily diet.

If one of my parents has diabetes, there is nothing I can do about it – I will develop diabetes eventually.

If you have a genetic predisposition to type 2 diabetes, you have all the reason you need to embrace a healthy lifestyle. While genetics may contribute 30 to 40% to the development of any condition, including diabetes, environmental and lifestyle factors may have a 60 to 70% impact. If you maintain a healthy body weight, stick to a healthy eating plan, avoid tobacco use and keep physically active regularly, you have a very good chance of not developing diabetes.

If I have diabetes, I can’t exercise.

On the contrary, diabetes is a compelling reason to exercise regularly. The reason for this is that physical activity plays a very important role in lowering blood glucose levels. Exercise also predisposes your body cells to being more sensitive to insulin, and of course, it helps to achieve and maintain a healthy body weight. Aim for at least 150 minutes of moderate intensity activity a week, such as brisk walking, while doing some resistance or strength exercises at least twice a week. If you use insulin it is important to check your blood glucose levels before and after physical activity. If you get results below 6 mmol/l it is recommended that you lower your insulin dose or eat a healthy snack to prevent a hypoglycemic attack during or after exercise.

Early diagnosis of diabetes is vitally important. This year the theme of World Diabetes Day is “Eyes on Diabetes”, focusing on the screening for type 2 diabetes to ensure early diagnosis and treatment, which can in turn reduce the risk of serious complications. The sooner that elevated blood glucose levels can be treated and returned to normal, the better. If you are diagnosed with either pre-diabetes or diabetes, you need to start moving towards a healthier lifestyle that focuses on regular physical activity, good nutrition and weight-loss if you are overweight or obese.

Everyone over the age of 45 years should be screened for diabetes every 2 to 3 years, or earlier if you are overweight and have other risk factors for diabetes (such as a family history, high blood pressure or previous diabetes during pregnancy). If you haven’t yet been screened, visit a healthcare professional to find out if you are at risk.

Should you experience any of the following symptoms contact your doctor as soon as possible – sudden weight loss, hunger, blurred vision, tiredness, excessive thirst and frequent urination.

To find a registered dietitian in your area who can assist you with a diabetic-friendly lifestyle plan, visit www.adsa.org.za.

 


Navigating the journey to healthy living

adsa-spokesperson_alpha-rasekhala

We recently chatted to Registered Dietitian, Alpha Rasekhala, to find out why he became a dietitian, what he enjoys most about the work her does, the challenges he faces. Alpha is also a member of the ADSA (Association for Dietetics in South Africa) Executive Committee and looks after the Representation Portfolio (Liaising with the Association’s Representatives to obtain feedback from nutrition and profession related bodies on which they serve and to obtain and provide feedback from the Association to these nutrition and profession related bodies)

Why did you become a Registered Dietitian?

I grew up in Limpopo and severe acute malnutrition was a problem. I always wanted to find a solution. As subsistence farmers we had a good harvest of maize, wild spinach,  nuts and peanuts. During high school the marketing manager from University of the North came to my school to inform us about the new dietetic programme the university was running.  I knew then and there that dietetics was my passion and could help me find the solution to my community’s malnutrition problems.

What do you enjoy most about the work you do?

I work as a private practising dietitian. I love the fact that I educate people on positive diet changes and navigate the journey to healthy living with them. It is such a great feeling when I help a client to make a turn around turn from poor nutrition choices to better choices and experience the improvement in health.

What are the most satisfying moments?

I always have a big smile on my face when a client makes the connection between the chronic disease of lifestyle and the bad food choices. Helping a client find the missing piece of the nutrition puzzle and transform their relationship with food is so rewarding.

What have been your career highlights?

I have worked in government, industry and private health sector. I have done a full circle in dietetics. I have been honoured to serve on the board of dietetics and nutrition for 10 years. I have learned about governance and regulations. I am on the ADSA executive committee, for the second time. I have completed my masters in dietetics. I have met amazing people through my dietetics journey.

What are the most challenging aspects of your career?

Nutrition misinformation. There is a lot of advise out there and it can be downright confusing to sort through it all and make sense of it. Most people can cook and think that dietetics is all about cooking. The majority of people forget that nutrition is a science, and the advise given is evidence based. Poor nutrition advice has life implications which have serious consequences.

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

I am never on diet. I enjoy food. My motto is moderation is key.

What are the three things that you think people should stop saying when they meet a dietitian?

  • Email me a meal plan as if we are in a business of issuing out meal plans. People do not understand that a lifestyle change is needed to achieve a goal.
  • What should I do to lose weight?
  • Are carbohydrates fattening? No magic food causes weight loss and no food is inherently fattening. Eat a variety of foods from leagues, meat, dairy, grains, fruits, vegetables and small amount of fat daily.

What should clients look out for when deciding which dietitian to work with?

Look for a dietitian who understands your cultural background, beliefs, socio economic status and eating habits. Someone who will listen to you and work with you and be a partner through your journey to a healthier you.

What is your favourite dish and your favourite treat food?

My favourite dish  is samp and beans, spinach and beef stew.

My favourite treat is strawberry cheese cake.

To find a Registered Dietitian in your area, visit the Find a Registered Dietitian page on the ADSA website. 


Lentil, Pea and Sweet Potato Curry

Food blogger, Taryn Littleton, created this delicious curry for us.

We love the legume and sweet potato combo – both are sources of low glycemic index carbohydrates, rich in slowly digested starch and fibre, helping to control blood sugar levels.

Also, eating dry beans, peas and lentils at least 4 times a week can help prevent chronic diseases, including cardiovascular disease, diabetes, cancer and overweight, as well as improving gut health.

 

INGREDIENTS (serves 6)

  • 2 tbsp avocado oil
  • 2 onions, finely chopped
  • 2 cloves garlic, minced (crushed)
  • 2 carrots, finely chopped or grated
  • 2 tsp grated fresh ginger
  • 2 tsp ground coriander
  • 1 tsp ground cumin
  • 1 tsp ground tumeric
  • 1/2 tsp ground cinnamon
  • 1/2 tsp chili powder
  • 1 large sweet potato, peeled and cut into bite-size cubes
  • 1/2 cup red lentils
  • 5 tomatoes, chopped
  • 1 cup reduced fat coconut milk
  • 1 cup vegetable
  • 1 tsp garam masala
  • 1 pinch of salt
  • 1 tsp honey or brown sugar
  • 1 cup basmati rice
  • 1 cup green peas
  • 2 tbsp chopped fresh coriander
  • 1 tbsp lemon juice

METHOD 

  1. Heat the oil in a large saucepan over a medium heat and cook the onions for 10 minutes, stirring occasionally.
  2. Add the garlic, carrot, ginger, ground coriander, cumin, turmeric and chili and cook, stirring, for 1 minute. Add the potato and lentils and stir to coat with the spice mixture.
  3. Add the tomatoes, coconut milk, stock, garam masala, salt and sugar, bring to the boil and cover with a lid.
  4. Reduce the heat to medium and simmer, covered, for 20 minutes, stirring occasionally.
  5. While the curry simmers, cook the rice.
  6. Add the peas to the curry and simmer, uncovered, for 5 minutes.
  7. Remove from the heat and stir in the coriander and lemon juice.

SERVING SUGGESTIONS

Tomato and onion salsa: Combine 2 tomatoes chopped and ½ onion finely chopped. Season, mix and enjoy served with your curry.

Serve on a bed of rice with a dollop of plain yoghurt and with a tomato and onion salsa.

VARIATIONS

  • Replace the coriander with fresh mint. Serve with naan bread instead of rice.
  • For more nutrients add in a cup of frozen veg.

NUTRITION INFORMATION per serving (excludes serving suggestions, recipe serves 6)

Energy: 1316 kJ Protein: 10.6 g Carbohydrate: 52.0 g Of which, total sugars: 9.4 g Fat: 8.2 g Fibre: 10.0 g Sodium: 302 mg

Source and image: Taryn Littleton for the Association for Dietetics in South Africa


Love your beans for good health

South Africa celebrates National Nutrition Week from 9 to 15 October, and aligning to the Food and Agriculture Organization of the United Nations (FAO) which has declared that 2016 is the ‘International Year of Pulses’, this year’s campaign theme is ‘Love your beans – eat dry beans, peas and lentils!’ echoing the country’s food-based dietary guideline to ‘eat dry beans, split peas, lentils and soya regularly’.

“There’s a good reason to put dry beans, peas, lentils and soya into the spotlight. Unfortunately, they are largely overlooked as they are often seen as a ‘poor man’s food’ and they can take a long time to cook. We should be eating them, along with a variety of foods, at least four times a week; and yet, many of us hardly include them in our diets. There’s just not enough awareness of how they contribute to healthy lifestyles, or how to use them well to make delicious meals,” says Ms Lynn Moeng-Mahlangu, Cluster Manager of Health Promotion, Nutrition and Oral Health at the National Department of Health. “However, this National Nutrition Week, we hope to share tips and recipes to inspire South Africans to eat more beans, peas, lentils and soya. For information on these tips, access the National Nutrition Week website”.

National Nutrition Week is a joint initiative by the Department of Health, the Association for Dietetics in South Africa (ADSA), the Nutrition Society of South Africa (NSSA), the Consumer Goods Council of South Africa (CGCSA), the Heart and Stroke Foundation South Africa (HSFSA) and the Consumer Education Project of Milk SA (CEP). “We are delighted that this year’s theme highlights these affordable, versatile and tasty foods that make such a vital contribution to our health when they are a regular part of the family’s healthy eating regime,” says ADSA President, Maryke Gallagher.

So much nutrition advice is centred on what we need to eat less of, but when it comes to pulses – your dry beans, peas and lentils – the message is about eating more!

Carol Browne from the NSSA highlights some benefits of pulses. “Beans, peas and lentils also provide exceptional nutritional value for money, having a high micronutrient to price ratio. What’s more, they improve soil fertility, are water efficient and have a smaller carbon footprint, promoting environmental sustainability.”

The top nutritional benefits of eating dry beans, peas, lentils and soya are that:

  • They are low in fat, high in fibre and have a low glycaemic index
  • They are naturally cholesterol-free
  • They are naturally gluten-free
  • They are a good source of plant protein, providing twice as much protein as wheat
  • They are good sources of vitamins such as folate and minerals such as potassium and calcium

According to Professor Pamela Naidoo, CEO of the HSFSA, “Including dry beans, peas, lentils and soya regularly in your diet, along with other health promoting behaviours, contributes to better health, helping to improve blood pressure and the maintenance of a healthy weight, reducing the risk for conditions such as diabetes, heart disease and strokes.”

When it comes to cooking, pulses are wonderfully versatile and can be incorporated into the diet in many ways. “Pulses are excellent when used as the main ingredient in a vegetarian meal,” Linda Drummond from the CGCSA points out, “Or they can be used as an affordable way to extend meat in something like a meat stew or a bolognaise sauce. Cook up a large batch, portion and freeze to use to make a quick meal like soup or a bean salad.” As part of National Nutrition Week activities, a host of recipes celebrating beans, peas and lentils in tasty dishes are available on the National Nutrition Week website.

“Some people experience bloating and gas as a result of eating beans, but we would like to highlight steps that can be taken to prevent this from being a reason why many don’t include these nutritious foods in their eating plans”, says Maretha Vermaak from the CEP of Milk SA. Vermaak advises people to start with small amounts to build up one’s tolerance over time and to soak dry beans before cooking.

On Wednesday, the 12th of October, ADSA (@ADSA_RD) will be hosting a Twitter Talk from 13h00 to 14h00 where dietitians and National Nutrition Week partners will be answering questions such as: Why are beans, peas and lentils good for health? How do we avoid getting bloated and windy after eating beans? What is the best way to prepare dry beans for cooking? How do I introduce more dry beans, lentils and peas into my children’s diet? What are some ways we can use beans, peas and lentils in meals and snacks? Join the conversation live on Twitter, follow the @ADSA_RD handle or track the hashtag #LovePulses to get great ideas and tips that will help you and your family to love dry beans, peas and lentils. The Department of Health in the various provinces will also celebrate National Nutrition Week during the month of October.

For more information on National Nutrition Week 2016, please visit the website: http://www.nutritionweek.co.za/


Time To Make Lifestyle Your Medicine

DR. DAVID KATZ

103041_262 — GOOD MORNING AMERICA — DR. DAVID KATZ GM05 (CREDIT: ABC/ Ida Mae Astute )

“We could, as a culture, eliminate 80 percent of all chronic disease,” says Dr David Katz, one of the world’s leading proponents of lifestyle as medicine, during a recent visit to South Africa. “But my family and yours cannot afford to keep on waiting on the world to change. By taking matters into our own hands, we can lose weight and find health right now. We can reduce our personal risk of chronic disease, and that of the people we love, by that very same 80 percent. We can make our lives not just longer, but better.”

As current President of the American College of Lifestyle Medicine, the premise of Dr Katz’s work is based on the evidence of a litany of studies published since 1993 that show that around 80% of all chronic disease can be attributed to a particular short list of lifestyle behaviours. This is why cancers, cardiovascular disease, strokes, diabetes, dementia and other common killers are now commonly known as ‘lifestyle diseases’. Researchers have argued that they are not, in fact, ‘causes’ of death, but rather the tragic effects of disease-causing behaviours embedded in our lifestyles. As Dr Katz points out, the good news for us is that it means that 80% of chronic diseases are preventable if we make the necessary lifestyle changes.

“If you consider,” he says, “that a wealth of research has shown that people who eat well, exercise routinely, avoid tobacco, and control their weight have an 80% lower probability across their entire life spans of developing any major chronic disease, then we realize that this combination of not smoking, eating healthily, being physically active and managing weight is perhaps the greatest advance in the history of medicine.”

Internationally, Dr Katz is renowned for drawing our attention to what we are doing with our ‘fingers, forks and feet’. What we most need to reduce our risk of the most common diseases is to make sure our fingers are free of cigarettes, our forks are full of healthful food and that our feet carry us a fair distance each day. Stopping smoking may be hard, but it is a clear and possible goal. Body Mass Index (BMI) is a rougher measure, but it still serves to give us a fair enough indication of what our healthy weight should be. We know that at least 30 minutes of physical activity a day will go a long way to both managing weight and staying physically strong and limber.

However, with one fad diet after another capturing media attention and shifting us wilfully from low-fat to low-carb, from high-fat to high-protein, from vegan to carnivorous, there is unnecessary confusion and complexity about what really constitutes healthy eating.

Dr Katz cuts through the clamour of ‘the latest, greatest diet’ phenomenon by championing the simple, common sense advice of writer, Michael Pollan: “Eat food. Not too much. Mostly plants.” (In his book ‘In Defence of Food: Eater’s Manifesto’, Pollan expanded on what he means by ‘Eat food’ to assert that we should ‘avoid eating anything your grandmother wouldn’t recognize as food’.)

What most countries’ most recent dietary guidelines have in common is the recommendation of eating patterns that are higher in vegetables, fruits, legumes, nuts, whole-grains and seafood; and lower in red and processed meats, sugar-sweetened foods and beverages, as well as refined starches. As Dr Katz pointed out: “Additional strong evidence shows that it is not necessary to eliminate food groups or conform to a single dietary pattern to achieve healthy dietary patterns. Rather, individuals can combine foods in a variety of flexible ways to achieve healthy dietary patterns, and these strategies should be tailored to meet the individual’s health needs, dietary preferences and cultural traditions.”

“It was wonderful to experience a leading international authority supporting a message that is at the very core of the work of South African dietitians,” says Association for Dietetics in South Africa (ADSA) spokesperson, Cath Day, “Just because it can be such a profitable industry, there’s always going to be a ‘new’ idea for the next ‘right’ diet, which is usually based on some or other distortion of scientific evidence. But what Dr Katz emphasises is that, as nutrition professionals we already know exactly what balanced healthy eating is, and it is never going to be one single eating regime for everyone to follow. What we eat is rooted in our diverse cultures, affected by availability and influenced by our individual tastes. It is always possible for a person to transform to a healthy diet while fully taking into account their unique circumstances around food; and this is exactly what our dietitians work with clients to achieve.”

Dr Katz pointed out to the South African nutrition community that what conspires mightily against a culture of healthy eating in Western societies is far less about the distracting ‘noise’ of the latest fad diet. Instead he urged that the focus should remain steady on the proliferation and accessibility of a vast array of highly processed, fast and convenient foods which have invaded our eating regimes and are overwhelming our habits of sourcing fresh, natural foods and preparing healthful home meals from scratch.

“If lifestyle is the medicine, it is culture that is the spoon that makes the medicine do down,” concludes Katz. The trouble is that we currently have a culture that largely values convenience over health, and we make lifestyle choices, including what we do with our fingers, forks and feet accordingly.

Dr David Katz was in South Africa to speak at the 2016 South African Nutrition Congress hosted by the Nutrition Society of South Africa (NSSA) and ADSA. He invited the South African Nutrition community to join http://www.truehealthinitiative.org/ an international coalition uniting nutrition experts in the global consensus on lifestyle a medicine.
To find a dietitian in your area who can assist you with a healthy eating lifestyle plan, visit www.adsa.org.za


“I’m fascinated about the effect of food on our health”

We chatted to Registered Dietitian, Kelly Schreuder who also has professional culinary experienceadsa_kelly-schreuder2, to find out why she became a dietitian, what she loves about her work and what the challenges are:

Why did you become a Registered Dietitian?

I was very interested in health and the prevention of disease – always reading about nutrition and fascinated about the effect of food on our health.

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

I love supporting individuals through healthy lifestyle change. Everyone is totally unique and it’s very satisfying to work out what inspires and motivates each person. Everyone also has a point of readiness they need to reach before lifestyle change starts to feel easier and I love getting people to that point.

What has been your career highlight?

Running a sustainable business – making a living doing what I love and working on things that inspire me.

What are the most challenging aspects of your career?

Running my own business! Even when you love what you do, there will always be admin, chores, and those days when you’d rather not show up.

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

Get over it and start again – always going back to what I know works for me.

What are the three things that you think people should stop saying when they meet a dietitian?

  • “Oooh…Don’t look at what I’m eating!” (We trust that you are able to make your own decisions and we are not always perfect either)
  • “Is this fattening?” (The answer will always be “it depends”)
  • “What do you think of [insert latest diet trend]?” (unless you want a long answer that will also end up being something along the lines of “it depends”!)

Generally though, we are quite used to answering these questions, so bring it on!

What should clients look out for when deciding which dietitian to work with?

Good rapport with the person. Our training is the same, and you should always feel that you can trust a dietitian, and get good advice, but when you have to work with someone long-term, it really helps to enjoy the time you spend with them.

What is your favourite dish and your favourite treat food?

At the end of the week I like to chop up all the leftover vegetables in my fridge and make a kind of fried rice (with brown rice, ideally) with spring onions, garlic and ginger. Favourite treat: Chocolate with nuts – any kind will do. I have a couple of squares almost every single day after dinner, with a cup of plain rooibos or green tea.

To find a dietitian in your area visit the ‘Find A Dietitian’ section on the ADSA website.

 

 


Add to your ‘must try’ dessert list: Avocado Chocolate Mousse

Chocolateavomousse(3)We just couldn’t resist re-sharing this amazing ‘Raw Avocado Chocolate Mousse’ – a much healthier alternative to regular chocolate mousse and just as delicious. The mousse is packed with healthy unsaturated fat and an ideal alternative for vegans. It also contains none of the major allergens (cows milk, egg, soya, tree nuts, peanuts, wheat/gluten) and is ideal for individuals suffering from allergies to these food items. Developed by chef, Vanessa Marx, this should be at the top of your list of ‘desserts I must try’.

Our dietitians say:

Avocado pears contain primarily mono-unsaturated fats that have been shown to assist in keeping your heart healthy! They are also a good source of Vitamin E, which keeps your skin healthy and speeds up healing, as well as protecting red blood cells; Folic Acid, which helps with the production of red blood cells; and Selenium, which is an integral part of anti-oxidants (these help protect body cells from the damaging effects of free radicals and also needed for the proper functioning of the immune system)

RECIPE

Makes 4 portions

Ingredients

1 ripe avocado

1 ripe banana

1 orange

3 tablespoons cocoa powder

2 tablespoons xylitol

How to make it

– cut the avo in half. Remove the pip from the centre and discard. Remove and discard the skin too.

– in a food processor, add the avo, banana, cocoa powder, and xylitol.

– zest and juice the orange and add both to the food processor.

– blend the mixture until completely smooth and dark chocolate brown. The sweetness and darkness can both be adjusted by adding more or less xylitol and cocoa powder. The xylitol can also be substituted with honey, a low calorie or non-nutritive sweetener.

– you can remove the orange and replace with another flavour variation like cinnamon, lemon zest etc.

– spoon the mousse into 4 glasses for serving and refrigerate until ready to serve.

– serve with fresh fruit or biscotti

The nutritional value serves 4:

Energy: 1075 kJ

Protein: 3 g

Carbohydrate: 17 g

Total fat: 19 g

Dietary Fibre: 6.5 g

Sodium: 46 mg

To download the recipe card, visit http://www.adsa.org.za/Public/Recipes.aspx


Flying the flag for nutrition – Meet Lisanne du Plessis (RD)

lisanneWe chatted to registered dietitian Lisanne du Plessis who is a senior lecturer and the Head of Community Nutrition at Stellenbosch University, to find out why she became a dietitian, what she loves the most about the work she does and what she wishes people would stop saying when they meet a dietitian.

Why did you become a Registered Dietitian?

While I was in high school, I was randomly selected to take part in the MRC’s Coronary Risk Factor Study (CORIS). I was fascinated by the information provided to us about the ways in which nutrition could prevent and treat diseases. Two dietitians (Edelweiss Wentzel-Viljoen and Marjanne Senekal) were part of the research team who visited my hometown, Robertson, for this project and I was inspired by the prospects of the profession. I went on to study BSc Dietetics at Stellenbosch University and it was a very proud moment for me when I could write “RD/SA”, and for some time now, also “NT/SA” behind my name.

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

I am a senior lecturer at Stellenbosch University in the Division of Human Nutrition. I enjoy teaching, experiencing students who engage with nutrition theory in a positive way, watching them translate the theory into practice, seeing them graduate with big smiles and when they say: “Mam, you have instilled a passion in us for infant and young child nutrition” – those are golden moments for me.

What has been your career highlight?

I am fortunate that there have been many. I was exposed to wonderful, humble and sincere people in my very first job as a community dietitian. I have treasured the life lessons I learnt from them during my career. I was honoured to serve the profession on the ADSA Western Cape branch and the ADSA Executive committee in my early career and I also served as ADSA President (2002-2004). I have met amazing mentors and colleagues who have become friends and partners in flying the flag for nutrition; I have seen interesting and beautiful places and have had the opportunity to listen and speak to diverse nutrition audiences. Obtaining my PhD and surviving to tell the tale is the latest on the list of career highlights!

What are the most challenging aspects of your career?

Juggling life (husband, children, home, family, friends) with an intense and diverse workload.

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

Sigh…and try to do better the following day. I enjoy exercise – so that helps!

What are the three things that you think people should stop saying when they meet a dietitian?

  • Please don’t look in my shopping trolley/plate!
  • I usually eat healthily.
  • Can you work out a diet for me?

What should clients look out for when deciding which dietitian to work with?

They should always feel that the dietitian carries their best interest at heart.

They should be able to build a trust-relationship with a dietitian fairly quickly.

They should be convinced that the dietitian is truthful when he/she says: “we practice evidence-based nutrition.”

What is your favourite dish and your favourite treat food?

I love many different kinds of food and especially enjoy tapas-style meals. I am well-known for my love of chocolate and bubbly!

 

To find a dietitian in your area, please visit http://www.adsa.org.za

 

 


Why breastfeeding should be everybody’s business

It is common sense that ‘breast is best’ when it comes to feeding infants and young children. After all, breast milk is uniquely, organically fit for a singular purpose. Yet, South Africa has an extraordinarily low rate of babies breastfeeding exclusively in the first six months of their lives. In fact, at just 8% against a global rate that is almost 40%, the South African statistic is regarded by UNICEF as one of the lowest in the world. (http://www.unicef.org/southafrica/media_10469.htm)

The World Health Organisation (WHO) defines optimal infant and young child nutrition as breast milk exclusively up until the age of six months; and then breast milk supplemented by safe and appropriate foods up until the age of two years, or beyond. (http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/)

“There is a significant body of scientific evidence that informs these global nutritional guidelines and attests to the many benefits of breastfeeding when it comes to the health and well-being of not just baby, but Mum as well,” says Cath Day, ADSA (Association for Dietetics in South Africa’s) spokesperson. “For instance, new research presented in The Lancet, an international medical journal, states that optimal breastfeeding could save the lives of 823 000 children a year, and there’s substantial evidence that breastfeeding can help to ward off breast and ovarian cancers in mothers too.”

With World Breastfeeding Week spanning the 1st to the 7th of August, we face the reality that the majority of women all over the world, but particularly in South Africa, don’t meet accepted international, or national, nutritional guidelines for breastfeeding their babies because they experience strong, often, culturally-institutionalised barriers to breastfeeding. And, that is why we all have a part of play in transforming the country into an enabling environment that properly supports, encourages and upholds breastfeeding mothers.

Over the past years, South Africa has taken steps to rectify the provision of inaccurate information by health care providers and implemented measures to mitigate the aggressive corporate marketing of breast milk substitutes which undermine breastfeeding. In addition, the country’s employment laws have enshrined the rights of mothers with infants under six months, who have had to return to work, to take two 30-minute breaks during work hours to express milk. (http://www.labour.gov.za/DOL/downloads/legislation/acts/basic-conditions-of-employment/Amended%20Act%20-%20Basic%20Conditions%20of%20Employment.pdf)

But clearly this is not enough, as reviews show we have stagnated at the exceedingly low rate of 8% for years on the most important marker of infant nutrition.

“The proper support needed to achieve the scale of breastfeeding that would meet global guidelines and significantly improve infant mortality in South Africa has to be multi-level and multi-pronged,” says Thembekile Dlamini, also a Registered Dietitian and ADSA spokesperson. “That is why breastfeeding should rather be viewed as ‘everybody’s business’ versus an activity that a mother feels she needs to guard and hide, perhaps even in her own home, family environment, workplace and community. A positive attitude to breastfeeding needs to permeate all aspects of South African society, across all socio-economic levels.”

This highlights the reality that breastfeeding as the source of optimal and exclusive infant nutrition is unfortunately, too often, transformed from a natural, basically unremarkable human activity securely bolstered not just by straightforward good sense but by modern scientific evidence too, into a contentious nutritional fashion or a fad, buffeted by fleeting, often self-serving opinions, agendas and perceptions.

Everyday barriers that breastfeeding women experience range from partners who are unsupportive due to self-interest to grandparents who morally disapprove of public breastfeeding. Corporate environments may not provide suitable facilities, nor accept the routines for lactating mothers who are back at work.

Let’s find ways and work together to support women who are trying to give their children the best start in life:

  • Fathers and partners who are informed about the benefits of breastfeeding and supportive of a breastfeeding mother can have a major influence on successful outcomes
  • Other family members, particularly grandmothers and aunts, who a mother might turn to for advice and support also have a considerable influence to bear when it comes to encouraging or discouraging breastfeeding
  • Mothers also often rely on advice and support from their friends, especially those who might be more practiced mothers than they are. While there is much value in friends’ sharing their experiences of motherhood, the breastfeeding advice you give should be objective. Mothers who are experiencing difficulties with breastfeeding should be encouraged to get professional help before considering giving it up
  • Employers can support breastfeeding mothers who have returned to work to establish a routine to express milk in private and comfortable surrounds

 

Breastfeeding support is available in South Africa:

  • Mothers can obtain professional help with breastfeeding from lactation consultants, who are health professionals with advanced training in breastfeeding support http://www.salactationconsultants.co.za/index.php
  • La Leche League South Africa is a voluntary organisation which provides information and support to women who want to breastfeed their babies. La Leche League Leaders are experienced breastfeeding mothers, trained and accredited by LLL, who are happy to help other mothers with questions and concerns about breastfeeding http://www.llli.org/southafrica.html
  • Milk Matters is a community-based breast milk bank that pasteurises and distributes donations of screened breast milk from healthy donors to premature, ill and vulnerable babies whose own mothers cannot supply the breast milk to meet their baby’s needs. Their website has valuable information for breastfeeding mothers http://milkmatters.org/breastfeeding-breastmilk/

 

Breastfeeding provides the foundation for lifelong health and wellbeing. This year, the World Breastfeeding Week theme is ‘Breastfeeding: A Key to Sustainable Development’. The website is packed with useful and interesting information on wide range of positive impacts of breastfeeding on society and the planet http://www.worldbreastfeedingweek.org/resources.shtml

 


It is never too early to change to a healthy lifestyle

ADSA_Zelda_Success Story_1We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved.

It is never too early make lifestyle changes and start a nutritional journey that will benefit you for the rest of your life.  This week we chat to 16-year old Chad Niebur, who started seeing Registered Dietitian Zelda Ackerman last year:

Tell us about your journey with the dietitian?

The journey with my dietitian was definitely a very insightful one. We’d usually arrive in the morning just before we headed off to the grocery store to stock up on the newest list of food products suggested, and reducing the amounts of some of the others that we’d usually buy. From the first to the last session, there was always something new to learn. A new food item to add, another one to reduce. We’d be asked how the week prior went, if we were keeping up with our exercise regime, etc. All and all, it was very insightful and much more easy going than I expected.

Tell us about your results?

My results were definitely more prominent than I expected. Within two months I went from baggy tracksuit pants and to skinny jeans. I can remember within the first three weeks losing just over four kilos, and went on to lose much more over time.

What was the hardest part of the journey?

The hardest part of my journey was cutting out Coca-Cola, but over time I grew to miss it less and less. To this day I don’t drink Coca-Cola at all, nor do I miss it.”

What are the top three tips you can share?

  • Find a healthy substitute to you favourites drinks and snacks. I replaced Coca-Cola with carbonated water and a low-cal fruit juice concentrate.
  • Don’t really make a big deal out of it, treat it as something you’ll be doing for the rest of your life and you’ll come to accept, get used to, and genuinely favour it over the way you used to live.
  • Try and get the rest of the family involved, it’s definitely easier since there will be a lot less junk food in the house.

Feedback from Chad’s dietitian, Zelda Ackerman

Few patients really make a complete lifestyle change, and Chad really did! He changed his eating habits and became much more active. He used the eating plan as a guide, not as something that controls him. He learned to make healthy choices and be in control of his own eating habits. His mother was extremely supportive without being controlling, an attribute that is vital for parents to help their children attain an ideal body weight. I am very proud of Chad and his mother Sharrin.

To find a Registered Dietitian in your area visit: http://www.adsa.org.za/Public/FindARegisteredDietitian.aspx


“I love the versatility our profession”

Monique_1We chatted to Registered Dietitian, Monique Piderit who works mostly in the corporate wellness space, to find out why she became a dietitian, what she loves about her work and what the challenges are:

Why did you become a Registered Dietitian?

I heard about dietetics for the first time when I was in 2nd year at Wits doing a BSc. I soon realised that all my subject choices where right in line with the types of subjects done in dietetics. It was one of those “aha” moments where I realised I have just fallen in love with my future profession.

If you ask my mother this question, she will tell you I was born to be a dietitian. From an early age, it was natural and easy for me to choose the healthier foods. I disliked fatty meats, chicken skin, and creamy-based foods, and processed meats like polony made me ill. I was quite happy to have milk with my meals, never went overboard on sweets and chocolates, and there was never a struggle as a toddler to eat veggies. It really is just something that is instinctive for me to be healthy and thus it’s easy to lead by example.

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

I love the versatility our profession. People think dietitians just help with weight loss diets. The truth is almost every medical concern, disease or condition can be managed, treated, or even prevented with good food choices.

Also, I enjoy how impactful our profession can be. I work mostly in the corporate wellness space. Employees spend 1/3 of their time at work, making the workplace the ideal opportunity to promote and encourage healthy nutrition. I am involved in onsite nutrition consultations, canteen audits, nutrition workshops and article writing for corporates, all impactful yet undervalued ways to address nutrition.

What has been your career highlight?

There are many dietitians that I look up to and admire in our profession, and when these dietitians express acknowledgement in the work that I do, it is hugely fulfilling. It is gratifying and rewarding when your mentors, dietitians who love and protect profession as much as you do, recognise and compliment you on your contribution to the profession.

What are the most challenging aspects of your career?

Everyone eats, so everyone thinks they’re an expert in nutrition. The truth is nutrition is far more complex than calories and not as simple as just being about food. On a daily basis, dietitians, the nutrition experts who study for years to practice, are confronted by people who (unknowingly) cannot discern evidence-based nutrition from sensationalist ‘fact’ found on the internet. It has been a personal challenge to learn how best to address the controversial questions in a friendly manner, remaining true to the science. Regardless, my immense pride to be a dietitian always helps me keep my head high.

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

I never let it get to a point of an entire day of poor choices, but rather a cheat window where I allow myself to relax the nutrition strings, thoroughly savouring and enjoying the less healthy choice. It’s so vital to change how you think about food. Food nourishes the body and is not a sentence to a life of unhappiness. There will be meals where you overeat or eat incorrectly. But the power resides in you that at the next meal or even in the very next bite you decide you are in control. Be kind to yourself. No one is perfect (not even your dietitian).

What are the three things that you think people should stop saying when they meet a dietitian?

  • Are you really going to eat that? Dietitians are humans and have taste buds and emotions like everyone else. When you’ve eaten well most of the time, your body can certainly tolerate a little cheat here and there, so yes, I’m not only going to eat that but delight in every bite along the way.
  • So tell me, what’s your opinion on Banting? The answer is I don’t have an opinion, I have a position, a position that, like other health care professionals guided by science, is based on scientifically-sound, evidence-based, high quality research.
  • Can you make me a meal plan quickly? Meal plans take time and effort and require an understanding of your needs, likes, dislikes, medical history, budget, lifestyle, etc. If meal plans were the ultimate answer, then one could simply download one of the thousands on the internet and be healthy, happy, skinny, and fit. A meal plan is a guide to healthy eating, not the ultimate answer.

What should clients look out for when deciding which dietitian to work with?

Our relationship with food is so very intimate and personal that you need to be comfortable to open up and share that with your dietitian. You need to find a person that you trust in and can connect with. It’s also important to remember that dietitians are the leading experts in nutrition and you should note red flags when the person favours a certain diet, pushes sales of a product that you “have to have”, or “prescribing” weight loss medication. Chances are this person is not a dietitian.

What is your favourite dish and your favourite treat food?

My family is Portuguese and I am the first generation to be born in SA. The culture, language, and of course, food, is still a large part of who I am. A freshly baked, hot bread roll with butter or perfectly plump roast potatoes are an all-time comfort and favourite. I am also not inclined to part with my beloved red wine (red grapes count as a serving of fruit, surely?

Monique is a registered dietitian with a background in corporate wellness and Masters degree in Dietetics in sports nutrition. Guided by evidence-based nutrition, Monique believes in an integrated approach to wellness where the key to being healthy is to adopt small yet sustainable changes to your lifestyle. Monique is a member of the ADSA (Association of Dietetics of South Africa) Gauteng South branch and registered with the HPCSA (Health Professionals Council of South Africa). She is also a Discovery Wellness Network dietitian and DNAlysis accredited practitioner.

 

 


The Importance of Healthy Eating to Corporate Wellness

Today is the first day of Corporate Wellness Week, which is running until 5 July.

Employees eat nearly half of their daily meals and snacks at the workplace, which means that what is consumed during working hours can have a great impact on overall diet and health. It’s not uncommon to find that many of us, who may well be healthy eaters at home, give way to speed and convenience when it comes to the food choices that are made, often under pressure, during working hours.

Corporate Wellness Week emphasises the need to put workplace nutrition in the spotlight. The calories we consume at work do count, as does the quality of the nutrients in the types of food we are choosing. While employers need to focus on the food that is being made readily available to employees, we also need to reflect on our choices and habits when it comes to eating on the job.

It is vital that companies focus on making healthy eating choices accessible and affordable. Canteen or cafeteria menus need to be in line with the SA Food-based Dietary Guidelines or developed together with a Registered Dietitian. Vending machines in the corporate environment should offer a majority of healthy eating options. Likewise, drinks and snacks made available at corporate meetings and events should be wholesome and healthy options. The benefits to businesses that care about healthy nutrition are far-reaching. There’s a wide array of research studies that provide comprehensive evidence of the effects of what we eat on performance. Who doesn’t want healthy, focused and productive employees?

There’s also a lot that each of us can do to ensure that we are eating healthily during working hours.

Monique Piderit a Registered Dietitian and spokesperson for ADSA (Association for Dietetics in South Africa) works regularly in the corporate sector and has particular insights into the challenges of workplace nutrition and its important place in Corporate Wellness. She recommends:

  • Be aware of everything that you are eating and drinking during working hours. Yes, you are under pressure but every calorie, and every nutrient still counts just the same
  • Take note of your eating habits at work, especially those triggered by workplace stress and pressure. If you find yourself routinely buying a packet of chips or a chocolate from the vending machine around the corner from your desk every time the going gets tough, it’s time to change your habits and make better choices that will really help you to feel better. For example, replace a crunchy crisp craving for healthier nuts, popcorn or pretzels, and a sweet tooth with fresh fruit or dried fruit like cranberries.
  • If your healthy eating choices are limited by what’s available around you at or in close proximity to work, consider taking charge and preparing your own daily healthy lunchbox. It is actually not as much work as you may think, and it can be cost-saving too. When you get the balance of protein, carbohydrate, healthy fat and vitamins and minerals right in your lunchbox, you’ve aligned your workplace nutrition with your healthy lifestyle goals. When preparing dinner allow for a portion of food to be allocated for the next day. As you serve dinner, immediately set aside a portion of food into a container for lunch the next day.
  • Make an effort to reduce your processed foods intake and go for the real thing. For instance, buy more lean chicken pieces than what you will eat for dinner, and then tuck a left-over drumstick in your lunchbox rather than spending extra on buying vienna’s and other processed meats for your lunchbox.
  • Declare an outright ban on sugary drinks in the workplace which are often all too easily available. Make water your first port of call. You can bring it to work infused with citrus, ginger or mint. Choose rooibos or herbal teas as your hot drinks at meetings or have cooled as a homemade iced tea in summer.
  • Stock up on nutrient-dense, fresh fruit, veg and nuts that are so easy to snack right at your desk. Maybe you can stock the fridge at work, or also choose long-lasting fresh produce options like citrus or bananas that can stand on your desk all week long.
  • Also keep easy options at hand like wholewheat/high fiber crackers, salt and sugar-free peanut butter and lean biltong. These foods can keep for weeks at a time. Making the healthy options the closest to hand so that when you are under pressure you will grab something that is really good for you

As Monique points out: “We can’t talk about Corporate Wellness during this awareness week without talking about nutrition. A healthy employee is a focused and productive employee. What we eat is fundamental to our well-being in the short and long term. It is also fundamental to our performance in the moment. Work dominates the lives of adults and how we manage and choose our food at work is critical to our well-being.”

To find a Registered Dietitian in your area visit http://www.adsa.org.za/Public/


‘Balance is key!’ Our latest success story

We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved. This week we chat to Robyn White, who started seeing Registered Dietitian Kezia Kent after she had her second child.

Tell us about your journey with the dietitian?

My husband and I went to see Kezia Kent after the birth of our 2nd daughter. I was the heaviest I had ever been in my life and decided that I needed to focus on my health and fitness so that I could be an example for my daughters. What I loved about Kezia instantly is that we could be honest with her. I was not an easy client. I told her I had Irish blood in me and loved potatoes, that I had given up wine obviously for 9 months during my pregnancy and had no desire or intention to give it up again so it needed to be in my eating plan, and that I had a small obsession with Woolworths Hazelnut Cappuccinos! Kezia included all of these in my eating plan! Additionally Kezia always explained very thoroughly the importance and effects of each food group. I always left her sessions feeling I had gained knowledge and power. Kezia’s words constantly pop into my head, “Remember the word “die” is in diet, we do not diet, this is an eating plan and way of life!” This has really changed my perception and thinking around food and eating!

Tell us about your results?

My very first appointment with Kezia was the first day I was allowed to exercise after my C-section surgery. That day I ran/walked 5km in 58 minutes. Exactly 5 weeks later I ran 5km in 38 minutes! It was a huge accomplishment! My eating plan (even with having only 4 – 5 hours sleep each night because of the baby) had increased my energy levels drastically. I had honestly not felt so energetic and “good” in many years! In 16 weeks I have lost 12 kgs and the greatest feeling is being able to feel like I am maintaining that easily. And I finally fit into the clothes I was wearing before both my babies! Exactly 4 months after having my second daughter I ran my first ever half marathon! What an amazing feeling.

What was the hardest part of the journey?

Honestly, having the willpower to order a jacket potato over chips when we went out for meal (that Irish blood)! I sometimes had to seriously give myself a pep talk. But it got easier and eventually I was choosing sweet potatoes over normal potatoes. What a change for me!

On par with that, my husband and I are very sociable and have a very sociable family and circle of friends. It was hard to go to braais and events and not want to snack on chips and biltong, but we did not stop being sociable. We took our own healthy snacks, learnt how to make our own healthy dips and still enjoyed the social events.

What are the top three tips you can share?

  • Exercise is so important! I make it a priority. Even with work, being a wife and mother to a toddler and a baby, it is a priority and I always feel so good afterwards.
  • Listen to your dietitian, they know better and they are way more qualified! I learnt so much from Kezia and will be eternally grateful.
  • Balance, balance, balance! Balance is the key! I always remember Kezia’s advice that you have to have that one cheat meal. But have the self-control and willpower to eat healthy again the next day. Great advice!

What the dietitian says

The most exciting moment for me was when Robyn came in with her husband and they both said to me, almost simultaneously, “It’s time for that health change”. That determination and drive from the get go will put a smile on any dietitian’s face. I knew immediately that Robyn wanted to improve her eating habits not just for herself but to ensure that the family is as healthy and adequately nourished.

Robyn knew it was not going to be easy, especially with a busy household, but she went forward with the plan knowing that she cannot follow this way of eating for a couple of weeks, it needed to be a lifestyle change. A lifestyle that does take a degree of planning, changing the snacks at social events, getting your friends on board and of course ensuring that it is manageable for all, even if potatoes are served with dinner. I reassured Robyn that my stance in general is not to exclude or cut out food, but rather encourage the addition of more nutrient dense foods as well as enjoying those small delicacies in life in a responsible manner. How boring would life be without that small bite of chocolate!

Robyn has lost a significant amount of weight but more importantly a large percentage of body fat. But her confidence in herself is far more of an achievement.

Well Done Robyn!

To find a Registered Dietitian in your area visit: www.adsa.org.za


“We all make mistakes or have bad days” – meet dietitian, Faaizah Laher

ADSA Spokesperson_Faaizah Laher_1

Why did you become a Registered Dietitian?

Cooking has always been a favourite pastime and being Indian so many of our occasions revolve around food and the kitchen. Helping people through what they eat became an interest when I was in high school and applying for a degree in dietetics seemed like the most natural and ‘next step’.

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

The feeling when a patient with a perforated bowel or frozen abdomen – after a prolonged stay in ICU, high care and general ward – os finally able to leave the hospital and able to eat normally. When a renal patient who feels like they have no hope realises there are healthy and nutritious food choices they can make to ensure they live a healthy life.

What has been your career highlight?

My healthy cooking demos – getting this project off the ground and inspiring participants to eat and lead a healthier life. Translating nutrition knowledge into little pieces of practical advice for a magazine article or radio interview.

What are the most challenging aspects of your career?

The uncertainty when I left government service to start a private practise. Private can be a lonely place and fostering new relationships and keeping old ones close is so important!

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

Get right back into eating healthy again. We all make mistakes or have bad days. Accept it, learn from it and move forward.

What are the three things that you think people should stop saying when they meet a dietitian?

  • I really need to come see you! (As they rub their tummy)
  • Oh, so should you really be eating that?
  • Email me a diet, I don’t eat but I just keep putting on all this weight!!

What should clients look out for when deciding which dietitian to work with?

Proximity to your work or house. Someone located close to you makes follow ups easier and also enables success in terms of achieving goals and relationship building. Consider choosing a professional that has an interest in the needs you have. Not all are comfortable in terms of allergies/ paeds and other specific conditions.

What is your favourite dish and your favourite treat food?

  • Favourite dish at the moment: Tandoori chicken grilled perfectly, with a crunchy salad and grilled potatoes. Using the leftovers in a wrap the next day for work! .
  • Popcorn!!

 


Healthy Nutrition during Pregnancy

We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved. This week we chat to Bonnie Classen, who started seeing Registered Dietitian Alex Royal when she fell pregnant:

Tell us about your journey with the dietician? 

Over the past few years I have strived to lead a healthy lifestyle, with my food choices being based around eating as many real foods as possible, and minimal processed and refined foods. Despite my diet being healthy for the most part, I still  found that I still struggled in a few areas – such as afternoon slumps, sugar cravings, and low energy during certain times of the day.

After falling pregnant, I felt it would be a good idea to visit Alex Royal for a dietetics consultation, to help guide me on the optimum food choices during my pregnancy. As the majority of my food choices were already healthy, I was very curious to see the assessment of my current diet, as I couldn’t imagine what possible improvements could be made.

Wow did I have a lot to learn !!

 While on the whole my food choices had been good, Alex highlighted so many interesting points regarding my current diet. From the excessive amount of fat I was eating each morning (I was shocked to hear how much fat I was consuming with my breakfast each morning, I had no idea), my very low calcium intake, and so much more.

Using my existing food choices and lifestyle – Alex helped adjust my current eating regime. Adjustments were made to my meals. From distributing my fat intake more evenly throughout the day, increasing of calcium, including protein & vegetables during certain times and so much more.

 As Alex worked with my current eating style and diet when making these adjustments, these changes weren’t very challenging to implement into my daily routine, which made them far more manageable to achieve.

What a difference these seemingly simple changes made to my life !

She also helped highlight some really important information to me regarding my dietary needs during pregnancy, such as the importance of calcium intake during pregnancy and the daily recommended dosage, as well as information on all the other essential nutrients required during pregnancy.

During our second consultation Alex also suggested I bring in all my vitamins, and assessed my vitamins dosages, giving fantastic suggestions on inclusions and improvements here too.

 Tell us about your results? 

The results I achieved after implementing the dietary changes were nothing short of fantastic! My afternoon slumps diminished, and I realized that my previous afternoon ‘sugar’ cravings was simply hunger – I was eating lunch far too early in the day and then only eating dinner after 7pm. So without an afternoon snack, was starving by 5pm!

By adjusting my food quantities, including protein into my breakfast each morning, and spreading out my fat intake –  I also felt far more sustained throughout the day.

Alex also gave me tips on how to ‘give in’ to my pregnancy craving, but ensuring that this was done with the right food choices, so that the extra calories I was consuming weren’t empty calories. She took my pregnancy experiences into consideration when creating my customized eating plan. Despite being starving, I was also struggling with severe nausea (a combination I didn’t know was possible prior to pregnancy!) After most meals, I then also suffered from heartburn and indigestion, making eating full-size meals very unpleasant.

One of Alex suggestions was to eat a healthy snack a few hours after dinner, which ensured I still got my extra calories required despite eating a small dinner. By also eating this healthy snack before the hunger & cravings hit, I felt satisfied and managed to avoid the late night “pregnancy” sugar binges I found myself giving into prior to my consultations.

During my consultations Alex tracked my pregnancy weight gain, ensuring this was on track, while still increasing my muscle mass. I have now managed to maintain an extremely healthy weight gain throughout my pregnancy. I have not only loved my pregnancy body, but also feel such a great sense of confidence that I have given my baby the best head start in life, by ensuring she has had the optimal nutrition needed 🙂

 What was the hardest part of the journey? 

The hardest part was to be more disciplined in preparing lunches and snacks for my work day. While packing lunch was easy (as we generally made a generous healthy dinner the night before – and took leftovers to work), I never prepared any snacks for work.

So it took some time to adjust to having to be slightly more disciplined in my preparation each morning, but the results were worth it! By simply taking those 15 minutes each morning to pack for the day, I now am completely able to avoid the 5pm ‘binge’ I found myself falling into each afternoon.  

What are the top 3 tips you can share? 

  • From the 2nd trimester you should increase your daily calorie, but the extra food you eat shouldn’t just be empty calories, as it should provide the nutrients for your growing baby needs. It is also easier than you think to get these extra calories!
  • You can get creative with your eating schedule during pregnancy. As mentioned, I suffered from extreme nausea, heartburn and indigestion when eating full-size meals, often making meals unpleasant. By splitting up your meals and eating smaller meals and snacks at different times within the day, it helped ensure I still consumed the calories and nutritional intake during pregnancy, while avoiding the excessive pregnancy heartburn & indigestion i experienced with larger meals.
  • Be prepared !! When you have a busy work schedule, it is very easy to get caught up in your day and go for long stretches without food, then give in to the ‘convenient’ foods that are in reach (these usually being unprocessed, sugar filled snacks) By simply making time to prepare your lunches & snacks for your day ahead, you can maintain your healthy diet habits and continue to feel sustained throughout the day.

Feedback from the Alex Royal

It was an absolute pleasure to help Bonnie along this path. She made excellent dietary and lifestyle changes which benefited both her and her little one. Her body composition improved during her pregnancy with her body fat decreasing while her muscle mass improved. She managed her cravings and followed the meal plan to the letter, including the nutrients that we needed to focus on to help her baby develop and grow well.  Her motivation and commitment to her health and to her baby’s well being was inspiring.


“Sensible, long-term healthy eating is not the sexiest of subjects” – meet dietitian, Hlanzeka Mpanza

ADSA Spokesperson_Hlanzeka Mpanza_1Why did you become a Registered Dietitian?

By accident actually. My father brought a career guidance book home that featured a dietitian when I was in standard 9.  I was fascinated about the idea that everyday food could help with getting the most out of life whether in sports, work, disease and general mental well-being. I still am.

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

I work in the food industry. I believe this is the most exciting area to work in in dietetics today as there is so much happening in the field of food policy worldwide. My job as an industry dietitian is to make nutrition relevant and accessible to our consumers through relevant  products, messages and projects. And most importantly to provide our consumers with nutrition information that they need to make informed choices.  I like knowing that when we hit that sweet spot between the right health message and product/ project, we can positively change lives of millions of people every-day.

What has been your career highlight?

For a black girl from very humble beginnings, my job has allowed me to travel to places I never thought I’d see in my life. After qualifying, I registered as a dietitian in the UK, where I later went to work as I travelled my way around the continent over a number of years.  I not only got to work and live with diverse people from all over the world, I did it whilst still feeling like I was making a difference in peoples’ lives. Those years were special for me.

What are the most challenging aspects of your career?

Sensible long-term healthy eating is not the sexiest of subjects.  How do we as a profession get better at enabling the general public to eat better, without bells and whistles?  I’d like us to crack the key to population-wide healthy eating messages that are based on nutrition science yet are simple, engaging and accessible (not just financially but culturally as well).  We have to get to a point where investing in credible nutrition is the only sensible choice. At the moment, there is so much information clutter that the general public is mostly confused about what sensible healthy eating is. And when people are not food literate, they are not able to make lifestyle changes that they need to make for them live longer, more productive lives.

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

Except I don’t call them nutrition disasters. I call them celebration days like when your BFF gets a promotion and you share one big cake between the two of you or sad days when you get ceremoniously dumped by your ‘not-really-serious-boyfriend’ and you eat all the food in the house.  The problem is when sad and celebration day kind of eating becomes the norm, which is when you need to start recreating a healthier normal.  How I cope is I pick myself up the following day and go live my best life, it’s all about trying to do better every-day. I believe food is a legitimate way of coping with emotional events and marking milestones, that’s ok.  I don’t think shame and guilt are useful when it comes to sustainable healthy eating.

What are the three things that you think people should stop saying when they meet a dietitian?

Are you really going to eat that?

How do I gain muscle or lose weight?

Don’t look at what I’m eating! (this makes us feel like the food police, which we’d like to think we are not)

What should clients look out for when deciding which dietitian to work with?

Find someone who gets you and your vision. Someone who understands what you want to achieve. Other than when dealing with certain medical conditions, success in nutrition is mostly relative. Define what success means for you, your health, your culture, your work, your mental well-being, your budget, stage of life, support system, etc. Choose someone that can help you navigate what success means for you and how to get there without giving up the most basic parts of yourself that make you YOU. You are more likely to be successful when you do that.

What is your favourite dish and your favourite treat food?

It changes, right now I am loving ujeqe obrown ( steamed brown bread) that I make at home a serve with everything. As a treat, I have a weakness for  spicy chicken wings from the orange fast food chain.


How can a Dietitian guide you through the Nutrition Minefield?

From Great Aunt Phyllis, to your Facebook friend that lost 30 kilos last year, to the latest in the multitude of global ‘so-called experts’ who just published a fad diet book, everyone seems to know exactly what we should all be eating. And, unfortunately, very few of them agree with each other.

When it comes to food, just about everyone has strong opinions, views, and diverse assertions about what constitutes healthy nutrition. Caught in the crossfire of a flurry of intense beliefs and often forceful advice, we don’t know who to trust and where to turn to when we know we need to manage our nutrition better. It’s a minefield; and if we are not careful, we can find ourselves trying a bit of this and a bit of that, chopping and changing, and never reaching our healthy living goals – whether that is to lose weight, optimise our physical activity or manage a serious condition such as diabetes.

Because nutrition affects our health in many ways, there’s just about no place more important to find that calm, clear space in the eye of the storm. And, that is where you can find a steady, consistent ally in the nutrition expert, a Registered Dietitian. These are health professionals, regulated by law, who have spent a minimum of four years studying a relevant science degree at an established university. They commit themselves to on-going professional development that keeps them abreast of scientific evolution. They are therefore, a reliable source of the latest nutrition expertise that is wholly evidence-based; and it is this that can help you cut through the noise of the fad diets, sweeping universalities and old wives’ tales when it comes to working out what eating routine would be healthy and sustainable for you at your particular life-stage.

“A common misconception is that a dietitian’s work is simply focused on helping people lose or manage their weight, comments Cath Day, Registered Dietitian and spokesperson for ADSA (Association of Dietetics in South Africa). “While weight loss is an important aspect of dietetics, the reality is that the role of the dietitian is much, much broader.” As a result, dietitians do not only work in private practice; they are also employed across governments; businesses; social, educational, healthcare and research institutions.

Day points out that professional advice from a dietitian is important at different life stages, for instance to determine healthy eating plans for the different nutrition requirements of childhood and for old age, as well as during pregnancy and breastfeeding. “Dietitians also help patients over the long-term to prevent or improve the management of disease,” she says, “It is important to have professional nutritional advice if you are dealing with conditions such as eating disorders, hypertension, gastro-intestinal disorders, pre-diabetes and diabetes, kidney failure, cardiac disease, as well as cancer and HIV/AIDS.” For women, optimal nutrition can play an important role in preventing or improving osteoporosis and polycystic ovarian syndrome. The advice of dietitians is also often sought after in a wide range of states of health from those wanting to optimize their recovery from illness or injury, to athletes and others in peak health who want to improve their performance in sports and physical activities. After all, our greatest wealth is our health.

The great advantage that a dietitian offers is that they deal with each person and their nutritional needs on a completely individual basis. “Diets and dietary supplements are marketed as if they will work for everyone,” Day says. “But in truth, we are all very different when it comes to our eating habits, food preferences, physical activity and metabolic rates, and our lifestyle choices at any given time in our lives.” A dietitian works closely with you to determine an optimal nutrition plan that takes all these variances into account so that it is easier for you to make the necessary changes and sustain them over the long term. In addition, they are an advisor and a coach providing vital support and encouragement while you are on this journey.

Did you know?

Dietitians Week, 6th to 10th June, highlights the work and worth of dietitians and the impact of the dietetic profession. To find a dietitian in your area who can assist you with your nutrition journey, visit http://www.adsa.org.za/Public/FindARegisteredDietitian.aspx

ADSA will be joining theBritish Dietetics Association (BDA) and the South African Society for Parenteral and Enteral Nutrition (SASPEN) to celebrate Dietitian’s Week. Please keep an eye on our social media channels for more information.

Facebook www.facebook.com/adsarogza | Twitter www.twitter.com/ADSA_RD | Website: http://www.adsa.org.za

Trust a Dietitian


4 NUTRITION TIPS FOR HEALTHY LIFESTYLE AWARENESS MONTH

February is Healthy Lifestyles Awareness Month and with high rates of obesity and the so-called ‘lifestyle’ diseases, such as diabetes, it’s quite clear that South Africans need to develop more awareness about making healthy eating choices. We asked four of our dietitians what South Africans should know about nutrition:

  • Let’s head for the kitchen and start cooking, invites Cath Day, RD:

“My top tip to my clients is to start cooking your own healthy meals from scratch as often as possible, using the freshest and healthiest ingredients. It’s the best way to control not only everything that goes into your meal, but also portion sizes. If you cook often at home, you have full awareness of making healthy eating choices most of the time. Cooking with fresh, healthy ingredients, making delicious meals and snacks can easily be fun rather than a chore. You can cultivate a family culture of great enjoyment at healthy eating by involving your partner, your kids, the whole family, and even, friends in preparing and sharing healthy food.”

  • Let’s limit the sugar, advises Catherine Pereira, RD:

“ADSA supports the recommendations by the World Health Organisation (WHO) that added sugar intake should be limited to no more than 5 % of total energy intake. The South African Food Based Dietary Guidelines states that ‘sugar, and foods and drinks high in sugar should be consumed sparingly’. These foods include all types of confectionery (biscuits, cakes, etc.) as well as sugar-sweetened drinks. The key to getting this right is to become far more aware of ‘hidden’ sugars. We all know that when choose to eat a packet of sweets, we’re eating too much sugar; but we’re perhaps less aware that when we order an iced tea or a glass of wine at a restaurant, these also spike our daily sugar intake beyond sensible levels. When it comes to avoiding empty calories, what we drink counts every bit as much as what we eat; and we need a far higher level of awareness of our actual daily sugar intake in order to make sure we are keeping to the guidelines.”

  • Let’s get over obsessing over restrictive or fad diets, says Kezia Kent, RD:

“Following your friends’ latest diet or the newest fad promoted on social media is not necessarily going to work for you as it may be working for others. Eating healthily should be tailored specifically for you and it should happen every day, not just over a time when you are trying to lose weight. There is always going to be a ‘latest’ diet; and chopping and changing according to fads can prevent you from developing sensible and sustainable healthy eating habits that truly suit your lifestyle and your body. Especially, avoid diets that promise you’ll lose weight quickly. Slow, steady weight loss lasts longer than quick, dramatic weight loss. If you lose weight quickly, you may lose muscle and water which increases your chances of regaining the weight. If you need to change to healthier eating or need to lose weight, get professional advice to develop a sustainable plan for you.”

  • Let’s be careful about making carbs an enemy, warns Monique dos Santos, RD:

“There’s an immense amount of attention on low carb-high fat diets right now. We’ve got to keep the perspective that there are good reasons to include carbohydrates in our diets. Obviously, you want to limit sugar and refined starches, but there are carbohydrates in many, many foods that are good for us. Our bodies rely on a combination of carbohydrates and fat for energy to fuel daily activities. Carbohydrates are the brain’s number one energy source so cutting out carbs will zap your energy levels and leave you feeling fatigued. When carbs are limited excessively, you get really, really cranky. We also need carbohydrates to build muscle (in combination with sufficient protein in the diet and training). Fibre-rich carbohydrates such as fruits, some vegetables, legumes and wholegrain starches like oats, wild rice, and whole-wheat pasta are important for gut health. Let’s not forget that many carbs are also rich in other nutrients. If you restrict fruits, vegetables, and wholegrains then you are also limiting your intake of nutrients like vitamins, minerals, and antioxidants. B-vitamins, vitamin C, beta-carotene, magnesium and other essential micro-nutrients are all found in carbohydrate-rich foods.”

Our ‘Fishcakes with Barley Salad and Lemon Drizzle’ recipe ticks all the boxes – high in fibre, packed with omega 3 fatty acids, heart healthy mono-unsaturated fatty acids, an array of vitamins and minerals and contains a great balance of protein, carbohydrate and fat; and besides that its good for the earth and tastes yummy!

 

Fishcakes2

Serves 4

FISHCAKES

Ingredients

1 x can (400 g) of mackerel (middle cut)

1/4 cup oat bran

1/2 cup grated carrot

1 free-range egg

Zest of 1 lemon

10 g chopped fresh herbs (chives, dill, parsley)

Salt & pepper

2 tablespoons avocado oil

How to make it

– drain the mackerel of any liquid, and put it into a large mixing bowl.

– using a fork, shred the fish up until it’s fine and there are no large chunks.

– add the oat bran, carrot, egg, lemon zest, and chopped herbs, and mix well. Leave the mixture to stand for a bout 30min in the fridge, so the oat bran soaks up excess liquid in the mixture.

– separate the mixture into 8 equal sized balls, and shape them into patties.

– season the fishcakes with salt & pepper.

– put a large non-stick frying pan onto a medium heat and drizzle the oil into the pan.

– once the pan is hot, add the fishcakes and fry on the first side for around 2 minutes, until golden brown. Turn them over and repeat on the other side.

BARLEY SALAD

Ingredients

1 cup cooked pearl barley, cold

40 g watercress

1/2 medium cucumber

1 avo

50 g almonds, raw & chopped

50 g mixed bean sprouts

100 g cherry tomatoes, cut in half

50 g sliced red onion

10 g basil

10 g fennel

100 g feta

Salt & pepper

How to make it

 – wash the cucumber, tomatoes, and herbs.

– using a peeler, shave the cucumber into ribbons.

– cut the avo in half, remove the skin & pip and cut the avo into chunks.

– in a large bowl, mix together the barley, cucumber ribbons, almonds, bean sprouts, tomatoes, onion, tear the fennel & basil up and add to the salad.

– assemble the salad on a platter. Spread the barley salad mixture on the bottom of the platter. Add the chunks of avo, and crumble the feta over the top of the salad. Sprinkle the watercress on top of the salad.

LEMON DRIZZLE

Ingredients

zest & juice of 1 lemon

1teaspoon smooth Dijon mustard

4 tablespoons extra virgin olive oil

1 teaspoon chopped chives

Salt & pepper

How to make it

– whisk together the lemon juice, zest & mustard.

– drizzle the olive oil into the lemon mixture whilst whisking.

– mix int he chopped chives, and season with salt & pepper.

 

Bon appetit!

To find a dietitian in your area who can assist you with a healthy eating lifestyle plan, visit www.adsa.org.za


“I enjoy helping clients design their wellness paths” – Meet dietitian, Mpho Tshukudu

Why did you become a Registered Dietitian?

My favourite childhood memories are around food. My mother constantly told me about hungry children somewhere in East Africa, and I thought I would work for the World Health Organisation and feed hungry children. When I graduated, I had been exposed to different aspects of dietetics and nutrition and the initial plan was not an option. I still dream of the coastline of Kenya.

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

I enjoy helping clients design their wellness paths. They do have some knowledge and as I guide them, they gain confidence to assess what is right for them.

Satisfying moments: when clients meet their health goals and experience how a healthier body feels, how food and self-love can enhance their life and energy levels.

What has been your career highlight?

Since I studied Functional Medicine, I have widened my understanding of the relationship between diet, lifestyle, genetics and disease processes and this has influenced my practice.

What are the most challenging aspects of your career?

Dealing with clients who do not want to take responsibility for their health, and wanting to blame someone and rely on medication.

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

I really do not have those days. It helps that I do not have a sweet tooth, and because of my allergies to nuts, gluten and soya – nothing in the stores will be permissible to sort out any need for emotional and comfort eating.

I make time to prepare and enjoy my meals. I eat whole foods and do enjoy them tremendously. Yoga is my moving meditation and it helps to clear my mind.

What are the three things that you think people should stop saying when they meet a dietitian?

“Please give me a diet “

“Do I look fat?”

“I am on this diet. Is it healthy?”

What should clients look out for when deciding which dietitian to work with?

Someone who takes into consideration your culture, lifestyle, socio-economic status, family and social life. You have to be able to relate to the dietitian, to form a trusting relationship.

What is your favourite dish and your favourite treat food?

My daily treat : honest hot chocolate (raw, organic and milk and sugar free), coconut cream and milk.

My favourite dish is whole grain sorghum risotto with mushrooms and a mature (12 or 18 months) cheese.

 

To find a Registered Dietitian in your area visit http://www.adsa.org.za/Public/FindARegisteredDietitian.aspx


Making the healthy choice is for yourself

This week we chat to Bruce Burgess, as part of the series of success stories we have and will be sharing over the next couple of months. Bruce started seeing Registered Dietitian, Alex Royal, when he was training for his second Half Iron Man and felt that he had hit a weight loss plateau:

Tell us about your journey with the dietitian?

I met Alex through mutual training partners while preparing for my second Half Iron Man. Of my own volition I had been on the Banting diet for a few months by then and had lost a few kilos, but after some time had started to feel like I was slowing down physically and I just wasn’t getting lean. One day I eventually realised how silly it was that I had been strictly following a diet that I had only read about in a single book, when I actually had access to Alex, a professional who had several years’ experience in the field, who could personally assess and guide me. In our first appointment she took the time to understand my goals, eating habits, professional and social lifestyle, and exercise regime before building a meal plan that genuinely suited me. Throughout our interactions and follow-ups she has been an absolute professional. Her input has always been realistic and honest and I knew from the outset that anything personal that we discussed in her office was going to remain confidential, which was a critical part of our success so far. I look forward to our check-ins, even when I suspect that I might not have achieved all my goals in-between, because she understands that I’m a real person and that this is a journey.

Tell us about your results?

From literally the first week on the eating plan that Alex put together for me, I started to feel more energetic throughout more of the day and could notice my body becoming more lean. I also felt more agile on my surfboard, which really put a smile on my face! At my first check in, it was clear that it was genuinely working. I was lighter, my metabolism was faster and I had reduced my body fat. Running has always been my weakest discipline, but a few weeks ago, I completed a 21km in 1h43min, which is a full 17 minutes faster than what I was expecting – and close to 45 mins faster than my personal best. My friends have noticed my results too and I have had a lot of compliments on my leaner appearance and questions about what my secret was – to which my answer has always been a sincere recommendation of Alex’s services.

What was the hardest part of the journey?

The hardest part of the journey for me has been trying to maintain my eating plan during my week-long work trips into Africa. Exactly the right food options can be quite hard to come by and mealtimes when you are on the road can be quite irregular. However, having an understanding of what I am supposed to be eating and avoiding, has meant that for the most part I’ve been able to make healthier decisions while travelling instead of just eating whatever is easiest.

What are the top three tips you can share?

Making the healthy choice is for yourself. You’re going to run into resistance from the world around you, but at the end of the day, your health needs to come first.

Don’t forget your protein shake when you travel. There’s always water around, so at least you can get something healthy in when you’re feeling hungry between irregular meals.

Just because the perfect meal isn’t available, doesn’t mean you have to go all bad. If the only thing you recognise on a menu is the burger, you can still order it with a salad or baked veg (if you’re concerned about raw foods in whatever far flung corner of the content you are) rather than eating deep fried chips.

And just because you got breakfast and lunch wrong, doesn’t mean that a healthy dinner isn’t going to make a positive difference. One or two naughty treats aren’t going to ruin your diet, but I know just how quickly a cheat day can turn into a cheat week.

A word from the dietitian

When Bruce came to see me he was training for his second Half Iron Man and was determined to get his eating habits on track. But like most people he was bombarded with weird and wonderful tips from blogs and the internet. So we kicked off by discussing all the myths and outlined a good way forward. The diet plan was aimed to suit his busy work schedule and social lifestyle while meeting his body composition goals. His overall aim was to drop body fat and gain muscle, all while eating adequate calories to tweak his athletic performance…in other words to become a machine!

I was so thrilled when I saw Bruce for his first follow-up. He was well on track and following my guidelines to the Tee. We had subtly changed his eating patterns and lifestyle and he was seeing the results. He has continued to impress and peaked his athletic performance by logging his personal best at the Knysna half marathon.

Well done Bruce!


GETTING THE FACTS RIGHT ABOUT DIABETES

Diabetes remains a major cause of death in South Africa, and the prevalence of the condition continues to rise. ‘People with diabetes have to follow a special diet or have to eat special diabetic food’ is just one of the common misconceptions surrounding diabetes. In commemoration of World Diabetes Day (14 November) ADSA (Association for Dietetics in South Africa) spokesperson and Registered Dietitian, Ria Catsicas, looks at some of these misconceptions that can result in people avoiding health testing or seeking treatment.

Ria has a special interest in the medical nutrition management of diabetes, metabolic syndrome and obesity and is the author of the book “The Complete Nutritional Solutions to Diabetes”.

#1: People with diabetes have to follow a special diet or have to eat special diabetic foods
“Actually, people with diabetes do not have to follow a ‘special’ diet. The whole family should eat healthy unprocessed foods such as fresh fruit and vegetables; whole grains; lean meats and poultry; low fat milk and dairy products; seeds, nuts, legumes and plant oils. Everyone should avoid or limit eating processed foods such as fatty red meats, processed meats, all foods made from white flour and foods with a high sugar content. Healthy eating is good for all of us as it is essential for supporting our immune systems and protecting us against disease, as well as to ensure that we have optimal energy levels throughout the day.”

#2: If I am diabetic, my food is going to be more expensive
“It is not necessary to buy expensive foods marketed to diabetics. Healthy eating can be economical, and is often cheaper than buying unhealthy treats. Buying fresh fruit and vegetables that are in season is certainly cheaper than buying processed fruit juices and soft drinks. If you eat fruits and salads as snacks and as dessert, you can save on the money you would have spent on buying biscuits, rusks, cakes, desserts, sweets and potato crisps.   Legumes, such as lentils and beans, are cheaper than red meat and high fat hard cheeses. A tasty bean curry is, for instance, a much cheaper meal than a red meat alternative.”

#3: Eating too much sugar causes diabetes
“There is truth in this statement, but it is too simplistic. Research shows that there is a correlation between the high intake of sugar-based soft drinks, energy drinks and fruit juices and the development of obesity. And, obesity, in turn, can be a significant contributing factor in the development of T 2 diabetes. However, a person’s complete diet must be taken into account. A diet that is characterized by the high intake of sugar, such as soft drinks, chocolates and sweets; as well as a high intake of refined starches, such as white or brown bread, pap, fast foods, biscuits, rusks and potato fries; while also poor in healthy foods such as fresh fruit, vegetables and whole grains, can contribute to the development of diabetes.”

#4: People with diabetes cannot eat carbohydrates
“Not all carbohydrates are unhealthy. Both the type and the amount of carbohydrate foods you eat at a meal will affect your blood glucose levels afterwards. Therefore, for optimal blood glucose control it is important to control the quantity, and be aware of the type of carbohydrates you are going to eat. Small portions of whole grains, fruit and vegetables that are evenly distributed throughout the day can contribute to optimal blood glucose control. Research has also shown that the consistency of your carbohydrate intake from day-to-day can help to optimize blood glucose control.”

#5: People with diabetes should restrict their fruit intake
“Yes, too much fruit can contribute to an increase in blood glucose levels. However, portion size is important. It is recommended that you consult your dietitian to calculate the amount of fruit that you should include in your daily diet.”

#6: People with diabetes should be on a high-fat diet
“There is no research to date which has proved that a high fat diet can contribute to either weight loss or improved blood glucose control. To lose weight, your calorie intake from both foods and drinks must be less than your energy expenditure on both voluntary and involuntary activity. The restriction of any food group, whether it is carbohydrates or fats or proteins can contribute to weight loss. To achieve successful weight loss, people with diabetes need to adhere to an eating plan that restricts their usual calorie intake. Research has shown that diets promoting extreme macronutrient manipulation, whether it is carbohydrates or fats or proteins actually lessen people’s adherence to the eating plan. It is much wiser for people with diabetes to develop sustainable healthy eating habits that can easily be incorporated into lifestyle for the long term. The best diet for a person with diabetes is a healthy eating plan that the person can adhere to. To facilitate adherence, a dietitian would take into consideration the individual’s cultural preferences; their budget constraints; their age and gender; the logistics of their daily life, such as their work circumstances or travel requirements; as well as their weight status, the medications they use and their activity levels.”

#7: There are no proven health dangers of consuming too much saturated fat
“It is well-established that a high intake of saturated fats can contribute to increased LDL cholesterol levels in some individuals. While it has not been proven is that increased LDL cholesterol levels contribute directly to cardiac events, this is because there are NUMEROUS compounding factors that would cause a heart attack. Atherosclerosis is an inflammatory condition and a high intake of saturated fats in a nutrient poor diet can aggravate inflammation. It has been proven that a high saturated fat intake in a nutrient poor diet can also contribute to decreased sensitivity of the body cells to the action of insulin.”

 #8: If I am diabetic, I should stop my medication and go onto a low-carb high-fat diet
“As a person with diabetes you should never stop your medication without your doctor’s recommendation and agreement that this is the best medical course for you. It has been established that when diabetes is diagnosed most individuals would have already lost 50% of the insulin-producing capacity of the Beta cells in the pancreas. Therefore, the optimal way to manage diabetes is to follow a healthy diet; to lose weight if overweight; to engage in physical activity, such as walking three to five times a week for 40 to 60 minutes at a time; and, to take appropriate medication on your doctor’s advice.”

#9: If one of my parents has diabetes, there is nothing I can do about it – I will develop diabetes eventually
“If you have a genetic predisposition to diabetes, you have all the reason you need to embrace a healthy lifestyle. While genetics may only contribute 30 to 40% to the development of any condition, including diabetes, environmental and lifestyle factors may have a 60 to 70% impact. If you maintain a healthy body weight, stick to a healthy eating plan, manage your stress and get regular physical exercises, you have a very good chance of not developing diabetes.”

#10: If I have diabetes, I can’t exercise
“This is not true at all. Diabetes is a compelling reason to exercise regularly as physical activity plays a very important role in lowering blood glucose levels. Exercise also predisposes your body cells to being more sensitive to insulin, and of course, it helps to achieve and maintain a healthy body weight. If you use insulin it is important to check your blood glucose levels before and after physical activity. If you get results below 6 m mol/l it is recommended that you lower your insulin dose or eat a healthy snack to prevent a hypoglycemic attack during or after exercise.”
To find a dietitian in your area who can assist you with personalised nutrition advice, visit www.adsa.org.za


Veggie Burger

We love this veggie burger recipe. The lettuce leaf is a perfect low kilojoule & low carb ‘roll’! The burger includes sweet potato, butternut, almonds and lentils! Our dietitians say… Sweet potato is a low GI alternative to regular potato with a high soluble fibre & vitamin A content. Lentils contain a combination of protein, carbs, fibre, minerals, folate & vitamin B. Legumes’ low glycaemic index keeps you full for longer!

Avo is a low sugar fruit & high in healthy mono-unsaturated fat. It’s a power house of vitamins & minerals like folate, potassium & lutein (good for eyesight).

RECIPE

Makes 6 burgers

Ingredients

350g butternut cubes

350g sweet potato cubes

150g lentils, cooked

2ml ground cinnamon

2ml ground nutmeg

30ml extra virgin olive oil

Salt & pepper

1/2 cup ground almonds

1 whole ice berg lettuce

How to make it

  • Preheat the oven to 180°C.
  • Add butternut, sweet potato & oil in a roasting tray.
  • Sprinkle cinnamon, nutmeg, salt & pepper.
  • Roast in the oven for 30min, until soft.
  • Leave buternut & sweet potato to cool.
  • Mix lentils, veg & half the almonds in a bowl.
  • Mash the mixture together until even.
  • Taste and add more seasoning if necessary.
  • Split the mixture into 6 evenly sized balls.
  • Shape into burger patties & coat in the remaining almonds.
  • Drizzle oil into a non-stick frying pan on medium heat.
  • Fry the paties for 1min on each side until golden brown.
  • Put your burger paty on the middle of a whole ice berg leaf. Wrap your burger up in a letuce leaf & serve.

TIP: Add favourite burger toppings like guacamole, salsa & fresh sprouts

For more amazing recipes scroll through the blog or visit: http://www.adsa.org.za/Public/Recipes.aspx


“I made a complete lifestyle change” – Glenise’s Story

We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved. This week we chat to Glenise Valentyn, who started seeing Registered Dietitian Retha Mostert after she struggled to fall pregnant and was diagnosed with insulin resistance. Here is her story ….

Why did you decide to see a dietitian? (the before story)

When I visited a gynaecologist, because I was struggling to fall pregnant, he did some tests and I was diagnosed with insulin resistance. He explained the dangers involved for the baby and me, should I fall pregnant and advised me to immediately start with a healthy lifestyle. I decided to see a dietitian.

Tell us about your journey with the dietitian?

I made my first appointment with Registered Dietitian Retha Mostert soon after I saw the gynaecologist. She worked out very easy meal plans (not diet plans) for me. All the ingredients were readily available at our supermarket. I could prepare food that my whole family enjoyed. She taught me how to make the right choices when making decisions on what to eat. I was very comfortable with her. A little bit later I found out that I was pregnant. I visited Retha throughout my whole pregnancy, looking forward to my bi-monthly visits with her.

Tell us about your results / successes?

I could feel a difference in myself right after I started to see Retha. I had much more energy. I only gained a total of 5kg throughout my whole pregnancy. Most of it was only in the last weeks. The gynaecologist was very worried at first that I wasn’t gaining weight, but she checked the baby’s progress and growth and was happy. I was tested for insulin resistance during my pregnancy and there was no sign of it. I gave birth to a normal baby daughter of 2.89kg. My weight after the birth of my baby was less than before I fell pregnant. Seeing Retha helped me make a complete lifestyle change.

What was the hardest part of the journey?

The hardest part was to resist pregnancy cravings. I always had to remind myself of the consequences of eating the wrong foods.

What are the top three tips you can share?

  1. Believe in yourself
  2. Trust your dietitian
  3. Always plan ahead and put your plans in writing

What the dietitian says (a few words from Retha Mostert)

Throughout her pregnancy Glenise was so motivated. Her sugar levels were showing warning signs before the pregnancy and by making smart food choices she kept them under control throughout her pregnancy. She proved that its not necessary to ‘eat for two’ when you are pregnant. Even when she went for her regular check-ups with her gynaecologist, he couldn’t believe that she herself was not gaining a lot of weight, but sonars confirmed that her baby was growing the way she should. At 38 weeks Glenise had a healthy baby girl! What better reward can there be?

To find a Registered Dietitian in your area, please visit: www.adsa.org.za


LET’S TALK ABOUT ‘HEALTHY EATING IN THE WORKPLACE’

What we eat at our place of work has a huge impact on our overall diet and influences our productivity. The prevalence of overweight and obesity combined is now 65% for females and 31% for males (2012 South African Health and Nutrition Examination Survey – SANHANES) and unhealthy workplace eating behaviour is believed to be playing a role in South Africa’s growing obesity problem.

The Association for Dietetics in South Africa (ADSA) has partnered with National Nutrition Week since the late 1990s to highlight important nutrition messages to South Africans. “In line with our continued efforts to support South Africans in living healthier lifestyles and to promote dietitians as the go-to experts for nutrition advice, the issues around healthy eating in the workplace are close to our hearts and something our dietitians deal with on a daily basis”, says ADSA President, Maryke Gallagher.

Employees consume at least half of their meals and snacks during work hours, making this an important place to promote healthy eating. Registered Dietitian, Alex Royal, says that healthy eating at work can be a challenge as there are often too many temptations: the vending machine, the sweets trolley, colleagues who have bad habits that influence others. “During a busy day we don’t have time (or forget) to prepare healthy meals or even forget to eat. So blood glucose levels drop, resulting in an energy dip and potentially cravings, especially for highly processed and sugary foods. This fuels the cycle of unhealthy eating at work”, Royal concludes.

The question is what can employers do to create a healthier food environment at work? Suggestions include changing meal options available at work to be in line with the guidelines for healthy eating, offering a variety of foods, controlling portion sizes, overhauling vending machines and kiosks to include healthy snack options, offering drinks that are not sugar-laden and changing the menu of food provided during meetings. Cath Day, Registered Dietitian and ADSA spokesperson, also offers some tips for employees:

  • Before grabbing a snack, first ask yourself if you are really hungry or if you rather need to take a break from what you are doing. Going for a short walk or getting some fresh air – may be all you need.
  • Don’t skip meals or healthy snacking between meals. Skipping meals and snacks results in dips in blood glucose (sugar) levels and thus you will be more likely to crave unhealthy foods.

We often talk about school lunchboxes, but what about work lunchboxes? These go a long way in giving employees more control over what they eat during the day. According to Registered Dietitian Kelly Schreuder the goals of a healthy work lunchbox include: Variety and balance of foods, providing a variety of nutrients, including protein, carbohydrates, fat and micronutrients. Real food, as opposed to processed snacks and those that are high in added sugar, excess salt and poor quality fat, and portion control.

And what about fluids – what should we be drinking while we are at work? “The simple answer is that water should be the main beverage we are drinking while working but there are many other healthy options to choose from as well. People often forget that beverages can contain a large amount of energy (and many beverages contain too much sugar such as sugar sweetened beverages and fruit juice) so we need to be more mindful about what we are drinking”, say ADSA spokesperson Catherine Pereira.

Being active in the workplace is also important and employees should try to be as physically active as possible. Durban-based dietitian, Hlanzeka Mpanza says that it is not impossible to include some physical exercise in the workday. Use the steps instead of the lift; form an exercise club with colleagues and try to fit in a 15 minute walk during the lunch hour; wear a pedometer during the day to keep track of activity levels and as a motivator; and stretch your legs by walking over to your colleagues’ desk instead of sending them an email.

What we eat affects our mood, how alert we are and our overall productivity. We asked dietitian Maryke Bronkhorst why food influences us in this way. “Some foods contain nutrients that are used to manufacture certain brain chemicals that may enhance mental tasks like memory, concentration, and reaction time.   Protein foods enhance the brain’s production of dopamine, a natural brain chemical that helps one to feel alert. Large quantities of carbohydrates, on the other hand, result in the production of serotonin, a natural brain chemical that can cause drowsiness, but glucose in the bloodstream is the brain’s main source of energy. So it’s important that you eat at regular intervals and choose low glycaemic index options to prevent your blood sugar levels from dropping too low”, says Bronkhorst. Lean biltong, a small handful nuts, a piece of fresh fruit e.g. blueberries, vegetable crudités with a dip like hummus and plain yoghurt flavoured with handful of berries are great ‘go-to’ snacks.

On Tuesday, 13th October ADSA (@ADSA_RD) is hosting a #WorkplaceNutrition twitter talk from 1pm to 2pm. The talk will focus on healthy eating and healthy living in the workplace providing employees with tips, ideas and advice about achieving a better nutrition balance during work hours. Dietitians and National Nutrition Week partners will be answering questions such as:

  • What are challenges employees face with healthy eating at work?
  • What can employees or workplace do to improve healthy eating during the workday?
  • What should be included in a work lunchbox?
  • What should we be drinking while we are working?
  • How do we stay active while working?
  • What are the go-to snacks that give energy needed to work well?

Join the conversation live on Twitter, follow the @ADSA_RD handle or track the hashtag #WorkplaceNutrition to get some great ideas and tips on how to eat healthily at work.


Raising Superheroes – Book Review*

In the newly released book, “Raising Superheroes”, Prof Tim Noakes, Jonno Proudfoot and Bridget Surtees advocate for what could be considered broadly as a healthy, balanced diet for infants and children. Fresh and real foods are promoted, which include red meat, chicken, fish, eggs; full cream dairy; vegetables and fruit; and grains such as quinoa, oats and millet. The ‘golden rules’ of “Raising Superheroes” echo principles stated in dietary guidelines generally advocated, such as “steering clear from added sugar and highly processed starchy foods”. The book showcases recipes that include fresh ingredients and the healthier version to some old time classics. It is not a “Banting” for children book, as what might have been expected, although the book has similar branding to the “Real Meal Revolution” and uses many of the same arguments.

The revised South African (SA) paediatric food-based dietary guidelines (SA-PFBDGs) are cited (Reference 36) in the book, however, reference is also made to “national guidelines” which include other country’s guidelines (e.g. UK, USA, Canada). It is therefore not always clear which guidelines are referred to, causing confusion about statements made in the book concerning dietary guidelines in general. In reference to the SA-PFBDGs specifically, it is stated that the guidelines are “still to be tested”. It should be noted that the proposed SA-PFBDGs will be field-tested for understanding and feasibility before they can be accepted as the official infant and young child feeding (IYCF) guidelines for the country. This process is currently underway with studies being conducted by Stellenbosch University researchers in collaboration with other academics. The statement that the promotion of these guidelines has not reversed the epidemic of obesity and diabetes (p318) is therefore unsubstantiated. It is important to note that the “Raising Superheroes dietary guidelines” proposed from page 319 has not been tested in rigorous research for understanding and feasibility in the SA context and population, which is considered a major shortfall of these proposed guidelines.

Some information and advice provided in the introduction to the different chapters are based on current best practice and international guidelines; while some information and advice is considered lacking a solid evidence base and posing potential harm. In the chapter covering pregnancy to 6 months period, it is stated on page 34 that “we don’t necessarily advise that pregnant or breastfeeding women should be following a fully ketogenic Banting diet. In other words, we’re not recommending that you exclude carbohydrates from your daily intake to such a degree that your body’s energy source switches completely from glucose to ketone bodies. (The scientific evidence on a fully ketogenic diet during pregnancy is insufficient to make definitive calls, though we suspect it would be perfectly fine.)”. It is not responsible to state “we suspect it would be perfectly fine” when providing advice, especially during vulnerable periods, such as during pregnancy. In fact, ketogenic diets during pregnancy have been linked to amniotic fluid insufficiency, bone mineral loss and calcium excretion, putting both mother and baby at risk of complications and/or deficiencies. The arguments of a ketogenic diet during pregnancy and the benefits of ketones for infant brain growth are taken further in the last chapter. A statement is made that “A key benefit of breastfeeding is that it maintains a state of ketosis in the newborn baby for as longs as it continues”. This blanket statement is not evidence-based and is made out of context when considered against the reference cited.

Furthermore, the advice provided in the section on foods to avoid during pregnancy, states that mothers should “Watch out for – Alcohol.” Furthermore, “the safest option is to abstain from drinking, though recent research appears to show that a very limited intake is fine.” No guide is provided to indicate what is meant with a “very limited intake” of alcohol. The one reference cited was written in the context specific to the United Kingdom and can therefore not be extrapolated to SA. Moreover, this advice is contradictory to what is advocated in SA by various authorities, including Department of Health. To refer very casually and jokingly to drinking during pregnancy as “not getting drunk” (page 39) is an irresponsible and insensitive statement in a country such as SA with the highest prevalence of Foetal Alcohol Spectrum (FAS) disorder in the world.

The guideline on breastfeeding rightly states that “breastfeeding is the gold standard of nutrition for your child, and it comes with a range of health benefits, as we cover elsewhere”. The benefits of exclusive and continued breastfeeding are reiterated, in summary, in the book. However, the actual detail provided on breastfeeding in the mentioned chapter, states that “From a purely nutritional point of view, you should be aiming to exclusively breastfeed until 4-6 months, and continue breastfeeding in combination with solid foods for longer – until two years, at least.” The guideline advocated by the World Health Organisation and which has been adopted by the SA Department of Health (DOH) states very clearly: “As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” The guideline on 4-6 months of exclusive breastfeeding is outdated and confusing in the SA context where the 6-month message is being strongly promoted. In a country where very poor breastfeeding practices are evident, especially in as far as the exclusivity is concerned, it is unacceptable and irresponsible to state this outdated recommendation. There is good evidence as to why exclusive breastfeeding for 0-6 months should be promoted, protected and supported and why the 4-6 month guideline should not be advocated as a broad public health message.

Furthermore, poor breastfeeding practices have a knock-on effect which leads to poor complementary feeding practices. The battle is therefore lost if a sound foundation of appropriate breastfeeding practices is not established. This fact is not emphasised sufficiently in the “Raising Superheroes” book. In the detailed section on breastfeeding, breastfeeding is described in negative words and language (including: first biggest challenge; intimidating; many experience a plethora of problems; common problems; for many women breastfeeding is difficult and can be extremely disheartening; hurdles; painful; incorrect; problem; insufficient), and this does not encourage breastfeeding as the most natural and healthful first food for infants and young children.

The paragraph to end the breastfeeding section disappointingly states: “But if you’ve done everything you can to breastfeed and it’s just not working, or if your lifestyle prevents you from breastfeeding for as long as you ideally might, then take heart; there are alternatives.” The need for strengthening the Mother Baby Friendly Initiative; breastfeeding friendly communities; maternity benefits; breastfeeding policies in the workplace which supports mothers to continue breastfeeding and/or express breastmilk; are not mentioned. Instead, what follows is a jump from the most healthful first food (breastmilk and breastfeeding) to an ultra-processed product (UPP) i.e. formula milk which is described as “practical and viable” and suggested as an alternative to breastfeeding. This is in stark contrast to statements elsewhere in the book that warn against “ultra-processed products” and promote real food. Formula milk should not be seen as an alternative to breastfeeding/breastmilk; it can only be considered a substitute if a mother chooses to formula feed.

In the ‘Science’ section at the end of the book, the following remarks are made: “Breastfeeding is nutritionally superior to formula feeding, a point that may not be sufficiently stressed in major feeding guidelines” (pg. 319) and “They [current national feeding guidelines] fail to stress the importance of continuing breastfeeding beyond six months” (Pg 344). These statements are inaccurate within the South African context. The SA paediatric food-based dietary guideline (Reference 36) for complementary feeding contains as its first message: ‘From six months of age, start giving your baby small amounts of complementary foods, while continuing to breastfeed for up to two years and beyond’ as does the first paper in the series. Furthermore, the SA DOH’s Infant and Young Child Feeding Policy (2013) states as a key component ‘continued breastfeeding for two years and beyond’, a recommendation provided in many other national policies.

The ‘Raising Superheroes’ book refers to complementary foods (or the introduction of solids) as “weaning” throughout the book. This is an outdated term, which implies and is interpreted as the cessation of breastfeeding. The term is therefore not used in the literature globally, when optimal infant and young child feeding is discussed. The authors clearly criticise the use of baby cereals or grains for children when complementary foods are introduced. It needs to be acknowledged that South Africa is a country with high levels of household food insecurity. Often, families cannot afford or access animal protein and vegetables or fruit daily. In such situations, grains such as oats and millet, appropriately fortified staples, such as maize and brown bread, and commercially produced enriched complementary foods, such as infant cereals, may provide cost-effective food options.

In the chapter for 1-3 years of age, nothing is mentioned about the continuation of breastfeeding up to two years of age and beyond, although it is mentioned in the last chapter. The importance of continued breastfeeding during the introduction of complementary foods is also omitted. The protective effect of breastfeeding against food allergies, in particular is not mentioned. It is also not explained that food allergies are related to certain proteins in foods (e.g. protein in cow’s milk, fish, peanuts, egg white, soy and gluten) and that elimination diets (including the elimination of carbohydrates) are not routinely recommended for infants and young children, as they can negatively affect a child’s growth.

Furthermore, it is not appropriate to introduce a culture of ‘dieting’ or being placed on a diet in childhood. Fostering a healthy relationship with food during childhood is important, and balance, variety and moderation are important components that contribute to this relationship. In addition, many families in South Africa would struggle to sustain the recommendations made in this book, from a practical and cost point of view.

Several sections of the ‘Science’ chapter of the book are written from the point of view of the authors and, in particular, Prof Tim Noakes’ personal opinion and experience. Expert opinion and personal experience can be valuable when backed up by a solid evidence base and tested in rigorous research. In the case of this book, however, Prof Noakes often expresses his own views and opinions in a colloquial way and makes statements that have not been tested.

To summarize, this book provides many ideas for parents to incorporate fresh ingredients, an array of vegetables and fruit, incorporate various protein rich foods; and to cut down on sugar (with some clever party food ideas). Drawbacks of this book include conflicting messages about the inclusion of certain foods, e.g. whole grains and legumes or ‘unrefined carbohydrates’ are stated as being acceptable, but rarely used in recipes; the use of ‘fresh’ and ‘real’ food are often referred to while numerous recipes include high salt ‘processed’ and ‘cured’ meat such as bacon and ham. Furthermore, even though the evidence-based guidelines refer to grains and legumes as being acceptable, very few recipes include these ingredients. Although vegetables and fruit are recommended, the authors state that “The message of five or more vegetables a day has been overplayed by official guidelines” which is inaccurate. There is substantial evidence to support the recommendation of five-a-day and recent research suggests that it may not be enough.

In general, the target market of the book is vague. It is mentioned that a real meal revolution was started in SA and the intention is to take it to the rest of the world. The last statement in the book reads: “In summary, if the parents of newborn and young South Africans were all to follow the advice in this book we would revolutionise the long-term health of all South Africans. And that continues to be the goal of our eating revolution.” The stated aims of the “Real meal revolution” and “Raising Superheroes” point to a broad public health approach. However, the guidelines and advice, as well as recipes provided do not take into consideration the public health problems and issues of SA, and specifically those related to infant and young child nutrition. Culture, availability of foods and income are factors which should be taken into consideration when formulating broad guidelines intended for a population. Cost of food, in particular is considered a major barrier to following dietary advice. The advice and recipes in the book are clearly not targeted at the average South African, but rather the higher income market, which does not align with a public health approach. There appears to be a constant conflict between these approaches (individual VS population) in the book, which raise many unanswered questions from a public health nutrition perspective.

*This review was compiled by Lisanne du Plessis, with inputs from Catherine Day, Maryke Gallagher, Catherine Pereira, Sasha Watkins and Marlene Ellmer (Registered Dietitians and ADSA spokespeople).

References:

Department of Health. Infant and young child feeding policy. Pretoria: Department of Health; 2013.

Department of Health. Regulation R991: Regulations relating to foodstuffs for infants and young children. Pretoria: Government Gazette (Department of Health); 2012.

Department of Health. Roadmap for nutrition in South Africa for 2012-2016. Pretoria: Department of Health; 2012.

Department of Health. Strategic plan for maternal, newborn, child and women’s health and nutrition in South Africa, 2012-2016. Department of Health [homepage on the Internet]. 2012. Available from: http://www.doh.gov.za/docs/stratdocs/2012/MNCWHstratplan.pdf

Department of Health. Framework for accelerating community-based maternal, neonatal, child and women’s health and nutrition interventions. National Department of Health [homepage on the Internet]. 2012. Available from: http://www.cindi.org.za/files/eNews/enews24/Framework_Final.pdf

Department of Health. The Tshwane declaration of support for breastfeeding in South Africa. S Afr J Clin Nutr. 2011;24(4):214.

Department of Health. Landscape analysis on countries’ readiness to accelerate action to reduce maternal and child undernutrition: nationwide country assessment in South Africa. Pretoria: Department of Health; 2010.

Department of Health. Infant and young child feeding policy. Department of Health [homepage on the Internet]. 2007. c2012. Available from: URL: http://www.doh.gov.za/docs/policy/infantfeed.pdf

Du Plessis LM & Pereira C. Commitment and capacity for the support of breastfeeding in South Africa. S Afr J Clin Nutr 2013:3, S120-S128.

Du Plessis LM, Kruger HS, Sweet L. Complementary feeding: a critical window of opportunity from six months onwards. S Afr J Clin Nutr 2013:3, S129-S140.

Fisher JO & Birth LL. Restricting Access to Foods and Children’s Eating. Appetite 1999: 32: 405-419

Heinig MJ, Dobme K. Weighing the Risks: the Use of Low-Carbohydrate Diets During Lactation. J Hum Lact 2004:20, 283

Jacobs L & Steyn NP. If you drink alcohol, drink sensibly.” Is this guideline still appropriate? S Afr J Clin Nutr 2013:3, S114-S119.

May P, Hamrick KJ, Corbina KD, Haskena JM, Maraisd AS, Brookee LE, Blankenship J, Hoymef HE, Phillip J. Dietary intake, nutrition, and fetal alcohol spectrum disorders in the Western Cape Province of South Africa. Reproductive Toxicology 2014: 46, 31-39

Meyer R, De Koker C, Dziubak R, Venter C, Dominguez-Ortega G, Cutts R, Yerlett N, Skrapak AK, Fox AT, Shah N. Malnutrition in children with food allergies in the UK. Journal of Human Nutrition and Dietetics 2013, 27: 227-235

Onyeije CI, Divon MY. The impact of maternal ketonuria on foetal test results in the setting of post term pregnancy. Am J Obstet Gynecol. 2001:184(4):713-8

United Nations. Global strategy for women’s and children’s health. United Nations [homepage on the Internet]. 2010. C2012. Available from: http://www.who.int/pmnch/topics/maternal/201009_globalstrategy_wch/en/index.html

The United Nations Children’s Fund. Programming guide: infant and young child feeding. UNICEF [homepage on the Internet]. 2011. Available from: http://www.unicef.org/nutrition/files/Final_IYCF_programming_guide_2011.pdf

The United Nations Children’s Fund/World Health Organization. Baby-Friendly Hospital Initiative, revised, updated and expanded for integrated care. Section 1: Background and implementation. New York: UNICEF; 2009.

World Health Organization. Global strategy for infant and young child feeding. World Health Organization [homepage on the Internet]. 2003. c2013. Available from: http://whqlibdoc.who.int/publications/2003/9241562218.pdf

World Health Organization. Guidelines on HIV and infant feeding: principles and recommendations for infant feeding in the context of HIV and a summary of evidence. WHO [homepage on the Internet]. 2010. c2012. Available from: http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf

World Health Organization. International code of marketing of breastmilk substitutes. Frequently asked questions. WHO [homepage on the Internet]. 2006. c2012. Available from: http://whqlibdoc.who.int/publications/2008/9789241594295_eng.pdf

World Health Organization. Infant and young child feeding. Model Chapter for textbooks for medical students and allied health professionals. Geneva: WHO; 2009.

World Health Organization. Baby and young child nutrition. Geneva: WHO; 2009.

World Health Organisation. Guiding principles for complementary feeding of the breastfed child. Geneva: WHO; 2003.


Creamy Broccoli & Barley Soup

Our latest NutritionConfidence recipe is all about the super vegetable BROCCOLI. Part of the cruciferous vegetable family, broccoli has cancer-fighting power and may even help to improve memory. Together with a ‘made at home’ seed loaf this is a perfect family meal. 

WE LOVE IT!

If you could choose only one vegetable to remain after drought or famine, it would be a good idea to choose broccoli!

OUR DIETITIANS SAY….

Broccoli belongs to the cruciferous vegetable family (including kale, cauliflower, brussel sprouts, bok choy, cabbage, collard greens, rutabaga and turnips). They have a high nutrient density, which means that they are packed with vitamins (Vitamin A, C, K, Folate), minerals (potassium) and phytonutrients.

Eating a high amount of cruciferous vegetables has been associated with a lower risk of lung and colon cancer. Studies have suggested that sulforaphane, the sulfur-containing compound that gives cruciferous vegetables their bitter taste, is also what gives them their cancer-fighting power.

SOUP INGREDIENTS

300 g broccoli florets

15 ml olive oil

1 medium onion, peeled & chopped

100 ml water

100 ml reduced fat cream

1 sprig fresh thyme

5 g fresh parsley

1/2 cup cooked pearl barley

30 ml plain yoghurt for garnish

METHOD

  • Put the olive oil, thyme and onions into a medium pot on a medium heat.
  • Sweat the onions until soft and translucent. Add the broccoli, cream and water and put a lid on the pot.
  • Cook for 5min until the broccoli is soft.
  • Add the parsley, and remove from the heat.
  • Blend in small batches until smooth. Do not over fill the blender or it will come out the side of the blender!
  • Remove the soup from the blender back into the pot and season with salt and pepper.
  • Add the cooked barley and heat the soup. Serve with a dollop of yoghurt to garnish and fresh chopped herbs.

Serves 2 as a main or 4 as a starter.

Broccoli Soup (serves 2) – per serving:


Energy: 1050 kJ

Protein: 9.2 g

Carbohydrate 17.4 g

Total Fat: 13.2 g

Fibre: 8.4 g

Sodium: 62.5 mg

SEED BREAD INGREDIENTS (10 slices)

300 g stone ground bread flour

150 g stone ground whole wheat flour

5 g salt

20 g poppy seeds

30 g pumpkin seeds

20 g sesame seeds

20 g flax seeds

20 g sunflower seeds

25 g digestive bran

40 g rolled oats

1 sachet dried instant yeast

425 g water (lukewarm)

METHOD

  • Preheat the oven to 180 deg C.
  • In a large bowl, mix together the dry ingredients.
  • Make a well in the centre of the dry ingredients and add the lukewarm water.
  • Mix the dry ingredients into the water until all the ingredients are combined into a soft dough.
  • Grease a non-stick loaf pan and dust it with a little flour.
  • Pour the batter into the loaf pan and top with a few oat grains to decorate.
  • Put the loaf in a warm place to prove (rise) until nearly doubled in size.
  • Once your loaf has sufficiently risen, bake in the oven for 30-40min until deep brown and crusty.
  • Remove the loaf from the bread tin and place it in a wire rack to cool.

Bread, per slice (x10 slices per bread)

Energy: 984 kJ

Protein: 8 g

Carbohydrate: 37 g

Of which total sugars: 0.5 g

Total Fat: 5.4 g

Fibre: 6.3 g

Sodium: 199.2 mg

To download the recipe card, please visit: www.adsa.org.za/Public/Recipes.aspx


Breastfeeding and Work – Let’s Make it Work!

ADSA_Breastfeeding Logo_30July15

Every year, World Breastfeeding Week is celebrated from 1-7 August and this year’s theme is ‘Breastfeeding and Work – Let’s make it work!’.

Optimal infant and young child feeding is defined by the World Health Organisation as ‘exclusive breastfeeding from birth for the first six months of life and starting from six months of age, feeding safe and appropriate complementary foods, along with continued breastfeeding for up to two years of age or beyond’

South Africa’s paediatric food-based dietary guidelines state ‘Give only breast milk, and no other foods or liquids, to your baby for the first six months of life’.

“Women from all communities need to be supported to continue to breastfeed when they return to work, and everyone should work together to ensure that breastfeeding mothers receive the support they need”, says ADSA spokesperson, Catherine Pereira. Most women do not receive adequate maternity protection and returning to work is often a barrier to breastfeeding because a mother becomes separated from her baby for long periods of time. Many mothers struggle to balance breastfeeding and paid work, therefore stopping breastfeeding earlier than they should.

Did you know?

  • Breastfeeding mothers in South Africa are protected by the Basic Conditions of Employment Act and are legally entitled to two 30-minute breaks per day for breastfeeding or expressing milk if their infants are younger than 6-months!
  • The Act also states that an employee is legally entitled to at least four consecutive months maternity leave, during which time breastfeeding can be established at home.
  • In 2011, the Tshwane Declaration of Support for Breastfeeding in South Africa was signed by the Minister of Health and many other stakeholders. This stated that “the promotion, protection and support of breastfeeding requires commitment and action from all stakeholders, including government and legislators, community leaders, traditional leaders and healers, civil society, HCWs and managers, researchers, the private sector, employers, the women’s sector, the media and every citizen”.

How can we ensure that the workplace is breastfeeding- and mother-friendly?

  • Have a breastfeeding-friendly room, corner or space in your workplace where mothers can breastfeed their babies or express milk.
  • Ensure that there are refrigeration facilities for mothers to store breast milk if they are expressing.
  • Support part-time work arrangements for breastfeeding staff.
  • Make sure that your employees or employers know the legal rights of breastfeeding women.
  • Show a positive attitude towards friends and colleagues that are breastfeeding mothers.
  • If you are a woman who managed to breastfeed when you went back to work, share your experiences as inspiration for other women.
  • Fathers and partners should read up on breastfeeding and how they can support women.
  • Breastfeeding women should form or join support groups, such as La Leche League or contact a lactation consultant.
  • Listen to women’s needs and respect a woman’s decision on infant feeding and offer support for her choice without prejudice.

Do you know why breastfeeding is so important for your baby?

  • Give your baby only breast milk for the first six months; no other food or drink is needed at this age. If a baby is given other food and drink, they will consume less breast milk and receive less nutrition.
  • Babies are protected against infection when they are breastfed. In addition to containing all of the nutrients your baby needs for the first six months, breast milk also contains antibodies that help to protect your baby against illness.

Did you know that a dietitian can assist you with breastfeeding? 

Dietitians are trained to assist mothers with breastfeeding as well as to assist mothers with continued breastfeeding when returning to work. Click here to find a Registered Dietitian in your area visit the Association for Dietetics in South Africa’s website.

For information and resources on WBW 2015, including posters, infographics and other documents from around the world, visit www.worldbreastfeedingweek.org


“Improving health through diet therapy” – Meet registered dietitian Astrid Wichmann

This week we chat to Astrid Wichmann, Chief Dietitian at Inkosi Albert Luthuli Hospital in Durban.

Astrid completed her BSc Degree in Dietetics at the University of Stellenbosch, followed by one year community service in Barberton. She stayed in the public sector and her interests are mainly in the field of clinical dietetics. To date Astrid has one publication, one husband and one child.

Why did you become a Registered Dietitian?

My plan was to trek up Africa in an old Land Rover and help all the Kwashies. The outcome – I’m based in a clinical setting where I play a role in rehabilitating individuals, with all types of ailments, through nutrition therapy.

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

Enjoy most: Playing a role in enhancing recovery of patients and improving health through diet therapy.

Most satisfying: Seeing the twinkle in patient’s eyes when they grasp a concept and are eager to learn more. Seeing a child grow well after diet therapy has been implemented.

What has been your career highlight?

Being given the opportunity to work in a flagship tertiary and quaternary hospital.

What are the most challenging aspects of your career?

  • Helping individuals attain a goal with limited resources in their poverty stricken setting.
  • Eloquently defending fact against sensationalistic fiction.

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

By not going on a diet! (Or should I rather say: I do not see it as a disaster and recover by aiming for optimal nutrition)

What are the three things that you think people should stop saying when they meet a dietitian?

  • Oh!….I need to speak to you about a diet, I need to lose weight!
  • Don’t look at what I’m eating.
  • You are not supposed to eat that if you’re a dietitian.

What should clients look out for when deciding which dietitian to work with?

Look out for the field of interest the practitioner has and what client base he/she mainly serves. Generally you are likely to benefit more by seeing someone who specialises in the area you need assistance with, than someone who does not have much exposure to such cases e.g. allergies/diabetes/paediatrics/kidney diseases/ infertility etc.

What is your favourite dish and your favourite treat food?

My “last supper” would be: moms roast chicken & potatoes with a mixed salad.

Treat food: ice-cream that contains icicles.


Work highlight – “Being able to witness how positively nutrition changes affect clients’ every day lives!” – Meet The Dietitian

As part of our ‘Meet the Dietitian’ series, we chatted to Lila Bruk about why she became registered dietitian, what she loves about her work, how she copes after a day of nutrition disaster and bad eating choices, and what people should look out for when choosing a dietitian.

Meet Lila Bruk a registered dietitian (RD) in private practice (Lila Bruk & Associates)

Why did you become a registered dietitian?

I have always been passionate about health, but I was particularly interested in the nutrition side and liked how dietetics allowed for creativity as well as interaction with people.

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

I love meeting new people, guiding them on their journeys and seeing them achieve their goals along the way. Without a doubt, the most satisfying moments are when people start to feel a significant difference in their health, energy and wellbeing and being able to witness how positively these changes affect their every day lives.

What has been your career highlight?

There have been so many, so it’s hard to pick, but I would have to say being involved with many high-profile projects and companies is definitely a highlight. Having said that, every day is filled with highlights and seeing my clients’ progress and being there when they achieve their goals is always so rewarding.

What are the most challenging aspects of your career?

This would definitely be managing the different sources of misguided nutrition information out there. Unfortunately the public gets so many conflicting nutrition messages from so many different sources that it can lead to them being extremely confused. This is especially difficult when the source of the nutrition information is seemingly reputable websites, health professionals, celebrities or other media. A lot of my time is then taken up trying to debunk many of the myths and misconceptions that these sources have put forward.

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

I think the best thing is to try to get back on track as soon as possible. Trying to cut out food from the next day will only backfire and you will land up overeating at a later stage. Getting back on your plan is the best strategy.

What are the three things that you think people should stop saying when they meet a dietitian?

  • “Do you eat like this?” – dietitians are people too. Sometimes we have good days and sometimes bad, but ultimately most of the time we do our best and make good choices.
  • “I don’t like the taste of healthy food” – healthy eating is not all about boiled chicken and steamed broccoli! Healthy food can also be delicious, vibrant, tasty and exciting. It’s all about preparing it right.
  • “I hate exercise” – being more active is all about finding something you enjoy. If you hate running and love dancing, then by all means do the dancing!

What should clients look out for when deciding which dietitian to work with?

Try to find out whether the dietitian has dealt with similar situations to yours, but also see how you feel about them, whether they inspire confidence and whether they have a good reputation and the right qualifications.

What is your favourite dish and your favourite treat food?

My favourite dish is grilled teriyaki salmon with steamed veggies. My favourite treat would be frozen yoghurt or liquorice 🙂

Lila Bruk is a registered dietitian and nutritional consultant in private practice in Illovo, Johannesburg. 

She graduated from UCT with a Bachelor of Science degree in Microbiology and Biochemistry in 2002, followed by a Bachelor of Science Medical (Honours) degree in Nutrition and Dietetics in 2004 also from UCT. In 2010 she completed a Masters in Nutritional Sciences through the University of Stellenbosch in the fields of body image in pre-adolescent girls, digestive disorders (e.g. IBS), sports nutrition and food allergies.

Lila is passionate about promoting health and good nutrition and thus has written for various general and health-related publications such as O Magazine, FairLady, COSMOPOLITAN, Women’s Health, Men’s Health and Longevity. She also gives regular lectures on nutrition-related topics around the country, and appears regularly on television and radio. 

Her main areas of interest include nutritional management of lifestyle diseases (including diabetes, insulin resistance and heart disease), glycaemic index, food allergies, post-operative nutrition, sports nutrition, adolescent body image and digestive and gastrointestinal disorders (e.g. Crohn’s disease, Irritable Bowel Syndrome).

Lila is registered on the Discovery Vitality Dietician Network and thus is accredited to perform Discovery Vitality Nutrition assessments. Lila is registered with the HPCSA (Health Professionals Council of South Africa) and the Association for Dietetics in South Africa (ADSA). She holds the Sponsorship portfolio on the ADSA Executive Committee for the July 2013 to June 2015 term of office. She was also the chairperson for the ADSA Gauteng South branch from July 2009 to June 2013.


New NutritionConfidence recipe – Stuffed chicken breast wrapped in proscuitto

We love our latest NutritionConfidence recipe because it is the perfect easy-to-prepare option for a dinner party and is sure to wow guests.

This recipe is for special occasions and can be served with beautiful, seasonal vegetables, which at this time of the year include: asparagus, beetroot, broad beans, broccoli, brussel sprouts, fennel, Jerusalem artichokes, Kale spinach, parsnips, pumpkin, radishes, turnips and watercress.

Our dietitians say:

This is the lower fat version of bacon wrapped chicken breast stuffed with creamy feta and spinach. Leaner or lower fat protein options are used in this recipe – skinless chicken breasts instead of thighs; prosciutto ham instead of bacon; and Danish feta instead of Greek feta. To lower the saturated fat content of this recipe further, use reduced fat soft feta and remove excess visible fat from the prosciutto before cooking. Unfortunately the sodium content of this dish is high – the feta cheese and prosciutto ham being the main contributors. So rather keep this meal for special occasions!

Stuffed chicken breast wrapped in prosciutto

Makes 2 portions

Ingredients

2 free-range chicken breast fillets

100 g soft Danish style feta

100 g baby spinach

10 ml olive oil

4 long slices of prosciutto ham

Pepper

2 tablespoons chopped parsley

Zest of half a lemon

How to make it

  1. Heat a medium pan on a high heat.
  2. Add the olive oil and the baby spinach. Season the spinach with a pinch of pepper, and sauté the spinach until just wilted.
  3. Remove the spinach from the pan and put into a mixing bowl to cool. Once cooled, squeeze any excess liquid from the spinach and crumble the feta into the spinach. Add the lemon zest and parsley and mix to combine.4
  4. Preheat the oven to 180 deg C.
  5. Lay two slices of prosciutto onto a chopping board, slightly over lapping.
  6. Place the chicken breast on top of the prosciutto slices. Make a lengthways slit down the middle of each chicken breast, to butterfly it. Split the feta and spinach mix into two and stuff one half of the mixture into the chicken breast. Repeat the same process with the other chicken breast and stuff with the other half of the spinach mixture.
  7. Roll the chicken breast up, wrapping it in the prosciutto.
  8. Use a toothpick to pin and seal the ends of the chicken roll.
  9. Put a non stick pan on medium heat.
  10. Brown the chicken breasts for about 2 minutes until golden brown, turning them every couple of seconds for an even colour.
  11. Transfer the breasts into an oven proof dish and bake in the oven for 12 minutes.
  12. Remove from the oven and remember to remove the toothpicks.
  13. Serve with a fresh seasonal salad or side dish of your choice.

Nutritional Value (per portion)

Energy: 1063 kJ

Protein: 35.2 g

Carbohydrate: 2.1 g

Total Fat: 11.6 g

Dietary Fibre: 2.3 g

Sodium: 1082 mg

To download the recipe card, visit http://www.adsa.org.za

Next week we start with our new series of NutritionConfidence recipes that will be perfect for the coming Winter months.


Dietitians and consumers deserve more credit

ADSA Executive Member, Maryke Gallagher, has responded to a recent article by Sonia Mountford, published on the BizNews website, entitled “Dietitians dishing you up a daily menu of unhealthy eating advice”

http://www.biznews.com/health/age-well/2015/05/25/are-dietitians-dishing-up-a-daily-menu-of-unhealthy-advice/

DIETITIANS AND CONSUMERS DESERVE MORE CREDIT

By Maryke Gallagher (van Zyl)

The recent article by Sonia Mountford in BizNews titled “Dietitians dishing you up a daily menu of unhealthy advice?” makes several allegations against the Association for Dietetics in South Africa (ADSA) and, regrettably, also brings an honourable profession into disrepute.

I would like to address some of the concerns and provide a more balanced view on the issues raised.

Ms Mountford’s arguments are not new and she quotes several international studies to justify her arguments but references no credible empirical research locally that finds an “unhealthy”, compromising and complicit relationship between big foods and dietitians, which she claims.

ADSA is not the only body that raises funds from the sector in which it operates. It’s a common practice and there is nothing sinister about it. That is exactly why ADSA is open and transparent about who our sponsors are and our sponsorship policy is readily available on ADSA’s website. Sponsors should never be allowed to dictate an organisation’s messaging and content, especially in the health sector where all information should be evidence-based and ‘first do no harm’. We firmly believe that, as health professionals, we follow this mantra and that our members have sufficient training to be able to assess evidence-based, peer reviewed literature and are aware of possible undue influence.

The independence of ADSA is not compromised by the support it receives from the food industry. While, in a perfect world, professional associations should be completely independently funded, we, like many other associations, don’t have the resources or benefactors to support the work we do to promote the profession and provide ongoing professional training to members. We are proud that we raise 66% of our funds from members’ fees, but this is insufficient to sustain the organisation. Only 34% of our funds are raised from sponsors, with their full understanding of our sponsorship policy.

Many of our sponsors are retail competitors which in itself mediates unfair advantage of one product or company over another. The most we get from any one sponsor annually is about R60 000. Ms Mounford’s concern creates the impression that we are cash flush and powerful enough to dictate a nation’s diet. Far from it. An operating budget of less than R500 000 annually to serve roughly 1 350 dietitians nationally is hardly the resources required to conduct the work we do let alone indulge in the antics we’re accused of.

Dietitians themselves have a code of conduct that specifies that they are committed to providing systematically assembled, evidence-based advice after careful assessment and diagnosis based on the individuals nutritional and health status, and must take the necessary steps to avoid bias and commercial interests.

ADSA does not recommend or endorse brands, products or services. Our donors are not permitted to publicise their support nor use our logo on their websites or on their products. Anyone who has recently consulted a dietitian would know that, rather than promoting a brand or products, dietitians advise patients to read the labels of products and consume foods that address their particular health needs, whether it’s no sugar, low fat, low salt, high fibre or reduced carbohydrates, for example. Dietitians are trained as experts in nutrition and that training includes being able to interpret scientific evidence and separate fact from marketing hype. Ultimately, we educate our patients by providing sufficient information to empower them to make informed food and purchasing choices. Patients can choose to shop at large retailers, eat organic foods or support local farmers markets. It’s their choice.

ADSA does contribute to related draft legislation as do many NGOs, industry bodies and even members of the public. This is not unusual and ADSA does not unfairly influence legislation in the interest of big foods. ADSA has often submitted comments that might be considered unpopular by some food companies. We comment on legislation to benefit the health of all South Africans based on current best practice. To craft legislation in the absence of such evidence would be ill advised. Ultimatley Government drafts regulations based on its own policy considerations which, at present, is guided by the fight against Non Communicable Diseases (NCD’s) such as hypertension and obesity. ADSA strongly supports the policy of reducing such NCD’s through diet.

Finally, South African consumers can take comfort that the local food industry is highly regulated. Food labelling regulations, for example, include permitted and/or prohibited nutrition and health claims, endorsement and the presence and levels of additives.


Making sustainable lifestyle changes and creating new habits – Michael’s success story

This week we chat to Michael North, as part of the series of success stories we will be sharing over the next couple of months. Michael started seeing Registered Dietitian, Elienne Horwitz, when he started gaining weight and feeling unhealthy:

Why did you decide to see a dietitian? (Michael’s before story)

The short answer is I was getting fat and feeling and unhealthy and all my attempts at watching what I ate and drank were short lived and unsuccessful. I was exercising a bit, mountain biking on the weekend and playing the odd game of squash, but these were usually followed by reward lunches with my friends.

Combined with this was that some friends who I would generally beat up the hills and round the trails started beating me! I also started noticing how slow I was getting and how steep and more difficult the hills were becoming. I guess when the lunches were getting longer and more taxing than the mountain biking, I knew I needed some help.

Tell us about your journey with the dietitian?

My first visit to Elienne was for a Discovery Vitality assessment that a friend from work said I should do to get points on my card to qualify for the discounts. After doing this and realising that the dietitian was not a scary food nazi intent on making me feel useless unless I weighed the same as I did in primary school and only ate salad and tofu, I knew that I needed to step up if I wanted to make any changes. Elienne was really friendly, honestly wanted to help and also had a nice, but slightly strict way about her.

She made me aware of what I ate but also explained why things were good or bad. If I didn’t like some of the food items she suggested, she always had several alternative options and by explaining why I needed those food choices I was, over time and with some practice, quite easily able to choose my own alternatives.

Elienne started out by giving me a breakdown of the number of carb, protein, dairy and fat portions I should eat a day and when and how I should eat them; breakfast, mid-morning snack, lunch, mid-afternoon and dinner.

I started swimming with a group at my local gym and was still mountain biking a bit so she showed me how I should adjust my diet during exercise and for recovery after.

The basic principle was not a quick weight loss scheme but more of a healthier living choice, which facilitated weight loss until reaching a weight appropriate for my height and age, etc. So my journey was not a very quick one but my weight loss and fitness levels gradually but consistently went in the right direction.

Tell us about your results / successes?

I think it took me about a year but I lost 18 kg and quite a few centimeters. I also started cycling more, doing events like the Argus and several open water swims. Most importantly, I just felt better.

After a while I started looking for other challenges to help keep me active and on track with my plan instead of back to the pub everyday! I joined a group called Embark, in Sea Point to train for the Ironman 70.3 event in East London and not only completed the triathalon, but also won the Embark “Most Improved Over All” award at the club after party. I was quite proud of that, considering that I had sworn to never run more than 5km in my life!

The following year I joined another triathlon group (My Training Day) and in April 2014 completed the full Ironman. Now the bug has bitten and this year I improved by time by about 30 minutes.

I still keep pretty much to the same eating plan that Elienne put me on in the beginning but am able to eat a bit more now with all the training I am doing. What is great though is that I now know that when I go off track a bit and maybe pick up a kilo or two and it doesn’t take much to fall back into the routine of eating properly and losing the excess again.

What was the hardest part of the journey?

Avoiding beer, red wine and pizza!

In the beginning, the hardest part was eating 5 times a day. Generally in the past I would not eat breakfast or eat very little, then be so hungry by lunch that I would eat a big, junk food lunch and would justify it by saying that I hadn’t eaten all day “so it was ok”. Then I did the same for dinner.

What are the top three tips you can share?

  • If you want to eat more, exercise more and substitute some of the bad stuff for good stuff.
  • If you want to lose weight, don’t make excuses, you know that pies and chips are not going to help.
  • If you can, go to a dietitian or someone like that to help get you started on your way and explain the ins and outs of the process. Being held responsible for your progress with regular weigh-ins can be a real help and motivation to say no to the extra beer or second helpings.

What the dietitian says

Michael lost 18kg, 13% body fat and 15cm around the waist over 16 months. He slowly changed his habits and started putting more energy into planning and preparing his meals and increasing his levels of exercise. He maintained his weight even a year later.

The most important reason Michael managed to lose the weight and keep it off was because because he did not diet – he made sustainable lifestyle changes and slowly created new habits.


HPCSA inquiry

A concern was lodged with the Health Professionals Council of South Africa (HPCSA) as a matter of public interest after a tweet from Professor Tim Noakes advising a mother to “wean” her baby on to a low carbohydrate high fat (LCHF) diet.

The concern was referred to the HPCSA to adjudicate in February 2014 on behalf of members of the Association for Dietetics in South Africa (ADSA). Following a preliminary hearing last year, the HPCSA has decided to convene an inquiry into the conduct of Professor Tim Noakes. They will then rule on the matter.

The advice, via Twitter, is not considered to be in accordance with both international (WHO Guiding principles for complementary feeding of the breastfed child) and national (South African Paediatric Food Based Dietary Guidelines) feeding guidelines for infant and young child nutrition. Furthermore giving one on one nutrition advice on social media to a patient who has not been assessed, as well as providing information outside of the scope of practice for which you are registered with the council is in contravention of the HPCSA ethical guidelines.

“I look forward to a resolution of this matter that will provide clarity on complementary feeding recommendations for infants and young children. It should also set a precedent on how social media should be used by health professionals. Clarity on these issues will help to advance health care in South Africa in the interest of the public. It should also clear any public and professional confusion on these issues,” said Claire Julsing Strydom, President of the ADSA.


Carte Blanche – Sugar Addiction

Tonight at 7pm Carte Blanche is airing an insert on ‘Sugar Addiction’ which includes an interview with ADSA President, Claire Julsing-Strydom. They asked some interesting questions and we would like to share those with you:

Is sugar addiction real?

The answer is that yes sugar can lead to addictive like eating behaviour. Food addiction is real, especially in individuals who have a predisposition towards addiction and addictive like eating behaviour. Studies refer to the hedonic pathway of food record, what we know is that excessive sugar intake alters dopamine and opioid neurotransmission thereby increasing food intake.  But it is important to note that BOTH sugar and high fat foods mobilise the latter establishing hard wired cravings in these areas.  Current literature indicates that addictive like eating behaviour can be attributed to refined carbohydrates (sugar and white flour) as well as fats.  The Yale Food addiction scale suggests that highly processed foods that combine sugar and fat are more likely to lead to addictive like eating behaviours.

How much sugar is too much?

The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100g/day in adolescents. This represents roughly 5-10% of dietary energy, but could be as much as 20% in many individuals. The South African Food Based Dietary guidelines recommend that sugar and foods and drinks high in sugar be used sparingly.  The World Health Organisation have in their most recent guidelines recommended reducing total energy from sugar to below 5% from the previous 10%.  This equates to about 25g pf sugar per day which is approximately the same as 5 teaspoons of sugar. Keep in mind then that a single can of cold drink will exceed 25g of sugar.

In a balanced diet what kind of sugars should we be eating?

Naturally occurring sugars in whole foods such as lactose in yoghurt or fructose in fruits which occur in a fibre matrix have a very different metabolic process then refined carbohydrates and sugar.  It is important to avoid the excess intake of sugar – there is allowance for moderate intake in accordance with dietary guidelines. However research does intake that intakes of added sugars in on the rise and people need to start adjusting their intakes.

Why does ADSA have sponsors that have products that contain sugar?

Woolworths and Pick n Pay are sponsors of ADSA they stock chocolate and colds drinks, but just because they stock these particular food items and are sponsors of ADSA, does not mean that we as ADSA endorse or promote these particular products.  Our sponsorship policy states that we don’t endorse products and in accordance with the South African Food Based Dietary Guidelines and evidence based information we make recommendations to our patients based on their individual nutritional requirements.

A food product that contains sugar can be included in a balanced meal plan as discussed earlier in line with local and international guidelines. Excess sugar intake however should be avoided as it is associated with adverse health risks. What is important to note is that when we have sponsorship discussions with industry it is made very clear that our sponsorship policy does not allow for endorsements in any way. ADSA is an NGO and all the dietitians that work for ADSA do so on a voluntary basis and do not get paid for the work that they do to serve the dietetics profession and the public by informing them on nutrition related matters. Various companies sponsor ADSA and all the funds that we collect through sponsorship are pooled. These funds are used in order to support the dietetics profession and ultimately the improvement of nutritional status for all South Africans. To read more on our sponsorship policy please visit our website: www.adsa.org.za


Raw Chocolate Truffles

Spoil the one you love with some homemade ‘Raw Chocolate Truffles’ made from raw cocoa paste, dates, goji berries, raw almonds, sunflower seeds, flaxseeds, cinnamon and honey.

Our dietitians say:

Date flesh is a high source of energy and 100 g of flesh (about 4 mejool dates) can provide an average of 1300 kJ. It is rich in mainly fructose and glucose; low in fat and protein; and a good source of magnesium, potassium, copper, selenium and manganese. The consumption of 100 g of dates can provide over 15% of the recommended daily allowance from these minerals.

Vitamins B-complex (especially Vitamin B6) are the major vitamins in dates and they are an excellent source of dietary fiber (up to 8.0 g/100 g).

Last, but not least, dates are a good source of antioxidants, mainly carotenoids and phenolics.

We love this recipe:

Easy to make, package in a beautiful box and voila … a great gift for mom.

The raw chocolate balls are also a great dessert option – and can double up as a high energy lunchbox snack or perfect ‘take along’ energy boost for runners or cyclists.

Ingredients

100 g raw cocoa paste

100 g dates

30 g goji berries

50 g raw almonds, chopped

20 g sunflower seeds

20 g flaxseeds

2 ml cinnamon

20 g honey

*Makes 20 truffles

How to make it

– put the dates into a small saucepan and cover with a little water. Cook the dates in a medium high heat until soft (about 5 minutes) and the water has evaporated. Mash the dates into a purée and set aside.

– gently melt the cocoa paste on a low heat.

– mix the melted cocoa paste, date purée, goji berries, almonds, seeds, cinnamon and honey into a firm paste.

– roll the mixture into 15g balls and dust with cocoa powder, or roll in seeds or coconut to decorate.

The nutritional value per truffle (makes 20 truffles):

Energy: 254 kJ

Protein: 2 g

Carbohydrate: 4 g

Total fat: 3.2 g

Dietary Fibre: 1.1 g

Sodium: 48 mg


Basic Nutrition Guidelines and Needs of Infants

There is global recognition that the first 1,000 days of life (from conception to two years of age) is a key window of opportunity for improving health outcomes during childhood and into adulthood. Optimal infant and young child feeding is defined by the World Health Organisation (WHO) as exclusive breastfeeding from birth to six months and continued breastfeeding to two years and beyond along with complementary feeding from the age of six months (World Health Organisation, 2003). South Africa has adopted these recommendations.

Babies should be given only, where possible, breast milk from birth until the age of six months. Following the 6 month period, small amounts of food introduced into a baby’s diet, called complementary foods, should be safe, available, affordable, appropriate and culturally acceptable. Breastfeeding should continue while complementary foods are introduced, for up to two years of age and beyond.

The principle of responsive feeding, (i.e. when a child communicates feelings of hunger and satiety through verbal or non-verbal cues and the mother/caregiver responds appropriately) should guide the amount of complementary food that is offered. Since each child’s needs differ, each child consumes different quantities of breast milk and complementary foods, and each child grows differently, the amount of complementary foods should not be overly prescriptive.

The WHO and the Institute of Medicine (IOM) (IOM, Dietary Reference values 2006) recommend that an infant’s energy (which is provided by breast milk and complementary foods) should come from about 30 – 45% of total fat, 6 – 7% of protein with the remainder from carbohydrates. This is very much in line with the composition of breast milk at that age. It is also recommended that infant diets do not contain more than 15% of energy from protein, until more is known on the effect of protein on obesity later on in life (Michaelsen & Greer 2014). Major expert paediatric committees such as the The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), American Academy of Paediatrics (AAP) and Canadian Paediatric Society (CPG) support these guidelines, until more research becomes available on the matter.

High nutrient needs, due to babies’ rapid growth and development in the first two years of life, coupled with the relatively small amounts of complementary foods eaten in this period, means that the nutrient density in complementary foods must be very high. Gradually increase the amount of food, number of feeds and food variety as your child gets older.

Guidelines on suitable complementary foods                                   (Du Plessis, et al., 2013)

  • Provide a variety of foods to ensure that nutrient needs are met. This includes vegetables, fruit, whole grains, meat and meat alternatives (meat, poultry, fish, eggs, legumes, nuts, seeds and nut butters) and dairy products (from the age of 12 month and in addition to, but not replacing breast milk).
  • Foods from animals (meat, poultry, fish or egg) should be eaten daily, or as often as possible to meet protein and iron needs. In infants and young children, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used.
  • Dark green leafy vegetables and orange coloured vegetables and fruit rich in Vitamin A (e.g. sweet potato, carrot, pumpkin, broccoli and spinach, mango, peaches, apricot, paw-paw) should be eaten daily.
  • Provide diets with an adequate fat content (from plant foods e.g. vegetable oils, avocado, nut butters and foods from animals, listed above, and also including breast milk).
  • Use fortified complementary foods or vitamin-mineral supplements for infants, as needed or prescribed.

Low nutrient-dense liquids, such as tea and coffee, energy-dense sugar-sweetened drinks, an excessive intake of fruit juice, high-fat and salty snacks, and highly refined starchy carbohydrates worsen poor nutrient intake and displace healthy food in the diet, and are therefore not recommended for complementary feeding.

When considering nutrition guidelines and dietary advice, it is very important to differentiate between public health messages and those that are tailored to meet the specific needs of individual members of the public. Public health messages are intended for the general public, and can be communicated as “blanket” evidence-based messages based on proven public health problems in a population and based on the profile of the majority of the population. Messages to individual members of the public should be interpreted following a one-on-one consultation with a qualified healthcare worker, based on scientific reasoning and motivation for deviation from the public health message, if needed and appropriate.

Restrictive diets for infants should only be followed in specific medical conditions and under strict medical supervision.

Sources:

  1. Du Plessis LM, Kruger S, Sweet L. Complementary feeding: a critical window of opportunity from six months onwards. South African Journal of Clinical Nutrition 2013;26(3)(Supplement):S129-S140 Available at http://sajcn.co.za/index.php/SAJCN/issue/view/67/showToc (Accessed 25 April 2015)
  2. Pan American Health Organization PAHO/World Health Organization (2003) Guiding Principles for Complementary Feeding of the Breastfed Child. Available at http://whqlibdoc.who.int/paho/2003/a85622.pdf (Accessed 15 April 2015)
  3. World Health Organization (2003) Global Strategy for Infant and Young Child Feeding. WHO: Geneva.
  4. Institute of Medicine (IOM). Dietary Reference Intakes Essential Guide Nutrient Requirements. 2006.
  5. Michaelsen KF, Greer FR. Protein needs early in life and long-term health. Am J Clin Nutr 2014 Jan, 99(suppl):718S-22S.
  6. Agostoni C, Desci T, Fewtrell M et al. Medical position paper on complementary feeding: a commentary by ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutri, 2008; 46(1): 99-110.
  7. Handbook of Paediatric Nutrition, 3rd Edition, American Academy of Paediatrics, 2005.
  8. Grueger B; Canadian Paediatric Society. Weaning from the breast. Paediatr Child Health 2013;18(4):210

For more information, contact the Association for Dietetics in South Africa +27 (0)82 376 4446


Gluten & Sugar Free Brownies

This month seems to be all about chocolate, so we thought we’d share a recipe that is all about chocolate, but a much better alternative to other sugar-laden chocolate treats (and because the recipe contains no flour it is perfect for anyone who is gluten intolerant). Chef Vanessa Marx created the most delicious Gluten & Sugar Free Brownies, our latest NutritionConfidence Recipe.

Our Dietitians say: 

Historical evidence shows that cocoa has been used in a medicinal capacity for over two thousand years (since the time of the ancient Mayan and Aztec civilisations and following its introduction to Europe in the Middle Ages).

A large Harvard study showed that cocoa consumption is associated with decreased blood pressure, improved blood vessel health, and improvement in cholesterol levels, among other benefits.

The cocoa bean’s therapeutic properties can be attributed to certain constituent compounds, known as flavonoids.

RECIPE

Makes 48

Ingredients

200 g raw cocoa paste (solid)

375 g ground almonds

6 whole free-range eggs

250 g xylitol

300 g cocoa butter

50 g desiccated coconut

3 tablespoons cocoa powder

1 teaspoon baking powder

How to make it

– Preheat the oven to 160 C

– Grind together the cocoa paste, ground almonds, coconut, cocoa powder & baking powder.

– Whisk together the eggs and xylitol until light and fluffy and the xylitol is dissolved.

– Melt the cocoa butter.

– In a large bowl, fold together the ground cocoa mixture & the egg mixture until combined.

– Fold the warm cocoa butter into the mixture until all combined.

– Pour the batter into a greased baking dish and bake for 30-40min until set.

– Leave to cool a pond then slice into squares

The nutritional value serves 48:

Energy: 572 kJ

Protein: 2 g

Carbohydrate: 6 g

Total fat: 12 g

Fibre: 1.7 g

Sodium: 13.5 mg

Enjoy! If you want to download the recipe card visit: http://www.adsa.org.za/Public/Recipes.aspx


Liquid Assets

Considering a juice fast? Read this first. Lauren Shapiro from My Kitchen magazine chatted to ADSA spokesperson and Registered Dietitian Nathalie Mat to find out if this is just another fad diet or if there is more to it:

ADSA_My Kitchen_Liquid Assets_April15

http://www.tfgclub.co.za/mykitchen

MyKitchen_April15 Cover


Success Story – Carla Schoeman

Over the next couple of months, we are going to share some success stories with you and find out why people decide to see a dietitian, what happens on the journey, what is hardest part of that journey and the end result from the client’s point of view.

First up is 32-year-old Capetonian, Carla Schoeman, who consulted with Registered Dietitian, Catherine Boome:

Why did you decide to see a dietitian? (Carla’s before story)

I have lived a relatively healthy life, eating what I thought was a balanced diet, and exercising regularly but not really seeing or feeling the results I felt I deserved with the effort. I do have some hormonal challenges that also complicate weight loss and felt that I was just getting heavier and heavier –despite pretty much always being on some form of a diet.

I tried my best to hate all carbs and mostly avoided sugar. But not only did I not lose weight, I gained weight, a little more every year. I’ve always been a runner and despite drastically increasing my mileage over the years, I kept getting slower.

At the end of 2012, I just decided enough was enough! I needed to get really serious about my health. I clearly didn’t have all the answers so decided to find someone who does. This was a big step for me – I’m a very proud person and asking for help didn’t come easy.

Tell us about your journey with the dietitian?

I was referred to Catherine Boome by a friend who raved about her holistic, “normal” approach to food and nutrition. I wasn’t too keen on weighing things or counting points, so this was a big plus. I met with her at the end of January 2012 and told her my story.

I expected her to be as perplexed as I was about my weight gain/lack of weight loss but she wasn’t. She was convinced she could help me. After spending about 90 mins with her going over my routine, my likes and dislikes etc. she developed a personal plan for me.

A week later, after spending some time explaining to me how my hormonal imbalances are impacting the way food behaves in my body, she presented me with a plan that not only compensates for that, but also included carbs! (I was worried about that!) .

The main focus was on portion control – helping me understand what my body really needs, how much and how often. She also spent quite a lot of time preparing me mentally – calling me out on being too hard on myself and not having faith in my abilities to accomplish my goals.

The plan was so simple, I couldn’t believe it. It was applicable to pretty much every part of my life. Even when I went out for dinner with friends, I was able to make smart choices within the eating plan, no matter what restaurant I was in.

Once I understood why my body was being so stubborn about weight loss, I could work with that to make smarter food choices. Even after the “diet” finished.

Catherine was also fantastic in providing leadership when I decided to enter the Argus – helping me make the best choices for my body’s needs over such a long distance. She helped me prepare for holidays, giving me tips on what types of foods I should favour when I’m in another country and not in control of the preparation or the menu.

Every time I had a question (or a meltdown), Catherine calmly provided me with the information I needed to make the right choice. She is part and parcel of my success story – she provided the framework I needed to get to where I wanted to be, and which allowed me to be “in charge” of the decisions I made.

Tell us about your results?

I refuse to weigh myself so the only times I’ve been on a scale in the past 5 years has been in Catherine’s office. Three months into the plan I had lost about 6kgs. No one was more surprised than me.

I continued to lose another 8kgs by the end of 2013. That was 14kgs in about 11 months. I dropped 2 dress sizes and my entire body composition changed. Also, I went from average runner to a really good one – taking almost 30mins off my average time for a half marathon.

At the end of 2013 Catherine gave me a maintenance plan. I check in with her every 6 months to keep myself accountable and I’ve managed to keep my weight consistent over the past 15 months, since finishing the plan. I also talk to her regularly for advice on changes in my routine, or when I’m training for a particular race. I feel so in tune with my body, I can feel when I’ve had an unhealthy couple of days – and I know exactly how to fix it. No need for a panic, or a crash diet. I just go back to the basics that Catherine gave me.

What was the hardest part of the journey?

For me the biggest hurdle was to actually make the appointment to go and see her, as I couldn’t imagine that she would be able to tell me something I didn’t know. I was very wrong!

That first winter was pretty tough too because I was less active and therefore home more and wanted to eat more! Catherine provided some great advice and ideas that got me around those hurdles without any long-term damage. Socially I struggled a bit with friendship-dynamics changing when I gave up alcohol, but mostly I was very well supported in my journey. I haven’t given up alcohol completely – I love my red wine, but now have it as a treat when I’m with friends. It’s not part of my daily routine anymore.

What are the top three tips you can share? 

  1. The dietitian’s advice won’t help you unless you do what she says.
  2. The only way to get lasting results is to make lifestyle changes. You can’t do a fad diet and expect a long-term result. It must be about being healthy, first. Weight loss is a consequence of that.
  3. It’s TOTALLY worth it

What the dietitian says (feedback from Catherine Boome)

Carla was destined to succeed right from the minute she walked into my rooms. She was very motivated to be healthy but just so confused with what, when and how to eat in order to manage her weight. She had been making a great effort to lose weight but she was not being rewarded with the results she deserved. Something just did not make sense and she decided to approach an expert in food and nutrition to help her make sense of it all.

We started with basic Nutrition 101. Nutrition Education in order to facilitate a good understanding of food as a source of nutrition and fuel for the body, understanding metabolism and how certain food choices and eating habits can affect the body’s metabolism, hormones, insulin response, fat burning capabilities and therefore the ability to either gain or lose weight.

It was important for me to find out a bit about Carla – her food preferences, type of work, lifestyle patterns, exercise and hobbies in order to put together something that would fit into her way of life so that it would be practical for her to follow.

I then put together an individualized eating plan for Carla to follow and encouraged her to return to me periodically (as and when it suited her) for more support and motivation. This would also be an opportunity to tweak the plan if we needed to, or to answer any questions she might have had.

Incorporating healthy eating habits into Carla’s life did not appear to be too difficult, in fact she made it look very easy! This was a result of her motivation levels and go-getter personality. I believe that benefits of her improved energy levels, vitality and overall health served as a great motivator for her to keep going.

I believe that one needs to learn HOW to eat in order to manage weight, as opposed how to learning NOT to eat. This is such a valuable lesson for many of my patients.

To find a dietitian in your area visithttp://www.adsa.org.za/Public/FindARegisteredDietitian.aspx


Sustainably Farmed Kob Stuffed with Fennel & Orange

Next up in our NutritionConfidence recipe series is a simple and tasty fish recipe from Chef, Vanessa Marx. This recipe is perfect for a gourmet meal that is also good for your health. An added bonus is that sustainably farmed kob is also good for the environment.

Our dietitians say:

There are many benefits to eating fish more often. Fish includes key micronutrients: mineral phosphorus, selenium, potassium, iodine, zinc and magnesium and vitamins B2, B12 and D.

The South African Healthy Eating Guidelines emphasise the importance of fish intake – it should be at the top of your list when choosing a protein for a meal.

The aim should be 2 – 3 portions of fish per week.

RECIPE

Makes 4 portions

1 whole sustainably farmed kob

1 medium fennel bulb, sliced

1 orange

1 lemon

20 g dill

20 g chives

30 g butter

50 ml olive oil

Salt & black pepper

Tin foil

– stuff the belly of the fish with the sliced fennel, chives and dill

– slice half of the orange and half of the lemon

– stuff the slices of citrus into the fish

– use the remaining half of the orange and lemon for the juice, and squeeze the juice over the fish

-rub the outside of the fish with butter and drizzle with olive oil

– season with salt & pepper

– wrap the fish up in 2 layers of foil

– place on the braai over medium to low coals for about 15 minutes, then turn the fish for a further 15 minutes

– unwrap the fish from the foil, taking care to reserve the juices which you can use to dress the fish when serving.

The nutritional value serves 4:

Energy: 1459 kJ

Protein: 23.7 g

Carbohydrates: 9 g

Total fat: 22.5 g

Fibre: 4 g

Sodium: 788 mg

To download the recipe card, visit http://www.adsa.org.za/Public/Recipes.aspx


Response to Grass Consumer Group Questions

Grass Consumer Group asked us some very important questions on Twitter last week. Some of our answers won’t quite fit into 140 characters, so we’ve put together a Q&A in response to their questions:

Question1: ‘You state that you share science-based research with your members – what about public awareness? Any sugar studies? How do you promote the nutritional well being of the community?

We are involved in numerous activities to raise public awareness around nutrition issues including National Nutrition Week, a Department of Health initiative to inform the public on practical ways to incorporate the South African Food Based Dietary Guidelines. This includes messages around sugar.

We also support the South African Food Based Dietary guidelines that clearly state the following about sugar: “Use foods and drinks containing sugar sparingly, and not between meals” and agree with the following abstract from SAJCN on the reviewed dietary guidelines 2010: “This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate dietary advice.” (http://www.sajcn.co.za/index.php/SAJCN/article/view/752)

The South African Food Based Dietary guidelines and this technical paper were shared with dietitians and nutritionists at the 25th Congress of the Nutrition Society of South Africa and the 13th Congress of the Association for Dietetics in South Africa.

A document “Guidelines for Healthy Eating Information for Nutrition Educators” was created to be used by nutrition educators in the public sector.

We have partnered with PEN Global Resource for Nutrition Practice, a dynamic knowledge translation subscription service to bring our members the most up-to-date, evidence-based nutrition resources.

ADSA Spokespeople are always available to engage with the media on nutrition topics and communicate nutrition messages to the public via ADSA website http://www.adsa.org.za, ADSA blog https://nutritionconfidence.wordpress.com/, ADSA Twitter account https://twitter.com/ADSA_RD and ADSA Facebook page https://www.facebook.com/ADSAorgza.

We share nutrition information around many topics, including but not limited to strategies to reduce salt intake (we are involved in the Salt Watch campaign), sugar, obesity, portion control, food labeling, nutrition during pregnancy, breastfeeding, nutrition for active kids, nutrition for cancer patients and nutrition for optimal diabetes management.

We have in the past (and will continue in the future) been involved with campaigns during Salt Awareness Week, Breastfeeding Week, Diabetes Month and many more.

Question 2: How do you approach your sponsors? Who approaches whom? What is a gold sponsor?

Some of our sponsors have approached us directly and others we approach. We (ADSA) and some of our members work with industry and think that is a powerful way to make change happen. We believe that it is important for us and dietitians to be involved with the food industry – imagine the food supply if we didn’t.

At the same time we don’t believe in endorsing brands to the communities within which we work, hence the decision to remove logos from our public-facing channels as this can influence public perception. Our sponsors are also not allowed to use the ADSA logo on their websites or with their products. We don’t hide our sponsors (https://nutritionconfidence.wordpress.com/2015/02/19/a-word-from-claire-julsing-strydom-adsas-president-on-sponsorships/) but don’t allow for endorsements of any kind and therefore have made these changes to our sponsorship policy. More info about our sponsors or their products are only available to our members through the Log In function on our website. It hasn’t always been like this, but we learn and evolve and make changes.

Our members are trained health professionals that are able to look at a variety of food products (that are used by the public) with the necessary knowledge to ascertain how and when various nutrients and food products would be beneficial for a client based on their individualised nutritional requirements.

We are currently working with corporates outside the food industry, to get them on board as sponsors, because we are unable to function as a not-for-profit organisation without financial support. The income from our membership fees only covers 66% of the budget we need to continue educating and supporting our dietitians, as well as promoting the nutritional well being of the community. Sponsorship funds are pooled and use for the administrative costs. All nutrition related matters or purchasing of functionalities like PEN will come from membership fees, which have increased dramatically in the last year to accommodate these changes.

We have various tiers of sponsorship, which are based on the level of financial contribution a company makes and offers different benefits to the sponsor. These benefits are all related to industry affairs and member communication, not public interaction or communication. Our sponsors have never influenced decisions made by ADSA and donate funds to the association to promote the dietetics profession in South Africa and ultimately improve nutrition education to the public through dietitians and we are grateful to our sponsors for their assistance.

Question 3: Please respond to why you promote sports cereal bars for kids and suggest sweetened low fat flavoured milk drinks for kids as per this article on your website: http://www.adsa.org.za/Portals/14/Documents/Nutrition%20Info/NutritionTipsForActiveChildrenByKarlienSmit.pdf

The @GrassAction tweet with regards to the article was taken out of context. We advocate evidence-based, individualised advice.  When choosing foods, context, portion and frequency are key considerations. This article specifically referred to active kids that take part in sports and is backed by relevant evidence.

As medical professionals we are bound by ethical codes and at all times ensure that our content is backed-up by evidence. The links are included in the article. Please have a read-through and let us know if there are specific questions you have about the evidence or flaws within that evidence.

We stand by this article, within the context of “An ideal training diet for active children”.

___________________________________________________________________________

We find that many South African’s blindly follow nutrition advice and fad diets without asking questions, digging deeper and really looking at the research. Without consumer groups like Grass Action some questions would never make it into the public space. Thank you for asking the tough questions.