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.

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.

 


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

 


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”.


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. 


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