Women and Diabetes in the Spotlight this November

Over the past decades, the rise of diabetes around the world has been so prevalent and extreme, it is sometimes referred to as the epidemic of our modern times. In 2017, the diabetes focus theme is Women and Diabetes. Globally, diabetes is the ninth leading cause of death in women, resulting in 2.1 million deaths each year. It is estimated that there are currently more than 199 million women living with diabetes, and by 2040, this total is expected to reach over 310 million.

Registered dietitian and ADSA (the Association for Dietetics in South Africa) spokesperson, Ria Catsicas says, “According to the latest mortality report for South Africa released earlier this year, diabetes is ranked as the leading cause of death in women, and the most important risk factor for developing Type 2 diabetes is obesity. At this time, more than 60% of South African women are either overweight or obese, putting them at higher risk than men of developing diabetes in the future.”

Gender also means that women experience additional health risks due to obesity. As Ria notes: “Almost 17% of pregnant South African women experience gestational diabetes which is directly related to obesity. This condition puts them at risk of experiencing high blood pressure during their pregnancy, miscarriages and still birth. In addition, the babies of mothers-to-be with gestational diabetes tend to be large which can contribute to complications during birth and are themselves at a higher risk of developing type-2 diabetes later in life. Obesity also plays a role in increasing the risks of female infertility.”

Optimal nutrition is key for the person with diabetes; it is also crucial for those who may not have diabetes yet, but are insulin-resistant and those with a family history of diabetes, as genetics are also a risk. Optimal nutrition is also essential for all women – up to 70% of cases of Type 2 diabetes can be prevented by following a healthy lifestyle.

Type 1 diabetes is managed by medication (injectable insulin and or tablets),a controlled diet and exercise; but when it comes to Type 2 diabetes, good nutrition along with other healthy lifestyle changes are usually the first line of treatment to manage diabetes, and if medication is required, a healthy diet can complement and often influence the medicine, to help avoid experiencing the life-threatening complications of diabetes. Tabitha Hume, also a registered dietitian and ADSA spokesperson, points out that common-sense healthy lifestyle changes can be a vital safeguard. “Balanced meals that are made up of a combination of high fibre, low-GI carbohydrates, lean protein and healthy plant fats with generous helpings of vegetables and salads and some fruit (in controlled portions) can be a general guide. However, plasma glucose control is very individual, depending on the severity of the diabetes, and the type and dosage of medication being used. Diabetics will need the help of a registered clinical dietitian who can support them in translating these guidelines into the practical meal plans that best suit their food culture, their taste preferences, daily routines and lifestyles.’’

ADSA spokesperson, Nasreen Jaffer agrees, “There is no ‘one size fits all’. In order to make a sustainable change to a healthier eating plan, all aspects of a person’s life must be taken into account. A working mom with kids at school does not have the same amount of time for food planning and preparation compared to a stay-at-home mom. It is the role of the dietitian to help tailor an eating plan that is healthy – as well as practical, affordable and do-able for the individual.”

All three experts agree that this year’s World Diabetes Day focus on women is relevant to the adoption of healthy lifestyles across South Africa’s population.   While many men play a prominent nurturing role in the home, and many are becoming increasingly interested in the impact of nutrition on health and physical performance, it is still common for women to take the dominant role in the nourishing of the family, and ensuring health and disease prevention.

Tabitha points out: “Since women are most often the home chef, the grocery shopper, and the planner of meals and snacks for children and the family, if nutrition education is targeted at women, there is a higher chance that healthy nutrition guidelines filter through the whole family and have the biggest impact. Family traditions, practices and cultures most often derive from the mother in a family which is why children often adopt the religion and language of the mother. This is where the ‘Mother Tongue’ phrase originates. South African women are encouraged to develop a ‘Mother Meal’ concept moving forward, helping to instil healthy eating habits in children from a young age.”

World Diabetes Day on 14 November aims to shine a light on the risks for developing diabetes; as well as the needs for regular screening, access to information, self-management education, treatments and support, which includes optimal nutrition.


Getting the right help can change your life!

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 Julie Greensmith, who started seeing Registered Dietitian Nathalie Mat after she was diagnosed with Diabetes. Here is her story ….

Tell us about your journey with your dietitian

I changed doctors. I have always been a shut up and get on with it person. After a battery of blood tests to create a profile for my new doctor, she phoned me and asked “Did you know you were a diabetic?” I had no idea and the shock was mixed with the relief of understanding why I had been only half alive for a very long time. I had absolutely no energy, some days I could hardly get up, walking was becoming more and more painful. I even gained weight if I ate a lettuce leaf and seemed to be permanently swollen. Shoes were impossibly difficult. In my volunteer work I am communicating with people all the time and frequently having to stand up and address groups. My concentration was disappearing, I could not think and kept just losing words. It was very scary, I felt out of control and my world was shrinking. All this time I had thought well this is what getting old is all about (I am 72 or to look at it another way I have been 37 twice).

On hearing the word Diabetes my husband immediately went out and bought the Banting book and we went strictly onto the Banting diet. Although I lost 6 kilos I plunged into depression and being no stranger to depression I knew what was happening but just could not get control of it. One really bad day my husband just said enough is enough and made me a piece of rye toast with apricot jam. Within twenty minutes I felt absolutely fine again. A colleague from Lifeline suggested I should see Nathalie Mat, a registered dietitian – which proved to be the best thing ever that could happen for me and a turning point in my recovery.

I was greeted with kindness, consideration and understanding. My fear at being in unknown territory was fully understood and allayed. I felt so supported. My preferences were discussed and incorporated as far as possible and I never felt judged. She was very happy to discuss recipes and wine with my husband (my chef and food policeman) and look for ways of adapting and fitting them into my programme. She also has a great collection of tasty recipes. Not only is Nathalie highly qualified with a huge depth of knowledge, she is so willing to share it finding simple ways of explaining absolutely everything. I understand and trust the importance of all the steps we have taken which makes it so easy to trust the process and feel fully committed to it. It is one thing to have the knowledge but being so enthusiastic and prepared to share is a great gift. It makes me feel like a respected equal and I have felt that partnership thought our journey.

She has understood my fears and celebrated my triumphs, however small. I have felt heard, supported and understood through the whole process.

Perhaps best of all when I don’t stray at all from my diet I never feel as hungry as I did in the past.

Tell us about your results

So far I have lost 20 kilos. I used to be sick all the time with gastro and flu. That hasn’t happened for 18 months now. When I wake up early in the morning I get up with energy. All my blood tests register within the recommended parameters.

My mind is firing on all cylinders again and all thoughts of giving up my work have flown out of the window. I am able to be creative and busy. My movement is far better and my legs and feet are no longer swollen and far less painful. Between the Podiatrist and Biokinetisist I am very mobile and my balance is coming back. Nathalie and my Biokinetisist have worked together to design a programme that addresses both their needs to get the best results they can with my limitations. I have a life back and, let’s face it, is important, my dress size has gone down 3 times which my credit card and sewing machine are busy rectifying.

What was the hardest part of the journey

This is a difficult one to answer. Any hurdles I have had to overcome have been self-imposed. Of course certain deprivations can suddenly get the better of me and I fall off the path now and then. When that happens I see the results on the scales and the rise in my feelings of hunger and those realisations spur me on back into the disciplines of my eating plan. I am so supported by my relationship with Nathalie, my new doctor, and by my husband who is joining me in treating our older age years as a team effort.

I have struggled with the exercise and fighting with my damaged foot and the pain and a certain degree of laziness!

What are the top three tips you can share

Sometimes it is not good to shut up and get on with it. Getting the right help can change your life.

Communicate. Talk about the difficulties you are experiencing with your dietitian and be one hundred percent honest so that you can work out a plan together and trust the process. Leave your ego outside the door.

Patience. Be patient and don’t beat yourself up and set impossible targets that are bound to disappoint, dishearten and even sabotage you.

Trust. Trust the process and embrace it fully.

What dietitian Nathalie Mat says

When I first met Julie, she had not felt well for a long time. Poor blood sugar control was affecting her nervous system and her immunity. She was ready to make changes, but really needed assistance finding the right fit for her body. Diabetes is a scary diagnosis that does not have a simple cure. I wanted Julie to know that she had a partner in understanding her body and the limitations of her blood sugar control. Her eating along with close monitoring by her GP helped stabilize her blood sugar levels and Julie even learnt how she could incorporate less healthy options into her lifestyle without affecting her health.

Julie has amazing support in the form of her husband. He noticed that Julie was regularly having energy dips. I recommended we use a new device which continuously monitors blood sugar levels and we discovered that Julie was spending much of her day with low blood sugar. Julie’s doctor has since dropped Julie’s diabetes medication by half!

Julie has made incredible changes to her health. Her support from her husband as well as her consistent efforts have played a pivotal role in her success. I have so enjoyed being part of her journey to health and look forward to celebrating ongoing successes.

 

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

 


6 Eating Habits for Healthy Kidneys

When it comes to health advice, our hearts are often in the spotlight. However, as equally vital organs, our kidneys really shouldn’t be relegated to the shadows. Worldwide, Chronic Kidney Disease (CKD) is on the rise – 1 in 10 people globally are affected, and that’s every bit as serious as cardiac disease.

Our kidneys work very hard for our bodies, and the downside of their dogged efficiency is that by the time we are bothered enough by the symptoms of CKD, the damage has been done. In the late stages of CKD, only ongoing dialysis or surgical transplant may help prolong life – treatments that are not available to many South Africans. This is why health professionals drawing attention to Kidney Awareness Week from 2 to 6 September, advocate for regular screening of kidney function, especially if you fall into the high risk categories.

Interestingly, similar to heart health, obesity, diabetes and hypertension put us at risk for CKD as well. The view of ADSA (the Association for Dietetics in South Africa) is that with the high prevalence of obesity, diabetes and hypertension in the country, it stands to reason that we need to become a nation aware of, and caring about our kidneys.

People who are overweight or obese are up to seven times more likely to develop end-stage renal disease compared to those of normal weight. A family history of CKD or renal failure is also a red flag indicating that you need to actively focus on the health of your kidneys. However, the prime culprit in the majority of CKD cases in South Africa (64%) is undetected or uncontrolled hypertension, which is abnormally high blood pressure. So a basic step in ensuring kidney health is regular blood pressure testing and adherence to treatment and lifestyle changes in order to keep your blood pressure in check.

Every day, our valiant kidneys help us dispose of the excess salt and water that we consume. In the process, they also happen to eliminate toxins that would otherwise build up and take down the living system that is our body. Our kidneys also play an important role in controlling our blood acidity and blood pressure levels. For those who are obese, the kidneys have to work harder, filtering more blood than normal to cope with the demands of the greater body weight. This increased workload can damage the kidneys and raise the risk of developing CKD in the long-term. “When kidneys do fail, the body is literally overwhelmed by excess water, salt and toxins, which defeat every other organ and body system,” says ADSA spokesperson, Registered Dietitian, Abby Courtenay, “The job of the kidneys may not be glamorous or poetic, like the heart, but it is every bit as important.”

The good news in all of this is that there is a lot we can do day to day to promote the health of our kidneys. Courtenay adds: “If you have been screened and diagnosed in the earlier stages of CKD, or need to implement measures because you suffer from obesity, diabetes or hypertension, you can make a significant positive difference just with your daily diet.”

“Nutritional strategies to deal with CKD, as well as its risk factors are well-researched and documented,” says Registered Dietitian, Cecile Verseput, “What’s important to note is that in the most up to date professional interpretation of the research available, the focus has turned from considering single nutrients to looking more holistically at an overall healthful dietary pattern, particularly rich in plant-based foods.” Cecile points out that recent SA consumer statistics show that fresh fruit and veg, as well as healthy sources of vegetable protein, are low shopping priorities in the country.

Here are her Six Top Tips for Boosting Kidney Health:

  1. Go green – and red, yellow, orange, purple and blue! Boosting the fresh fruit and veg in your diet is one of the best ways to protect your kidneys. There are so many ways to make vegetables and salads a delicious part of your family’s eating.
  2. Get real – Drop the high-salt, trans-fat takeaways and convenience foods like hot cakes. Cultivate a real interest and enjoyment in cooking from scratch with fresh, healthy ingredients. It’s so much more delicious, and good for your kidneys.
  3. Be choosy about fats – They are not equal. Go for extra virgin olive oil and avocado oil rather than hard fats to protect the blood vessels in your kidneys.
  4. Go nuts – Boost your intake of nuts and legumes. They are delicious, and provide healthy fats and fibre.
  5. Forget the convenient fads – Let go of the sugar-sweetened drinks and treats, fast foods, processed and red meat.
  6. Embrace plant protein power – Open up to the wide range of legumes, grains and nuts that are readily available and make them part of your daily eating. Swap red meat with legumes or alternatively with fish or poultry.

 


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

 


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.


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

 


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

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.

 


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


It’s the year of the pulses – try this Lentil Bobotie

It’s the year of the pulses and the theme of National Nutrition Week is ‘Love your beans – eat dry beans, peas and lentils’, so this delicious Lentil Bobotie, created by chef Vanessa Marx, is the perfect family meal.

We love lentils (and you should too)! Dried lentils are a quick cooking legume, taking just 15 – 20 minutes to cook with no need to remember to soak them beforehand. The also pack a lot of punch, they are: low in fat, high in protein and high in dietary fiber.

Legumes (including lentils) provide a valuable and cost-effective source of protein and other nutrients. A 2010 review by Drenowski of different foods found that beans were among the top 5 classes of food having the highest micronutrient to price ratio, making them exceptional nutritional value for your money.

 

INGREDIENTS

(serves 4)

2 cup lentils, cooked

30ml canola oil

1 onion, peeled & chopped

2 cloves garlic, peeled & finely chopped or crushed

20g grated fresh ginger

100g green beans, chopped

1/2 cup raisins

2 carrots, peeled and diced

1 red pepper, diced

1 can chopped tomatoes

1/2 cup water

30ml mild curry spice

5ml ground cinnamon

2 bay leaves

2 free-range eggs

1/4 cup low fat yoghurt

2ml ground turmeric

salt & pepper

10g fresh coriander, chopped

2 extra bay leaves

METHOD

  1. Put a large pot on the stove on a medium heat and add the oil.
  2. Add the chopped onion, ginger & garlic and sauté lightly for about 5 minutes.
  3. Then add the carrots, red pepper, green beans and raisins and continue to sweat for another 5 minutes.
  4. Add the curry spice, cinnamon and bay leaves and stir in for 2 minutes.
  5. Add the chopped tomatoes and water and stir in.
  6. Cook the sauce for about 15min until slightly thickened and the vegetables have softened a little.
  7. Add the lentils and season with salt and pepper to taste and mix in.
  8. Put the lentil mixture into an oven proof dish and set aside.
  9. In a bowl, whisk together the yoghurt, eggs and turmeric.
  10. Pour the egg mixture over the lentil bobotie and place the 2 bay leaves on top.
  11. Bake the bootie in the oven at 180ºC for about 20min until the egg custard has set and is slightly golden brown on top.
  12. Remove from the oven and serve hot with chopped fresh coriander.

NUTRITION INFORMATION: per serving (recipe serves 4)

Energy: 1441 kJ Protein: 16.1 g Carbohydrate: 49.6 g Of which, total sugars: 24.1 g Fat: 11.0 g Fibre: 14.0 g Sodium: 94 mg

Visit the National Nutrition Week website for more recipes that include beans, peas and lentils!


Ostrich Stew with Gremolata

A great choice for health-conscious red meat lovers and a wonderful in-between seasons recipe – Ostrich Stew with Gremolata, created by chef Vanessa Marx.

Our dietitians say: Ostrich is a great tasting lean read meat. It is low in fat (only 1.4 g fat per 100 g meat), rich in protein (22 protein per 100 g meat), lower in cholesterol than other red meats (only 60 mg per 100 g meat), and a good source of biologically available iron  (3.2 mg iron per 100 g serving of meat)

INGREDIENTS

500 g ostrich fillet cubes

1 tablespoon (15 ml) canola oil

2 cans (400 g each) chopped tomato

1 cup (250 ml) red wine

1 carrot

1 onion

100 g mushrooms

100 g green beans

10 g thyme, fresh

10 g rosemary, fresh

1 can (400 g net, 244 g drained) beans e.g. kidney, butter beans or cooked sugar beans, drained and rinsed

salt & pepper

1 tablespoon (15 ml) xylitol

2 cloves garlic

10 g Italian parsley

1 lemon

METHOD

  1. Peel and chop the onion and carrot, and slice the mushrooms and green beans.
  2. Place a large pot on a high heat and add the oil. Once hot, add the onion, mushroom and carrot and sauté for 2 minutes.
  3. Add the ostrich cubes, chopped tomato, wine and chopped herbs and reduce the heat to low.
  4. Allow the pot to simmer for about an hour, stirring occasionally, the sauce will reduce and thicken and the ostrich will soften. Once this happens, add the green beans and season with salt and pepper, add the xylitol and the can of beans & stir.
  5. Simmer the stew for another 5 minutes to cook the green beans.
  6. To make the gremolata, chop the fresh garlic finely, chop the parsley and zest the lemon. Mix the parsley garlic & lemon zest together.
  7. Serve the stew hot and sprinkle with the fresh gremolata.

NUTRITION INFORMATION PER SERVING

(recipe serves 4)

Energy: 1400 kJ Protein: 35.6 g Carbohydrate: 23.8 g Of which, total sugars: 9.1 g Fat: 6.7 g Fibre: 17.2 g Sodium: 180 mg

 

 


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


Get ready for National Braai Day!

In celebration of one of South Africa’s favourite past times (braaing) and the day dedicated to it (National Braai Day) our dietitians, Monique Piderit and Brigitte Leclercq, have put together some practical tips for a healthier braai:

  • A braai is a great excuse to get your greens in. Be creative when doing this, such as making interesting salads.
  • Try alternate your protein sources instead of only eating red meat, which may become boring after a while- try something like stuffed fish (stuff with nectarines for something different)- always make sure you are making a sustainable choice such as choosing fish from the green SASSI-approved list.
  • Grilled chicken and vegetable kebabs are an easy way to get your vegetable intake, without anyone noticing.
  • Have a healthy snack before you go out for a braai. This will prevent you from being overly hungry when you arrive and less tempted to over-eat on snacks. If you are hosting the braai, be sure to start your fire early enough to eat at a reasonable hour. The later the lunch, the longer you may sit mindlessly nibbling away on unhealthy snacks.
  • To keep your guests cool in the summer sun, serve cold water. Add colour and flavour using mint, lemon slices or strawberries, and top with lots of ice.
  • Choose chicken or fish over red meat. Select barbeque basting to still ensure flavour. Flavour your food with fresh herbs and spices, and limit the use of salt.
  • Leave condiments and toppings off starters, salads and side dishes. Substitute for flavour with lower fat condiments such as lemon juice, pepper, mustard, salsa and Tabasco. Make a potato salad with low-fat mayonnaise, or mix half mayo with low-fat yoghurt for a creamy alternative.
  • Surprisingly, even salads at a braai can be laden with unnecessary calories by the addition of croutons, bacon bits, cheeses and salad dressings. Look for garden salads with more vegetables than high fat ingredients. Fill up half of your plate with healthy salad and veggies.
  • Request that the host not dress the salad or ask for a portion before doing so. Add a splash of balsamic vinegar and olive oil and some black pepper instead of a pre-prepared salad dressing. Alternatively, offer to bring a salad to ensure you have a healthy option of veggies at the braai.

The weather promises to be amazing, so join friends and family to celebrate our heritage and braai!

 


Celebrating Heritage Day with Food!

Mpho Image.pngIn celebration on Heritage Day (24 September), ADSA member Mpho Tshukudu and food writer Anna Trapido, authors of the wonderful cookbook EAT TING, share one of their many ‘traditional recipes with a modern twist’ with us!

EAT TING will make you fall in love with timeless African flavours – while also improving your health and well-being. Lets celebrate our heritage and get cooking:

Modernised Dikgobe Salad of Red & White Sorghum, Fennel & Radish

Ingredients

(Serves 8)

2 cups wholegrain sorghum (red, white or a mix), rinsed

salt

1/2 cup cowpeas or letlhodi (mung beans)

1 large fennel bulb, cut lengthwise into thin slices

2 tbps olive oil

freshly ground black pepper

1/3 cup orange juice

1/4 cup lime juice

1 shallot or small onion, finely chopped

2 tbsp chopped fresh dill

1 tsp finely grated orange zest

1/2 cup olive oil

5 large radishes, thinly sliced

1/4 cup olives, pitted and halved

2 tbsp finely chopped fennel fronds

1/2 cup fresh dill sprigs

Method

Place sorghum in a pot, add water to cover by about 3cm and season with salt. Place cowpeas in a separate pot and add water to cover. Bring both pots to the boil, then reduce heat and simmer, uncovered, until tender and water is absorbed (about 45 minutes to 1 hour). Add additional water to the cowpeas if needed. Preheat the oven to 200˚C. Toss fennel slices and 2 tablespoons olive oil in a medium bowl to coat. Season with salt and freshly ground pepper. Spread fennel slices out in a single layer on a baking sheet. Roast until fennel is crisp-tender and beginning to brown in spots, about 18 minutes. Cool on baking sheet.

Whisk orange juice, lime juice, chopped shallot, dill and orange zest in a medium bowl. Whisk in 1/2 cup oil and season to taste with salt and pepper. Set vinaigrette aside.

Mix cooked sorghum and cowpeas in a salad bowl; add fennel and juices on baking sheet. Add radishes, olives, fennel fronds and dill sprigs. Drizzle vinaigrette over and toss to coat.

GI is lowered by the ascorbic acid in the fruit juices.

Nutritional values per serving

Energy: 834,6 kJ

Carbohydrate: 25,6 g

Protein: 6,3 g

Fat: 9,9 g

Unsaturated fat: 8,5 g

Saturated fat: 1,3 g

Fibre: 2,6 g

 


“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


‘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!!

 


New Recipe: Veggie Frittata

Our latest NutritionConfidence recipe (developed by chef Vanessa Marx) is quick, easy, packed with good nutrition, and a versatile choice for breakfast, brunch, lunch or dinner. It may sound exotic but a veggie frittata is really just a fancy omelette mixed with colourful vegetables and cooked in the oven.  Once you get comfortable making a frittata, branch out and make different flavours by swopping in seasonal vegetables like broccoli, cauliflower, tomatoes or spinach.

What the dietitian says: Eggs are a good source of high quality protein. They are also one of the few foods that contain high concentrations of Choline – essential for normal development and linked to improved memory and performance.

This recipe serves 8

INGREDIENTS

6 large free-range eggs

salt and pepper

1 tablespoon olive oil

½ a medium onion

½ a red pepper

2 courgettes

100 g mushrooms

100 g mozzarella, grated

50 g feta, crumbled

5 g Italian parsley, chopped

5 g fresh coriander, chopped

METHOD

  1. Preheat oven to 200°C.
  2. Beat the eggs together, season and set aside.
  3. Drizzle the olive oil into a large ovenproof, non-stick frying pan and set over medium heat on the stove.
  4. Slice up the onion, red pepper, courgettes and mushrooms.
  5. Add the sliced vegetables to the pan and fry until they begin to get a little colour.
  6. Add the beaten eggs and the cheese and mix slightly. Turn the heat down to medium-low and cook for three to five minutes until a crust begins to form on the bottom (do not stir the mixture).
  7. Place the pan in the oven and bake for 10 minutes until the mixture has set.
  8. Remove the pan from the oven and allow the frittata to cool slightly (five minutes).
  9. Tip the frittata out upside down onto a board or platter, sprinkle with the chopped parsley and coriander and serve warm.

NUTRITION INFORMATION: Per slice (8 slices per frittata)

Energy: 527 kJ Protein: 9.5 g Carbohydrate: 3.9 g Of which, total sugars: 2.6 g Fat: 9.6 g Fibre: 0.9 g Sodium: 195 mg


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.


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


“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.


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


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.


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.


“People don’t eat nutrients, they eat food” – Meet The Dietitian

Over the next couple of months we will be introducing you to some of the amazing dietitians we work with every day. We are going to find out why they became registered dietitians, what they love about their work, how they cope after a day of nutrition disaster and bad eating choices, and what people should look out for when choosing a dietitian.

Meet Nathalie Mat, a clinical dietitian in private practice.

Why did you become a Registered Dietitian?

I grew up in a family that loves and celebrates food but is also concerned with health. What really drew me to becoming a dietitian is that dietetics is based in science but requires artful skill for successful implementation. People don’t eat nutrients, they eat food and it’s my job to help interpret ever-evolving nutrition research into real food that people can eat and enjoy.

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

My heart absolutely sings when someone walks into my office looking vibrant and healthy and tells me how much better they feel – and all we did was fine tune their eating. I love seeing people transform their health and their relationship with food. It is wonderful seeing people achieve their goals and it is a privilege to share the journey with them.

What has been your career highlight?

Presenting my thesis at an international congress and receiving my masters in nutrition was a definite highlight. I’ve also really enjoyed serving as the ADSA Gauteng South chair and being part of my profession.

What are the most challenging aspects of your career?

Because everyone eats food, almost everyone has a theory on nutrition that is their own and is unique to them. Helping people find their individual recipe for health is my job – but I have to fight a lot of misperceptions. Just because something worked for your aunt/friend/colleague does not mean it’s right for someone with your genetic background or lifestyle.

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

Firstly, if I am making a slightly less healthy choice, I really savour and enjoy it. I think food is meant to be enjoyed! I then make sure that I get back on the healthy bandwagon as soon as possible; I do not wait for Monday. Life is about balance. Your arms and legs won’t fall off if you eat a chocolate; just make sure that you’re choosing chocolate 10-20% of the time and making healthy, balanced choices the other 80-90% of the time.

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

Everyone always asks for a quick tip to losing weight – I don’t mind answering but people tend to ask a second time because they do not like my answer of “Eat more vegetables”. It makes me laugh.

If someone meets me for the first time and we’re having a meal, they often say “please don’t watch what I’m eating”. If it’s Saturday night or after hours, I’m not on the clock. I love answering nutrition questions but I am not secretly calculating everyone’s kilojoule intake.

“I have ; what should I eat for that”? I do my best work when I am in my office; if you’re keen on getting quality nutrition advice, go and see your dietitian for an appointment. Not only can a dietitian miss important points while you’re both eating dinner or having coffee, you are not likely to remember everything that was said over a meal.

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

I think the most important aspect of working with any health professional is that they should hear you. Finding the right dietitian is like finding the right psychologist – you need to be on the same page. You’ve found the right dietitian for you if he/she can create a way of eating that is sustainable in the long term; is manageable (in terms of money, time and effort); and is tasty.

What is your favourite dish and your favourite treat food?

I love everything. I really enjoy eating a wide variety of cuisines and styles so my favourite dish can change every time I’m asked. I am loving fragrant Indian curries at the moment. In terms of a favourite treat, my parents are both Belgian so I think chocolate will always be one of my favourites.

Nathalie Mat completed her Bachelors in Dietetics at the University of Pretoria where she is completing her Masters. Nathalie has experience in both State and Private hospitals and clinics. As a qualified personal trainer and avid cook, she is able to translate up-to-date scientific information into practical and achievable goals for her patients. Nathalie has been published across a variety of media and platforms including CPD activities, Oprah Magazine, Business Day and e-tv. She has worked as a guest lecturer and enjoys a variety corporate work. She’s the treasurer and chair for the ADSA Gauteng South branch.


Quinoa & Fig Salad

With beautiful weather forecast for most of the country for the long weekend, our latest NutritionConfidence recipe “Quinoa & Fig Salad” is the perfect meal. We love the combination of sweet, salty and sour in this recipe. A lovely vegan main meal containing a good combination of protein, carbohydrate and healthy mono-unsaturated fats. Also perfect as a side salad for a braai this weekend!

Our Dietitians Say

Quinoa is a good source of fibre, folate, magnesium, manganese, phosphorus and B vitamins. It has an amino acid score of 106, which indicates a complete high-quality protein. Quinoa is also a good source of carbohydrate and contains roughly the same amount of carbohydrate than a 100 g portion of cooked brown rice.

And importantly, figs are currently in season here in South Africa and available at most grocery stores.

RECIPE

Serves 4

Ingredients

1 cup white quinoa

2 cups water

8 purple figs, cut into quarters

100 g walnuts, raw & unsalted

200 g mixed salad greens (rocket, baby spinach, watercress)

1/2 cucumber

120 ml extra virgin olive oil

50 ml white wine vinegar

1 tablespoon honey

1 teaspoon smooth Dijon mustard

How to make it

– Preheat the oven to 150 deg C.

– Put the quinoa & water into a medium saucepan on a medium heat. Cook the quinoa for about 20 minutes until it expands and opens slightly. Cook with the lid on. Remove from the heat and strain the excess water from the quinoa. Season with a pinch of salt and leave the quinoa to cool.

– Roast the walnuts on an oven proof tray for about 10 minutes, check on the walnuts now and then to make sure they don’t burn. Remove the nuts from the oven and leave to cool.

– Using a peeler, peel the cucumber to make long thin ribbons. Peel around the cucumber using only the firm outside parts. Discard the middle part of the cucumber with the seeds or eat as a snack.

– To make the dressing: whisk the vinegar, honey & mustard in a mixing bowl. Slowly drizzle the olive oil into the bowl, while continuously whisking to combine.

– Assemble the salad greens on a large plate or platter. Sprinkle the cooled quinoa over the salad leaves. Arrange the figs and cucumber ribbons on top of the salad. Sprinkle the roasted walnuts over the salad and drizzle with the dressing.

– Serve as a light main course or as a healthy side salad to your favourite dish.

The Nutritional Value serves 4

Energy: 2689 kJ

Protein: 11.3 g

Carbohydrate: 51.3 g

Total Fat: 44 g

Dietary Fibre: 41 g

Sodium: 8 mg


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


Salt Awareness Week 2015

This week is Salt Awareness Week. My Kitchen magazine’s Lauren Shapiro chatted to ADSA spokesperson and Registered Dietitian, Alpha Rasekhala, about thinking twice before grabbing that salt shaker:

Salt_MyKitchen_2015

Also visit http://www.saltwatch.co.za

MK Mar Cover


Skipping breakfast will do more than damage your health

It’s 6am, you are up and about and ready to start your day, but have no appetite or time to eat breakfast, and so you decide to postpone eating until the next meal of the day, which is only at 12pm. In essence, choosing not to eat breakfast means you are consciously making the decision to hamper your health as well as your performance at work or even at home. Perhaps it’s because you want to lose a few kilos?

Registered Dietitian Nathalie Mat puts that weight-loss myth to rest and explains how, by not eating breakfast, you are in fact depriving your body of sufficient nutrients that it needs in order to function on a daily basis. “Our bodies are not given any food overnight while sleeping, the first meal of the day helps to get our body started and get our metabolisms going,” says Mat. “Skipping breakfast is associated with higher weight gain and poorer performance.”

Perhaps you struggle to gulp down a meal in the morning due to the fact that you simply do not possess an appetite at that time. According to Mat, you are not alone: “Many people report having no appetite in the morning. I often find this is because they are eating too large a dinner. Reducing the size of your dinner may improve your morning appetite.” Choosing healthy foods that form a balanced meal will ensure your blood sugar levels are consistent meaning you won’t burn out later that morning, which is often the case.

“A healthy breakfast is a balanced one that includes a mix of wholegrain starchy foods (such as high fibre cereals, porridge, wholegrain or sourdough bread and even legumes like as beans or chickpeas) and protein rich foods (such as dairy products, eggs, lean meats or fish),” says Mat. “For example, it could be oats porridge with low fat milk, bran rich cereal with milk or wholegrain bread with some cheese, egg, beans or even peanut butter.” You can also add fruit to your breakfast. Fruit is a natural source of sugar but should be consumed as fresh fruit rather than juice if you want to control your blood sugar levels well.

Not only will eating a decent breakfast improve your performance throughout the day, but sustaining a lifestyle that is balanced in general will put diseases like cancer, strokes and heart attacks at bay. “Poor diet, physical inactivity and smoking are believed to contribute to those conditions,” says Mat. “These can be prevented by managing your lifestyle choices.”

The sooner you make the first step by eating the first, crucial meal of the day, the sooner you will begin living a more health and vitality-filled life.