Success Story: Zandra Sissing

ADSA_Success Story_Zandra DixonHaving been a runner from a young age, Zandra always thought “I can eat what I like” and just run it off …. until she couldn’t.  She met up with registered dietitian Maryke Gallagher to help her develop better eating habits that would complement her training and recently completed her first ever Half Ironman triathlon. Here is her story:

Why did you decide to see a dietitian? (The Before Story)

At the age of 38 I hurt my knee while running, and three months later had surgery.  I was off exercise for over six months, and during that time I ate: depression from a difficult relationship, depression from not being able to get out there and run, poor eating habits within the household.  My blood sugar and cortisol levels had gotten so disrupted I used to keep a glucose monitor with me.

Fast forward some time and I started training again, but was struggling to shake the weight.  Nothing I did helped, and if I wanted to keep the knee and joints healthy, I needed to do something.  I was referred to Maryke by my coach and that’s when my life changed.

Tell us about your journey with the dietitian

Firstly, I have an unpredictable schedule and she was so accommodating. Most of our communication was Skype, telephonic or whatsapp. Maryke took all this in her stride.

I have always thought I ate correctly, and had tried banting with no great success. Maryke taught me balance, how to realise when I was emotionally eating (and how to fix that).  She taught me how to include that one (or two) glasses of wine a week. Best of all, she taught me how to adapt my meals to meet my ever-changing schedule.  She did not give me an eating plan, she taught me which choices to make to suit MY body.  This sounds strange but even for my pre-run snack we went back and forth on options until I knew BOTH what worked for me and what I liked.

Tell us about your results / successes

My results were the things a runner dreams of: steady and consistent.  From a start of 74 kg I lost 6 kg to reach my goal of 68kgs.  I remember sending her the picture of the scale at 67.9kgs with great excitement.

I stopped looking at the scale but in my head I wondered if I could reach 66kgs, which my run coach had advised would be a good weight for me. It was a month later when I got on the scale and there it was: 66kgs!

I had lost almost 10% of my original weight, and a total of 9% body fat.  All the while enjoying life.

Since then, I have got married, moved home and changed jobs, changed countries and damaged a ligament in my foot. All these things combined have meant I could once again not run for a while.  The best part about having all the skills taught to me by Maryke is that I didn’t pick up the weight again.  I was able to deal with anything and still be healthy and happy.

What was the hardest part of the journey?

Starting out is the hardest part. The first weeks as you are learning and adapting. If you are consistent in the first few weeks, you see results and that really motivated me to keep going.  Think long term and not short term, because you want these results to last.  Changing my mindset to one that includes better carbs and fats.  Learning to remember that I need to eat for my body, and not for what works for someone else.

What are the top three tips you can share?

  • Don’t design your eating from what you read on Google/social media/books. A dietitian takes years of study and trains to put this learning into something unique for you.  Different bodies, different solutions.  Do not be caught up thinking you need to do your eating in a “specific way”.
  • Make sure you like what you are eating. You should not resent the food but enjoy a meal. Slow down your eating, enjoy the flavours and you will find yourself eating less.
  • If you  need that 5pm snack, plan it in.  Many a time the snack suggested by Maryke has prevented a ‘carb’ craving dinner (you know that one where you walk in the door and open the cupboard, ready to consume anything ).  I now carry snacks with me every day to work.

What the dietitian says

I met Zandra for the first time through a Triathlon club meeting and noticed her bubbly and determined personality. A few months later she contacted me to assist her with her diet and weight loss goals – for health reasons and to achieve her training goals. She was motivated and questioning, willing to work through the main areas in her diet and lifestyle that were hindering her to achieve her goals. She was willing to let go of the ‘all or nothing’ approach of certain food groups and foods being ‘bad’ or ‘good’, to eating habits that are best for her personal needs. Seeing her achieve her weight loss goals slowly but surely, and most of all being able to make the necessary changes and develop a healthy relationship with food and her body was very rewarding! Thank you Zandra for choosing me to help you in this journey.

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

 

 


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

 


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

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

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

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

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

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

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

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

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

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

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

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

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


Raising Superheroes – Book Review*

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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