‘Making a contribution to the bigger health picture’

ADSA_NeilStephens2017a_1We chatted to Neil Stephen, Chief Dietitian at Addington Hospital in Durban, to find out why he became a dietitian, what he loves about his work and what the challenges are:

Why did you become a Registered Dietitian?

I developed an interest in nutrition when someone at the gym suggested I should see a dietitian to improve my performance.  I asked my parents if they knew of any dietitians and they told me that my cousin Nathan was one.  Later I decided to change from a general BSc to BSc Dietetics.  I was going to pursue a career in sports nutrition… which is the last thing I am interested in now.  To my surprise I was one of very few males in the class,  I had no idea that dietitians were mostly female!

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

I have quite a diverse range of areas I really love.  Top of the list is child health, followed by critical care, maternal health, student training and lastly, monitoring and evaluation of health systems and programmes (I’m a bit of a nerd).  I work daily with patients who have very little or nothing.  These patients are so humble and appreciative of any assistance you give them, whether its counselling or treatment.  The most satisfying moments are when I bump into moms with their young children or babies, who stop me, and they proudly tell me they are still breastfeeding. Another is when an acutely ill malnourished child improves over night and I know that nutrition has greatly contributed to the positive outcome.  Finally, its awesome speaking to previous interns and finding out they are succeeding at what they do. 

What has been your career highlight?

Well I started to collect data on every patient I treated when I started working.  I had a good amount of information per patient.  I put together a cool spreadsheet in excel to do my monthly stats for me, and eventually got my whole department on to it.  After a few years I decided to study further and used the information I had been collecting over the years.  So a highlight was definitely that I was selected to present my research for the MEC and Head of the KZN Department of Health.  Being selected really made me feel like I was valued and was making a contribution to the bigger health picture. 

What are the most challenging aspects of your career?

I think that for me its been a long journey of challenges and realisations which have grown me into the dietitian I am today.  Working in the public sector, I experience first hand the outcomes of social and economic  issues that face the general population on a daily basis.  It is heartbreaking to find that children are severely malnourished purely because they have a limited access to food.  A large proportion of patients of all ages are referred for HIV related problems which are often hard to manage and outcomes may be poor.  I need to mention that I love pregnant moms, children, and critically ill patients because they almost always accept advice and are compliant – the challenge is the patient who is resistant to change, because they don’t embrace the importance of lifestyle and dietary change.

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

Hahaha, I usually just take a nap.

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

  • How can I lose the fat on my….(insert body part!!)???
  • Isn’t there some kind of a pill or something I can take??
  • I don’t eat carbs.

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

Dietitians are all equally qualified to treat any patient presented to them.  If you have a specific need, some dietitians will list their special interests, one of which you may be looking for. 

What is your favourite dish and your favourite treat food?

  • Favourite dish – Butter Chicken Curry with garlic butter naan bread
  • Favourite treat food – chocolate mousse (I can eat it by the litre)

 

Read more about the career of a registered dietitian: Is a career as a dietitian for you?

 


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

 


Meet the new ADSA President!

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

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

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

Why did you become a Registered Dietitian?

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

 

 


Why breastfeeding and work can, and should, go together

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

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

 

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

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

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

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

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

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

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

‘I feel healthier, fitter and more energetic!’

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

ADSA_AdrienneBewsher

Tell us about your journey with the dietitian

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

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

Tell us about your results

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

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

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

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

What was the hardest part of the journey?

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

What are the top three tips you can share?

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

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

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

What the dietitian says

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

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


Turnip Tagliatelle with Chicken & Herb Sauce

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

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

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

INGREDIENTS

(serves 4)

4 medium turnips

4 teaspoons olive oil, divided

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

4 leeks

250 g mushrooms

2 teaspoons crushed garlic

½ cup plain yoghurt

2 large eggs

30 ml fresh chopped parsley

¼ cup grated parmesan cheese

Salt and pepper, to season

METHOD

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

 

Nutrition Information: Per serving

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

 

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

 


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

 


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

What your dietitian wants you to know about diabetes

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

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

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

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

There are foods that should be avoided completely.

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

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

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

Eating too much sugar causes diabetes.

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

 People with diabetes cannot eat carbohydrates.

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

People with diabetes should restrict their fruit intake.

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

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

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

If I have diabetes, I can’t exercise.

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

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

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

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

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

 


Navigating the journey to healthy living

adsa-spokesperson_alpha-rasekhala

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

Why did you become a Registered Dietitian?

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

What do you enjoy most about the work you do?

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

What are the most satisfying moments?

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

What have been your career highlights?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

My favourite treat is strawberry cheese cake.

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


“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.

 

 


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

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

Why did you become a Registered Dietitian?

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

 

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

 

 


Why breastfeeding should be everybody’s business

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

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

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

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

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

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

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

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

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

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

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

 

Breastfeeding support is available in South Africa:

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

 

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

 


It is never too early to change to a healthy lifestyle

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

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

Tell us about your journey with the dietitian?

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

Tell us about your results?

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

What was the hardest part of the journey?

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

What are the top three tips you can share?

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

Feedback from Chad’s dietitian, Zelda Ackerman

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

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


“I love the versatility our profession”

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

Why did you become a Registered Dietitian?

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

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

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

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

 

 


The Importance of Healthy Eating to Corporate Wellness

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

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

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

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

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

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

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

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

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


‘Balance is key!’ Our latest success story

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

Tell us about your journey with the dietitian?

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

Tell us about your results?

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

What was the hardest part of the journey?

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

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

What are the top three tips you can share?

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

What the dietitian says

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

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

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

Well Done Robyn!

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


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

ADSA Spokesperson_Faaizah Laher_1

Why did you become a Registered Dietitian?

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

 


Healthy Nutrition during Pregnancy

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

Tell us about your journey with the dietician? 

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

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

Wow did I have a lot to learn !!

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

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

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

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

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

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

 Tell us about your results? 

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

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

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

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

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

 What was the hardest part of the journey? 

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

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

What are the top 3 tips you can share? 

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

Feedback from the Alex Royal

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


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

ADSA Spokesperson_Hlanzeka Mpanza_1Why did you become a Registered Dietitian?

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

Are you really going to eat that?

How do I gain muscle or lose weight?

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

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

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

What is your favourite dish and your favourite treat food?

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


How can a Dietitian guide you through the Nutrition Minefield?

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

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

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

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

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

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

Did you know?

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

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

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

Trust a Dietitian


“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


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.


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

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

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

Why did you become a Registered Dietitian?

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

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

Treat food: ice-cream that contains icicles.


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

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

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

Why did you become a registered dietitian?

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

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

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

What has been your career highlight?

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

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

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

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

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

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

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


“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.


Healthy eating, healthy living in 2015!

Signing up for the gym, eating more tuna and drinking 9 cups of water per day are the seasonal New Year’s resolutions that sit on the top of South African lists. Not to say eating healthier and exercising on a regular basis are not top priorities, but going on a whim when it comes to your health based on what you see on TV and the internet will see those resolutions be pushed down the list as the year progresses.

This is because simply downloading a meal plan for a quick fix diet will not necessarily work for your body, since most of the time they are generalised templates. Seeking expert advice from a Registered Dietitian should replace your first New Year’s resolution on your healthy list and this is where the Association for Dietetics in South Africa (ADSA) plays a vital role.

Consulting a Registered Dietitian (RD) will ensure that you get professional guidance as well as an analysis of what is best for your specific needs with regards to eating and gaining optimum health. “A Registered Dietitian is a trained professional in the nutrition field, providing expert advice and support to ensure you embody a balanced healthy lifestyle as a permanent one. It is essential for consumers to ask for a Registered Dietitian in order to receive nutrition info they can trust”, says Claire Julsing-Strydom, ADSA President.

A Registered Dietitian is:

  • A qualified health professional registered with the HPCSA
  • Has a minimum qualification of a four year scientific degree
  • Has been trained in all aspects and fields of nutrition therapy

Registered Dietitians are involved in many different fields and areas of expertise including: Private Practising Dietitians, Therapeutic Dietitians (who mainly work in a hospital setting), Community Dietitians (who work in the public sector) and Food Service Management (managing healthy and specialised diets in institutions).

Nutrition is a science and there isn’t one solution that fits everyone. Registered Dietitians are the recognised experts in the field of evidence-based nutrition and will develop personalised nutrition plans for each one of their clients to ensure that they are able to stick to the plan and reach their goals. “Consumers need to be aware that there are many unscientific health and nutrition gimmicks around, with new fad diets launching all the time”, concludes Julsing-Strydom.

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