Meet the Dietitian: Community service series

By Kinza Hussain

 

I always say the profession of dietetics chose me. After completing a 3-year B.Sc degree in Biochemistry, I attended the Honors evening at the University of Cape Town to figure out what my next step would be. I was always intrigued by the medical field but when I heard what an honours degree in nutrition and dietetics could offer me, it was love at first sound!

I loved the idea of working in a hospital setting and more so, I was fascinated by the role nutrition plays in health and disease in both critical and stable phases. For this reason, I completed a rather stressful (to say the least) two-year honours degree and graduated as a dietitian in 2017.

 

It took a year before I got a post to do my community service and during this year, I explored the other branches of dietetics, namely fitness, research and healthy cooking. Instead of losing hope of one day practising as a clinical dietitian, I grew even fonder of the field and was convinced more than ever that this path was for me.

February 2019, I finally got placed at Kopanong Hospital in Vereeniging, Gauteng. I am responsible for part of the pediatric ward where I overlook a spread of diagnoses. From Severely Acute Malnourished babies to obese children to lactation consulting. I am also responsible for the female medical ward and the surgical ward. Here I see to the management of non-communicable diseases as well as the numerous indications that lead to nasogastric feeding in adults.

Although it is not my responsibility, I sometimes get given the opportunity to manage infectious diseases such as HIV/TB to remind me of how broad this field really is.

Being placed in an Afrikaans speaking community, the initial stages of my job was quite challenging due to the fact that I do not speak or understand the language at all (originally being from Zimbabwe). My other challenge was mastering the art of doing all that I can with all that I have. Once I overcame these two main challenges, I really found myself truly enjoying my work. The grand pediatric ward round which includes the entire multidisciplinary team kicks off my week every Monday morning.

Not only does nutrition play an ample role in the patient’s management, but how it ties in with other spheres of treatment such as the rehab input from occupational therapists and physiotherapists really fascinates me. I also love the fact that I am still learning. From my fellow dietitians in my field and from the doctors as I nutritionally manage a patient.

More than halfway into my community service year, do I have any words of encouragement? Definitely!

  • Getting into this year, know that your experience is going to be similar but different. You may face the same challenges as everyone else but how you handle them is what will make your journey unique. I would say don’t let these challenges dim your sparkle.
  • Continue and complete this year with the same enthusiasm as you started it. There may be days you’ll feel otherwise but you will be making a difference in lives as you hoped to.
  • Don’t underestimate the small but valuable extra effort you make for your patient. It goes a long way for them and their recovery.
  • Always respond to your gut feeling. If something bothers you while managing a patient, speak up. And speak again. And again.
  • Ninety-nine percent of the time, you will pick up on missed ques which can literally save a life!
  • Develop and maintain a good working relationship with the nursing staff of your hospital. They run the hospital and if you want to successfully manage a patient, their support will help you achieve that.
  • Lastly, while you enjoy what will most probably be one of the best years of your life in terms of personal and professional growth, be sure to let it all out. When your first patient passes on, you may think you’re alright but it has a way of surfacing way later. Be sure to allow yourself to heal so that you can continue improving lives…with your nutritional and dietetic powers!

All my best wishes ☺


Meet the Dietitian: Nadine van Niekerk

Inspirational Dietitians Nadine van Niekerk and Stefanie du Plessis make a huge impact in their area (Bethlehem, Free State) by going above and beyond their job description of Dietitians. They empower, encourage and equip their patients and colleagues and frequently reach the papers for the impact they are having.

We spoke to them both and decided to launch both their ‘Meet the Dietitians’ on the same day! Read on and be inspired.

 

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Why did you become a Registered Dietitian?

I had thought a lot about what career path to choose in school, and after shadowing a lot of different careers I ended up choosing dietetics. I love the science and research behind it and I was fascinated by the physiological effect of food on the human body. And I just love eating!

Where did you study (degree and/ or postgrad)?

I studied at North-West University, Potchefstroom campus and completed my B.Sc. Dietetics degree in 2010.

Where do you work and what does your job entail?

I am a dietitian for the department of health, stationed at Dihlabeng Regional Hospital in Bethlehem in the Free State.

The Hospital is Regional and caters to a large community. It offers all specialised fields of medicine, from intensive care, surgical, orthopaedic, gynaecological, paediatric, obstetric, medical and outpatient services. As the dietitian, I tend all wards rotationally and ensure all nutritional needs are met, especially in critical care, surgical and paediatric wards. I am also responsible for product selection and prescription.

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

What I enjoy most is really feeding the patients that cannot feed themselves. Critical care is my passion and I love ensuring those that cannot speak for themselves are taken care of. Ensuring our ICU discharges survivors, not victims is basically our focus and what we strive for, focusing on early effective nutrition and ensuring better outcomes.

I also love working with the premature unit and being involved in breastmilk banking and striving for a formula free unit. Breastfeeding advocate is an understatement! We make a very big deal of breastfeeding week and always try to go the extra mile when promoting. Debunking all the terrible myths around breastfeeding is a very high priority.

We also organise a big event each year to ensure more people are aware of the benefits of breastfeeding and why we are so obsessed with it. We usually use all proceeds from sales for our own lodger mothers and NICU, as the unit is so close to our hearts. This year we raised over R 5000 in the breastfeeding event, which really focused on the empowering role breastfeeding plays.

We used the proceeds for toiletry packs to improve the personal hygiene in the unit and also just to treat the moms to something nice, as we are expecting so much of them. The toiletry project is ongoing, so we also encourage anyone interested to contact us for more details with regards to donating.

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My most satisfying moments are seeing patients leave the hospital in better condition than they arrived, helping mothers reach breastfeeding goals and making a difference in people’s lives that would otherwise be unable to afford your services.

At this year’s breastfeeding event we also let mothers get the opportunity to take professional portraits of themselves in a professional studio setting by an accomplished photographer. The point was to remind all women of how beautiful they are and just to boost their confidence. The photos came out more beautiful than we ever imagined. Giving opportunities to people that would maybe otherwise not have been able to have them, is I think, by far the most satisfying aspect of my job. Government work is really what I love to do and I am so thankful that I have the opportunity to work for the Department.

What has been your career highlight?

That’s a hard one! I think this year’s breastfeeding event and all that was achieved and all the money raised is something I am very proud of. But also each year offers a new highlight, we have really also made our mark in the Hospital and are at an all-time high when looking at in-hospital referrals and ensuring no patients fall through the cracks.

 

What are the most challenging aspects of your career?

Working in Government you sometimes have to make difficult choices with regards to stock availability and you have to be flexible due to budget restrictions. I also find the Intern doctors very challenging, hahaha 😉. Having to go through the same routine each year to ensure proper referrals is often exhausting.

  • What are the three things that you think people should stop saying when they meet a dietitian?
    Oh my word don’t look at what I am eating!
    Can I quickly ask you something?
    What do you do all day in a hospital?

Meet the Dietitian: Stefanie du Plessis

Inspirational Dietitians Stefanie du Plessis and Nadine van Niekerk make a huge impact in their area (Bethlehem, Free State) by going above and beyond their job description of Dietitians. They empower, encourage and equip their patients and colleagues and frequently reach the papers for the impact they are having.

We spoke to them both and decided to launch both their ‘Meet the Dietitians’ on the same day! Read on and be inspired.

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Why did you become a Registered Dietitian?

I was interested in a career in health and dietetics was brought under my attention and I immediately knew that was what I wanted to do, especially the type of work that a hospital dietitian did.

 

Where did you study?

I studied at the University of the Free State in Bloemfontein and completed my degree in 2008.

 

Where do you work and what does your job entail?

I work at Dihlabeng Regional Hospital in Bethlehem. It’s a level 2 hospital which serves a very large community and offers a variety of services which includes intensive care for adults and neonates, surgery, medical, orthopaedics, paediatrics, obstetrics, renal as well as an outpatient department. We are 2 permanent dieticians at the hospital and we rotate between all the departments on a weekly or monthly basis. We are very fortunate to gain experience in all the different specialised fields that the hospital offers.

I am also responsible for managing the budgets for the Dietetic Department, monitoring stock levels and placing orders to ensure that sufficient stock is always available.

I also attend all management related meetings and I am responsible for all Quality improvement programs involving the Dietetic Department.

 

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

The part that I enjoy the most is definitely feeding the critically ill patients, doing a thorough assessment of their condition, calculating their nutritional requirements and choosing a suitable product. Working in the paediatric ward is also a part of my work that I enjoy a lot, especially tending to the severely malnourished babies and children. With both of these scopes of patients, it’s very gratifying to see the big difference that proper nutrition can make in a short while and see my patients going home in a better condition.

Dihlabeng is a Mother and Baby Friendly hospital so I also have a lot of passion for breastfeeding and everything that goes with it. We really strive towards enabling all mothers to breastfeed successfully before they leave our hospital. We recently had a big event for World Breastfeeding Week where the aim was to empower parents and this then leads to a mother being able to successfully breastfeed her baby and to continue at home.

All the proceeds made on the day was used for our newly established Toiletry Project for the lodger mothers in the Neonatal Intensive Care Unit. The aim of the project is to supply all the mothers with basic necessities for their stay in NICU.

Toiletry packs containing all the goodies for both mother and the baby

These mothers do so much for their tiny babies and sometimes stay there for up to 3 months (sometimes longer). We recognised the need to do something special for the mothers and that’s when the Project was born. We would like this to be an ongoing project, so anyone who is interested in donating or becoming involved in any way is more than welcome to contact us.

Furthermore, I also enjoy and appreciate the fact that we, at Dihlabeng Hospital, are able to work very well together as a multi-disciplinary team. This really makes all our jobs much easier. Especially me and my colleague, Nadine van Niekerk, we really work well together as a team to ensure that the Dietetics Department is run as smoothly and well as possible!
What has been your career highlight?

Wow, there are so many! But one of the highlights is definitely being accredited as a Mother and Baby Friendly Hospital in 2016. All of our staff put in a lot of effort and hard work to achieve this, so this was a very proud moment for us all.

And then, of course, our Breastfeeding Empowerment Day that we held for World Breastfeeding this year. It was a very gratifying experience for us as the dieticians and staff of DRH to be able to do this to show our support and dedication to breastfeeding!

 

What are the most challenging aspects of your career?

It can be challenging to plan and decide which nutritional products to order due to dealing with budget constraints, but this also keeps our work interesting.

 

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

  • You’re a dietitian and you are eating that???
  • Can you give me a diet?
  • Asking about detox diets.

Diabetes in the family – It’s All for One, and One for All

 

A diagnosis of diabetes in the family comes as a shock and sets in motion a range of emotional and practical lifestyle changes. How well you come together as a family to master those changes, not only restores peace in the home, but also positively impacts on the ongoing well-being of your loved one with diabetes. Diabetes is a chronic lifelong condition but with good medical care and through education to empower more effective self-management of the condition, the potential complications can be prevented or delayed. According to the World Diabetes Day campaign which is featured on the 14th of November, it is the world’s leading cause of blindness, amputation, heart disease, kidney failure and early death. However, maintaining healthy blood glucose, blood pressure and cholesterol levels can help delay or prevent such diabetes complications.

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ADSA (Association for Dietetics in South Africa) spokesperson, Liana Grobbelaar, who works at the Centre for Diabetes & Endocrinology, points out that knowing what to eat, and how much to eat is one of the most challenging parts of managing the treatment plan of a family member. “Getting the whole family on board makes it easier for the person with diabetes to stay healthy,” she says. “It breaks the isolation that comes with being the sole member whose plate looks different, for one thing. But there’s another positive effect – everyone else can get healthier, too.”

 

The reason for this, Liana points out, is that there is actually no ‘diabetic diet’. Instead, the person living with diabetes and their family, find themselves on a journey of understanding the impact of different foods on blood glucose levels and health. “Healthy eating should be for everyone, with or without diabetes,” says Liana. “It’s actually an ideal opportunity to take positive steps to adopting a healthy family lifestyle. You can transform the negative into positive by educating your whole family to help them understand the importance of making the necessary changes, healthy choices and to be more supportive.”

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Psychologist, Rosemary Flynn also emphasises the importance of family-wide support. “The way each member of the family responds to the necessary changes influences how well the person with diabetes will accept and manage their condition,” she says. “If they feel criticised and devalued because of their condition, they can feel alienated and resentful. If they feel empathy and support from the family, they will have the encouragement to embrace their treatment management in an effective way.”

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Knowledge is power

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Understanding diabetes, its symptoms, treatment and lifestyle impacts is key for the whole family. All people with diabetes should be offered a referral for individualised nutritional education provided by a registered dietitian with experience in diabetes management.
Registered dietitians are uniquely skilled in equipping people living with diabetes with the knowledge to better understand the impact of food choices on blood glucose levels and overall health, which can lead to improvements in quality of life. A registered dietitian will take into account factors like culture, religion, age, other health conditions, medications and your finances, food preferences and family dynamics which will influence the approach that will work best for you and your family.

 

Practical tips for families with a loved one with diabetes include:

  • Choose healthier carbohydrates – All carbohydrates tend to raise blood glucose levels, but some carbohydrate sources provide nutrients important for health. Focus on high fibre carbohydrate sources such as vegetables, fruits, whole grains, unsweetened dairy products and legumes such as chickpeas, beans, peas and lentils instead of refined carbohydrates with added sugar, fat and salt. From a blood glucose perspective, the portion size of these foods is critical.
  • Eat a rainbow of vegetables and fruit – Vegetables, particularly non-starchy vegetables, contain much bulk relative to the amount of energy they provide. They also contain phytonutrients or plant chemicals that play many vital roles in the body including behaving as antioxidants (repairing the body from daily damage) and stimulating a good immune system response. Although fruits also contain these properties, they do contain natural sugars which can affect your blood glucose management, so, don’t eat fruit to excess.
  • Swop out red fatty and processed meat with healthier alternatives – Replace red, fatty and processed meat with protein-rich legumes such as beans and lentils, as well as eggs, fish and poultry.
  • Choose heart healthy fats – Fats are an essential component of one’s daily food intake. But, the type and quality of the fats you consume is vital. Eat foods rich in long chain omega-3 fatty acids or anti-inflammatory fats found in naturally fatty-fleshed fish like mackerel, pilchards, sardines, salmon, trout and herring, at least twice a week. Reduce your intake of saturated fats such as animal fats, coconut and palm kernel oils. Rather choose mono-unsaturated fats like olive or canola oils, avocado, olives and nuts. Remember that fats are a concentrated source of energy and should only be used in small amounts.
  • Treat any new foods as an experiment – test your blood glucose before and after trying out something new to understand the effect of your food choices on blood glucose levels.

Meet the Dietitian: Community service edition

By Marlize Erasmus

Every 4th-year Dietetics student experience feelings of stress, anxiety and excitement when making the decision of where to do their community service year. I googled every hospital on the list, trying to figure out where to go. I got my first choice (believe it or not) – a rural hospital (Connie Vorster Memorial District Hospital) in a small town called Hartswater in the Northern-Cape. This is where driving past cows and chickens on your way to the clinic is a daily norm.

The first time I heard about dietetics was from my grade 9 teacher when I had to do an assignment on what career to follow. I decided to shadow a clinical Dietitian in grade 11 and got intrigued by the profession. It wasn’t until my first year while studying dietetics at the Potchefstroom Campus of the North-West University that I knew I made the right choice. I realised that dietetics is my passion.

I did not really know what to expect when I started. I quickly realised that this was nothing like that perfect picture of dietetics that you have while studying. Especially when you are working in a place with severely limited funding and resources with communities in extreme poverty. This makes both spectrums of under-and-over nutrition (Obesity and Non-Communicable Diseases as well as a high prevalence of Severe Acute Malnutrition) major problems in the communities in the area.

I originally felt estranged to dietetics because working in rural is nothing like the bigger hospitals I was used to when I did my internship. Something important to know is that working in a rural hospital means there is no such thing as parenteral nutrition, fancy surgeries or certain wards like ICU or Renal. You are working with the basics.

I was not enthusiastic about community nutrition at varsity so I felt a bit discouraged when I found out that half of my time this year would entail working in the clinics. I developed a new kind of appreciation and love for working in the community. Community nutrition started to change me. It is especially in rural communities where dietitians are extremely needed. Working in the community can be challenging but the reward is sweet when you can see you’ve made a difference. I came to love going out into the community to fetch a SAM kiddie, to do outreaches and health talks and to work at a hospital alongside people who make the hard days better. I believe it was God’s plan that I got placed in Hartswater. This has shaped me into a better Dietitian and a better version of myself.

No matter at what hospital you are or what type of dietetics work you do, it is always important to realise that at the end of the day your happiness as a human being is a necessity. This is not only a year for practical experience in the dietetic profession but a year of personal growth and new adventures. Be open-minded as you step into the unknown.

 


Meet the Dietitian: Karla Pretorius

Not only is Karla Pretorius a Dietitian; she is also a Protea netball player, vice-captain and announced as the Player of the Tournament at the Netball World Champs earlier this year! Thank you Karla for flying the Dietetic flag high.

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Karla Pretorius:

My participation as an elite netball athlete in the professional world of sports has increased my awareness and understanding of the indispensable importance of nutrition in the lives of both individuals and communities. The effective implementation of nutrition knowledge can drastically enhance the quality of every individual’s life, including athletes performance and overall wellbeing.

My path first crossed with nutrition as a science during my undergraduate studies at the University of the Free State (Kovsies) in Bloemfontein. I would later also complete my masters in dietetics and nutrition at the institution. This quaint city, located in the wide-open gold plains of the Free State proved to be a great learning experience, both on and of the court.

Balancing full-time studies with the close to year-round netball season, both domestically for Kovsies and the Free State Crinums and nationally for the Proteas proved challenging at times. Although challenging, the opportunities presented by netball could not be turned down. With support from various stakeholders and determination, I was able to manage both. I strongly encourage all athletes to pursue further studies whilst working towards their personal sporting goals. With hard work, a good balancing act and support it can be done. Also, do not be ashamed to ask for help and assistance along the way. I am most grateful for the time spent at Kovsies, playing for the university team in the Varsity Cup Netball league and at the University Sport South Africa Games.

At the end of 2016, I was approached to join the Sunshine Coast Lightning netball club in their inaugural season in the Australian premier league, the Suncorp Super Netball League. This marked my entry into the sport as a Professional Netballer. The club managed to secure two consecutive wins in the premier league in 2017 and 2018. We are currently continuing our campaign for the 2019 season, after a month-long break for the 2019 INF World Cup in Liverpool. The Spar Proteas, which I am honoured to vice-captain, excelled in the tournament by managing a win over number 2 ranked Jamaica and achieving an overall 4th place.

Noting that Netball is not a professional sport in South Africa, many athletes wanting to pursue a career as a professional netballer are necessitated to look abroad for opportunities in professional leagues, most notably in Australia, England and New
Zealand.

And that is what I did, firstly with a move to England to represent Team Bath, and later on the Sunshine Coast Lightning in Australia. The move abroad also meant that I had to temporarily sacrifice my professional career as a full-time dietician.
Remaining informed of developments in the field of dietetics and adding to my skills and knowledge compelled me to read towards my masters, enrol for online courses, and to do community volunteer work abroad.

Dietetics and nutrition should be incorporated in every high-performance sport and environment, including netball. From my experience, I found that the importance thereof is underestimated and valued in South African netball. There is a clear difference in the value-added to the role and profession of a dietician in the amateur league of netball in South Africa compared to the professional league in Australia.

The main objective for our team dietician, and myself, is to ensure that I am ‘nutritionally healthy’, whereby my performance is maximised. This is achieved by the development and implementation of practical nutrition strategies, guidelines and policies. The rewards of effective use and implementation of nutrition strategy have ensured that I reach my goals, enhance my performance and recovery and minimise
injury risk.

 

Vitality Netball World Cup: SPAR Proteas v Trinidad and Tobago


Meet the Dietitian: Community service series

Dietetics might have been my plan B, but it turned out to be the (B)est plan yet!

 

By Carmyn Gast

 

Nutrition has been known to play a key part in good health since the time of ancient Greeks, with Hippocrates famously writing “Let thy food be thy medicine, thy medicine be thy food” in the 5th century BC. However, the profession of dietetics itself is relatively young, having only been put in the forefront of patient care by Florence Nightingale and Alexis Soyer during the Crimean War in the 19th century. And it was only in 1974 in South Africa that the Health Professions Act officialised Dietetics as a profession.

So being a dietitian means that you’re also a pioneer in this profession – an exciting but sometimes frightening experience. Which is exactly what I felt like when I walked into the very rural district hospital in KwaZulu Natal on the first day of my community service year. As the only dietitian in the hospital, I was immediately given all of the responsibilities of running an entire Dietetics Department. From consulting with and managing all the in-patients and out-patients, to budgeting and controlling all the nutritional feed stock, to auditing the hospital kitchen and the surrounding clinics, to supervising and assisting the Nutrition Advisors (something unique to KwaZulu Natal), to doing seemingly never-ending administration tasks and statistics, to training fellow health care professionals on nutrition, to advocating for patients’ nutritional health at meetings, to learning the local isiZulu language to be able to communicate with patients – there was (and still is) always something more to do and something more to learn.

The most important thing I have learned thus far is to always remember your heart. The nature of our job is to deal with people, and people are extremely complex and they often only encounter us when they’re not feeling well. Unfortunately the public healthcare system is under immense pressure in our country so most health care professionals only spend a handful of minutes with each patient before moving on to the next patient. So I consider it a privilege that, as a dietitian, I get to spend more time with patients. It gives me great joy to be able to sit down, talk with and really get to know my patients. After all, food and nutrition is such a personal thing – it gives you a real understanding of a person and their life. And this enables you to meaningfully and effectively help a patient to reach and maintain their optimal nutritional status. And a healthy happy patient makes for a very happy heart.

Sometimes the importance of dietitians is undermined and poorly understood, but as pioneers, it is up to us to continually show and prove our worth as a profession. And hopefully sometime in the near future the rest of the world will catch up and wake up to the most important fact that we already know – that food is life. In the meantime, let’s show them how it’s done!

 


 

Carmyn had the wonderful initiative to take a photo and add a caption each day of her Community Service Year to document the real and ‘unfiltered’ journey. See more on Intstagram @BecomingAnRD.

 

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First day out to the clinics #Day10 #BecomingAnRD #scenicroute #roadtrip #longroad #landscape #blueskies #mountains #Drakensberg

day 78

Some days I forget how lucky I am to be working in such a beautiful setting… Yes, it’s rural and in the middle of nowhere. Yes, the resources are limited and the circumstances are trying. Yes, there is sadness and heartbreak when patients pass away/ you can’t help them in more ways. Yes, I can barely understand/ speak the local Zulu language. BUT the people are friendly and welcoming, and the natural environment is breath-taking. Each and every day has beauty in it, you just have to find it. This aloe is flowering just outside my office and is proof that something beautiful can still emerge from harsh circumstances. #Day78 #BecomingAnRD #dietitian #dietitiansofig #nutritionexpert #rurallife #nature #aloe #naturalbeauty #outdoors #flowers #hope #indigenousflowers #hardyflowers

 


Make Eating Whole Foods a Way of Life

NNOW2019_Logo_17Sept19 Despite what we know about the impact of food choices on our health, overweight and obesity are still on the rise in South Africa, alongside a host of preventable diseases that can be attributed to unhealthy lifestyles. Thanks to our industrialised food system, and far greater, ultra-processed and fast food choices aimed at our ‘convenience’, we’ve got further away from eating the whole foods that are really good for us. This is the message that a coalition of health professional associations, including the Department of Health, is highlighting in October across both National Nutrition Week and National Obesity Week.

The 2019 theme, ‘Make eating whole foods a way of life’ aims to focus the country’s attention on the importance of consuming a mostly plant-based diet of mainly unprocessed and minimally processed foods. Whole grains, fresh vegetables and fruits, legumes, nuts and seeds are health-promoting foods that are nutrient-dense, high in fibre, and free from food additives, added sugar, fat and salt. Whole foods offer a wide range of choice and enable a family lifestyle centred around healthy eating choices, that for children, can help cement these healthy lifestyle habits for years to come.

Carol Browne of the Nutrition Society of South Africa (NSSA) points out that the risks of unhealthy diets and lifestyles start in childhood and build up over our lives. She says, “Approximately 13.3% of South African children under 5 years of age are overweight or obese; and according to the 2012 South African Health and Nutrition Examination Survey (SANHANES), 14.2% children aged 6 to 14 years are overweight or obese. The situation amongst adults is even worse, with the 2016 South Africa Demographic and Health Survey finding that 68% of women and 31% of men in South Africa are overweight or obese. Severe obesity which is life-threatening affects around 20% of women and 3% of men. Unhealthy diets and a lack of physical activity are contributing to a considerable burden of disease in our country.”

These concerns are shared by the Heart and Stroke Foundation South Africa (HSFSA) which reports that every day 225 South Africans die of cardiovascular disease (CVD). Only a small proportion of the deaths are age-related. HSFSA’s CEO, Professor Pamela Naidoo says, “South Africa has one of the highest rates of overweight and obesity in the world, a major contributor to diabetes which in turn is a risk factor for CVD. We have to understand the link between making poor food choices on a daily basis, being at an unhealthy weight and the risks of disease and early death”. Bianca Tromp, registered dietitian at the HSFSA states: “Many South Africans don’t think twice about consuming large amounts of sugary drinks, salted snacks and ultra-processed fast food meals. This constitutes a daily diet that while overly dense in energy is actually dangerously nutrient-deficient.”

President of ADSA (Association for Dietetics in South Africa), Dr Christine Taljaard-Krugell points out that prevention of overweight and obesity in South Africa is urgent and requires multi-disciplinary collaboration. She says: “As national government departments, industries, academia, non-governmental organisations, health professionals, communities, households and individuals we have to urgently, actively and collectively turn towards the actions that are needed in order to address obesity, to ensure better health for all South Africans. Many of these actions can be linked to what we do – physical activity – and what we eat. As this week’s message focuses on the consumption of whole foods, it is important that each and every role-player, from government level to the individual level, re-think and creatively contribute to enable households to truly make eating whole foods a way of life.”

The campaign is also supported by MaTCH, the Maternal, Adolescent and Child Health Institute, an indigenous non-profit organisation providing a broad range of HIV and TB-focused assistance. Lenore Spies, the technical advisor of MaTCH says: “Limiting the intake of ultra-processed foods and rather eating mainly whole foods plays an important role in a healthy pregnancy as well as ensuring good nutrition for children, families and those whose immune functioning may be compromised. A diet based on a variety of whole foods; which are foods in, or close to, their natural state, provides us with a broad spectrum of nutrients we need to safeguard our health.”

Another important aspect of healthy eating is getting into the habit of reading the ingredient lists on the labels of the prepared food and drinks that you buy. An ultra-processed food or drink is one that usually has five or more ingredients listed on the label, and typically a number of these are not recognisable as foods you would use in home cooking. Rebone Ntsie, Director of Nutrition at the National Department of Health says, “Ultra-processed foods typically contain a wide range of food additives such as stabilisers, emulsifiers, preservatives, flavourings and colourings. These are the opposite of whole foods, which are unprocessed like fresh vegetables or minimally processed such as brown rice. We should make our drink of choice clean water instead of sugary drinks. In addition, we should plan and prepare more home cooked suppers so we have extra for our lunches and snacks the next day.”

Strategies to make eating whole foods a way of life include:

• Enjoy a variety of unprocessed and minimally processed food choices – Make sure that the vegetables, fruit, whole grains and legumes make up around 80 percent of your daily food intake. Make at least one day a week all meat-free with plant-based meals.
• Eat plenty of vegetables and fruit every day – Eating a variety of vegetables and fruit every day can help prevent chronic diseases, including heart disease, high blood pressure, strokes, some types of cancer, aging related eye diseases and type-2 diabetes. These foods also contribute to a strong immune system.
• Eat dry beans, peas, lentils and soya regularly – Naturally high in plant proteins, micronutrients and dietary fibre, soya and legumes such as beans, split peas and lentils make excellent substitutes for meat or can stretch a meat dish further. They can also be used to make soups, salads and side dishes.
• Plan and prepare healthy home meals rather than buying ready-to-eat meals and snacks or eating out frequently – Eating healthy home-cooked meals ensures that you are in control of the ingredients that go into your family’s meals. It helps save money spent on ultra-processed and fast foods.
• Always check food and beverage labels to read what is in your food and drink – Knowing how to read labels is very important in making the healthier choice when choosing foods. Product ingredients are listed by quantity, from the highest to lowest amount, so watch out for foods that have sugar, salt or fats listed in the first three ingredients.

By focusing on whole foods as a way of life, we can ensure that our families are eating the vegetables and fruits, legumes, seeds, nuts and whole grains that are essential to build and sustain healthy bodies.

National Nutrition Week and National Obesity Week Partners are:
• National and Provincial Departments of Health http://www.health.gov.za
• Department of Basic Education (DBE)www.education.gov.za
• SA Military Health Services (SAMHS)
• Maternal, Adolescent and Child Health (MaTCH) http://www.match.org.za
• The Association for Dietetics in South Africa (ADSA) http://www.adsa.org.za
• The Cancer Association of South Africa (CANSA) http://www.cansa.org.za
• The Nutrition Society of South Africa (NSSA) http://www.nutritionsociety.co.za
• The Heart and Stroke Foundation SA (HSFSA) http://www.heartfoundation.co.za
• Consumer Education Project (CEP) of Milk South Africa http://www.rediscoverdairy.co.za
• Consumer Goods Council of South Africa (CGC-SA) http://www.cgcsa.co.za
• Humane Society International (HSI) http://www.hsi.org

For additional information on how to make eating whole foods a way of life, including tips and recipes, visit http://www.nutritionweek.co.za


Thai Meatballs with Green Salad and Corn

Serves 4 – Makes 16 mini meatballs

 

Ingredients:

  • ½ small onion, very finely chopped or grated
  • 5 ml fresh crushed garlic and ginger mix (1 t)
  • freshly ground mixed peppercorns to taste
  • 10 ml fish sauce or soya sauce (2 t)
  • 10 ml soft brown sugar (2 t)
  • 90 ml fresh coriander leaves, chopped (6 T)
  • 400 g extra lean beef mince or ostrich mince, or a mix of both
  • 60 ml oats (4 T)
  • 1 egg, beaten
  • 100 g washed mixed lettuce leaves
  • 30 g fresh rocket leaves (3 handfuls)
  • ¼ English cucumber
  • 150 g  baby tomatoes
  • 250 g tinned sweetcorn, drained (1 x 410g tin, drained)
  • 15 ml  sweet chilli sauce (1T) (optional)

 

Instructions:

  1. Place the grated onion, garlic and ginger, ground peppercorns, fish / soya sauce, sugar and chopped coriander leaves in a bowl. Mix all the ingredients.
  2. Add the mince, oats and beaten egg, and mix well, ensuring that all the ingredients are well mixed into the meat. If the mix does not stick together add another tablespoon of oats.
  3. Using 1 tablespoon of mixture at a time, roll the mix into 16 small balls.
  4. Gently heat a frying pan that has been sprayed with aerosol non-stick cooking oil.
  5. Place the mini meatballs side by side into the lightly greased pan.
  6. Cover with a lid or aluminium foil.
  7. Cook on low heat for 7 minutes until the underside of the meatballs are brown.
  8. Turn all meatballs and cover again. Cook for 5 minutes until the other side of the meatballs is browned.
  9. Remove the meatballs from the pan and leave to cool while assembling the salad.
  10. To make the salad, divide the salad leaves, sliced cucumber, tomatoes and rocket onto 4 dinner plates, add the drained sweetcorn and the cooked meatballs and serve with a drizzle of sweet chilli sauce.

 

NUTRIENTS PER SERVING

Energy                                     1372 kJ

Protein                                     25.1 g

Carbohydrates                       18.5 g

Total sugars                            6.3 g

added sugar                           3.7 g (chili sauce (optional) & sugar)

Total fat                                   17.5 g

Saturated fat                          6.7 g

Fibre                                         4.8 g

Sodium                                     429 mg

One serving is equivalent to 1 carbohydrate, 3 protein and ½ vegetable.

 

Dietitian notes:

Remember that red meat immediately increases the fat content of any dish, even if you use the extra lean beef mince as we recommend in this recipe. Only four mini meatballs made with lean beef mince contain 17.5 g fat per serving. Using ostrich mince, however, reduces the fat content to 6 g per serving for 4 mini meatballs. So it is important to “dilute” red meat with lots of vegetables (salad) and a little starch (sweetcorn).

 

We would not suggest that you especially buy sweet chilli sauce for this recipe as this may tempt you to use it in other recipes or on food which will only add to the added sugar content. If you don’t have sweet chilli sauce then feel welcome to omit this ingredient or use ½ diced kiwi fruit or ½ grated apple for a little sweetness instead. Alternatively, you could also use light chutney.

 

A wonderful tasty recipe from Cath Day from her recipe book alongside Gabi Steenkamp – Food for Sensitive Tummies.

#foodforsensitivetummies

@cathsday

@dietitian_cathD

 


Meet the Dietitian: Robyn Duarte

We spoke to Registered Dietitian, Robyn Duarte, working in the interesting field of Molecular Diagnostic Services (MDS).

 

Why did you become a Registered Dietitian?

 

I’ve always had an interest in food; the effect different nutrition has on our bodies and the psychology behind eating. In school there were many girls with eating disorders and helping individuals with these disorders was the avenue down which I wanted to go after my studies. This changed however as different opportunities presented themselves.

 

 

Where did you study (degree and/ or postgrad)

 

I studied my BSC Degree and PG Diploma in Dietetics at the UKZN in Pietermaritzburg, completing my community service at Appelsbosch hospital in 2010.

 

 

Where do you work and what does your job entail?

 

I am a Wellness Consultant/Dietician/Marketing HOD at Molecular Diagnostic Services (MDS). MDS is a private specialist molecular (DNA) diagnostic laboratory focusing on genetic and veterinary diseases, DNA paternity, identity and wellness tests. I have worked at MDS for 8 years, within the WellPro Wellness division liaising with practitioners and clients interested in exploring various tests to try and identify possible causes of adverse symptoms experienced. I believe that personalised testing – knowing about your own genes and about the foods that you react to – help to optimize your well-being.

 

 

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

 

I am excited to be at the forefront of this rapidly developing field with the use of the most advanced technology used for testing. The most satisfying moments are when clients contact me, emotional and grateful that they have finally found symptom relief or improved health after many years of struggling with various adverse symptoms.

 

 

What has been your career highlight? 

 

Being able to travel to Poland and Germany for international conferences as well as hosting our very own in Cape Town and being able to share experiences with, and learn from, intelligent, like minded individuals who offer similar tests in their countries.

 

 

What are the most challenging aspects of your career?

 

Science and technology is continuously improving. What I do now is completely different from the content included in our standard dietetics degree. Thus many aspects of the job require research in order to try to stay abreast of this rapidly developing field. Sometimes, also, the technology can be ahead of the routine adoption of certain tests in current practice and we have to wait for more clinical trials to be conducted to make the findings more valuable to a practitioner.

 

 

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

 

“Oh, I never knew that dietitians drank wine/ate dessert!”

“What do you think about xxx diet?”

“I don’t like eating around you because I feel like you’re watching everything I put in my mouth”.

 


Meet the Dietitian: Community service series

Take the journey!

By Colette Dreyer

 

Are you ready for your journey in Dietetics? My journey started from a young age having a passion for delicious food and a healthy, active lifestyle. Cycling competitively made me realise that proper nutrition was essential to sustain performance.  I realised how big the impact of food is on our health, energy levels, performance, overall well-being and daily lives when a close family member was diagnosed with Idiopathic Pulmonary Fibrosis and had to lose weight in order to be added to the lung transplantation list. This encouraged me even more to become involved in changing lifestyles of individuals.

I started off by completing a BSc. Human Movement Sciences degree followed by BSc. Honours in Nutrition. This was a great combination, but my aim was to provide individualized meal plans for individual goals and specific disease related conditions. The best decision I finally made was to study BSc. Dietetics at the North West University, Potchefstroom.

And so, my journey as a community service dietitian, and the only dietitian placed at this specific community health centre in Johannesburg began. This came with uncertainties at first as I am responsible for all dietetic services at the facility. Although I was placed out of my comfort zone, as this was not one of my five placement options, and I’m only the third dietitian placed at this facility, I realised the lack of education in this community and the opportunity to contribute to the dietetic department. I gain a lot of experience in various aspects such as malnutrition, cerebral palsy, tuberculosis, brain injury, percutaneous endoscopic gastrostomy, pregnancies, hypertensive and diabetic patients as well as patients living with HIV.

Everyone has a unique nutritional composition and individual goals to attain. When patients progress towards, or reach their goal, their gratefulness is very rewarding. I developed skills to explain complex ideas simply, and to use different techniques when a communication barrier occurs. Creative methods were developed to improve patient’s lifestyle and nutritional status with their available food and resources. Attending monthly district meetings held at different facilities provide the opportunity to meet other dietitians and to become familiar with surrounding facilities. This is truly a great year to improve your practical skills and to gain more knowledge.

Tips:

Say yes to the journey – Life do not always go according to your plan. Sometimes an unexpected opportunity arises. Be open minded, say yes to the opportunity and climb out of your comfort zone. That is the only way to grow and learn.

Be friendly & have respect – It can be difficult to obtain cooperation from colleagues and patients but being friendly and treating them with respect will assist you in doing your job more efficiently.

Promote our profession – Amongst staff and patients.

Do not leave the facility unchanged – You have a big opportunity to make a difference wherever you are placed. Identify a gap and fill it or bring something new to the facility.

Lastly, remember that the community service year is what you make of it. Make sure your journey count!

 


SPRING CLEANING YOUR LIFESTYLE

 

Finally!  It’s time to emerge from the heft and sluggishness of Winter, and tune into the bright, clean energy of Spring.  It is the season for clearing out the old and slow and kicking up our heels to livelier, sunnier rhythms.  Springtime brings the perfect opportunities to reboot our immune systems after the cold-and-flu blues; use the extra daylight hours to boost our Vitamin D and swop stodgy comfort food for the juicy buoyancy of the new season’s bounty.

There are many potential benefits to responding to the effervescent energy of Spring; however, specialist healthcare professionals such as Registered Dietitian and ADSA (The Association for Dietetics in South Africa) spokesperson, Retha Harmse cautions against getting caught up in making lifestyle changes that are too sweeping.  “Trying to make too many changes, or really big changes overnight doesn’t always stick,” she says.  “A great approach to the new season is to just aim to be the better person than you were the day before.  When you begin with small steps, it is far easier for the changes you make to improve your health and well-being to be sustainable.”

 

Go with the season

Keeping your focus on the in-season fruit and vegetables is an easy way to usher in small daily changes that can make a big difference.  Swopping out soups and stews for fresh and delicious salads and plant-based bowls helps you to increase both the amount and variety of fruit and veg you eat. Jade Seeliger, also a Registered Dietitian and ADSA spokesperson points out that Spring produce can have a restorative effect on the body.  “After a long, cold winter, our immune systems take a knock and many of us turn to antibiotics to help us recover.  Antibiotics wipe out both the bad and good microbiota living in our gut.  Certain fruit and vegetables are known as prebiotics provide food for your gut bacteria and help them to flourish once more.  Prebiotic-containing fruit and vegetables in season in Spring include artichokes, apples and asparagus.”  Keep your attention also on the versatile cruciferous veg such as broccoli and cauliflower; and stock up on the Spring avocados, tomatoes and berries.

 

Experience an awakening

Much of our less than healthy eating is rooted in being on auto-pilot when it comes to choosing what we eat and how we eat it.  Spring invites us to wake up to our habits, and there’s no better way to do this than by exercising our mindfulness.

“Mindful eating is an ancient, mindfulness-based practice with profound implications and applications for resolving problematic eating behaviours and troubled relationships with food,” says Retha. “It also fosters the development of self-care practices that support optimal health.

Here are five ideas to you get started with mindful eating:

  • Start with a favourite: Choose a favourite food or a dish you really enjoy and have eaten often.
  • Sense it: Observe the look, touch, texture, and smell. Appreciate the appearance and scent of your food and begin to perceive any sensations happening in your body, particularly stomach and mouth.
  • Observe before you chew: Once you take a bite, observe the sensation of food in your mouth without chewing. Carefully think about the taste of the food.
  • Go slow and think: Chew slowly and pause briefly. Think about the location of the food in your mouth, as well as the taste and texture. Concentrate on how the taste and texture change as you continue chewing.
  • Pause: Before you swallow, pay attention to the urge to swallow. Do so consciously and notice the sensation of the food travelling down the oesophagus to the stomach. Pay attention to any physical sensation.”

 

Lighten up!

More sunshine and warmth, new green shoots and coloured blossoms all give Spring its quintessential lightness that lifts the spirits and invigorates the body.  It’s an ideal time to choose a few new habits that feel good.  Jade suggests:

Cut the Cuppa’s! – “Caffeine has always created a buzz, and cappuccinos are always a perennial favourite.  Unfortunately, when it comes to kilojoules, these milky drinks come at a cost.  A ‘short’, ‘tall’ or ‘grande’ cappuccino is approximately 500, 700 and 900 kilojoules respectively (based on low-fat milk and no sugar), which are kilojoule equivalents to 1.7, 2.7 and 3.7 slices of bread.” If you find it too difficult to cut out your daily caffeine-fix, replace your cappuccino with an Americano or filter coffee with a splash of milk, which will help reduce the energy to approximately 150 kilojoules per serving.

Eat your water – “Thankfully, this does not mean crunching away on ice cubes to help shut down the hunger, rather pile your plate high with vegetables and salad.   Most vegetables are between 90 – 95% water, this paired with fibre, vitamins, minerals and anti-oxidants makes them the perfect accompaniment for every meal.  Try to ensure that at least half of your plate is vegetables and/or salad and that they represent all colours of the rainbow, from purple eggplants, yellow peppers, red radishes, orange butternut to green spinach.”

Bring back balance – “Extremes have always held so much appeal, from fasting to carb-free to fat-full to fun-less.  Diets seem to be a collection of short-term restrictions that never reach the pot of gold at the end of that ‘goal weight’ rainbow.  When it comes to meals and snacks, and eating in general, it is worth bringing back some balance which will help you to not only achieving those health goals but also being happy at the same time.”

 

Get an energy boost

Take inspiration from all the joys of Spring to boost both your physical and mental well-being.

Get outside and get more Vitamin D – Find your Instagram moments outside.  Nature has a calming effect on us and spending time outdoors is so good for that extra Vitamin D. Embrace walks in the park and picnics; think about taking up gardening, especially growing your own salad leaves and edible flowers, Spring veg and herbs.

Find the ways to make healthy fun – Spring offers an opportunity of starting a-fresh; it’s worth using this new season to approach your health journey differently.  Embark on a healthy cooking class or actually use the recipe books that adorn your shelves; ditch the gym if you don’t like it and find a new exercise you actually enjoy.  Make health your new wellness goal, not deprivation and dieting, which is often the case leading up to summer holidays

Spring clean your sleep – Our bodies and minds need enough sleep to recover and be sharp for the next day. Sleep hygiene refers to your pre- and bedtime habits that help you to get the rest you really need.  Ensure that you remove distractions close to bedtime to fully wind down and fall asleep quicker and more easily.


Meet the Dietitian: Leanne Katzenellenbogen

Meet Dietitian, Leanne Katzenellenbogen, that dispels the myth that “diet” food is boring.

My name is Leanne Katzenellenbogen and I am a dietitian.

I originally decided to study to become a dietitian because I love helping people and I believe that good nutrition is integral to good health. I did my undergraduate BSc degree at WITS and then went on to do my Honours in Human Nutrition at UCT and my Masters after that through Stellenbosch University.

I currently work in the Northern suburbs of Johannesburg in a private practice. I see people daily for various dietary issues. These may entail clients wanting some knowledge of how to eat healthily or people wanting lose weight. I also counsel many people who have either type 1 or type 2 diabetes on how to eat appropriately for their condition and how to manage their food and insulin.

The most satisfying part of my job is being able to help people achieve their dietary goals; whether it’s to achieve a certain weight, eat healthier or get their blood sugars under control. There are several client success stories that I could tell but my favourite is of a client who lost 50kg. It was such an enormous sense of achievement for him and brought great joy to him.

The most challenging aspect of my career would have to be keeping people motivated. In theory, to set a goal and stick to it seems simple. But… then real life gets in the way
and the task is way more challenging than it initially appears. Often goals are set and then not achieved and it can be very frustrating.

Having said that, there are still many people who do achieve their goals and it is very rewarding. There is a great misconception that the diets that dietitians give out are too strict, are boring and are unachievable. People often don’t realise that we are able to make meal plans exciting, fun and delicious.

I have written two books called “simple fabulous lunchbox ideas” and “Delicious Modern healthy Recipes for Diabetes” for just this reason. To try and dispel the myth that “diet” food is boring. The books highlight how delicious, creative and modern food can be even if you have certain dietary constraints.

So I would suggest that if you have any dietary issues that need sorting out, to go and visit a dietitian to help you maximise your chances of success on your nutrition journey.

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Twitter: @LeanneDiet

FB: www.facebook.com/sandtondiet

Instagram: @sandtondiet

Pinterest: www.pinterest.com/sandtondiet

My website/ blog: www.sandtondiet.co.za


Meet the Dietitian: Community service series

“DIETITIANS ARE ADAPTABLE!”

 

By Yuri Bhaga

 

I am a community service dietitian currently working at a hospital in Witbank, which places me very far from where I got my dietetics training at UCT . But a lot closer to home in Pretoria where I completed my BSc degree 3 years ago.

When I got accepted to study dietetics I had no idea what I was getting myself into. Much like everyone else who hasn’t gotten the formal training, I had a very narrow understanding of what the title “Dietitian” stood for. Now 3 years later it has become a great passion of mine and I make sure to promote the profession and spread awareness of the role that nutrition has in all areas of our health.

Being familiar with the Western Cape health system, Mpumalanga was new to me.  The province had its own set of unique challenges and demands that I had to learn to adapt to. The system is under immense pressure with far less than adequate resources and it would be a lie to say it doesn’t get frustrating at times. Some days will go smoothly and you will be able to implement a plan within the hour, thanks to a great multidisciplinary effort. Other days you will receive the wrong referrals and it will take up to 2-3 days just to start a feeding plan. It’s not always easy but it does provide hands on experience and a great opportunity for learning – and the feeling when you see an improvement in a patient’s condition or receive sincere thanks from a patient post counselling can really put things into perspective. Sometimes it’s not even about the clinical work or education you give but simply chatting to the patients and seeing how they feel that can make a world of difference to their stay.

I have been very fortunate to have arrived to an established and supportive department with members of staff who have years of experience and are always open to lending input and giving help should I need it. The hospital offers the majority of the services of a tertiary hospital which means I will have been exposed to a diverse patient population by year-end which is both a wonderful thing and a little daunting. That said, not everyone will have the same experience of community service, but if you are willing to work with what you have and find opportunity to improve and make good of what’s at your disposal you will come out having grown as both a person and as a professional.

Community service year is a great opportunity to gain independence and to be a fresh pair of eyes to fill gaps that are missing. Personally, it has put meaning to a phrase that I heard from an educator in my internship year: “Dietitians are adaptable!”. This year is all about what you are willing to put into it and the attitude you have going into the year will determine what you get out– as cliché as it sounds.

That’s not to say you MUST be busy day in and day out with no chance to breathe. Rest is equally important. I have found it has been of great benefit to find a support group. I am lucky to have been warmly adopted into the Speech and Audiology department where I go to spend most of my lunch breaks, or to vent about something that’s on my mind and have made new friends with their comm-serves. Working in a hospital is different for everyone and can be very taxing so it’s always good to have something other than work to help destress. If time allows it, find a new hobby or continue engaging in activities you enjoy –  I have decided to try my hand at sign language classes.

To conclude :

  • You won’t know everything (and that’s fine, you have plenty of time to learn and read-up)
  • Ask as many questions as you need (granted you have tried to come up with the answers yourself first)
  • Speak up and be firm – but polite.
  • Get to know your surroundings and the people you work with.
  • Have confidence, you likely know much more than you think! 😊
  • And lastly , enjoy it and take it all in!!

 


Meet the Dietitian: Community service series

Read more about her love-at-first-sight story with Dietetics.

By Rhodene Oberholzer

A little over seven months ago I moved into a tiny apartment in Johannesburg, nervous about starting my community service year at Charlotte Maxeke Johannesburg Academic Hospital. Suddenly, I felt as if I forgot everything I learned in my four years studying at the North-West University of Potchefstroom. I could feel my heart making 20 000 jumping jacks per minute as I walked through the hallway on my way to the dietetics department, my very first day as a dietitian. I honestly did not think I would be able to do this, but fast-forward seven months later and I cannot believe how much I have learned and grown as a person so far.
The reason why I decided to become a dietitian is quite simple, it is like a love-at-first-sight kind of story. I always knew I wanted to work with people, but being a dietitian never really crossed my mind as something I wanted to pursue. It was only in my matric year that I decided to shadow a clinical dietitian. The profession fascinated me, and I soon realised that my idea of what I thought a dietitian did was only a drop in the ocean. So, I instantly knew I found my calling.
Now this year has probably been the most challenging, but rewarding time of my life. I feel so blessed to be able to work in a place where I get to see and learn so much.

Working in a clinical environment, we as dietitians are responsible for all the dietary needs of patients, whether it is total parenteral nutrition (TPN), enteral nutrition, dietary education, supplementing a patient’s diet or prescribing a special diet meeting the requirements for their specific disease condition. At first, this was very intimidating for me, but after a while, you can see how your interventions pay off, and it gets so much easier. Nothing is more rewarding than seeing the premature baby gain weight, the severe acute malnourished child gaining his appetite again, to hear the patient with muscle wasting say that she feels much stronger after drinking the supplements you provided, or even just getting a smile from a patient because you ordered him some extra jelly and custard.

I also have the opportunity to work in various clinics this year (such as Paediatric Diabetics; Orthopaedic Slimming; Neonatal; as well as a General clinic) where we assess and counsel out-patients with a specific nutrition related health problems.
For any future community service dietitian that feels nervous about starting this next chapter: I understand how you feel. I don’t think starting your first job is supposed to be a walk in the park, so be kind to yourself if you feel anxious and unsure. I did not believe it at first, but I promise you it will get better. Take your December holiday to rest, and have peace about where you are placed as it is only for 12 months and time goes by so fast. I think the biggest mistake you can make as a community service dietitian is to finish your 12 months, feeling like you did not learn much and made no difference where you were placed. Enjoy being a dietitian, fall in love with your work, as it really is such a fun and exciting profession to be in!

 


Meet the Dietitian: Raeesa Seedat

We spoke to Registered Dietitian, Raeesa Seedat, creative and passionate about the field of nutrition.

 

Why did you become a Registered Dietitian?

Being a Dietitian is like being the Terminator, except that you’re analysing food instead of potential threats (even though some may be treated as such). So you get to see each food with special vision and all the constituents are flagged.

 

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

I enjoy being involved in nutrition education and promotion. I am passionate about writing and communicating science and evidence into nutrition advice with tangible benefits to an audience. I also enjoy working with paediatric patients and mums who are very appreciative for managing various conditions in infancy and childhood.

 

What has been your career highlight?

I think I still have a long way to go to achieve all my career goals. For now the highlight would be graduating with my Masters of Science degree in Dietetics.

 

What are the most challenging aspects of your career?

It is sometimes a challenge to convince patients that even though they have been eating a certain way for a number of years the effect on one’s health is cumulative. The value of one’s health cannot be taken for granted and preventing disease is easier than treating it.

 

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

Dietitians are mere mortals and we all enjoy a treat every now and again. However, I try not to let it get to a point where I am wallowing in guilt over what I have eaten. I try to balance the energy I have taken in with energy expended through physical activity.

 

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

  • I need a diet a plan
  • Will eating this make me gain weight?
  • How do I get shredded?

 

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

It often narrows down to who you feel comfortable opening up to. Also, some Dietitians may have a special interest in specific areas such as food allergy or sports nutrition and if you require such expertise you can contact one of these Dietitians.

 

What is your favourite dish and your favourite treat food?

My favourite dish at present is homemade nachos (you can play around with healthier variations) and my favourite treat food is chocolate ice cream (yum!)

 


EMPOWERING PARENTS TO ENABLE BREASTFEEDING: COMMUNITY

 

Breastfeeding is one of the most crucial strategies to boost mother and child health. While South Africa has made some gains over the years, we still have one of the world’s lowest rates of exclusive breastfeeding for the first six months of life. Instead of being revered as the ‘superfood’ that it is for babies, a mother’s breastmilk is still often doubted as enough nutrition for her growing infant.  Often, close family members and friends are the ones who undermine exclusive breastfeeding by suggesting to the vulnerable mother that her breastmilk is ‘not enough’ and wrongly pressure her to introduce solid foods.

 

Another major barrier to exclusive breastfeeding for the first six months of life, and ongoing breastfeeding for two years, is society’s attitude towards this most natural nurturing of babies, especially in public.  Breastfeeding in public is protected by law; yet so often women are shamed and humiliated if they dare feed their babies, when and where they are hungry.

 

With its 2019 theme for World Breastfeeding Week, from 1 to 7 August, ‘Empower Parents, Enable Breastfeeding’ the World Alliance for Breastfeeding Action (WABA) is resolutely focusing on how we shift public and private attitudes to be appropriately supportive of the optimal nutrition for babies.  This is a theme that cuts across all sectors of society and applies to breastfeeding moms across the board.

 

In celebration of World Breastfeeding Week 2019, we asked ADSA (The Association for Dietetics in South Africa) spokesperson and lecturer in the Division of Human Nutrition at Stellenbosch University, Thembekile Dhlamini, who also happens to have breastfed her child, to answer two burning questions about how we can empower parents to best enable breastfeeding.

 

#BurningquestionbreastfeedingNo1 – Empowering Parents – What do you wish you had known before you started breastfeeding?

  • Due to my work, I was involved in breastfeeding training and advice for many years before I gave birth to my first son. Little did I know that the theoretical experience doesn’t equate to the actual experience. I wish I had known that.
  • I wish I had known more about Lactorrhea, the continued discharge of milk between nursing, as one of the challenges that I could face. As dietitians our experience is often about dealing with the perceptions of ‘Not Enough Milk’, so as a mother, I was caught off guard by ‘too much milk’. Lactorrhea means you need to know about breast shells versus breast pads, because you need different solutions, especially when you are going back to work.
  • I also wish I had known that hand expression of breastmilk is a hassle. I quickly understood why mothers struggle to do it at the beginning.
  • I wish someone had told me that I would not want to go back to work at the end of my maternity leave because I wanted to breastfeed all the time. I thought I would be ready when time came, but the pain of separation cannot be forgotten. My little one is now 20-months old and I still struggle with separation.
  • I wish I had known that breastfeeding goes deeper than most human bonds. It’s true love at its best.  Breastfeeding moments are like meditation; nothing exists except you and the little one.

 

#BurningquestionbreastfeedingNo2 – Enabling Breastfeeding – How do you think family, friends, businesses, shops, corporates, public spaces can enable mothers to breastfeed?          

  • Family: I want my family to support exclusive breastfeeding without their interference. My baby does not need gripe water, Phipps, etc. They should allow me to experience breastfeeding the best way I know how and understand that my baby does not cry because he’s hungry. Families should understand that breastmilk is food like any other; it does not make anyone sick.  I would like my family members to be there to feed my baby when I’m separated from him.
  • Friends: I need my friends to respect my space and choice to breastfeed. They should not bring dummies, bottles and formulas to my baby shower. My friends should respect that my baby’s container is my breast. Also, they should not come along with teething biscuits, or anything else that contributes to mixed feeding.
  • Workplaces: Businesses and big corporates need to adhere to the laws that ensure time and space for breastfeeding moms. They should take pride in promoting and enabling breastfeeding.  Facilities for breastfeeding moms to feed or express should be enabling, safe and comfortable. 
  • Shops: We need to get breastfeeding out of the shopping centre toilets and parking lots. Why should bottle-feeding babies be allowed anywhere, anytime but breastfeeding is an issue? Shops and restaurants can really be a part of the solution by putting up signs that communicate their support that breastfeeding is the best and is welcomed in their establishments. 
  • Public spaces: There should be an emphasis on safe public spaces where mothers and babies will be comfortable and free from harm, such as tobacco. Mothers should not be expected to hide the natural beauty of breastfeeding. Our South African public needs to learn to appreciate breastfeeding.

 

Essentially, while breastfeeding is a deeply intimate time-bound bond shared between mom and baby, it remains a team-supported effort.  As the WABA states: “Breastfeeding is in the mother’s domain and when fathers, partners, families, workplaces, and communities support her, breastfeeding improves.”

 

We can all play our part in enabling breastfeeding for the greater good by protecting, promoting and supporting it.

 

For information on World Breastfeeding Week 2019 visit www.worldbreastfeedingweek.org


EMPOWERING PARENTS TO ENABLE BREASTFEEDING

 

Snickering, disparaging, denigrating and casting aspersions on breastfeeding; shaming moms who breastfeed; who breastfeed in public or who excuse themselves to express breastmilk at work; raising doubts that a breastfeeding mom is producing enough milk to meet her baby’s needs; expecting a breastfeeding mom to place other priorities above her baby’s hunger – these are some of the insidious ways that we, as society, routinely disempower parents and ultimately discourage the very best way to feed a baby for the first six months of its life, and beyond.

 

You may think: ‘It’s not my baby, it’s not my problem’; or ‘I am so uncomfortable, I have a right not to have a breastfeeding mom near me!’  You would be wrong on both accounts.  As part of society, we all have a moral obligation as to how we collectively foster the care for our most vulnerable children; as well as a vested interest in them turning  into healthy, well-adjusted, contributing citizens.   Also, breastfeeding wherever, whenever a baby gets hungry is perfectly legal, and deserves to be fully supported.  Shaming moms into desperately breastfeeding their babies, or expressing breastmilk, in cold toilet cubicles and cramped cars in parking lots is the real problem.

 

With its 2019 theme for World Breastfeeding Week, from 1 to 7 August, ‘Empower Parents, Enable Breastfeeding’ the World Alliance for Breastfeeding Action (WABA) is resolutely focusing how we shift public and private attitudes to be appropriately supportive of the optimal nutrition for babies.  This is a theme that cuts across all sectors of society and applies to breastfeeding moms across the board.  In celebration of World Breastfeeding Week 2019, ADSA (The Association for Dietetics in South Africa) has brought together a panel of Registered Dietitians, who also happen to be past and current breastfeeding moms, to answer two burning questions about how we can empower parents to best enable breastfeeding.

 

#BurningquestionbreastfeedingNo1 – Empowering Parents – What do you wish you had known before you started breastfeeding?

NASREEN JAFFER:  “I wish I knew that breastfeeding is a learned skill for mom and baby.  As first-time moms, we are expected to know exactly what to do.  No matter how much you read, the practical experience of breastfeeding is learned, so expect it to be something new and not something you have to master from Day 1.”

VANESSA CLARKE: “As with everything in life, everyone’s story is different. From my university days I was very aware of the theory regarding breastfeeding.  However, I didn’t have any idea of the variables that existed. I really struggled to breastfeed my children and what made it even harder was seeing other mothers whose children latched beautifully, or they didn’t struggle with pain. I wish I had known that sometimes breastfeeding doesn’t come naturally and that everyone’s story is different – and that is okay to struggle.”

MARYKE GALLAGHER:  “I never knew how much I would enjoy it and how much I would miss it once I stopped!  Being able to breastfeed your baby is such a great privilege and the wonderful quality time you have with your baby is priceless.  I also learnt that just because it was easy first time around, doesn’t mean it is going to be easy the second or third time. Feeding my first and second child was relatively easy as they both loved breastfeeding. When my third child arrived I just assumed she would latch easily and feed easily like the other two did. But this wasn’t the case, although with perseverance I’m still breastfeeding 15 months later. My advice to new moms is to get help from a lactation consultant if you are struggling with breastfeeding. They are able to assess each situation individually and provide you with sound advice and support.”

LISANNE DU PLESSIS:  “Before I had my children, I had completed most training available on breastfeeding in the public sector at the time; so I had a good knowledge base. However, what training cannot instil is the VASBYT-factor; the perseverance required to make breastfeeding work for you and your baby. I believe that perseverance to breastfeed exclusively and to continue breastfeeding stems from the deep belief that it is the right thing to do and the very best nutrition and nurture I could provide my children. When times were tough, I reminded myself of this truth.”

THEMBEKILE DHLAMINI: “I wish someone had warned me that I would not want to go to work at the end of my maternity leave because I wanted to keep breastfeeding. The pain of separation that I thought I would be ready for; well, when the time comes, it cannot be forgotten. 20 months later with my little one, I still struggle to separate.”

CHANTELL WITTEN:  “I never knew how important my mind-set would have to be, to truly engage and enjoy my breastfeeding journey. I learnt as a mom that breastfeeding is not a job or a task to complete.  It is relationship you build and invest in; therefore it takes time.”

MONIQUE PIDERIT:  “Before I started breastfeeding, I wish I’d known just how much of a team effort this journey would be. I went in with the idea that breastfeeding was solely my responsibility and put a lot of pressure on myself. However, I, unknowingly, had a great support team, each contributing in their unique way. Friends and close colleagues shared their real-life mom stories and lactation consultants guided me on choosing the right pump as working mom. Within minutes of my baby being born I had the hands-on, practical support of great midwives in hospital, and by the time I got home, I underestimated the encouragement and support I would get from my husband.  He kept motivating me to keep positive and took care of things like stocking up the breastfeeding station with water, tea and healthy snacks, and bringing baby to me when I was utterly exhausted. As Helen Keller said: ‘Alone we can do so little. Together we can do so much.’”

 

#BurningquestionbreastfeedingNo2 – Enabling Breastfeeding – How do you think family, friends, businesses, shops, corporates, public spaces can enable mothers to breastfeed?          

 

We asked our ADSA Dietitian moms.  Here’s what they say:

NAZEEIA SAYED: “More shops, restaurants and other public spaces need to declare their support for breastfeeding mums to normalise breastfeeding.  All work places need to have a policy around support for breastfeeding mothers and take action to support breastfeeding mums returning to work.”

THEMBEKILE DHLAMINI: “My friends need to respect my space and choice of breastfeeding.  They should not bring baby dummies and formulas to my baby shower. I want my friends to respect that I choose to give my baby the breast, not milk from containers. Also, I do not want friends bringing teething biscuits as they contribute to mixed feeding.  Breast is best exclusively for six months, and that’s an important goal for breastfeeding moms.”

LISANNE DU PLESSIS: “Family is so important. My mother, sister, husband and extended family were all on my side. They fed me while I fed my babies! They also cuddled, winded, bathed and changed nappies so that I could shower, eat, sleep. There is power in the family circle!”

NATHALIE MAT:  “Breastfeeding takes a lot of time and energy; and only a mom can do it. Please support mothers by helping take other tasks off her plate that anyone can do. At home, this can mean tidying the kitchen or doing the laundry. At work, this can mean delegating tasks that are easily transferable so that the overall load on a new mom doesn’t become overbearing.”

NASREEN JAFFER: “Family members need to be careful about not telling a first-time Mom what to do, what to feel and what not to do.  Each person will find their way.  When it comes to public spaces, we definitely need to have many more public environments in which mom can breastfeed comfortably, and these need to be welcoming, clean and attractive spaces.”

CHANTELL WITTEN:  “Breastfeeding needs to be openly welcomed.  Salute to Spur Restaurants which has a public pro-breastfeeding policy.  We need many more corporates to normalize and encourage breastfeeding.”

MARYKE GALLAGHER:  “Business needs to look at longer maternity leave so that they give moms a bit more time for breastfeeding to be well established.  Providing breastfeeding mothers with flexi time that enable them to breastfeed when they need to can make a big difference. Having childcare facilities at businesses could benefit both the business and the mom as the mother can continue breastfeeding while at work.   Providing dedicated, private and relaxing areas for moms to feed and express breast milk is vital.”

Essentially, while breastfeeding is a deeply intimate time-bound bond shared between mom and baby, it remains a team-supported effort.  As the WABA states: “Breastfeeding is in the mother’s domain and when fathers, partners, families, workplaces, and communities support her, breastfeeding improves.”

 

We can all play our part in enabling breastfeeding for the greater good by protecting, promoting and supporting it.

 

For information on World Breastfeeding Week 2019 visit www.worldbreastfeedingweek.org


Meet the Dietitian: Community Service series

 

Meet Community Service Dietitian, Iman Gierdien! She is passionate about forming relationships with patients, remembering faces and seeing the impact she is making on, not only the patients, but on their families too.

Written by Iman Gierdien

The thought of becoming a dietitian never crossed my mind. I didn’t know much about the profession until I came across it when applying for university. After researching, the then unfamiliar occupation showed to be a perfect combination of my interests and hobbies: the human body and food. The more I researched, the more I became excited even though the ‘’mighty’’ google couldn’t fully describe what, and how much, you do as a dietitian.  

So, I started my roller-coaster journey at Stellenbosch University. Four years blinked away, and I was halfway through final year applying for community service. Being married and never having been away from home I naturally chose options close home or big cities. To me family and being close to those who love and support me was more important than the type of facility, the type of work I would do or the state of the working environment.  

My greatest fears then came true; I was only placed after swops and appeals were closed. When I read the name I thought, wow, where is that? I had never heard of it, never even seen it on the list and it was definitely not one of my ‘’many’’ (5) options. Again, I relied on google and google maps to help me along.  

Making the decision to accept the post was difficult. I would be 14hours away from home and family, 7 hours away from my husband and in rural Eastern Cape, deep deep rural. After much deliberation and many tears, I accepted. However, it is nothing close to what I was expecting both socially and emotionally. I have made friends that feel like family and I’m in an environment that is so uplifting and positive even though I came with such a pessimistic attitude.

 I am one of two dietitians at the hospital and together we conquer the challenges thrown at us. We are working with a community riddled with non-communicable disease, TB, HIV, teenage pregnancies and severe malnutrition in its children.  We are working with a community that is set in their ways and beliefs and that is crippled by their economic status.

 However, the best part of work is the people. Being a primary, small, hospital you’re able to form relationships with patients, remember faces and you’re able to see the impact you’re making on, not only the patients, but on their families too with such limited resources and little contact sessions.

 Community service shouldn’t be a year for you to think about how much academic experience you gain. It’s an opportunity to go outside your comfort zone and develop soft skills. It should be about gaining understanding and empathy for the determinants of health and actions so that it allows you to grow into a holistic healthcare practitioner and human.

 So, the greatest advice I could give is to use your community service as a year for you to cultivate the skills that cannot be taught.


AGEING AND ITS NUTRITIONAL CHALLENGES

Around the age of thirty years, the strength and vigour of the human body naturally begins to decline.  There are gradual losses we have to accept as we make our way into our older adult years; less elasticity, less muscle and bone mass, less energy and physical efficiencies.  Decades later, we reach a time when our health is simply much more vulnerable than younger adults and it takes a different effort to take good care of our health.

We cannot avoid the natural consequences of ageing, but embracing a healthy lifestyle does a lot to help us enjoy our senior years.  Older adults have unique nutritional needs and challenges, and this often demands changing lifelong eating habits.  While overweight can be an issue for some seniors, malnourishment is much more common and the causes of this are variable.  The diminishment of senses, such as smell and taste can lead to a disinterest in food.  Living alone; preparing most of your meals just for one and eating all by oneself can similarly lead to a lack of concern about nutrition that the elderly cannot afford.  Chronic health issues associated with ageing can lead to a poor appetite or an avoidance of eating.

In general, seniors do need fewer calories, but more nutrients.  The body’s ability to efficiently absorb vitamins and minerals declines, and therefore nutrient-rich meals become even more important.  According to Cath Day, a registered dietitian and spokesperson for ADSA, the Association for Dietetics in South Africa, ageing healthily requires greater intake of calcium, magnesium and folate, as well as of Vitamins B12, D, E and K. She says, “These needs can be met with a varied diet of healthy foods.  However, good nutrition exists in the context of a healthy lifestyle.  Interestingly, meals that promote social interactions for older adults in a variety of settings are associated with improved food and nutrient intake or nutritional status.” There are no guidelines for the elderly to take nutritional supplements as a matter of course, but Day adds, ”If deficiencies are noted, supplementation becomes imperative as these need to be corrected through therapeutic supplementation and under the supervision of the medical team.”

Another nutritional priority for seniors is to focus on their protein intake. Sarcopenia is, most commonly, age-related muscle degeneration which leads to weakness, frailty, delayed wound healing and other vulnerabilities in seniors.  Even if it cannot be prevented, you want to decelerate sarcopenia.  Day says, “As dietitians, we often find that older people – over 70 years of age – are less efficient at using the protein in the food they eat. This means that they may not be getting enough. Seniors who suffer from a loss of appetite should monitor their protein consumption strictly.  Tips include eating protein at each meal instead of only at lunch or dinner.  Add yoghurt, cheese or egg for breakfast instead of only eating marmalade on toast. Include protein in your snacks by switching from sugary biscuits or a packet of crisps to peanut butter and banana on toast, whole-wheat crackers topped with cottage cheese and fruit or veggies, beans or sardines on a whole-wheat cracker.”

The loss of muscle mass also leads to a lower fluid requirement; but despite less need, the elderly still have a much higher risk of dehydration.  The reasons for this are variable – it could be a side-effect of medication, a fear of incontinence or simply the diminishment of thirst as the self-regulatory mechanism against dehydration.  Seniors need to be aware of the risk; monitor their hydration and adjust their fluid intake accordingly.

While a healthy old-age demands this kind of focus on nutrition and, the adoption of different eating habits, Day reminds that diet alone cannot make people live well for longer.  She says, “A varied diet made up of good quality protein, lots of fresh vegetables and fruits, beans and legumes, whole-wheat breads and brown rice, healthy fats such as olive oil is vital.  However, seniors need to embrace other healthy living habits as well.”

Healthy lifestyle habits also include:

  • Maintaining a normal weight
  • Getting regular physical exercise.
  • Drinking alcohol sensibly
  • Not smoking.
  • Finding your purpose in life as a senior and interacting socially often, such as sharing meals with family and friends; going on outings; pursuing interests and hobbies; learning something new
  • Assessing your stress levels and managing your stress if necessary through meditation or yoga or mindful techniques such as deep breathing

Meet the Dietitian – Estée van Lingen

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We chatted to Estée van Lingen, a dietitian who is passionate about growth and evolving in her field. And is willing to share a chocolate brownie or cheesecake!

 

Why did you become a Registered Dietitian?

I have always been passionate about food as well as helping others achieve their goals. With Dietetics I get to work with both! Nutrition is also a field that is consistently growing it is also nice to keep on evolving with it and keep on learning and not just a set of rules that we learn in University and stick with for the rest of our careers.

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

Clients that are actually motivated and come to you for help. When they then leave your office feeling like they have learned a lot and you have made everything so clear and easy for them and then they go home eager to start implementing it.
Its always satisfying when clients achieve their goals following the advice you gave them but not just that. The fact that they also believe you made a difference in their lives and that you played a key role. Even if it was just for clearing bloating or improving energy levels.

What has been your career highlight?

Being able to start my own private practice without working in a private practice setting before. I would never have though that I could actually achieve it and now to just keep on seeing my practice growing on a daily basis. It has been a true blessing that I would never have been able to achieve without help from my heavenly Father and the support of family & friends.

What are the most challenging aspects of your career?

Convincing clients that a healthy balanced diet is the way to go especially if they have been following other diet trends with success.

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

We all make mistakes, and yes dietitians also have bad days, believe it or not ☺
I just tell myself its ok and it’s not a train smash so I just have to get back on the wagon tomorrow or with the next meal and start afresh. We can’t keep on getting stuck in the past, then we will never be able to move forward.

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

  • I know I am fat. Do you think I am obese?
  • What do you think about the banting diet?
  • I want to lose the weight quickly, how can we speed weight loss up with supplements?

Tell us about what work you have done in the past as well as what work you are currently involved in?

I have finished my community service in a government hospital where after I went into a corporate company doing catering. I was responsible for compilation of meal plans for special diets eg Diabetes, high cholesterol, IBS, soft diets etc for in a hospital set up as well as healthy meal alternatives in canteens. I also did training with the chefs and staff on what healthy meals consist of as well as special dietary needs for patients in hospital. I then started my private practise where I still consult with clients to assist them with weight loss as well as special dietary needs.
Where did you study your undergraduate degree and where did you do your community service?

I studied at NWU (Potchefstroom campus) for my 4 year Dietetics degree (incl honours) and then completed my community service in Tambo Memorial hospital in Boksburg.
Tell us about your community service experience.

It was great to learn from other dietitians in the government setup as well as see what things are like in a public setting as well as the different needs there is for patients. I also enjoyed helping people that was not able to afford Dietetic services otherwise and it made my heart melt when you could see the difference you made in their lives. It also was frustrating at times when you really wanted to assist people but did not have the right resources due to unpaid accounts or lack of funds. But overall it was a life-changing experience
Have you continued studying and what do you do to keep up to date on nutrition?

I have not continued studying a degree but have done a few shorter courses/ diplomas in Sports as well as Advanced sports nutrition. I also keep up to date with the latest research through CPD activities/ events/ articles as well as attend congresses

 

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

Have a look at the Dietitians website/ Facebook profile and have a look at what their passions are, what clients they see and compare it to your goals you want to achieve.
If a close friend or doctor refers you they are normally doing it after seeing great results themselves or with their clients so trust their judgement.

What is your favourite dish and your favourite treat food?

My favourite dish is any form of seafood including sushi. I normally enjoy a treat of a nice dessert such as a chocolate brownie or cheesecake which I normally would share with someone.


Media release: Stress, digestion & nutrition

Stress, as an appropriate response to a real danger, is an evolutionary life-saver.  Thanks to the fight-flight responses in our ancestors’ bodies, we, the descendants have made it through to the 21st Century.  It’s ironic that in this modern age with extraordinary technologies devoted to eliminating hazards and increasing our ease in life, our stress is off the charts.  We’ve become aware that our bodies, almost perpetually flooded with the stress hormones, adrenalin and cortisol, are now at risk from their own, age-old, protective ingenuity.

Our bodies are well-designed to cope with short bursts of life-saving stress, but it is sustained stress, resulting from a barrage of perceived threats, that takes its toll.  Flowing adrenalin and cortisol from our activated endocrine system ignite both visceral and cerebral reactions; and they do so by drawing the body’s energy away from other systems, such as our digestion and immunity.

Registered dietitian and spokesperson for ADSA (Association for Dietetics in South Africa), Maryke Gallagher explains that it is our autonomic nervous system (ANS), comprising of sympathetic, parasympathetic and enteric nervous systems, that controls our involuntary responses.  “Stress hormones switch on the sympathetic nervous system to increase your heartbeat and send blood to the areas to cope with the emergency,” she explains.  “In the process, the effects of the parasympathetic system in charge of other functions, such as digestion, are dampened. This can lead to unwanted digestive symptoms such as constipation, diarrhoea, nausea, stomach cramps, malabsorption and irritable bowel symptoms. Stress may also exasperated symptoms of heartburn and acid reflux in susceptible individuals and those suffering from stomach ulcers.”

How stress can undermine our nutrition

Apart from raising the risks of digestive ailments, chronic stress can influence how and what we eat, to the detriment of our healthy eating plans.  Gallagher says, “Research has shown that in susceptible individuals chronic stress can lead to overeating especially highly palatable, less nutritious foods that are high in highly processed carbohydrates, sugar, salt and unhealthy fats. High cortisol levels, in combination with high insulin levels, may be responsible. The hormone ghrelin that regulates hunger, may also play a role. The happy hormone serotonin may have an impact as the consumption of carbohydrate-rich foods may trigger its release, which can have a momentary calming effect on stressed individuals. Unfortunately, the consumption of these foods can have a negative effect on blood sugar levels, causing spikes and drops in blood sugar that then make one feel agitated, fatigued and hungry and grabbing for the same sugary, highly-processed foods that initiated this process, leading to a vicious circle of poorer dietary choices.

The impact of stress on our weight

Sustained stress might well impact on our weight management.  While some individuals may lose weight because of their stressed state, those who are inclined towards emotional eating can go the opposite way.  Mpho Tshukudu, also a Registered Dietitian and ADSA spokesperson says, “Adrenalin can trigger overeating or eating unhealthy foods to calm the response after the body has used up glucose for the stressful situation. One may eat mindlessly whilst thinking about the problem at hand and not even focus on the taste of foods, portions and your satiety level.  Elevated cortisol creates physiological changes that help to replenish the body’s energy stores that are used and depleted during the stress response. It makes you want to eat more to obtain more energy. This leads to increased appetite and cravings for sweet and fatty foods, which can lead to fat gain particularly around the belly.”

Nutrition’s role in stress management

Just like physical activity and mindfulness, nutrition has an important role to play in managing our stress and caring for ourselves well during a difficult time.  Keeping your healthy eating regime on track, or changing to one during times of prolonged stress can have positive physical and emotional impacts.  The experts recommend:

  • Eat regular meals to avoid blood glucose dips, which helps to keep hunger and hormones such as insulin in check. Skipping meals on the other hand can exacerbate symptoms of stress and erode your stress response.
  • Focus on a diet rich in plant-based, high fibre foods such as vegetables, fruit, legumes, nuts and whole grains, as well as lean proteins and healthy fats. This will assist in better blood sugar regulation to better manage the short term effects of stress, while protecting the body against chronic disease in the long run.
  • Avoid highly-processed carbohydrate rich and sugary
  • Be careful of regularly eating treat foods, such as chocolate in order to make you ‘feel better’. Likewise be aware of not increasing your intake of caffeine or alcohol during stressful times.
  • Consider including fermented foods in your diet, or taking a probiotic supplement to keep your gut microbiome healthy. Research has shown that stress affects the amount and type of healthy bacteria in the gut, which in turn can affect our immunity that may be suppressed due to stress. Tshukudu points out: “There is a complex two way connection between the digestive system and the brain, called the brain-gut axis. A troubled intestine can send signals to the brain, just as a stressed brain can send signals to the gut.  This system is sensitive to our emotional state and affects digestive illnesses such as irritable bowel syndrome, indigestion and heartburn. It also affects the whole body function.”

 

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


Dietitian’s week 2019

Dietitians do much more than you think!

The careers of dietitians are way more diverse than many think.  The typical assumption is that a dietitian is a nutritional health professional available through private practice to those who need and can afford weight loss expertise.  The reality couldn’t be more different.  Dietitians are employed across private practice and public healthcare; academia and research; corporate, government and non-government sectors.  While they all have the expertise to deal with weight loss and weight management, which can be critical health issues, their expertise in science-based nutrition means that they work far more widely on a myriad of nutrition-related issues.

Our relationships with food are so complex that it is not uncommon for a community-based dietitian to be dealing with both issues of obesity and malnutrition not just in the same day, but even within the same family.  If you are in hospital recovering from cancer surgery or a debilitating stroke; how do you take in the nutrition you need?  If you are a consumer goods company wanting to offer healthier food products; who will you turn to?  If we want to understand the latest claims about Omega 3 fats; who will help us sort the fact from fiction?  If a school needs to revamp its tuck shop and find healthier, popular alternatives; what are the best, proven recommendations?

In support of Dietitian’s Week, which runs from the 3rd to the 7th of June, ADSA, the Association for Dietetics in South Africa, is highlighting the wide range of services dietitians are specifically trained to deliver. SASPEN, the South African Society for Parenteral and Enteral Nutrition; ENASA, the Enteral Nutrition Association of South Africa and HDIG, the Hospital Dietitian Interest Group have all joined forces with ADSA to raise awareness that there’s much more to the work of a dietitian than is commonly assumed.

Registered Dietitian and ADSA spokesperson Abby Courtenay says, “At the core of every dietitian’s work is evidenced-based nutrition science and the ability to interpret this to meet an endless variety of demands for sound and expert nutrition advice.  Worldwide, nutrition research is ongoing, and Registered Dietitians are required by regulatory bodies to keep studying after they have qualified in order to ensure that they are at the forefront of the latest nutrition science, no matter what field or industry they work in.”

SASPEN spokesperson, Logesh Govender, further explains: “In South Africa, dietitians must be registered with the HPCSA which regulates the professional titles of Dietitians, Supplementary Dietitians, and Student Dietitians, as well as Nutritionists, Supplementary Nutritionists, and Student nutritionists. Requirements for eligibility for registration include a recognized bachelor’s degree in dietetics or nutrition from an accredited educational institution. The undergraduate training should include the three practice areas of therapeutic nutrition, community nutrition, and food service management. Dietitians can then select any of these areas to practice. Even in these different areas there are dietitians who may develop a keen interest in specific components.”

These are some of things that Registered Dietitians do:

Christine Taljaard-Krugel: “As a Registered Dietitian researcher and consultant, I make nutrition evidence useful for different sectors, including government, the private sector and the public.  I also invest in developing leadership capabilities in nutrition professionals across the continent to move the nutrition agenda forward.”

Linda Drummond: “My role at the Consumer Goods Council of South Africa (CGCSA) is to be the Nutrition Consultant to the Food Safety Initiative (FSI).  The CGCSA is a non-profit organization representing more than 12000 member companies engaged in the manufacture, retail, wholesale and distribution of consumer goods in South Africa and internationally. The FSI advocates for sustainable initiatives, forums, projects and programmes related to food safety, nutrition, quality and sustainability. My work focuses on helping members achieve compliance to food and nutrition regulations and I am responsible for driving the Healthy Food Options Industry Initiatives programme. The work in this programme aims to make healthier food options available and accessible to South Africans, as a means of curbing non-communicable diseases and promoting good health.”

Nazeeia Sayed: “I am a Consultant Registered Dietitian. I have over 20 years’ experience spanning food composition, research, lecturing dietetic students, supporting food industry research and development, regulatory and marketing teams in product development (in particular salt reduction, healthy recipe development and fortification), and developing nutrition communication.”

Bianca Tromp: “As a Registered Dietitian at the Heart and Stroke Foundation South Africa (HSFSA) which is a non-governmental and non-profit organisation, I am responsible for creating public awareness of cardiovascular disease and stroke in order to reduce the prevalence in South Africa. With this aim in mind, I provide scientifically accurate information to healthcare professionals and the general public in the form of research updates newsletters, television, radio and written media. The Nutrition Science team at the HSFSA also play a fundamental role in the Heart Mark endorsement programme where we endorse products that meet our strict nutritional criteria.”

Gaby Sidelsky: “I am a private hospital Clinical Registered Dietitian which means I work in a hospital. On a daily basis I work with doctors, mainly surgeons, who perform procedures on patients who require nutritional counselling on discharge. This is usually a gut surgery which requires a long term change in diet. I also work in ICU where I calculate a patients nutritional requirements and provide nutritional support if they cannot eat orally such as feeding through a tube from the nose directly into the stomach or through a vein. I also provide extra nutrients for patients who can’t get enough through their food or have a poor appetite due to side effects of medication, such as cancer patients on chemotherapy.”

Qudsiyah Kassim:  “As a public service Clinical Registered Dietitian I play a role in the public sector by providing therapeutic nutrition to both in and outpatients. I am part of the hospital’s multidisciplinary team and engage in ward rounds in my allocated wards. I provide therapeutic nutrition through assessing patients and prescribing the appropriate nutrition intervention as per the patient’s medical condition, as well as delivering nutrition intervention for in-patients through the prescription of a hospital diet/enteral nutrition/parenteral nutrition/dietary education and providing a meal plan on discharge.  For outpatients, I conduct a nutrition assessment and provide relevant dietary education (with appropriate meal plan and/ or supplementation if needed).”

Cindy van Rooyen: “As a Registered Dietitian I am also qualified to work in the food service industry. I currently work at a school hostel as their food service manager. In this role, I am responsible for menu planning, which includes making sure that the meals are nutritionally appropriate for our students (13-18 years). I am responsible for doing stock take and stock control to ensure the products are fresh, nutritious and safe to consume.  I also have to ensure that we comply with the health and safety act and that the appropriate hygiene practices are followed.”

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization 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 the Dietitian: Community service series

An unforgettable community service experience in the ‘forgotten province’…

By Inarie Jacobs

Health should not be taken for granted – a lesson I learned as a child whilst being very ill due to my poor lifestyle and dietary habits. After this experience, I decided to study dietetics at the North-West University of Potchefstroom to share this lesson as far and wide as possible.

I started my community service journey in December 2018 at a small rural hospital in the beautiful Transkei area of the Eastern Cape – a.k.a. “the forgotten province”. The challenges seemed a bit overwhelming at first as I had to trade my luxurious lifestyle habits for much simpler ones. Not only was the hospital an hour away from where I lived but it also never had a dietitian or a dietetic department before. No equipment and no supplements together with a huge language barrier made counseling with patients nearly impossible. To be honest, the tunnel did not seem to have light at the end.

However, after a few weeks of feeling really sorry for myself, I noticed how heavily the burden of wasting, obesity and poverty weighed on this community. The effects of the nutrition transition were clearly visible in this rural area which made me realized how badly nutrition intervention was needed. This led me to change my perspective and strategy towards this year and soon my challenges transformed into endless opportunities.

I get to build and establish a whole new dietetic department to promote our profession – an opportunity few community service dietitians have. I’m forced to improvise and to be more creative with cost-effective tools and methods to educate and treat patients – a skill I would have never developed if things were easy. I’m forced to reach out to the surrounding dietitians for help – a network of professional colleagues I would have otherwise not built.  I’m also trying to learn the beautiful isiXhosa language to interact with patients – a privilege I would have otherwise not had.

In short, comfort does not enhance growth! I’m grateful to be pushed beyond my comfortable limits as it is teaching me more than any book ever will!

I encourage all future and current community service dietitians to rise to the opportunity to lead, to influence and to inspire others with your attitude, deeds, and knowledge. To Quote Anne Frank: “You don’t always know how great you are, how much you can accomplish and what your potential is”. Dare more boldly, walk that extra mile and give it all you have!

A few rural survival tools:

  • Breathe…
  • Rural is never a textbook case.
  • Be culture sensitive and respect different views/religions.
  • Get to know local indigenous foods, what traditional foods are and how they are prepared.
  • Ask for help as much as possible. You don’t have to know everything, just be willing to learn.
  • Know that change doesn’t happen overnight and that some may be very resistant towards it.
  • Be kind and treat people with respect, no matter their background, title or position.
  • Be gentle and patient with yourself, your progress and setbacks.

 

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization 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 the Dietitian: Community service series

“The best decision I’ve made in my life…”

By Bonnie Evert

“TPN? Food in arteries?” These were my thoughts, as a very inexperienced 17- year- old girl, when the Registered Dietitian (RD), who was assisting a very close family member of mine in the ICU, explained what all the little bags hanging above the bed were in aid of.

My perception that RDs only help fat people lose weight was destroyed and the profession fascinated me. I canceled my application for the air force and immediately applied to study B.Sc. Dietetics at the NWU Potchefstroom Campus – which has been the best decision I’ve made in my life, thus far.

Five years later, I am working at a psychiatric hospital to complete my community service year. It is not quite the same as the acute setting we became familiar with in our 4th-year internship. This psychiatric hospital specializes in patient-care for the intellectually disabled patient, rehab for mood disorders, substance abuse or both, and a rehab unit that accommodates patients with spinal cord as well as brain injuries.

When starting anything new, there are a few challenges and opportunities. Here are a few of mine as a new Comm-serve.

  1. Opportunity

Working in a psychiatric hospital is very interesting and different to an acute hospital. Not a day goes by where an opportunity doesn’t arise to learn something new, read up on a rare condition or have a heart-warming encounter with a patient.

  1. Multi-professional team

I have realized the importance of working together in a multi-professional team, including the occupational-, speech- and physiotherapists, and how important each unique role is regarding nutritional management and overall patient care. I have come to understand that one cannot be a one-dimensional dietitian: yes, we are the nutrition experts, but it won’t hurt to learn more about all the complex medical aspects of different patients. In fact, it will improve your nutritional decision-making.

  1. To err is human – it’s okay to make mistakes

This is only relevant IF we use our unintended mistakes as learning curves and IF they do not harm anyone, of course. I have often felt as though my opinion is not worthy or helpful until I realized that if I don’t speak up immediately and take a stand for my patients (who often cannot speak for themselves), a greater risk is imposed on their healing and well-being. However, it is our responsibility to be updated with the latest evidence-based guidelines and medical nutritional therapy to support our opinions.

  1. Separate your work from your private life

In our line of work, it is our job to be empathetic towards patients and to remain professional. I learned that to keep my emotions from getting the better of me at work, I will have to find a way to debrief – and believe me – it is important to talk about your feelings. Thankfully, I have the best support system at work and an absolute role model as my supervisor who taught me this: It is important to be empathetic towards patients, but so is protecting yourself and ensuring the quality of your work.

Some of the highlights I have enjoyed about this year include the opportunity and privilege to help others and actually make a difference. The possibility of improving my knowledge as well as my work ethic – which includes earning a salary – has been outstanding.

My heartfelt message to anyone reading this article is NEVER to underestimate yourself, treat others the way you would like to be treated, stay up to date with the latest research, be positive and most of all enjoy the journey, it passes all too quickly!

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization 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


Sesame chicken

This mouth watering sesame chicken recipe was created by the lovely Cheryl Meyer, registered dietitian and food blogger from Dish and Delight.

Serves 4

INGREDIENTS

1 tablespoon olive oil

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

3 tablespoons low-sodium soya sauce

2 tablespoons apple cider vinegar

2 tablespoons honey

1 teaspoon crushed garlic

1 teaspoon crushed ginger

1 teaspoon corn flour

⅓ cup finely chopped spring onion (optional – extra to garnish)

2 teaspoons sesame oil

1 teaspoon toasted sesame seeds, to garnish

salt and pepper, to season

 

METHOD

  1. Season chicken cubes with salt and pepper.
  2. Sauté chicken in olive oil, stirring occasionally, until the chicken is cooked through.
  3. While chicken is cooking, whisk together the soya sauce, apple cider vinegar, honey, garlic, ginger, and corn flour until combined.
  4. When the chicken is cooked through, add the spring onions and soy sauce mixture to the pan and stir to coat the chicken – the sauce will thicken quickly.
  5. Stir in sesame oil, then remove from heat and enjoy.

 

SERVING SUGGESTIONS:

Serve over cooked rice, cauliflower rice, zucchini noodles or quinoa with steamed broccoli, stir-fried mixed veggies or cooked green beans topped a sprinkle of toasted sesame seeds and spring onion slices.

 

We Love:

This is simple Asian cooking at its best, a quick dinner that tastes like takeout but you control the ingredients, you control the flavor.

 

What the dietitians says:

Tip: measure the olive oil in your tablespoon before the honey, so it slides out easily.

 

Nutrition Information: Per serving

Energy: 1017 kJ Protein: 29.8 g Carbohydrate: 10.8 g Of which, total sugars: 8.7 g Fat: 11.4 g Fibre: 0.5 g Sodium: 556 mg


Making the best food choices for HIV & TB

Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and Tuberculosis (TB) are two of the most prevalent infections in South Africa, and both conditions present nutritional challenges that must be met to effectively treat these diseases.

“HIV/AIDS and TB patients are not just eating to maintain their normal bodily functions, like moving their muscles and the pumping of their hearts,” says Chantell Witten, a registered dietitian and spokesperson for ADSA (Association for Dietetics in South Africa). “When you have a disease, it becomes even more important to  maintain good nutrition because you often need additional energy and nutrients to effectively treat the disease, maintain a healthy weight, help the medication work optimally and support the body to repair damaged cells.”

According to Yzelle Watermeyer, a clinical dietitian working at the coal-face at the Kopanong Hospital in Vereeniging, one of the most serious challenges many patients face is the danger of getting caught up in a vicious cycle of malnutrition and an impaired immune system.

“Sickness and some medications can cause loss of appetite, malabsorption and an altered metabolism (increased nutrient needs).  This, together with a lack of access to quality food may result in a vicious cycle of weight loss, decreased immunity and worsening of the chronic infection (HIV and/ or TB).”

The significant link between healthy eating and wellness is at the heart of an ongoing Department of Health (DoH) message to broadly increase awareness that what we choose to eat and drink really matters.  “South Africans needs to be empowered with the knowledge of how nutrition impacts on their health, and their lives,” says DoH Director of Nutrition, Rebone Ntsie.  “With information and understanding, people can take responsibility for their wellness by making small lifestyle changes that can have a big impact. For instance, if you have money to buy a packet of chips as a snack; this money would be more wisely spent on fresh fruits which are packed with vitamins, minerals and fibre. If you have money to buy a fizzy, sugary drink; again you can make a better choice by choosing to drink life-giving water instead. You can reduce intake of unhealthy fat (saturated fats and trans fats) by buying a good quality piece of meat with no visible fat, grilled chicken or fish rather than fried ones.  This is how every South African can make better food choices and improve their wellness, and it is particularly important to people living with HIV/AIDS and TB.”

So, what should South Africans infected with HIV or TB eat?

The experts are unanimous that basic healthy eating guidelines as per our South African Food Based Dietary Guidelines apply to all, regardless of your HIV or TB status. Whilst, some medications may present challenges due to malabsorption and/ or nutrition-related symptoms, sticking to the rule of following a healthy diet made up of a variety of foods goes a long way.

“As we would advise healthy individuals, it is equally important for those affected with HIV/ TB to eat a variety of foods that will supply their body’s with much-needed nutrients,” points out Witten.  “Eat foods that are minimally processed which will provide you with a good dose of micronutrients (vitamins and minerals), as well as a  good quality macro-nutrients (protein, carbohydrates and fats).  We encourage everyone to eat plenty of fresh vegetables and fruits; wholegrains and legumes (such as beans and lentils); good quality meat, chicken or fish as well as eggs and unsweetened dairy products. These whole foods will help you  manage the disease and build and repair damaged cells.”

Watermeyer emphasises that eating fermented, probiotic-rich products like yoghurt or maas every day helps to support gut health, which is often compromised by HIV and TB. “Try to stick to the unsweetened/ plain dairy products because, with infections like HIV and TB, patients have a propensity towards developing thrush. Adding excessive amounts of sugar to the diet may worsen this. So whilst sugar is energy dense and may help you gain weight, it should be consumed in moderation as it may worsen side effects and is considered a nutrient-poor choice as it does not contain any additional vitamins and minerals to support the body,” she says.


What foods should HIV and TB Patients avoid?

Watermeyer says:

  • Avoid unpasteurised dairy products such as milk, yoghurt and cheese (always check the label if unsure, almost all dairy products sold in supermarkets are pasteurised, but milk bought directly from the farm, although more cost effective is not always pasteurised, so rather be safe than sorry!)
  • Alcohol (increases risk-taking behaviour and can exasperate malabsorption)
  • Raw or partially cooked animal products (can be a source of potentially harmful bacteria like Listeriosis)
  • Do not use anything past its expiry date
  • Limit tea and coffee as they affect some nutrient absorption and are not beneficial to the body (for example iron)
  • Avoid sugary coldrinks and energy drinks (these are high in sugar and low in nutrients a.k.a nutrient poor.)

Witten adds: “Avoid processed meats like polonies, viennas and corned tinned meats.  Although you may think these taste good, they are often high in salt and saturated/ trans fats which is not ideal for your health.) If you can’t afford fresh meat, chicken or fish every day, rather than buying processed meats daily, save up for a piece of good quality piece of meat once or twice a week and remember that legumes such as beans and lentils, eggs and tinned fish like sardine’s and pilchards are wonderful and healthy alternatives.” 

Top tips to help patients access safe, healthy foods that are more affordable include:

  • Make a vegetable garden at home and grow your own fresh vegetables
  • Legumes (like beans and lentils), soya mince, eggs and tinned fish are fantastic sources of good quality protein
  • Shop at the most affordable stores, be price-aware and look out for the specials
  • Buying in bulk is often cheaper, share the cost and produce with family, friends and neighbours
  • Do not buy and eat cracked eggs (check them before you buy them)
  • Be vigilant about keeping your hands and food preparation surfaces clean at all times.

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 the Dietitian: Community Service Series

Challenge… Accepted!

By Liezel Engelbrecht

I am probably not your typical community service dietitian: I am 37 years old. At 32, after nearly a decade in the media industry, I gave up my career as a content editor in order to pursue a new goal: to make a contribution in the field of preventative healthcare.

I was probably a little less apprehensive than first-time careerists going into my community service year (I am currently placed at a provincial hospital in Cape Town). It thus came as somewhat of a surprise when I found it challenging to adjust to the new routine, my new role and establishing new goals.

Let me start with the routine. Initially, I was thrilled to be able to start at 6:30 if I preferred. Getting up early in exchange for a more leisurely afternoon sounded like a good deal. I didn’t, however, take into account how emotionally taxing being a hospital dietitian would be. Even though I now technically had a large chunk of the afternoon to myself, I was so tired from the adrenalin of the day that I didn’t feel like my usual gym class or an afternoon run. Almost four months in, I have now adjusted my working times slightly, but I’m still working on striking the right balance to optimize my energy levels while building in some much needed “me”-time.

Secondly, the new role was an adjustment. A month before I started at the hospital, the chief dietitian contacted me to share that she’s had a major health setback, and would only be coming in intermittently for the first three months. Needless to say, I was a bit anxious, as this meant I wouldn’t have a supervisor or mentor. Luckily, this angst soon dissipated. She had arranged for the previous (very competent) community service dietitian to help out in her absence, who was extremely patient in showing me the ropes and guiding me through the hospital systems. Now that my supervisor is back, I am using the opportunity to soak up as much of her 25 years of experience as possible.

Which brings me to the next challenge I experienced: setting new goals for myself. It’s not called “community service” for nothing. In my final (internship year) studying at Stellenbosch University, we got a taste of working in various practical settings, such as hospitals, clinics and in rural areas. The hospital environment did thus not feel uncomfortable. However, in the community service year, your focus shifts from being a good student to being 100% focused on serving patients eight hours a day, every day. And serving takes up a lot of mental and physical energy! My goals thus changed from expecting results and feedback following projects, assignments, and exams, to attempt giving quality service to each patient, every day. Though this goal sounds obvious, it really is challenging to be fully present and equally enthusiastic and thorough with every patient you see, especially since you might do counseling for the same type of conditions and work out requirements for similar types of patients repeatedly. The end result will however only be rewarding if you manage your own expectations.

In conclusion, I encourage all prospective community service dietitians to see this year for what it is: an opportunity to get a better understanding of how the public health system works; an opportunity to become really good at something (you can become an expert at diabetes education, breastfeeding counseling, or any other area where you have an interest in), and, most importantly, the opportunity to serve.

Whether you love or hate this year, one thing is certain: you will grow.

More tools that work for me:

  • Respect the system, but don’t lose your enthusiasm. Fresh eyes are great for spotting areas of possible improvement. And if you have an open-minded chief dietitian (like I have), your ideas or suggestions might just get used and have a long-lasting positive effect.
  • Smile (even if you’re in a terrible mood). This makes you appear friendly. And if someone smiles back, you’ll instantly feel better.
  • Ask for help. It’s okay not to know how everything works initially, or what all the diagnoses and abbreviations mean. You’ll get better.
  • Accept (and face) your mistakes. I had many (I lost a scale, measuring tape and calipers in the wards, all in my second month!). You can only learn from them.
  • It’s okay to be affected if you lose a patient. Make sure you can talk to someone. It also helped me to talk to more experienced health professionals about their coping mechanisms.
  • Don’t neglect yourself. If you’re not in a good space mentally, chances are this negative energy will follow you around.

If you are a community service dietitian and would like to share your story, pop Abby Courtenay an email at adsapublicrelations@gmail.com with the subject line ‘Meet the Dietitian- Community Service Series’.

ABOUT ADSA
ADSA, the Association for Dietetics in South Africa, is one of the country’s professional
organizations for registered dietitians. It is a registered non-profit organization 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


Red Lentil Veg Curry

Our latest NutritionConfidence recipe, created by registered dietitian Alex Royal, is a delicious Red Lentil Veg Curry, filled with veggies, herbs and aromatic spices.

We love lentils. Not only are they a great plant protein (containing the third highest levels of protein of all legumes and nuts) but they are also a great source of soluble and insoluble fibre, folate and magnesium, which all contribute to a healthy heart!

This recipe is super easy and quick, so ideal for weeknight dinners and the leftovers are great for a work lunch the next day. 

INGREDIENTS (serves 1)

1/2 cup red lentils, raw, making 1 cup cooked

2 handfuls baby spinach

1/2 small onion

1 large tomato

1 clove garlic

Salt and pepper

1/2 tsp turmeric

1/2 tbsp coriander

1 tsp cumin

Fresh chopped chilli (to your taste)

1 tbsp olive oil

Fresh coriander

PREPARATION

Boil the lentils until tender.

Finely chop the garlic & fry in the olive oil, at medium heat, in a large pot. 

Add the spices, salt, pepper and chilli and fry for about 5 minutes.

Chop the baby spinach, onion and tomato. Add into the pot and fry on low for 5-10 minutes.

Mix the lentils into the mixture.

Top with coriander.

NUTRITIONAL VALUES

Per serving:

Energy: 245 kCal

Carbohydrates: 23g

Protein: 10g

Fat: 14g

 


The planetary health diet: what, why and how…

For the first time in human history there is a proposal on the table that all the world’s people follow the same diet.  The EAT-Lancet Commission brought together more than 30 world-leading experts to figure out if we can feed a future population of 10 billion people a healthy diet within sustainable planetary boundaries.  According to the report’s authors, food is “the single strongest lever to optimise health and environmental sustainability on earth.”

The healthy eating plan that they have subsequently developed, and are now promoting to governments and other agencies around the world, is closely aligned to the World Health Organisation (WHO) guidelines for healthy diets and the current trend of prioritising plant-based foods.  Lecturer at North-West University and spokesperson for ADSA (Association for Dietetics in South Africa) Dr Mariaan Wicks describes the planetary health diet as: “…rich in plant-based foods, with fewer animal source foods and limited amounts of added sugars. The planetary health plate consists of approximately half a plate of non-starchy vegetables and fruits, preferably locally produced, fresh and in season.  The other half of the plate should primarily consist of whole grains, plant protein sources such as legumes and nuts, with only modest amounts of unsaturated plant oils and animal sources of proteins.”

Why is the planetary health diet good for the earth?

The world’s food systems are grappling with the issues of needing to produce more food for a growing population on a planet where the sustainable boundaries have already been breached.  The EAT-Lancet researchers looked at how to feed more people while reducing greenhouse gas emissions, preventing further species extinction, curbing the expansion of farmland and conserving water.  Their recommendation to reduce our consumption of animal protein is because its production has the highest detrimental impact on the environment.  Similarly, the limitations on eating highly processed foods are in line with reducing the negative consequences of food manufacturing and distribution.  According to Dr Wicks our will to create a more sustainable world for our future generations makes changing our diets inevitable.  “The composition of our diets determines the impact of food on the environment, and the food system is where the domains of our health and the health of the environment meet,” she says. “Earth is our home, and it is the only one we have.  The responsibility to take care of the planet falls on each one of us, and therefore, dietary adaptions are essential.”

How do we change to the planetary health diet?

Following the planetary health diet will demand different changes for different peoples and different countries.  In South Africa, the biggest impacts would be the reduced intakes of animal proteins, added sugars and starchy vegetables.  Globally, the eating plan aims to halve the world’s consumption of red meat, and to achieve that goal, the world’s top red meat-eating countries, such as the USA, need to reduce their consumption by 80% which equates to eating one hamburger a week, or a big steak once a month.  Dr Wicks advises that South Africans can take small steps towards eating more sustainably rather than making sweeping changes.  The planetary health diet offers an incredible variety of plant-based foods, and there are excellent sources of plant proteins that provide complete amino acid requirements.  Getting used to eating less meat, eggs and dairy doesn’t mean we won’t be eating delicious meals.  “Every little change can make a big difference,” says Dr Wicks.  “Start with little easy changes, and then as you become more comfortable and familiar add new changes.”

Dr Wicks points out that eating more sustainably is not just about food choices but also includes food packaging issues and how we reduce food waste.  Her examples of simple changes that we as South Africans can make to eat more sustainably include:

  • Rethink the amount of meat you consume in your regular diet. Little changes such as reducing your portion size and the amount of times in a specific day or week that you consume meat, especially red meat, can contribute greatly in reducing your carbon footprint.
  • Try to include at least one meat-free day in your week, breakfast, lunch, snacks and dinner. Experiment with beans, lentils and chickpeas in the place of meat. There are fantastic recipes available online that are easy and affordable. My personal favourites are tomato-based whole-wheat pasta dishes and a chickpea, black bean and cauliflower curry with brown rice.
  • Exchange your breakfast of eggs, bacon and sausages for a delicious vegetarian omelette with onions, tomatoes, mushrooms and peppers.
  • Develop a week menu and plan your meals and food shopping for the week. By having a clear plan for what you want to buy, you will not only save money and time but will also limit your food waste.
  • Limit the amount of meat included in your weekend braai to only one meat option. You can always add other braai items such as black mushrooms with a garlic butter filling, brinjals in barbeque sauce and vegetable sosaties made with onions, peppers, cherry tomatoes and baby marrows.
  • To reduce dependence on refined starches, experiment with other starchy foods such as brown rice, couscous and whole-wheat pasta. You can replace your starchy vegetables and maize meal side-dishes by creating other fantastic side-dishes simply by adding these starchy foods to your salads and vegetables. Include some lentils or chickpeas and then you have a complete meal.
  • Rethink what you do with food waste. Using leftovers for the next day’s lunchboxes or freezing the remaining sauces for a base for a next meal is a good start.
  • Buy fresh, seasonal, locally-produced fruit and vegetables, and limit pre-cut and packaged fruits and vegetables. By doing this you will not only save money but will also dramatically reduce your plastic use.
  • Choose water instead of sugar-sweetened beverages. Use re-usable bottles to limit your single- use plastic items.”

While the planetary health diet focuses on a sustainable global food system that is better for the environment, we mustn’t forget that it has also been specifically designed to be beneficial to human health.  The EAT-Lancet researchers believe that the planetary health diet can save 11 million human lives by reducing overweight, obesity and other diet-related health issues.  In the sense that all life is connected and interdependent, what is good for the planet is also good for us.

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


‘Stay consistent’ – success story: Simone de Pinho

ADSA_Success Story_Simone de Pinho.pngWe chatted to Simone de Pinho about her journey with registered dietitian Michelle McDermott.

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

I have been a yo-yo dieter all my life. I struggled with my weight from the time that I became aware that weight means something in the world. I have lost a considerable amount of weight often but always put it back on as I failed to stay consistent.

The reason that I went to Michelle, which is the reason that I always start, is because I became so uncomfortably large that my only option was to lose weight. Sometimes I wished that I had a medical reason to lose weight (it might have pushed me to be more motivated) but my health has generally not been a factor.

Tell us about your journey with the dietitian?

Michelle is not like other dietitians. Her approach is one of realism, when all I strived for was perfection.

Michelle helped me realise that my excess weight was a result of emotional eating – although this could sound obvious to someone else, I only realised this when I would go to weekly sessions, see weight gain on the scale and then cry while Michelle tried to console me and give me the motivation I needed. How Michelle didn’t fire me during those weeks, months, years, I have no idea!

I think Michelle now knows me so well that she can see when I am motivated and when I am slipping. Michelle also gives the most amazing advice just when I need it. 

I also want to mention that my boyfriend and I see Michelle together. I can see how Michelle’s approach to a man differs to that of a woman and that is a testament to her experience and the wealth of knowledge that she holds! Our sessions are always fun (especially when we know we have stuck to our plan) and Michelle always gives us great feedback and measures all sorts of other things (such as body fat, water retention and metabolic calorie rate).

Tell us about your results / successes?

Most (if not all) of my over eating stems from emotional eating. This is something that I have researched over and over in an effort to understand it. I am successful with my plan when I remember to focus on eating healthily and within my plan. I am unsuccessful when I let me emotions overwhelm me and my brain literally doesn’t engage. Binge eating cannot be stopped no matter how much my brain tries to see the logic!!

I first started seeing Michelle in October 2014 and lost about 30kg’s from October 2014 to September 2015. I then started falling off the wagon and during 2016 and 2017 put all the weight that I had lost (plus an additional 10 kg) back on. In January 2018 Michelle put me on a strict medical weight loss program using meal replacements and I have lost 18.4kg’s in approximately 3 months. 

What was the hardest part of the journey?

Definitely maintaining the weight loss! The hardest part of the weight loss journey is not losing the weight, it’s about maintaining a healthy lifestyle and being consistent, after you have reached your “goal weight”.

The other difficult part is to actually start – for me it’s all about getting my mind right. Learning how to self-motivate has been a journey and is still a journey.

What are the top three tips you can share?

• Stay consistent

• Have treats but make sure you get back on your plan immediately afterwards

• Exercise is key to ensuring that your mindset is correct

What the dietitian says

Simone has been a dedicated patient and is a true example of how you can do things when your mind is in the right place. We have worked together to find a plan that works for her and all I did was provide the tools and the guidance – Simone did all the hard work after that and is achieving wonderful results. Starting on any new plan needs clear guidance,  goal setting and tools to make it work within your lifestyle so that the changes made can be sustained long term.

This is what a dietitian would aim to achieve with a patient as well as offer encouragement and  ways to make easy sustained changes to reach the health and nutrition goals of the patient.

Congratulations and well done to Simone – a few more steps to go!

 

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


‘Notice and appreciate the smallest changes in yourself and body’ – success Story: Kim Gunnell

ADSA_Success Story_Jade Seeliger_KimKim Gunnell struggled with her weight her entire life. Her gran’s passing was her turning point, which resulted in her meeting registered dietitian Jade Seeliger and kicking off her weight loss journey and a whole new way of seeing herself:

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

I’ve struggled with my weight throughout my life. No matter what I tried, things didn’t work and neither did my motivation to stick it out when the going got tough.

After my gran past away in March 2017, I decided to get rid of my comfort blanket (my hair) and I donated over 35cm to CANSA. This was the surprising start of my journey and the start of the investment in myself. 

Tell us about your journey with the dietitian?

Jade has become a part of my life, from when I stand in the queue at Woolworths and am tempted by sweets to when I am having a bad day and am not wanting to go to the gym. 

It’s so important to have a honest relationship with your dietitian, you can only BS your way to a certain extent as they honestly become a part of your life as you cover everything from bowel movements to menstrual cycles.  

Jade has shown me that my relationship with food was they way it was because of my home environment, no concept of portions and a lack exposure to variety. This was all that I knew for 25 years of my life. However the past 365 days have opened my mind and mouth up to new foods, recipes and cooking methods. 

Our relationship has well surpassed that of client and patient as she has not only guided me throughout the process but when I had stumbling blocks, she was able to recommend the next steps that were beyond her expertise. 

Tell us about your results / successes? 

To date, I have lost just short of 20kg’s in less than a year – with ups and downs along the way and with Jade being on maternity leave. 

I hated running since I was a child. I used to dread having do it from both a physical and mental perspective and was never been able to wrapped my head around it. In 2016 I attempted the 10km Soweto Marathon race and it was one of the most eye opening experiences of my life at nearly 130kg (I cried all the way to the finish). However, this has changed since I decided to start running at gym and to enter the Spar Series, JP Morgan and my nemesis Soweto again. Needless to say, I finished my 10km in 1h19min which was 2 minutes faster than the time I set myself as a goal and I am now hooked. I’m participating in Park Runs every weekend and clocking a minimum of 10km a week at gym. Further to this, I have a goal of doing at least 10 x 10km races before the end of the year.

I’ve always put off things which have a predetermined weight restriction or will make me look ‘silly’ for trying, but I have now gone for a wake boarding lesson and learnt to ride a scooter. To some this may seem like small, but for me those were a big deal and something I’d always put off. 

What was the hardest part of the journey? 

There were two parts of my journey that were really hard and I still work on them daily: 

1 – Loving the Scale (well trying to) – The scale was avoided for years prior to my choice to confront it. I had to learn to love and understand it far beyond the numbers that are displayed. 

2 – Self Love – I’ve had to learn to love myself and recognize the change that I have undergone, past the numbers on the scale. This has been my biggest challenge as I have always done everything for everyone else, except myself and have been the size that I am for as long as I can remember. It has affected me from clothes shopping to getting in a aeroplane and feeling as if there is now more space. I am a work in progress as 25 years of negativity cannot be undone overnight or in a few months. 

This is still a challenge for me, as I have to completely adapt my mindset and way I perceive myself and the world around me on a daily basis. 

What are the top three tips you can share?

  • You aren’t going to lose weight every time you get on the scale – make peace with it 
  • Notice and appreciate the smallest changes in yourself and body
  • Stick to it, but don’t be too hard on yourself – even wheels fall of wagons

What the dietitian says

Some clients have the ability to not only to motivate themselves in their health journey, but in fact everyone they come into contact with.  Kim was such an inspiration to me, to see someone turn their entire life around through the lessons they learnt in health made the journey a deeply fulfilling one for me as a dietitian. 

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

 


Banking Your Breastmilk Saves Lives

The breastmilk bank is probably the most altruistic banking system in the world. Healthy, lactating moms express and donate their excess breastmilk. The milk is tested and pasteurised, and then distributed to neo-natal intensive care units around the country, where it is used to feed the most vulnerable babies.

Every year, donated breastmilk saves the lives of thousands of vulnerable babies in South Africa. Eight out of one hundred babies in the country are born prematurely and, every year, approximately 11 000 premature babies die from preventable infections and complications.

“All babies have immature immune systems,” says Abby Courtenay, a Registered Dietitian and spokesperson for ADSA (The Association for Dietetics in South Africa), “Breastfeeding plays a vital role in transferring not just nutrients but antibodies and other immune-boosting properties to an infant to strengthen the immune system and protect them against infections. This is why breastmilk is the perfect first food, and why the World Health Organisation recommends exclusive breastfeeding for the first six months of life.”

Many mothers giving birth to premature babies in neo-natal intensive care units don’t produce milk immediately, or enough of it. Some mothers experience health complications and cannot breastfeed. If their babies can be fed donated breastmilk instead of formula, it dramatically increases the baby’s chance of survival and offers greater protection against life-threatening infections such as the intestinal infection – necrotising enterocolitis. Donated breastmilk also helps premmies to gain weight and grow faster. This is why donated breastmilk is the next best option when the mother’s own milk is not available.

Breastmilk banking was pioneered in South Africa sixteen years ago by the South African Breastmilk Reserve (SABR) and, today, they have a network of 27 banking facilities across the country. The breastmilk movement in South Africa has since grown to include several other initiatives such as ithemba Lethu milk bank and children’s home in Durban, the KZN Breastmilk Bank Initiative and Milk Matters in the Western Cape.

Every year, more than a thousand South African moms help save lives by donating their milk. “What we would like to see is breastmilk banking being used far more frequently,” says Executive Director and SABR founder, Stasha Jordan. “Expressing breastmilk has become the norm for many new moms who have to return to work while still breastfeeding. Some women have an abundant supply of breastmilk and can easily express more than their baby needs. That surplus can literally save the life of another child. Our donor moms are real heroes helping the most vulnerable in our society to survive.”

SABR and ADSA have partnered to raise awareness of breastmilk banking, which is supported worldwide by both the World Health Organisation and UNICEF.

Who can bank their breastmilk?

A healthy, lactating mom with an excess of breastmilk can make donations. It’s important that you have not received a blood donation in the past year; that you are a non-smoker; that you do not consume alcohol regularly and that you are not on any medication. Donor mothers do need to undergo blood tests to be screened for HIV and hepatitis B.

How does banking my breastmilk work?

  • Donor moms complete an online screening questionnaire
  • SABR contacts you telephonically to refer you to your nearest sign-up facility.
  • Arrangements will be made for the necessary blood tests.
  • You will receive all the information you need for the safe storage of your expressed milk, which will be collected from you.
  • Your breastmilk will be screened, pasteurised and distributed to help save the lives of premature babies in neo-natal intensive care units.

 

Every drop counts and small donations can also be used, so don’t be put off from donating if you don’t have a particularly excessive supply. To find out more visit https://www.sabr.org.za


‘Be dedicated and committed to your journey’ – success story: Bongi Ncube

We chatted to Bongi Ncube, who has been seeing registered dietitian Monique Piederit, to find out more about her health and fitness journey:

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

In January 2017 I started on the fitness journey – due to work pressure and the amount of stress I endured, I needed an outlet to release the pressure; gym became that outlet. The initial intent was to keep fit, but I soon realised that I was not happy with how I looked and thus wanted to lose weight.

I procured the services of a personal trainer who later recommended that I consider consulting with a dietitian as diet plays a key role in weight loss. 

 Tell us about your journey with the dietitian?

The first consultation was an eye-opener! I realised that approximately 50% of my weight comprised body fat – the task at hand was to work on reducing the body fat %.

The first week was very tough as the portions I had to eat were far smaller than what I used to eat, but with time I got used to the eating plan.

What I appreciated the most is that the eating plan that was recommended for me was easy to follow – no food types were cut out, instead the portions were reduced.

My dietitian was been very supportive and encouraged me on this weight-loss journey and the eating plan complemented the training schedule I had with my personal trainer.

Tell us about your results / successes? 

I have successfully managed to loose 17.5kg (from 88.6kg in July 2017 to 71.1kg in September 2018). This has been a consistent gradual reduction of my weight over the months.

What was the hardest part of the journey? 

Taking the first step to consult with a dietitian was certainly not easy. I was not sure of what to expect and was very nervous at my first consultation.

Getting used to the smaller portions was not easy. It took me at least 1.5weeks to get used to the eating plan. Over the period October 2017 to January 2018, my weight remained stagnant at 81.6kg – this was very difficult to accept as I was doing everything that was recommended and still there was no change. It took a lot of courage to press on through this period.

What are the top three tips you can share?

  • You need to have a good relationship with food – do not be scared to eat, but eat right.
  • Don’t view the eating plan as a diet, view it as an eating plan (a guide to follow to ensure that you consume the right amount of micronutrients).
  • Be dedicated and committed to your journey; it pays off. It does not matter how long it takes, as long as the weight keeps coming down.  

I never thought that I would ever be able to reach my 2012 pre-baby body weight, but through the help of both my dietitian and personal trainer, I have been able to achieve this goal. My family’s support has been a huge contributor and enabler to my weight loss.

My fitness level have reached new heights – over and above the 10kms runs, I have managed to run 7 X 21.1kms with PB of 2:46. I am now working on toning my body and maintaining the weight.

What the dietitian says

Bongi is the perfect example of how you can do anything you put your mind to. She started seeing another dietitian, Kezia Kent, after a wellness challenge at work inspired the start of her journey, starting at 88kg and moving down to 81kg. When Kezia immigrated, I continued working with Bongi who in total has lost over 20kg. Apart from making daily and sustained changes to her diet, Bongi’s new found love of running has supported her weight loss even further where she regularly challenges herself to 21km half marathons.


Spicy Tofu Bowl

Our first NutritionConfidence recipe for 2019 is a delicious  bowl of food that is high in fibre, low in saturated fats but full of heart healthy fats. The ‘Spicy Tofu Bowl’ created by registered dietitian Julie Perks is dairy, wheat and gluten free and is also vegan with a lovely source of protein. People often  don’t include tofu in their diet as they don’t know how to cook it or flavour it. We love how the spicy chilli sauce in this recipe lends a wonderful taste to the tofu that makes the bowl really delicious as a lunch or light dinner.

INGREDIENTS (Serves 1)

Marinade:

1 tablespoon chilli sauce (I used sriracha)

½ teaspoon olive oil

1 tablespoon soya sauce (or Tamari for Gluten Free)

Salad Ingredients:

100g Tofu

1 cup spinach

½ medium avocado

½ cup black beans

1 small carrot, spiralized

5 baby tomatoes

1 tsp sesame seeds

Picked Radish & Onion:

¼ red onion

2 radishes

2 tablespoons white wine vinegar

1 tablespoon water

½ tsp sugar

Pinch of salt 

METHOD

Slice radish and onion finely and place in a small container with the other pickling ingredients and leave to stand until serving. The longer the onion and radishes pickle for, the softer they will become.

  1. Preheat the oven to 180 degrees Celsius.
  2. Make the marinade with the chilli sauce, olive oil and soya sauce by combining all the ingredients in a small bowl.
  3. Add the tofu to the marinade and once covered well, place onto a baking sheet.
  4. Place the tofu in a preheated oven for 10 minutes.
  5. While the tofu is cooking, start preparing the salad bowl by placing the spinach at the bottom of the bowl, followed by the spiralized carrots, tomatoes, black beans, pickled radish and onions and avocado.
  6. After the tofu has been in the oven for 10 minutes, turn and cook for a further 10 minutes. Once cooked, remove from the oven and add to the tofu bowl.
  7. Garnish with lemon juice.

Nutrition Information: Per serving

Energy: 1225 kJ Protein: 14g Carbohydrate: 25g Of which, total sugars: 2,2 g Fat: 17g Fibre: 11g Sodium: 200,4 mg


Healthy Eating for a Healthy Pregnancy

There’s nothing else quite like pregnancy to sharpen your focus on your health and well-being. The journey of carrying and nurturing new life within your body is an exceptionally special time, and moms-to-be are deeply invested in doing it as well as they can. Advice will inevitably come from all quarters, and it is important to tap into expert sources that will give you peace of mind that you are on the right track.

The aim of Pregnancy Awareness Week this month is to help moms access the information they need to support a healthy pregnancy and safe motherhood. The Department of Health urges pregnant South African women to access antenatal care as early as possible in their pregnancies. This provides the opportunity to understand and manage any health issues, as well as get information on important factors such as self-care and nutrition. Once the pregnancy is confirmed by a nurse at a health facility, the mother can register for MomConnect, a free cell phone-based resource for accessing pregnancy-related health information.

Nazeeia Sayed, a registered dietitian and spokesperson for ADSA (Association for Dietetics in South Africa), points out that good nutrition is vital as it supports a healthier pregnancy and a healthier baby. “Pregnancy is a great opportunity to get yourself and the family into the habit of healthy eating before the new baby arrives,” she says. “You don’t need special or expensive foods. A healthy diet during pregnancy is made up of foods that we commonly encounter when grocery shopping. A variety of fruit and veg, whole grains, legumes and lentils, dairy, plant fats and lean meats, fish and eggs can all be enjoyed while you are pregnant and will provide the nutrients you need.”

What nutrients should moms-to-be focus on?

Following a balanced diet according to the accepted healthy eating guidelines is the optimum nutritional route to support a healthy pregnancy. Pregnancy is definitely not the time for weight loss or fad diets that focus on particular nutrients at the expense of others. Registered dietitian and ADSA spokesperson, Cath Day says, “Energy (kilojoule) restriction during pregnancy is not recommended! High protein diets which increase ketone production are also not recommended as the foetus has a limited ability to metabolize ketones. It is much healthier for you to adopt a balanced diet with a good variety.”

Nutrients such as folic acid, calcium, iron and protein are all important to the developing baby; however a balanced diet will, in most cases, meet these needs. Women enrolled in the government’s antenatal care programme will receive supplements of the essential micro-nutrients; and many women choose to supplement with folic acid to prevent the risks of Spina Bifida and cleft palate.

Day points out that meeting protein requirements during pregnancy is as simple as ensuring that you eat roughly six servings or between 180 g- 210 g of protein each day (size of two palms or two decks of cards). One serving equates to 30 g lean meat or fish, 1/2 cup of legumes, 15 g nuts or one egg. “These are also the best sources of iron which is needed to prevent anaemia,” she says. “By eating fruit and vegetables high in vitamin C at the same time as eggs, nuts and pulses, you can enhance iron absorption from these foods.”

Focusing on a variety of healthy foods for each meal or snack, rather than the particular nutrients, is what helps to ensure you and baby get what you need. Sayed says, “Some examples of this are choosing nutrient-dense meals or snacks like an omelette with veg, a fruit and yoghurt smoothie, a salad with raw veg, nuts or lean meat; or a cooked lentil dish with green leafy veg and rice.”

What should moms-to-be avoid?

Smoking tops the list of what shouldn’t be going into a pregnant body. While there’s debate about whether drinking one glass of wine is safe for a growing baby, many experts and governments around the world advise a complete avoidance of alcohol during pregnancy. Pregnant women should avoid foods with a greater risk for contamination with Listeria or other bacteria or parasites, including under-cooked meat and eggs, raw fish, processed meats and unpasteurised dairy and soft cheeses. Dietitians also advise avoiding fish that may contain high levels of mercury such as swordfish, shark, tuna steaks and canned fish brands that are not tested. Caffeine intake should be limited, and rather swopped out for decaf options, with water as your best beverage of choice. Foods that are high in salt, sugar and other refined carbohydrates should be limited as they crowd out the opportunity for you to eat healthy foods which provide for your vitamin, mineral and fibre needs. They can also lead to excessive weight gain which increases your risks of developing high blood pressure issues and gestational diabetes.

Reach out and get help when you need it

Healthy eating during pregnancy does not have to be complicated or a minefield. It might be more challenging for moms-to-be who need to make big changes; or who are overweight or managing other health conditions. A registered dietitian can be an important ally to come up with a healthy eating plan that suits your food preferences, your budget and your lifestyle. “The big advantage of using your pregnancy as the inspiration to eat well is that you can go on to become a healthy eating role model for your precious child, instilling healthy eating habits that can last them a lifetime,” Sayed concludes.

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


Success Story: Zandra Sissing

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

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

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

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

Tell us about your journey with the dietitian

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

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

Tell us about your results / successes

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

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

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

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

What was the hardest part of the journey?

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

What are the top three tips you can share?

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

What the dietitian says

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

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

 

 


Ride For Hope

ADSA_Ride for Hope 3Our dietetic students are often involved in awesome projects and we love the Ride For Hope campaign that Bernadine Blom, a third-year student studying Dietetics at the North-West University (NWU), started with her father. Here is her story:

 

 

Bernadine Blom

I’m a third-year student studying Dietetics at the North-West University (NWU). My passion for dietetics started when I learned about the impact that food can have on your health. Cliché I know, but once you read my story you will understand.

When I was 9 years of age my mom became ill and was diagnosed with kidney failure. It was something we didn’t know much about, just that my mom had to get treatment every 4 hours at home. This treatment is known as peritoneal dialysis. The peritoneal treatment wasn’t very successful; my mom then switched to haemodialysis, meaning 4 hours of treatment 3 times a week. During this time my mom was referred to a dietitian who helped her make important lifestyle changes. She changed her diet to reduce her potassium and phosphate levels. I kept asking why she should prepare food differently or why she isn’t allowed to eat her favourite fruit anymore? Then I started to understand the effect of different food choices on my mother’s health. It soon became part of my life but never really affected my food choices. I was still allowed to eat things my mother was not allowed to have like chocolate (Sorry Mom!)

My mother was in and out of hospitals during my school years. In 2012 we received the good news that my father  was a match and could donate a kidney to my mom! The transplant was performed on the 31st November 2012. Life was back to normal for almost a year. Then in October 2013 she got an infection and became very ill again. The kidney was damaged and my mother returned to dialysis in July 2014.

This was my Grade 11 year, the year of many decisions with matric approaching rapidly. With no idea of what exactly I wanted to study after finishing school, I had developed a passion for baking, food and helping people. I attended NWU’s open day and discovered what dietetics really entails and decided to study dietetics – the perfect way to help people while doing something I love.

I went off to university and for the next two years both my brother and I were out of the house studying at NWU. My mom’s health was like a roller coaster. She continued the haemodialysis, which was essential for her survival.

2018 became a year that really shaped me. I was chairperson of the Academic Student council for Dietetic and Occupational Hygiene students. I was also on the ADSA North West Branch as the student representative. I really learned a lot! I waited 3 years once I started studying to learn more about nutrition therapy in renal patients. 2018 was also the year I could finally ask all the questions I had as to why certain things can and can’t be eaten by someone with kidney disease! I now know the importance of healthy dietary intake in renal patients, as we are training to become nutrition experts, but with my history I also better understand the emotional part of making drastic changes to one’s diet.

My passion for organ donation grew strongly during the years of personally seeing the effect of it on a person’s life as well as the family. My mother is currently still on dialysis as the waiting list for a kidney transplant is between 10 – 12 years.

Ride for Hope

My father and I are currently busy with a campaign called Ride for Hope. It started one night when he told me about his idea and I immediately say YES! So, the scheming and planning started. Our aim is to get as many new registered organ donors as possible. Our wish is also to give hope to those who are waiting for a transplant.

There are currently 4 300 adults and children in South Africa waiting for an organ or cornea transplant. Less than 600 will get the gift of life this year, because of the shockingly low rate of organ donors in South Africa. It’s estimated that only 0.2% of all South Africans are registered organ donors. We discovered that lots of people have little to no knowledge about organ donation as they have never been affected by it. For others the fact of organ donations is just too scary. With this journey we hope to inspire and motivate people to take action! To register is really as easy as 1, 2, 3. It only takes 5 minutes of your life and has no hidden costs or any medical tests required. All that is required is your commitment to do 1 final act of kindness after you have passed away.

My father, Braam Blom, is currently travelling from Pretoria to Cape Town on the bicycle with the aim to create awareness around organ donation. The journey started on the 17th of November 2018 from Netcare Jacaranda Hospital in Pretoria. Our goal is to reach the 10 000 mark in new registered organ donors during the 1700km of cycling. Reaching 10 000 may sound like a lot and not possible for 2 people to achieve but with the help of other people it can be possible. Anyone can be a possible registered organ donor including YOU!

We have a few more days left on the journey, so please visit our Facebook page @ Ride for Hope for more information. Ride for Hope is endorsed by the Organ Donor Foundation & has a dedicated link to register. https://www.odf.org.za/ride-for-hope.

We currently have 305 new organ donors successfully registered.

 


Meet registered dietitian, Jessica Oosthuizen

ADSA_Jessica Oosthuizen.jpgWe chatted to registered dietitian Jessica Oosthuizen to find out why she became a dietitian, what being a dietitian means to her, the challenges she faces in her profession and her views on healthy nutrition:

Why did you become a registered dietitian?

I was diagnosed with Type 1 Diabetes when I was just 13 years old. I had always been a competitive swimmer and sportsman at school so healthy eating was always a way of life (although I did have the ultimate sweet tooth as well). After being diagnosed with diabetes, nutrition just became that much more important. Juggling diabetes with school, swimming and being a teenager had it’s up and downs. I became a dietitian because I am passionate about helping children and adults understand diabetes and the role that nutrition plays and I felt that having the personal experience and empathy can make such a difference.

How do you promote a healthy lifestyle as a registered dietitian from day-to-day?

I feel that a healthy lifestyle incorporates more than just nutrition and it includes aspects such as being physically active, practicing mindfulness, decreasing stress as much as possible, smoking cessation and of course following healthy eating principles. I feel very strongly about not being able to blanket the same message to all my patients because everyone is a unique individual and this always needs to be taken in to account. I also try to promote a healthy way of life on social media using my Instagram account dietitian_with_diabetes.

What does being a registered dietitian mean to you?

I like to think that this means that I am respected as a trusted healthcare practitioner. That I am someone who my patients trust to provide them with evidence based scientific information that I am able to translate into easy-to-understand language for the general population.

What in your opinion are some of the biggest nutrition-related health issues South Africa is faced with?

Overweight and obesity is definitely up there and something that I see on a daily basis. This of course increases the risk for a host of diseases such as Type 2 Diabetes, cardiovascular disease, certain cancers, non-alcoholic fatty liver disease and stroke.

If you only had 30 seconds to convince someone to eat healthier, what would you say?

Start with a focus on quality, quantity and frequency!

  • Eat not too much, mostly plants
  • Include whole grains to ensure adequate fibre to maintain a healthy gut
  • Include lean protein sources with a focus on fatty fish to get in your omega 3’s
  • Include healthy fats daily such as olives, avocados, nuts, seeds and olive oil
  • Don’t forget to drink water – the specific amount will depend on the person but 8 glasses (2 litres) per day is a good goal to aim for

What is your biggest challenge as a dietitian?

Dr Google is definitely right at the top! The general population can find an answer to anything in a matter of seconds on the internet so why would they believe me? Convincing patients that the latest fad diet is not the healthiest way to lose weight, or in fact is just not heathy at all, can sometimes be quite challenging.

What do you think are some of the most important skills or personal traits a dietitian should have?

A dietitian should be non-judgemental, a very good listener and they should not be too quick to give advice without getting all the information from the patient first. We need to have good time management and organisational skills. I also feel that a dietitian should be passionate about the work that they are doing.

How do you handle difficult clients/patients?

I put the ball in their court and try get them to understand the situation. I focus on trying to educate the patient because I often felt that a lack of education is the problem when they’re so set in their ways. I try to negotiate and come to a happy medium where both parties are able to understand and communicate openly and freely.

What is your opinion on fad diets?

There are so many fad diets around and if they are so successful then why are there so many different ones? Yes, of course fad diets will cause weight loss for most people at the beginning because you are creating a severe calorie deficit and often cutting out complete food groups. However the weight regain after stopping the diet is generally more than the weight that has been lost. This is because fad diets:

  • Are completely restrictive
  • Are unsustainable for most people
  • Can be anti-social
  • Are unhealthy and unbalanced
  • Do not teach you healthy eating habits around food
  • Are not individualised

 

ABOUT 

Jessica Oosthuizen RD (SA) obtained a degree in Sport Science from Stellenbosch University and furthered her studies at the University of Cape Town where she graduated with a Bachelor of Sciences Medical Honours Degree in Nutrition and Dietetics.

Jessica is registered with the Health Professions Council of South Africa (HPCSA) and the Health and Care Professions Council (HCPC) in the UK. She is a member of the Association for Dietetics in South Africa and a Vitality Wellness accredited dietitian.

She has experience working in the clinical hospital setting as well as experience with a variety of chronic diseases of lifestyle such as obesity, hypertension and type 2 diabetes.

Being a Type 1 Diabetic herself since the age of 13, Jessica has a special interest in the nutritional management of children and adults with diabetes. She also has a key interest in weight management and eating disorders.

Jessica is passionate about the ever-changing profession of dietetics. She enjoys helping individuals achieve optimal health through nutrition to live their best life as a healthy and happy individual.

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

 

 


Diabetes in the Family, How to Cope

More often than not a diabetes diagnosis is experienced as devastating; not just to the patient but to their loved ones as well. Even though the condition is manageable, and it is possible to live a life full of well-being, a diabetes diagnosis comes as a shock and ushers in all sorts of changes. Association for Dietetics in South Africa (ADSA) spokesperson and registered dietitian, Jessica Oosthuizen describes it as a ‘rollercoaster ride of a diagnosis’, full of stress and anxiety for the whole family – and she should know, she was diagnosed herself with Type 1 diabetes when she was thirteen years of age.

A host of challenges faces the family when a member is diagnosed with diabetes. With more than 1.8 million cases of Type 2 diabetes in South Africa in 2017, the wider impact is significant in our country. “I think for most families shock is the first feeling,” Jessica says. “Family members are also faced with the emotional, financial and physical adjustments that need to be made with a diagnosis. These feelings can weigh on family members, and stress and anxiety are common challenges faced by parents, siblings and other family members who are involved. One of the biggest challenges is the confusion and uncertainty. It is very daunting being diagnosed with a condition that you don’t know very much about. Even though patients and family members should get a good explanation of what diabetes is and how it can be managed, this amount of information may be very overwhelming and often very little is taken in initially.”

Today is World Diabetes Day the focus is ‘The Family and Diabetes’. Jessica points out that the impact of a diabetes diagnosis is typically more acute when the patient is a child. “The challenges faced with the diagnosis of diabetes in a child is different,” she says. “The parent or caregiver will probably be much more involved with their day to day care as it may take some time for children to comfortably be able to measure their own blood glucose and inject themselves with daily insulin injections. For children who are of school going age, there generally has to be a third party helper involved which can cause added stress and anxiety for a parent or caregiver as they can’t have control over the situation at all times in the day. Parents may also feel frustration, guilt and anger, as their child’s hurt and pain is something that they are not able to fix.”

Young or old, Type 1 or Type 2, what diabetes does bring about are lifestyle changes. As Jessica points out: “With Type 1 Diabetes once you’ve had the diagnosis, there is never a holiday or break from it.” While the treatment regimens do differ between Type 1 and Type 2 Diabetes, both kinds of diabetes demand discipline, constant thinking, planning and control. The patient and the family need to understand a number of things including how the medication works; how many carbohydrates they can consume, and how often. For some, these lifestyle changes can be completely overwhelming. In addition, having a chronic illness like diabetes is expensive and the family may well suffer from financial stresses, which brings a different dimension to the anxiety experienced.

Ideally, a team approach can deliver vital support to the family. Overtime diabetes patients may need access to various diabetes experts including an endocrinologist, a diabetes educator, a psychologist, a dietitian, a biokineticist, a podiatrist and an opthalmologist. As the family moves from shock to acceptance, regular touching base with the different members of their team helps them to gain a holistic view of diabetes care.  “If it is possible, regular follow ups with your doctor or diabetic educator are essential to fix any problems that the patient or family are facing in a timeous manner instead of trying to fix a problem months or years down the line. There are also diabetic support groups such as Diabetes South Africa and Youth with Diabetes, and social media platforms that patients and family members can join,” Jessica advises.

Perhaps, the biggest challenge is that of normalising life after the diagnosis, so that the chronic condition is well managed and does not get in the way of day-to-day life. “It is important for patients and families to know that while diabetes is a chronic condition that requires daily discipline, control and organisation; it is possible to still live a completely normal life,” Jessica says. “After diagnosis and implementing treatment, it is useful to note that everyday can be completely different as blood glucose readings can be influenced by a number of factors such as exercise, illness, sleep, stress, caffeine, alcohol, types of food and the timing of medication. By taking every day as it comes, you will learn something new that can be used to improve your control and become adept and efficient at managing your condition.”

Jessica advises those who are newly diagnosed to keep a diary recording blood glucose readings, the amount of insulin used and the timing of insulin doses, as well as all food intake and exercise. While it is time-consuming, this journaling doesn’t have to be done forever and it does help to provide a clear and accurate picture, as well as insights into what is working well for you, and what isn’t. This is important because every diabetic’s experience is completely individual. There are also mobile apps available such as FatSecret, Carbs & Cals, mySugr and MyFitnessPal. Strategies such as these empower the person with diabetes to set targets and chart their progress towards managing their condition in the most optimal way. Family support for gaining control over the treatment is vital for the person with diabetes, and helps them to get on the road to wellness and enjoy their life to the full.

For those who are newly diagnosed or who have family members that have recently been diagnosed with diabetes, you can get support from a registered dietitian in your area by visiting www.adsa.org.za.


BUSTING THE BREAKFAST MYTHS

Starting the day with a healthy breakfast is the opening act for a healthy lifestyle, and lays the foundation of our future health over the longer term. Yet, if there’s a meal to be skipped, it is most likely to be breakfast.

This year, National Nutrition Week from 9 – 15 October and National Obesity Week (NNOW) from 15 – 19 October 2018 have united a coalition of health partners, including the National and Provincial Departments of Health, the Association for Dietetics in South Africa (ADSA), The Nutrition Society of South Africa (NSSA) and The Heart and Stroke Foundation SA (HSFSA) amongst others to promote a shared and very important message that breakfast is the best way to start the day.

“There are a number of key reasons why people skip breakfast,” says ADSA spokesperson and Registered Dietitian, Abby Courtenay. ”This is why it is so important to bust the myths around breakfast and give South Africans from all walks of life the information and help they need to make a healthy breakfast a happy, lifetime habit.”

Myth #1 I am skipping breakfast to lose weight

There is a host of studies that show that people who have a healthy breakfast habit have better weight outcomes than those that skip. Not eating breakfast puts you at risk of grabbing convenience foods with low nutritional value to help you make it through to lunchtime. Feeling starving by lunchtime also causes you to blow out proportions and overeat. “It’s a common belief that if you want to lose weight you should skip breakfast,” points out Kim Rutgers, also a Registered Dietitian and ADSA spokesperson. “This is far from the truth. Skipping any meal will mean important nutrients like vitamins and minerals will be missed.” Effective, and sustainable weight loss and management is instead achieved through healthy food choices, which includes breakfast.

Myth #2 I don’t have time in the morning for breakfast

Healthy avocado, egg open sandwiches on a plate with cherry tomaIt is true, that for most of us, the morning is far more time-stressed in comparison to supper. However, planning, preparation and smart food choices will result in being able to either sit down and eat breakfast with your family or eat your breakfast over the two to three hours after waking.  Abby advises: “From a time perspective, drinking is often quicker than sitting down to a full meal and so my suggestion is a nutritious smoothie. I encourage my patients to blend together a small banana, oats, sugar-free peanut butter and low fat milk. Baby spinach is an optional extra. Not only is this the quickest meal, but it contains balanced portions of fruit, vegetables, minimally processed grains and healthy plant fats. What a way to start your day!” With some planning, preparations for breakfast can be made the night before. Beat the clock by soaking your oats, cutting fruit and boiling eggs during your supper preparation so that it is as easy as possible to make breakfast a quick, enjoyable family meal.

Myth #3 I can’t eat breakfast, I don’t wake up hungry

Many people question the advice to eat when they don’t yet feel hungry, but breakfast doesn’t have to be immediate or done all in one go. It can take place during the two or three hours after waking. Abby says: “Swap your smaller mid-morning snack and breakfast around. For example, eat a fruit when you are getting ready for work or school and then enjoy a bigger, more complete meal at around 10h00. This way you are getting in all the food and nutrients you need whilst still honouring your body’s natural hunger cues.”

Myth #4 I can’t eat breakfast, I don’t like cereals or eggs

A healthy breakfast doesn’t have to be traditional or contemporary breakfast foods. If you don’t like them, don’t eat them; other healthy food choices make a great breakfast. It’s also important to keep in mind that many processed foods marketed as breakfast foods can be laden with sugar and are nutrient poor, and are not the healthy options. “Use up your leftovers for breakfast,” says Abby. “Breakfast food doesn’t always have to be cereal and eggs. Why not have leftover mince on toast with fresh tomato slices or use your leftover pumpkin to make pumpkin fritters?”

When it comes to what a healthy breakfast should consist of, Kim agrees: “The 3 main nutrient groups are carbohydrates, proteins and fats. When all three of these macronutrients, in the right proportions are included in one meal, then you are getting in a balanced, nutritious meal.”

Myth #5 Not eating breakfast saves us money

In the short term, reducing your food bill by skipping breakfast is a folly that will play out in your future and cause unforeseen health expenses. Studies have shown that people who regularly eat healthy breakfasts are at lower risk for expensive conditions such as overweight and obesity; hypertension and heart disease. The issue is rather about how to make breakfast more affordable. According to Abby, healthy eating does not have to expensive. “It may take a little extra planning but when you are in the routine of eating well, you will actually save money. Consider how much you can save with less store bought convenience foods, takeaways and eating out.”

 Top tips for affordable, healthy breakfasts include:

  • Shop around for bargains
  • Buy bulk where possible; share bulk purchases with family and friends
  • Buy seasonal fruits and vegetables; not only will you save money but you will get fresher, tastier produce and contribute to the reduction of your carbon footprint.
  • Use your leftovers
  • Draw up meal plans and budgets; proper planning reduces costs
  • Single portion items, for instance single serving tubs of fruit or yoghurt is often more expensive than buying a large tub of yoghurt. Decant the yoghurt into reusable containers if you need to travel with it.
  • Ready-to-eat cereals cost more than double the price of maize meal, oats and mabele porridge. Save money by making your own muesli instead of store-bought options.

For more information on how breakfast is the best way to start your day, visit the National Nutrition & Obesity Week 2018 website for more tips and recipes: http://www.nutritionweek.co.za/

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


Meet the ADSA President!

We sat down and had a chat with the new ADSA President, Christine Taljaard-Krugell, who has taken over from Nicole Lubasinski, following her relocation to the UK.

Christine brings along a wealth of experience as the general manager of the African Nutrition Leadership Programme. “With ADSA turning 30 this year, I am truly humbled for the opportunity to contribute in my new role as ADSA president.”

 Why did you become a Registered Dietitian?

My sister had DM type 1 from a young age. The way that her disease impacted not only her own life but also our family’s as a whole made me realize just how big the potential impact of optimal nutrition can be. I have the utmost respect and deepest empathy for any family who is faced with chronic illness. It was only later in life, in my fourth year that I was exposed to what I now enjoy the most, public health nutrition related research.

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

Being a researcher I love the diversity that my work brings. Research is challenging in the sense that you have to invest for a very long period of time before you get the reward. It is when one’s research is usable, when it reaches the target audience that I think the satisfying moments emerge. I am also very privileged to have been involved in the African Nutrition Leadership Programme for the past 6 years. Investing in individuals in the field of nutrition, and to experience the change within such a person, must be some of the most satisfying things one can do.

What has been your career highlight?

In 2016 I was chosen by the International Agency for Research in Cancer to partake in their “50 for 50” initiative to be held in Lyon, France. The initiative entailed that 50 young leaders from around the world were selected to participate in their initiative called “Empowering future cancer research leaders”. It was an absolute wonderful opportunity where I have met great mentors and made new colleagues and friends.

What are the major nutrition-related health issues that South Africa is faced with?

South Africa remains to be utterly complex. South African households are faced with significant challenges that include high levels of poverty, unequal distribution of income and wealth and inequality in health outcomes. In addition to the above malnutrition, including both under and over nutrition prevail. While one fifth of households do not have enough money to buy food for the household till the end of the month, two thirds of women are either overweight or obese. Dietitians needs to provide a health service to the population that is evidence informed as well as attainable.

What are the positive side to the relative dark picture painted above?

Malnutrition is preventable. In the words of Lawrence Haddad, the executive director of the Global Alliance for Improved Nutrition (GAIN):

Despite the challenges, malnutrition is not inevitable, where leaders in government, civil society, academia and business are committed… anything is possible.

How do you see a nutrition champion?

The nutrition champions in my life are men and women who have an inextinguishable passion for their work. They invest unlimited time, resources and knowledge into young (nutrition/dietetic) professionals. They have the highest work ethic that they choose to stand by.

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

I think a good routine (even if a bit boring) helps in preventing a day of total nutrition disaster. However, if that day happens, I hope it was in good company, under the blue sky and enjoyed with friends and family.

What is your favourite dish and your favourite treat food?

I have to stick to my Dad’s braaivleis and for my favourite treat food it has to be Clover Vanilla Milk.

 

More about Christine

Christine Taljaard-Krugell is a registered dietitian and currently a part-time researcher and lecturere at the Centre of Excellence for Nutrition at the North-West University, Potchefstroom Campus.  She holds a PhD in Nutrition and a MSc in Dietetics with her research area being Public Health Nutrition.  She is the general manager of the African Nutrition Leadership Programme (www.africanutritionleadership.org) and the Editor and founding member of The Leader  the official newsletter of the African Nutrition Leadership Programme which is published quarterly.

Her research career started with clinical trials investigating the effect of a multi-micronutrient fortified beverage on cognitive growth in primary school children.  Since 2014 she has been actively involved in the South African Breast Cancer study.  This population based case-control study of breast cancer aims to clarify the role of body size, diet and physical activity in the African female population. In 2016 she was invited as part of the prestigious “50 for 50 initiative” where the International Agency for Research on Cancer (IARC) identified 50 future cancer research leaders from low-and middle income countries to attend a specialised workshop entitled Fostering Leadership in Cancer Research. 

Christine has an interest in evidence informed decision making and was the project lead for the South African leg of the EVIDENT (Evidence informed decision making for nutrition and health) project.  This multi-country project included other African countries such as Benin, Morocco, Ghana and Ethiopie.  The aim of the South African study was to document decision-making processes for public health nutrition programming.


Weight loss – a journey, not a destination

Today we meet Debbie de Coning who after many years of trying to improve her health and loose weight unsuccessfully, reached out to registered dietitian Monique Piderit.

She shares her journey with us, as well as some great tips for anyone embarking on a journey to better health:

Why did you decide to see a dietitian?

I had been on a quest to improve my overall health for many years and as a result had developed an interest in nutrition and healthy eating. I had already eliminated several food groups in my efforts to reduce inflammation, sinus and increase my energy levels. I had cut out sugar and refined carbs; wheat; as well as dairy – and while I did feel some benefits from significantly reducing all these – my energy levels remained low and the weight refused to move.

I had got to the point where I felt there must be a missing link somewhere and that if I could find out what it was, I was sure that I would be able to lose weight. I had tried so many approaches – and even although my health improved – the weight did not budge. Quite simply, I was tired of all the guesswork.

I kept researching, and after reading about DNAlysis, decided that I was going to invest in my health and get my weight sorted out once and for all.

Tell us about your journey with the dietitian?

I put a request out on Facebook asking for recommendations of dietitians who worked with DNAlysis. Someone tagged Monique in that post, and Monique reached out and offered to assist me on my weight loss journey.

What I really loved about working with Monique was the holistic way in which she approached this ‘project’. While we waited for the DNAlysis results, we had an in-depth consultation about relationships with food, family and friends. We also spoke about lifestyle. She found out which foods I liked and which I didn’t. We did a comprehensive set of blood tests and adjusted my supplement intake. By the time we had the DNAlysis results, we had a sound scientific platform from which to work.

The test showed that my body does not metabolize fat well. So, I went onto a low-fat eating plan. When I received my eating plan from Monique, it was scientifically worked out. There was nothing on it that I didn’t like and so it all felt pretty normal and do-able.

I now knew, that if I put something fat (good or bad) into my mouth, it wasn’t going anywhere anytime soon! I drastically reduced my red meat and chicken intake. I had to learn to use different sources of protein that were lower in fat, and had to make decisions to cut back on foods though they were healthy fats, such as peanut butter, almonds and avocados, and watch portions. No more guesswork: we had an informed strategy. Having the scientific knowledge has really helped me to rationalise making the right choices.

I really recommend working with a dietitian. Healthy living and good nutrition is a science. You need someone with the knowledge and skills to assist you, and it’s a real plus to find someone who is your champion as well.

 Tell us about your results / successes? 

In a relatively short time (8 months) and with what felt like minimal effort I lost 20kg. My waist and hips reduced by 14cm each. I also reduced my insulin by half and reduced my cholesterol count. My energy levels have also increased.

I went to see a biokineticist to get the appropriate exercises to tone and strengthen my muscles. My fitness is the next leg of the journey that I need to work on. Before losing weight, I wouldn’t have been able to complete even half of the exercises, but after the weight loss, I was able to complete all the sets of repetitions, albeit slowly.

When I first picked up the 2 x 2kg weights, I could hardly lift the 4kg. It was a shock to realise that I had been carrying five times that weight all day and every day. No wonder I had no energy!

What was the hardest part of the journey? 

Being a people pleaser, it was often hard for me to say no when being offered well-intentioned albeit wrong food choices. I had to become firm in making decisions to decline food without being apologetic and feeling the need to explain myself to others. Drinking enough water is always a challenge. And of course, who wants to offend a Lindt chocolate on offer?

What are the top three tips you can share?

  1. Be pedantic about portion sizes. Have a good food scale and measuring cups to make sure you stick to your portion sizes. If it’s 80g of chicken, then it’s 80g and not 95 or 100g. Also, split portions to allow for variety and texture. Instead of a full starch portion of mealies, have half mealies and half couscous. This helps to make food interesting with a variety of colour and texture. The minute food becomes boring, you are sabotaging yourself and feel hard done by.
  2. Embrace the new normal. I only told a few people about my weight loss journey while I was in the trenches, those I knew would support me. I did not want people watching me, watching what I was eating and passing judgement. There will always be pessimists and naysayers. Limit your exposure to them. It was a personal journey and I just wanted to get on with it. Sometimes the downside of setting a goal is thinking that when you’ve reached it the journey is over. Embracing the new normal means exactly that. When you’ve reach your goal weight, your healthy lifestyle continues.
  3. Celebrate a range of milestones. It’s not just about the weight. Celebrate reducing your insulin or centimetres lost. I celebrated cleansing my wardrobe and adopting a minimalistic capsule wardrobe approach. It’s not about buying things to reward yourself necessarily. You are making a conscious lifestyle change, so why do you need to be rewarded for that? Celebrate mindshifts and lifestyle choices. They are rewards in themselves.

What the dietitian says 

Monique says: “A key lesson is how Debbie approached this change in her life as a journey and not a destination. Right from the beginning, she chose to embrace the process of change by eating healthier, controlling portions, and making better food choices every day and at every meal, consciously avoiding dieting and the deprivation that it entails. Debbie’s dedication to her health is a great inspiration to other women. I am so proud of you, Debbie!”

To find a registered dietitian in your area, visit the ADSA website!


Why Breastfeeding is the Foundation of Life

 

This  year’s World Breastfeeding campaign celebrates breastfeeding as the foundation of life for the good health of mothers and children. Co-ordinated by the World Alliance for Breastfeeding Action (WABA), the campaign identifies breastfeeding as an essential strategy to prevent malnutrition in all its forms, combat inequality, crises and poverty – all major issues in many South African communities.

ADSA (Associations for Dietetics in South Africa) spokesperson and Registered Dietitian Mbali Mapholi, points out how important it is that women in South African communities – where hunger, poverty and inequality are rife; where crises such as fires, floods and social unrest are frequent – realise that breastfeeding their babies can provide many vitals benefits.

“Breastfeeding provides babies with the best source of highest quality nutrition possible, at the very small cost of just ensuring that the mother’s nutritional needs are met,” says Mbali. “Malnutrition is the third highest cause of infant death in South Africa, and breastfeeding can prevent malnutrition in all its forms. Breastfeeding also provides complete food security for infants, even in times of crisis.”

 Breastfeeding saves you time

  • Breastmilk is always available
  • Breastfeeding requires no preparation

Breastfeeding saves you money

  • No need to buy infant formula
  • No need to buy bottles, teats and sterilising products
  • No need to use electricity

Breastfeeding boosts your baby’s health. A breastfed baby is likely to get sick less often. This means there are fewer clinic visits, and fewer days off absent for Mom.

  • Lower risk of death
  • Lower risk of diarrhoea
  • Lower risk of chest infections
  • Lower risk of ear infections
  • Lower risk of overweight and obesity

Breastfeeding boosts mom’s health

  • Lower risk of breast cancer
  • Lower risk of ovarian cancer
  • Lower risk of high blood pressure

“There are so many incredible advantages to breastfeeding,” says Mbali, who is currently breastfeeding her 14-week old twins. “Moms need to feel confident that it is the natural, perfect food for their infants under six months; and it continues to be a vital source of nutrition as a baby grows into a toddler and their immune systems continue to develop. Some Moms may need to return to work, but because breastmilk is best for baby, they should consider expressing and storing their milk so their children continue to receive the benefits for longer.”

Tips for expressing breastmilk

  • Allow 20 to 40 minutes of relaxed private time
  • Gently massage and squeeze around the nipple area and your milk will start to flow
  • Collect your breastmilk in a wide-rimmed container that has been sterilised with boiling water
  • Transfer the breastmilk to sealable bottles, food containers or food bags that have been sterilised with boiling water. You can even get pre-sterilised, resealable food bags.
  • Breastmilk can be safely stored in the fridge for one to two days or in the freezer for up to six months
  • If you are expressing and storing a lot of breastmilk, date the storage containers so you can keep track of the milk that needs to be used first

“World Breastfeeding Week reminds us that breastfeeding is a universal solution that gives everyone a fair start in life and lays the foundation for good health and survival of children and women”, concludes Mbali. “Moms need to be fully supported by their families, friends and employers because breastfeeding is a major strategy to fight poverty and boost food security in our communities, and we hope to see a significant increase in breastfeeding across South African communities.”

For information on World Breastfeeding Week 2018 visit www.worldbreastfeedingweek.org


BREASTFEEDING, NOT JUST BEST FOR BABY, BUT BEST FOR SA!

Today is the start of the 2018 World Breastfeeding Week, which runs from the 1st to the 7th of August. This year the emphasis is on breastfeeding as ‘the foundation of life’ and highlighting the advantages of improving breastfeeding for communities and countries. The campaign, co-ordinated by the World Alliance for Breastfeeding Action (WABA), identifies breastfeeding as an essential strategy to combat the impacts of inequality, crises and poverty – all major issues across South Africa. Yet, we remain one of the countries with the lowest rates of breastfeeding in the world.

In an attempt to turn this around, South African organisations, which promote and support breastfeeding, such as ADSA (Association for Dietetics in South Africa) are driving conversations around the 2018 World Breastfeeding Week themes. On the individual level, breastfeeding significantly boosts the health of children and mothers, while saving family income. Amplified at the country level, breastfeeding contributes to breaking the cycle of poverty, reduces the burden of health costs by preventing all forms of malnutrition and ensures food security for babies and young children in times of crisis. It is a universal solution that gives everyone a fair start in life and lays the foundation for good health and survival of children and women.

Optimal infant nutrition is defined by the World Health Organisation (WHO), as exclusive breastfeeding for the first six months of life, and continued breastfeeding until the age of two years and beyond, whilst complementary foods are introduced. One of the key Sustainable Development Goals of the United Nations is that by 2025 at least 50% of infants aged 0-6 months in every country will be exclusively breastfed. At just 32% currently, South Africa has a long way to go in the next seven years if we are to reach this goal.

ADSA spokesperson, Registered Dietitian/Nutritionist, lecturer and researcher at Stellenbosch University, Associate Professor Lisanne du Plessis, explains that breastmilk and breastfeeding are referred to as ‘the economic choice’ because mothers produce custom-made breastmilk for their children at no additional expense to their households. She points out that the high costs of not breastfeeding include the impacts on nutrition, healthcare and the environment. It is essential that the barriers to mothers providing their children with the most natural, nutritious and health-boosting free option need to be overcome. Lisanne points out that: “On average, 20 kilogrammes of formula is needed to feed a baby for the first six months of life. At an average price of R190 per kilogramme, the formula bill adds up to almost R4000. Add to this, the cost of bottles and teats as well as fuel to boil water and clean utensils, and families face a staggering expense of thousands of rands to feed their babies.”

There are also substantial environmental costs associated with not breastfeeding. According to the widely cited Lancet Breastfeeding series, breastmilk is ‘a natural, renewable food that is environmentally safe’. It is produced and delivered to the consumer without fuel inputs, pollution, packaging or waste. By contrast, breastmilk substitutes have a substantial ecological footprint, which includes agricultural production, manufacturing, packaging and transport just to get to the consumer. In the home, it requires water, fuel and cleaning agents for daily preparation and use. A host of pollutants and significant waste are generated along the way. It is estimated that more than 4000 litres of water is needed to produce just 1 kilogramme of infant formula. “It is clear that from the household to the country level, breastfeeding can significantly reduce costs and contribute to breaking the poverty cycle,” Lisanne concludes.

A nation of breastfeeding mothers can also reduce the burden of their country’s healthcare costs. Registered Dietitian and ADSA spokesperson, Chantell Witten, who is also a researcher at North West University says, “It is well-proven that breastfeeding reduces disease risk. Breastfeeding substantially protects infants against death, diarrhoea, chest and ear infections. Breastfeeding also helps to prevent malnutrition in all its forms. It protects against overweight, obesity, diabetes as well as the various health consequences of under-nutrition. For mothers, breastfeeding reduces the risk of breast and ovarian cancers, and of high blood pressure.” As pointed out by Chantell, infants who are not exclusively breastfed; who are given food earlier than age six months and who are not following a varied diet, are at higher risk of malnutrition and death. Globally, if higher rates of optimal breastfeeding were practiced, 823 000 annual deaths in children under the age of five years and 20 000 deaths from breast cancer could be averted.

The third key message of the 2018 World Breastfeeding Week is concerned with the role of breastfeeding in a world of upheaval. Breastfeeding has the power to ensure food security for infants and children in times of crisis. This is highly relevant to disadvantaged communities in South Africa, which bear the brunt of disasters such as fires and floods, but are also increasingly thrown into crisis due to protest action.

University of the Western Cape lecturer, Registered Dietitian and ADSA spokesperson, Catherine Pereira points out that breastfeeding provides complete food security for babies up to six months of age. “Furthermore, from 6-24 months, breastmilk still provides a substantial contribution to a child’s nutrient and energy needs. Breastmilk is accessible, sufficient, safe and nutritious and it is therefore quite clear that breastfeeding can contribute directly to ensuring food security during emergencies.”

Catherine emphasizes the need for us to think carefully about the ways in which we respond and give help as a crisis unfolds: “When it comes to making sure that babies are fed in a crisis, for many people, the first thought is to donate infant formula. Infant formula is expensive, and so there’s an assumption that it is something valuable that could help. Unfortunately, this is not the case. Rather, providing support to mothers to continue breastfeeding, especially during a crisis, is a much more important priority. The WHO and UNICEF have issued a very recent brief on breastfeeding during a crisis which includes suggestions consistent with what has been mentioned by Catherine.

In addition to this, many women struggle to continue breastfeeding when they return to work and research shows that breastfeeding rates go down when women go back to work. It is therefore important for South Africa to focus on improving comprehensive maternity protection for women, which is defined by the International Labour Organisation (ILO) as: health protection in the workplace, a minimum period of maternity leave, some form of cash and medical benefits while on maternity leave, job security, non-discrimination and support to breastfeed or express milk upon return to work.

In South Africa, we have a far way to go to support breastfeeding mothers in the workplace. Current law indicates that women should receive four months of maternity leave, however paid leave is not mandatory (although government departments and some companies do provide paid leave). It would be very important for all stakeholders to advocate for longer maternity leave (up to 6 months) and that paid leave is mandatory. Non-standard employees (employees placed by temporary employment services, employees on temporary or fixed-term contracts and part-time employees such as domestic workers or farm workers) are a particularly vulnerable group. This group of women often have to claim pay for their maternity leave from the Unemployment Insurance Fund (UIF) and this can be an extremely time-consuming and complex process for some women.

Once back at work, women should be informed that they are entitled to two 30-minute breaks during their work day to breastfeed or express breastmilk until their infant is six months old. This enables mothers to return to work and earn an income whilst still providing their infants breastmilk, the best feeding option. All stakeholders should work together in an attempt to improve the support of women to be able to continue breastfeeding when they return to work.

It’s clear that South Africa has much to gain in turning around its low rates of exclusive breastfeeding and actively striving to reach the 2025 target of 50% of mothers’ breastfeeding exclusively for the first six months of life. Developing a national culture that supports the truism that ‘breast is best’ can have far-reaching positive impacts for our children, mothers and country.

For information on World Breastfeeding Week 2018 visit www.worldbreastfeedingweek.org

 


Meet Registered Dietitian, Nazeeia Sayed

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We chatted to registered dietitian Nazeeia Sayed, who is the Branch Liaison on the current ADSA Executive committee, acting as the communication link between ADSA branch chairpersons and the national Executive Committee to ensure consistency in operations. She also manages the mentorship programme. We wanted to find out why she became a registered dietitian, what she loves about her work and what the challenges are:

Why did you become a Registered Dietitian?

I love food and cooking and was all set to study Consumer Sciences – but I stumbled into Dietetics at UKZN when I received a bursary. 

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

I most enjoy the variety in the work that I do: teaching dietetic students, supporting new mums on breastfeeding, or technical R&D support to food companies.  Every day is different!  I also enjoy the flexibility my work as a consultant dietitian allows me so I have time for other things I enjoy and value.  The most satisfying moments are being able to see the positive impact I can make and the feedback I receive from the people I interact with.

What has been your career highlight?

I have been a dietitian for over 20 years now with lots of exciting times.  My career highlight would undoubtedly have to be working on my own the last 3 years as a consultant dietitian.  It has been tremendously challenging and rewarding.

What are the most challenging aspects of your career?

Trying to stay abreast of all the nutrition research and information!  I have embraced the fact that I cannot be a Jack of all trades but I need to focus and build my expertise in a few areas of nutrition.  This also allows me to market myself to potential clients more strongly.  

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

A hot cup of tea can resolve most things!  There will be periods when we all find it difficult to have a healthy eating day – I don’t focus on that – I move on and make better decisions the next day!  If I do overindulge then I make the extra effort to have lighter meals the next day.

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

I didn’t know dietitians ate cake.”

“Do you have a diet sheet for me about xyz?”

“But I was not breastfed and I turned out ok.”

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

All dietitians are equally qualified but their special interests and experiences vary.  A client (individual or company) can ask the dietitian about his/her experience, and ask him/her for a brief proposal. 

What is your favourite dish and your favourite treat food?

Lamb biryani with cucumber raita is my favourite! I am easy to please – chocolate would be my favourite treat!

 

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


Nutrition at the centre of sustainable corporate wellness

We live in an era when many of us, not just aspire to, but have an expectation that living well for longer is a real possibility. Increased awareness of the impact of lifestyle on health has made it clear we can’t just rely on medical industries to reach this goal – we play the most important part. It is a part that is played not at all in sweeps of grandeur, but in the small details of our daily choices – What will we eat? When we will exercise? How will we get sufficient rest and sleep? What do we need to do to actively manage our stress today?

Corporate Wellness Week, from 2 to 6 July, emphasises the need to properly consider our time spent at work when we answer these questions. We’re the master of our own universe at home – we are able to muster up great salads and fresh food inspired dishes; take yoga classes, mountain bike, meditate and walk the dog along the beach in our free time. But what happens when we go to work?

If you are a corporate employee, chances are that you eat nearly half of your daily meals and snacks at work, and your physical activity is low. Typically, home is the haven of well-deserved respite, relaxation and free choice; while the workplace, driven by the demand for efficiencies, is stressful, demanding and limiting. This is why we like weekends.

But two days a week of healthy living is not enough. We need workplaces that also support our wellness, simply because that is where we spend most of our time. This is not just an agenda from the employee perspective. As ADSA spokesperson and Registered Dietitian, Lerato Radebe points out: “Wellness in the workplace is not only a means to keep employees happy, but has tremendous effects on absenteeism, presenteeism and productivity.”

Lerato explains that wellness is an active process of becoming aware of and making choices towards a healthy and fulfilling life. “Wellness is more than being free from illness, it is a dynamic process of change and growth. WHO, the World Health Organisation, describes it as: “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.”

Nathalie Mat, another Registered Dietitian and ADSA spokesperson, weighs in: “Nutrition is one of the easiest modifiable factors that controls a person’s energy levels and productivity. A company’s culture can perpetuate or inhibit healthy eating. I have experience of many companies where health is still not prioritized, leading to poor nutrition and health overall.”

So, what can South African business do to promote a sustainable culture of wellness in the workplace?

With nutrition at the centre of wellness, ADSA experts offer these guidelines:

  • Create and maintain higher levels of wellness awareness through ongoing advocacy, engaging a Registered Dietitian and other wellness professionals through a dedicated wellness programme;
  • Make wellness exciting by avoiding tick-box exercises or initiatives that are punitive in spirit. Wellness programmes need to be dynamic and up to date with latest trends that are interesting, value-added and that inspire employees to make lifestyle changes;
  • Combat rising healthcare costs by rewarding employees’ participation in your corporate wellness programme through rebates on health insurance;
  • Make healthy eating the workplace norm with healthy meeting snacks, healthy options in the canteen, water as the primary drink and bowls of fresh fruit;
  • Have a dietitian available on site and facilitate dietitian-led support groups as a great way to foster healthy eating without forcing programmes on employees.

 

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


All the ways that Dietitians do Prevention

Across the world, health and social care services are under stress; and in South Africa, the inaccessibility of quality health care for many people remains one of the country’s intractable problems. These pressures have intensified the focus on the prevention of disease as the key driver of public health. At the forefront of prevention is food. As one of the only healthcare professionals trained and qualified to interpret the latest nutrition science and dietary guidelines, dietitians play multiple roles in the prevention of diseases.

Dietitians Do Prevention is the theme of the 2018 Dietitians Week which starts today and runs until 8th of June. To create awareness, ADSA (Association for Dietetics in South Africa) joined SASPEN (South African Society for Parenteral and Enteral Nutrition), ENASA (Enteral Nutrition Association of South African) and HDIG (Hospital Dietitian Interest Group) in highlighting the six major ways that Dietitians Do Prevention and help to reduce the burden of disease in South Africa through their vital work.

ADSA spokesperson Jessica Byrne points out that: “Not many people are aware that dietitians, who must be registered with the HPCSA (Health Professions Council of South Africa) in order to practice their profession, are employed across many different sectors from industry to communities; as well as in health, research and educational institutions. Across the board, they play a key role in disease prevention.”

ADSA_Dietitians Do Prevention_JPG

 

The Six Ways that SA Dietitians Do Prevention, are:

Guidance during first 1 000 days – Dietitians support expecting mothers to promote healthy pregnancies and prevent complications, but their work doesn’t end there. Jessica Byrne says: “Due to the country’s suboptimal rates of breastfeeding, the dietitian’s promotion of breastfeeding, monitoring of infant growth and ongoing guidance as a baby starts to also consume solids has become critical prevention work. Breastfeeding not only provides the best source of nutrition for a baby but also promotes growth and enhances the vulnerable immune systems of babies to help prevent disease.”

Public Health and Primary Prevention – Healthy eating and hydration is essential for health. Dietitians work to educate the general public on good food choices to maintain their health, which helps prevent illnesses and avoid diet-related conditions such as diabetes, malnutrition or obesity. Dietitians do prevention at community level through the promotion of house hold food security and the drive to eliminate hunger. Various community projects involve the services of a dietitian.

Mental Health and Addiction Recovery – Good nutrition and a healthy diet can impact positively on both the prevention and management of mental health conditions, including helping to support recovery and prevent relapse in the case of addictions.

Hospital, rehab and home-based care – “You will find dietitians working right across the health care system,” says Alta Kloppers, spokesperson for HDIG. “This is because nutrition plays such an important role in survival, recovery, rehabilitation and symptom relief, as well as reducing the risks of further illnesses and preventing more admissions to hospital and other health care services.” Dietitians do prevention through screening of hospitalised patients to identify patients at risk of developing malnutrition, and providing specialised nutrition interventions to manage specific diseases and conditions.

Optimising Health and Secondary Prevention – Dietitians do prevention by helping people with existing conditions such as diabetes, kidney failure or dementia to optimise their nutrition in order to get relief from symptoms, prevent complications and enhance their quality of life. This will include individualised dietary advice and appropriate follow-up and monitoring.

Making Every Contact Count through Healthy Conversations – Dietitians don’t just advise on diet and nutrition when they do prevention. Instead they engage also with clients on the other issues related to good health such as the importance of physical activity and not smoking. They also take into account the social and emotional factors that can easily contribute to a client’s need for a healthier lifestyle. Conversations with dietitians can then easily direct people to where they can also access professional help for the non-dietary issues that also impact on disease prevention.

“The important message of this year’s Dietitian’s Week,” says Lizl Veldsman SASPEN’s spokesperson, “is that it is impossible to separate disease prevention from nutrition and therefore, from the work of a dietitian.”

Lynne Mincher, ENASA spokesperson agrees: “Good nutrition is the foundation of prevention and recovery. Whether you are talking about supporting breastfeeding tube-feeding or oral nutritional supplements, a person recovering from an operation or guiding someone with a chronic condition such as diabetes, we need that expertise of the dietitian right at the frontlines of prevention.”

A collection of “Dietitians Do Prevention” recipes by South African dietitians has been published and includes 39 recipes, covering breakfast, lunch, dinner and snacks. Each recipe comes with a prevention message. It can be downloaded here: http://www.adsa.org.za/Public/DietitiansWeek2018.aspx

You can also download the Dietitian’s Week infographic here: http://www.adsa.org/za/Public/DietitiansWeek2018.aspx

 


Meet Registered Dietitian, Retha Booyens

ADSA_Meet the Dietitian_Retha BooyensWe caught up with registered dietitian Retha Booyens, who is passionate about nutrition and dietetics, to find out what drives her,  why she chose dietetics as a career and how she is making a difference through her work:

Why did you become a Registered Dietitian?

Contrary to what people believe, dietitians are actually foodies and love experimenting. I can remember that from a young age I loved food and eating, but also loved health and being active (athletics, acrobatics, hockey, netball etc). It seemed like an obvious decision to become a dietitian, but I need a bit more convincing. I took a gap year and did shadowing in dietetic lectures, at clinical dietitians and outpatient consultations. And after that there was no turning back.

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

The pleasure is in the small things, like a client progressing to solids after a long battle on IV nutrition and tube feeds or helping someone reach personalised goals (such as athletes).

Knowing that I can be an instrument in the saving of a person’s life is a tremendously satisfying feeling. I have a huge passion for critical care and renal dietetics and love to see how I can not only save someone’s life but also improve quality of life.

What has been your career highlight?

Becoming an ADSA spokesperson and being able to share my passion on a larger scale (in print, radio, etc).

Very close second was hosting a radio talk show (Bite for Life with Retha Booyens) on a local radio station in North West before relocating.

What are the most challenging aspects of your career?

Having to make peace with the fact that I cannot help everyone.

Knowing the vast amount of misinformation that is available, that is not only unsustainable but also damaging to people’s health. That is why I’m passionate about my Facebook page and Instagram account, just another platform where I can share evidence-based nutrition guidelines.

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

I always try to remind myself (and my clients) that it is a lifestyle and not a diet. Therefore there are bound to be weddings, parties and other occasions where over-indulging will happen.

What I do after a day where I didn’t make all the right choices is just to get back on the wagon the next day and get back into my usual healthier routine.

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

  • Then you shouldn’t look what I have on my plate now.
  • Can you give me a sample meal plan?
  • You probably never eat unhealthy foods.

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

Choose someone that you feel comfortable with and can relate to. Someone who will be able to support you on an emotional level as well.

The relationship between a dietitian and client/patient is far more than just ‘what you eat’ and therefore you need someone that will be able to assist with the other aspects besides the food.

What is your favourite dish and your favourite treat food?

The dish I love making is any type of interesting salad – I love to invite people over and them saying ‘I didn’t know that healthy food can be this tasty.

On the other hand, when I treat myself I love to have anything Italian – so pastas and pizzas are right at the top of my list.

 

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


Busting the two biggest myths about your immune system

Winter is here, and that gets us thinking about our immune system, and what we need to do to boost it, so that it helps us avoid colds and flu, or at least recover from them more quickly.

The immune system is one of the most complex networks in the body that is still far from being completely understood by the world’s scientific community. As pieces of research are added to the picture, myths about the immune system arise in the gaps, and they are often acted upon as truths.

Registered Dietitian and spokesperson for ADSA (Association for Dietetics in South Africa), Linda Drummond helps us sort fact from the fiction:

MYTH # 1 – ‘All I need for a winter immune boost is a multi-vitamin or more Vitamin C’ – “This is probably the most common misconception – that nutritional supplements, or greater doses of one particular vitamin, can be an effective protective solution,” says Linda. “While Vitamin C does play an important immune-boosting role, research has shown that supplementing with Vitamin C does not actually help you to avoid developing colds and flu. Studies have found that in some, but not all cases, Vitamin C, as an isolated strategy, may help to reduce the duration of the illness, but not protect you from it. Nutritional supplements can play an important role in supporting improved health for vulnerable people, such as children, the elderly, pregnant women and those with health conditions that compromise their immunity. However, others should rather aim to get their daily intake of immune-boosting micronutrients from their food. Eating a variety of healthy foods every day, including lots of vegetables and fruits, wholegrains, dairy, meat, chicken or fish, beans and lentils, and plant fats provides not just Vitamin C, but also the other immune-boosting nutrients such as Vitamins A, D and the B’s, as well as trace elements such as zinc and selenium. You cannot expect that if you eat poorly, but take a supplement, your immune system will still be highly effective. What you eat, not what you supplement with, is what is most important to build your defences against winter germs. Supplements are not the antidote to unhealthy eating. They can help to fill in gaps in an otherwise healthy eating plan, and you should get your dietitian’s advice on this. However, we should all be clear that when it comes to what we consume and our immune systems and our health, there is simply no substitute that we know of at this time that beats the effectiveness of eating a variety of quality, minimally processed foods, which are mostly plant-based, every day. It is the way to go.”

MYTH # 2 ‘To improve my immunity in winter all I have to do is focus on the food I eat and the supplements I consume.’ “This is false,” says Linda. “While healthy eating is a vital immune boosting strategy, and nutritional supplementation may be necessary for you if you have a compromised immune system, it remains one critical aspect of having an effective immune system during the challenging winter months. But, it is a complex system and other factors are at play.

Scientific research has shown that:

  • Sufficient sleep is also important to support the immune system;
  • Regular exercise is a powerful immune system booster;
  • And, a positive mental and emotional state strengthens your resistance to disease.

What this means is that during winter, if we want to effectively develop our resistance to illnesses, we need to keep our focus on our whole body and our entire lifestyle, not only one part of it. We must get enough quality rest that is balanced by also getting daily physical exercise. We need to take regular action to manage stress, develop mindfulness and be in charge of our disruptive emotions. Sleepless nights; days of inaction and stress that is off the charts for most of the time will batter our immune system as surely as nutrient poor food and other poor eating habits.”

The bottom-line is that you should boost your immune system this winter, and, based on real evidence, you can do that each day by:

  • Eating healthily by focusing on a variety of minimally processed quality foods from the different food groups to ensure your body gets all the nutrients it needs. Aim for at least five colourful vegetables and fruit daily;
  • Saying no to high energy, sugar, salt and fat foods including take-aways, sweetened drinks, sweets, chips, cakes, biscuits and all the other highly-processed options;
  • Enjoying tucking up warm at night and getting the sleep you need to wake up refreshed and strong;
  • Keeping active every day and
  • Letting go of your stress and anxieties.
  • Washing your hands often with soap and water for at least 15 seconds. When you are not near a sink, use a hand sanitizer.

 

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


Chicken Meatball Harvest Bowls – NEW RECIPE

Harvest bowls are awesome – lots of nutritious, yummy food and different flavours in one bowl to enjoy.

This Chicken Meatball Harvest Bowl, created by registered dietitian and foodie Cheryl Meyer from Dish & Delite, packs in cooler-weather seasonal veggies – brussels sprouts, zucchini, cauliflower and carrots. A great fibre boost and lovely variety of colour, vitamins and minerals.

We also love this recipe because all the elements keep well in the fridge and can be mixed and matched through the week for on-the-go lunches and quick, easy dinners.

 

This recipe serves 4

INGREDIENTS

Rice

½ cup raw brown & wild rice

 Chicken meatballs

250 g chicken mince

1 cup coarsely grated zucchini

¼ cup finely grated parmesan cheese

¼ cup fresh wholewheat or low GI bread crumbs

½ onion, diced

1 teaspoon crushed garlic

½ tablespoon fresh thyme or ½ teaspoon dried thyme

½ teaspoon chicken stock powder

vegetable oil – for frying

Roasted veggies

300g Brussels sprouts, trimmed and halved

300g cauliflower florets

2 tablespoons olive oil

1 tablespoon fresh thyme or 1 teaspoon dried thyme

1 teaspoon crushed garlic

Dressing

1 cup fat-free plain yoghurt

¼ cup fresh parsley, finely chopped

salt and pepper, to season

Carrot

1 large or 2 medium (200 g) carrots, coarsely grated

 

METHOD

  1. Rice: Cook the rice as per the package instructions.
  2. Meatballs: Combine the chicken meatball ingredients. Using a tablespoon to measure, divide the mixture into 20, roll each meatball between your hands to form 20 small balls. Chill in the fridge for at least 30 minutes. When ready to cook, heat a frying pan with a shallow coating of vegetable oil and cook the meatballs in batches until lightly golden on all sides and cooked through. Once cooked, place on paper towel to soak up any excess oil.
  3. Roasted veggies: Line a baking tray with baking paper or foil. Add the Brussels sprouts and cauliflower to the tray, drizzle with olive oil, thyme and crushed garlic and toss to combine. Roast at 200°C for 15-20 minutes, tossing mid-way.
  4. Dressing: Combine the dressing ingredients.
  5. Assemble: Enjoy your bowls warm or cold. Divide the rice, roasted veggies and grated carrot into four bowls, add 5 meatballs to each bowl and top with a generous drizzle of dressing.

 

NUTRITION INFORMATION: Per serving

Energy: 1532 kJ; Protein: 26.8 g; Carbohydrate: 37.1 g of which, total sugars: 7.1 g; Fat: 16.1 g; Fibre: 10.0 g; Sodium: 287 mg

 


“We should be as kind to ourselves as we are to others”

This week we chat to Tabitha Hume, a registered clinical dietitian in private practice, to find out why she became a dietitian, what she enjoys most about the work she does and what the challenges are:

Why did you become a Registered Dietitian?

I danced very seriously when I was at high school (ballet) and fell prey to the eating disorder monster. When I went to UCT, I started out studying BSc with an aim to genetic engineering, but then someone mentioned that dietetics was offered as a post-grad honours degree and my interest was piqued. I changed my BSc subjects to physiology and psychology and then was equipped for dietetics. I had a very strong interest in the physiological development of metabolic problems and so when I started my honours thesis on the hyper-metabolic response of paediatric burns patients, I was in heaven! Then after honours, my huge thirst for knowledge blessed me with a research and lecturing post at Wits Physiology Department, doing my thesis on carbohydrate and insulin metabolism, which was incredible. I knew I was in the right career when I started private practice and saw how rewarding it was, helping people with disordered eating and eating disorders completely lose their fear and anxiety of carbohydrates and remain skinny whilst eating a LOT.

So, it was really an evolution into dietetics, but a perfect fit!

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

I love interacting with people. I see myself as a bit of a teacher. Watching as the penny drops with people is very rewarding. Seeing previously restrictive people turning into satisfied eaters with a genuine passion for eating, and losing weight or stabilising muscle mass makes me feel like I’ve helped both body and mind, and made a positive difference. My most satisfying moments are probably seeing my past anorexic and bulimic patients enjoy food, socialising, eating with their families, and moving on to inspire other eating disorder sufferers with lecturing, blogging and mentoring. That’s paying it forward and I feel blessed that I am able to be part of that journey.

What has been your career highlight?

I think this answer has two parts: The first was the success of my first three books. Then, the second highlight has been slow: working my way back up from complete financial and emotional ruin after being accused of malpractice in 2001. However, the exoneration and my ongoing passion for helping people recover has put me back in the practice seat and made me stronger in the process. I’m proud of that.

What are the most challenging aspects of your career?

There are 3 main challenges, which hit me every day.

  • The fact that everyone and anyone dishes out conflicting and pseudoscientific dietetic advice and that the public is not protected against this. More disease and death is being caused by confusion, yo-yo dieting, eating disorders and orthorexia arising directly from ‘diet gurus’ who have little or no physiological or medical background. Because the public sees these ‘diet gurus’ and registered dietitians as equal authorities and equally qualified to dispense dietetic advice, I sometimes feel angered that I am forced to highlight the vast difference in qualifications there are. It’s crazy that we are forced to ‘convince’ patients that we are the experts. After all, someone with a rotator-cuff injury would not question a physiotherapist on what advice she received from her personal trainer!
  • Apropos the above: I also find it very challenging that medical aids still don’t see the massive value in dietetic therapy. This hinders the patient from obtaining the full scope of care that they actually need from a dietitian, and this incomplete process leaves the full lifestyle change open to failure, further exacerbating lost faith in dietetics.
  • With the plethora of rubbish advice available to people, much of the limited time in consultation is spent trying to teach complicated physiological concepts so that they can understand and thus ‘trust’ the advice we give, because it is often so contrasting to what is fashionable and the latest fear-mongering fad. Patients so often say, “I need to spend a whole day listening and understanding because only with understanding it ALL can my enormous fear of food be undone.” We, as dietitians, shouldn’t have to do this. We should be able to guide, direct and heal. Not have to spend patients’ valuable time convincing them that eating normal food is OK.

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

I speak to myself kindly, as I would to a child who made mistakes. We all do things for a reason, and I show myself WHY I made those mistakes, and rapidly make small adjustments to address that problem for the future. As soon as I let guilt in, my tendencies to be mean to myself start, and this simply starts a complicated restrict/defiance pattern in my eating which is not healthy. We should be as kind to ourselves as we are to others.

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

  • “Are you sure? Everyone else seems to be saying that blah blah blah (insert pseudoscientific rubbish)”.
  • “I know what I should be doing I just can’t seem to have the discipline”. …..Um, no! If you don’t have the discipline, it’s probably because you are doing it wrong!
  • I won’t need much time with you… just give me a diet sheet of what I can and can’t eat”.

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

I think this is a very difficult one to answer, seeing as most dietitians have equal qualifications. I’d say that because patients usually require a lifestyle change (and that is a fairly personal process), finding a dietitian with whom the patient ‘clicks’ on a personality level is very important to motivation and trust.

What is your favourite dish and your favourite treat food?

Undoubtedly a hot lentil curry with chutney and tons of fresh coriander!

My favourite treat food would be warm apple pie! (Vegan of course!)


Be Kind to Yourself!

ADSA_Success Story_Alex Royal_Bianca

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 chatted to Bianca Dorp who worked with registered dietitian Alex Royal to improve her health and diet.

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

I was training about 5 to 6 times a week in the gym, and seeing a personal trainer twice a week during those sessions. The results I was seeing were not correlating to the amount of activity I was doing, so I decided to enlist the help of Alex to see where my nutrition could be improved in order to reap the rewards for the amount of effort I was putting into training.

Tell us about your journey with the dietitian?

The main surprise for me was that the amount of food that I was eating was far too much, albeit healthy. Alex gave me the tools to live a healthy lifestyle that was designed for my body and physical activity level. Since I love cooking I’ve found this extremely helpful because now I know what portions I’m allowed to eat, and I can invent meals that stick to this ratio, while still being very tasty.

I loved my journey with Alex! It is very rewarding to see those centimetres drop off month by month after the hard work I put in. It was great to have a sounding board to talk about food, any difficulties I was facing, and simply learning about my body and how to feed it well.

I felt like I was treating my body with the utmost respect and felt amazing during the whole process. 

Tell us about your results / successes?

The results were incredible, but like anything came with hard work and dedication. Alex was an expert in making me pick up muscle mass, but reducing fat at the same time, which is a rare combination I believe. My monthly measurements showed a good reduction in fat percentage and a good pick up in muscle mass, which showed off all the muscles I wanted to from training. I not only physically looked better and felt stronger, I’ve never felt more energetic in my life. My body felt so healthy and well nourished. Another benefit was that my skin became very clear and radiant, which is always appreciated!

What was the hardest part of the journey?

The hardest part in the beginning was dealing with the amount of food I was allowed to eat, mainly on the protein side. During the journey I decided to lessen my alcohol intake significantly, which sped up my results even more. This was initially hard to do as I do love a good glass of wine. Throughout the journey I would say staying motivated is definitely a important factor. It’s very easy (for me) to rather stay at home instead of exercising, but you just have to keep at it. And to also be kind to yourself if something does slip through the cracks and you take a tiny step backwards. Alex taught me that in the big picture of life, gaining 1cm back is not a big deal. It’s your overall well-being that is important.

What are the top three tips you can share?

  • Meal prep and plan! This was a huge help since I then couldn’t stray from the plan, because all the meals were already measured out and prepped.
  • Carry healthy snacks with you. If I was feeling very hungry during the day I’d make sure to have an apple or some nuts on me so that I could snack on something healthy rather than resorting to buying something.
  • Be kind to yourself. I would beat myself up a lot if my results weren’t consistent every month. But as Alex said, it’s a journey so try to not be too hard on yourself if one month is ‘worse’ than the rest

What the dietitian says

I loved every minute of the journey with Bianca. She was so enthusiastic and committed to improving her health and diet, which showed in her beautiful, well deserved results. I think she was also motivated as she picked up speed and saw that the results were actually tangible. To be honest she inspired me and reminded me why I truly love what I do. Thank you Bianca!

 

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


“Teaching nutrition is my passion”

 

ADSA_Meet the Dietitian_Zelda Ackerman

We chatted to Registered Dietitian Zelda Ackerman who runs Family 1st Nutrition and is the author of a wonderful book called ‘Eet Reg (Bevry jouself en jou kinders van emosionele eet)’. We wanted 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?

My interest in nutrition started when I was at school. In Grade 8 we learned about nutrients and their functions in the body in Home Economics. This fascinated me and I decided that I wanted to become a dietitian.

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

I enjoy teaching groups of parents and dietitians about nutrition the most! Teaching nutrition is my biggest passion, more specifically teaching about paediatric nutrition.

The most satisfying moment is when a patient tells you how they followed your advice and how good they feel since changing their lifestyle!

What has been your career highlight?

My career highlight was when my book Eet Reg was published in May 2016. It was a great honour to be approached by NB Publishers and be offered a contract to write about what I love.

What are the most challenging aspects of your career?

Staying motivated to make a difference when people do not follow your advice and rather opt for quick fixes (which you know will only last for a few weeks).

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

Contrary to what most people may think I am not a health food freak. I eat healthy 90% of the time and I enjoy it! But when I eat junk or unhealthy food I don’t feel guilty or bad about it at all. I enjoy it and go back to eating my normal healthy food the next meal.

If I eat unhealthily for a longer time period, due to for example being with family who eat unhealthy, I’ll eat smaller portions of starch and larger portions veg to get back on the right track.

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

  • “Oh boy, now I have to tuck in my tummy”
  • “You probably only eat healthy foods”
  • “I have to come and see you!”   … and then they don’t!

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

Nutrition is such a broad field and I believe you should look for someone who has personal experience if possible and then lots of experience in the specific conditions / age group that you need advice on.

What are your favourite dish and your favourite treat food?

My favourite food is vegetables. My favourite meal would be one with a few different types of vegetables and a few different types of salads.

I don’t believe in calling any food a treat, because that gives food an emotional connection. As I explain in my book Eet Reg, I believe food should not have emotional connections, but should be only for nutrition. My favourite sweet food is a good quality dark chocolate!

 

If you are looking for a dietitian in your area, please visit the ADSA website


The Role of the Dietitian in Eating Disorder Treatment

Eating disorders are complex illnesses with both psychological and physical aspects that require treatment. For this reason, over the past few decades, it has become more common for the treatment of people with eating disorders to be managed by multi-disciplinary teams which can deliver the necessary medical, psychological and nutritional help. As society’s foremost expert on nutrition, the dietitian has an important role on the treatment team for a person suffering from an eating disorder, and more opportunities are opening up for dietitians to develop as experts in this role.

Julie Deane-Williams, a registered dietitian and ADSA (Association for Dietetics in South Africa) spokesperson who has a special interest in treating people with eating disorders, points out that in some cases, the dietitian may also be the first port of call for help.

“Even though there are high levels of denial associated with disorders such as anorexia nervosa or bulimia nervosa, the dietitian is often the health care professional on call, especially when it comes to a person struggling with emotional/comfort eating or binge eating disorder. Typically, in the first session, a sufferer, usually female, confides that she is desperate to lose weight; reveals disgust at her body, even if she is within a healthy BMI (Body Mass Index) and feels shame that she has been unable to stick to a diet. The dietitian soon discovers that the emotional eater has tried many different diets. Patients commonly are keenly aware of the energy content of different foods but that doesn’t mean that they know much about nutrition. Often the patient hopes that the dietitian can provide a ‘miracle’ diet that is finally going to help her lose weight and keep it off.”

In combination, these are the warning signs for the dietitian who can recognise the symptoms of disordered eating. It is important that the dietitian doesn’t play into the patient’s scenario but instead helps them to acknowledge disordered eating and address it appropriately.

Deane-Williams makes it clear that the dietitian who works with people with eating disorders needs to acquire particular expertise and skills.

“It is important for the dietitian to understand how the different eating disorders develop and are maintained by patients, as well as to have sound knowledge of the medical, psychological and physiological aspects of the range of eating disorders. In order to play their role effectively on a multi-disciplinary team, they also need to have a general understanding of the mental health issues as well as the various psychological interventions and their applications. It would be an advantage to the dietitian to have expert communication, counselling and behaviour change skills. This is a relatively new role for dietitians, and the complexity of eating disorders demands education and training that goes beyond the minimum required to simply qualify as a registered dietitian.”

The dietitian who works with people with eating disorders plays an important role in the assessment, treatment, monitoring, support and education of the patient. As advocates of evidenced-based science, they serve as important resources of nutrition knowledge for the patient, the patient’s family and the other health care professionals on the treatment team. They need to be skilled at determining a patient’s nutritional status, eating patterns and behaviour, food rules and beliefs. It is the dietitian who takes into account the patient’s meal planning, food shopping and cooking skills. The dietitian works closely with other team members to understand how the patient’s underlying psychological and emotional issues impacts on their eating behaviours, as well as their motivation and capacity for behaviour change. The dietitian will work collaboratively with the patient to develop the nutrition aspect of the treatment plan, and to support the patient and the rest of the team throughout its implementation.

In the light of recent research in the UK that has attributed more deaths to eating disorders than any other psychiatric disease, Deane-Williams urges people with unhealthy relationships with food to seek help sooner rather than later.

“Using food, or the lack of it, to cope with distressing emotions and situations is a maladaptive way of managing life,” she says. “All eating disorders are addictions, and it is the nature of an addiction to further and further alienate a person from their own inner truth. Addictions also usually drastically stunt emotional growth. Once a person accepts that they have an eating disorder, and they seek good medical help, the healing journey is one that is difficult yet immensely rewarding. Not only can they recover, but they find out who they really are – bright and exceptionally intuitive people who had developed a coping mechanism to keep their ‘heads above water’ during extremely challenging times in their lives. Once they develop healthy ways of managing difficult emotions, they can go on to thrive, and create healthy and very happy lives.“

If you think you or a loved one might be struggling with an eating disorder, consider visiting a registered dietitian for expert guidance and advice. If you are looking for a dietitian in your area, please visit www.adsa.org.za


A Delicious One-Pot Meal!

Beef and Butternut Casserole with Mushrooms and Tomato

We love the latest NutritionConfidence recipe from the authors of Food for Sensitive Tummies, registered dietitians Cath Day and Gabi Steenkamp! It is packed with vegetables (a whopping four servings), high in fibre and a good source of iron. Comfort food, which is still a healthy balanced meal.

This is a meal-in-one casserole, which is easy to prepare ahead of time. Perfect for dinner guests and to make during a very busy week. Butternut contains double the starch compared to the other vegetables, so may be used as a carbohydrate in this dish. Since there are four other vegetable servings, the butternut can serve as the starch of the meal.

RECIPE (Serves 4)

INGREDIENTS

1 onion

1 leek

4 cloves garlic

2 rashers bacon, optional

2 sprigs fresh rosemary

2 t olive oil

2 bay leaves

1 butternut, large (800 g)

250 g  mushrooms, mixed are most delicious

410 g  tinned chopped tomatoes (1 x 410 g tin)

150 ml red wine, optional

500 g beef goulash pieces, check for minimal visible fat.

8 black olives

2.5 ml salt & freshly ground black pepper (½ t)

METHOD

  1. Preheat the oven to 180ºC
  2. Peel the onion and chop. Trim, wash and slice the leek. Peel and slice the garlic.
  3. Heat a large pan or ovenproof casserole on medium heat.
  4. Finely slice the bacon. Pick the leaves off the rosemary sprig and chop finely.
  5. Pour the olive oil into the hot pan, add the sliced bacon, chopped rosemary and the bay leaves and gently fry, stirring regularly
  6. Add the sliced garlic, chopped onion and leek and cook for 10 minutes, stirring regularly.
  7. Meanwhile, peel and cut the butternut into bite size cubes and add to the pan.
  8. Clean the mushrooms and cut off the stems. Add both the stems and whole mushroom tops to the pan.
  9. Add the meat cubes, pour over the wine and simmer for 10 minutes.
  10. Add the tinned tomatoes.
  11. Rinse the tomato tin out with quarter tin of water and add to the pan or casserole.
  12. De-stone the olives by cutting in half. Add to the casserole and mix in gently.
  13. Bring the casserole to a boil and then place in the pre-heated oven to bake for 45 mins, until thick and delicious.
  14. Serve on its’ own as a complete balanced meal.

NUTRIENTS PER SERVING (600 g)

Energy                                                      1918 kJ

Protein                                                      30.3 g

Carbohydrates                                         31.3 g

Total sugars                                               4.5 g

Added sugar                                              0.0 g

Total Fat                                                     18.5 g

Saturated fat                                              7.7 g

Fibre                                                           7.7 g

Sodium                                                       682 mg

One serving is equivalent to 1 carbohydrate, 4 proteins and 4 vegetables

 


Pregnancy and Nutrition

This Pregnancy Week a reminder that good nutrition before and during pregnancy may influence the pregnancy, the delivery and the health of mother and child later on. What you eat now will help your baby to grow healthily and give them the best start in life and help you to feel your best. We asked registered dietitians and ADSA (Association for Dietetics in South Africa) spokespeople to provide their top tips for healthy eating during pregnancy.

Does eating for two mean doubling up your portions?

“Additional energy is needed during pregnancy to support the growth demands of your baby, however the saying ‘eating for two’ has been taken out of context,” says Cath Day, Registered Dietitian. “During the first trimester, you don’t need any additional energy. This means that if you were maintaining a healthy weight before you became pregnant, you can continue eating the same amount. It is only in your second and third trimester that you need to eat a little more.”

But, how much more?

The professional advice from a dietitian is that an expectant mom who is at a healthy weight should take in an extra 350 kCal / 1470 kJ per day in her second trimester. This would be the equivalent to eating an extra half a cup of fruit or one tennis ball-sized fruit, a 175 ml of plain low fat yoghurt, two wholewheat crackers, two teaspoons peanut butter without added sugar and salt, and a 30 gram portion of a medium fat cheese.

In the third trimester, the recommended additional intake rises to just 460 kCal / 1930 kJ per day, and that would be equivalent to eating an extra one cup of fruit or two tennis ball-sized fruits, 175 ml plain low fat yoghurt, four wholewheat crackers with the same two teaspoons peanut butter without added sugar and salt, and a 30 gram portion of a medium fat cheese.

What should you do if you are overweight and pregnant?

Overweight and obesity can present health challenges during pregnancy, so health professionals do advise that women should get to a healthy weight before they fall pregnant. However, in South Africa where women’s rates of overweight and obesity are high, less than ideal conditions for pregnancy need to be managed.

“Pregnancy is not the time to think about dieting and weight loss,” says ADSA spokesperson and Registered Dietitian, Nazeeia Sayed, “An overweight pregnant woman should focus on the healthy eating of a variety of nutritious foods, and her weight gain needs to be monitored at her ante-natal check-ups. She should also focus on light exercise such as walking.”

Day also points out that: “Overweight and obese pregnant women would benefit from seeing a registered dietitian who can assist them with an eating plan which will support baby’s growth and ensure that they gain weight within healthy parameters.”

How can you eat healthily on a budget?

Day has some sensible tips:

  • Eat fruits and vegetables which are in season and more affordable
  • Get your family members and neighbours to shop with you for bulk fruits and vegetables that are more cost-effective
  • Start a vegetable garden using water-saving ideas at home or in your community. NGOs such as Soil for Life and many more help households and communities to sustainably increase their access to fruits and vegetables
  • Spend less money on fizzy cold drinks, junk food and take-aways, and use what you save to buy seasonal fruits and vegetables instead
  • You can save money by reducing your meat intake by half and instead use beans, split peas and lentils to bulk up your favourite meat dishes. These legumes are a more affordable, healthy vegetable protein source that also include the B-vitamins and folic acid
  • Buy frozen vegetables when they are on promotion – they contain as much or even more nutrients than vegetables which have been on the shelf for an extended period of time

What can pregnant women who can’t afford supplements eat to get the micro-nutrients important to pregnancy?

Pregnant women and those planning on falling pregnant should take a supplement of iron and folic acid, as these are essential nutrients needed for a healthy pregnancy.

Sayed points out that it is important for all pregnant women to know that they have access to the State ante-natal services because supplements such as folic acid, iron and calcium are included in their free healthcare.

Day also adds that there are many affordable food sources that provide these nutrients that are vital to a baby’s healthy development. “For instance,” she says “Green leafy vegetables such as spinach, morogo and legumes such as beans, split peas and lentils are good sources of folic acid and iron. You can also find staples such as maize meal and brown bread that are fortified with folic acid and iron. Amasi and milk provide calcium. Tinned sardines and pilchards provide calcium and iron, and chicken livers are another good source of iron.”

How can you use your pregnancy to develop healthier habits?

Pregnancy is a time when your health and the health of your developing baby is an absolute priority.   Day says that it is not only what you consume but also what you do not consume that counts. “Don’t drink alcohol when you are pregnant. All forms of alcohol could be harmful to your baby and the safest choice for your unborn baby is not to drink any alcohol at all when you are pregnant.”

Sayed concludes: “Pregnancy is not a state of ill health but a time to be enjoyed, and it can help you to develop life-long healthy eating patterns that you sustain as you become a role model for the new addition to your family!”


“No day is ever the same”

ADSA_Jessica Byrne_Blog VersionWe chatted to Registered Dietitian, Jessica Byrne, who is currently undergoing her Masters studies in Therapeutic Nutrition and fulfils the role of chief operating officer for ADSA, 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?

Biology was always my favourite subject at school, and I knew from fairly early on that I wanted to follow a career in health. Finding out more about dietetics when I started varsity, I knew it was the perfect fit for me, incorporating science as a base but also allowing me to work with people on a more personal level.

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

For most people their first thought about a dietitian is that our job is helping people to lose weight. But I love that our profession is involved in such a diverse range of areas, and with that it brings versatility and variety. For me no day is ever the same. One day I could be seeing patients in the ICU, and the next assisting a journalist with evidence-based content for an article on nutrition, through my role in ADSA.

In my work in the hospital setting, it is rewarding to know that through providing nutrition therapy, I am contributing to enhancing the recovery of that patient and improving their health.

What has been your career highlight?

A recent highlight for me is when I represented ADSA and the dietetic profession at parliament, where I presented ADSA’s position and recommendations for the sugar tax. It was an exciting experience, and certainly not something I saw myself doing when I first became a dietitian!

What are the most challenging aspects of your career?

The public is being exposed to more nutrition information that ever before, but unfortunately not all this information is accurate, from credible sources or might not be appropriate for every individual. Trying to correct these misperceptions around diet is an important part of a dietitian’s work.

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

I don’t let it get to the point where the entire day has been filled with poor eating choices, but if I’m having something less healthy I don’t beat myself up about it, but try to really savour it and know that I will get back on track at my next meal. I truly believe that moderation is key to keeping yourself on track long term, rather than putting yourself under unnecessary pressure to always make the healthy choice. That is why I follow the 80:20 rule – 80% of the time make the healthier choice, and then allow yourself that 20% for a treat now and then, without feeling guilty about it.

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

  • ‘Please don’t look at what I’m eating!’ (I’m not the food police and I do not judge, especially as I don’t know what the rest of your eating patterns and lifestyle are like.)
  • ‘So, do you ever eat chocolate/cake?’ (Of course I do, just not every day!)
  • My initial thought was to add ‘What do you think about (insert current diet trend)?’ to this list because, let’s be honest, we don’t want to be talking about work when we’re out enjoying time with friends. But in fact, I don’t want people to stop asking that question! It actually makes me excited when someone asks a dietitian for their opinion on a new diet trend or popular headline they might have read. They are trying to make their mind up about a particular issue, and it’s a fantastic opportunity as a healthcare professional to provide guidance that is scientifically sound and based on evidence.

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

Dietitians are all trained and qualified to treat any patient presented to them. However, some dietitians might have special interests and be more knowledgeable in certain areas, so this can be useful to guide you on finding the right dietitian for you.

 What is your favourite dish and your favourite treat food?

I love so many different foods, it’s so difficult to choose a favourite dish. It might sound cliched, but I really do love veggies! I love trying new dishes where veggies are the hero, particularly using vegetables to take a boring salad to something super tasty. And when it comes to a treat food, without a doubt, my favourite would be anything that contains chocolate!

Jessica holds both a B.Sc degree in Physiology and Biochemistry, and a B.Sc (Medical) (Honours) degree in Nutrition and Dietetics from the University of Cape Town. She is currently undergoing her Masters studies in Therapeutic Nutrition at Stellenbosch University. Before joining ADSA in the role of chief operating officer, Jessica worked at the Heart and Stroke Foundation SA where she provided up-to-date scientific content for media, planned public awareness and education campaigns, and worked on local government projects. Jessica also consults at private hospitals, where she is responsible for the nutritional management of critically ill, medical and surgical patients.

To find a dietitian in your area please visit the ADSA website and click on the PUBLIC button.


Keeping your healthy balance over the holidays

We know it well, silly season is not for sissies. We always head into it with the best intentions not to give way to the over-indulgence; not to leave our healthy eating plans by the wayside, and to make sure we have the ‘me-time’ for prioritising the physical activity and self-care that we need to maintain our healthy balance. But we can trip up.

No sooner have we got through the swirl of team, company and client lunches, drinks and parties than we’re whirling off on holiday with non-stop plans for spending (well-deserved) time with family and friends. And, you know what? It’s actually, all good.

Our human drive to gather together around food is really not the problem. No matter what is available, what’s on offer and even, what might be pressed upon us, we still remain absolutely in charge of everything that we choose to eat or drink over the upcoming festive season. What’s critically important is how you think and how you decide to act in the moment.

For some, the legendary lavishness of the holidays is an excuse to let go despite the stated aspirations to achieve that bikini body this summer. It’s easy to take an ‘everybody’s doing it, I can’t avoid it’ approach, and lose your balance and your focus on your personal goals.

Or, you can see it for what it is – a highly social time that is good for you in so many ways, but will inevitably be accompanied by loads of food and drink. It’s important to stay mindful of this fact: you are completely in charge of how the holiday unfolds for you. You have all the power to maintain balance and progress on your healthy lifestyle goals – without suffering, and without setting yourself uncomfortably apart from others.

Healthy lifestyles have gained serious traction over the past years. Sure, no one has yet been able to convince Grandma to replace the condensed milk with low-fat yoghurt in her classic Christmas Day potato salad, but the chances are you will still find plenty of others in your social circles who, like you, want to start some new, healthier traditions and eating habits when it comes to the food we share over the festive season. It’s actually so unlikely at any holiday gathering this year that you won’t find some companions who also intend to stay focused on balanced eating in the context of a healthy lifestyle. Find them, band together and forge forward into a festive season that truly recharges mind, body and soul.

We asked Registered Dietitians, Retha Booyens and Mbali Mapholi, spokespeople for ADSA (Association for Dietetics in South Africa) to each give us their top festive season tips for mindful, in charge, healthy eating over the holidays:

Mbali says:

  • It’s the same packet of chips – “Yes, you’re relaxing on the beach with friends and the context is the holidays – but the packet of chips being offered around is just the same as any other time, so, stick to your same reactions. If you’re not hungry, or if you would prefer a healthier snack, pass it on. This is not different advice from how to choose when waiters at a party are offering trays of canapes – just because it is in front of you, doesn’t mean you have to eat it. Be mindful about what you choose to eat. Sometimes when it comes to food offerings, we go on autopilot and think we need to hoover up everything in our sights just because it is on offer. But, we don’t. It’s just food. There will be more. There will be other contexts. We still have free choice, and we need to keep this in perspective – it is the same packet of chips you could say no to any other day, so say no today.”

Retha reiterates:

  • Keep it in perspective – “If you find yourself in Rome on a rare holiday with the chance to enjoy an Italian Gelato alongside the Trevi Fountain – just go right ahead and enjoy it. But if the choice is about yet another third helping of Mom’s peppermint crisp tart, you can probably skip that this time around. If it is a genuine once in a lifetime experience, go for it, but if it’s a holiday habit that just trips you up, let it go.”

Retha says:

  • You won’t feel happy if you just over-ride your healthy weight loss or weight management plans – “You can avoid the stress that compromises your enjoyment of the holidays by sticking to your goals and plans in flexible and practical ways. Keep your portion sizes in check at every meal. Cut back on the empty calories of alcohol by consciously reducing your intake and also drinking a glass of water between every glass of wine or beer. Never slake your thirst with an alcoholic beverage. Stick to your exercise regime. If you can’t access your usual classes, sessions and activities, then run, walk, ride or play physical games for a minimum of two and a half hours a week.”

Mbali adds:

  • The devil is in the detail – “It’s not the holiday season that is the pitfall but rather our mindless reactions. Step away from the snack table. When you eat; choose well, chew slowly and be aware of what you are eating. Bring your favourite healthy dish to the family braai. Don’t hesitate to eat well and share that. Keep your eye on portion size and trade the treats you don’t want to miss out on with increased exercise and a more balanced meal before or after.”

 

For more information about ADSA or to find a dietitian in your area, please visit www.adsa.org.za


Zucchini, oatmeal & chickpea fritters with grilled chicken, tomato, feta & mint salsa

We have a brand new NutritionConfidence recipe, created by chef, Vanessa Marx!

The oat bran and chickpea flour used in the fritters provide a good source of healthy soluble fibre, which lowers the glycaemic index of this dish and aids in blood sugar control. Adding zucchinis not only ups the fibre content even further, but is also an easy way to get in a portion of veggies.

Instead of using store-bought marinades, which are often high in salt, sugar and preservatives, Vanessa has packed in some punchy flavours by using paprika, lemon and thyme to season the chicken.

INGREDIENTS (Serves 4)

For the Fritters:

1/2 cup ground oats or oat bran

1/2 cup chickpea flour

1 tsp baking powder

1/2 cup low fat milk

2 free-range eggs

3 medium zucchini, grated

10 ml chopped fresh parsley

a pinch of salt & pepper to season

10 ml canola oil

  • In a bowl, mix together the ground oats and chickpea flour, with the baking powder and seasoning.
  • Make a well in the centre, and add the two eggs and milk.
  • Mix the wet and dry ingredients into a batter, and then add the grated zucchini and mix well.
  • Heat a non-stick pan on a medium heat, and drizzle with half a teaspoon of the canola oil.
  • Spoon a tablespoon at a time into the pan to make the individual fritters.
  • Let the fritter form a crust on the underneath side and become golden brown and set a little, before flipping them over with a spatula.
  • Let the fritters cook through and have colour on both sides, then remove from the pan and set aside.
  • Cook the fritters in 2 batches, so you don’t over crowd the pan.
  • Set them aside on a platter or plate.

Makes 12 fritters

For the Chicken:

4 free-range chicken breasts

1/2 tsp smoked paprika

zest & juice of 1 lemon

5 ml chopped fresh thyme

salt and pepper to season

10 ml canola oil

  • Cut the chicken breast into strips and season with the paprika, lemon, thyme, salt & pepper
  • Put a frying pan on a high heat and add the canola oil.
  • When the pan is hot, add the chicken breasts and cook for around 2 minutes on each side, until browned, and cooked through.
  • Remove the chicken strips from the pan heat and set aside until you are ready to serve.

For the Salsa:

2 large tomatoes

30 g spring onion

1 TBL chopped fresh mint

100 g feta, cut into cubes

1 TBL lemon juice

1 TBL olive oil

salt & pepper

  • Roughly chop the tomatoes into dice, and slice the spring onion
  • Mix together the chopped tomatoes, mint, spring onion and feta and drizzle with lemon juice and olive oil. Season to taste and mix well.

To assemble:

  • Place the fritters onto individual plates or a platter to serve.
  • Top the fritters with the grilled chicken
  • Pile the salsa over the top of the chicken and garnish with fresh coriander leaves

 

Nutrition information: Per serving (recipe serves 4)

Chicken*: Energy: 160 kCal/ 675 kJ, Fat: 3.6 g, Carbohydrates: 0.27 g, Fibre: 0.33 g, Protein: 31.4 g, Sodium: 95 mg

*130 g raw portion per chicken breast

Fritter: Energy: 43 kCal/ 178 kJ, Fat: 2.1 g, Carbohydrates: 2.9 g, Fibre: 1 g, Protein: 2.5 g, Sodium: 210 mg

Salsa*: Energy: 107 kCal/ 448 kJ, Fat: 6 g, Carbohydrates: 4.9 g, Protein: 6.2 g,  Sodium: 181 mg

*Using reduced fat feta


Women and Diabetes in the Spotlight this November

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

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

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

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

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

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

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

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

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


Getting the right help can change your life!

We are sharing success stories to find out why people decide to see a dietitian, what happens on the journey, what the hardest part of that journey is and what results are achieved. This week we chat to Julie Greensmith, who started seeing Registered Dietitian Nathalie Mat after she was diagnosed with Diabetes. Here is her story ….

Tell us about your journey with your dietitian

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

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

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

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

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

Tell us about your results

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

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

What was the hardest part of the journey

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

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

What are the top three tips you can share

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

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

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

Trust. Trust the process and embrace it fully.

What dietitian Nathalie Mat says

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

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

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

 

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

 


RETHINK YOUR DRINK – CHOOSE WATER

Clean and clear, refreshing and invigorating, we know instinctively that water is good for us. Yet, many of us have lost touch with water. Overwhelmed with the wide choice of what to drink, most of it sweetened with sugar, we’ve somehow left the simple, but profound goodness of water behind.

National Nutrition Week 2017, running from 9 to 15 October and, with its theme “Rethink Your Drink – Choose Water”, aims to help us rethink when it comes to water and get into the habit of making water our beverage choice each day. Water contains no kilojoules and hydrates. It is essential for health and is the best choice to quench thirst.

What the campaign highlights is that when we are not drinking water, we are probably choosing a sugar-sweetened drink which spikes our daily kilojoule intake, degrades our diet, and leads to weight gain and the onset of non-communicable diseases such as type 2 diabetes, heart disease and dental caries.

“The prevalence of obesity and non-communicable diseases in the country is alarming,” says Rebone Ntsie, Director: Nutrition, of the National Department of Health). “The South African Demographic and Health Survey conducted in 2016 found that the prevalence of overweight was 13.3% among children 0 – 5 years of age. About 67.6% and 31.3% of South African women and men respectively are overweight and obese. These findings show that overweight and obesity among children and adults have increased from earlier surveys. Replacing sugary drinks with water can help.”

Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa (HSFSA)warns that the risk of coronary heart disease and ischaemic stroke rises with an increase in body weight. “There is also a clear link between sugary drink consumption and heart disease,” she says. “Indicators of heart disease such as blood lipids and uric acid also increase with an increase in consumption of sugary drinks.”

Daily consumption of two or more sugary drinks has been found to increase the risk of developing diabetes by at least 24% compared to consuming less than one sugary drink per month. According to Statistics South Africa, diabetes was the second leading underlying cause of death in the country in 2015, accounting for 5.4% deaths and the leading cause of death in females (7.1%).

On average, commercially produced sugary drinks contain the following amounts of sugar per 500 ml serving (2 average-sized cups/glasses):

  • Sweetened fizzy drinks: 13 – 17 teaspoons
  • Energy drinks: 13½ to 15 teaspoons
  • Fruit juice: 12 – 16 teaspoons
  • Sweetened milk or yoghurt-based drinks: 7 – 13½ teaspoons
  • Sweetened iced tea: 8 – 10½ teaspoons
  • Sports drinks: 4½ – 12 teaspoons
  • Sweetened drinks, such as sweetened flavoured water, vitamin enriched water and coconut water: 4 – 8 teaspoons of water

The World Health Organization (WHO) recommends that the intake of free sugars, i.e. sugars added by the manufacturer, cook or consumer or sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates, should be less than 10% of the total daily energy intake for adults and children and less than 5% for further health benefits.

“This means that the maximum intake of free sugars from food and beverages per day for adult men and adolescents (14 – 18 years) should not be more than 12 teaspoons, and for adult women and children 5 – 13 years, not more than 9 teaspoons”, says Nicole Lubasinski, President of the Association for Dietetics in South Africa (ADSA).“To achieve more health benefits, the number of teaspoons of sugar from food and beverages per day for adult men and adolescents (14 – 18 years) should not be more than 6 teaspoons, and for adult women and children 5 – 13 years, not more than 5 teaspoons”.

Some sugary drinks have a nutrition information label, this will indicate how much of the carbohydrate in the drink is found as sugar”, says Carol Browne of the Nutrition Society of South Africa (NSSA). “Sugar is one of the primary ingredients in drinks, and so it will be listed high up on the list of ingredients. In milk based drinks some of the sugar will be the sugar from milk, and this is not classified as a ‘free sugar’. In these products the total sugar content on nutrition information label should be considered with the ingredient list.”

“It makes good sense to replace sugary drinks with lots of clean safe water”, says Rebone Ntsie. “Drinking lots of clean and safe water is essential for one’s health. Besides keeping you hydrated, it helps with digestion, regulate your body temperature, and to lubricate your joints. Furthermore, tap water is cheaper than any other drinks.”

“There are several ways to increase your intake of water”, says Abigail Courtenay, registered dietitian and spokesperson for ADSA.   “Make sure you always carry water with you; set reminders on your cell phone or notes at your desk every hour; drink water with meals; before and after exercising; and send a bottle of water with your child to school every day. You can also add fresh slices of lemon, cucumber, mint leaves, lime or fresh fruit to your water or unsweetened rooibos or herbal teas to add more flavour.”

On Wednesday, the 11th of October, ADSA (@ADSA_RD) will be hosting a Twitter Talk from 13h00 to 14h00 where dieticians and National Nutrition Week partners will be providing information, tips, ideas and advice on choosing water as the beverage of choice instead of drinking sugary drinks. Join the conversation live on Twitter, and follow the @ADSA_RD handle to get great ideas and tips. The Department of Health in the various provinces will also celebrate National Nutrition Week during the month of October.

For more information on National Nutrition Week 2017, visit the website: http://www.nutritionweek.co.za/


“I believe in moderation, not deprivation”

Meet registered dietitian Abby Courtenay, who is serving on the current ADSA executive committee and looks after the PR portfolio. We chatted to her about why she loves being a dietitian, what the challenges are and what people should consider when deciding which dietitian to consult:

Why did you become a Registered Dietitian?

From a young age I had an interest on the effects of nutrition on the human body. I vividly remember reading the ‘How my body works’ books and being fascinated by the complexity of the digestive system. By the time I was in standard 9 (or grade 11), I knew I definitely wanted to become a dietitian. Strangely though, in Matric I changed my mind and pursued a degree in architecture. After 1 year I realized that architecture was not my passion and so I started my BSc degree and subsequently was accepted for dietetics at the University of Pretoria in 2007. People often ask if I regret my round about journey to dietetics, but I made some amazing friends along the way and learned a great deal about myself in that time. I don’t think I would be the dietitian I am today, had it not been for my experiences.

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

I have been in private practice for almost 3 years, and I still feel a great sense of pride and joy when I receive feedback from my patients telling me how amazing they feel. I think that many people feel pretty terrible on a daily basis, but with correct diet and adequate lifestyle changes they can truly reach their full potential. I strive to incorporate a strong message of moderation and I do not believe in deprivation.

What has been your career highlight?

I will be attending FNCE conference in Chicago (coming up in October 2017), so for me I feel like all my hard work and dedication to my career and dietetics  has culminated to this point and I am beyond excited to represent South African dietitians at an international conference.

What are the most challenging aspects of your career?

Trying to correct nutrition misconceptions. People unfortunately get their nutrition information from un-credible sources (usually on the internet) and it can be challenging to correct these perceptions. I believe that for dietitians, knowledge is power and the more you arm yourself with current, up-to-date nutrition information to more you can educate the population.

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

To be honest I don’t ever feel as if my day has been nutritionally disastrous. When you give yourself permission to eat all foods you remove the guilt from eating and thus stop the diet cycle (binge, guilt, deprivation and repeat).

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

  • Do you ever eat *insert indulgent food here*? Of course we do, we are only human and can eat anything in moderation!
  • Don’t judge what I am eating/ buying! This will often happen at a braai or when I see someone at the shopping mall, and I can promise you that I never judge and don’t give my professional opinion unless it is asked for!
  • Can you print me/ email me a diet? All the plans I do are individualized, it is not a “mik-and-druk” process. In order to be successful (with regards to dietary change), you will need to see a dietitian for a one-on-one consultation. She needs to get to know your medical history, lifestyle, likes and dislikes, level of nutrition education and current diet history before she can even think of creating a plan for you!

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

If you have a specific medical problem, ask the dietitian if this is her special interest. If it is not, ask if she can refer you to a dietitian who is more knowledgeable in your problem area and the dietitian should also be conveniently situated, so that it is convenient for you to see her regularly .

What is your favourite dish and your favourite treat food?

I like to experiment in the kitchen and try to update my recipe folder on a regular basis, so don’t ever have a ‘favourite dish’ but rather a favourite dish of the week. At the moment I am trying out a homemade tuna and butterbean fishcake.

My favourite treat food is without a doubt baked cheesecake!

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

More about Abby
Abby Courtenay RD (SA) is an associate dietitian at the Nutritional Solutions Grayston and Melrose. She graduated with a Bachelor of Dietetics at University of Pretoria and also holds a Masters’ degree in Nutrition from the University of Stellenbosch.
She is registered with the HPCSA and is the current ADSA Executive Public Relations portfolio holder and previously served as the Public Sector portfolio and Communications portfolio the ADSA Gauteng South branch.
Abby has a special interest in: maternal, infant and child nutrition; renal and oncology nutrition. In addition to that, she also has extensive experience working with adults within the realm of weight loss and treatment/ prevention of lifestyle-related conditions.
Abby is a regular guest writer for Living and Loving, ChildMag and Clicks magazine, and also contributes as a nutrition expert to medical newsletters both to the public and healthcare professionals through Ann Lake Publishing. Abby is a regular contributor to various radio stations including Radio Cape Hope and Radio 702 and has appeared on television in relation to various nutritional matters.

The perfect Braai Day side dish!

If you are planning to celebrate Braai Day this weekend, add this delicious, South African Baby Marrow, Feta & Peppadew Salad to your menu. Created by dietitian and co-author of Eat Ting, Mpho Tshukudu, this salad is versatile and goes well with meat, chicken and fish.

Baby marrows are indigenous to South Africa. They make beautiful salads, soups, stir-fries and can also be used in baking to add moisture and fibre to the dish. They are a relatively low kilojoule vegetable and are a source of fibre and vitamin C.

INGREDIENTS

4 medium baby marrows (about 180 – 200g)

1/2 cup (125 ml) peppadew peppers, drained and roughly chopped and 1 Tbsp of the liquid

1 tsp (5 ml) + 1 Tbsp (15 ml) olive oil, divided

1 cup (250 ml / 220 g) halved cherry tomatoes – use different colours if available

Juice of 1/2 lemon

1 garlic clove, minced

2 Tbsp (30 ml) fresh thyme

3 Tbsp (45 ml) chopped chives

(60 g) feta cheese, broke into small pieces or cubed

Salt and pepper to taste

METHOD

Preheat grill to medium. Slice baby marrow into 1/2 cm rounds.

Toss the baby marrow with 1 tsp (5 ml) oil.

Lay the baby marrow on a hot grill and turn once water droplets form on top, and there are slight char marks on the heated side.

Place the baby marrow on a cooling rack to cool, in a single layer to prevent them going too soft

In a large bowl, toss together baby marrow, peppadew peppers, tomatoes, chives and thyme.

In a small bowl, whisk together the remaining oil, lemon juice, garlic and black pepper.

Add the dressing to the vegetables and toss to coat.

Add feta cheese.

 

NUTRITIONAL ANALYSIS PER SERVING

This recipe serves 4.

 

Energy: 113.75 kCal / 477.75 kJ

Carbs: 9.7 g

Protein: 4.2 g

Fat: 8.2 g

Sodium: 197.8 mg

Fibre: 1.5 g

 


‘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.


NEW Recipe: Lettuce & Pea Soup

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

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

 The dietitians say:

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

INGREDIENTS (Serves 4)

5 ml         butter (1t)

5 ml         olive oil (1t)

3 leeks    well washed and sliced with the green tops

1 ml         dried crushed garlic (¼ t)

2.5 ml     salt (½ t)

1              head of butter lettuce, finely sliced

250 g      frozen peas (1½ c)

1.25 L     boiling water (5 c)

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

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

125 ml    chopped parsley (½ c)

METHOD

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

NUTRIENTS PER serving (200 ml of soup)

Energy                                   740 kJ

Protein                                   6.7 g

Carbohydrates                     28.0 g

Total sugars                         6.2 g

Added sugar                        0.0 g

Total Fat                                3.1 g

Saturated fat                         0.8 g

Fibre                                      6.4 g

Sodium                                 773 mg

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

FOOD FOR SENSITIVE TUMMIES

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

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


Dietitians urge South Africans to ‘Eat Fact Not Fiction’

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

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

Dietitians and Evidence

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

Dietitians and the Food-Based Dietary Guidelines

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

Dietitians and Patients

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

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

Dietitians and Sustainability

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

Dietitians and Diseases

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

Dietitians and Malnutrition

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

The Dietitian and You

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

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

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

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

 


Turnip Tagliatelle with Chicken & Herb Sauce

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

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

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

INGREDIENTS

(serves 4)

4 medium turnips

4 teaspoons olive oil, divided

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

4 leeks

250 g mushrooms

2 teaspoons crushed garlic

½ cup plain yoghurt

2 large eggs

30 ml fresh chopped parsley

¼ cup grated parmesan cheese

Salt and pepper, to season

METHOD

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

 

Nutrition Information: Per serving

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

 

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

 


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

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

The complaint

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

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

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

The HPCSA charge and inquiry

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

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

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

ADSA’s concern

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

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

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

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

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

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

About sponsorship and big foods

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

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

On Tim Noakes

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

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

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

Useful links:

ADSA’s position on infant nutrition:

Infant Nutrition Statement

Comprehensive Q&A:

Q&A

ADSA’s sponsorship policy:

ADSA Sponsorship Policy

Tim Noakes tweet: 

ADSA_Noakes Tweet

  1. The HPCSA charge:

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


Is a Career as a Dietitian for You?

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

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

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

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

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

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

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

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

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

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

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

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

Do you have what it takes?

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

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

 

 

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

 ABOUT ADSA

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

 


ADSA News for Private Practising Dietitians

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

Practice cost survey

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

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

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

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

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

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

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

Professional Indemnity Insurance

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

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

Clarity on billing practices

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

Update on Discovery Vitality benefits

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

Some practical information with regards to the new changes:

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

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

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

 


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

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

 

ADSA_Salt week banner

Salt – a forgotten killer

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

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

A world-leader in salt reduction

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

What can the food industry do?

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

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

How do we eat so much salt?

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

Do YOU eat too much salt?

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

How to reduce salt intake

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

ADSA_Change your salty ways

Get tested

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

The next step forward

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

 

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

Meet registered dietitian, Thembekile Dlamini

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

Why did you become a Registered Dietitian?

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

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

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

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

What has been your career highlight?

I have a couple of those:

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

What are the most challenging aspects of your career?

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

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

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

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

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

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

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

What is your favourite dish and your favourite treat food?

Pap and Masonja (Mopani worms) in tomato sauce!

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


Expert Tips for a Healthier Lifestyle

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

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

How to Get Healthy Eating Right

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

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

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

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

How to practice balance in your life

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

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

How to improve our sleep

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

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

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

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

How to relax more

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

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

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

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

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

The facts about ADSA

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

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

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

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

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

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

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

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

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


The Low Down on South Africa’s Sugar Tax

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

How much sugar do South Africans really consume?

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

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

What is ADSA’s recommendation for sugar intake?

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

The sugar tax – is it a good idea?

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

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

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

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

 


10 Healthy Ways to Survive the Festive Season Eating Frenzy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Melk Tart, a South African Classic

We love the sweet tooth satisfaction offered by this better-for-you twist on a classic South African dessert. Created by chef, Vanessa Marx, this Melk Tart recipe is a great family dessert.

Dietitian Cheryl Meyer says that seeds like pumpkin, sunflower and sesame seeds are easily incorporated into a variety of dishes. They not only boost flavour and crunch, they pack a nutritional punch loaded with fiber, protein and healthy fats.

For the crust:

INGREDIENTS

1/2 cup rolled oats

1/2 cup desiccated coconut

20g sunflower seeds

20g sesame seeds

20g pumpkin seeds

1/2 cup unsweetened fresh apple juice

4 Tbl honey

1/4 vanilla pod

  • Preheat the oven to 160℃
  • Mix together all the coconut , seeds and oats
  • Cut the vanilla through the pod lengthways and scrape out the seeds
  • Put the apple juice, honey & vanilla pods and seeds into a small sauce pan and heat until infused and combined
  • Pour the apple juice over the oats mixture
  • Spread the mixture out onto an oven proof tray and bake until golden and crispy, stirring every 10 minutes, to make sure it is cooked evenly
  • Remove from the oven and allow to cool
  • Line the base of your pie dish with the mixture to prepare it for the milk tart filling

For the filling: 

INGREDIENTS

3 eggs

80ml corn flour

½ tsp vanilla extract

2½ cup low fat milk

¼ vanilla pod, seeds removed

½ cup xylitol

Cinnamon for dusting

  • Mix together the eggs and corn flour in a bowl
  • Cut the vanilla through the pod lengthways and scrape out the seeds
  • Put the milk, vanilla pods and seeds, vanilla extract and xylitol into a saucepan and heat together until it comes to a boil
  • Remove from the heat and pour a little of the warm milk into the egg mixture, whilst whisking
  • Add the egg mixture back into the pot with the remaining milk, and whisk
  • Put the mixture back on the heat and whisk vigorously until it thickens and comes to a boil
  • Have your pie dish with the base ready, and pour the custard mixture into the pie dish
  • Leave the tart to cool at room temperature, and then refrigerate for at least 2 hours until completely cold
  • Remove the tart from the fridge and dust generously with cinnamon

Nutrition Information: per serving (recipe serves 12)

Energy: 825 kJ Protein: 6.8 g Carbohydrate: 25.4 g Of which, total sugars: 8.9 g Fat: 8.3 g Fibre: 1.3 g Sodium: 64 mg