In many diet and exercise sales ploys, there are before and after shots. This one person is showing f sexy six-pack or loss of half their body weight. They look great.All you can see is their before and after. Yes, they probably did what the site is selling you. What you don’t know is what other things were in their favor at that particular time. It is likely that there were a lot of other good things happening to them that made their success more likely.The other thing we don’t see is their progress between the before and after. Progress could have been full of plateaus, lapses and times where they got stuck. For whatever reason they found the support offered by the organization good for them. The people selling the product kept them going through their tough times
To be successful making change you need several things:
Identify goals that are targeted to your needs.
Information on how to make the appropriate changes to achieve those goals.
Resources, tips, and tricks to help you develop plans to embed the changes in your daily life.
Support for when things don’t go as planned – for example when daily life takes a surprising detour.
Time to establish the new routines.
Monitoring to measure your outcome.
A cheer squad to help you celebrate your success.
This blog series is going to go into some details about the how, why and
what around behavior change. My experience as a dietitian has taught me
some interesting things about change. If you have a different
experience or other ideas please post a comment. We can chat about them –
I love learning from others.
Mix vegetables in a bowl. If you have red runner beans you could also add small strips of these. Mix the dressing ingredients in a container. Stir through salad. Try to stand for 30 minutes before serving.
Inactivity is the modern smoking. Although I doubt we will have a smoke free New Zealand by 2025, we have made huge reductions in smoking rates. This has happened through changes to workplaces and public spaces to discourage tobacco use. At the same time, with increased mechanization and computerization we have become less active. We are now seeing the serious health consequences of physical inactivity.
Inactivity a problem from cradle to grave
Occasionally I see people for advice on their children’s
health. Recently I saw a family with a child who was very overweight at 18
months. I referred them on for
specialist advice because of other matters but one thing struck me. No one in
that family had time for the wee fella to spend tummy time and tottering time.
Both parents worked, he was in day-care. He had no regular times where he got
encouragement to move his little body.
Everyone was on such a tight schedule.
As a stepmother and a dietitian, I have to tread a fine line
around my step kids (skids!) in relation to their eating and activity. The
younger one has never heard my rant about her not doing physical activity at
school. Why? She because she “didn’t
want to do it.” I loathed and detested
PE. Even now I get anxious about sport,
despite having found a wonderful fitness specialist who has helped me overcome
my physical limitations. I even enjoy playing lawn bowls…something I wish had
been on the PE curriculum.
At the other end of life, people remark I have amazing
parents. They both are active well into
their 80s. They both know that they are either going to use it or lose it and
remain active despite aches and pains.
Modern life is pushing us to inactivity. We need to think
how to push back.
So what are the activity guidelines.
These changed in 2015 and reflect modern research physical
Sit less, move more! Break up long periods of sitting.
Do at least 2 ½ hours of moderate or 1 ¼ hours of vigorous physical activity spread throughout the week.
For extra health benefits, aim for 5 hours of moderate or 2 ½ hours of vigorous physical activity spread throughout the week.
Do muscle strengthening activities on at least 2 days each week.
Doing some physical activity is better than doing none.
Moderate activity means moving so you have an elevated heart rate. You feel warm but you can speak in sentences. As you get fitter your capacity to exercise moderately will increase. You will need to increase either the intensity or duration to get the same benefits.
Vigorous activity means activity with a heart rate close to your maximum capacity. You will feel hot and be unable to talk in sentences.
Muscle strengthening means using your body to resist gravity. It includes things like carrying items and lifting things. The most obvious non-strength building activity is cycling.
2 ½ hours represents 30 minutes 5x per week. You can do this in one or two bursts of activity each week. If you do it will have less cardiovascular health benefit.
5 hours represents 60 minutes 5x per week. This is the guideline for children and young people. This means we need to encourage movement at home as well as at school. Play can be active.
Reducing inactivity means trying to avoid sitting for more than 25 minutes in each half hour. Aim to get up and move for 5 minutes.
Many people, because of pain, physical disability or lack of fitness will not even try. For them trying is important = doing some is better than none.
Look at active transport to work – 10 minutes twice a day of walking to and from the bus will add up
Have a ½ hour screen free time after dinner for everyone to do something active, even if it is the housework!
Find some activity you can tolerate, if not love to do. I tolerate going to the gym. I love playing lawn bowls. And it doesn’t have to have a cost – walking, dancing to music, playing with the kids are all free.
Try to avoid short trips by car. If a trip is less than 10 minutes by car it is walkable.
If you have pain or a health concern reducing your activity speak to your GP to find out what is best for you. Most joint pain will improve with physical activity.
Physical activity the cardiovascular benefits
Blood pressure: regular physical activity reduces blood pressure and strengthens the heart’s pumping mechanism.
Cholesterol: Activity meeting the guidelines will reduce LDL cholesterol and increase HDL cholesterol
Stress reduction: Physical activity reduces psychological stress and distress.
Workplaces can have policy to help people maintain physical activity. The most important thing a workplace can do is recognise the importance of reducing inactivity and make it possible for people to get up and move. Even if jobs are active you can reduce the risk of injury by activity rotation and having regular breaks for movement .
This post is really about the obvious end of the vegetarian diet -when you go vegetarian legumes become an important source of protein in your diet.
If you start cooking vegetarian food you quickly realize that doing beans out of cans is expensive. Dried beans are cheaper. Unfortunately they take a long time to cook in a pot on the stove. You can also end up with pot-burning disasters if you are like me and you wander off while cooking your beans and boil them dry.
Your remaining two options are slow cooker and pressure cooker beans.
Slow cooker beans
Slow cooker beans are great. Rinse the beans under cold water and discard broken, and odd looking beans. They do not need soaking, with the exception of red kidney beans, which need to be put in a pot and covered with boiling water and left to stand for at least 1 hour. Once the red kidney beans have been soaked, then rinse them, cover them with water in the pot and bring to the boil, letting boil for 10 minutes. Transfer them to the slow cooker and cook for the remainder of time.
Water for 500g
Black eyed peas
4 – 5.5 hrs
4.5- 6 hrs
Red Kidney Beans
5-6 hrs after 1 hour hot soak and 10 min rapid boil
Pressure cooker beans
Not everyone has a pressure cooker but if you are making a commitment to eating at least 3 meals a week of vegetarian foods it soon becomes obvious that a pressure cooker is very useful. I have ended up getting some pressure cooker envy going into small appliance retailers as I use my cheap old-fashioned one, I picked up from a charity shop…here is hoping my family realizes my next big birthday is within a couple of years and I would really, really, really like one of the fancy ones!
Understanding pressure cooker times is what matters, and the different ways of reducing pressure once cooked. Also most beans (red kidney beans the MAJOR exception) can be cooked from hard rather than soaked, but if you do soak the cooking time of many beans is seriously short.
This link is excellent and has all the information you need on cooking with a pressure cooker. Most of our pressure cookers work at 15 PSI.
If you are cooking up bulk beans, spreading them thinly on a tray to cool then freezing them so you can then put the free-flow into a container is a great idea. I have learned to label my recycled ice-cream containers extremely well to avoid disappointment of going into the fridge and hoping there is ice-cream.
Cholesterol 101 – what are the different parts of cholesterol
Total cholesterol is the sum of all the different types of cholesterol in blood. The target level 4 or under for people who have previous diagnosis of heart disease or diabetes. LDL cholesterol is the “bad” cholesterol. LDL is like a dump truck. It deposits cholesterol into the fatty plaques on the artery walls, narrowing the blood vessels. The target for LDL is 2 or less. HDL cholesterol is the “good” cholesterol. It is like a grader, removing the cholesterol from the fatty plaques and widening the walls. The target for this is greater than 1. Triglycerides:. If elevated this fat prevents HDL from doing its job. It is like traffic measures that prevent the good cholesterol getting to where it works. This value should be under 2. Elevated triglycerides occur with heavy alcohol intake and when people eat excessive refined carbohydrate.
Does saturated fat cause bad cholesterol and heart disease?
Over time the research on fats has varied on how saturated fat intake can be linked to heart disease risk. Heart disease like diabetes has multiple risk factors. Both prospective cohort studies and clinical trials suggest a relationship between high saturated fat and heart disease. This is why as a dietitian I recommend reducing saturated fat to less than 10% of energy. In a 2000kcal (8,400kJ) diet that represents reducing to 23g (5tsp) of saturated fat. This is a reduction from from around 35g (8tsp) for most people.
How to reduce saturated fat intake?
Enjoy a variety of nutritious foods every day including:
some milk and milk products, mostly low and reduced fat
some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red meat with the fat removed
Enjoy a variety of nutritious foods every day including:
with unsaturated fats instead of saturated fats
that are mostly ‘whole’ and less processed
8 dietary changes to reduce fat
Choosing low fat or reduced fat milk and yogurts (Less than 2 g fat per 100g).
Portion controlling cheese to 30g per serving.
Having at least legume based meals per week.
Trim, skim and skin meat and chicken, to reduce the total amount of fat from animal products.
Portion control meat portions to no more than 150g per meal (raw weight)
Use oil in cooking, not solid fats
Use margarine instead of butter
Limit the amount of processed foods you have. If you need snacks then have real food.
This advice has been around for years and it hasn’t worked
We have 8 points for change, so whydo we still have a problem.Yes, we have been giving this advice for years but few people follow it. Why? There are a lot of myths and false news about saturated fats. Conspiracy theorists believe the research is funded by “big food or big pharmacy to maintain their market. These claims are amusing at best and offensive at worst.
What if you are wrong – the diet change trial.
If someone presents with raised cholesterol and is suspicious about my advice I set this challenge. Follow my advice for 3 months. At the end of it we check again and see the impact. If your cholesterol worsens despite following my advice, I will support them to try a different approach FREE OF CHARGE. Not many people try something different (I can think of two in my career). Most people can get a significant reduction in their bad cholesterol. With careful selection of the oils and some increase in physical activity, their good cholesterol increases
Saturated fat and diabetes
There is strong links between saturated fat intake and insulin resistance. Insulin resistance can be demonstrated by an increase in HBA1, when there has not been any weight change. Some people having a high saturated fat have a marked increase in HBA1c. Again in this case I will offer them a chance to manage their pre-diabetes or diabetes. If they don’t get an improvement on my advice, I will help them find something that works for them FREE OF CHARGE.
So if you think you want to change your diet. Come and see me. Let’s see if we can improve those numbers. Employers may benefit from supporting their staff to access my services. Improving diabetic control and heart disease risk pays off.
This started its life as an idea for a patient who appeared
to be sensitive to tomatoes. It then reincarnated when my lovely partner
pointed out he was getting sick of tomato based pasta sauces.
2 TBSP olive oil
1 medium onion finely chopped
2 garlic cloves or 2 tsp crushed garlic/
1 kg of squash or pumpkin peeled, seeded and cut into 1 cm cubes.
1 red chili de-seeded and cut into fine strips.
If you have time and a warm oven the day before, prepare the
squash or pumpkin and put onto a lightly oiled tray for about 20 minutes in a
moderate oven, this will roast it and give it a nice caramel taste. It is an
optional step but a great option.
Heat oil in a pan and add onion and garlic and saute until soft. Add in the squash or pumpkin and chili. Add about 1 C water, bring to the boil, then reduce heat. Put lid on and leave 5 minutes. Check if the pumpkin is tender. If not add another ½ C boiling water and leave to simmer with lid on another 5 minutes. Blend until very thick and smooth. Use in place of tomato based pasta sauce. This can last in the fridge for about 5 days, but unfortunately is not good to preserve in jars unless you use a pressure cooker method, because it is not acidic enough to be safe to preserve.
Diabetes and Heart Disease are intimately linked. During Heart Month (February 2019) I will be posting regularly how individuals and employers can tackle these diseases together.
People with Type 2 diabetes (T2DM) have 2-4 times the risk heart attack or a stroke than people who don’t. Making lifestyle change to either preventT2DM, reverse it or manage it better reduces this risk. Managing risk needs to happen in all parts of people’s lives. As an employer if you want a healthier workforce, invest in advice and education to support your staff.
The American Heart Association has defined a list called
Life’s simple 7. These changes manage heart disease risk and diabetes. They are
core to the messages taught in group, online and individual education sessions by
Helen Gibbs Dietitian Ltd
My education sessions promote dietary improvement. Diet improvement can improve health independent of weight loss. Recent research has demonstrated the importance of a high fibre diet, part of ‘nutrient dense eating.’. In my courses and 1:1 sessions I focus on “nutrient dense eating”. This style of eating improves health and reduces disease risk, regardless of weight change.
regular physical activity
I work hard achieve appropriate physical activity levels, so I get it. I have a lot of empathy for clients and their struggles to be active. This personal experience has informed my learning. I use what I have learned to motivate people to be more active. Employers may need to think how they can support increased activity in daily living. If people are active there is a benefit to the employer in reduced absenteeism
weight if you are overweight
Unlike some dietitians I am not a proponent of Health At Every Size (HAES) model of care. We have to get rid of the worst parts of dieting culture; but we need to support people to improve their health through body fat reduction. Individual care means addressing the most important aspect of eating for that person. If clients have disordered eating or eating distress, they need support to address this. Many people are too ashamed to discuss their eating distress. Having a compassionate and experienced dietitian accessible to your workforce increases their chance of asking for help.
5. Keep your
blood pressure in the proper range
In group sessions I talk about what to do, and how to do it. This includes the changes needed to reduce blood pressure. The good news is these changes can also improve other aspects of health. Workplaces with canteens or onsite food supplies may need to match education with better choices. If you are large enough to have these services you are large enough to need a detailed food policy. The impact of alcohol can not be overstated with blood pressure. I provide alcohol harm reduction education as part of lifestyle education.
6. Keep your
blood fats and cholesterol levels in a healthy range.
The media coverage of the possible causes of heart disease
has left people confused. Providing evidence-based
advice and practical ‘How to’ education helps your staff make informed choices.
7. Keep your
blood glucose under control.
Elevated blood sugar damages the circulation. Even if you have a fit and healthy workforce,
they damage their health by drinking sugar containing soft drinks and energy
drinks. Your business can have policy to support water drinking. Once people have pre-diabetes or Type 2
diabetes, cutting back sugar is not enough. I work with people so they
understand that they need to cut their saturated fat to lower blood glucose
levels. Saturated fat acts to increase insulin resistance, making the locks
stickier (link to video). Insulin resistance limits the work of circulating
New Zealand has an aging workforce. We also have increasing
rates of diabetes and heart disease. Having unwell staff costs you money.
Investing in prevention makes sense. Contact me if you want to know more about
the services I offer.
First step: If you have health insurance for your staff see if dietetic services are covered. If they are not ask why.
Lots of people ask me why they should see a dietitian rather than a nutritionist. I am a dietitian. So I am registered to practice with the dietitian’s board. I have completed a recognized qualification in Dietetitics . Each year I have to provide evidence I am maintaining my professional learning. I am also a nutritionist, although currently not on the Nutrition Society register. This illustrates an important difference.
Anyone can call themselves a nutritionist. It is illegal to use the term dietitian unless you are on the register.
What about qualifications? In the title I hint at an irony. I have worked with nutritionists. I have seen very skilled practitioners with an undergraduate qualification in nutrition. I believe that nutritionists and dietitians can work in partnership. Here is the difficulty. Everyone needs to know what they are good at. They need to know what to do when a patient has some health issue they are not familiar with.
Why come and see me , not another dietitian?
I have spent 20 years in practice learning how my job fits in with other health professionals working in primary care. As a result I have gained a lot of experience in the health conditions that a GP will see and treat. So I am more of a generalist than a specialist, and that works for most people who need dietary advice in our community.
I have also worked with enough secondary care team members, that my sense of “that’s not routine” is quite well developed. I am quite happy to share that with anyone who needs to hear it too. I have good relationships with specialists and I work to maintain them.
The single most important qualification a dietitian or nutritionist can have other than their professional learning is the ability to listen. In psychology they talk about a therapeutic relationship. Because food is such an intimate subject, you need to trust the person giving you advice. This is why I am happy to speak to you on the phone before you book. This is so you can work out if I am the right person for you. So if you need dietary advice, give me a call, no obligations.
Last week saw the publication of the report from the EAT-Lancet Commission. EAT-Lancet outlines how to achieve a globally fair and nutritious diet. They are aiming to feed the 10 billion humans on the planet by 2050. It is the first report to consider the impact of nutrition on the natural environment.
“Transformation to healthy diets by 2050 will require substantial dietary shifts. Global consumption of fruits, vegetables, nuts and legumes will have to double, and consumption of foods such as red meat and sugar will have to be reduced by more than 50%. A diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits.”
Target 1 is healthy diets. I have analyzed the report and created a table (below) with the food intake in standard portions. A copy of the report summary can be downloaded here. This is for people wanting to read the second target (sustainable production) and the 5 goals. I examine a planetary healthy diet in comparison to current NZ eating patterns .
All other vegetables
Meat and poultry
3 portions of 100g/week
2 portions of 100g /week
5-6 90g portions /week
11-12 30g portions/ week
This represents a fairly strict flexitarian diet. Most people could achieve this eating patter with planning. It would be more difficult to eat like this if you were time poor or had limited cooking skills. Food manufacturers and retailers would have to change their offerings to be part of a sustainable food system.
Whole grains: We eat mostly refined grain foods in NZ. It would involve both a shift to whole grains and increased amounts of whole grains in the diet.
This would be less potato, kumara or taro than currently eaten.
For most people this is a significant increase in non-starchy vegetables.
Most people would be increasing their fruit,
This a significant reduction in dairy intake.
Only 6 of the 14 non-breakfast meals would have animal source protein, the rest would have legumes or nuts as primary protein.
There would be a tight limitation on butter, with a liberal allowance of oil. Added fat intake means frying and foods with added fats (baked goods) would be an occasional treat.
The added sugar at 6tsp per day represents a big shift away from sugar sweetened foods. It would be biggest in the diet of younger people.
Concern has been expressed over iron and calcium intake from this diet. Again, this diet relies on good cooking practices to maximize non-meat source minerals. The caloric intake provided by this diet is approximately 10.5MJ or 2500kcal. This is approximately an “average” diet for an adult and some variation would be needed.
Many people would be reluctant to make these kinds of changes. If humanity is to protect the environment, while feeding 10 Billion people, we need to start making changes now and this is a good start. On a personal level following a diet like this will both reduce the risk of long term health conditions including Type 2 diabetes and heart disease as well as managing them more effectively than the current diet.
I support and endorse the principles of this diet. Where
possible I will demonstrate how to cook and eat within the limits outlined in
the EAT-Lancet report. Please subscribe if you want to learn more.