Nutrition and Immunity – the case for vaccination.

Some people claim that the children who get sick and die of measles are Vitamin A or Zinc deficient. The people making this claim then go on to say a healthy diet protects all children against measles.

Vitamin A

Vitamin A deficiency is one factor that increases measles deaths and long term complication. There are other things that increase these risks. Diet alone won’t alter the severity of an infection. When we talk about healthy diets we must remember one thing. Food is only nutritious if your child eats it. Many kids are fussy eaters. If a kid is fussy enough there is a risk of insufficient vitamin A .
In New Zealand we get Vitamin A in dairy and meat. We consume beta-carotene to make up the recommended intake of Vitamin A daily. Our bodies can convert beta-carotene to vitamin A. We don’t have data for children about their Vitamin A status. Around 1/3 to 1/2 of 15-18 year olds have insufficient Vitamin A intake. They don’t eat enough fruit and vegetables.

Can you take Vitamin A supplements?

Vitamin A in toxic doses can cause birth defects and liver problems. Vitamin A accumulates in the liver and fatty tissue, so it builds up over time. If someone is taking multiple supplements, the first thing I check is vitamin A. I have rung clients at home to stop them taking an excess. I do not believe Vitamin A tablets are is safe except under supervision. The highest risk group for insufficient Vitamin A is children with a restricted diet. Kids who eat mostly “white and tan” carbohydrate rich foods are the most at risk. If this describes your child’s diet I suggest seeking a dietitian to advise you. They would work with your medical team to prescribe appropriate supplements

What about zinc to support the immune system?

It is generally older adults who have insufficient zinc intakes in New Zealand. Zinc usually comes from meat and grains. Zinc is a co-factor for many processes in the body. There is no research to support the use of zinc in measles infection or prevention. I am always hesitant to supplement with single nutrients when there is no evidence of deficiency. In the case of zinc,it is taken up via the same pathways as iron, copper and calcium. High doses of zinc over time could compromise these other nutrients.

Why vaccinate?

I have family members who have health consequences of illnesses we vaccinate for. The statistics are that 1 in 1000 children will have serious long term effect from a case of measles. Vaccine related harm occurs less than 1 in 100,000 and most of those are events like a one off seizure event. I feel very sorry for people who have children who have severe reactions to vaccines. Any tragedy involving the life of a child is awful. Vaccines along with good nutrition and good hygiene, means most of us have not seen the illnesses or their consequences. So the last thing I want to see is a return of conditions we can minimize through use of vaccination.

6 ways to increase your activity levels to improve heart health

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 activity.

  • 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.

Terminology Explained

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.

So how do we start being active more often.

My top hints

  1. If you use a computer for work or leisure use a pomodoro timer
  2. Look at active transport to work – 10 minutes twice a day of walking to and from the bus will add up
  3. Have a ½ hour screen free time after dinner for everyone to do something active, even if it is the housework!
  4. 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.
  5. Try to avoid short trips by car. If a trip is less than 10 minutes by car it is walkable.
  6. 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

Blood glucose: Physical activity reduces insulin resistance and lowers blood glucose

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 .

What 7 steps help reduce both diabetes and heart disease?

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

1.            If you smoke, stop.

How can you help those who still smoke? Many smokers fear weight gain.  Getting information on the relative risk of weight vs. smoking is important. Receiving education on how to minimize this gain helps.  

2.            Eat better.

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.

3.            Get 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

4.            Lose 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 insulin.

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.