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 .

8 ways to cut saturated fat and reduce your risk of both diabetes and heart disease

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

  1. Choosing low fat or reduced fat milk and yogurts (Less than 2 g fat per 100g).
  2. Portion controlling cheese to 30g per serving.
  3. Having at least legume based meals per week.
  4. Trim, skim and skin meat and chicken, to reduce the total amount of fat from animal products.
  5. Portion control meat portions to no more than 150g per meal (raw weight)
  6. Use oil in cooking, not solid fats
  7. Use margarine instead of butter
  8. 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.

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.

Some of my best friends are nutritionists…

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.

Understanding the Planet Healthy Diet – Eat-Lancet Commission Report

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.”

Eat-Lancet Report

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 .

Food Item g/day    (range) Portion size Notes
Whole grains 232 30g 7.7 portions/day
Starchy vegetables 50 80g 3 portions/week
All other vegetables 300 80g 3.75 portions/day
Fruits 200 80g 2.5 portions/day
Dairy Foods 250 250g1 portion/day
Protein sources  
Meat and poultry 43 100g3 portions of 100g/week
Eggs 13 58g1.6 eggs/week
Fish 28 100g2 portions of 100g /week
Legumes 75 90g5-6 90g portions /week
Nuts 50 30g11-12 30g portions/ week
Added fats  
Unsaturated fats 40 1 tsp8-9 tsp/day
Saturated fats 11.8 1tsp2.5 tsp/day
Added sugars  
All sugars 31 1 tsp 6 tsp/day

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.

Key differences

  1. 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.
  2. This would be less potato, kumara or taro than currently eaten.
  3. For most people this is a significant increase in non-starchy vegetables.
  4. Most people would be increasing their fruit,
  5. This a significant reduction in dairy intake.
  6. Only 6 of the 14 non-breakfast meals would have animal source protein, the rest would have legumes or nuts as primary protein.
  7. 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.
  8. 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. 

Nutritional Adequacy

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.

How do you get 30g fibre in your diet daily?

There has been a lot of media coverage about fibre in the diet. A high fibre diet reduces the risk of heart disease. We know that 90% of people are failing to get enough fibre.  So how do you improve your dietary fibre intake? How do you do it on a low income?

Fibre occurs in plant-based foods. The relevant Eating statements for adult New Zealanders are:

Enjoy a variety of nutritious foods every day including:

  •              plenty of vegetables and fruit
  •              grain foods, mostly whole grain and those naturally high in fibre
  •            some legumes, nuts, seeds, fish and other seafood, eggs, poultry (e.g., chicken) and/or red meat with the fat removed.

Choose and/or prepare foods and drinks:

  •    that are mostly ‘whole’ and less processed

I demonstrate how I would address each eating statement below. In the lists I only show the fibre containing foods. There would be other things added to the meals such as milk, cheese, yogurt, meat and cooking oils etc

Plenty of vegetables and fruit

I used the “what’s fresh” website to select seasonal fruit and vegetables based on the day of writing the blog. Eating seasonally can be a challenge if you have strong likes and dislikes.  It is important to encourage ongoing “tries” of vegetables to encourage a wide variety. Frozen vegetables are acceptable

Item Amount (as eaten) Fibre
Green Beans 80g 2.7
Corn on the cob – 1 medium 90g 2.4
Lettuce 50g 1.0
Tomato – medium 50g 1.7
Cucumber – 4 slices with skin 50g 1.5
Strawberries – 4 large 80g 1.2
Orange – 1 medium 90g 3.1
  TOTAL 13.6g

In this instance I imagined that the salad would go with lunch, and the cooked vegetables would go with dinner.

grain foods, mostly whole grain and those naturally high in fibre

The most common complaint I get is the cost of wholegrain bread. For the purpose of this exercise I am going to use a $1 loaf of bread. This will illustrate cheap bread can still help you meet your fibre intake. I am suggesting you use a sandwich slice and choose the wheatmeal bread

Item Amount (as eaten) Fibre
3 slices wheatmeal bread ($1 range) 94g 4.2g
Oats 45g 5.8g
Pasta (white own brand) 200g (100g dried) 4.0g
  TOTAL 14g

some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (e.g., chicken) and/or red meat with the fat removed.

Item Amount (as eaten) Fibre
Peanut butter 20g 1.2g
Almonds 15g 1.3
Lentils 15g 1.6g
  TOTAL 4.5g
  • 20g peanut butter – see below
  • 30g of almonds consumed every second day
  • If you had two vegetarian meals each week e you would meet this goal. Each meal contains at least 50g (120g cooked) of lentils or other beans. If you are not able to sneak vegetarian past your family use lentils mixed in with your mince.

Choose and/or prepare foods and drinks: that are mostly ‘whole’ and less processed

 One of the biggest ways to improve fibre intake is have snacks that are mostly whole and less processed.

Snacks arranged here are not the usual processed cakes, biscuits and crackers.

  •               1 slice bread with 20g peanut butter daily (afternoon tea)
  •               1 piece of fruit as snacks (supper time)
  •               30g almonds every second day (morning tea)

This is a fairly basic diet.  Not everyone is going to stick to this all the time. Following the 80% rule (make good choices 80% if the time) then you can get a good fibre intake

If you would like to know more about fibre in the diet and have a diet makeover to increase your fibre intake, then make an appointment to see me.

Individualized Nutrition – what this means and why it is important

Our population is getting both older and sicker. One reason for the increasing incidence of poor health is the increasing weight on the average New Zealand adult.
On an individual level excess body weight is a poor predictor of health. On a population level, people who have excess weight are more likely to develop long term health issues. So with this change in the population body weight adult New Zealanders are developing long term conditions such as diabetes, heart disease and kidney disease younger.

Considerable time and money is spent promoting public health messages. Although many people believe healthy behavior is an individual responsibility, it is economically sensible to reduce harm through public health campaigns. The majority of public health campaigns focus on these areas of physical health.

4 ways we can all improve our health are:

  • Don’t smoke, or if you smoke stop
  • Drink alcohol within the safer drinking limits
  • Be active at least with 30 minutes of moderate intensity activity daily.
  • Eat plenty of vegetables and fruit, get your 5 servings daily.

Mathematical models suggest that if everyone followed these recommendations, we would have a very healthy population, with far less chronic disease.
At this high level there are only two messages associated with nutrition. Anyone who eats food will tell you that there are many more things suggested as important. So where do these other messages fit in?
Many of the other messages are around factors have smaller influence on health outcomes than these big 4. Take for example reducing the amount of saturated fat into your diet to the recommended level of 10%. If you modify your fat intake it may reduce your risk of heart disease by ½, which is a relatively small margin. Whereas with smoking the risk of heart disease is 5 times that of a non-smoker. If you stop smoking, you reduce your risk by a big margin. It is simpler to understand if you try to explain it as a fraction of populations.

  • If you have 1000 smokers, 200 to 400 of them die from heart disease directly caused by their smoking
  • If you had 1000 people who had a diet high in saturated fat, 20 to 40 of them will die from heart disease directly caused by their diet.

Many people look at the risk of death associated with saturated fat intake and say they are willing to live with those odds and stick with the diet they like. What they miss is that heart disease deaths is only one factor influenced by the saturated fat. Other health consequences including disability and other conditions such as Type 2 diabetes are influenced by saturated fat intake. Many risk factors are cumulative, so high saturated fat and low vegetable intake magnifies risk. Other risk factors such as genetic history or childhood experiences are often unmodified by lifestyle change.

When it comes to dietary advice, we are now on the edge of a revolution in thinking. Dietary advice could be individualized based on genetic and epigenetic testing, giving the “best diet” for your genes. That holds some promise, but it fails to recognize one thing. We eat for many reasons. Food is not just nutrition, and the other reasons are why we need to get individualized advice.

As a clinician my heart sinks if someone asks me for a diet sheet. I have never met someone who has stuck to one in 20 years of practice. Some people can make a good attempt, but others are completely unable to follow a prescribed diet and in that case we need to individualize the advice to take into account non-nutritional eating.

Recently I had a lady who was eating broccoli. She HATED broccoli, but broccoli was a super food, so she was having it daily. I helped her see there were foods that were just as useful to her as broccoli that she liked. What was the difference between her eating broccoli and not? It was the advice of a dietitian.

Why see a dietitian

A dietitian is a registered health professional. They have to have a post-graduate qualification in dietetics after an appropriate undergraduate. To maintain registration they must demonstrate life long learning. Dietitians must abide by a code of practice and can be disciplined if there is a breach of ethics or a significant complaint.

Dietetics is the interface between the science of nutrition and medicine. It involves modifying the diet to optimize well-being of individuals. The ultimate goal of dietetic intervention is either to prevent or manage health problems which have a dietary component.

I supervise young Dietitians and love that part of my job. Initially young Dietitians will struggle because they have license to practice but don’t feel competent. In supervision I liken the experience to riding a bike. Initially you have to concentrate on the skills needed to ride a bike. After practice you become a skilled bike user. You can start enjoying the scenery and navigating complicated terrain. Dietetic practice starts with giving advice based on theory and develops over time as the practitioner becomes more skilled to include practical knowledge about how to make changes. Dietitians are trained in the science of nutrition. Their skill is to help the patients translate the science into a diet they can eat. A competent dietetic practitioner practices holistically. The British Dietetic Association poster I am using as the image on this article is my favorite representation of the complex process in my head when I talk food to someone. As we discuss their diet I am gathering knowledge, as we start discussing intervention I am looking for cues and clues that this intervention will work for them in their current life stage. Ultimately I would hope to form a relationship with them and they come back for further assistance as their life circumstances change.


As of January 2019 I have started a major refresh of my blog. Lots of my blog will be about the science of nutrition. Some will be about the art of making the vegetable eating more possible. Other topic suggestions are welcome. With the pace of nutrition science I am not always going to be answering what you want…so please feel free to ask me questions or send me information you would like me to discuss.