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.

Meat Free Monday: Green Bean Risotto

Many vegetarian risottos rely on cheese for the protein. In this quirky variant I use ½ rice and ½ red lentils to give some protein while still getting that risotto texture.

  • 2 TBSP olive oil
  • 1 large onion, finely chopped
  • 150g risotto rice
  • 150g red lentils
  • 1 litre vegetable stock
  • 150g runner beans cut into short lengths
  • 200g cooked broad beans
  • 50g vegan Parmesan or Parmesan cheese
  • freshly ground black pepper
  • 1 heaped tbsp chopped fresh herbs or 1 tsp dry herbs.

Heat oil in large pan, add onion and lower heat keep stirring until onion is tender and transparent. Add rice and lentils (pre washed) to the pan and stir for a few minutes to slightly brown. Add vegetable stock and once up to boil reduce heat to simmer. 5 minutes before the end add the two different beans and stir through. Sprinkle with parmesan cheese (or vegan parmesan cheese), pepper and herbs for flavour before serving.

Behavior Change – if it was easy it wouldn’t be change

If it looks too good to be true, it probably is…

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.

Meat Free Monday: Red Cabbage and Apple Coleslaw

  • 1/4 red cabbage finely shredded
  • 1 red onion finely diced
  • 1 medium beetroot, grated
  • 1 red apple, grated
  • 2 TBSP tahini
  • 1 TBSP balsalmic vinegar
  • Ground black pepper
  • Pinch of salt

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.

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 .

Cooking Beans, legumes, pulses etc

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.

Bean/Legume Water for 500g Cook time
Black 1600 6-8 hrs
Pinto 1900 7-9 hrs
Cannelini 1900 7-9 hrs
Black eyed peas 1600 4 – 5.5 hrs
Chick peas 1750 4.5- 6 hrs
Brown Lentils 1250 3-4 hrs
Red Kidney Beans 1900 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.

Pressure cooker beans

Storing your beans

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.

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.

Butternut squash pasta sauce

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.

Courgette and Lentil One Dish Meal

  • 1 C brown rice
  • 1 C french/puy/brown lentils – well rinsed

Cook together in a pot using an absorption method (i.e.3 C water, bring to boil, cover with tight fitting lid, reduce to a low heat and cook for 40 minutes. Switch off and let stand for 10 minutes)

  • 2 TBSP vegetable oil
  • 1 small onion, chopped
  • 3 cloves garlic, minced
  • 325g tomato tinned tomato OR 500g fresh tomatoes chopped
  • 1 teaspoon dried basil
  • 1 teaspoon dried oregano
  • 1 teaspoon ground cumin
  • salt and pepper to taste

Heat the oil and then saute the onion and garlic until soft then add all other ingredients and cook until vegetables are tender.

Layer into a casserole dish (rice and lentils, vegetables, rice and lentils, ending with a vegetable layer).

  • Breadcrumbs
  • Vegan Parmesan cheese substitute

Sprinkle a layer of breadcrumbs, if you wish add a couple of tablespoons of this homemade vegan Parmesan cheese substitute to your crumbs for extra flavor. Bake at 180 degrees until bubbling at the edges

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.