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.