Good Life Dietitians: November 2011

Tuesday, 29 November 2011

How to spot a fad diet

The Atkins diet, the Zone diet, the Cookie Diet- fad diets come and go as quickly as fashion changes in New York. If these diets were really so great the Good Life Dietitians would be non-existent and the whole planet would be made up of Brangelina-type couples. In this post we teach you how to spot a fad diet and help remind our readers that if it is too good to be true, it probably is.

Dramatic statements

This is probably the biggest warning sign to any fad diet. Any diet promising that you will lose 10kg in a month is a fad diet. Weight loss is only healthy and sustainable at a goal of 500g to 1.0kg per week. Also look out for statements like “eat all you want and still lose weight”, and terms like effortless, easy, guaranteed, breakthrough formula, and the likes.

Restricting foods

When a diet tells you to avoid apples or eggs ask yourself, “Can I eat this way for the rest of my life?” The answer will be no. A diet that tells you to completely eliminate a certain food or food group from your diet should send alarm bells off in your head. Restricting a food or an entire food group will exclude vital nutrients and put you at an increased risk for developing nutritional deficiencies in the long run.

Good vs. bad foods

Any diet that tells you that certain foods are bad and certain foods good is worrisome. No food is good or bad, and all foods can form part of a healthy diet, though some foods need to be eaten in moderation. Just like a car needs the right petrol to run properly, we need to fuel our bodies with a healthy diet for adequate carbohydrates, protein, fat, vitamins and minerals, all which come from a variety of foods.

Quick fixes

In this era of instant gratification the idea of working towards a long-term goal is fiction to most. There is no such thing as a quick fix when it comes to healthy weight loss, and it is almost guaranteed that just as quickly as you lost the weight you will pick it up again. If no long-term behaviours are put into place, can a 30kg weight loss really be long-term?

Buy me!

Be wary of diets that require for you to buy certain products, pills, powders or lotions in order to work effectively. These gimmicks are merely to make your pocket and not your butt lighter. Be wary of diets that recommended the use of specific products with claims that they will improve your weight loss.

The best diet is not to diet at all, but rather make healthy food choices to lose and sustain weight loss. At the end of the day, sustainable weight loss can only be achieved by eating a healthy, balanced diet in combination with an increase in physical activity. If you feel you need help, make an appointment with a registered dietitian.

Monday, 28 November 2011

Breastfeeding and the HIV-positive mom

We have stumbled across many forums and discussions, and it has come to our attention that the public is ill-informed on the facts with regards to breastfeeding and HIV. Since December 1^st is World AIDS day, we wish to enlighten our readers on the most common questions with regards to feeding a baby in the context of HIV.

What is the best way to feed a baby?

Whether HIV negative or positive, exclusive breastfeeding for the first 6 months of a baby’s life is recommended. This involves giving a baby only breast milk and no other fluids or foods other than multivitamins or medications prescribed by health care workers.

If a mother is HIV positive, should she breastfeed?

Definitely! There is a misconception among the public that HIV-positive moms should not breastfeed. HIV-positive moms are encouraged to exclusively breastfeed just as HIV-negative moms are. Exclusively breastfeed babies whose mothers are HIV-positive thrive and benefit just as well as babies with HIV-negative moms.

Can HIV be transmitted through breast milk?

Transmission of HIV in breast milk is as low as 1%. We now know that there is less of a chance of transmitting HIV through breast milk when antiretroviral treatment is used by either the mother or baby, compared to using no antiretrovirals. A study in Botswana showed higher survival rates among HIV-positive babies who were breastfed compared to those that were formula fed. The study also showed that 7.5% of 6 month olds who were breastfed died from diarrhea compared to 33% of formula fed babies who died from diarrhea and pneumonia. Also, research shows that there is less HIV transmission when exclusively breastfeeding a baby versus mixed feeding (feeding a combination of breast milk and infant formula).

Can HIV transmission through breast milk be prevented?

Yes HIV can be transmitted in breast milk, but to effectively reduce the transmission of HIV to the baby, the mother, baby, or both, should be placed on antiretroviral treatment. The chances of HIV transmission when a mother or baby is on antiretriovirals during breastfeeding significantly reduces the chances of HIV transmission.

The South African government has adopted a program called the prevention of mother-to-child transmission (PMTCT). This treatment is available to all HIV-potive mothers free of charge at all government hospitals and clinics. The PMTCT guidelines give recommendations on antiretroviral use during pregnancy and breastfeeding:

§ All babies whose mothers are HIV-positive must receive antiretrovirals daily for 6 weeks after birth.

§ If the mother is already on ARV treatment, she must continue to take the treatment as per normal throughout breastfeeding. In addition, the baby must receive nevirapine for the first 6 weeks.

§ If the mother is breastfeeding (and not on prior ARV treatment) then the baby must be given nevirapine throughout the breastfeeding period, plus for one week after stopping breastfeeding.

§ If the HIV positive mother is not breastfeeding, then the baby only receive nevirapine until 6 weeks after birth.

If the baby tests HIV-positive, should the mother continue to breastfeed?

If a baby tests positive for HIV, the mother should definitely continue to breastfeed. This will continue to protect the baby against infections and disease.

If an HIV positive mother chooses not to breastfeed, what are her other options?

Every mother has the right to chose how she feeds her baby. However there is great concern with formula feeding, and mothers should be thoroughly informed by trusted health care workers on the potential risks of doing so.

If a mother chooses to formula feed, the following criteria (called the AFASS criteria) must be met:

Affordable The mother must be able to afford formula as well as the necessary equipment, such as bottles, teats, and sterilization.

Feasible

Acceptable Formula feeding must be supported and accepted by the mother, guardian, caregiver, partner, and community

Safe Formula feeding must be prepared hygienically, and frequently enough that it is safe

Sustainable Breast milk is always available, reducing possibilities of difficulties in accessing supplies. There must be a reliable and sufficient supply of formula milk. Can the mother consistently feed the baby?

When must the HIV positive mother stop breastfeeding?

As we’ve established, whether HIV positive or not, babies should be exclusively breastfed until 6 months, after which solids are introduced. The only difference is in the length of breastfeeding: 24 months for HIV-negative moms, and 12 months for HIV-positive moms.

§ If HIV negative: Breastfeed exclusively for 6 months. Introduce solids at 6 months and continue to breastfeed until 24 months.

§ If HIV positive: Breastfeed exclusively for 6 months. Introduce solids at 6 months and continue to breastfeed until 12 months. When the HIV positive mother stops breastfeeding, this should be done so gradually and over a period of one month.

As a final word, we encourage the public to speak to trusted health care providers, like doctors, pediatricians or dietitians, with regards to HIV and feeding a young child. Help us to pass on the correct, scientifically-based information so that South Africans stand together in support of our HIV-positive moms.

Go to the Word AIDS Day website for more information.

References

Department of Health. National Breastfeeding week (1-7 August 2011) - questions and answer guide.

Yezingane Network and UNICEF. Infant feeding in the context of South Africa- questions and answers. December 2010 (Updated July 2011).

Yezingane Network. Preventing mother-to-child-transmission of HIV (PMTCT). June 2010.

Friday, 25 November 2011

Bread for sustained energy

As November is Diabetes Month, we would like to give you accurate information on the GI of different foods to help you to eat for sustained energy.

Bread needn't be evil as (most dieters make it out to be). Make sure you choose one with a low GI, meaning it will breakdown and release sugar (glucose) slowly into your blood and keep your energy levels constant. Have this list handy the next time you go down the bread aisle at your supermarket- it's super handy!

Bread and crackers: low GI	GI
Fruit & honey wholegrain rye bread, Woolworths	48
Brown low GI bread, Blue Ribbon, Albany	48
Brown Low GI Seed Bread, Blue ribbon	48
Provita, original	49
Provita, Multigrain	52
Pumpernickel, Wholegrain Rye bread, woolworths	52
Olde Cape Homestyle low GI brown health bread, Albany	52
Low GI seed loaf, Woolworths	55
Soya & linseed bread, Sunbake	55
Low GI Soy Lin loaf, Woolworths	55
Low GI Brown seed loaf, Albany	low
Whole-grain bread plus omega, Woolworths	low

Thursday, 24 November 2011

Is exercising important in diabetes?

Nicole Picas, a registered biokineticist in Houghton, gives some insight on the importance of exercising in managing diabetes. For more by Nicole log on to her blog Nicole Picas Biokineticist.

Diabetes is a fairly dreaded word, as many people just think of pricking and injecting oneself numerous times a day. However, this is not always the case. Being World Diabetes Day today, as well as Diabetes Awareness Week this week, I thought I would provide some insight into this common, yet often misunderstood, condition.

What is Diabetes?

Diabetes is defined by ACSM as: “a chronic metabolic disease characterized by an absolute or relative deficiency of insulin that results in hyperglycaemia”. More simply put, diabetes is a condition resulting in prolonged high blood glucose (sugar) levels, as a result of little or no insulin production.

Various types of diabetes exist. I will discuss the two most common types – type 1 and type 2 diabetes. The first distinction to make is the difference between Type 1 and Type 2 diabetes mellitus. Type 1, or insulin-dependent, diabetes is usually present from a young age, although late onset type 1 diabetes may also occur later in life. Type 1 diabetes is an autoimmune disease, in which there is destruction of the beta cells in the pancreas – the cells responsible for producing insulin. The result of this is a complete insulin deficiency; therefore, these people immediately start insulin injections.

Type 2, or non-insulin dependent, diabetes usually presents itself later in life and occurs as a result of a combination of insulin resistance and decreased insulin secretion by the pancreas. Various factors increase the risk for developing type 2 diabetes. These include obesity (especially a large waist circumference), physical inactivity, family history, smoking, high blood pressure, high cholesterol, and stress. Individuals with type 2 diabetes usually start with oral medication to improve insulin sensitivity and will possibly start insulin injections later on if necessary, to accommodate for the decreased insulin secretion. Thus, it is possible to have type 2 diabetes and be insulin-dependent; this does not mean you have type 1 diabetes.

Why is exercise so important in managing diabetes?

There are many complications associated with diabetes, including cardiovascular (heart), renal (kidney), and neuropathies (nerve system damage). Physical activity is essential in managing these complications. Both type 1 and type 2 diabetes put individuals at increased risk for heart disease. Therefore, exercise is important to reduce the risk of heart disease, as has been discussed in previous blogs. Exercise also improves insulin sensitivity and glucose tolerance, thereby decreasing insulin requirements. Individuals with type 2 diabetes also often have high blood pressure and high cholesterol and are often overweight. Exercise is particularly important for these individuals to manage these conditions, as well as to reduce body fat percent.

Individuals who are on insulin therapy (injections) must be carefully monitored, especially when starting an exercise programme, as they tend to respond very quickly to exercise. During exercise, the body uses glucose as an energy source. Different types of insulin have different peak onset times. If the insulin peaks at the same time as the individual is exercising, then too much glucose may be used up, resulting in the individual experiencing a hypoglycaemic incident – the glucose dropping too low to keep the body functioning. The individual may faint and lose consciousness. Usually, one will have other symptoms first, such as sweating, shaking and nausea. Individuals will generally start to learn how their bodies react to hypoglycaemia.

On the other hand, individuals with type 1 diabetes are at risk of developing ketoacidosis if they exercise with very high sugar levels. If the blood glucose levels are not controlled and are too high, then there is no glucose in the cells, which means that fat must be broken down and used as an energy source. During this process, ketones, which are acids, are produced. This causes the body to become acidic and a coma may result if this state is prolonged.

An individual with diabetes will benefit from any exercise regimen. It is recommended that these individuals do at least 150 minutes of aerobic activity per week, to reap the cardiovascular benefits of exercise. They must also do light resistance training at least 2 to 3 times per week to improve muscle strength, decrease body fat percent and increase glucose metabolism. Stretching is also important to maintain flexibility and joint mobility and to reduce stress.

So, if you have diabetes, don’t pretend it is not there and that it can’t cause any harm because you don’t have any visible symptoms. It is crucial to check your blood glucose levels regularly, follow a healthy diet and exercise on a regular basis. When exercising, be aware of how you are feeling and check your blood glucose levels whenever necessary if you are not feeling quite right. Always have a snack or some fruit juice nearby in case your glucose levels drop too low.

Diabetes is not something to be afraid of. If it is carefully monitored and correctly managed, one can live a reasonably hassle-free, long and healthy life. Educate yourself on how it works, so that you can be proactive and look after your body.

Tuesday, 22 November 2011

GI made easy

The terms 'GI' and 'glycemic index' has become a buzzword in the health and nutrition circles. This Diabetes Awareness month the Good Life Dietitians help make GI easy for you.

What is the Glycemic Index?

The Glycemic index (GI) in simple terms is a measurement used to determine the speed at which a food or food product, when consumed, raises your blood glucose levels. If the food increases your blood glucose rapidly it is considered to be high GI. If a food is digested and absorbed more slowly, it causes a steadier increase in blood glucose levels and is considered to be low GI.

As we’ve established foods breakdown and release glucose into the blood stream at different rates. The glycaemic index ranges from 0 to 100, where 100 is taken to be pure glucose (or sugar). The effects of all other foods are then compared to that of glucose. A low GI food would be a food with a GI less than 55, an intermediate GI between 56 and 69, and a high GI higher than 70.

Why do I need the Glycemic Index?

The GI is not only beneficial for diabetics, as many may believe. Eating a low GI diet will cause slow and steady rises in blood glucose without creating sudden spikes or falls in your blood glucose, the result of which is you are left feeling very sluggish. Because low GI foods increase the blood sugar slow and steadily taking pressure is taken off the pancreas too produce high amounts of insulin.

Keeping this in mind you will have sustained energy and concentration throughout the day, improved physical energy and performance due to and stable blood glucose if you eat these low GI foods at regular intervals and in the right portions throughout the day.

Who can benefit from the GI?

Insulin resistant and hyperinsulinemic patients
Pre-diabetics
Those who suffer from low blood glucose levels (hypoglycemia)
Diabetics (type 1 and 2)
Those aiming to lose weight
Scholars, students and the work force who need optimal concentration and learning all day long
Children and adults suffering from ADHD
Athletes who need endurance and sustained energy over a longer period
Those who suffer from heart disease

How do I incorporate GI in my everyday life?

Many foods are marked as high or low GI or their exact GI is indicated on the product. However, many will still not be indicated. Choose foods that are less refined and containing lots of fiber.

Factors that influence the GI may include the amount of cooking, amount of processing, size of the particles, type of fiber, acidity of the product, the presence of fat or protein and the type of sugar.

Keeping the above facts in mind, you should choose a starch product that:

is cooked and processed as little as possible (close to it’s original state),
has bigger particles (such as wholewheat kernels),
contains soluble fiber (oat bran, legumes, beans)
contains resistant starch, meaning that the body has difficulty processing the food, such as cooked and cooled starches
contains acidic ingredients such as lemon juice or vinegar
has a fat or protein combined with it to decrease the rate of absorption

For example:

Basmati rice has a low GI. When it is cooked and cooled the GI further lowers. By adding lentils you can further reduce the GI. Add a protein such as low-fat grilled chicken breast strips and finishing it off with lemon juice, olive oil and vinegar dressing for an example of a low GI meal. It has low GI starch, added soluble fiber, added acidity, protein and some healthy fats. Remember that even though it is low GI, you will still need to keep portion size in mind.

The low GI is a healthy way of eating for all individuals, not only those at risk of diabetes or any other disease and would be most beneficial when combined with a low fat diet. Look out for the GI rating on labels and follow these guidelines to make sure you compile low GI meals at home for yourself and your family.

For more information on the glycaemic index log onto the GI Foundation website.

Monday, 21 November 2011

Constipation in pregnancy

Many pregnant women complain of constipation, a common problem during the latter part of pregnancy. The causes of constipation in pregnancy are three-fold: a decrease in physical activity as pregnancy progresses, decreasing motility of the gut due to hormonal changes, and increasing pressure on the gut by the ever-expanding uterus.

Increase your intake of fibre.

Fibre acts like a broom in the intestines and helps sweep the gut clean. Eat whole-grain/whole-wheat foods instead of refined, processed foods. Avoid food products that are refined as these have not only the fibre removed during processing, but also several vitamins and minerals important for a healthy diet.

Foods that are high in fibre include:

Whole-wheat/whole-grain bread, rye or seed loaf instead of white bread
Whole-wheat pasta instead of white pasta
Whole-grain or brown flour instead of white flour
All-bran flakes, Special K, Hi-Fibre bran, oats or whole-wheat ProNutro instead of Rice Krispies, Cornflakes or Coco Pops
Fresh fruits: 2 to 3 fruits per day
Fresh vegetables: 3 to 5 portions per day
Eat fruits and vegetables with edible skin, pips and seeds
Dried fruits e.g. prunes, pears, peaches, apples, raisins
Dried beans, peas and lentils
Oat bran: sprinkle onto breakfast cereals, use to thicken soups and gravies, or add to smoothies

Exercise at least 2 to 3 times per week to get the gut moving.

A woman who is just starting an exercise programme should keep her heart rate below 140 beats per minute. Types of exercise that provide the best benefits with the least risk during pregnancy include walking, jogging, stationary cycling, and swimming. Consult with a professional such as a biokineticist with regards to appropriate exercises for pregnant women. (For more info on biokinetics, go to Nicole Picas Biokineticist)

Increase your intake of fluids, especially water, to about 8 glasses per day.

While fibre acts as a broom, water acts as a lubricant to help get the gut contents moving. Whenever increasing fibre intake, always increase fluid intake at the same time to avoid worsening constipation.

If struggling to manage constipation, several nutritional supplements are available from pharmacies.

Nutren Fibre (Nestle) is a nutritionally balanced drink designed to help gastrointestinal function in both constipation and diarrhoea. Nutren Fibre may be added to water or milk. Follow instructions on the tin for preparation.

Try all these tips before using laxatives.

Always consult your doctor when using complementary and over-the-counter medicines.

Friday, 18 November 2011

Breakfast for Sustained Energy