What is Dietetics

Dietetics may be one of the most misunderstood professions to date, and the reason therefore remains a mystery. To eradicate elements such as ignorance and confusion, attention must be given to the following factors:

Dietetics is the science and administration of nutrition to obtain and maintain optimal health. Dieticians study for four years to obtain a Bachelors degree, after which they are required to complete an internship to obtain a diploma, which registers them with the Medical and Dental Council. Without such registration, they are not allowed to practice. During this internship they acquire knowledge on physiology, psychology, pharmacology, nutrition and diet therapy, to name but a few. Dieticians are therefore not only concerned with basic dietary advice.

Dieticians play a fundamental role in virtually all diseases / illnesses / intolerances and general dietary issues. A dietitian can, for example: assist a pregnant woman with good nutritional practices to improve both her, and her unborn child’s health; alleviate and treat spastic colons; prescribe weight loss or weight gain regimes; assist in cardiovascular diseases; treat patients with diabetes and nutritional trauma, etc.  For all these situations dietitians are the specialists in the field. They are the individuals who ensure that you achieve all you nutritional requirements for optimal recovery and maintenance of good health. 

Education represents a crucial part of the role which dieticians play within a community. They assist newly diagnosed patients understand their illness / disease and the effect it will have on their lives and life styles. Good practical guidelines are then offered to assist the individual in the management of the condition. Nutritional education is provided in clinics to create awareness of good nutritional practices in obtaining and maintaining good health as well as the management of certain conditions.

Why go to a dietician when you have such a wide selection of practitioners to source from? Doctors, pharmacists, “nutritionists”, gym instructors, herbalists and homeopaths all provide diets, tonics and nutritional advice which too, has its place and role. It is common knowledge to get the best advice and help from the best-qualified person / profession / institute. For example, if you have cancer, you will consult an oncologist and not your GP. It is not a reflection of your GP’s inadequacy, but purely your choice of consulting the best possible practitioner for the condition you have. One can use gardening as an example too – you will not use a rake when you need to dig a hole (it does not mean that the rake is not a perfectly adequate tool, it is just not the right one for the job at hand). 

Thus, when you require good, sound dietary advice, get it from the best: go to see your local dietitian! 

A healthy diet and lifestyle consists of a number of important components. Each component plays a vital role and can therefore not be replaced or ignored! It would be pertinent to discuss each component and its role, followed by the integration of the various components to find the balance required.

The components are:

1)      Protein:

If you have been fortunate enough to watch the movie ”My Big Fat Greek Wedding”, you will have new found respect for the father, since he was correct in saying that most words are derived from Greek. The word “Protein” is no different: it is derived from a Greek word of which the meaning is “of first importance”.   Proteins are the key components of all living organisms since it is found in muscle tissue, bones, teeth, blood and other bodily fluids.  It is the key structural component of cells and it is what hormones and enzymes are made of.

In this light, daily quality protein intake becomes vital since it is the building blocks of the body. Proteins need to be consumed on a daily basis to ensure normal growth and cell regeneration. Basically keeping the body in tip top shape.

Good sources of protein are:

  • meat (red, white and fish)

  • milk and milk products (yogurt, cheese, buttermilk, etc.)

  • eggs

  • nuts

  • soya

  • legumes

2)      Carbohydrates:

Carbohydrates seem to have become a forbidden food in our generation.  People do not realize how vital the intake of carbohydrates on a daily basis is. Carbohydrates play a role in the protection (vitamins and minerals) of the body as well as in providing it with vital energy. Both these components are essential for normal functioning of all organs and systems in the body. Yes, this is the energy and protection that keeps us going.

The best sources of Carbohydrates are:

  • grains (rice, bread, porridges, cereals, etc.)

  • syrups

  • sugar

  • starch – rich vegetables, which are not considered in the vegetable group (potatoes, sweet potatoes, corn on the cob, etc.)

  • fruits

  • vegetables

Whole grain starches are recommended, since they are high in dietary fiber. Examples of food items with high dietary content is legumes (split peas, lentils, etc.), nuts, whole wheat flower and whole wheat flower items (provita, whole wheat bread, etc.), brown rice, high-fiber ready to eat cereals, oats, fresh fruits and vegetables eaten with the peels and pips.

So what or what makes fiber so special? Dietary fiber is what many refer to as roughage in food.  It has several benefits, including:

  • Lowers blood cholesterol levels

  • Improves blood sugar control

  • Assists in weight loss

  • Assists in normal bowel movement

  • Assists in the prevention of large bowel (colon and rectum) cancer

3)      Fats (lipids):

Fats are responsible for providing energy to the body. If the body were a car, fat would be seen as the fuel that provides it the power to go. Sources of fat are:

  • Margarine or butter

  • Oil (sunflower, olive, etc.)

  • Cream

  • Bacon

  • Products high in oil content such as mayonnaise, oil based gravy, etc.

Lipids or fats can be broken down into three types due to their chemical structure: Saturated, Poly -unsaturated fats and mono-unsaturated fats. Animal fats tend to be more saturated, whilst plant oils and extracts as well as the fatty acids from some fish, are more poly- and mono- saturated. An ideal diet should consist of more unsaturated (poly- and mono-) fats than saturated fats, since it lowers the risk of cardiovascular diseases such as atherosclerosis.

4)      Vitamins and Minerals:

Vitamins and minerals provide our bodies with the assistance it requires to grow optimally, regenerate when and if needed, fight infection and operate at optimal levels from all bodily perspectives. Vitamins play a role in regulating our metabolism, assist in converting fat and carbohydrates into energy the body can utilize for normal functioning and it is involved in the forming of bones and tissue. There are two groups of vitamins: fat–soluble (Vitamin A, D, E and K) and water–soluble (Vitamin B and C). Both types are required on a daily basis.

Minerals, on the other hand, forms part of bodily fluids and have several functions in the body. Some of the functions include the regulation of metabolism of many enzymes, maintenance of nerve and muscle irritability and the maintenance of the acid-base balance in the body.

Both components are found in a variety of food items: from your protein products to fruits and vegetables. Insufficient daily intake of vitamins and minerals will lead to a variety of deficiencies which has adverse effects on growth, reproduction and general function of the body.  Daily intake of a varied diet including fresh fruits and vegetables are thus essential to maintain the body and promote good health.

5)      Water:

Water is so often neglected out of a good dietary regime.  It is essential not only for the normal existence and functioning of the body,  but also for basic survival. In light of the fact that +/- 60% of the human body’s weight consist of water, it is an element of the diet that can not be ignored. Water plays a part in various functions in the body. Examples of some of the functions are:

  • Transport medium for nutrients

  • It is a building material for cell growth and repair / regeneration

  • Vital for absorption,  digestion, circulation and excretion

  • Maintenance of body temperature

  • Assists in normal bowl function, since water is absorbed by dietary fiber which in turn swells and increases fecal weight and ultimately assists in the elimination thereof.

  • Lubricant

  • Assists body in elimination of toxins

The list of benefits is endless. With this in mind, it is essential to include water in your daily diet. The recommended amount of water to consume is 8 glasses (2 liters). Preferably this must be consumed in its pure form, i.e. not as coffee, tea or part of any other drink.

Implementation

Now that we have briefly discussed each of the essential components of a healthy diet, it is necessary to discuss the proportions of each component, as well as other important issues such as “fad diets”, special products, “forbidden foods” and supplementation. Ideal body weight and good dietary practices will also be covered.

Every morning is a start of a brand new day in which the body requires good nutrition to operate optimally. Often the value of a balanced diet is grossly neglected due to various reasons, ranging from stressed lifestyles to ignorance. This has adverse effects on people’s lives, health and their ability to cope with daily stresses and issues. To combat this, each day should consist of the basic elements as discussed previously. The question is just in which quantities, since we too often eat either too much starch or fats or even protein. How do we find a healthy balance? In the lives we live with fast foods and “ready made meals” our fat intake is too high, there is virtually no fiber and we are lucky if we see any fruits or vegetables. Not to mention the “fad” diets a lot of people go on, which promotes unhealthy balances such as “protein” diets, energy deficient diets or the ever popular grape detoxification diet, to name but a few.  Every second article we read is about how to eat, the latest dietary trends, the weight you should have and don’t forget the “quick fixes”. It all ends up fruitless since nothing seems to work. The reason for this is simply that there are no quick fixes. Trendy diets, more often than not, are also nutritionally unbalanced. So, what is the answer?

The answer is fairly simple. There are no quick fixes.  If there were, none of us would have any dietary related issues.

Firstly, establish what your daily energy requirement is. This you can obtain by visiting your dietician and having him/her calculate your daily energy requirements, using your height and build and a diet history. She will assist you with the correct energy requirement value to ensure that the energy intake is equivalent to the energy consumption per day. In order to maintain your ideal body weight, the energy intake should be equal to the energy expenditure, thus creating a balance and you maintain your weight.

Secondly, every day should consist of the following in the stated proportions (this is for healthy individuals):

  • Protein – 15% of the daily diet (this includes your milk / milk-products as well as nuts, soya and legumes)

  • Fat – 30% of the daily diet

  • Carbohydrates – 55% of the daily diet

  • 8 Glasses of water per day

In addition to this, include the following as guidelines to assist good health and nutrition:

  • Keep the intake of refined sugars and syrups to a minimum. If you can avoid such intake, do so. This includes the intake of cakes, sweets and chocolates.

  • Rather have a high fiber starch than a refined starch (whole wheat bread rather that white; brown rice rather than white; etc.)

  • Lots of fresh fruits and vegetables. Try to have them with the peel and core / pips if possible, since it is an excellent source of dietary fiber.

  • Fat should rather be unsaturated (plant and fish oils) than saturated (animal fats). A good way to introduce it is by using poly-unsaturated margarine rather that butter. Bake, stew, steam, boil and grill food rather than fry.

  • Purchase lean meat, but also remove ALL visible fat from meat before preparation. On chicken, all the fat is just under the skin so remove the skin before preparation. This type of animal fat is very high in cholesterol, which in turn is bad for your heart since it can cause arthrosclerosis (blocking of arteries with fatty deposits)

  • Try to have red meat only twice a week. The rest of the time, one should have chicken or fish. One can even use legumes and soya instead of an animal protein once or twice a week.

  • Use only low fat or fat free milk and milk products. When purchasing cheese, look out for the low fat ones, such as Baby Bell, Ricotta, Edam and Lichten Blanc. Please do not be fooled, since all white cheeses are not low fat cheeses. Tussers, for example, have fooled many users but is in actual fact a high fat cheese.

  • Use salt and high salt products moderately

  • Rather use fresh products than canned or pre-prepared. Pre-prepared and tinned items typically have both a high fat and salt (sodium) content. Both these items are killers for your heart.

  • Eat regularly. Try not to skip meals, since it does affect the body’s metabolism. Choose between having 3 meals or 6 small meals per day. If one can, the 6 small meals are better since it stimulates the metabolism. If your lifestyle does not allow for it, at least maintain the 3 meals per day.

All the above principles can be used when dining out too. Order grilled, steamed, stewed or boiled items instead of fried. Do not accept butter or cream with the baked potatoes; order the salad with the dressing on the side. Rather have a fresh fruit salad as dessert than a rich, cream-filled cake.

By including all of the above in the recommended proportions, it will provide all the required nutrients for a healthy functioning body.

Exercise is also very important, since it not only assists with the normal functioning of the body, but it helps improve blood circulation and gets rid of excess energy. It helps build muscle mass and controls the depositing of fat and thus the formation of new fat cells. It also assists in appetite control, by lowering one’s appetite. This in turn assists with the maintenance of an Ideal Body Weight. It has also been found that people who do some form of exercise has lower incidences of osteoporosis.

You don’t even have to join a gym or purchase several of the equipment pieces you find advertised on television. All you need to do is take time for a brisk walk. Try to walk at least five times a week and for +/- 20 minutes at a time. Please remember though it is not a slow snail’s pace stroll, but a brisk walk. All you thus need is a good pair of comfortable and supportive shoes.  You can do this any time of day and pretty much in all weather conditions. For those who have been inactive for a while, start of slow with a 10-minute walk and increase the time gradually. This is going to take time and discipline, but persevere. Make a pact with yourself not to give up before the end of 3 weeks. If you need to, reward yourself with a nice movie or book, but keep going! 

To SUPPLEMENT or NOT to SUPPLEMENT – that is the question...

There are a variety of beliefs regarding vitamin supplementation. It ranges from supplementation being overkill due to the availability of all nutrients in a balanced diet, to the belief that supplimentation is essential because our products lack required vitamins and minerals due to production methods, storage and production processes. Some feel it to be essential for maintained energy and vitality while others believe it to be imperative to improve and maintain one’s immune system.

Be this as it may, all of the above have it’s merits. However, as humans we frequently require a “crutch” to make us feel better or even stronger, and we abuse vitamin supplementation to obtain the required good, protected and energized feeling. Vitamin supplementation, in my opinion, is required when:

  • dietary intake is not balanced

  • dietary intake composes largely of processed and unenriched / unfortified food items

  • Individual has illness that affects vitamin status (either depletes vitamin levels in body or requirement becomes elevated, etc.)

  • Chronically ill

  • Pregnant woman

  • Elderly

There is no harm in supplementing one's diet if one is of the opinion that the daily vitamin requirements are not being met. I frequently recommend supplementation to individuals who have severely stressed life styles, but at the same time, I do need to caution individuals that it might not always be required, especially if you are maintaining a healthy diet and exercise program which helps with stress relief. Very often, it just makes us feel better.

When the body requires additional supplementation, it will be utilized, but if there is continual over- supplementation that is not required it can lead to “hypervitaminosis”. Hypervitaminosis is the excessive intake of certain vitamins, which can lead to clinical abnormalities.

If vitamin supplementation is administered, I recommend supplements in a “food-state” form, which has been proven to be more accessible to the body.  Thus the body utilizes the supplementation more effectively and obtains all the benefit it should.  “Food-state” supplementation is available at selected pharmacies and some organizations distribute the products direct.

Some individuals supplement their diets with additional protein, amino acid and/or carbohydrates. These are for various reasons ranging from exercise regimes to “special dietary” requirements. My recommendation would always be that you consult your Dietician before and during the administration of the supplementation, since some of the supplementation can be detrimental to your health. It is always advisable to get a professional opinion on regimes that are out of the ordinary.

We are lead, and so often mislead by the media, organizations and/or people’s opinions. I often hear individuals claim that you can not afford to eat healthily, since it is extremely expensive. Companies and organizations often create that impression, since it inspires you to purchase their products. People on weight reduction diets are frequently told to choose specific “branded”, more expensive products, when often there are cheaper alternatives.

The solution: Create a culture of awareness within your family and friendship circles.  Think carefully about what you are being told. No matter how credible and convincing information may seem, attempt to ascertain the person/company's motives. Some companies and organizations will tell you anything to make a “quick buck”. Become an aware consumer and READ LABELS. Lately most products provide you with a nutritional composition breakdown on the rear of the wrapping. Read to see if it is a low fat or low sodium (salt), etc, product. This way you can choose “ordinary” products instead of branded items to achieve your goal.

Please do not be mislead by marketing and word play. Often companies advertise their products to be something when in essence it is not. An example that jumps to mind is a yogurt that has been released specifically for children (adults can use it too). All the marketing around this product states how healthy and nutritious it is, making it essential for each household with a child. When reading the dietary information, I could not help but frown. My child will never see this product. It consists mostly of cream, sugar and artificial fruit flavors. I would rather provide my child with a yogurt, which contains real fruit (containing natural sugars and fibers). Also, just because children typically have a higher energy requirement should not imply that the fat intake should escalate. A low fat yogurt is recommended, since it is low in cholesterol. Remember, children develop their eating habits during childhood and it is hard to change bad habits once you hit adulthood.

Another example is products claiming to be low in salt, but when reading the dietary description at the back, you quickly pick-up ingredients such as “mono-sodium glutamate”. Anything called sodium (or related) is salt. Thus the product is not as “salt-free” as advertised.

When looking for fat free products, just read the labels. Very often there are cheaper alternatives to the known brands which are equally, if not more suitable and effective.

Another important aspect of maintaining a balanced diet is to know how to deal with CRAVINGS and the ever-dreaded “FORBIDDEN” foods. There will always be days when you feel like a chocolate or that piece of cake you have been craving for weeks. These cravings typically arise either due to an unbalanced diet where we are deprived from various items or it is a psychological depravation of some sorts, where we feel we need it since we had such a bad day or we feel lonely, depressed, etc.  Some people just crave and eat high fat, high sugar items out of habit.

“Forbidden” foods are typically items which are high in fat, high in refined sugar, no or low in fiber, and apart from a very high energy value, have very little or no nutritional value. It is easy for me to tell you to rather have something more nutritious and beneficial to eat, but the reality of the matter is that these items are around us all the time. At parties, functions, in shops at the counter whilst waiting in the queue – it screams your name! Isn't it amazing how attractive the forbidden fruit are?

The question is how to deal with this. First, follow a balanced diet plan (this does not include any of the fad or quick fix diets on the market). The balance diet is a diet which promotes the guidelines I have provided you with earlier. By following some of these fad and quick fix diets you end up being deprived either from an energy or nutritive aspect. This leads to cravings that in turn will lead to an obsession with food, which at some point will result in eating of the forbidden items (possibly in excessive quantities). This results in guilt, which leads to the feeling of failure and eventually results in the person absconding from the diet and picking up weight.

Individuals who eat these items for emotional reasons (depressed, sad, lonely, etc.) will go through the same emotional cycle afterwards(guilt, feeling of failure, etc.) as those on a deprivation diet.

Secondly, it should not be seen as forbidden foods. It is quite psychological really, since if you know you can't have it,  you crave it so much more and feel guilty when you have it. The key is just to control the intake. If you feel like something sweet, rather have a fruit and in most cases the craving will go away. If not and you still feel like that chocolate, then have it, but do not think about it again after you have had it. What you can do to compensate for it is to have smaller meals for the rest of the day, but again, do not deprive yourselves of meals because of this.

Moderation is the key. When you have this craving and it just wont go away, have a small slice of cake or a small chocolate, not a slab or half of the cake. This way you get what you want with impunity.

A good idea is also always to incentivise yourself.  Do not just give in to any and every craving or temptation. Always ask whether you are really hungry and whether you really need it. Set yourself goals: If you are good for a month, then with month end shopping you may have the ice cream. You will note that by doing this, you will not feel guilty for having something, since you have deserved it. Very often you might not even have the treat, since by the time your incentive is due, you may find you do not feel like it anymore or even decide that you do not need it. Nothing beats that feeling - victory!

Never go shopping when hungry. Rather delay the shopping trip than end up in the shopping center surrounded by tempting smells and delicious looking food items. You will also save a lot more money this way, which can be allocated to that holiday and new outfit you wanted.

Faced with tempting items, we are presented with options. Whenever possible, try to have a better option than forbidden food. By this I mean that instead of having a cream puff, rather have an apple crumble. They are both high in sugar, but at least the apple crumble has no added cream. Instead of having chocolates, have a jelly sweet – again less fat! If it is a choice between a burger and a whole-wheat roll with more or less the same topping, rather have the whole-wheat roll.  You will never regret making the better choice.