The fight against social inequalities in health and disease: Is there an end?

Source:  Di Cesare, et.al. Inequalities in non-communicable diseases and effective responses. The Lancet, vol 381, 585-597 Feb16, 2013

Does your social status determine your risk of developing disease? How about whether it determines your risk of dying from cancer, diabetes or heart disease? The answers to these questions have long been a centre of debate, research and endless publications with the focus around social and economic inequalities in health and disease.

NCDs (non-communicable diseases) include illnesses such as cancer, diabetes and heart disease, and have been major causes of death in developed countries. Such diseases have been reported to cause 35 million of the 53 million deaths annually, where more than three-quarters of these deaths now occur in vulnerable, low and middle-income countries.

A series of publications in the journal The Lancet have looked deeper into health inequalities both globally and within-countries. They have also highlighted key actions to tackle NCDs, their risk factors and related social inequalities. The authors have emphasised on the key risk factors of NCDs, which are said to be increasingly concentrated in low and middle-income populations. They include smoking, alcohol abuse, unhealthy eating, obesity and high blood pressure. When looking at deaths caused by NCDs, it was reported that mortality appears to be higher in people with a low education, income or social class. Additionally, other vulnerable groups included marginalised ethnic groups and those living in poor communities. Using obesity as an example, regions such as the Middle East, Latin America and southern Africa are reported to have higher rates of overweight and obesity in comparison to high-income countries. Could westernisation of such communities be more of a health burden than a case of moving forward?

Access to healthcare, healthcare use and quality were other issues of inequality highlighted in the publication. Poor access to screening and treatment subsequently lead to a poor prognosis in people of developing countries where NCD rates are high. For example, if you are person with cancer living in a high-income country, your chances of survival are twice as high than those living in India or Africa.

In order to continue the fight against NCDs, the authors believe that success is only achievable if governments worldwide address health problems of their most vulnerable and disadvantaged groups. They have also highlighted key areas to reduce NCDs and NCD inequalities both globally and within countries and they include:

• Investment in early childhood development programs and high quality education
• Provision of employment security for disadvantaged groups
• Regulation and control of tobacco, dietary salt, processed foods high in sugar and fat
• Improved access to high-quality health care including implementation of universal health insurance

Could these provide a solution to the NCD epidemic and the abolishment of health inequalities? The debates about why such inequalities exist should shift into actions as to how they can end.

Weight Loss Surgery: What you need to know

•  Have you tried everything to lose weight? Really tried?
•  Have you had the support of a qualified dietitian to lose the weight?
•  Have you tried changing your lifestyle and maintain those changes for more than six months?
•  Have you engaged in any sort of activity in the last six months?

Answering these questions truthfully can help you decide whether weight loss surgery is the right decision for you. If you have answered no to a question, take a step back and avoid jumping to the conclusion that weight loss surgery is the only solution.

Weight loss surgery, also known as bariatric surgery, is usually the last resort an extremely obese person will undergo in order to lose weight. But why take such extreme measures? Suitable candidates for bariatric surgery are those with a BMI (body mass index) of more than 40 and those patients with a BMI of more than 35 with medically important obesity-related conditions that could be improved by weight loss. Priority should be given to those with significant chronic illnesses that are currently not well treated but which are known to respond well to weight loss. These conditions include high blood pressure requiring medication, type 2 diabetes and a few more.  Other selection criteria include history of weight loss attempts, age, surgical risk and mental health status.

Despite international guidelines highlighting such specific criteria for patient selection, bariatric surgery has turned into a craze where it can be seen as a ‘free card’ to a speedy weight loss. Unfortunately in some parts of the world, such as in the UAE, an important factor is often disregarded: all non surgical measures should have been tried but failed to achieve or maintain weight loss. What many don’t understand is that, just like any surgery, the risks and complications should not be ignored! Also, if you haven’t changed your lifestyle and eating habits before surgery then your chances of experiencing nutritional complications post surgery are extremely high. Let us dig deeper into the common surgeries performed:

• Gastric Bypass: In very simple terms, your stomach and intestines are divided and rearranged to make a new small stomach. Also, parts of the stomach and intestines are bypassed.
• Sleeve gastrectomy: A large part of your stomach (50-70%) is removed.
• Gastric Banding: An inflatable silicone ring is placed around the upper part of your stomach. The ring is adjustable where the surgeon can add or remove saline through a port which is placed under the skin and accessed with a needle.

The risks of bariatric surgery should never be taken for granted and they include complications such as excessive bleeding, blood clots, infection, stomach perforation, unfavourable reactions to anaesthesia and in rare cases, death. In situations of extreme obesity, the risk of death from not having the surgery could be greater than the risks from the possible complications of surgery. For this reason, assessing whether surgery is the right thing for you should be done carefully with a qualified surgeon and never rushed. Moving on, your team should include the following health professionals if surgery is a ‘go ahead’:

• An experienced and accredited bariatric surgeon
• A physician with a special interest in obesity
• An accredited dietitian
• A psychologist or licensed mental health care professional
• Anaesthetist

Now the reasons for consulting a dietitian before and after the surgery are endless! Usually, you will need to be on a specialised diet prior to surgery which can include meal replacements in the form of liquids. Also, thorough nutrition counselling and education should be provided to you such as discussing the importance of taking responsibility, the degree of calorie restriction and possible need for multivitamin supplementation. A dietitian will also help you modify any behaviours that will need to be changed for successful weight loss after surgery.

Once your surgery is completed successfully, you will need to be on a texture modified diet which will eventually be upgraded until a normal diet is reached. This means that your diet will change from a liquid diet, then to a pureed diet until a more solid texture is tolerated. This gradual progression can only be guided and monitored successfully if a dietitian is on board. Additionally, some nutritional complications may occur after surgery and they can include any of the following:

• Swallowing difficulties
• Vomiting, diarrhoea or constipation
• Low blood sugar levels
• Vitamin and mineral deficiencies

Being a dietitian who has worked in the area of bariatric surgery, I have witnessed happy endings and successful weight loss but only with the right health professional team and with a solid support system.  Yet the complications are very real where any of the following scenarios can take place (and actually, already have in the past):

• Extreme loss of total weight leading to malnutrition and death
• Extreme loss of muscle mass causing physical problems such as inability to walk
• Constant vomiting and diarrhoea leading to hospitalisation due to extreme dehydration

So before making a rushed decision about surgery, put your frustrations about not losing weight aside and try to answer these questions with a clear state of mind:

Are you ready for a life long commitment to medical and dietetic follow up?

Are you determined to keep the weight off after surgery and improve your health and lifestyle?

Are you fully aware of the surgical procedure, potential complications and of how your life may change after the surgery?

Weight loss, whether surgically or conservatively, is not something to be rushed since success is not a race! Be patient, be committed and get the support your need!

If you or someone you know have undergone bariatric surgery, please share your stories and experiences which may help others in their journey…

The ‘Two-Faced’ Phenomena of Food

Food is not just a word that signifies nourishment and health but can also be perceived as a cause for disease. Epidemics of both obesity and diabetes are still on the incline yet we fail to see the fine line between health and disease. What I hope to walk you through is to demonstrate how food is a life essential but also a possible hindrance to health. Starting with the current epidemics; obesity and diabetes…

Nutritional imbalance has been a major cause of chronic disease especially being in positive energy balance but what does that mean? In simple terms, we may be eating ourselves to the point of illness. Obesity is a chronic disease where a person accumulates excessive amounts of fat causing a number of disturbances in the body.  The two most important causes of obesity are inactivity and excessive intake of energy-dense foods i.e. foods that are very high in calories, fat and sugar. Yes, our society has provided us with an abundance of foods but when do we say “Thank you, I’ve had enough”? Who is to blame? Now, food’s major components are Carbohydrates, Fats, Protein and micronutrients, by which all have essential roles in health and wellbeing. But here’s what happens when consumed in excess:

Carbohydrates (especially refined types: biscuits, white bread, white rice…)	Fats  (especially saturated fats = animal fats including palm and coconut oils)	Protein (especially animal sources)
Excess Calories = Weight gain	Excess Calories = Weight gain	Excess Calories = Weight gain
Unstable blood sugar levels	Increase in cholesterol levels especially if consuming large amounts of animal fats	Constipation and stomach irritability
Stomach upset such as bloating and gas	Increased risk of heart disease and stroke	Increased risk of kidney & liver problems

So the key here is balance and also knowing your choices. For Carbohydrates, focus on healthier alternatives such as wholegrain breads, brown rice and legumes. In regards to fats, use olive oil instead of butter and include nuts in moderation such as walnuts & almonds. Finally, include lean sources of protein such as fish, chicken and limit red meat to twice per week. Healthy plant sources of protein also include beans, lentils and soy products as well as low fat dairy products.

One of the major consequences of obesity is the development of Type 2 Diabetes Mellitus. Diabetes is a chronic disease where there is an excessive amount of sugar in the blood. This occurs because of declined function of the pancreas and the insulin that is secreted. Type 2 diabetes mellitus was known to occur in adults but this is no longer the case. We are now seeing more and more teenagers getting diagnosed with Type 2 Diabetes. What’s the cause?? It all begins with insulin resistance. This is where the pancreas is producing insulin but it is not working as well as it should. As a result, the pancreas is under extra pressure to continue making more in order to keep blood sugar levels controlled. This continues until the pancreas can no longer keep up and blood sugar levels rise leading to type 2 diabetes being diagnosed.

When we look at the bigger picture, parts of the world are suffering from an excess of abundance leading to obesity and subsequently, diabetes. Yet, other parts of the world are experiencing severe under-nutrition and starvation. A global end to such crises is still far out in the horizon despite efforts by public health activists and health professionals but in regards to the obesity epidemic, there is a solution. Simply put, change has to start on an individual level. You have a choice. A choice to find your balance so start now, make a change and maintain it!

The next example I would like to discuss is in the case of a vitamin called Folate.  Folate is a water-soluble B-complex vitamin and is found in green leafy vegetables such as cabbage, spinach, rocket and wholegrain products. Folic acid is the synthetic form of the vitamin given as supplements. The main functions of folate include cell division, growth and blood cell formation in the bone marrow respectively. Now, for all the expectant mothers out there and those who are trying to conceive, take note! FOLATE IS AN ESSENTIAL VITAMIN AT THIS STAGE OF YOUR LIFE! Why? Failure to consume adequate folate pre-conception until 12 weeks post-conception might increase the risk of Neural Tube Defects. This is a condition when the neural tube of your baby fails to close within 26 days after conception causing a disease called Spina Bifida. The current recommendations are:  women of child bearing age without safe contraception are advised to consume a folate rich diet in combination with a supplement of 0.4mg of folic acid daily (preferably taken as a multivitamin) until 12 weeks after conception.

From being an important aspect of prevention to possibly aggravating disease, can folate speed up cancer progression? Some studies have shown that folic acid may have dual modulatory effects on cancer. In layman terms, folic acid may either inhibit the development of a tumour in normal tissue cells BUT can also promote the progression of established tumours. Therefore, the stage of cancer development is important to determine whether folate acts as a promoter or an inhibitor. So far, studies have been inconclusive in regards to showing an association between high folic acid intakes and cancer risk but neither do they exclude a risk. The World Cancer Research Fund (WCRF) have published recommendations for cancer prevention and they include the following:

• Be as lean as possible without becoming underweight
• Be physically active for at least 30 min. every day
• Avoid sugary drinks, limit consumption of energy- dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat)
• Eat more of a variety of vegetables and fruits (> 5 portions, > 400 g/d), wholegrains, and pulses
• Limit consumption of red meat and avoid processed meats
• If consumed at all, limit alcoholic drinks to 2 for men and 1 for women per day
• Limit consumption of salty foods and foods processed with salt
• Don‘t use supplements to protect against cancer
• It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods
• After treatment, cancer survivors should follow the recommendations for cancer prevention
• And always remember – do not smoke or chew tobacco

By discussing such examples, you may be able to realize the fine line between the effects of food in health and disease. The ‘two-faced’ phenomena of food does exist but it comes down to how well you understand, apply and maintain the balance in all aspects of life.

Tea Time: Fancy a Cuppa?

Whether it’s a cuppa for breakfast or a simple beverage to enjoy in the afternoon, tea has its endless varieties and benefits that may be overlooked. Each type of tea has characteristics that make it more distinguishable amongst others. From the popular ‘English Breakfast’ to Green Tea, drinking tea provides you with hydration, offers virtually no calories (obviously depends on how much milk and sugar are added) and can help boost your immune system.

The way by which tea enhances a person’s immunity is due to the role of antioxidants, compounds that naturally occur in food and help protect the body from cell damage. The antioxidants of interest include flavonoids & polyphenols, which are all different types of these cell protecting, immune enhancing natural compounds.

Let us introduce the different popular tea candidates..

 English Breakfast Tea

One of the most popular teas around, English breakfast is a blend of Assam, Ceylon and Kenyan tealeaves. This mixture of black teas provides English breakfast with its rich, full-bodied taste which can be diluted if milk and sugar are added (also a very common way to drink the tea). English breakfast is believed to be the favoured tea of choice in the UK where a typical English high tea is just not the same without it! Such teas do contain a small amount of caffeine but nothing comparable to a cup of coffee. Flavonoids found in black teas such as English breakfast are believed to reduce the risk of heart disease and stroke due to the probable anti-oxidative effect on blood vessels and possible reduction of bad cholesterol. Research studies are still inconclusive and ongoing but results could be promising. One important characteristic to remember is that black teas are a source of tannins, which are natural chemical compounds that reduce iron absorption in the body. Hence, I would recommend having about 3-4 cups of black tea per day for those who are not iron deficient and 2 cups of tea for those who are.

Green Tea

Another popular tea of choice, Green tea is one of the top contenders when it comes to promising health benefits. It is THE beverage to have in many Asian countries but has even appealed to all cultures around the world recently.  To add a kick to the norm, some green teas are scented with flowers such as jasmine or mixed with fruits to create a delicious blend. Green tea contains polyphenols (catechins in particular) which are a type of antioxidants linked to inhibiting the growth of cancer cells, however, much research is needed in that area to prove such a hypothesis. Additionally, green tea is believed to have cardio-protective characteristics such as reducing bad cholesterol and the risk of forming blood clots. Despite what the ‘diet gossip’ out there may be, there is no scientific evidence to prove that green tea speeds up metabolism to aid in weight loss. One study has demonstrated a minor spike in metabolism when green tea is consumed, however, it was only noted to be a short lived, minor spike and nothing permanent.

Rooibos Tea

Rooibos tea is becoming quite popular among the health conscious due to its perceived medicinal qualities. It originates from the South African red bush and is naturally caffeine free. Rooibos has a rich, fruity and sweet taste, which appeals to many and can also be infused with other ingredients, such as vanilla, giving it a great twist. Rooibos has a very low amount of tannins, is extremely high in antioxidants and is calorie free. The key areas of research that have gained interest in the benefits of Rooibos include diabetes prevention, protection against heart disease, and cancer. Yes, it is still unclear what the full benefits of drinking Rooibos tea are, however, given its high content of antioxidants, you are more likely to gain some benefit than any harm at all!

So in summary, drinking tea does exert health benefits due to its antioxidant characteristics and regardless of type, a calming, heart warming, guiltless feeling is guaranteed!

 Random ‘TEA’ facts:

• Brits drink about 60 billion teas per year making them one of the biggest tea drinking cultures in the world.
• Tea was created more than 5000 years ago, in China.
• Tea is the biggest industrial activity in India after tourism.
• The idea of afternoon tea is believed to have originated in the early 1800s. The idea of having tea around 4-5pm was seen as a way to keep hunger at bay between lunch and dinner.
• There is an estimated 1500 varieties of Tea.
• Black, Green and White tea all come from the same plant; Camellia sinensis
• A cup of black tea contains approximately 40mg of caffeine which is about half of that in coffee.

Food Facts: From the East to the West

 

Travelling could  be a could death sentence for some people trying to watch their weight as quoted by some of my patients or a simple break from the strict dietary routine many may follow. Whether you are trying to watch your weight or not, travelling is an opportunity for everyone to experience new and exciting cultures. Before getting into the topic of food facts from random destinations, here are some tips for the ‘travelling -weight conscious’:

• If a dish you really want to try is not prepared in a suitable way (i.e. lots of added cream/butter, deep fried…) then order an entrée serving, or share it.
• If you would like to include several courses, order 2 entrée sized meals rather than an entrée and a main. Ask for some fruit for dessert.
• Now, if you indulge at a particular meal, balance it at the next meal e.g. after a 3 course lunch, order a salad with minimal dressing in the evening.

Choosing the following destinations was based on how history, food and culture intertwined to produce some great dishes. So buckle up for some random bits of international yumminess…

Destination: Australia

Starting your day with a random “G’day Mate!” shout out is typical in the land down under. Australian cuisine has come a long way from the beginnings of European colonisation to the massive influx of other cultures such as Asian, North American, Italian and Greek. I find that defining Australian cuisine is not bound to one culture, which makes it exciting and unbelievably delicious. An ingredient often used in Australian cuisine is kangaroo. Some may find it disturbing to have those fluffy, adorable, hopping creatures right on your plate, however, take note of the following:

• Kangaroo meat is one of the leanest meats out there (i.e. about 98% fat free)
• It is extremely low in saturated fats, which are responsible for raising your bad cholesterol levels.
• It is a great source of high quality protein, iron, zinc and B-vitamins such as vitamin B12 and niacin.

And no, it does not taste like chicken! I can’t really describe what ‘Roo’ tastes like apart from saying it tastes like a lean cut of beef with an after-kick. Perhaps a mix between venison and beef for those who have tasted wild game before. Next up is the ‘Aussie’ favourite: VEGEMITE!

Vegemite is a dark spread made from yeast extract and let me say, it definitely has a kick! Vegemite is an acquired taste and has been part of the Aussie diet for many years. It is quite similar to Marmite, which is the British equivalent. It is an excellent source of the B-vitamins: niacin, riboflavin, thiamine and folic acid but it also very high in salt. Should you wish to get ‘Aussiefied’, spread some margarine onto some warm toast, then add a thin scrape of vegemite and voila! Behold the salty, bitter kick!

Destination: Japan

For centuries, Japan has undergone both social and political changes, which in turn, influenced the evolution of Japanese cuisine. Two dishes you will probably never miss to try are Ramen noodles and Sushi. Originally, Ramen is believed to be of Chinese origin where the simple definition of the word has created multiple theories as to what it really is. Ramen dishes vary widely depending on the broth used, soup flavours, toppings and noodle texture and are also known for being cheap and convenient. Unfortunately, Ramen noodles could be quite high in calories, fat and salt. The flavourings and broth do contain fatty chunks of pork or beef, miso and/ or soy, which are all a combination of not so healthy ingredients. However, that does not imply that you should never try a bit of Ramen! One thing I would say though is, do stay away from the ‘Instant’ kind, which is known as college food. Instant noodles are always a recipe for calories, salt and fat, hence, a not so healthy option to include as part of your daily diet! Moving on to Sushi … Two popular food components of sushi are the Shari (vinegared rice) and Nori (seaweed wrappers).  Sushi is probably a single word that produces a number of branches which include: Chirashizushi, Inarizushi, Makizushi, Narezushi, Nigirizushi and Oshizushi. For all sushi fanatics, you may know the laymen terms: Maki, Nigiri and Oshi which are different ways of serving sushi using different ingredients such as raw fish, tempura, vegetables and so on. Sushi can be considered a low calorie meal depending on what the filling is. Since rice is a major component of sushi, it is not considered a low carbohydrate meal unless you consume a little sushi and more sashimi (raw ingredient minus the rice).

Destination: Egypt

So we’ve got the pyramids, the Nile, the pharaohs, history worth thousands of years, have I mentioned the pyramids?! Egypt is a country that has witnessed endless transformations going back to the ancient pharaohs and dynasties lasting hundreds of years to the Ottoman times and most recently, a revolution. With it, came the many dishes that Egyptian culture is known for. Many would argue about what the ‘national’ dish would be but it’s fair to say that ‘Kushari’ would definitely be a contender. Kushari is a hearty dish consisting of rice, lentils, pasta, and chickpeas. If that’s not enough, it is then draped by a thick tomato based sauce, which is infused with caramelized onions, garlic, vinegar and other spices. Kushari is a common lunch choice for many locals as it keeps them fuller for a long period of time, which may help them endure long hours of labour. Or simply, it’s just a hearty meal that tastes good for a low cost! A maybe not so good choice for the ‘weight and carb-‘ conscious but definitely a dish I would highly recommend to try! Next up, introducing Foul Medames; a dish consisting of slow cooked fava beans mixed with oil, garlic and lemon juice. It can be served in a number of ways which in turn affect its nutritional content. Many would add butter or egg which increases the calorie content. However, by adding a little oil and some seasoning, foul medames can be an excellent source of low GI carbohydrates, protein and iron. And as Egyptians would say “Bil hana wil shifa” which is Bon Appétit!

Destination: Europe

Now, I couldn’t really pick just one country on this continent so why not highlight some ‘must-try’ top dishes! Starting with the Seafood Paella from Spain. One of my ultimate favourites with 3 essential rules: Use a paella pan, cook with medium- grain rice and cook over an open fire (or just head to the closest Spanish Restaurant!). Also called ‘Paella de Marisco’, this dish is a colourful and delicious combination of seafood and rice ranging from prawns, clams, fish, mussels and even chicken! Paella is very high in protein, carbohydrates and endless vitamins and minerals so I would definitely suggest to share this one. Moving on to yes, Italy! And as cliché as it may sound, Italian pizza is a must. Using a thin- crust base, freshly-made tomato paste, prosciutto, ruccola and funghi (mushrooms) and chunks of melted fresh mozzarella, you are simply headed to a mouthful of bliss! The history of today’s pizza starts off in 1889, in Naples. Pizza was actually a meal consumed by the poor for centuries in Italy and now has taken on many forms and toppings happily welcomed by all. A word of warning though: pizza may not be so ‘waist-friendly’ if consumed regularly so control your portions and frequency! As I will need to wrap things up at some point, Greek cuisine is a good way to end! A food culture rich in grains, vegetables, fish, healthy oils and legumes, Greek food can be considered healthy if we look at the big picture and bypass ‘baklava’ and fried ‘saganaki’! The top ingredient used in Greek cuisine is good ol’ Olive Oil. Rich in monounsaturated fats (i.e. healthy fats) and antioxidants such as vitamin E, olive oil has gained a massive following of researchers exploring its health benefits in preventing heart disease and strokes. Given that it is a type of fat, it is still high in calories so moderation is a must here. Some Greek dishes to try include Avgolemono which is a refreshing soup made with egg, rice and lemon, Dolmades which is similar to the Arabic dish ‘Waraq Enab’ and ‘Hortopita’, the famous spinach and feta pie.

Given all the travelling and food tasting, I would only ask of this: Savour every bite and keep walking and exploring as means to burn those calories! Happy Travelling!

Food the ‘Au Natural’ Way: Natural vs. Organic

Dietitians and healthcare professionals alike are all on the same page when it comes to promoting health and wellbeing especially when it comes to the food you eat. So why not look at food at its rawest form? Many of you may be aware of the hype surrounding organic and ‘natural’ foods thinking they are the same when in fact, they are not!

 We have become a society where food plays a major role in health and illness and focus is being placed on diets that promote health and wellbeing, prevent diseases and also, protect the environment. Top diets that appear to fall under such categories are those that promote either ‘natural’ or organic foods. The term ‘natural’ is used to describe foods that are free from preservatives, artificial sweeteners, colours, artificial additives, stabilizers, hydrogenated oils, hormones, added vitamins and so on. Basically, we are talking about minimally processed food!

As a dietitian, I do advocate for the all natural and unprocessed but sometimes, a number of factors may affect a person’s decision such as food availability, prices and storage. There is no doubt that fresh, unprocessed produce is the best but that doesn’t mean that good nutrition is not obtained from other options given that the foods you choose regardless of method of production, fall under the healthy eating guidelines. Here is a list of my essential raw and natural ingredients that should be on your shopping list:

• Salmon: An absolute favourite of mine, which should be included in everyone’s diet (vegetarians are an exception of course). Personally, I believe that Salmon is one of the top meats that everyone should consume on a weekly basis if not more often. Whether served raw as sashimi or baked in the oven, salmon has endless benefits. It is an excellent source of Omega-3 Fatty Acids which are healthy fats that reduce cholesterol, blood pressure and triglycerides. They are simply great for protecting your heart. Salmon also contains important minerals like iron, calcium and selenium which is essential for building up of tissues such as nails and hair. It is also a source of vitamins A, B and D.

• Cucumbers: Some may call them boring but I find that cucumbers tend to be taken for granted. Cucumbers are the easiest way to up your intake of water for hydration and fibre. The cucumber’s flesh is mainly composed of water and its outer skin contains the fibre. It is also a source of potassium and magnesium. Cucumbers are believed to help improve the complexion and health of your skin. Additionally, some may use cucumbers to help sooth burns and reduce eye swelling (i.e. puffy eyes!). So if you do plan to make a salad, don’t forget to add this important ingredient that will give your water and fibre intake a boost!

• Pomegranate: A funny looking, small, colourful fruit that is packed with goodness! Pomegranate is a source of vitamin C, B5, potassium and flavonoids and is also believed to have anti-inflammatory properties. Such properties have been investigated with Osteoarthritis where pomegranate compounds were believed to ease inflammation of the joints and preserve cartilage. Also considered another ‘protector of the heart’, some research shows that pomegranate may help reduce bad cholesterol in the body, lowering the risk of a heart attack.

• Ginger: Used in cuisines for its great flavoursome kick and for health due to its medicinal properties, Ginger is considered one of the top contenders in the nutrition world. Ginger is believed to boost your immune system, aid in digestion and help ease symptoms such as nausea. It is also believed to improve circulation. Many, myself included, may consume ginger as a hot beverage when fighting the common cold as it can act as a natural decongestant. A quick and easy way to include ginger in your diet is to add it to juice! Grate a bit of ginger root and put it in a juicer, along with carrots, apples and oranges.

Now, moving on to organic foods. People assume that the nutrient value of organic food is better. That is not necessarily true. The term organic refers to farming without the use of synthetic chemicals such as artificial fertilisers and pesticides. No irradiation of food is involved and no genetic modification is used. Organic farming also considers the welfare of animals and the environment where animals are treated humanely. The environment is also protected by the use of natural farming cycles and conservation of soil, water & energy. Organic foods are usually more expensive because organic farming is more labour intensive & production tends to be smaller since no pesticides & other chemicals are used. The two main reasons why people buy organic food include the following:

* Concerns over the long-term health effects of pesticides, chemical residues and antibiotics.

* Concerns for the environment where the use of modern farming has led to a number of problems related to soil fertility. Organic farming basically supports environment sustainability.

In regards to the nutritional value of organic food vs. conventionally grown food, studies have failed to show a significant difference in key vitamin & mineral contents. Only small differences were noted in that organic food demonstrated:

• Higher levels of Vitamin C & Selenium
• Lower levels of nitrate

My verdict on going organic :If you’re thinking in terms of health – consuming organic foods is a way to reduce your exposure to synthetic chemicals & antibiotics. Nutrient value is pretty much the same, however, some people believe that organic tastes much better! If you’re concerned about our environment, then do support organic farming!

Keep it Real.. With endless technologies enabling food producers to supply us with basically anything and everything, whenever, I am a strong believer that a person should try to keep things natural, chemical free and minimally processed in order to protect our bodies from any unknown or possible damage that may or may not occur in the long run.

What’s in a Fry?!

The simple word of ‘Fry ‘may appear, to some, as the forbidden word in the land of health and wellbeing, however, let’s look at it in a different light. As a dietitian, I love FRY. Yes, I’ve said it. Now, let me enlighten you as to why I hold such a simple 3-letter word so dear to my tummy. Starting with…

The FRY

Fry: Sing. form of the word ‘FRIES’. Source: potatoes.  Here’s a bit of history for everyone…Upon conducting some research, I found that good ol’ French fries were not invented by the French or the Belgians. Apparently, potatoes were introduced to Europe through the Spanish. To cut a long story short, some Spanish dude in 1537 came across a village in Columbia, found the potatoes, brought them back to Spain and then eventually, were introduced in Italy and so on. But then, some historians believe that the Belgians were the first to trial the art of slicing the potato into thin strips and frying them up. Reason being, it was a method of substitution to frying up fish. When fishing became difficult due to the rivers freezing up, they would cut up potatoes as they did the fish and fry away. The word ‘French’, to be honest with you, I skipped researching that part, as it was time consuming…

The evolution of the fry came a long way after that. Elongated pieces of fried potatoes = Fries. Thickly cut strips of fried potatoes = Chips. Different country, different word yet wherever you go, someone will know what French fries are. If you think about it, and which I find funny, is that the potato is practically fat free. Once in ‘Deep Fry’ position, the fat is absorbed by the potatoes shooting up the calories and possibly absorbing some other nasties with it depending on type of oil used. Am I an advocate for the deep-frying? Only as a treat! There are numerous ways were you can end up with yummy crunchy golden strips of goodness without the need of gallons of oil. One way I would do it involves the following:

• Slice the potatoes into thin strips taking the shape of French fries. You can use sweet potatoes for a lower GI.
• Toss with olive oil (and don’t be too generous with the oil)
• Place them in baking tray and lightly season.
• Bake at 350°C – 400°C for 30- 45 minutes.
• Halfway through baking flip them over to crisp on both sides.
• When they’re ready to go, place them in a bowl with paper towels to drain the extra oil and voila! Enjoy.

The Stir FRY

A good wok, CHECK! Choice of lean meat, CHECK! Variety of vegetables all chopped up, CHECK! Stir-frying is a Chinese method of cooking also called chao where a small amount of oil is used (traditionally peanut or sesame oil) at high temperatures to quickly sear the food. The mixture of food, which includes small pieces of meat or tofu and vegetables, does not retain much oil making it a healthy way of cooking (if you are actually doing it right and using a small of amount of oil- preferably canola or sunflower). When exposing vegetables to heat for a short period of time rather than extended periods of heating, retains more nutrition. The reason why I love stir-fries is simply because of convenience and time. With a good choice of sauce such as low salt soy sauce, some sweet chilli and a tiny bit of honey, you could have a great dish within minutes. Add some rice-based noodles to the dish as a source of carbohydrate. A great recipe to try: Ginger Beef and vegetable stir fry (Source: http://www.taste.com.au)                                          

Ingredients (serves 4)

• 350g lean beef sirloin steak, sliced on the diagonal
• 1 teaspoon sesame oil
• 6cm piece ginger, thinly sliced
• olive oil cooking spray
• 4 green onions, sliced on the diagonal
• 200g snow peas, trimmed, sliced in half on the diagonal
• 150g oyster mushrooms, chopped
• 1 red capsicum, sliced
• 120g baby corn, sliced in half on the diagonal
• 2 tablespoons reduced-salt soy sauce
• Cooked brown rice, to serve

Method

• Place steak, sesame oil and ginger into a shallow ceramic dish. Cover and refrigerate for 30 minutes if time permits.
• Heat a wok over high heat until hot. Spray with oil. Add one-third of the beef. Stir-fry for 1 minute or until browned. Remove to a plate. Repeat twice with remaining beef, spraying wok each time.
• Spray wok lightly with oil. Add vegetables and stir-fry for 3 minutes or until just tender.
• Return beef to wok with soy sauce. Stir-fry for 1 minute or until heated through. Serve with brown rice.

The FRY up

A favourite on a Sunday morning after a big night out or just simply, a Sunday morning delight. The Fry up aka a full English Breakfast involves the following key ingredients: eggs, bacon, hash browns, sausages and a thousand other foods depending on region. A Fry up could also be called a ‘heart attack on a plate’ but I would like to change that. It all comes down to how you cook such fine ingredients (‘fine’ being, lean cuts, less butter, lots of vegetables). The key is in portion and overall fat consumed. My Fry up make-over includes the following:

• Eggs: Crack eggs in a bowl, add a teaspoon of original pesto, add some skimmed milk, salt and pepper then whisk. Add eggs to a non stick hot pan and scramble.  Add to plate.
• Mushrooms, Baby Spinach & Avocado: Slice mushrooms of choice, marinade in balsamic vinegar. Grill then add to plate. Stir-fry baby spinach for a minute or two in a hot pan, add seasoning then add to plate. Slice some avocadoes, season with cracked pepper, add to plate.
• Wholegrain Toast: Slice, toast, serve (1 slice per person)
• Sausage (optional):  Sausages do contain a high amount of saturated fats hence I would consume wisely. Key is: portion – 1 small sausage GRILLED. Low fat options are available and yes they do taste just as good!

So after a bit of insight on what I love about ‘Fry’, things don’t seem so bad after all? Just remember what the key things to consider are: portions, frequency, ingredients and extras, which are things that you are in control of and can modify. Until my next post, enjoy the ‘Fry’!