Category Archives: Dietitian Advice

Make your own healthy “graze” snack boxes

So snacking, it’s one of those things I definitely do. I tend to eat my 3 meals and at least 2 snacks a day. Which means my snacks need to be healthy, well most of them! Currently I am breastfeeding which makes me quite hungry at times. It is those moments when I have children clamouring for me, a baby wanting to feed and I know I need to eat that I need a ready to grab and go snack. That moment when it could be biscuits. Although I do eat my share of those too, I’ve recently discovered a wheat free dark chocolate and stem ginger cookie… dangerously nice. So to keep me on the straight and narrow I’ve started making snack boxes. This is something I often recommed to clients and many find them so useful. You can literally make a pile up for the week and take one to work each day, keep them in your bag or just on the worktop if you are at home.

Here are some of my favourite combos:

Cranberry.almond.choc
15g Dried cranberries, 15 almonds and 10g dark chocolate

 

Pecan,apple.edam
15g pecans, 15g dried apple, 1 tbsp dried edamame beans

 

Cashew.mango
15g cashews, 15g dried mango, 1 tsp mixed seeds

 

Brazil.apricot
5 brazil nuts, 3 dried apricots, 1 tsp mixed seeds

Here is me trying out Facebook Live and showing off my not so great phone video skills:

Love to hear your healthy snack box combos. Leave me a message/comment so I can steal your ideas too 😉

I tend to buy my nuts and dried fruit in bulk online (it is cheaper per kg but costs a bit up front) and I store a supply in the cupboard and a supply in glass jars on my shelf. Which looks pretty and also means we all see them and are more likely to eat them instead of reaching into the biscuit tin. 

“Keep healthy food – In plain sight so it is in your mind to eat it”

A good example of this is my toddler boy who often asks for “prawns” and points at the jars… he means prunes! 

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Childhood Obesity – due to larger portions or eating too frequently?

One of the big connundrums around obesity is whether people put on weight because they:

1. Eat more at each meal/snack (larger portions) so eat more calories or…

2. Eat more frequently, so eat more calories.

Dietitian UK: Childhood Obesity

With levels of childhood obesity rising at an alarming rate, young children is an area we need to focus more on and study in more depth. If you become overweight as a child you are more likely to be overweight as an adult too. Habits learnt in childhood are hard to change.

 A study of the UK  2011 Diet and Nutrition Survey of Infants and Young Children (DNSIYC) looked at the eating habits of 2564 young children (aged 4-18 months) by asking to parents to complete diet diaries to report the childrens food intake.  The results were presented in an oral presentation at the European Obesity Summit in Gothenburg (1-4th June 2016). They show that overweight children consume larger portions at meals (141 calories versus 130 calories, respectively at each eating occasion), but do not eat more frequently, than healthy weight children.  This may seen small, only 11 kcals higher but if a child is eating 5 times a day this could be 56 kcals extra per day, 393kcals a week and 1703kcals extra a month. It soon adds up, so the overweight children were eating an extra 2 days worth of food each month. For every extra 24 calories (100 kJ) consumed during each meal, there was a 9% increased risk of overweight/obesity.

It was LARGER PORTIONS that were shown to be the main issue. The overweight children were eating more of the same foods: (160g of a food versus 146g).

The authors conclude: “Larger portions rather than eating more often may be a risk factor for the development of childhood overweight in early life. Further prospective studies that look at the development of excess weight over time are needed to establish causation.”

My Viewpoint:

The UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC) suggests that portion sizes are larger in overweight children. I would agree that this is often the case but it is not the only issue. The research used diet diaries which are subject to under and over reporting errors.

From my experience as a dietitian and a mum, the other issue is the type of snack foods being offered to children. There are a lot of sugary snack foods available to buy in the shops and these foods seem to be used regularly as a snack item instead of fruit and vegetables. Biscuits, juices and cakes are also frequently given at toddler groups and have become the normal foods to have. Parents need to focus on the balance of the diet, ensuring children get a good intake of fruit, vegetables, wholegrains and protein foods.

Being overweight now will mean that the child is likely to struggle with their weight throughout their adult years too. So the quicker a good lifestyle of eating and being active can be established the better things will be.

On the one hand we want children to learn to eat according to appetite and to be able to regulate their intake. However that is not always possible. Some children do this intuitively and others need to be taught. I find it fascinating that if I give my 2 older children a piece of cake, my boy will eat nearly all of it very quickly, then stop when he has had enough. My girl will eat it slowly and leave some to have later on. Both eat according to their appetite but eat in a very different way. Parents need to teach children that it is ok to leave food when they are full, that all foods are healthy in moderation and that listening to their appetite cues is essential.

Second helpings is a tricky issue. I do let my children have seconds if they ask but it may only be a small spoonful if I know they have had enough. Or I may talk through with them “Are they actually still hungry, do they want to wait for the next eating occasion instead, would having fruit or vegetables be a better option?” Think through how much your child had had to eat and if it should have been enough. Are they asking for more because it is a specific meal? (my children always ask for seconds of risotto and pasta). If you feel that they have had enough then keep seconds to vegetables or salad. We have started having salad on the table each night and it is making a huge difference to my girl who is really enjoying have seconds and thirds of salad!

Good guidance on portion sizes is available here from the Infant and Toddler Forum, here is a little snap shot, you can click through to get the full guidance.

Screen Shot 2016-06-22 at 10.15.25

As a general rule for fruit, vegetables and wholegrain starchy foods you can use your child’s fist or palm as a portion size. I’m planning on doing a blog post showing the portions I give to my children very soon.

 

Priya speaks out on the sugar in children’s drinks on Wave 105 radio

A Southampton dietitian has told Wave 105 how many parents are unaware of just how much sugar is in supposedly “healthy” fruit drinks for children.

Dietitian UK: Top 3 myths about sugar

Priya Tew is offering mums and dads advice on healthy alternatives to make sure their children are not exceeding their recommend daily intake (RDA) of sugar.

It comes as a new study shows many fruit drinks for children are “unacceptably high” in sugar.

The research, published in the journal BMJ Open 24th March 2016, found that 42% of fruit juices, juice drinks and smoothies surveyed contained at least 19g of sugars, 5 tsp, this is almost a child’s entire maximum recommended intake per day.

Action on Sugar is asking for a reformulation programme to reduce sugar in children’s drinks by 50% in 5 years and restrict them to 150ml serving sizes. Only 6 products surveyed were found in 150ml servings, meaning children are likely to be consuming more.

“The research doesn’t surprise me. Although it [fruit juice] is high is natural sugar, it’s a very accessible form of sugar.

“I do think parents are unaware of how much added sugar there is in fruit juice and smoothies, and they’re seen as a healthy option. I would beg to differ on that. I think a healthy option for a drink for a child is water or milk, perhaps some no added sugar squash.

“If you’re going to give your child fruit juice then my advice would be to water it down, make it half juice and half water, and only have that as an occassional treat rather than a daily option.”

When processed into fruit juice drinks, the sugars (fructose) in the fruit cell walls are released as ‘free sugars’ which damage your teeth and provide unnecessary calories; you take in more calories without feeling full (i.e. A 200ml glass of orange juice can contain 3 oranges).  

Co-author of the study Kawther Hashem, Registered Nutritionist and Researcher of Action on Sugar says: “It is highly concerning that many parents are still buying fruit juices and juice drinks for their children thinking they are choosing healthy products; children should be given as little juice as possible (maximum of 150ml/day).These juices rot children’s teeth and give children a ‘sweet tooth’ that will affect their general health in later life. 

“What is more concerning are the products with added sugar and glucose-fructose syrup. We call on all manufacturers to stop adding more sugars to already sweet juices, particularly in children’s products and to restrict children’s drinks to only 150ml bottles/cartons.

“Our advice is to eat the fruit, don’t drink the juice.  Juice should be an occasional treat, not an ‘everyday’ drink. These processed drinks are laden with sugars and calories and do not have the same nutritional benefits of fresh fruit and vegetables.” 

 

The NEW EatWell Guide

Finally. A moment that we’ve been waiting for in the nutrition world. The EatWell Plate has been updated. Remember this is aimed at the general population… so it is not for those on special diets for medical reasons but is a nationwide healthy eating message. It gives the public sensible, evidence based information on what should be in their diet. Very timely in light of the rise of health bloggers and other unqualified “nutrition experts” who are suggesting we reduce carbs, sugar, gluten, meat etc…

Here is the old version:

eatwell plate 377 sized

And the new version:

Eatwell-guide

5 top differences:

1. SUGAR:

After the SACN report the new plate has an emphasis on sugar reduction. So the high sugar foods have been removed from the model and are now emphasised as foods to eat less of. What I like is the fact these foods are very much still included. So going completely sugarfree is definitely not advocated. We can all enjoy sugary foods in moderation 🙂

2. FAT:

Quite a change for fat with the change in the purple segment size and now a focus on unsaturated fats. It would have been nice to have a larger range of these fats, however they often cross over into other food groups so it can be a little confusing. Other foods include: avocado (also a veggie), nuts, seeds and oily fish (also a protein), olives (also a veggie), olive oil.

3. FIBRE:

Hooray for more of a focus on fibre! With all the sugar madness that has been flying around, fibre has had to take a backseat. It is good to see the wholegrain message being highlighted. Recommendations are that we eat 30g of fibre a day, which is a lot. Eat wholegrain foods at meals, snack on fruit and veg and include 2 high fibre snacks (homemade flapjack with seeds in would be one of mine) and you will just make it.

4. CARBS:

The segment sizes have very much been revisited. Linear modelling (which I am not an expert on) was used to look at the guidelines and compare this to what the population currently eats. We have this data from the NDNS – regular dietary surveys that are carried out on the UK population. So what we have is an achievable version of the guidance, rather than the “perfect diet”. I like this, as a dietitian it is how I work, translating the science and guidelines into achievable bite size pieces of advice.  

5. HYDRATION:

The inclusion of a drink is a positive step towards helping education people on sensible choices of fluids to drink. It was also a change to make a change to the advice on fruit juice and smoothies, so you can see that now a smoothie will only count as 1 portion of your fruit and veggies a day. That’s 1 portion total, so if you drink 5 smoothies a day that is still only 1 portion of fruit and veggies…..and a lot of sugar. This has the aim of helping us reduce sugar intakes in light of dental health.

Other changes are there being less red meat and processed meat on the plate. So the 70g of red meat per day guidance has been integrated in. Drawn foods have been used after focus groups consulted on the images. I’m not so much a fan of this. To me the model looks very simplistic but perhaps that is what we need? A return to basics and simple, sensible advice?

What are your thoughts?

Do you like the new model? 

Does it help you think about how to eat healthily?

The rise of nutrition social media.

Since I qualified as a dietitian in 2005, the way nutrition information is communicated has changed at quite a pace. The basics of nutrition are still the same but we have moved from….

  • Books, journals and written journals to ebooks and blogs.
  • Face to Face meetings have become online meetings, virtual hangouts and video calls.
  • TV chefs have been challenged by food bloggers and YouTube cookery channels.

With social media being a huge knowledge driver it is clear that how we communicate affects language. So nutritional professionals with the RIGHT message need to be actively on social media, shouting about it.

Shoutnutritionmessages

The History:

1999 : Rise of Blogs.

2004 : Facebook begin and is now worth hundreds of billions.

2005 : YouTube started up.

2006 : Twitter, rising to more than 100 million users in 2012.

2012: : Health Bloggers emerge.

Rise nut social media

53% of consumers check their smart phones within 5 minutes of waking. Health bloggers are now prolific and widely followed, some are fast becoming household names with their own recipe books and published in the media. However many of these bloggers are giving out their own nutrition advice but with no real qualifications.

What do people now want?

  • Evidenced based nutrition knowledge presented online, in an easy to access format. Bite sizes snippets that is scientifically correct. 
  • Ethical products.
  • Natural foods.
  • Homemade, fast recipes.
  • Artisan ideas.
  • A unique story on food.
  • Smaller independent brands in a move away from the mass produced products.

As dietitian’s/registered nutritionists  we have a huge role here. 

My thoughts:

  1. How we communicate counts. Be present, be a part of the conversation.
  2. Be authentic. Dietitian’s eat cake! Model healthy eating, balance, moderations and all the things we preach about.
  3. Working with brands is ok as long as you are one about it using the hangtags #ad #spon and a disclosure in any blog posts.
  4. Share your tips, what you eat, your recipes, your work, your stories, new foods, your meals, the research you read, live tweet study days. Show your passion, shout about it.
  5. Keep abreast of the food trends. We can’t get left behind. Be current, be topical, be present.

Anxiety Techniques for Eating Disorders

Anxiety is one of the biggies when you are working on recovery from an eating disorder. I’ve worked through this with many clients: either whilst they are eating, after a meal or whilst choosing a meal. It can feel totally overwhelming and be quite debilitating. So you need tools available to help you deal with those consuming anxious moments. One thing I alway like to remind people is that anxiety is a natural body response. It may feel like it will overtake you and spiral out of control, but it has to peak and then lessen. Give it 10-20 minutes to pass.

Dietitian UK: Anxiety Techniques For Eating Disorders

Distraction

Find something that can change your focus. If you are eating you may need someone to start a conversation, the radio may help or watching a candle burn.

If it is away from a mealtime then crafty activities, a good book, a bath or a phone call to a friend could help. Write out a list of things to try out.

Do a Body Scan

A Body Scan is a a great way to reconnect to your body. In moments of anxiety your parasympathetic nervous system can take over, dry mouth, heart beating faster, harder to swallow, feeling hot, a pounding head, tunnel vision – none of it will help when you are trying to eat or to relax after a meal. By working through your body from feet to head you cab bring your awareness back to your body and reduce the anxiety.  

Here is a free video version from Elisha Goldstein.

I particularly like progressive muscle relaxation, probably because it is a more active form or relaxation so I have something to do! It works by tensing the muscles in a body part, holding for 30 seconds and then releasing. This leads to a sense of relaxation in that area.. The whole process makes your think about your body and not that anxious event and helps you slow down your breathing too. 

Here is a useful script you can use.

Or you can just work from your toes through each muscle you can think of going up to your jaw. Or pick large muscle groups such as your fists, feet, legs, jaw and just do those for a few minutes. 

Being Barefoot

Walking barefoot can be a good exercise in thinking about movement, feelings and breathing. Slowly walk around on difference surfaces, working slowly through the foot and focusing on using as many of the small muscles in the foot as possible. Use deep breathing through the ribcage whilst you walk.

Try using a tennis ball to massage and release through your feet first to increase the amount of movement through your feet. 

Mindfulness

I often ask clients if they have tried mindfulness. Some people love it and others struggle with it. If you haven’t tried it then good apps include Headspace and Breathworks. It can take time to really get your focus and practise will improve it. Try and find a set time to practise each day, even if it is only 5 minutes. 

Breathing

I know this is something we all do, all of the time, but there are some good breathing techniques that can help reduce anxiety. Deep breathing reduces the fight/flight response that occurs when you are stressed. So simply focusing on your breath and slowing it down can help. When you are sat eating and the anxiety starts to mount up, threatening to overwhelm you, try refocusing on your breathing. 

In Pilates we use thoracic breathing, where you bring yourself into a neutral posture – stacking your ribcage over your pelvis, breath in deeply expanding through the chest and breath out letting the chest fall back. It always amazes me that just deep breathing uses the right muscles can make a difference. 

Another one I like is square breathing – think about or look at a square. Breathing in for 4, hold for 4, breath out for 4 and hold for 4. The counting can be helpful and you can do this without anyone noticing.

Having an Eating Disorder over Christmas.

I love Christmas and all the build up that goes with it, I’m like a small child with the excitment of it. For me it is special celebration. However through my work in eating disorders I know what a hard time it can be for some. 

Christmas brings with it a lot of socialising, which can mean a lot of different meals. Eating in restaurants, buffet events, and more alcohol than usual. Then we have all the delicious, but high calorie festive foods: mince pies, christmas cake and pudding, stollen, pannetone, yule log, pastry items, cheese, nuts and those tubs of chocolates. All of this can cause someone with an eating disorder a lot of anxiety and that is before we get to the Christmas meal itself.

Dietitian UK: Surviving christmas with an eating disorder

I know I will freak out over buffet food but I really want to go, what can I do?

How can I eat in front of other people?

Should I cut my intake down the rest of the day if I am eating out?

How much can I drink and how does it affect my calories?

The 25th December. A special day, spent eating, drinking and being around people you may not see all the time. In our family we end up having 2-3 Christmas days as we visit my side of the family and hubby’s side to celebrate with them too. So it could end up being 3 Christmas meals. Suddenly you are in an environment where you may eat at different times, have higher calorie foods at meals that you haven’t eaten for a while and are eating with different people. 

Will everyone be looking at me and watching what I eat?

If the Christmas meal is late what do I do about sticking to my usual meal plan?

How much should I have at that meal, will it be more calories than  I am used to?

What will this do to my weight?

I don’t want to spoil the meal/day for everyone but how what do I do if I am not coping?

Should I have dessert?

This year, I have spent time with each of my clients talking through their plans for the build up to Christmas. It’s been a real challenge for some with meals out with work colleagues and planning the Christmas Day itself. However everyone has a plan in place and I hope everyone will be able to relax a little and enjoy the moment.

Dietitian UK: Surviving Christmas with an eating disorder 2

Here are my top tips:

  1. Preparation is key. Try to get as much information about what is going to be happening in advance. If you take some of that element of surprise out of the equation you will reduce  the anxiety somewhat.
  2. Ask others around you for support. Let someone know that you may find this meal/event tricky and if so this will be your signal and give them ideas of what they can do to help. Maybe they can distract you with conversation or use a few motivational phrases to boost your confidence. 
  3. If people do not know about your eating disorder then they are unlikely to be watching you. If they are watching you then it is probably out of sheer intrigue. You could try smiling at them to show things are ok (even if they are not). Remember that this is a moment for you to enjoy and you don’t want to let little things get in the way of your recovery.
  4. Plan out which days you will be eating differently over the festive time. Then also plan out a list of foods you want to allow yourself to eat. When are you going to do this? Can you swap a normal snack for a mince pie? One of my clients worked out a mini mince pie was not that different to her usual cereal bar so that was an easy way to build a mince pie into her meal plan. Try not to let yourself miss out.
  5. The meal itself can be overwhelming. It is one meal out of 21 in a week. It is 1 day out of a week. If you eat an extra 700kcals that day, it only equates to an extra 100kcals every day that week – not enough to cause any effect on your weight. You need to eat an extra 250-500kcals everyday for your weight to increase, and even that is not enough for some people.
  6. The 80/20 rule – stick to your meal plan 80% of the time and you can come off your meal plan and relax more around food 20% of the time. It is a normal and healthful way of eating – for example think how people eat in a more structured way during the week but eat differently at weekends.
  7. Keep some meals on that big day safe and normal. It may be you can have a normal breakfast and morning snack but then you have a large lunch with dessert. Listen to your body and your wise thoughts. Check out those feelings of fullness – are they related to your emotional fullness, your anxiety or your physical fullness? Use your knowledge and common sense to decide what else you need to eat for the rest of the day. 
  8. Restricting, purging or exercising after a big meal is not the answer. It may help you feel better initially but it won’t help your recovery in the long term. Find ways to distract yourself – crafty things can be good, get a mindfulness colouring book (all the rage right now it seems!), phone a friend, hang out with that family member you haven’t seen in ages, suggest a gentle post-meal walk with people. 

Relax a little.

Enjoy the moment so you can look back and be proud of you.

Keep recovery in mind and keep going one meal at a time.

If you need any support get in touch and we can set up a face to face or Skype consultation.

Dietitian UK: Surviving Christmas with an eating disorder 3

Filming – it’s a wrap “Good Enough to Eat”

This weekend has been busies that usual as I was asked to take part in some filming for a BBC2 new show. So as a family we travelled up early Saturday morning to the Chicago Rib Shack in Twickenham. 

Dietitian UK: Filming for Good Enough to Eat

Filming for me is something I quite enjoy and when done in a relaxed manner is quite easy and natural to do. See my top tips below if you are getting involved in any filming work.

IMG_0941

1. Do your research before hand. Find out what they want you to talk about, in what style and are there are key messages they would like you to convey. From this you can draft out your ideas or come up with a rough script.

2. Take a few outfits with you in case your first choice is not suitable!

3. Don’t expect it to be all glitz and glamour. You will probably have to do your own hair and make up and there can be quite a bit of standing around and waiting.

4. TV work is not usually well paid 😉

I spent 30 minutes talking, pointing and gesticulating towards a pile of red meat. What was great about this work was the opportunity to get a message out about red meat in a positive light, after the bad press.

IMG_0940

My top points were:

1. Red meat is fine to eat as part of a healthy. balanced diet and I would encourage it. It is all about that word “moderation” once again. The guidance is we can eat 500g uncooked weight of red meat a week, so think about having it 2-3 times a week.

2. Protein, iron, zinc, selenium, B vitamins and vitamin D are all nutrients found in red meat.

3. Red meat can actually help with some health conditions such as anaemia. It contains haem iron which is easier for the body to absorb and use than non-haem iron in plant proteins.

(This show won’t be aired until Spring 2016).

Why dietitian’s need to be blogging. The basics.

When I started blogging I had no real idea what I was doing or why I was doing it. I was dabbling and seeing what happened. I had a few friends who were blogging and told me I needed to get on it. So I listened and over the years I have learnt a lot. I’ve done things that have worked, I’ve done a lot of things that really haven’t.  So I thought it was about time I shared some of my tips.

Dietitian UK: Why dietitian's should blog

How hard is it to start a blog?

It really is about as easy as setting up your Facebook profile. I love WordPress and started out with a free account with them. There are templates and themes you can choose that will allow you to add some images and then you can go for it and start sharing your knowledge.

Why blog?

For me the benefits have been:

  • It is a great platform to use to share knowledge and recipes. I can then direct clients to my blog, send them certain links or I use my own recipes in people’s meal plans.
  • It raises your profile and gives people an idea of who you are and what you do. 
  • You can put examples of your work on there. I sometimes put up media work that I have done or a summary of a talk I have given.
  • The public are hungry for knowledge and there is so much incorrect nutrition information out there. We need to counteract this by sharing the right knowledge. Even if you don’t blog you can share other people’s work.
  • I’ve connected with brands, companies and people who I would not have met otherwise. Which can lead to work!
  • You can use some things as CPD.

The key components of a blog post:

  • Keep it short. Split a long post into a series.
  • Use pictures or video and label these. When you upload a picture name it as your own. For example I name things in this way: Dietitian UK – banana flapjack 1. Either take your own photos, buy one from an images site or create an image using a website such as Canva. Be aware that you cannot just use a random image off the internet as it may be copyright.
  • Blog about your interests, your specilialism and your passion. Add some of your personality in.
  • Add tags to your blog post, these are for when people search for a certain topic your post will be more likely to pop up. See right down the bottom of the post for my tags.
  • Share, share and share your blog post. Don’t hide it away once your have written it!
  • Try to blog regularly as then people get to know you and follow you.
  • Save your blog posts on your laptop or back up your blog.

If you are starting up a blog then do let me know as I would love to take a look at it and share it!