#winter, dietitians, Easy Recipes, eating well being healthy, Money Saving, Soup, vegetarian, vitamin D

Vitamin D

Winter is HERE. What now?! Stay healthy and don’t forget about Vitamin D.

Hi everyone! In our last post we covered Vitamin C. So I’d like to chat about Vitamin D next – are you getting enough?  Vitamin D has a vital role in the body.  A fat soluble compound, its responsible for increasing the absorption of calcium, magnesium, phosphate and zinc in the intestine and its essential for strong bones, muscle and immune system.  Vitamin D plus calcium supplementation effectively reduces fractures and falls in older men and women. Vitamin D is measured in International Units (IU) or micrograms (15 μg) per day and it is recommended to have:

–     600 IU (15 μg) per day for people aged ≤ 70 years; and
–     800 IU (20 μg) per day for those aged > 70 years.

Whilst most Vitamin D can be obtained from exposure to sunlight, but when sun exposure is minimal, vitamin D intake from dietary sources and supplementation should be monitored regularly as deficiencies can cause bone and muscle pain, and have a negative effect on the immune system.

Mushrooms are one of my favourite foods which are also rich in Vitamin D. There are several different types which you can use in different ways to improve the Vitamin D content of your diet., from shitake (chinese) mushrooms in stirfry to porcini in risotto and the classic button is always good on toast for breakfast. So much variety.

Exposing 100gm of mushrooms to sunlight for one hour will generate your daily needs of Vitamin D. winter sun for an hour will generate your daily requirement of vitamin D. The Medical Journal of Australia recommends “for moderately fair-skinned people, a walk with arms exposed for 6–7 minutes mid morning or mid afternoon in summer, and with as much bare skin exposed as feasible for 7–40 minutes (depending on latitude) at noon in winter, on most days, is likely to be helpful in maintaining adequate vitamin D levels in the body.”  Most people only get five to 10 per cent of their vitamin D from food. THATS RIGHT. Only 10 per cent. So its important to GET OUTSIDE and get some sun.

There are a number of other foods which contain Vitamin D naturally such as oily fish, and eggs but it is difficult to obtain enough vitamin D from diet alone so make sure you get some sunlight each day as well as these food types.  Margarine and some types of milk have added vitamin D.

People in high-risk groups may require higher doses. See your Dr if you are concerned about your Vitamin D levels.

One of my favourite winter dishes is soup so heres a recipe for Mushroom soup courtesy of the Australian Healthy food guide magazine.

Creamy mushroom soup

Recipe courtesy of Liz Macri of the Health Food Guide magazine.

Serves: 4
Time to make: 55 mins, prep 25 mins, cook 25-30 mins
See more at: http://healthyfoodguide.com.au

Ingredients

  • Olive oil or vegetable oil cooking spray
  • 400g button mushrooms, thinly sliced
  • 200g Swiss brown mushrooms, thinly sliced
  • 1 brown onion, thinly sliced
  • 2 cloves garlic, crushed
  • 1 tablespoon fresh thyme leaves
  • 1/4 cup plain flour
  • 4 cups reduced-salt vegie stock
  • 1/2 cup light thickened cream
  • toasted wholegrain bread, to serve

Instructions

Step 1 – Spray a large saucepan with oil and cook mushrooms over high heat, stirring, for 5 minutes, or until softened. Remove and set aside.

Step 2 – Spray the pan with more oil and cook onion, garlic and half the thyme over medium-high heat, stirring, for 5 minutes. Add flour and stir to coat. Add stock and mushrooms. Bring to the boil. Reduce heat to low and simmer for 10–15 minutes, until soup has reduced slightly.

Step 3 – Blend soup with a stick blender until smooth. Stir in 1/3 cup light thickened cream. Gently simmer for a few minutes. Divide soup among bowls, swirl through remaining cream and sprinkle with remaining thyme. Serve with toast.

Variations – Use any mixture of mushrooms. Try flat mushrooms or use more Swiss browns for a stronger, earthier flavour.

Nutritional information (per serve)

Kilojoules:  1,070kJ   Calories: 256cal

Protein: 14.2g                        Total fat: 7.9g

Saturated fat: 4.2g    Carbohydrates: 29.2g

Sugars: 6.8g               Dietary fibre: 5.7g

Sodium: 795mg         Calcium: 37mg

Iron: 1.1mg

References/Further Reading:

  1. Vitamin D and Health in adults in Australia and New Zealand – a position statement. Nowson, McGrath et al (2012): https://www.mja.com.au/journal/2012/196/11/vitamin-d-and-health-adults-australia-and-new-zealand-position-statement
  2. Sunlight and Vitamin D for bone health and prevention of autoimmune diseases, cancers and cardiovascular disease. Holick MF (2004): https://www.ncbi.nlm.nih.gov/pubmed/15585788
  3. Vitamin D and Healthy Living – Vic. Government Website https://www.betterhealth.vic.gov.au/health/healthyliving/vitamin-d
  4. Australian Mushroom Council http://www.australianmushrooms.com.au/
  5. Healthy Food Guide Magazine http://healthyfoodguide.com.au/recipes/2010/july/creamy-mushroom-soup

 

 

 

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#winter, dietitians, vitamins

Eating Well and Keeping Healthy – Vitamin C

Its officially Autumn in Australia now.. and Winter is coming. Its been confusing here in Sydney as its quite warm and humid, yet overcast and rainy. It feels like a non congruent fashion trend, mixing two patterns, which has everyone confused! But thats our weather right now. I’ve been kept busy at work and went to Melbourne last week for an Oncology study day at Peter MacCallam Cancer Centre, my visit there got me thinking more about nutrition and the basics as I often get asked about these things on a daily basis by patients going through their treatments. One big question I have had a lot lately is around vitamin supplements. Can they help or are they just expensive placebos?

I am going to discuss a series of Vitamins starting today with VITAMIN C.

Vitamin C or L-ascorbic acid is a water soluble vitamin present in fruit and vegetables and it was previously associated with Scurvy, or sailors disease. Without access to any fresh fruit or vegetables – the human body cannot synthesise vitamin C by itself because it lacks an enzyme called L-3 gulonolactone oxidase to do so. In Australia around 40% of vitamin C we eat comes from vegetables, 20% from fruit, and around 30% from fruit juices. The body generally has stores to last 4 weeks before it shows early signs of deficiency. These can be very subtle and often be mistaken for feeling under the weather or being tired so often people do not check in with the doctor until much later. In Australia for adults aged 19-70 the Recommended Dietary Intake is 45mg of Vitamin C per day and any excess is usually excreted through the urine. There are different recommendations for children and pregnant women. (Reference: Nutrient Reference Values for Australia and New Zealand )

Vitamin C deficiency can take awhile to develop but it can be diagnosed by blood test with your GP. High risk groups for this are the elderly, people on restricted diets without access to much fresh food, or those who use drugs or alcohol regularly. Vitamin C is important for keeping your skin healthy and has a role in wound healing, keeping connective tissue and bone healthy, and assisting in the absorption of iron from food. It has also been found to have a role in cold and flu prevention.

A Cochrane review exploring the role of daily supplementation of 0.2g/day (or 200mg/day) or more  published in 2013 on Vitamin C for prevention and treatment of the common cold showed:

  • regular supplementation had no effect on common cold incidence in the normal population (based on 29 trial comparisons involving 11,306 participants);
  • regular supplementation had a modest but consistent effect in reducing the duration of the cold symptoms (based on 31 trial comparisons involving 9,745 participants); and
  • in 5 trials involving 598 participants exposed to short periods of extreme stress (including marathon runners) – the incidence of the common cold was halved.

Other research into high dose vitamin C supplementation has shown that taking 1000mg/day for the first few days of a cold can reduce the duration by about half a day – but not stop you from developing one. Long term high dose vitamin C supplementation above this amount may also be dangerous to your health and should be discussed with your Dr as it may affect other minerals stored in the body like iron. Absorption of vitamin C is also dependant on the dose –  a 250mg dose four times daily is more likely to be better absorbed than 1000mg once a day. So its always best to talk to your Doctor before you start any new supplement routine. (Reference: Nutrient Reference Values for Australia and New Zealand )

Finally, there are insufficient studies into high dose supplementation for people undergoing specialised treatments such as chemotherapy at this stage.

Vitamin C can be found in:

  • tropical fruit (pineapple, mango, kiwi, papaya)
  • citrus fruit (oranges, lemons)
  • berries (strawberries, raspberries)
  • vegetables (capsicum, brussel sprouts, broccoli, kale, cauliflower and other brassica cruciferous veggies)

Read more about these veggies in a fun article written by Stephanie Eckelkamp here via Prevention Magazine. Having a plant based diet aiming for 2 fruit and 5 vegetables per day is sufficient to obtain suitable Vitamin C levels over taking a supplement. These fruit and vegetables also contain other vitamins and antioxidants which can be positive for your cardiovascular system, and fibre for your digestive tract. But many people know they are not eating enough nutrient rich foods so take a supplement as they work on their diet. Vitamin C supplement are fairly inexpensive compared to other supplements, however there is much more to be gained from sourcing and cooking something fresh for you and your family.

So as always, a healthy,  diet with plenty of fruit and vegetables will help to keep the system functioning well even when its getting cold outside!!

 

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Accredited Practising Dietitians Vs. Nutritionists. What is the difference, you ask?

Why APDs should be the specialists of choice for people needing advice for medical conditions.

Dietitians (or Dieticians) are highly trained individuals and we are specialists in the application of medical nutrition therapy. This year  it has been 10 years since I qualified from the University of Wollongong in Australia. Here in Australia, we study either a 4 year undergraduate degree in Nutrition & Dietetics straight out of high school – or if you are like me, a combined Undergraduate Science and Business degree, and then a Masters degree in Nutrition & Dietetics + research thesis.

Much of our Dietitian training centers around medical knowledge, scientific research around nutrition, and taking individual dietary histories, action planning and solution designing for an individual depending on their medical condition and nutrition status. We study the human body and biochemistry as well as metabolism and food in order to get a good understanding of the role nutrition can have to protect against illness and in reducing the progression of medical conditions like obesity and diabetes. We also train in hospital before we graduate.

As a dietitian working in hospital, I see a variety of clients from different areas and it is never the same day twice. Our work in hospitals is a given since we know malnutrition can be a consequence of hospitalisation or long illnesses.

Today for example, I was referred a client by one of the Geriatricians I work with for optimisation of energy after she was admitted to hospital quite weak, and having been unable to eat for several days at home.

She is on several different types of medication and has a cancer of her bile duct which has affected normal food digestion and absorption. We discussed her usual weight, diet and made a plan for her to preserve her en

ergy, muscle mass and strength.

She was great in that she was able to eat still, compared with some other patients who might require feeding via a nasogastric tube or special intravenous like drip called Total Parenteral Nutrition (TPN).

Contrast that with this afternoon and I have just seen a 50 year old male client who had an elevated Glucose Tolerance Test for weight loss with a background familial late onset diabetes. He is otherwise well and healthy, and wants to lose weight to allow him to be fitter and healthier. He told me that his personal trainer yelled at him for eating muesli in the morning because of the sugar content. I find this pretty unreasonable advice especially given that this client is bordering on type 2 diabetes but it is not uncommon for Personal Trainers to provide restrictive dietary advice. He needs the right advice to navigate his current situation and a meal plan which can provide nourishment and reduce the risk of advancement to diabetes, which unbalanced eating can sometimes do. This client is already feeling tired given his health status, and was considering restricting his intake of breakfast until he came to see me today.

avo-affirmations

Nutritionists, which have more of a whole food approach, might work more at a general population or public health level, or on a project basis within a food company. Nutrition Australia has a voluntary register for nutritionists which you can check out here http://www.nutritionaustralia.org/national/resource/nutritionist-or-dietitian

The Nutrition Society of Australia does too, look one up here http://nsa.asn.au/find-a-registered-nutritionist/

Nutritionists can study at the University level, and I became a Nutritionist before I became a Dietitian. Usually a Dietitian is also qualified as a Nutritionist, but it is never the other way around. Today there are many Tafe style, Diploma level courses offering qualifications of sorts which do not give the same level of academic vigour and scientific inquiry into Dietetics as a 4 year undergraduate University degree, or Graduate level qualification, however this title is not protected by any laws here and therefore this means that anyone could call themselves a Dietitian even if they are not someone who has gone to University, done the study, and qualified for their degree without being prosecuted for doing so.

Even though our title is not protected legally, our credentialing body, the Dietitians Association of Australia keeps a register of all Accredited Practising Dietitians (APDs) and holds us accountable for our work. We also have to complete a mentoring program to qualify as an APD when starting out, and then we must complete 30 hours of professional development education each year to retain our credentials. See this link to find an APD in your area. http://daa.asn.au/for-the-public/find-an-apd

I’ve been very lucky and been able to travel and work in other countries since qualifying for my degree back in 2006 from Wollongong University. In the United States, there are licensure laws which exist within the individual states to reassure consumers that they are accessing dietary advice from individuals with an the right education and experience. Their system is different depending on the state and the licensing laws around the Registered Dietitian credential. I worked pro bono and did a lot of voluntary work in the US in my travels there, and did not work in hospital as I did in the UK., so my work there had more of a public health and community focus. I learnt a lot from these experiences and I loved my time in the United States.

In the United Kingdom, the term Registered Dietitian (RD) is protected by the Health and Care Professions council and anyone using this title without the relevant qualification to match it could be subject to prosecution and a fine of up to 5,000 pounds. Read more about it here https://www.hpc-uk.org/aboutregistration/protectedtitles/

Overall, reflecting on the last 10 years, I can definitely say that my education began when I first stepped onto University grounds and it has continued each year since with every different role I have undertaken both here and in the UK. I relish my role as a Dietitian and it is always a pleasure to assist people to optimise their health and live happier and healthier lives.

The final point about dietitians vs. nutritionists are that we are recognised by Australian Health Funds, Medicare, and the Department of Veterans affairs and have item numbers we can use under Medicare. Most comprehensive health funds cover dietitian visits as well with some funds paying up to 55% back on our fees. The sad thing is that some health funds have started to cover nutritionists and naturopaths now, not only dietitians as they once did. Shame on you health funds.

So before going to visit someone who uses either of these terms, check if they are registered with an appropriate credentialing body, check your health fund and your coverage level. But most of all, enjoy the experience. We are here to empower and assist you to optimise your nutrition.

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