A few quick thoughts on the Ministry of Health Eating and Activity Guidelines for Healthy Adults

After over a year since the Ministry of Health asked for submissions to the draft food guidelines, they have finally announced an update. Undoubtedly they were waiting for the lead taken by the US who are in the process of updating theirs and, looking at ours, it’s a shame that New Zealand didn’t man up and take the lead from Brazil last year, who focused not only on food but non-food related factors related to eating behaviour, such as the eating environment, the social environment and food advertising. Anyway.

As in the first draft, there has been little more than just wordsmithing of the existing guidelines that were last updated in 2003 in this new document, the Eating and Activity Guidelines. While there is a paragraph on the end that recommends choosing ‘whole food’, (which is great, I do really like this), for the most part the guidelines remain largely unchanged from the existing ones and therefore aren’t in line with that recommendation.

While there has been an extended period of time between the original draft and now, and the guidelines say they are based on best available evidence, to my mind this actually is NOT evidence in some areas. As part of the Human Potential Centre we wrote a submission to the Ministry of Health and provided them some of this best available evidence. This hasn’t appeared in the final update. While unsurprising, it is still a bit disappointing.

The full guidelines are here and I just thought I’d give a quick summary of where I feel the Ministry could have improved the guidelines for the health of the population.*

Enjoy a variety of nutritious foods every day including:

  • Grain foods, mostly whole grain and those naturally high in fibre

Pasta and noodles and couscous and cereals aren’t whole grains. They may have been whole grain once (as they are grain products!) But they are FAR from whole grain despite what it says on the packet. Sorry. Regardless of whether they say ‘whole grains’ or not, there are few whole grains in the diet. Barley might be one. As Prof Mann from Otago has said ‘most wholegrains in the food supply aren’t intact and are equivalent to a bag of glucose (read this here for a dietitian’s view on the post – and then check out who his clients are or have been….cough cough).

With this in mind, and with two thirds of New Zealander’s categorised as overweight or obese, a growing number of people being diagnosed with pre-diabetes and type 2 diabetes (and many more estimated undiagnosed) it is perplexing that there is a focus on foods which are as nutrient devoid as the packaging they come in (i.e. pasta). Not all carbohydrate sources are created equal, and your naturally occurring carbohydrate sources such as potato, kumara, yams and fruit are far more nutritious sources of carbohydrates for people who can tolerate them. It’s not about ‘no carb’ – it’s about quality carbohydrate. The recommendation to include pasta, cous cous, bread and cereals –processed, refined carbohydrate foods – is in contradiction to the awesome recommendation to choose whole foods.

  • Some milk and milk products, mostly low and reduced fat

This is NOT the most up to date research. Many many epidemiological studies support the use of full fat dairy being beneficial for weight management, heart health, gut health in all age groups. Ministry of Health is scared to say ‘blue milk’ as it contains saturated fat (in context of whole food diet in normal amounts, this isn’t an issue.’ MOH should read my blog post on why full fat dairy has important health benefits that can’t be gleaned from low fat. And…. Full fat dairy is far more satiating than low fat. We feel fuller and are able to better manage blood sugar levels and with it mood, concentration and overall energy. We’ve been buying into the low fat message for far too long and it’s about time we kicked that to the curb.

  • Some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken) and/or red meat with the fat removed (Eat less than 500 grams of cooked red meat a week.)

A large proportion of New Zealanders are both iron and zinc deficient and red meat is the richest source of these nutrients, along with fat soluble vitamins and antioxidants such as Co-Q10 which play important roles in the health of our cardiovascular, digestive and musculoskeletal systems. Most dietary iron comes from breads and cereals which contain nutrients which bind iron and prevent absorption. There has been the recent IARC report suggesting that red meat is a carcinogen, and while it’s important that red meat intake is moderated to a palm size portion as part of a meal, it’s good to be aware of the critiques around the red meat issue (such as this and this). I do wonder, though, if there are differing health effects in populations eating red meat in places such as New Zealand, where our beef and cattle industry (predominantly grass fed, no antibiotics or hormones) is quite different from the hormone, grain-fed, antibiotic administered environment of that in the US.

In addition – as you know, it’s the processed meat that we need to be more mindful of. Luncheon and saveloys and chargrilled (burnt to a crisp) sausages on the BBQ should be avoided.

  • Choose and/or prepare foods and drinks with unsaturated fats instead of saturated fats (SAFA).

We’ve been over this a LOT I know – check this out and this out. Abnormal amounts of anything is going to tip the balance in the wrong direction health wise, especially in the context of a diet that is also high in refined carbohydrate. It can also be problematic for people consuming large amounts in the context of a real food, low carbohydrate diet actually. So it is individual. However there is a difference between consuming ridiculously large amounts (i.e. a bulletproof coffee for breakfast alongside bacon and eggs fried in butter) and encouraging people to choose butter (a minimally processed food) instead of margarine or other industrial seed oil spreads (highly processed) to sauté their green beans in.

In addition, while the guidelines say that it’s beneficial for heart health to replace saturated fat with polyunsaturated (PUFA) fat, I’ve asked some smart people about this and replacing SAFA (or any fat) in the diet with PUFA may only beneficial when the diet is deficient in nutrients such as antioxidants provided by the seed oil, or if the diet is deficient in PUFA (never really seen in New Zealand. Further, the real benefit comes from long chain omega 3 fatty acids (from fish for example) rather than seed oils, which are certainly beneficial for health, including heart, brain and vascular health.

So… while it’s great there is the inclusion of the paragraph that encourages the consumption of real food that is minimally processed (and on that most people are in agreeance), the continual promotion of grain-based foods, low fat dairy and plant-based polyunsaturated fats such as seed oils goes against this recommendation. I don’t know if this paragraph is merely a nod to the growing awareness the consumer is having with regards to their food (rather than a genuine recommendation) or a lack of understanding of what ‘minimally processed’ means. It feels like they have their feet in both camps, but it could only serve to confuse people who are navigating an already confused food environment.

*someone else much smarter and more articulate with more time could probably do a more indepth review.

What this nutritionist ate on Wednesday.

So after the Business Insider profiled the typical diet of a nutritionist this week, I got a number of people asking to see what I ate in a day. Happy to talk you through the photo essay that represented what I ate on the following day, a Wednesday. It’s a fairly typical ‘non-typical’ day for me. I have busy client days on Tuesday and Wednesday and if I’m not that prepared then it can end up a bit all over the place (as with most people). However I wanted to be genuine with it and not stage the perfect day. Because I don’t eat a perfect diet! Yes I follow the dietary principles that I advocate, but am pretty….normal?! If you follow me on Instagram then you’ve seen all of this before. What follows is going to be of no interest to anyone who isn’t interested in food or my general musings/setting the scene.

A bit of diet preamble: I would describe my diet as low carb,  healthy fat (LCHF). Not low carb high fat – the hangover from being an overweight teen/young adult and from preaching the low fat guidelines up until around four years ago. What does this mean? It means that if you come to my house for dinner then I’m unlikely to serve all of the vegetable dishes swimming in butter, cream, cheese or olive oil.  In fact, that kind of grosses me out to be honest. You might get one vegetable side dish like this. I will also typically drink my coffee black unless I feel a bit on edge for whatever reason, and I will have it with cream – I’ve tried to find some literature to support the idea that cream dampens down the cortisol response of coffee (which makes sense to me, as caffeine and other constituents of coffee stimulates insulin and cortisol) but have yet to do so. It also means that I no longer freak out if someone serves me a meal that DOES have the vegetables swimming in butter or coconut oil (and I will probably like it).  It means that I cook curry-type meals with coconut cream and not yoghurt, that I am no longer afraid to use more than a teaspoon of coconut or olive oil when I cook, that I add fat to my salads by way of mayonnaise or pesto. That I snack on cheese and that I add nuts and seeds to salad. That I don’t purposely buy food that has had the fat removed.

This may not be your LCHF diet, but for me it’s the healthy addition of fat in normal amounts (on my plate at least). If I was keto (as I have been before) then clearly this would be different.  It’s funny, there’s always backlash when I post a food that is (naturally) low in fat from the hard-out LCHF’ers. I use my ‘I know better than you’ nutritionist stance to remind them LCHF is a dietary pattern, not a food category. It doesn’t mean that every food you eat should be low carb, high fat. I prefer fresh and crisp, light and colourful, and I probably eat more of a ‘Zone’ type diet actually (if I was going to ‘label’ it in regards to macronutrient content). I haven’t put my food intake into an food database analysis to check this – but in my job you pretty much know things like calories, fat, protein, carb content of what you eat. Just like a personal trainer knows what muscles they are working when they do a set of mountain climbers. You don’t need a database to tell you the basics.

Anyway: this is what I ate on Wednesday:

  1. A tribute picture...forgot to take one at time so I staged this. You get the drift.

    A tribute picture…forgot to take one at time so I staged this. You get the drift.

    Up at 4.40am (yes, early! I channelled my inner elite athlete or morning radio host here) to do a longer run before an early client. I had a coffee (instant – Moccona. I have a Nespresso that sits on my bench that gets little use) and some coconut butter. I don’t always eat before a run, I base it on how I feel more than a schedule as such. Sometimes I eat before an easy run, sometimes I go fasted before a long run. I have coffee before a long run or a harder effort, and sometimes I have a teaspoon of coconut oil with the coffee. Alongside it, not in it. Not tablespoons of it blended with butter and labelled ‘bulletproof’, just a small amount. Perhaps more psychological than anything else. FYI this run isn’t a ‘long run’ in runners terms, but as I’m building up from Gold Coast many months ago, it was longer than normal.

  2. Sometimes I put psyllium husk in it. Not today.

    Sometimes I put psyllium husk in it. Not today.

    Two glasses of water, one of them with vital greens in it. The bonus of writing down what I’m eating is that I’m thinking about my water intake! (Women particularly shouldn’t just rely on the thirst mechanism to encourage drinking – while drink to thirst might be approrpriate for men, hormonal differences mean it may not be true for women. Anyway. Water FTW*

  3. It's v cool to ensure your feet are in pictures too right now.

    It’s v cool to ensure your feet are in pictures too right now.

    This is coffee – my travel plunger from Kathmandu that I’ve had for years AND LOVE IT. Yes it probably contains enough caffeine for 4 shots in here (!) but it is actually just for me. Sometimes I finish it, sometimes I drink just half of it. My question is: if it was meant for more than just one person, why put a sipper lid on it?! This coffee experience has ruined others for me though, as I demand a strong coffee, and like a lot of volume. Alongside this is a grapefruit custard thing that I’m testing as part of recipe development for my online nutrition coaching members. ½ grapefruit, an egg, ½ cup coconut milk, 2 tsp Great Lakes gelatin, 1 tsp psyllium husk. I also had a hardboiled egg alongside it. And (not shown) ½ a Canterbury bierstick (sorry I ate that before I photographed it). FYI The Canterbury brand has no nasties and, while sugar is in the ingredients, it is minimal – maybe 1.3g per 100g.

  4. Love this straw.

    Love this straw.

    Off to the Go Healthy Superfood launch. Get handed a smoothie tester made by one of my food heros Kelly Redmond (bonnie delicious blog). We have bonded via Instagram over a shared love of nutrition and health podcasts and she is as much of a geek as I am. The snoothie had cacao powder, date, almond milk, coconut water (I think?) and possibly another superfood super powder. I have about half of this. I’m not that enamoured by coconut water actually, so just put it to one side. I also have a couple of glasses of sparkling water.

  5. We've got zoodles, vegetable dips, raw cookie, a cacao brownie and some chocolate mousse.

    We’ve got zoodles, vegetable dips, raw cookie, a cacao brownie and some chocolate mousse.

    The recipes that we made as part of the launch. A tasting plate and there is no size distortion in this picture. It’s a small plate. FYI recipes developed by Kelly and Mon from The Snack Pack – she’s the creator of Amazeballs and has made a lower sugar Amazeball (a woman after my own heart). I’m not a big fan of raw treats that are heavy on honey, dates and the like – obviously from the ‘health halo’ perspective of ‘no added sugar’ but I’m mentioning it here not from a zealous nutritional stance, but just a taste preference actually. Another cup of water.

  6. IMG_1190Back up to the clinic in Ponsonby to have a quick snack before clients. Have a small cucumber with a couple of eggs. I also have a glass of water here. Normally I would have a salad actually, but I wasn’t sure if the launch was going to be lunch, or if it was going to be smoothies, or completely sans food, so I prepped some additional food just in case. Yes, those counting would see this is four eggs in one day. I don’t always eat four of them (as I try to vary my protein), however I do love them and they are super easy to just eat like this, so it’s not a major. This isn’t ‘lunch’ per se as it’s not big enough to be a meal – more like (along with the tasting plate and below) one of a series of snacks.
  7. The zucchini in a smoothie is an idea from Sarah Wilson. Makes it smooth and thick and adds vegetables. #winning

    The zucchini in a smoothie is an idea from Sarah Wilson. Makes it smooth and thick and adds vegetables. #winning

    Home to have a smoothie as the random eating pattern has made me hungry today. Usually I wouldn’t normally snack this often, and more often than not I don’t snack  – but if I’m hungry then I will eat. I’m also thirsty so this is perfect. It has cacao powder, zucchini, a cup of almond milk, a tablespoon of protein powder, some psyllium husk. I also have ½ a boerwors stick (found this Mrs Grills no nasties one at my local fruit and vegetable shop. Really hot though!!)

  8. IMG_1196I meet friends for a quick drink before dinner. I generally have 1-3 glasses of wine across the week. Not normally on a Wednesday.
  9. The usual.

    The usual.

    This is pretty standard and I love eating like this. Leftover chicken with assortment of vegetables (brussels, carrot, pumpkin, tomato, zucchini, red cabbage, avocado, almonds, carrot dip and babaganoush (both homemade), homemade mayonnaise and Be Nourished Ruby Raw Kraut. If not chicken (and rarely chicken breast) then it will be beef (mince, burgers), salmon (smoked, fresh), pork (belly, mince), lamb (roast, mince), liver (chicken or beef). I very rarely have vegetarian meals (unless doing some recipe development) and my days at Weight Watchers has put me off The Stirfry for life. It would be a rare event where (at home) I wouldn’t have a salad of some description. Weirdly I wouldn’t have canned salmon, tuna, eggs or sardines for dinner. Nothing wrong with that though – it’s almost like they aren’t on my radar past lunch. Of course if you serve them to me as part of a meal then I’m sure I will enjoy it immensely. I don’t often have steak as I have little confidence around cooking it. I’m no chef – more a food hack.

  10. IMG_1201After dinner treats. 99% of the time I eat a sweet treat after dinner because I enjoy doing it. This is a couple of squares of chocolate and some leftover genuine sugar free treat I made which is seriously delicious. I would often have some peanut butter and coconut after dinner if not chocolate. Yes that is a Starbucks cup. A different one from the one at the start of the day. I love these as they are big and hold a good volume. And cute too. I have a San Fran, a New York and a Los Angeles one.

So there you have it. Nothing was staged, this was my food for this day.  Unlikely to be interesting enough to go viral or to be picked up by a digital magazine (:-) – I mean these pictures are pretty dire even by MY standards). It reflects an ‘atypical’ day but gives you an idea of the choices I make on a day to day basis. I don’t avoid dairy but there’s none in my food intake for this day. I would definitely have a bigger lunch on a ‘typical’ day. I don’t avoid fruit either but I would probably eat more fruit during the summer months. I can’t think of any other disclaimers to add other than, like all posts such as these, it’s not up here for you to emulate (like I said, it’s not perfect! Not that I expect you to be perfect) as we are individual as to our nutrient, energy, meal, allergy requirements. General tips would be:

  • Include protein in all meals and snacks
  • Add fat for satiety and/or include fattier sources of protein
  • Your better sources of carbohydrate are always the starchy (potato, kumara, peas, corn) and fruit as opposed to pasta, bread, crackers etc. Your requirements for this are on a sliding scale from ‘none’ to ‘fist- 2 fist size’ depending on activity, metabolic flexibility (ability to burn fat as a fuel source), metabolic health, energy, mood….
  • Include vegetables where possible and I know you’re thinking Try for 5 or 5+ a day. Back yourself. Why not 8?! Your meal ideally would be based on an abundance of vegetables. As those over on Instagram like to boast #morevegetablesthanavegetarian

* FTW = for the win