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Welcome to this article, which today is about eating, in particular, the new Australian Dietary Guidelines. Coming to you on the Rural Health Channel. I’d like to acknowledge this program’s broadcast from the land of the Wangal people of the Darug tribe, traditional custodians of the land and part of the wider Aboriginal nation known as the Eora. We acknowledge their elders, past and present. You’re all interested in eating. This is not just for health professionals. Anybody watching can phone up and ask questions, make a comment, via phone, text, email or fax. The details are coming up on your screen. Send your emails to: You can text us on: Or give us a ring on: And we’ll put you on air. Or you can tweet us, using: So make a comment, ask a question any time you like, and our expert panel will answer them.
Let me introduce our expert panel. Amanda Jones is an accredited, practising dietician from Victoria. – Welcome, Amanda. – Thank you. Amanda Lee is professor in the School of Public Health and Social Work and School of Nutrition and Exercise at Queensland University of Technology. – Welcome. – Good evening, Norman. Caroline West is a general practitioner from Sydney who specialises in lifestyle medicine and alternates with me on the program. – Welcome. – Nice to be here. And Fiona Smith is an accredited practising dietician from Grafton in rural New South Wales. – Welcome, Fiona. – Thank you, Norman. Welcome to you all. Caroline, why do people come into the surgery talking about eating? We’re all obsessed. You’re a lifestyle doctor. Do you tell them just to get a hold and go home?
More so than ever, people are interested in food and nutrition, but they’ve got to wade their way through a lot of information. Some of it sensible, and some of it less so. Often their entry point to see a dietician or a doctor will be all about their weight. They’re interested in enhancing their health, but also in trimming their waistline. My impression is, people are focused on individual nutrients – the selenium, the antioxidants. I think that’s true. People get very interested in micronutrients. But that’s only part of the story. My approach with people is always about wholefoods. I try and engage them with this concept of – wholefoods is often the way to go. Micronutrients are important, but wholefoods offer the whole package.
Fiona, what do you think the biggest myths are that people come in to see you with? One diet that is particularly popular is low-carbohydrate diets or the Atkins diet. That’s my diet! Not the Atkins, but low-carbohydrate. It’s poison, isn’t it? Unfortunately, it’s completely inconsistent with the dietary guidelines we’re talking about. I’ll just leave now, then. It excludes the grains and cereals group completely. They’re an important source of fibre and other nutrients. It excludes fruit, starchy vegetables, most of the dairy food group, with the exception of cheese. You’re left with high-saturated fat – which we’re not recommending – low fibre, low calcium. Basically, not a good diet to be following. I’m on a certain program on Channel Ten sometimes, and it always astounds me how little people know about common foods. We once did a competition to identify common vegetables, and they couldn’t identify a beetroot. – Really? – You don’t find that? You’ve got much more intelligent consumers in Grafton in Northern New South Wales. When they come to me, they pretend… They’ve already been beaten up. Do you find many myths out there, Amanda? Probably not a huge amount of myths. Lots of people, when they’re seeing me, they actually try and cover some of their myths. They’ve gone through a bit of a screening process. They come to light later on as you’re talking. Definitely, that carbohydrate fear is quite common. No fat fear? I think people are getting more well educated. They’re getting to know what the better fats are, so, using mono and polyunsaturated fats, knowing how to incorporate avocados and nuts and things and avoiding the saturated fats. That knowledge is definitely coming through with my clients. Amanda, these dietary guidelines, why do them? Don’t people know what to do? We’re not hearing too strong a mythology from our panellists. The trouble is that there’s many, many papers written about what we should be eating, every year.
The National Health and Medical Research Council every five years undertakes to review the scientific evidence that explains not just the foods we need for health but what we need to do to avoid getting diet-related disease into the future. Caroline, to what extent is disease diet-related? I think there’s increasing evidence that the links are incredibly strong. If we look at prevention of the big-ticket items – cancer, heart disease, stroke, diabetes – there are very strong links with your lifestyle. What you eat, how much you exercise, your basic lifestyle package makes an enormous difference to how well you’ll live. So it’s total calories, but also what you consume? Yeah. The calories thing is a bit of a distractor. It’s the quality of the food that you eat. So much of our diet is taken up with essentially junk foods. People might be eating a reasonable number of calories, but the percentage of the day where they’re eating snacks, processed foods, on-the-run meals that are less nutritious is increasingly a problem. What did you do with this volume – 50,000-odd papers every year on nutrition?
It actually took four-and-a-half years to do this set of guidelines. – Did you read them all? – Oh, I know them all. Of course you do. There’ll be an exam later. That’s a strength and a weakness of the process. 50,000 papers reviewed to find the evidence around what Australians should eat. – You’re joking? Oh, God. – No. When you consider that people write whole books after reading three papers, it gives you an idea of the amount… – That’s what I plan to do. – (All laugh) That’s exactly why we need the dietary guidelines. They’re a way of translating very complex scientific evidence into ways that people can understand the foods that we’re meant to eat for maximum health. How does it differ from the previous guideline? There’s been a lot of strengthening of evidence. We’ve got stronger evidence that sugar-sweetened beverages are associated with excess weight gain in children and adults. That’s probably because there’s something about taking liquid calories that means we have that in addition to foods we eat. There’s really strong evidence now about the health benefit of fruit. In the past, a lot of research was done into vegetables. We know they’re associated with decreased risk of most cancers and of Type-2 diabetes, but fruit is particularly important. We know now that every additional serve of fruit we have decreases the risk of cardiovascular disease. That’s particularly important for men because men don’t seem to eat enough fruit in Australia. She’s looking at me when she says that. Certainly, Norman. – The other interesting thing… NORMAN: It’s carbohydrate? ..picking up from what Caroline said about wholefoods, when you look at milk and yoghurt and cheese, most viewers would probably be interested and a bit surprised to find that their consumption of those foods is associated with decreased risk of cardiovascular disease and stroke. NORMAN: Do we know why? –
Most research done in the past took the saturated fat out of those foods and found that it was associated with cholesterol. But when you’ve got all the foods together, the whole dairy food… NORMAN: Something happens. – ..something protective, something else in the foods. Caroline calls it Factor X. We don’t know what it is. But there’s something very special about the way that foods interact. It’s probably not surprising that food has become the most essential variable when we’re looking at diet, rather than nutrients. Take us through the structure of the guidelines. If we go onto the website, how does it get broken down? How do we think about it? What are the rules? OK. We’ve got five rules. The first one is about maintaining a healthy weight, so being sure to balance the amount of food that you eat with physical activity and other forms of energy you have. That can be hard for people. To a certain extent, the rest of the guidelines provide an easy prescription for that to happen, so we’ll go on to the second one. The second one is the foods we need to eat more of. Most Australians don’t eat enough vegetables, fruit, wholegrain cereals – all sorts of cereals, like rice, pasta, breakfast cereals as well. We don’t eat enough dairy foods, milk, cheese and yoghurt, particularly the reduced-fat varieties, and we don’t eat enough of meat and alternatives. Some Australians, like men again – poor men – eat probably 20% more red meat than is associated with optimum health outcomes. That’s associated with colon cancer and heart disease. It is. But a lot of young Australian women don’t eat nearly enough meat, so conditions like anaemia are prevalent. I notice in the guidelines, you no longer talk about ‘balanced diet.’ No, because our research shows that when you talk to people about ‘balanced diet,’ they sort of mean, half junk and half healthy stuff. The balanced diet we’re talking about is the wholefood groups, which really should be most of the Australian diet. – What’s number three? – The foods we should eat less of. These are foods associated with adverse health outcomes. They’re foods high in saturated fat, added sugars, added salt and alcohol too. It’s easier to talk about those foods in terms of different types of foods like biscuits, cakes, pastries – all those chips and snacks and things that people love to fill up on between meals. The sugar-sweetened beverages I talked about, the particular problem there isn’t just soft drink, it’s energy drinks, vitamin waters, ‘play waters’.
A whole plethora of sugar-sweetened drinks are hitting the market now. Then avoiding fatty foods such as sausages and wursts and salted foods like that. – And number 4? – Number 4 is promoting breastfeeding, a really important start to life and important to reduce the risk of weight gain in later life. There’s much stronger evidence about the benefits of breastfeeding now. NORMAN: And food safety? – Food safety is really important. Foodborne illness still is a major contributor to burden of disease in Australia. We’ve really got to learn how to better… ..to prepare and store food safely. Remember, if you want to ask a question or challenge us on an aspect – the supplements you’ve got in the cupboard, should you be taking them – or want to argue that we should be taking them, why don’t you give us a call on 1800 817 268? Or you can text us on: And you can email us at: Keep those questions coming in. Caroline, let’s go back to the beginning of these, not the balanced diet but the energy balance. What’s the exercise equation? It’s hard to exercise as much to counter what you eat. Definitely. What we’re up against is a sedentary lifestyle. Most of us are sitting on our bottoms for a bigger part of the day. We’re planning less exercise. It means we’re probably expending less energy. Even though the amount of energy going in, in terms of what people are eating, if we track that, often people only consume the equivalent of a chocolate biscuit more per day, but over the length of years, that little chocolate biscuit or the equivalent just adds up to this gradual, slow weight gain. You only need small differences in how much you’re taking in and how much you’re burning off to lead to long-term weight gain. If you’re looking at exercise alone to be your saviour… NORMAN: It’s not going to happen. – Not usually. You’ve really got to focus on nutrition as well. A lot of people join a gym and hope a miracle will happen in terms of their weight. They’ll certainly get fitter and healthier, but in terms of losing weight, you have to focus on what you’re putting into your mouth. It’s your get-out-of-jail on a binge day rather than anything else. Amanda, what are your techniques for motivating people to change? We’re asking people actually to take quite a big change. We’ll come to statistics in a moment, but they’re not good in terms of how we all comply with what is a good eating pattern. The small, little changes are the most important things. Making a plan, having something that people can achieve that is relevant to their current diet. It might be just swapping from white bread to a wholemeal or wholegrain bread. Maybe just one small thing that they think, ‘I can do that.’ Starting with the little things can be really important. So give me the argument. A move from a white bread to a wholemeal, what’s that going to do for me? It’s going to give you more vitamin Bs and higher fibre. The fibre will help fill you up and keep you full for longer. That will mean you may not end up with that chocolate biscuit at morning teatime. And decrease your risk of cardiovascular disease. Fiona, I get a bit panicky when I have this conversation. It’s only dieticians who stick to these diets. You all look so thin and wonderful. I get panicky that my appetite is out of control. How do I get it under control? You’re going to tell me to balance my diet during the day. How do I do this? The foods we are recommending will fill you more than other foods. This is your promise to me? – This is my promise to you. –
(All laugh) The higher-fibre foods are going to fill you up. You are going to eat less of them. If you start the day with a higher-fibre cereal as opposed to something like rice bubbles or cornflakes – they’re low in fibre, they won’t fill you up – something that’s higher in fibre like Weet-Bix, All-Bran something like that, or wholemeal or grain toast, you’ll be full for longer. Hopefully, you’ll need less morning tea. We get to lunchtime, if it’s a higher-fibre food, maybe with vegetables or salad, so there’s a lot of bulk. There’s very little calories from vegetables or salads, so you can eat quite a big volume of those foods without putting weight on. But on the other side of it, don’t we have to relearn how to be hungry? You’re going to feed me on a regular basis, and we’ll come to this meal plan you’ve designed for me, but don’t you have to learn only to eat when you’re hungry? You want to be a little bit hungry at mealtimes. NORMAN: Not fridge-raiding hungry. – Exactly. When you’re fridge-raiding hungry, you won’t look for healthier foods. You’ll go for whatever you can get your hands on quicker. It takes 20 minutes for your brain to realise that your stomach is full. NORMAN: Try an hour. – (Some laughter) Within that hour, imagine how many chocolate biscuits you can fit in. That’s not very helpful for weight control. We’ve had a question, Amanda, about the GI diet and the extent to which you think through the glycaemic index of what you’re taking. You told me to go from white bread to wholegrain. That’s also a move down in GI and less sugar going into your blood. Does this overlay it all, or do we not worry about that? We need to think about wholefoods first. We need to think about, is it a healthy food choice? Does it fit within the dietary guidelines? Then if you want to narrow it down and talk about glycaemic index, that’s fine. But you need to start with – is it a healthy food? Because then you’re going to get your nutrition from it. The GI doesn’t actually matter as much when it’s a healthy food choice. For example, white potato is a higher-GI food but it comes down to including it in a reasonable portion, then the GI won’t actually have a huge impact. It’s about enjoying the whole range of wholefoods. There are some paradoxes. Yeah. Some chocolate bars will be low-GI and some fruit and vegetables will be officially listed as high-GI. It doesn’t make sense to not use your common sense, and go, ‘If I eat all these low-GI confectionery bars, that’s not going to be healthy for me in the long term.’ We can get very distracted by the labelling. There’s also a food-industry imperative to manipulate some content of the food to get it into a category, whether it’s a low-GI category or whatever, from the point of view of encouraging sales. We have to use common sense with GI. It’s very useful to look at GI, but there’s a lot of confusion. A lot of my patients go, ‘I’m not eating that watermelon. I’ve read it’s high-GI.’ It doesn’t affect your blood sugars in a bad way, so I encourage people to forget the GI when it comes to fruit and veg. NORMAN: You won’t eat watermelon every day anyway. Not the volumes that would be required to have an impact. It’s a really healthy choice.
I encourage people to look at fruit and vegetables as being these wonderful superfoods. Does the food pyramid still exist in this new guideline, Fiona? We’ve actually got a round-plate model now. It was decided to use the round model because people eat off a plate, so they relate to that more than the pyramid. NORMAN: Let’s have a look at it. Have we got a larger shot? NORMAN: Yes, there we go. The wonders of modern television. We happen to have a larger shot. Talk us through the plate. FIONA: The orange section is breads and cereals. NORMAN: Top left. – Yeah. We’re recommending about a third of your daily intake comes from breads and cereal foods and hopefully wholegrains. Indirectly, the guidelines recommend lower-GI foods, but they’re not using the term GI. They’re saying things like, ‘wholegrain cereals.’ Next to that, the dark-green section. That’s the vegetables. NORMAN: Top right. FIONA: We want a third of our daily intake coming from vegetables – about five serves of vegetables a day. NORMAN: We’ll return to what serves are. FIONA: No worries. NORMAN: It’s the opposite of alcohol it’s more than you think. – (All laugh) FIONA: That’s right! Below the vegetables, we’ve got light green, which is fruits. We want about two fruit serves a day. Previously, in the pyramid, they used to put the fruits and vegetables together. Now they’re separated out. We want more vegetables than fruit. In among the fruit, the remaining third is also dedicated to the purple section, which is the dairy foods. That would be milk, yoghurt and cheese, hopefully the lower-fat varieties and the lower-salt cheeses. In the blue section we’ve got our lean meats – skinless chicken, fish and alternatives such as eggs, legumes and nuts or tofu. Can I ask a question? I notice that on that plate, in each section, you have a lot of different choices. What was the thinking behind that, rather than putting fruit in one section, veg in the other? It’s full of little suggestions. That was done on purpose. Australians come from vast different cultures and there’s a wide range of eating. These models in the new dietary guidelines are made to be more flexible than previously. Part of the idea about showing the multiple different choices that people can make within each food group is to support that flexibility so that there’s a wide range of options for people of all different cultural backgrounds and groups and age and sizes and food preferences. There should be something there for everybody.
We’re talking about eating patterns now, rather than individual nutrients. Did you consider recommending the Mediterranean diet or the Asian diet? Based on this food pattern, you can choose a diet that some people would call a Mediterranean diet. The problem with the Mediterranean diet is… There’s no one Mediterranean diet. You can have a really good summer holiday trying it out. There are lots of countries in the Mediterranean – just pick one. You could choose five different Mediterranean diets within the food groups here. We also modelled Asian-style eating patterns. If you choose rice, Asian-style vegetables and tofus, et cetera, they actually suit a wide range of cuisines. What about, Amanda, processed foods? We are consuming huge amounts of salt, causing high blood pressure. Recent systemic reviews suggested we could cut stroke risk by 24% just by limiting our salt intake. And if we increased our potassium through your vegetable bit, we would reduce our blood pressure. And it’s processed foods we’re getting salt from, isn’t it? Definitely. 75% of our salt comes from processed foods. Not that we recommend salt on the plate or in cooking, it is coming through manufactured foods. You really need to be mindful of manufactured food. The new guidelines do have suggestions about looking at labels and trying to reduce salt. It’s less than 120mg per 100g? That’s a really great choice if you can find that. The lower the better. Sometimes that’s challenging to find. There’s also controversy about what is wholegrain? If it says ‘wholegrain’ on the label, it’s not necessarily wholegrain. This is in processed foods. I would be looking at the list of ingredients. The list of ingredients is really quite useful. It’s like a recipe for what is included in a product.
If, at the top of the list of ingredients – the majority of the product – you’ve got oats or whole-wheat, rice, barley, you would be knowing that it’s wholegrain because those ingredients are. If the start of the list is saying, white flour or those types of products, it’s going to be less wholegrain. So, looking for wholefoods in the list of ingredients. Now, you’ve prepared tomorrow’s diet for me. Yes, we have. You’re handling my breakfast and lunch. – I know! – And midday. Let’s have a look. Breakfast is a really important meal. Often, people, they’re aware that breakfast is needed, but… Can I interrupt? I want to take a call. Bob from Armidale asks, ‘How do you get healthy snacks for kids and adults when so many supposedly healthy snack foods are advertised?’ Who wants to take this? Caroline? I’ve got kids myself, and I’m up against that pester-power factor – advertising, and trying to run the gauntlet down the supermarket aisle. It’s about being prepared and thinking creatively about how to prepare fruit and vegetables. I suggest that families involve their kids with picking fruits, preparing them in interesting ways, including it with each meal and having snacks like nuts and low-fat, low-sugar yoghurts. AMANDA LEE: Cheese and biscuits. Thinking ahead, and providing them with snack food that’s… ‘But, Mum, all our friends get chocolate and other stuff.’ I know. You’ve got to push through that. It’s really hard. You’re up against a lot of advertising and lunch box comparison, dare I say it. They go to school, open their lunch box and are crestfallen when theirs doesn’t match the others’ in terms of the contents of packages. Not every tuckshop has followed of Jamie Oliver. No. We need to be really proactive and do planning on that score. Keep your questions coming in. You can phone us on 1800 817 268. You can text us on 0408 408 932. And that’ll do. Phone us or text us and we’ll put your questions up. If you phone us, we’ll put you on air. I interrupted you when you were talking about breakfast.
I was salivating. Let’s go back to breakfast. We will actually talk about your breakfast. Your breakfast is quite large. We’ve got two serves of bread – or the grains. We’ve got a serve of legumes. NORMAN: That’s what you call baked beans these days, is it? Yeah, sorry – baked beans. Baked beans can fall into the vegetable category or into the meat-and-alternatives category. NORMAN: Protein. – Depends whether you’re vegetarian. Baked beans are a great source of protein. NORMAN: That’s a serve of beans? – That is half a cup, so a serve. NORMAN: If I was counting it as my veg, is that a serve of vegetables? Your first serve of the day. The tomato’s a little bit undergrilled at the moment. – (All laugh) NORMAN: I’m into raw food. AMANDA JONES: I knew that. That’s why I prepared this way. Already with breakfast, you’re getting two serves of vegetables, which is a fantastic start to the day. NORMAN: It’s got to be a large tomato to get the one serve. Yeah. If it’s a tiny tomato, it would be half a serve. – Not a cherry tomato. – You’d need several. – Right. – Also got a glass of milk beside it. Right. Very American. They’re always drinking milk. Doesn’t matter. I’m interrupting. That’s a low-fat milk, I take it. AMANDA JONES: That’s a low-fat milk. – Right. That is quite a big breakfast. That will really help break your fast. I can’t help thinking about calories. Forgive me. I’m looking at that, and it’s about 140 calories for the milk, probably 180 for the baked beans, probably 200 for the bread. Honestly, I don’t know the calories. I shouldn’t care? Calories in certain foods are really important. Snack foods in the dietary guidelines do have a limit on how many calories your snack or discretionary foods should contribute to your diet. NORMAN: Empty calories. – They’re empty. These are nutritional calories. NORMAN: Doing heavy lifting in my diet? – Yes. CAROLINE: There’s lots of protein in that. If you’d just been to the gym, Norman… Who’s Jim again? Those calories will fill you up and stop you going for a chocolate bar for morning tea, so you’re going to be ahead. CAROLINE: You’re not convinced.
NORMAN: No, I’m 100% convinced. Now I’ve got to eat more for breakfast than I normally do. The reality, Caroline, is the people who put on weight tend to eat most of their calories after dark. That’s very true. Often, what we see is a pattern. People will skip breakfast with this belief that they should tighten their calorie control. They have this restrictive pattern in the morning, eat a reasonable lunch, then afternoon, they get hungry. By the time they’ve eaten dinner, they’re so ravenous, they haven’t eaten much during the day, they go gangbusters with dinner, sit in front of the TV, then have dessert, then another snack. Most of their calories will be consumed in the evenings. I see that again and again. It’s false economy to not pace it through the day. The evidence from your 50,000 papers, if you pace it through the day, does that help you in the evening? You land better in the evening? There’s less evidence of that than there is around just avoiding the junk foods people tend to snack on. It’s more what you don’t eat during the day because you’re not hungry. There’s certainly an increasing amount of evidence that snacking during the day, and importantly, having a good breakfast is going to help you control your energy intake. What am I having mid-morning? I’ve got an apple here for you. Even though you’ve had quite a large, for you, breakfast, having a snack just as you’re starting to get hungry is a really good strategy to help control that hunger. It will keep you going through to lunch so when lunchtime occurs, you can make a more healthy decision with what you’ll have, rather than get quick-fix food. Fiona, how long does it take for your appetite – coming back to my appetite – to get under control? – Your appetite does readjust. – It does. By reducing the amount in the evening of snack foods, that can be a good start. Often, people aren’t hungry for breakfast because they’re still full from the night before. If we can get the day’s food evened out a bit, that’s going to help with appetite. Your peckishness occurs at the right time. That’s right – throughout the day rather than all at one time, which means you’re full the next morning. NORMAN: So, what’s for lunch? For lunch, we’ve got more serves of grains. NORMAN: This yummy-looking roll in the middle? –
This roll. – I’ll try to accept the carbohydrate round the side. AMANDA JONES: I’ve actually put some lean beef in it, so getting another serve of protein, or the meat foods, to help fill you up, and protein is good to keep you fuelled for longer, keep your appetite under control. NORMAN: I won’t ask you to dissect the salad, but what’s a serve of beef? In the dietary guidelines, a serve of beef is 65g. NORMAN: Smaller than the palm of my hand. Smaller than your palm, but it doesn’t mean to say that you only have to eat that amount. There’s allowances for multiple serves. For yourself, there are two-and-a-half serves that you can spread throughout the day. You can decide to put some with your lunch, then maybe a larger portion with your evening meal. – And there’s cheese as well? – There is cheese, again, to make sure we’re getting that range of dairy foods. We started the day with milk, then having more dairy foods at lunchtime. And milk’s OK mixed with a bit of espresso? Yeah, so long as you’re not doing it too strong and too often. OK. I won’t talk any more about that. You’re picking up the ball now, Fiona. You’re taking me after lunch. – Afternoon tea. – There are some nuts here. That’s a 30g serving. That would be one serve from the meat-or-alternatives food group. NORMAN: Does it matter what nuts? People get obsessed with almonds, walnuts, different fats, different benefits. A variety of nuts would be good. The main limitation would be – choose unsalted nuts. How they’re prepared? Some are higher-calorie. I know I’m not supposed to talk about calories. If you’re getting a good variety, that’s fine. NORMAN: You don’t worry about how they’re prepared? We’re having a small serving anyway. It’s only 30g, the amount in the palm of your hand. It won’t make a great deal of difference. NORMAN: You’ve got it in a container. The idea is that you don’t have a big bag of nuts which you then just munch on.
You have a pre-prepared packet. Yes. If you put it in your hand, put the packet back in the cupboard to limit temptation. I’ll have to practise that. – They’re so moreish, nuts. – Very hard. Although if you’re going to have more of something, that’s better than chips. OK. Dinner? I generally recommend to my clients that they use a plate. They wouldn’t have to use a plate like this, but use the proportions recommended on this plate. A quarter of the plate would be lean meat, skinless chicken or fish or eggs or protein foods. In the example here, we have chicken. 80g of chicken is one of the servings from the meat-or-alternatives food group. The skin has been removed. A quarter of the plate, we recommend to be carbohydrate foods. In this case, we’ve got rice – brown rice for a bit of extra fibre. Instead of rice, it could be pasta or potato or sweet potato. Half the plate, we would like to be non-starchy vegetables or salad. The vegetable serves are actually quite substantial. They are. We’re wanting to get at least five serves of vegetables a day. Half a cup of cooked vegetables is one of those serves. It really is quite a lot. If you just had the half a plate at dinnertime, it’s really not going to get to your five serves for the day. What proportion of the population… These are substantial serves of vegetables and bigger than you think. What would you guess? NORMAN: 20%. – No. It’s not even 7%, Norman. NORMAN: You’re kidding? – No. When you consider that vegetables are associated with decreased risk of many different sorts of cancers… That’s why the new dietary guidelines say… They’re the only foods we’re saying, ‘Eat plenty of.’ We’re saying eat plenty of vegetables of different colours and varieties, including the legumes. You can cover off a whole range of protective factors that decrease our risk of cancer, as well as cardiovascular disease, including stroke and as well as Type-2 diabetes. They’re a bit of a wonderfood, vegetables. We’ve got 7% of the population, most of whom are probably dieticians or GPs, that do manage to eat that. Not GPs, I can tell you that. David from Anna Bay wants to know – good question – ‘Do the new guidelines include age-specific guides?’ For example, people with insulin resistance and diabetes or pregnancy recommendations.
Yes, they do. The guidelines are designed for the walking well. They’re not for people that have serious medical conditions. The problem is, over 60% of Australian adults are already overweight or obese. Overweight and obesity, even though it’s associated with increased risk of serious medical conditions, now we’re having to provide guidance for people who are overweight and obese, because it’s most of us. For older people and for pregnant women… It’s the first time we’ve got guidelines for pregnant and breastfeeding women. NORMAN: How do they vary? You know, Norman, the interesting thing is they don’t vary a lot. The main difference is how active people are, which means that they may need additional serves. As you get older, of course, your energy expenditure usually reduces, and it’s even more important to eat very nutritious foods. NORMAN: Make every calorie count. – Yeah. What we’re worried about is, as people get older, the worst-case scenario is that situation where people have tea and biscuits and don’t eat healthy foods, particularly people living alone. There’s increasing evidence that it’s a really important time to eat more healthily than before. A text from one of our viewers asks, ‘What about vegetarians?’ Caroline? It’s interesting that vegetarians – you can have vegans and a plant-based diet. Diets that are leaning that way have a lot of solid evidence building up in terms of prevention of risk factors like heart disease. But it does mean you’ve got to plan a lot more. You’ve got to have a lot more legumes on board and plan those through the day. I see a lot of vegetarians, particularly young vegetarians, who are just eating a lot of cheese and pasta. They’re actually missing out on valuable nutrients. They’re often iron-deficient. You have to pay a lot more attention to your diet. You can certainly get all the nutrients from a vegetarian diet and from a vegan point of view, as long as you supplement with something like B12. Most soy drinks are now supplemented with B12. You can get a really good range of nutrition, you’ve just got to work a little harder at it.
There’s actually vegetarian and vegan options within each of the five food groups, but it does take more planning. – Cover that in the guidelines? – We do. – You can get that online. – Can get that information online. Let’s go to a case study. Matthew is a 35-year-old truck driver who comes in to see you, Caroline, seeking help. He and his family are overweight. He explains that he’s in the truck all the time, he doesn’t get much exercise, he’s eating rubbish at cafes. When he gets home, he wants to be nice to the kids and leave them in front of the telly. But he realises everybody’s fat in the house, and wants to do something about it.
This is a really common scenario. And it’s taken a truck to drag him in, by the way. Look, it’s a really common scenario. Often I’ll say straight up that we need to treat it as a family issue. I don’t tend to single people out of the family. I go, ‘We need to work with the whole family.’ Often we need to look at what they’re drinking in terms of liquid calories. There are a lot of soft drinks, juices, going through the system. People think that fruit juice is good for them. Yeah, there’s a myth about that. I’ll often say, ‘Do you eat fruit?’ and they’ll go, ‘Yeah, I have lots of fruit.’ When we dig deep, they’re actually having a lot of fruit juice. They’re getting a lot of sugar with no fibre. I always say, ‘Eat the whole fruit and have a glass of water.’ Matthew’s scenario is also about eating as a family group and focusing on having dinner together and actually planning those meals. Often, people will eat in front of the television and families will eat in a fractured way. The kids have something different to the adults, and they’ll all eat at different times. Even just having a unified meal in the evenings, spend time together with a group meal you’ve planned, you often will plan for more nutrition. Amanda, what would you do about him on the road? It’s easy just to pick up something at a roadhouse. That is really the convenient option. But planning ahead, like Caroline was saying with the evening meal, it is about that pre-thinking. NORMAN: ‘But I’m on the road for two days, nonstop.’ An esky. Thinking about food safety and making sure food is kept at the right temperature is important. A good-quality esky with ice bricks to keep things cool. Pack your sandwiches, your fruit. Have your container of nuts. Take your water, your Thermos. NORMAN: So, just be ready.
The paradox is, if Matthew’s grandfather had been a truck driver, he’d have been thin and probably taken his packed lunch. Definitely. He wouldn’t have had anywhere to stop along the way. He wouldn’t have stopped for a coffee like we do nowadays. It would be something that he would have to plan ahead and take the food. Fiona, what about cost? Matthew’s not flush, and a burger in a takeaway joint is cheap. True, but it does add up by the time he and his wife and the two children have eaten. They could prepare something at home much more cheaply than that. NORMAN: Is that right? Fresh vegetables and so on seem to be quite expensive. If they want something convenient because they’re not used to spending a lot of time cooking, they could get frozen vegetables. Or even pre-prepared, chopped up, stir-fry vegetables are still going to be cheaper than eating out. NORMAN: And you haven’t lost the nutrients? You’re getting far more than out of the burger. CAROLINE: There’s a big myth about that. A lot of my patients think vegetables must be fresh, not frozen. I say, ‘No. They’ve been frozen while they’re fresh, and they’re very convenient.’ You can get little sachets. Your limp carrot in the bottom of the fridge that’s been sitting there for two weeks isn’t fresh and doesn’t have the nutrients that frozen food does. I have noticed the crunch disappear. Even tinned vegetables, particularly in rural and remote areas, so long as they’re the ones that have got lower salt in the brine, can be really good options too. – Again, read the label. AMANDA LEE: Read the label. So that’s the answer for Matthew, and slow steps. – One thing at a time. – I’d also encourage him to have multiple breaks from his truck in terms of his health. I bet he’s sitting behind the wheel for… We recommend fatigue breaks, but you need movement breaks. There’s no point just getting out of the truck and eating and drinking. Get out and stretch your legs. Sarah is a single mother-of-two in a small, rural town. She works part-time but struggles financially.
What can she do, Fiona? FIONA: I would say to Sarah that healthy foods are actually cheaper foods. A program was developed in Western Australia called the FOODcents program. It looks at the cost of foods per kilo. Supermarket shelves tell you the price per hundred grams so you really can compare the cost of different foods. If we look at our food groups, those foods are economical. Baked beans are extremely economical. Eggs are economical. – So eggs are OK, are they? – Eggs are OK. Two eggs would be one serving from the meat-or-alternatives group. Fruit is really cheap. It’s unusual to find fruit at more than about $4 a kilo. Fruit roll-ups are $42 a kilo. When we look at food groups, the food that we’re eating is really quite economical. Buy in season as well, to make sure that you know… Seasonal fruit and vegetables taste better. Sometimes in small country towns, particularly towns that are fairly remote, it’s hard to get fresh stuff. Definitely. But a lot of country towns are really innovative in that they have farmers’ markets and they do food swaps and bartering of their own products. NORMAN: And there’s always the frozen foods. – And the tinned fruits. – And things on special, particularly when it comes to meat and dairy foods. There’s usually a choice you can find that’s cheaper. What do you recommend in the guidelines about the cut of meats? Some cuts are fattier than others. Like, lamb is a fatty meat. Yeah. The only thing you can control is cutting off that visible fat that you can see. If you cut up steak, removing the visible fat, the internal fat is going to be good. The most important thing is to have lean meats rather than processed meats like sausages or premade hamburgers, where the fat is ingrained, and it’s very hard to remove that at all. With the cheaper cuts of meat, they require slower cooking time. So a moist, slow, stew/casserole can be really beneficial too. That can be really helpful for the budget. Then you throw in the legumes and vegetables. Slow-cook it in the oven, come back to it an hour or so later. Good! Adding things like a tin of beans to a casserole can really extend the protein component of the meal. Most Australians need to eat four times the amount of legumes, beans, than we’re eating.
There’s lots of headroom. We’ve got another text, this time from Tory, who asks, ‘How can you be sure that what you buy is actually organic, and is organic better?’ Fiona? Supposedly, there are very strict regulations around the term ‘organic’. If it’s a packaged food, I would have to assume that if it said organic, it was organic. But if it was something you bought at the farmers’ market, you would hope that they were correct. It gets very confusing, though, doesn’t it? I got some shampoo that said, ‘organic shampoo’. I don’t want to eat that shampoo. Well, I could, I suppose. Your hair went green. It’s a term that’s bandied around. It would be wonderful to have a world without added chemicals, but the cost of organic food is prohibitive for some families. If you’re encouraging them to eat wholefoods, that might be the price deterrent. There was that study which looked at the nutrient content of organic versus non-organic, and there was not a shred of difference. Organic wasn’t better. It’s not the nutrient, it’s more the pesticides and residues. All foods are likely, in some part of the food chain, to have come into contact with things, which gets back to food safety. We need to be washing our fruit and vegetables. If we’re eating fruit and vegies, we’re getting nutrients that fight off cancer or heart disease anyway. You’re getting more important things from eating than by avoiding them. NORMAN: So, Tory, save your money. Or do what a Greek family I know does – they throw their vegetables in a pot of cold water and let them sit for a while before they cook them. The dietary guidelines found no benefit in organic foods for health reasons. People may want to do it for environmental sustainability or other reasons. By the time you get to purchase organic foods, they’re more expensive, less people buy them, so they can be in poorer condition. Maybe more food miles as well, but we’re not doing food miles. Jessica is a 24-year-old nurse.
Works long hours. Lives in shared accommodation. She eats takeaway and packet foods for convenience. She says to you, Caroline, she’s got no time to cook and feels generally tired and unwell. I have a patient who fits that perfectly. I encourage them to think about planning meals, and to have stuff in the pantry and the freezer that’s ready to go for when they get home from long shifts that they can easily assemble at low cost that’s high-nutrition. An example would be, keeping in the freezer sachets of vegetables and sachets of frozen fish. A simple meal. But to plan, and also take their lunch. When people are busy, if they take their lunch, they’re precommitting to a healthier choice at lunch. If they’re on the run, they’ll skip lunch or grab something on the run. And don’t eat the lunch at 11am. Hang on till one. Pauline has emailed to ask about dried fruit with nuts. ‘OK or not OK?’ Amanda? – It depends on the portion. NORMAN: Good for potassium. Dried apricots – really good for potassium. They can be problematic because they can be quite a condensed form of natural sugars that can stick to the teeth. Dentists will not like you eating a lot of dried fruits, but dried fruits can be a very convenient way of getting your fruit serve. You need to think of it as it was in the original form. Think of a dried apricot. You need to swell it up back to what a fresh apricot looks like. NORMAN: Like fruit juice – you can OD on fruit. Definitely.
You really need to think that only ten sultanas is equivalent to a serve of fruit. Just be mindful of the portion, but definitely it can actually add to variety. OK. A text from Helen asks – I was wondering how long this would take – ‘What about the two-fasting-days-per-week diet?’ Mm… Caroline? I know MY answer to this one. It’s a really popular diet at the moment. When people are striving for weight loss, for some people it works well to help them understand about hunger and portion size. Whether it’s sustainable is another thing. The idea, for people who don’t know about the 5:2 diet, is that you eat what you normally eat for five days, then for two days of the week you really restrict your calorie intake to about 500 calories. It’s not a useful long-term strategy in terms of the guidelines. NORMAN: So there you are. We’ve really got to be careful about what people eat on those five days. – High-nutrient food. – That’s right. It can’t be, you know, a bit of a muffin for breakfast. I’ve found people who’ve gone on it actually get in touch with portion size. They realise that they can have much smaller meals. NORMAN: They reach into their inner portion? And connect with their inner hunger. NORMAN: Natural hunger again. A lot of people have lost that sense of hunger. They’re eating so continually with snacks. A lot of people don’t go for more than an hour and a half without something – a cup of milky coffee or a snack or whatever. There is a risk with that that they can reduce their metabolism. Fasting can slow your metabolism down. It can potentially mean that you gain more weight in the future. We don’t want to do that.
The dietary guidelines really do assist with having regular foods, keeping your metabolism burning along so you’re not at risk of regaining weight. If somebody’s got a low thyroid activity, do the guidelines have answers? No, they don’t. The guidelines are really about the walking well. If there’s a condition that you would do better to get specific clinical advice, the dietary guidelines won’t cover that. The good thing about the dietary guidelines is that the patterns apply to a wide range of conditions, but you really need to get specific clinical advice if you’ve got a medical problem. NORMAN: Caroline? – That’s really important. Dieticians and nutritionists do a wonderful job. Within Medicare, if you have a chronic condition like a thyroid condition and you have what’s called a health care plan, you can access five visits with a dietician to help you sort out, if you’re eligible, your nutrition. That can be really important. Iodine would be an element in the diet anyway if you’re taking a balanced diet. We’ve modelled all the nutrients that you have a recommended dietary intake for. The type of dietary patterns prescribed cover all those nutrients except for iron in pregnant women.
It’s really hard to get enough iron from wholefoods during pregnancy. It might be just that the recommended intake is too high. NHMRC are looking at that at the moment. Brian has called to ask if there’s a gene that makes Indigenous people more likely to have problems with their diet. This is the feast-or-famine issue. It’s a bit of a myth, in Aboriginal people, because we’ve all got the feast-or-famine gene. That’s where the 5:2 diet – five days and two days off – comes from. We were used to feast or famine. We’ve all got it. That’s why Type-2 diabetes is so common in the non-Aboriginal as well as the Aboriginal community. But there are certain groups around the world who are more at risk of having diabetes when they’ve got smaller tummy sizes. From an Indigenous point of view, they’re in a very high-risk group for developing diabetes. We’re yet to fully understand the connections, but it’s probably a combination of genes and environment. There’s something switching those on and off. But they are a very high-risk group in terms of developing chronic diseases like diabetes. You’ve got all these dietary guidelines. We haven’t even gone into my evening snack yet, but we’ll leave that.
If you want to know what I’m having – yoghurt and a bowl of fruit. (All laugh) See? There’s so much there, you can’t even talk about it. They started in rehearsals with rubber and plastic food, and insisted we went to real food. It is more appetising. Implementing these guidelines, what do you do? How do we get into these if we’re interested in pursuing them? That’s the real challenge, isn’t it? Less than 5% of the Australian population know the guidelines exist. We’ve really got to promote that they exist. It’s not so much talking about the guidelines, but the messages they have. The National Health and Medical Research Council have developed a website – www.eatforhealth.gov.au – where you can find all sorts of resources. There’s brochures, there’s booklets. My favourite is the Educator Guide. Health professionals that might want to make sense of the complex messages and know more about the evidence and the way that the guidelines were developed and the way that the recommendations were achieved would be able to read that to help for planning diets of particular groups, different age and sex groups, and also people that may be vegan or want to follow a more Asian-style diet. There’s also information about the infant-feeding guidelines, which I believe Caroline will be covering soon. There’s the guideline document itself. There’s a summary booklet for people that may not want to read the whole 200 pages. Importantly, there’s a lovely little gadget where you can go on and put in your age… NORMAN: This is online? – Online. You put in your age and your sex and press a button, and it will tell you exactly how many serves of all these different food groups you should have a day and remind you to avoid eating the junk, which unfortunately makes up 30% of what we’re currently eating. If I’m not a dietician or a doctor, which a lot of these are for, really, go online, and that’s useful. Yeah. There’s information for consumers and the general public. There’s information for parents and carers about children. It should be a one-stop shop. There’s even fridge magnets. NORMAN: The famous plate is actually a fridge magnet. It’s a fridge magnet to remind people when they’ve got the munchies… NORMAN: So you eat the fridge magnet. AMANDA LEE: Yeah, eat the fridge magnet. There’s also even games for children on this website. I’d encourage them to go for a walk after they’ve played the games. NORMAN: Instead of nagging Caroline in the supermarket aisle. I’ve been fascinated, and I’m no longer feeling hungry. Take-home messages? Amanda? I just would be really urging people to be aware of all the evidence behind the dietary guidelines. Every day, we pick up a newspaper and there’s a new heading about a new wonderfood or a new study. Just to help people to be aware that there’s 50,000 papers that inform the evidence base about what we should be eating. They can use the dietary guidelines with confidence, is my message. – Fiona? – I would be hoping that, after this evening, consumers would realise it is practical for them to consume a healthy diet.
They might need the frozen vegies, the tinned fruit, depending where they live. They might need some convenience options. But hopefully, they’ll start to implement changes that will move their diet in a healthier direction. They don’t have to make all of these changes at once. Small, gradual changes can add up to make big improvements in the long term. Amanda? I would suggest that everyone needs to go to the website. The resources on the website, what Amanda was talking about before, you can key in your age and gender. It can be really personalised and quite simple. The message is, dietary guidelines are simple. But if you’re getting confused and need additional help, go to your GP, your dietician, and get more help if you need to. NORMAN: We’re going to. Caroline? Nutrition is a wonderful way for us to feel better and to allow us to live a longer, healthier life. It’s really important to plan for your nutrition. I encourage my patients to increase their fruit and veg, if nothing else. They’re superfoods. Even if you can just increase the colour on your plate, as long as it’s colour from wholefoods, you’re off to a better start. Caroline West ends the program. Caroline will be back in a couple of weeks, sitting in my chair
– I’m away for a few weeks – talking about infant-feeding guidelines, which are part of these guidelines. Do join us in a couple of weeks. I hope you’ve found this program on Dietary Guidelines informative and useful. There’s always more information available on the Rural Health Education Foundation’s website – Click on the program page, Healthy Eating, Healthy Life. Eat For Health – Australian Dietary Guidelines. You can get a lot of the information and even watch this program again. Wouldn’t that be fantastic? If you’re a health professional, complete your CPD evaluation form, which can be completed online. You’ll receive a certificate of attendance and, if eligible, CPD points. If you’re a member of the public, you don’t get continuous professional development, you just get a healthy diet.