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Ask our nutritionist - NEW FACILITY

Email us your question and we will have our resident nutritionist send a reply to you.  This is a free service, it is not intended to replace medical advice always consult your qualified health care professional if unsure.  The following are only a selected few questions of those we have received.

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Questions and answers

Q: Hello, I have a two year old who up until 3 months ago, loved her fruit and vegies. 

I offer vegies and chicken/meat every couple of days but she gags if I try to get her to try it. Everyone tells me its just a phase, which is all well and good, but it doesn't stop me worrying.  To try to get some vegies into her, I resorted to making Bolognese with loads of vegies (food processor chopped), mince and pasta.  Well, she loves this, (good for the veggie side) but now I wonder if she is having too much in the carb department! She eats about a cupped handful.  At the same time she didn't want to eat much fruit either.  So I started to make smoothies using small amount of milk with mostly fruit (mainly bananas and mango).  She has 2 of these a day. I had her to a speech pathologist at 14 months, as she wouldn't eat anything chunkier than puree food.  This rectified itself soon after, but to this day, she still spits out rice.  She had attachment problems as a baby, and was compelled with bottles, which I stopped the last one about 2 months ago, in an endeavour to make her eat more.  Am I worrying needlessly?  J

A: Hi J, it sounds to me as you are absolutely on the right track.  It is VERY common for toddlers and preschoolers to go through a picky eating stage, and contrary to some of the books it can last for some time.  You just have to ride it out and don’t open any can of worms by giving in to junk food like so many parents do in the end.  As they say parents offer, children choose, so all you can do is be clever like you are in disguising good nutritious food and keep offering healthy food taking it away without a fuss if it is uneaten.  I hope to have a recipe book for fussy eaters published later this year, so I will add you to our Enewsletters so you can keep up to date.  I have copy and pasted some more suggestions from our picky eating fact sheet below that may be useful (some you are already using).

• Fussy eating is common at this age also, in most cases it is a phase that they will eventually grow out of (I know that doesn’t help now). 

• Involve your little one in meal preparation, cooking, serving etc.

• Grow veggies or veggies bits (i.e. carrots and sprouts in containers on the bench).

• Be sneaky with foods by adding fruit and veggies where you can without detections such as pumpkin into scones, grated veggies into meals, pureed fruit into smoothies or into her yoghurt.  I try to consider colour so red veggies into tomato based pasta sauces, white veggies into baking etc.

• Try involving others in her meal time, for example if she has another carer during the day, say family day care, try asking the carer to give her a main meal at lunch.

• Make creative plates, hedge hogs, faces, houses and talk about what foods she is selecting, for example ‘oh my goodness, are you eating the clowns nose, now how will he smell things?’.  It is a great way of making meal times fun.

• Consider using iron-fortified cereals as they offer more absorbable iron than many foods and this will help with growth and immunity.

• Keep persisting.  Never give up and just keep putting a variety of foods on her plate and taking it away if it is uneaten without a fuss, (even if it means the dog is getting a little plum).  Even if she rejects it, she is still being exposed to food that will form a part of her diet down the line.

• Make creative plates, hedge hogs, faces, rocket ships and talk about what foods he is selecting, for example ‘oh my goodness, are you eating the clowns nose, now how will he smell things?’.  It is a great way of making meal times fun.

• Ensure all meals including snacks have some form of protein (meat, dairy, egg, nuts, seeds, pulses, fish etc).  Grind up nuts and seeds and add it to her breakfast each morning, add it into smoothies, frittatas, baking etc.  On the smoothie point, don’t forget to add natural yoghurt and opt for fluids such as almond, oat or rice that have around 100mg of calcium per 100ml.

• Freeze smoothies and make cool iceblocks that are a meal in themselves.

• Add tiny amounts of treats to foods for example make cream cheese crackers with a smidge of additive free hundreds and thousands.  Or pop a few on a banana and freeze etc.

• And remember to always be a good example.

In terms of servings per day of fruit and veg and other food groups see the chart below, it will give you a good idea of how much we believe children need as a minimum (keep in mind there is huge variation).  Take a one day record of what she eats and compared the number of serves to this chart below.  It sounds to me as though you are on the right track though.  Generally, overall carbs say on a plate would be about ½ the meal and protein containing foods are a third (the remaining is automatically filled with fat – ideally healthy fat – via the protein foods). 

Figure 13.6     Example servings for toddlers

Source:  Adapted from Eisenberg, 1999

Good luck and I hope that helps

Leanne

Q: Is dairy really a good source of calcium?

I have been taught that the calcium in dairy products is not well absorbed, that dairy causes allergies and that milk and other dairy foods aren't necessary and in fact may not be good for you.  What are your thoughts on this?

A: Well you have asked a number of questions it seems.  Firstly is dairy calcium bioavailable?  Is it more absorbable than other calcium containing foods?  Do we fair well if we don't eat dairy?  Why do the authorities push dairy? 

To answer this briefly, basically the calcium in dairy has been shown by research to be very well absorbed.  Some differences in foods exists however, generally speaking most foods - excluding those with oxalates such as spinach and rhubarb - that contain calcium are well absorbed.  Dairy is featured highly in the dietary guidelines around the world because it is a very accessible and rich form of bioavailable calcium, you don't need to eat large amounts to meet basic health requirements. 

In relation to cow's milk protein (CMP) allergy (clinically proven) keep in mind that about 40% of children with this allergy are also allergic to soy, unfortunately even some health care professionals fall victim to the belief that soy is a great milk alternative for all CMP allergy suffers.

There has been some research suggesting that the early introduction of cow's milk may be linked to diabetes, but this is still hotly debated.  Other studies have shown a relationship to obesity while others suggest a protective effect.  Like so many hot issues in nutrition there is enough research to argue both sides.

It seems that even as well accepted as calcium supplementation appears to be in relation to bone density there remains some who are unconvinced, given that countries such as the USA and Sweden who have very high rates of calcium intake via dairy products still have quite high levels of osteoporosis.   Some even suggest that excessive intake of calcium from dairy products may worsen bone density levels, with instead a preference for calcium from fish (bones), vegetables and nuts.  Perhaps it may be suffice to say that calcium alone is not the answer to some forms of bone problems.

My personal point of view, yes we should always be healthily questioning of authorities and research, but common-sense can often be an excellent guide.  Where there is a clinically proven reason for you to avoid dairy then amend your diet to balance out the loss of nutrients specific to dairy, consider only temporary removal where practical, never restrict a diet, expand on it.  Moderation can also reduce the risks that excesses of even 'healthy' foods may pose.  One of the nice things about being a human is our ability to make food from so many gifts from nature.

Ear well, live long

Leanne

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Q: Please explain insulin resistance and its relationship to weight gain.

Staff member of a child care centre, Blue Mountains.

A: Obviously a very topical issue with the press on diabetes.  Insulin is made by special cells in our pancreas, insulin is made and released into our blood as a response to sugar in our blood.  It is insulin that helps to balance out the amount of sugar flowing in our blood, when we eat something sugary insulin helps to 'mop' up the excess sugar in our blood by helping it to move into our cells (such as muscle cells to be used as energy).  However, the area on our cells that talks with insulin about the levels of sugar in the blood can sometimes not 'listen' well and miss read or not 'hear' signals.  In other words the cells may become resistant to insulin, which in turn levels greater levels of insulin in the blood.  It seems that diets high in saturated and trans fats may be implicated.

Insulin encourages the storage of fat in the body.  When blood insulin levels are high (most commonly after a meal that is rich in sugars) fats in our body are unable to leave fat cells so that it can't be used as energy. Of course in people with insulin resistance they will also will have higher levels of circulating insulin.  Hence the effect of insulin is increased storage of fats in the body and the prevention of the mobilisation of fatty acids from fat cells, leading to weight gain. 

I hope that helps with this topic.  Regards, Leanne.

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Q: Is fish oil better than flaxseed oil?

I love taking flaxseed as ground meal on my cereal in the morning, in fact our whole family uses it, its so much easier than using a supplement. But recently I was told that you don't get a lot of EFAs from flaxseed, and it is best to use a fish oil supplement.  Is this true?

A: Firstly, it is important to be clear about why you are taking flaxseed.  Is it for therapeutic reasons or dietary reasons? 

Flaxseed does give us omega-3 fatty acids e.g. ALA, this fatty acid has to then be converted in the body to EPA and DHA.  EPA and DHA have been shown to have a great many health benefits.  The amount that we can convert from ALA to EPA and DHA differs from one person to another, but is around 8%.  So yes therapeutically fish oils, which don't require this conversion, offer a far stronger effect.  We recommend you talk to a qualified health care professional about using fish oil supplements for the treatment of any ailments.

However, keep in mind the many benefits of adding whole seeds such as flaxseeds, they contain more than just a single nutrients or compound, add to a varied diet, are safe and inexpensive.  As you say it can often be more convenient to take a food than a supplement and compliance from the whole family can be better especially if you are talking about children.  So there are still many benefits from using flaxseeds in your diet. 

LC

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Q: Does unused muscle turn to fat?

Some one at the gym I go to told me that if I build up my muscle mass and then stop pumping iron that my unused muscle will turn to fat.  Is this true?  Michele, Manly, NSW.

A: This is a common belief and something we get asked quite regularly by people who are worried that once they stop working out, their muscle will turn to fat. However, this is in fact FALSE.  Muscle cells and fat cells are worlds apart.  They do different things and contain different substances.  In fact once you stop exercising your beautifully toned muscle cells simply loose their tone and shrink.  Of course if you keep eating at the same rate but are expending less energy you are likely to gain weight (your fat cells get bigger).

Cheers

Leanne

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Q: The biggest looser - is it safe?

This was an interesting question on how obese people can exercise at an intense pace safely.  Brendan asked "How can the people on those Biggest Looser shows exercise so intensely and not have heart attacks"?

A: While we don't have any inside information it would be fairly safe to suggest that a large team of medical and dietetic staff would assess and monitor the participants every move, nothing would be left to chance.  I am sure the health checks prior to the show are very rigorous.

Q: What if my child's weight percentile is different from his height?

I have a friend who's son is off the charts for weight (he is only just 1) but barely on the 50th percentile for height.  Should she be worried about this?  People keeping suggesting he is overweight and eats too much.  He has a healthy diet and doesn't eat junk foods.  Desma.

A: Firstly, if your friend is concerned she should ask to see a Paediatrician as they are really the best you can get in terms of child health. 

There is a new line of thought that it is velocity of growth, in other words, increases in height over specific length of time is a more valuable measure.  Some suggest that this in fact is a more sensitive measure of possible nutritional problems, given height velocity and weight-to-length ratios are valuable measures of stature (Mofidi, 2003).   Appropriate rates of growth or growth velocity may be useful in knowing whether to evaluate a child’s nutritional intake.  In most cases infants and toddlers are well adept at regulating their energy requirement over a day.  Often as a toddler begins to become active and mobile their body shape begins to change, by two many have lost that cuddly baby fat and beginning to look more like 'big kids'.  Hope that helps, any doubts though see a qualified medical practitioner. 

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Q: My GP reckons you have to take a multi because our foods are so deficient, is this true?

My GP is on a health kick and reckons we should all take supplements, and that our foods are so deficient in nutrients we can't possibly get enough vitamins and mineral from them.  Is supplementing more important than eating fruit and vegetables?  Desma.

A: I think it is great that your GP has such an active interest in nutrition!  To a degree the way many of our foods are grown, transported, treated and stored does sacrifice some nutrients, however this is improving year by year.  That is why so many people are turning to organics (and to avoid the chemicals).  So while some organic foods are higher in nutrients than 'ordinary' produce fruit and vegetables remain an excellent source of not just vitamins and minerals but plant compounds many of which are not able to be reproduced.  Personally, I think you should get your diet right (as best you can) to create a platform and then consider nutrient deficiencies from their (taking a targeted approach with supplements).  There is more evidence now that supplementing is not as straight forward as we once thought.  Some levels of nutrients can inhibit others, nutrients mixed with others at the wrong dose can cause free radicle damage in the body and so on.  Also plant compounds (phytochemicals) are more and more being haled as major preventatives to an increasing range of diseases.  In the US fruit and vegetables have recently been given an antioxidant rating called ORAC, the top five are in the table below.  Fruit and veggies are not just about vitamins and minerals they give us so much more than that.  As you can see I am very passionate about produce - personally I think we will see much more about vegetables and their link to disease prevention in the next few years.

Reference: http://www.ars.usda.gov/is/pr/1999/990208.htm

 

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Last update: 09 June 2008