[Food as Medicine] Making choices: Food and diet

The challenge with portion sizes

SIMONE GIBSON : video transcript

So not only is it important what we eat, but how much we eat is equally paramount, especially with the rise of overweight and obesity across the world. I'm going to demonstrate some different serving sizes that can often be misleading, meaning that people eat or drink more than what they plan to.

I'm going to start with alcohol because that's an area that can be quite confusing for people. A standard drink of wine is actually 100 ml. And depending on the drink-- the volume of a standard drink vary-- this bottle of wine says that it contains 6.8 standard drinks. And it's 11% alcohol volume. So I'm going to pour 100 ml. OK, so that's just a tiny bit more than 100 ml. And in this glass, that's what it looks like. So that's a standard drink. Then what it looks like in a bigger glass is only that much, and then in the restaurant-size glass we can see that it's even maybe only about a quarter. So I wonder what a glass of that would be in ml, which is actually about 300 ml. So we're looking at nearly half a bottle for a glass of wine. So please be careful when you're drinking wine out of big glasses. And just remember, this goes for other drinks as well-- soft drinks, juices. We can always be misled according to the size of the glass or bottle that we're being sold.

So another way that people can overeat without meaning to is what size chocolate bar we buy. So first, this was a chocolate bar that came as a twin pack, but it was all together. And I think most people, once they start opening the packet, they're going to finish the whole bar. Then there was a medium-sized one. And there's a fun size one. So you can still have chocolate. But if you look at this fun size one(small size), it's actually about a quarter of the big one. And that's going to make a difference. If you're only having this once a week as opposed to one of these ones every day, it's going to make a big difference to your saturated fat intake, your sugar intake, and your overall calorie intake.

So one serve of breads and cereals is half a cup of pasta(1 serves). So I'm going to show you what that looks like. I'm going to squash it down. OK, so this is one serve, or one half a cup. And you can see what that looks like in the bowl.Now putting it in a large bowl-- it really looks like hardly anything. So I'll do the same thing as what I did with the wine in the amount of pasta. So that's 1 serve, or one half a cup 2 serves, 3 serves. Whoops. And still, the bowl's not quite full. So keeping in mind when you're having a big bowl of pasta-- although foods from the grains and cereals group we encouraged you to eat-- the amount is also important.

Serve sizes also apply to prepackaged things such as bread. You can see that all of these breads are different sizes, different thicknesses. So looking at these two slices of bread, which are both soy and linseed, you can see that they're different sizes, and they're different thicknesses. Also when you're looking at them, this one seems to have more soy and linseed. So it's likely that because of the size, this one has fewer calories and probably has more goodness because of all the extra grains and seeds that are in it. This smaller one is actually the size that fits in a serve of grains and cereals. So I would encourage people to buy smaller loaves of bread if they're trying to control their weight.

Here's a really great way to increase your portion size of something without really increasing the calorie content and adding a lot of vitamins and fibre to it. So he we have 125 g of meat and 125 g of meat. The difference is this patty has two serves of vegetables or grated zucchini and onion. So this larger portion size is going to be a lot more satisfying once it reaches your stomach. But also it's a lot more satisfying to know that you're eating something substantial. When we look at something, it's going to make us feel fuller if we think that it's bigger.

Today it's really difficult for us to control our portion sizes. A lot of us eat out, get takeaway, and portion sizes seem to be growing. One thing that we do need to do is being aware of what a serving size is and how different things like packet size, plate, or bowl, or glass size can affect how much where actually consuming.

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Food labels are an important part of understanding portion sizes and what ingredients are included in foods. When looking to understand how foods can affect health and potentially be used in prevention and treatment of illness, understanding their content is important.

‘Serve’ and ‘portions’ may have different meanings in different countries

In Australia and US a serve is a standard size of a food, usually referred to in government guidelines, while a portion is the size of food you eat e.g. a portion of pasta may have three serves in it. While in the UK it seems that they use the term ‘portion’ as a measure of size of food.

Requirements for food labels may differ around the world

You may like to find out more about food labelling in Australia, USA and UK, or learn about some healthy cooking tips.

https://www.nhs.uk/live-well/eat-well/5-a-day-portion-sizes/

5 A Day portion sizes

https://www.betterhealth.vic.gov.au/health/healthyliving/healthy-cooking-tips

Healthy cooking tips

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Australian dietary guidelines

SIMONE GIBSON : video transcript

When you're looking at how to use foods as medicine, a great place to start are your own counties' dietary guidelines. Most countries have developed guidelines to help people make decisions about what food to eat and how much of it too to eat. Now, these guidelines are based on huge amounts of evidence. For example, the Australian dietary guidelines are based on tens of thousands of studies. These studies are evaluated and assessed for the strength of the evidence. Some of the things that they consider are things like how many people were in the study, what kind of people were in the study, what sort of foods did they use, were they using foods, were they using supplements, and who was sponsoring the study? So for example, a vitamin company sponsoring a study might have a bias in what kind of output is going to be published.

Dietary guidelines aim to summarize all of that information from those tens of thousands of studies into information that everybody can digest and follow. I'm going to discuss the Australian dietary guidelines here, but keep in mind your own country's guidelines. They will be very similar to these ones, but they might call the food groups slightly different things.

The Australian dietary guidelines include the Australian guide to healthy eating, which is summarized in the form of a plate. So that's divided into five different food groups, which includes grain, or cereal foods, mostly whole grain and/or high cereal fiber varieties. There's vegetables, legumes, and beans, lean meats, poultry, fish, eggs, tofu, and nuts, and seeds, and legumes and beans. There's the dairy section, which includes milk, yogurt, cheese, and/or alternatives, which might include soy milk and their derivatives, and mostly reduced fat. And finally, there's fruit. It's also recommended that Australians drink plenty of water. Outside of the plate, you'll see that there's a small section about healthy fats, which are to be consumed in small amounts. And there's the discretionary foods, which are your typical high sugar, high fat, or high salt foods. And the thing about these foods are that we don't actually need them in our diet, although some people do choose to eat them. These foods don't provide very much nutrition, but they do provide a lot of that saturated fat, or sugar, or salt.

The latest Australian dietary survey shown that many people get a significant amount of their energy from those discretionary foods, which is not healthy, because as I said, they don't really provide the nutrients that our body needs.

The benefits of these guidelines are that they're very flexible. I'm going to talk about the grain foods, mainly because they're really controversial at the moment, and I'd like to unpack that a little bit. A lot of people think that the grains and cereals group consists of bread, pasta, and cereal. And a lot of people try to avoid that, because they think those foods make them fat. However, this group is so much more diverse than those three foods. For example, it includes quinoa, red rice, brown rice, wild rice, freekeh, oats, whole grain cereals, whole grain pita breads, just to name a few. I want to emphasize how important the whole grains part of it is. When breads and cereals are processed, the milling means that the outer shell of the grain is removed, and that's where most of the nutritious properties are. And therefore the health benefits are largely discarded during this process. The whole grain varieties of this group have been shown to help prevent cardiovascular disease, and diabetes, and colorectal cancer. This food group provides a really wide range of nutrients. These include protein, fiber, lignans, phytoestrogens, different types of carbohydrates, B group vitamins, iron, zinc. So you can see that we do get a lot of our nutrition from this food group.

The next group I'd like to focus on is the vegetable group. The reason being that this group seems to have the most health benefits when it comes to preventing chronic disease later in life. Another important reason is the latest Australian dietary survey has shown that only 6.8% of Australians actually meet the recommended intakes of vegetables each day, which is five serves a day. Well it's important to have a wide range of vegetables from this group, to ensure we're getting the wide range of nutrients, it's also important to consider how much we're eating. So what is a serve? A serve is half a cup of cooked vegetables or one cup of salad vegetables. Trying to get five serves of vegetables into someone's diet is quite difficult, and I know that I find it challenging also. Some tips that I have include having vegetables as snacks. So thinking about things like carrot sticks, cucumber sticks, or sliced capsicum, and having that with dips. Or a really great way is to add vegetables into something that you're already cooking. An example of this is making Bolognese sauce for pasta. So usually you just have your meat, maybe some onion, and some tomato sauce, but adding a tin of lentils, some grated carrots, some chopped mushrooms, or whatever else you can find in the fridge or pantry. And just really bulk up that sauce with a lot of vegetables and you'll find that you might make an extra two or three serves just in that dish. It's pretty difficult to have too many vegetables because of the health benefits. And also, the fact that foods from the vegetable group generally don't contain very many kilojoules, so they're not that likely to contribute to weight gain, with probably the exception of the high carbohydrate vegetables, such as potato and sweet potato for example. Contrastingly, with the cereals group, we have to be careful not to have too many of these, because they do contribute to weight gain if eaten excessively.

We'd love to hear from you and your experiences of using your own countries' guidelines. It would be really interesting to see where they're similar and where they're different.

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https://www.gov.uk/government/publications/sacn-dietary-reference-values-for-energy

SACN Dietary Reference Values for Energy

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Health guidelines

Government-produced health guidelines are sometimes met with scepticism(회의적인태도, 의심); fears of “nanny states”, over-regulation and conflicting information may leave people hesitant to follow public health advice.

Dietary guidelines form part of public health advice

National and international dietary guidelines are examples of public health advice, along with anti-smoking guidelines, immunisation recommendations, and in Australia, the Slip! Slop! Slap! campaign to help prevent skin cancer.

What is interesting is we see many people seem willing to pay attention to some public health guidelines, but less so for those relating to nutrition, despite the weight of evidence behind them.

Creating guidelines and making recommendations

In many countries, one of the guidelines suggests people eat plenty of fruit and vegetables. In the Australian Dietary Guidelines you can identify the studies that were used to make this recommendation and references are given in full so that you can look them up in the scientific literature.

Much of the strongest evidence comes from large meta-analyses of cohort and prospective studies involving thousands of people around the globe. A meta-analysis combines the results of all the different studies that can be found for a given topic and delivers an overall analysis derived from all their findings.

A cohort study is one that is carried out on a population at a single point in time whereas a prospective study follows a group of people for a long length of time.

After evaluating all the available information, the experts who were developing the Australian Dietary Guidelines were able to say that eating plenty of fruit and vegetables has a “probable” or “suggestive” association with improving certain aspects of health.

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• United Kingdom

The Eatwell Guide

The Food and Agriculture Organisation

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• Reference 

Food as Medicine from Future Learn. free courses https://www.futurelearn.com/courses/food-as-medicine

Food As Medicine Online Nutrition Course - FutureLearn

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