Healthy Eating, Healthy Lifestyle: Eat for Health – Australian Dietary Guidelines
24
September

By Adem Lewis / in , , /


Hello, I’m Norman Swan. Welcome to this program,
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. Our thanks to the Department
of Health and Ageing for making this program possible. Thanks to all of you
for taking time to watch and to those of you who contributed
to our discussion. We’d appreciate your feedback.
Your comments are important to us. Let us know you watched
by flicking us an email or a text. Feel free to share your views.
We’d love to hear them. I’m Norman Swan.
Goodbye for now, but join us again
on the Rural Health Channel. Captions by
Captioning & Subtitling International Funded by the Australian Government
Department of Families, Housing, Community Services
and Indigenous Affairs.


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