Hard to come by a New Year resolution list of 2012 without a tilt towards health, fitness, dietetic regimen meticulously compiled from magazine snippets or bookmarking web pages on fruit mélange, vegetable combo, 'poulet' for 'protein-intake', 'selective consumption' for 'specific purpose' (intriguing!). Point is whatever drove you to make the list where you allotted a space for your health and wellbeing, Medindia applauds you and wishes you to stay motivated with expert guidance from Dr. Dharini Krishnan Ph.D, Registered Dietitian, and Former National President of Indian Dietetic Association.
Q. What goes into diet counselling?
AdvertisementA. Diet counselling involves lot of skills, dieting techniques, the nutritional part of it plus you need to know psychology. Sometimes patients, for example diabetics, are actually in a state of shock when they walk in. You have to calm people before you tackle diet counselling. When talking of diet, you have to make sure that the person is at ease to listen to what you are saying. So diet counselling involves lot of psychological counselling even if not for any particular medical attention.
Q. In general what is taken into consideration to prescribe a diet?
A. 'A' stands for Anthropometric measurements - height, weight, body fat, skin fold thickness. 'B' for Biochemical measurements, if one has any reports of their blood profile we look into it and 'C' for Clinical analysis where a person's eyes, hair are observed. By looking into a person's eyes a trained health professional will know if one is anemic, by examining the hair it can be inferred if the person has protein deficiency, nails give away the health of a person. And then we arrive at 'D' for Diet.
Q. How is a diet prescribed?
A. Before suggesting a diet, we ask the person about their current diet and then take detailed dietary calls. We take inputs on what the person eats on a weekday and what on weekends. We also take inputs on the person's allergy; it's imperative since food allergies are common today. Family also matters, so we find out what they do? How much oil they use per month? How much vegetable they eat per day, per week? How often they eat out? if they do where is it they eat? Do they eat at restaurants where only fried stuff is available or where salads are available? We need to know people's lifestyles.
Q. Does physical appeal impact on a diet?
A. We follow certain parameters and formulas, with their height and weight. Then we decide how overweight or underweight they are, so formula used is customised for the person. Just because somebody wants to lose or gain weight we are not going to help. Suppose in a hospital, a burn patient needs attention, we look into the surface area of the burn, the area that is burnt, the depth of the burn, according to the need the diet changes. Even for a normal person, height and weight are normal parameters from which we need to start off.
Q. Is natural food sufficient or does a person need supplements?
A. As long as a person is eating properly, regularly, traditional meals cooked daily, there is no need for supplements. Supplements have a role only in people who are not eating properly anddepend on processed foods. For example, if a person is staying in a PG (Paying Guest) accommodation, if the place does not allow them to cook, they are dependent on outside food, always. Unfortunately, in India you get food stuff only of two types that are rich in carbohydrates and fats. You don't get vegetables and fruits in large quantities for an average Indian which is hygienic and can be eaten outside. For such a person, if the hemoglobin is unbalanced then we may have to resort to supplements. In a normal family, cooking sensibly and regularly it is not needed.
Q. An ideal balance between meat and vegetable - how does one decide?
A. Meat is not equated to vegetables at all. If you take any meal, let's leave breakfast alone because it does not have all the five food groups. However lunch and dinner are two major meals. The first part is cereal which is rice or chapatti. The second is dal or meat which is the protein source and the third being vegetables. The fourth is dairy which is optional, because in a vegetarian diet, whether it is curd or milk or paneer it adds to the protein value. It gives you high biological value. Hence meat can be equated only to dals. Recent trends promote a wrong thought - where non-vegetarians on a day they take non-vegetarian food do not take vegetables and this is not the best practice. A decade ago non-vegetarians ate vegetarian food in a meal with meat. But because of affluence and other influences people eat only meat which is not a good turn.
Q. Is it safe to quit meat all of a sudden and become a vegetarian?
A. Does not matter as long as you take care of the total protein. A non-vegetarian family does not take as much dal or milk as much as a vegetarian. So if a person moves from non-vegetarian to vegetarian food they have to take care of these two things and the person will do fine.
Q. And what if a vegetarian shifts to non-vegetarian diet?
A. It does not matter as long as vegetable intake continues. So if dal is replaced by fish or chicken or egg it doesn't matter. But if you leave vegetables and go headway with meat then the balance will flip.
Q. When is the ideal time to visit a dietician?
A. Back in 1987 when my name board went up people did not understand who I was or what I did but today women before they get pregnant come asking, What food is good for healthy pregnancy? What do I eat before the baby is born, What food should I give the baby until six months? After six months? At every stage people are concerned about the right diet. Many kids who are taking their Board exams, starting December till March don't go to school. After giving their exams, they hang at home, eat and put on weight. The moment 10th standard and 12th standard exams are over they come to us saying, "Suddenly we have put on so much weight, we have to go live in the hostels, what diet do we follow?". So, different age groups come to us. For kids parents accompany them but right from teenagers onwards people come to us either to put on weight or lose weight. "Is it the right balanced meal that we eat?" is another common question.
Q. At what intervals do you change a person's diet?
A. We take a pattern of the family and we give them dietary options. We give them options of vegetables, fruits and quantity for each person. People who are losing or gaining weight we see them at an interval of two weeks, at least for five visits until they fall into the pattern. Those who want to lose 20 kgs or 40 kgs come every 15 days. They want new advice, re-iteration, they want to check their weight in the same scale. They want to take measurement of their hands and thighs and waist so the fat is going down and not the lean body mass. Every 15 days there's a change of diet, if they want a change, then there's travelling and what diet to follow while travelling. The change in weight and measurements shows in 15 days, if they follow the advice strictly. Weekend and week day options are worked out.
Q. How safe is comfort food?
A. Comfort differs from one person to another. Some say I have to have a chocolate truffle. I have a 'sweet tooth' is a very common statement. We give them options of the right sweet. We use sweet for people who need to put on weight. We use it so that they eat a little more of the right things. If a person looking to put on weight delights in 'payasam', we allow the sweet dish if it is made with green gram/Bengal gram , that's high in protein, along with sugar and milk. We develop comfort food which can be used judiciously. So the rest of the time they follow the diet we are very happy. We teach them to share their dessert or sweets. The size of a laddu used to be like a ping pong ball today it resembles a tennis ball. Somehow in India we take one serving of any food; size does not seem to worry people.
On a general note Dr. Dharini Krishnan commented on people making sweeping statements that they don't like vegetables at all, which is not fashionable at all. Vegetable and fruits are the sustainers. These are the ones which give you vitamins you don't get enough from cereals or pulses. Dietary fibres you get more in fruits and vegetables. More intake of vegetables and fruits the less of diseases. Because the greater the intake of fruits and vegetables the lesser would be the calorie load on the body. Whether we are heavy or light or fat or thin it doesn't matter as long as we can avoid illness from healthy eating. Vegetable and fruits build immunity, and provide anti-cancer properties. Fibre makes you eat less of high calorie food. When asked how a person remains disciplined, she said, "If you love yourself, you will take care of yourself".