Healthy Diet? I Can Do It!

Healthy Diet? I Can Do It!
Joyce Bernardino MD, FPCP, DPBCN

Dr. Joyce currently heads the Diet and Nutrition Support Team at GENTRIMEDical Center and Hospital. She is also an active consultant at Emilio Aguinaldo Medical Center-Cavite, and part-time faculty at De La Salle University Medical Center.

TRUTH: We do not simply eat. Our body is designed to be fueled by food. Today’s access to information has made us aware of the benefits of a healthy lifestyle. However, it can sometimes make us feel overwhelmed. Here are some bites for healthy eating.

The Basics: Have a Balanced Diet
Balancing does not mean a burger in each hand. But like a burger, our diet is comprised of 3 macronutrients. It contains our carbohydrates (the bun), protein (the patty) and fat (the cheese). Each plays a different role in our body. Carbohydrates provide energy and should comprise at least 55-60% of our intake. Proteins provide our body with structure and maintain muscle mass, and should be 10- 15% in our diet. Fat has hormonal, cellular functions and completes the remaining 30%. This is according to the Philippine Dietary Reference Index (FNRI, 2015). To keep it easy, one way to execute this would be by using the plate method. When having a meal, divide the plate into 4 quadrants, with each quadrant allotted for Starch (Rice/Bread), Meat, Vegetable and Fruit. This ensures that we have enough intake from the different food groups. This is known as the “Pinggang Pinoy” advocated by the Department of Health and the National Nutrition Council.

Know the Difference between Carbs
Simple carbohydrates are made of one or two sugar molecules. They are broken down and absorbed more easily. Some examples are sucrose or table sugar, lactose found in milk, and fructose derived from fruit. These can give a quick burst of energy. However, these can also be found in foods which have little nutritive value, such as sodas, sweets and candies.

Complex carbohydrates are composed of a chain of sugars making them take longer to digest. These can be found in foods such as whole grains and vegetables, hence we are bound to absorb additional nutrients such as fiber, vitamins and minerals.

The glycemic index (GI) was created to tell the effect of a certain food to the blood glucose. Simple sugars have higher glycemic indices (70 or more) and are absorbed faster with a higher peak in blood sugar. Low glycemic index foods (55 or less) include complex carbohydrates. The latter is preferred for those who want to feel full for longer, and for blood sugar control in diabetic patients. Glycemic values of foods are available online.

Keep the Supply of Protein
Protein is made up of different amino acids. Our body requires these to create enzymes, and maintain muscle mass. However, not all amino acids are made in our body, hence they are called essential, or have to be provided by our diet.

Animal proteins such as meat, egg, or milk contain all the essential amino acids. However, these may contain saturated fats as well. Plant proteins which are found in legumes, nuts and vegetables, are lacking in one or more essential amino acids. Vegetarians are encouraged to take vegetable protein from different sources in order to meet the essential amino acids required by the body. Variety of both is key.

Choose more Good Fat than Bad Fat
Fat always gets a bad reputation for cardiovascular disease. However, not all fat clogs arteries. Some are good energy stores, and actually protect against heart disease. Which one should be avoided? Saturated fat was found to increase bad cholesterol or LDL. This usually comes from animal sources such as bacon, butter or lard. Unsaturated fat is better since it does not increase LDL. It is found in plant oils such as soybean, sesame, corn or canola; nuts such as almonds, pistachios or cashew, and fatty fish which includes salmon, tuna and mackerel.

Meanwhile, monounsaturated fatty acids found in avocado and extra virgin olive oil can increase HDL or good cholesterol. This is protective for heart disease, as seen in the diet of those living in the Mediterranean area. Now we have a good reason to eat Greek.

Have Fantastic Fiber
Fiber is carbohydrate from plants which we are unable to digest. It can aid digestion and regulate absorption of nutrients. It can also serve as prebiotics for gut microbes, with an additional effect of increasing calcium absorption and maintaining gut pH and flora. The daily recommended intake is 25 – 30 grams a day. This can be achieved by eating whole grains, fruits and vegetables. Taking a supplement is designed to fill in, but should not equate to nutrition. Higher doses are only given if there is a deficiency as prescribed by a physician.

Fad Diets: Know When To Say No.
Have you ever heard of an eating style that promises quick weight loss or medical benefits (like cancer cure), without enough scientific evidence? If it’s too good to be true, then it must be. Here is why: Fad diets can be restrictive or unusual when it comes to the food involved. It may have some short term benefits but may not be sustainable, or even harmful for the long term.

Here are some of the more popular diets- Atkins Diet (low carbohydrate, with no caloric restrictions), Ketogenic Diet (high fat, low carbohydrate), Paleo Diet (no processed food, encouraging patterns like that of the Paleolithic era), South Beach Diet (stages of low carbohydrate in increasing amounts). Low Carbohydrate diets may lead to the utilization of fat stores and production of ketones, or a condition called ketosis. Normal individuals may experience thirst, urination, headache or fatigue.

High Fat diet may increase serum lipids and place one at risk for cardiovascular complications. High protein diet should be used with caution in those with kidney impairment, since high protein intake can worsen existing kidney disease. There is also no proven additional benefit of providing excessive protein that is more than 2 grams per body weight. Conclusion: A balanced low calorie diet would be the best option to have sustainable weight loss without risks.

These are the micronutrients, because they are needed in teeny tiny amounts. Adequate amounts can be derived from a varied and balanced diet. Some good sources of vitamins include:

Vitamin A from yellow foods such as carrots and pumpkin,
Vitamin B complex found in eggs and grains,
Vitamin C from citrus fruits and peppers,
Vitamin D taken from fatty fish and milk,
Vitamin E from nuts and seeds and
Vitamin K from green leafy vegetables.
For minerals,
Calcium can be found in dairy products,
Potassium can be taken from fruit,
Magnesium can be taken from beans and nuts,
Iron can be found in organ meats
Zinc is in oysters, spinach and beans

How do we know how much we are supposed to take? In a specialized diet, an individual must be measured. The body mass index (BMI) is a function of a patient’s weight against the height. The formula is weight divided by the height in meters squared, or use an online calculator. There are two standards, the WHO or the Asia Pacific Classification.

For those who are underweight, one must increase the caloric intake. If there is any sign of unintentional weight loss, or difficulty in gaining weight, seek physician consultation to rule out any medical problems. For those who have a normal BMI, congratulations! However, they can still be at risk if there is poor eating habits or sedentary lifestyle. For those who are overweight or obese, it would be best to reduce caloric intake in order to decrease weight.

Another parameter is the Waist -Hip Ratio (WHR). It is calculated by dividing the measurement of the narrowest part of the waist to the widest part of the hip. According to WHO, abdominal obesity is defined as WHR that is >0.85 for women, while in men, it is >0.90. This is an indicator of excess adiposity, which places the person at risk for cardiovascular complications. Now that you know your risk of disease, you may be able to set your health goals for your diet.

When in doubt, seek (professional) help. A routine doctor visit may be able to tell you your health status. If one has diabetes, hypertension, or other conditions, he should be seen by a physician. The physician will be able to provide restrictions or recommendations when it comes to your dietary intake.

A dietician would be best to provide food lists for these restrictions and allowances. The dietician will provide a meal plan for calorie-controlled diets, in order to tell you the number of exchanges, how much you will need from each food group per day to meet daily needs. Motivate!

There are different factors which influence the compliance of a person to lifestyle change.

One is internal, which means that the person must be willing to commit to a healthy diet. It may be based on your goals or your big “WHY”s. Do you want to improve your blood sugar or your cholesterol level? Do you want to increase strength? Do you want to delay or prevent disease? Keeping an eye on these goals will help you stay on track.

The other is external, which involves the person’s environment. Do you have enough time to shop and prepare healthy meals? Can fast food be avoided? Do you have support from companions at home, work or school? They also play a role in helping you comply to a healthy diet.

Start Small and Monitor
If you want to start a change, simply start one at a time. Choose the healthy diet advice which relates to your lifestyle. Do you take sodas or fast food regularly? Are you taking enough fruits or vegetables during meals? Do you skip and binge? Addressing a bad habit one at a time and making small conscious choices will help build confidence.

A food diary can help monitor. Listing down one’s intake can provide awareness of diet patterns and compliance to the recommended plan. For those who are tech-savvy, some health applications are available online which can help keep track of calorie intake and even exercise. It can even be shared among friends as a form of moral support.

Overall, a healthy diet is a combination of having knowledge to make the right choices and forming good habits. It is a way of caring for oneself. Hope this encourages you to eat healthy today and feel good about it!


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What is PCEDM?

The PCEDM is a sub-specialty society of the Philippine College of Physicians, a founding member of the ASEAN Federation of Endocrine Societies, and a member of the International Society of Endocrinology.

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