Through their eyes

Even if you don't have a medical professional background,

Even if you don't enter university to study,

Even if you don't read any nutrition related magazines or books,

Even if you don't have a chronic disease...

Please put yourself in the person's shoes. See things through the person's eyes. 

Not simply giving information which is not evidence based and not true, while you're not a medical profession person, you don't read nutrition books, you don't read medical books and you do not have a chronic disease. 

____________________________________________________________________________

A couple of weeks ago, a girl whom I am not close to her at all, came out of nowhere to fb-message me about my so-called insulin-injecting-pathetic-diabetes-life (by the way, my life is actually fantastic with insulin keeping me alive). 

She approached me and asked me: Mind sharing with me about your situation? I can help you. 

I am doing perfectly fine. But, I am curious about what kind of help she would like to offer me.

Then she started saying: If you want to give yourself a chance, there is a way to cure your diabetes. We have lots of critically ill patients, all successful stories. 

When I tried explaining to her about there is no cure for diabetes at the moment. More, my T1D is different a bit, and having to inject every day doesn't mean I am a bad type of diabetic (if she has been studying about this). Why can't people understand, why can't they just try to understand before judging me ARGH. 

Then she came judging again: I am not selling you anything. That's why I am asking you whether you want to give yourself a chance or not? Hepatitis B also no cure, but we have many successful cases.

Hello miss, if I were to judge you, I will straight ask what you're trying to sell in the first place. And who told you that there is no cure for Hepatitis B?! (Luckily that I have learned much from my boss) And you were saying medical books do not tell us everything?! (Those words from your mouth tell me everything is it?)

Few things I would like to clarify:

1. Having to inject insulin every day does not make me a bad diabetic. Just my beta cells are not making insulin hormone. I am injecting the insulin hormone, I am not injecting a medicine!
2. Testimonials are not evidence-based. 
3. There is a cure for Hepatitis B. Please do consult gastroenterologist for further discussion of which evidence-based treatment suits best for you, not by listening to testimonials only!
4. Hope is important for all of us. Hope keeps us alive. But, do not give false hope which may result in a more terrible consequences.

Seriously, thanks for offering your "help" to me. Through your eyes and words, I have learned that every time I correct a misconception, there will be another person who claimed that she is not selling anything, but spreading this misconception out again. God knows who is the next victim. 

Memes from diabetesdaily.com

Eating outside

Where to find healthy food? Either is cooking in the kitchen or eating outside. 

Because healthy food will not drop from the sky. You need to find it, either it grows from the ground, tree, flowers, seeds or from the water. 

Cooking in your kitchen is easy for you to eat healthily because you get to pick the right variety of food. So, for those who do not have a kitchen, how?

The good news is you get to pick the right Menu in order to eat healthily, despite you don't own a kitchen! Like me, I don't own a kitchen here at my rented place. So, I try to pick my menu properly or else I will just pop over to my friend's or boyfriend's house to cook. Because those menus from cafe can be quite expensive at times, at least for me, because I am currently living on a budget!

Last week I was at The Burgertory, SS15 Subang Jaya with my buddy. It serves Pork Burger, fries or apple walnut salad as side dish andddd I get to choose Coke light as my drink! (very rarely an individual restaurant sells Coke Light, but I think it is getting more and more in Selangor!)

This Curry Pork Burger costs me RM20, with a whole big chunk of apple walnut salad! I hardly finished the meal because the salad already filled up half of my stomach. But it was all satisfying and I was glad that I did not choose fries as my side dish, though I love potatoes.

Seriously, no much obstacles eating healthily, although living outside without a kitchen. One of the ways is the pick Mixed Rice. Because I get to choose the dishes that I want! Honestly, I will not have much choices if the food order is always fried rice, fried noodles and other fried stuffs, though these are the easy-to-order food menus. Moreover, don't forget your daily intake of at least two servings of fruits! Because fast food restaurants don't serve you fruits unless you order them. Neither the Mixed Rice restaurant serves you fruits, so buy your own fruits! You certainly don't need a kitchen to prepare fruits. Just a knife, bowl and water will do :)

Bought an avocado yesterday to cook with spaghetti, never actually bought an avocado before. Usually I eat avocado in those Japanese restaurants only, on top of sushi or in vege salad. This kinda small avocado costs me RM3. I am very untrained on how to pick the ripe avocado. I guess this small healthy fat fruit was a bit raw :p

Eat to Live & Live to Eat

Which category you think belongs to you?

The same 3 words, but when you arrange them in separate ways, totally distinct meaning.

I put my title as "Eat to live And (&) Live to eat", because I do not agree with putting Or (/) in this quotation.

If you were to choose either one...

Let's talk about EAT to LIVE. It's kinda sad when you hear someone says: "Oh food is just my fuel, I eat because I need to keep my heart pumping. That's it." Food is colourful and should be creative! Food is not medication (though some medications can be quite colourful lol) that only treat or control your diseases. Food is a Wonderful Enjoyment in life! Food surely is not fuel that only cause you to gain weight and gain fats. When you gain much weight and body fat, most certainly is related to Metabolism and Mindful eating. Don't blame real food. 

Secondly, let's talk about LIVE to EAT. Oh, I continually encounter people who practise live to eat and believe me, I struggle hard to make them change. Even require extra effort to make him/her sit there for consultation.  Because a dietitian will make sure all their favourite foods are being eliminated. Wronggg! The moment I said healthy eating plan, I am so not going to ruin your "purpose in life" which is to eat. You will never go wrong by a variety of REAL healthy FOOD. And when I mentioned healthy eating plan, I am not saying the bland dull food. I am talking about Real Food cooking which is worth changing your eating habits for! Try a different cooking method, try using spices for a new flavor happening on your tongue, try exploring adding fruit and vegetables in your cooking and baking!

It's again the BALANCE of these two. Any extremity of either one, is a nonono. Enjoy your real food for the fuel, nutrients, satisfaction and pleasure that you can get from it!

_______________________________________________________________________________

Everytime I talk about real food, I get really hungry. And my rented house here is having water rationing for April. The whole April month. @#$%@#$% Seriously, I really pik cik (frustrated).

Yesterday night went to Cold Storage and wanted to buy some avocados. But, they don't sell there. Probably have to go Jaya Grocer. Aiks.

Anyway, I bought a very expensive potato chips. I like how they specified the amount of carbohydrates in the chips. Really interesting informative Food Label for potato chips.

So precisely, about 13 chips = 16g carbs (1 serving!)

Now that I know how much to put in my bowl for snacking next time. But, at times, counting 26 chips every time I snack, can be quite bothering. I rather boil 2 medium potatoes, sprinkles salt pepper and eat haha!

Make food with 2 C

I usually will not comment much on buying Real Food at organic shop, especially for those nuts, seeds and grains family because we hardly or totally don't find them at wet market or supermarket. Nuts, seeds and grains not only give us the vitamin and minerals, also the healthy fats and fibre! Particularly for vegetarians who barely receive healthy fats from fruits and vegetables.

Last weekend, I over heard some promotional sentences from an auntie who is selling Chia Seeds. She marketed her chia seed as excellent in lowering cholesterol, lowering body fat, making your tummy small, good in controlling sugar level and it's from Mexico, chia seeds' origin country. Also, you must only eat her chia seeds in this way: Soak it in your drinking water until it expands, becomes gelatinous, then drink it together with drinking water whole day. 

Chia Seed totally sounds like a super food from her mouth. My idea of super food is not one food, but a variety of food. And of course Chia Seed is one of the super food that is rich in Omega-3 fatty acids and fibre! And you know what? The famous "Chia Pet" that you always see in RM5 store, the hair that grew out from the ceramic head is actually grass that grew out from Chia Seed :p

Interesting huh. haha I just found out today!

Chia Seed which is rich in Omega-3 fatty acids no doubt can help you to control your cholesterol (I used the word "control" because I don't want anyone to mistaken it as can lower cholestrol, no matter how much cholesterol diet intake). However, reducing your tummy's fat? Sorry to say, Chia Seeds do not act specifically on your tummy's fat. Controlling sugar level? Perhaps yes due to the fibre content. But be watchful of the intake of Chia Seed because too much of fibre may cause gastrointestinal discomfort. Also, Chia Seed is a high protein seed, which may not be suitable for some patients. Please talk to your physician or dietitian first, before you start consuming. 

Oh ya! My title today is make food with 2 Cs - Colourful and Creative! Why la you want to eat this nutritious Chia Seeds only by letting it expand in drinking water? 

Please sprinkle it on your oats! Add it into your cookies dough! Enjoy it with your fruit smoothies! Incorporate it in your puddings! For more, visit WellnessMama. 

Real food can never ever be dull!

By the way, in real life, Chia Seed looks like this in pudding.

Picture from ifoodreal.com

After expanding, somehow looks like our biji sago, right? :)

I do not want to consult a dietitian?

Excuse me. You do not want to consult a dietitian? May I know the reasons for this? 

I was thinking about this a few days ago. In fact, I think about this matter almost every day now. Perhaps the public does not know what a dietitian is, or perhaps they thought they knew what a dietitian is, but they got all the wrong thoughts in their heads.

In the hospital, I only see patient with a doctor's referral. Of course I can be such a volunteer to go and see patients who do not have referrals. Once in a blue moon, a really rare blue moon, a patient will ask for a referral to see a dietitian. I'd very glad to consult such patient because his/her readiness to change is COMMITTED, i.e. He/she is willing to take whatever it needs to achieve the goal that the dietitian targeted! Such patient not only motivate his/her own self, but also motivate me tremendously!

It has been several times already, when I introduce myself as a dietitian that provides nutrition consultation, they will start commenting about how much restrictions a dietitian will ask them to do, and they still want to enjoy their food for another half century, so a dietitian is like a headmaster restricting their daily favourite food intake. They said all these even before I start explaining on what I am supposed to do.

Dear Tuan-tuan dan Puan-puan (Ladies and Gentlemen),
I will not restrict you from eating your favourite food. For goodness sake, I hate restrictions more than you do.

1) I am not your mother. Like what is written at Eatright.org, the last thing I will do is to give you a one-size-fits-all diet advice. I totally believe that each individual is extraordinary in their own ways. Asking you to stop eating this or stop drinking that will only make me look more like your mother. Okay, I may talk like your mother, but I definitely will set a goal that is realistic and of course predominant for you only.

2) I am not a salesperson. After talking and explaining to you about nutrition, my ultimate goal is not to persuade you to buy a million dollar product, but my goal is to educate you about what is the best nutrition for you and how you can make better health based on your personal usual dietary intake and lifestyles. Okay, I will only recommend the real food, whole food for you, which you can easily buy from the market outside.

3) I am not an accountant. I am not so calculative as: One day, exactly 8 glasses of water.  If not, you failed.  One day, sugar level must be within 4 to 8 mmol/L. If not, you failed. Okay, of course I do count calories and nutrients, but my paramount idea is to want you to enjoy real food, play around with nutrition, while being at optimal health status. Nutrition is easy to understand, just need some proper guidance and encouragement on how to master it and maintain it.

Haiyo, just eat la.
But MINDFUL eating :)

Beating the Bloat

Title adapted from one lecture by Prof. Peter Gibson, Monash University, Melbourne.

During my internship year in UKM Medical Centre and Hospital Kuala Lumpur, or even during those days studying in University, NONE of the lecturers or dietitians mentioned about FODMAPs. 

F - Fermentable

O - Oligosaccharides

D - Disaccharides

M - Monosaccharides

A - And

P - Polyols

Just got the latest publication of Gastroenterology Journals (January 2014) from my boss to read. January's HIT TOPIC is finally FODMAP! A rather new topic to the Malaysia's dietitians, but the reason to prescribe this diet is not new at all, the most familiar, usual, recurrent syndrome presenting to gastroenterologist everyday.

Irritable Bowel Syndrome (IBS) is categorized into four categories, namely: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (both diarrhea and constipation alternating) and IBS-U (neither diarrhea nor constipation). However, the very frequent complaint that I heard from patients are bloating, belching, burping and flatulence. I believe very much in some food can potentially worsen the "wind problem", other than bacteria in your colon. And FODMAP can definitely beat the bloat up to 80% in most patients!

And of course, before you start finding an experienced dietitian to consult you on this diet. You must make sure the gastroenterologist has ruled out all other diseases first. We do not want to risk your life, missing any of the organic diseases. Medical diagnosis should be made and confirmed by the specialist doctor. After diagnosis of IBS is confirmed by the gastroenterologist, now it is the time for DIET THERAPY by dietitian (never ever try practicing this diet by yourself!).

I don't know if you are like me. If I can choose, I would like to be on a whole-life diet therapy for my T1DM, without depending on insulin. I would choose to have a whole-life diet therapy, rather than a whole-life medication-poking treatment. Okay, insulin is a hormone, not medicine. (So, am I like hormone imbalance now? loll)

When we talk about nutrition or any new diet therapy, we must first look at the evidence before we start to recommend. Although the scientific evidence on positive effect of reducing high FODMAPs food in IBS has so far been relatively limited, but good news is the research is growing and accumulating over the last few years! More and more studies are showing us that gastrointestinal symptoms can be lessened through diet therapy, though there is no cure in IBS, but symptoms can be controlled, just like T1DM :)

I love how nutrition and diet can help us not only to enjoy healthy food, but also to control diseases and symptoms. I know how terrifying and disheartening it is to know that some diseases are incurable. Despite all the bad news that come together with your disease, at least you know you are still in control of it. Never lose hope. 

Diet therapy is not a cure, but it is your sword in the battle :)  

Nothing about Nutrition

I realised that sometimes it is not essential to talk about nutrition during the first visit with the patient or client. Because nowadays, majority people practise an unhealthy hectic lifestyle that lead to their nutrition deficiency or diseases. The first measure should be to find out why are they unable to eat meal on time, eat high trans fat easy fast prepared food, eat their meals speedy and etc. And then suggest ways to overcome these obstacles. Especially for weight management clients. 

I have to admit that I am still a junior dietitian and there are a lots more for me to discover. Even till the day I become a senior dietitian, there are still much about nutrition and dietetics to explore because nutrition dietetics progress everyday to a better era. It is a long-life learning.

A senior pharmacist was chatting with me on the other day. He told me that my role is not only to educate about nutrition but also to consider little things about eating habits. For example: To eat fruits before or after meal? Is drinking water before a meal makes a better diet or worse? What kind of nutritious food when taken in large amount will result in indigestion?

I will try to answer these questions at here. But, to be frank, again there is no 100% in nutrition. Hence, every diet must be individualised. There is no one recommendation that works for everyone. 

1) To eat fruits before or after a meal?

   Many claim that we should eat fruits alone or on an empty stomach, due to better absorption of nutrients as all the enzymes work for the ingested fruit only. Some also mentioned that if fruit is taken with a meal, it will slow down the digestion process, leading to fermentation of sugar in fruits (fermentation by the bacteria). Hmm yes, fructose sugar might cause gastrointestinal problem for people who have sensitive bowels, but it also depends on how much fruit and what type of fruit. And generally, fructose sugar is easier to digest with the intake of other food or with intake of glucose. About better absorption of nutrients, our body is basically designed to absorb a mixture of nutrients/food, unless if the person has malabsorption problem. 

I guess, whether to eat fruits with a meal, before or after a meal is depending on your needs. For example, Vitamin C in fruits helps in absorption of Iron, therefore if you want to have better absorption of iron, please do not eat your oranges on empty stomach. Whereas, if you want to avoid over-eating during a main meal course, perhaps you can try eating 1 serving of whole fruit before your meal. Fibre in fruit can help to fill up your stomach with lesser calories.

2) Is drinking water before a meal makes a better diet or worse?

   I remember my coach dietitians were giving tips to weight management client on how to increase their satiety before they consume a main meal. Drinking 1 glass of water before meal can avoid the patient from over-eating during the main course. But somehow we have forgotten to mention when to drink water before a meal. 

Okay, one essential thing that I must mention is drinking water during a meal/with a meal is not essentially good. Because while our stomach is secreting gastric acid to digest the food in the stomach, if we were to drink too much water, we can potentially dilute the gastric acid and hence making the digestion not so efficient. Alright, my idea is too much of water is not good, but little water may be helpful, and also when you drink it. Drinking 1 glass of water 30 minutes before your meal, can prepare your stomach for digestion, other than giving satiety signal. And of course, sipping soups during your meal is definitely alright. But, keep in mind is sipping, not too much. 

I remember the gastroenterologist always consults his patients with this: If an emergency of acid reflux happens and you do not have any medications at home, you can try drinking lots of water so as to dilute the acid in the stomach. But of course, if too severe, please visit the Emergency Department.  

3) What kind of nutritious food when taken in large amount will result in indigestion?

   Beans, honey, garlic and onion are basically nutritious food. From my experience, after I advised the patient to stop eating these food and start them back in smaller quantity, their gastrointestional problem improved by almost 80% most of the time. 

Picture from www.wholesomeone.com

Please do consult your dietitian or pharmacist for any related topics.

Sorry, I give up.

I am sorry, sometimes I give up explaining to you about T1DM.

Today, I was consulting a 60 year-old Indian uncle about Food Intolerance and Diabetes. His diabetes is Type 2.

A few misconceptions that he is having:

1. Guava can help in lowering sugar level. But he forgot about eating guava with all other different types of fruits can increase his sugar tremendously, despite Guava is known to have a low Glycemic Index (GI).

2. Bitter gourd cannot help in reducing blood sugar level (which I agree with him, but I disagree with his explanation). His explanation is bitter gourd has a natural insulin property. So, when we eat bitter gourd, it will actually stimulate our pancreas to secrete less insulin. Less insulin = Higher sugar level.

3. I told him that I am also a diabetic patient, but is Type 1, in which my pancreas no longer produces insulin due to autoimmune. Then he started showing me an astonished face and saying that my parent must have diabetes but they didn't know yet. I told him, neither my parent nor my grandparent has diabetes. He insisted that my great grandparent must have diabetes, and during their time, medical diagnosis wasn't so advanced yet, so doctors missed out the diagnosis. 

Okay, I give up. If I continue to correct him, I wouldn't be able to finish my consultation and he would start pointing all my Nenek Moyang (ancestors) have diabetes. 

I do not want to sound too harsh in my consultation that would make him feel that I am offensive. Therefore, I corrected his "Guava" and "Bitter gourd" misconception slowly and I praised him that not many people know about Glycemic Index. One extra compliment for him is when I gave an example about 2 bowls of Brown Rice and 1 bowl of White Rice, he actually understands well about Glycemic Load. 

Okay la uncle, I forgive you because you certainly should know more about T2DM, instead of T1DM :)

Picture from BBC Science

Variety is the key

Someone asks:

I heard salmon fish is good. What do you think?

It depends.

Ohhh heard soy products can help in preventing cancer and allergies. What is your view?

It depends.

I heard broccolis are good. That is why I take them every day for my three meals. Good for me, right?

It depends.

I bought this Manuka Honey with an expensive price. I know it is a pure honey, good for my digestion. It can't be wrong.

It depends.

There is rarely a same diet for two individuals. And of course, there is no one food that gives you the best.

Variety is the key to health. Whenever someone recommends you a new diet or food, keep in mind that variety is the key. There is no super food in this world which, when you only eat that, you get all the benefits that you want. No matter it is a protein based, carbohydrate based or a healthy fat based, keep your micronutrients proportion correct and consume a wide variety of fruits and vegetables. 

Please try out variety first, before you start considering: If I am insufficient, there is always a supplement for me. I was thinking like this earlier on, at the end of the day, I seriously became lazier to start getting my nutrients from real food. Please do enjoy real foods people!

Food for Thought

I really don't mind working 10 hours a day if I can get back something good in return.

Either is money, friendship, knowledge or reputation. Of course the two latter one are what I matter the most now.

The money will come when you have the experiences. So, bear in mind: Everyday, I might get back something of the above four from that particular boss or company or client. And of course, I must get these four in an incremental basis. Today must be more than yesterday. If not, find alternatives.

Search for FOOD, even when you're hungry. Not when you're already starving.

_____________________________________________________________________

Currently I am figuring out the best practical way to lose weight. Have been reading other blogs about weight loss. All are about "Mindful eating", "Eat Nutrient-densed food", "Eat more, exercise more", "Rebel dieting" and etc. Talking about all measures, but rarely about intense calorie counting. 

Seriously have to figure out a better way of channelling my ideas to patients/clients' head. I have already encountered one uncle today, whom the moment he knew I am dietitian, he said: "Oh no, she will be asking me to stop eating all my favourite food and drinks. Like that I can't enjoy my life anymore la." 

Uncle, I am not here to make your life miserable. Never. Nutrition has always been colourful and I will never change the way nutrition looks! I am not here to sell you a product or supplement. I am here to sell you my knowledge, rather than my service. I sell you Food for THOUGHT.

Organic?

What is the definition of "ORGANIC"?

Do you really need to eat organic food?

How do you make sure the product is certified organic?

Picture adapted from internet

Quoted from the Year 2014 Chinese New Year movie <Golden Chickensss 金鸡2>, the moment the actor looked at the non-plastic surgery woman, he said: "So organic~" . I was laughing when I heard how he pronounced the word "Organic" in a sarcastic way.

Read an article from The Star last week about Organic Labels and Organic Certification. So, make sure you check out your product's certification before you decide to buy an overpriced brown rice, cereals, oats, muesli, fruits, vegetables and etc. 

Last two days, there was one almost 100 years old patient came in to see my boss for consultation advices on gastrointestinal. The patient is an educated businessman. Was asking if taking organic food is alright for him. When being asked the reason for taking organic food, he answered it is because...everyone says they are quite good. Then, he got a reply like this: Well, whether organic food is good or not, I am not too sure. But, generally they are overpriced. Whether you need to eat them or not, maybe you should ask yourself what have you been eating since 90+ years ago that keep you living until today? I just chuckled together with the patient after hearing this reply.

If a product is stated "100% Organic" (And of course, if it is 100% Organic, it cannot be a food product, it must be a real food aka single-ingredient-food). Talking about "100% Organic", here's a story to share with you all when I was at a volunteer diabetes discussion last Saturday. Heard a rather upsetting than shocking real incident from a participant whom has friend farming organic vegetables in [you-know-where-in-Malaysia]. He told us that his friend claimed that all his vegetables are organic with evidence of worm bites on edges of leaves. However, the truth is actually his friend rinsed off the pesticides on the vegetables, and then spread out some worms onto the vegetables on the night before the market starts. Alarming right, I always search for worm bites marks to ensure that there are less chemicals on vegetables.

Okay, it is not like I disagree with "Organic". It is just the trustworthy of farmers, good manufacturing practices of producers and prices of organic food, that make me think thrice before I buy. 

My advice is to take a few seeds and grow yourself some farms in the back yard of your house. hahaha.

What is a must-have in my dream house in the future? A "So organic~" Mini Farm  :p

20·20·20

This morning's FM radio gave me a link between nutrition, lifestyle, and genetic. 

On the first day when your relatives and friends knew that your profession is Dietetics. They will start asking questions like these...

: I want my hair to grow thicker, what should I eat?

: I want to grow taller la, what can I eat har? Calcium supplement?

: I hor...want to have bigger breast, you recommend what type of cooking method with papaya?

: I want to have fairer skin leh, which herbs will work for me?

: I think my eyesight power getting serious la, you think eat carrot will work anot?

(Typical Malaysian-Asking-Style)

A dietitian can help you in answering nutrition questions because she is an expert in nutrition. But, think twice if you were to see a self-claimed nutrition expert who keeps on promoting a single supplement/product, without revealing the reality about all nutrients work in the same boat. Not forgetting lifestyles and genetics are all in the same boat as well.

Nutrition has never worked alone all these while

Questions about hair amount, height, breast size, skin color are all generally related to genes. I can help you in getting better and healthier hair, stronger bone, how to properly proceed with exclusive breastfeeding after delivery and how to have a hydrated moisturizing skin. But, altering a gene expression which is already there in your body for more than decades already, sorry that I am helpless. I know Nutritional Genomics is a Hit Topic right now, but please don't confuse with gene-diet-disease related topic.

A person with a sufficient daily supply of nutrients, but without a good proper habit/lifestyle, I can guarantee nutrition will not help you much. As mentioned earlier, nutrition does not work alone. If you're an IT person or a student, and facing laptop everyday is something that you could not afford to avoid, will more carrot or bilberry or healthy fats work for you? Yes, they will. 

Ehem......

Provided you practice the "20·20·20" rule. Every 20 minutes, Rest your eyes for 20 seconds and Look 20 feet away from your laptop (adapted from LiteFM this morning). Now that you are taking care of all factors in the same boat. Even if genes were to be the culprit, believe me, it will take time to happen :)

Okay, I should actually take 20 minutes rest now! :p