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Healthy Options for the Chinese Diet Alda Lee NZ Registered Dietitian Senior Lecturer AUT University Topics Services Traditional Chinese Foods Heart Healthy Guidelines Education – Reading Labels Case Studies Conclusion Some nutritional issues: Allergies / Anorexia Blood Pressure Cholesterol Diabetes Eating Disorders Food Intolerances Gastric Reflux Hiatus Hernia Irritable Bowel Kidney Digestive Health Malabsorption Nutrient deficiency Obesity / Osteoporosis PCOS Respiratory Salicylate Sensitivity Teenage Nutrition Underweight Vegetarian / Vegans Weight management Traditional Chinese Diet Low in fat and high in fibre High intake of vegetables Lean meat, fish, tofu and beans Rice Adequate intake of fruit Using cooking methods such as steaming, grilling and stir frying Meal Patterns - Breakfast Asian Rice porridge (congee) Noodles Rice and vegetables Savoury steamed or fried buns Dumplings Kumara European Cereal (Weetbix, muesli, cornflakes, Special K) Porridge Toast Yoghurt Fruit Weekends Cooked: e.g. eggs + bacon+ toast + tomato Lunch Asian Rice or noodles or buns + Vegetables + meat or chicken or fish or egg Buns – steamed or fried Snacks: Rice crackers Instant noodles Peanuts, cashew nuts Prawn crackers (deep fried) Fruit European Sandwich Filled Rolls Pies Salad Yoghurt Takeaways Snacks: Fruit Cheese and crackers Scones / Biscuits Cake / chocolate Potato chips Dinner Asian Rice + Meat or chicken or fish Vegetables Soup Dessert: Fresh fruit Drinks: Tea/Wine European Chicken meat or fish Potato or kumara or Rice or Pasta Vegetables or salad Takeaways: e.g. Fish & chips Dessert: Fruit Yoghurt Ice cream Chocolate/ Biscuits Drinks: Wine/beer/sodas But: Eating Out Chinese restaurants are certainly quick and easy. But the typical sauces can be sugary-sweet or way too salty, and a lot of options come battered and deep-fried, e.g. lemon chicken, sweet and sour pork / fish Bigger portions of meat and rice eaten Family Dinners More is Better! Yum Char Deep-fried, high in fat High in salt, mono sodium glutamate (MSG) High in sugar such as in desserts Health Consequences Overweight High Cholesterol Diabetes Hypertension Heart Healthy Eating Guidelines 1. 2. 3. 4. 5. 6. Eat a variety of foods from each of the major four food groups each day. Prepare meals with small amounts of salt and sugar added. Choose prepared foods, drinks and snacks that are low in fat, sugar and salt. Maintain a healthy body weight by regular activity and by healthy eating. Drink plenty of liquids each day, especially water. If you drink alcohol, do so in moderation. Healthier Options: Less Fat Remove visible fat during preparation (e.g. chicken skin) Choose mono / poly unsaturated fats Use small amount of oil Removing skin from chicken and duck before eating Limit pieces of roast pork (special occasions only) Choose steamed dishes e.g. tofu or organic chicken instead of crispy deep fried Polyunsaturated Fats Safflower oil, sunflower oil Corn oil, Canola, soya bean oil Polyunsaturated margarines Wheat germ Wholegrain cereals and breads Seeds Walnuts, Brazil Fish oils naturally present in fish Mono-unsaturated Fats Avocado Peanuts and peanut butter Canola oil Olive oil and olives Olive oil-based margarines Almonds, Cashews Hazelnuts, Pistachio Macadamia Rice bran Oil Photo source from http://images.google.co.nz/imghp?hl=en&tab=wi Recommended fat intake levels Total fat intake should provide 30 – 35% of total energy Saturated fats should provide no more than 15% of total energy Females less than 30g/fat per day Males less than 40g/fat per day Less Salt Use Lo Salt or salt reduced soy sauce (Kikkoman) Prepare meals with minimum salt added Use herbs and spices to add flavour eg garlic, ginger, chillis, lemon juice, 5 spice powder, aniseed Limit salty foods such as salted fish, oyster sauce, hoisin sauce Less Sugar Important for managing weight, diabetes and high triglyceride levels Use sugar substitutes such as stevia or artificial sweeteners Choose diet drinks, diet or light yoghurts, canned fruit in water or juice Choose green tea or water How To Read Labels Fat – Total - Saturated per 100g 10g or less 2g or less Carbohydrates - Sugars Sodium 15 - 20g Under 450mg Fat Content of Crackers Ryvita, assorted flavours Crispbread, rye Rice/prawn Salada, Arnotts Wholemeal and Sesame Cheese Sesame Snax, Griffins Meal Mates, Griffins Total fat per 100g 1.9 2.1 3.7 8.2 15.7 22.4 22.6 24.5 25.7 Fat Content of Cheese % Fat Low Fat Cottage cheese Bega Super slim Mainland Lite Slice Mozzarella 3 9.5 14 18 Medium Feta Camembert Brie Edam 22 23 23 24 % Fat High Processed Cheese Gruyere Gouda Parmesan Blue Vein Colby Cream Cheese Cheddar 28 30 30 30 31 32 34 35 Case Study 1 Patient X Male 64 years old Height: 1.73m Weight: 87.9kg (ideal 70kg) BMI: 29.2 Total Cholesterol: 7.2 mmol/l HDL: 0.93 mmol/l Total: HDL Ratio: 8 Cardiovascular risk (5 years): 15-20% (High) Impaired glucose tolerance HBA1c =43 Family History – Father had stroke in his 50’s now deceased Medications: Lipitor 20 mg, asprin Stopped smoking for over a year Not very compliant with taking his lipitor LOVES his food Food History Breakfast: 10.30am Muesli, 2x weetbix and soy milk Lunch: 2.00pm 4x bowls white rice with 250g -350g meat and stir fry veges or 4-6 slices bread with avocado or Double whopper burger king with cheese, regular fries and soft drink or Large pizza Dinner: 8.00pm Burger King – double whopper, chips and soft drink 2x bowls rice, 2x small kumara and quarter of chicken Chinese restaurant – fried pork chops, 2 bowls of rice, tofu and vegetables Quarter of chicken, 2 small kumara, 2 x bowls of rice, tofu and stir fried vegetables Average fat intake per meal 45 g fat = 9 tsp fat Diagnosis: Too much carbohydrates, fat sugar and salt Healthy Changes Decrease portion sizes – palm size for meat and handsize for fish or tofu Decrease amount of rice to only 1 bowl Increase his fish intake Increase vegetable intake, increase water intake Dinner mainly tofu and vegetables Water with meals Increased exercise to 6 times per week Weight dropped from 87.9kg to 83.8 kg in 5 weeks Results: Feels better, more energy, stomach smaller work in progress Case Study 2 Patient Y Female 62 years old Height: 1.59m Weight: 57kg BMI: 22 Cholesterol 3.9mmol/L Triglyceride: 1.3 mmol/L HDL: 1.25 mmol/L LDL: 2.1 mmol/L Chol/HDL Ratio: 3.1 HBA1C = 49 mmol/mol Medications Statins Metformin – not started Ex-nurse now tutor working from home No exercise Food History Breakfast: 7 - 9.30pm 1 slice plain toast or V8 Juice or Oatmeal porridge + banana + 1 tablespoon sultanas Water Lunch: 12-2pm Yum Char daily when husband home or 2x week or 2 eggs/bacon/sausage and toast or Macaroni Dinner: 9.30pm Fish once a week Salmon or tofu Rice only once a week when out Mainly vegetables Diagnosis: Too much food at Yum Char, too many calories, no exercise and eating too late Healthy Changes Decreased Yum Char – only once a week better choices – steamed rice roll, congee, vegetables, steamed vegetable and meat dumplings, green tea Reading labels Smaller portion sizes Water with meals Walking 4x week for 20 minutes Results: Feeling better, more energy, blood test results improved, more aware of how much to eat! Where to from here? Traditional Chinese Diet Low in Fat and high in fibre High intake of vegetables, 2-3 pieces of fruit daily Palm size serving of lean meat or chicken Handsize serving for fish, tofu and beans Rice ( 1 bowl for men and half –three quarter bowl for females) Choosing more steamed dishes when eating out, no msg Conclusion: Work together as allies to improve the health of our Chinese patients in our community Doctors + Dietitians + Allies There is NO magic pill! Questions?
