What’s in my food campaign

The Healthy Living Alliance (HEALA) launched a campaign, #whatsinmyfood, that asserts the right of every South African to know what is in the processed food they are eating. HEALA have called on government to help them do this.


About the campaign

The overall message of the #whatsinmyfood campaign is that South Africans have the right to know what’s in their food. The campaign aims to raise awareness and encourage dialogue among ordinary South Africans about the harmful contents of unhealthy food sold by the food and beverage industry.

There is a direct link between obesity and related non-communicable diseases such as diabetes, and the excessive consumption of foods high in salt, sugar and saturated fat.

The objective of the campaign is to get people to realise that a lot of the everyday processed food they are eating is unhealthy, and that there is a correlation between eating unhealthy food and poor health. Everyone needs to scrutinise the contents of their food, and particularly to cut down on foods high in sugar, salt and saturated fat.

Obesity stats

According to a 2016 Lancet study, South Africa is the most obese nation in Sub-Saharan Africa. Almost 40% of women and 11% of men are obese and over two-thirds (69,3%) of women and 39% of men are overweight1.

Obesity is one of the top five risk factors for early death and disability in the country2. In addition, 1,6 million South African children are considered obese and the condition is growing at a much faster amongst kids than adults1.

The study further reveals that obesity is linked to the development of chronic non-communicable diseases, such as Type 2 diabetes, heart disease and strokes. These are among the top 10 causes of death in South Africa, accounting for 43% of deaths1.

Fighting obesity

The availability of unhealthy food combined with aggressive marketing, advertising and incomprehensible food labels, disempowers the consumer from making healthy food choices.

It is the responsibility of the food and beverage industry to clearly disclose the contents of the food they produce, market and supply to the public.

HEALA requires government to create policies and laws to ensure that the food and beverage industry provide South Africans with the clear and accurate information they need to make better food choices for themselves and their families.

Microsite

Linked to the campaign is a microsite (www.whatsinmyfood.org.za) that features simplified nutrition information on popular packaged foods and beverages. There is also a pledge for visitors urging government to put in place policies that call for clear food labels and hold industry accountable for the harmful ingredients in the food they supply.

People can support and benefit from the campaign by engaging in social media conversations using the #whatsinmyfood, visiting the microsite and taking the pledge at www.whatsinmyfood.org.za.

References:

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. The Lancet. 2016; 387(10026): 1377-96)
  2. Pillay-van Wyk V, Msemburi W, Laubscher R, Dorrington RE, Groenewald P, Glass T, et al. Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease.

 

FUTURELIFE® ZERO Smart food™ with berries and nuts

Ingredients

  • 4 Tbsp. (40g) FUTURELIFE® ZERO Smart food™
  • 100 ml cup warm water
  • ¼ cup warm milk (optional)
  • 1 Tbsp. dried berries e.g. goji berries
  • 1 Tbsp. chopped nuts e.g. almond

Method

  1. Cover the FUTURELIFE® ZERO Smart food™ with warm water, mix until combined.
  2. Sprinkle over raisins and nuts.
  3. Add milk (optional).

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-zero-smart-food/


Warm FUTURELIFE® HIGH PROTEIN Smart food™ Chocolate Drink

Ingredients

  • 25g (1/4 cup) FUTURELIFE® HIGH PROTEIN Smart food™ chocolate flavour
  • ¾ cup warm low fat milk
  • ½ cup boiled water
  • 1 teaspoon cocoa

Method

  1. Blend together until smooth and enjoy immediately with your feet up under a blanket.

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-high-protein-smart-food/


FUTURELIFE® Smart food™ Banana and Chocolate smoothie

Ingredients

  • 1 small frozen banana
  • 2 Tbsp. cacao powder
  • ½ cup milk or dairy alternative such as soy / almond milk
  • ½ cup of water
  • 2 Tbsp. chia seed
  • ¼ – ½ teaspoon cinnamon
  • 25 g FUTURELIFE® Smart food™ Original or Chocolate
  • Few blocks of ice (optional)

Method

  1. Blend all ingredients in a high speed blender until smooth.
  2. Adjust sweetness by adding xylitol, stevia or another artificial sweetener to taste.
  3. Enjoy cold and immediately.

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-high-energy-smart-food/


FUTURELIFE® HIGH PROTEIN Smart food™ MUFFINS

Ingredients

  • 200ml (4/5 cup) FUTURELIFE®HIGH PROTEIN Smart food™
  • 250ml (1 cup) whole wheat flour
  • 5ml (1 tsp) salt
  • 20ml (4 tsp) baking powder
  • 15ml (1 Tbsp.) sugar
  • 1 egg
  • 60ml (4 Tbsp.) butter/margarine/coconut oil
  • 250ml (1 cup) low fat milk
  • 1 tsp of low sugar low salt peanut butter for each muffin’s centre

*Optional: Grate 1 cup carrot or apples and a few Tbsp. of seeds to the wet ingredients.

Method

  1. Pre-heat the oven to 200°C and grease a muffin tin.
  2. Mix all the dry ingredients together.
  3. Whisk egg. Add the butter/margarine/coconut oil and milk to the beaten egg and whisk until combined.
  4. Add wet ingredients to dry ingredient and fold together until just combined.
  5. Spoon equal amounts of batter into greased muffin tin. Spoon a teaspoon of peanut butter into each centre of the muffins.
  6. Bake for 15 – 20 minutes.
  7. Freeze in an airtight bag or enjoy fresh.

* Make a batch and freeze. To defrost leave to thaw at room temperature.


For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-high-protein-smart-food/


FUTURELIFE® Smart food™ with Strawberries and a yoghurt topping

Ingredients

  • 50 g or ½ cup FUTURELIFE® Smart food™
  • 125ml of warm water or low fat milk (or more to get your preferred consistency)
  • 1 – 2 tbsp. low fat plain yoghurt
  • 1 – 2 sliced strawberries
  • 1 tsp of shaved coconut flakes (optional)

Method

  1. Add your FUTURELIFE® Smart food™ and milk to a bowl and mix well.
  2. Top with yoghurt, sliced strawberries and coconut shavings.

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-high-energy-smart-food/


FUTURELIFE® ZERO Smart food™ TROPICAL BREEZE SMOOTHIE

Ingredients

  • 2 passion fruit (granadilla)
  • 125ml skim milk
  • 125ml water
  • 3 tablespoons FUTURELIFE®Zero Smart food™
  • 4 ice cubes

Method

  1. Add all the ingredients to your blender and blend together on full power until smooth. Serve and enjoy.

Serves 1 – meal
Serves 2 – snack


For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-zero-smart-food/


When food stands still


Dr Angela Murphy shares one of her patient’s stories to explain the connection between diabetes and gastroparesis.


Ms DL is a 28-year-old lady, who was diagnosed with Type 1 diabetes at the age of 15. She had poor control from the start due to not being able to accept the diagnosis. She was admitted regularly with diabetic ketoacidosis, with extreme dehydration. During these episodes, she would go into renal failure. Closer questioning revealed that symptoms would begin with nausea and vomiting. She had been experiencing bloating after meals for over a year.   A gastric emptying study was done, which showed significant gastroparesis.


What is gastroparesis?

It is a condition where the stomach does not empty properly, resulting in food not moving into the small intestine. Normally, the muscles of the entire gastrointestinal tract contract and release rhythmically to move food along, which is necessary for the digestive process. This muscle action is controlled by the vagus nerve. However, damage to the vagus nerve results in weaker, poorly contracting muscles and slows the movement of food out of the stomach.


Causes

Unfortunately, there are many causes – it can occur as a complication of surgery to the gastrointestinal tract; as part of neurological disorders; infective and inflammatory conditions; or in underactive thyroid disease. Over a third of cases are due to diabetes, and in some cases no specific cause can be found.

Poorly controlled diabetes can result in damage to the vagus nerve, and is the most common known cause of gastroparesis. Patients classically present with stomach pain, bloating, indigestion, nausea and vomiting. In an insulin-dependent diabetic patient, vomiting will lead to ketones, and the presentation may look like an episode of ketoacidosis. In addition, patients may have documented reflux disease or irritable bowel syndrome (IBS), and the symptoms may be attributed to these conditions. A careful examination and history is needed to work out the sequence of events.

Diagnostic tests

Ms DL had a variety of tests to diagnose her problem, such as:

  • Upper gastrointestinal gastroscopy is performed by either a gastroenterologist or a surgeon, and can be carried out as an outpatient. The patient fasts for six hours, then a flexible camera is used to look inside the oesophagus, stomach and the duodenum (the first part of the small intestine).
  • Barium meal and follow-through is when a patient must fast for eight hours and then drinks barium – a chalky type liquid – that is used as the contrast agent. A series of X-rays are then taken. Barium lines the gastrointestinal tract so will show any obstruction, such as food in the stomach, quite clearly on the X-ray.
  • Ultrasound allows the radiologist to exclude any disease of the gallbladder or pancreas.
  • Gastric emptying scintigraphy is usually the gold standard for diagnosis. The patient fasts from the night before and is then required to eat a bland meal which is radiolabelled with technetium. A camera then scans the abdomen to follow the progress of the radiolabelled food hourly for four hours after a meal. If more than 10% of the meal is in the stomach after four hours, the diagnosis of gastroparesis is made.

Treatment

Ms DL was started on domperidone (prokinetics) and erythromycin (antibiotic). After 10 months, the episodes returned despite medical treatment. She then had a gastric pacemaker inserted, which only seemed to give benefit for six months. Ms DL recently spent weeks in hospital being treated with anti-nausea medication and intravenous fluids. Unfortunately, there was no way to improve the result with the pacemaker so she was given the option of Botox injections; however, the relief in symptoms after this was very short. After almost two years of suffering, Ms DL underwent a sleeve gastrectomy. (See medical explanations below).

  • Prokinetics are drugs that improve the contraction of the stomach muscles, and move food through to the small intestine more effectively.
    • Metoclopromide is the active ingredient in Maxalon and Clopamom. This should be taken 20-30 minutes before meals. It helps reduce nausea and vomiting. Although it is approved for gastroparesis, it may have side effects, such as tardive dyskinesia – a movement disorder which causes shaking.
    • Domperidone
  • Erythromycin is an antibiotic. When it is prescribed chronically at low doses, it improves stomach muscle contractions. Unfortunately, it can also cause nausea and stomach cramps which limits its use in the gastroparesis patient.
  • Anti-emetics are anti-nausea drugs.
    • Prochlorperazine (Stemetil) is useful when the patient is acutely ill, however, it has even more side effects with chronic use than metoclopramide.
  • Antipsychotic drugs
    • Chlorpromazine (Largactil) has frequently been used in patients with severe, persistent hiccups. Its actions on muscle have also worked in the patient with gastroparesis with some degree of success.
  • Botulinum toxin is used when a gastroenterologist injects Botox directly into the pylorus (the valve between the stomach and duodenum involved in the rate of gastric emptying) using an endoscope. This relaxes the valve, keeping it open for longer periods allowing food to pass through. The results of Botox are quite variable; some patients have relief of their symptoms for months, while others find no improvement.
  • Gastric pacemaker is a neurostimulator device which can be surgically implanted. This is normally done in patients with symptoms not responding to medication and diet changes. The battery-operated device has electrodes that are inserted into the stomach muscle wall. This then sends signals at regular intervals to stimulate the stomach muscle.   Studies have found that sending pulses that have a higher frequency than normal gastric contraction improves nausea and vomiting more effectively. However, more work needs to be done to refine this treatment for patients.
  • Jejenostomy is a feeding tube which is placed through the abdominal wall directly into the jejunum (the second section of the small intestine). Special, balanced liquid food can then be given to the patient. It is commonly used in a malnourished, dehydrated patient.
  • Surgery
    • Sleeve gastrectomy is a near total gastrectomy performed via keyhole surgery.
    • Roux-en-Y gastric bypass is when a small pouch is made from the top of the stomach and is attached to a loop of jejunum.

In both these surgeries, by removing most of the functional stomach it is possible to relieve symptoms of nausea and vomiting. Patients must be well-prepared, even though the dietary changes required are essentially the same as they should be following: small regular meals (see info on diet below).

Surgery is the treatment of last resort, but in my patient, this was life-changing. In the months post-surgery, she has had fewer and fewer episodes of vomiting. Generally, her symptoms have declined and her quality of life has improved incredibly.

Diet

There are several useful measures patients can take to improve symptoms:

  • Eat six small meals a day; this gives the stomach a chance to empty.
  • Limit the amount of fatty foods.
  • Limit fibre as it also takes longer to digest.
  • Eat in an upright position.
  • Avoid late evening meals.
  • Avoid carbonated drinks.
  • If the patient is very symptomatic then a liquid diet is the best choice until improvement.

Gastroparesis and diabetes

There is no doubt a vicious cycle exists when diabetes and gastroparesis occur together; high blood glucose directly slows down gastric emptying. Poor diabetes control for more than 10 years increases the risk of damage to the autonomic nervous system. The autonomic nerves control the automatic functions of the body, such as heart beat, blood pressure and gastric emptying.   The erratic emptying of food into the small intestine makes timing of insulin doses very difficult, and patients often swing from high to low blood glucose levels. It may be necessary to change the insulin regimen to get better control, and frequent blood glucose testing is vital.

Gastroparesis severely impacts a patient’s quality of life. Most patients with gastroparesis will respond to dietary changes, prokinetics and erythromycin.   However, for those that don’t, it is important to pursue more invasive treatment until relief of symptoms is achieved.

MEET OUR EXPERT - Dr Angela Murphy

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She is part of the Netcare Sunward Park Bariatric Centre of Excellence and has a busy diabetes practice.