What can I gain by consulting a dietitian? We are legally obliged to be registered with the HPCSA, which also means medical benefit where applicable. When you consult one of the dietitians at Combrink & Delport Consulting Dietitians, we take a medical history as well as a dietary history (food intake record). Accordingly a nutritional diagnosis is made and factors identified, contributing to the problem(s). We help you to address contributing factors or to make alternative choices with regards to diet and lifestyle, which will help to cure/improve/manage the condition(s). We provide you with a shopping list and create a diet for you that contains a daily meal plan, with recommended portion sizes, taking into consideration your age, gender, activity levels, weight and fat percentage, as well as medical conditions, if any. We also sell recipe and other books to help you adjust to new eating habits and lifestyle, as well as help you to make permanent changes for the better.

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We are registered Vitality assessment dietitians for Discovery Health (www.discovery.co.za), which means that, if you are on Discovery Medical Aid, you can have us do three nutritional assessments per year on you and the members of your family, for which you will obtain 1 000 Vitality points per visit and 3000 points in total.

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CDE

We are CDE (Centre for Diabetes and Endocrinology) www.cdediabetes.co.za trained dietitians, which means that if you are a diabetic person on the CDE program, you can be referred by your doctor or nurse educator for a free, yearly consultation, as well as one or more follow up consultations, as requested by your doctor or nurse educator.

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We can determine your height, weight & fat percentage & compile a special diet, tailor made for your unique needs, whether it’s weight loss, improved sports performance, muscle gain, more sustained energy or other medical conditions.

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We belong to ADSA (Association for Dietetics in South Africa; www.adsa.org.za), who organize many CPD events, which we attend to keep up to date with the most recent research, which we also use to keep our diets up to date. We also subscribe to the South African Journal of Clinical Nutrition (www.sajcn.co.za) as well as the journal of the Allergy Society of South Africa (www.allergysa.org), which we read to keep up to date with nutrition research.

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How often do I need to see a dietitian?

1 st consultation - 1 hour

Follow up – you need follow up diet therapy, as we need to “hold your hand” until your problem has been solved.

(a) ½ hour once/month (half price of first consultation) or
(b) weekly 15 min weigh in & motivational session (special monthly tariff).

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Your diet plays a major role in helping to prevent and manage various diseases, e.g.

Overweight and obesity increase the risk for diabetes.

It is reported in a study, that modest weight loss reduced the risk of developing type 2 diabetes by about 60%. In the group that was monitored, 7% weight loss was achieved through modification of diet and 150 minutes per week of physical activity.

(Diabetes Prevention Program Research Group: reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346; 393-402)

Food allergies

Food allergy prevention is of great interest for researchers, since the prevention of food allergy development may lead to reduced prevalence of asthma and allergic rhinitis.

Over the years a lot of strategies have been studied and implemented, such as the maternal avoidance during pregnancy and lactation and delayed introduction of solids into the infant’s diet. Despite the long term effects of these interventions being subsequently shown to be disappointing, these recommendations stayed in place for a number of years. A lot of studies add up to the evidence that the delayed introduction of solids into the infant’s diet did not reduce the risk of developing allergic allergies.

Strategies during pregnancy

There is a lack of evidence that the avoidance of certain food would protect the unborn baby against development of certain allergies. There is a greater risk of maternal nutrient shortages, which would affect the unborn baby’s growth. The emphasis moved from the avoidance of certain foods from the diet to the inclusion of certain food/nutrients into the diet.

  • Polyunsaturated fatty acids- increased omega-6 intake is associated with increased inflammatory markers, whereas omega-3 intake inhibits allergic inflammation. Studies are done where the intake of sunflower oil is reduced and the mother’s diet is supplemented with omega-3 rich fish oils. The clinical outcome is still investigated, but it seems positive for improved immunological changes.
  • Probiotics- these live micro-organisms plays an important role in the development of mucosal and systemic immune system, specifically the development of oral tolerance. The studies might seem to have conflicting results, but the outcome is influenced by the strain of probiotic used, dosage and time of probiotic use (mother and new born infant). It does seem as if maternal supplementation could have an effect on allergic disease.
  • Vitamin D- studies are currently looking at the role of maternal vitamin D exposure and food allergy in their offspring.
  • ‘Healthy Diet’- there seems to be a (weak) protective effect of fruit and vegetable intake in the development of asthma and allergy.

Breastfeeding and allergy development

Exclusive breastfeeding is recommended for 6 months, because of its protective effect on gastroenteritis, wheeze, necrotising enterocolitis and vomiting. Breast milk seems to have a protective effect on the development of allergies, only during the months of breast feeding while new foods are introduced. It seems as if there is no long term protective effect of breast milk on the development of food allergies in the toddler after breast feeding has been stopped.

Role of infant formula in allergy prevention

Early exposure to cow’s milk could increase prevalence of cow’s milk allergy. Soy milk formula should not be recommended for the prevention of milk allergy in infants. There is limited evidence that extensively hydrolysed formulas have a protective effect against cow’s milk allergies. The inclusion of pre- and/or probiotics in infant formulas seem to have conflicting results. Therefore, if it is within your budget to use such formula, it could only benefit your infant and would not harm him/her.

Role of infant feeding and allergy development

From 6 months there is no reason to delay the introduction of allergenic foods- e.g. wheat, egg, peanut, cow’s milk products and fish. Delaying weaning beyond 6 months could adversely affect the normal dietary and developmental milestones essential to establish a good varied diet and may increase the risk of allergy development. It would be prudent to introduce allergenic foods one at a time into the diet of high-risk infants.

Non-food strategies

  • Avoid smoking during pregnancy and ensure the baby is not exposed to passive smoking, as this has been associated with development of asthma and allergenic disease in the infant.
  • House-dust mite reduction measures have been shown to reduce sensitisation to house-dust mite at 1 year in high-risk infants
  • During pregnancy and lactation, the use of anti-reflux medication, paracetomol and non-steroidal anti-inflammatory drugs should be limited.

(J Allergy Society of SA; vol. 25, no. 1, March 2012, p18-23)

There is so much to be said on this topic. We have tried to simplify it and to discuss it during different phases. Please contact us that we could help you to eat a balanced sports diet that would optimize your performance.

Sports nutrition could be simplified to 4 different phases during which different goals want to be achieved. The first phase is the last meal before an event; the second phase is the nutrition during the event. The third phase is the recovery time immediately after the event and the fourth phase is the fuelling time between exercises and events, when the time between the events is at least 24 hours.

1. Last meal before an event

Competing in a fasting state is not advisable. Eating a low GI carbohydrate before an event could prevent you from hitting the wall and running out of energy.

It is observed that a single low GI meal before exercise increase the contribution of lipid oxidation to energy production with consequent sparing and extended availability of glucose sources during exercise.

In the first few minutes of exercise, blood glucose levels can drop dramatically and in some cases, fall below normal levels of blood glucose. This is referred to as rebound hypoglycaemia, lasts no longer than a few minutes, and is irrelevant to the availability of glycogen stores for exercise. Some athletes are very sensitive to low blood glucose levels during exercise and this phenomenon could affect their performance. In many studies blood glucose levels at 15 to 30 minutes during exercise were lower after high GI than after low GI pre-exercise feeding.

2. Nutrition during an event

The feeds that is needed during an event, depends on the length of exercise.

If the exercise last up to 40-60 minutes, no additional ingestion of carbohydrates are needed. It takes time before carbohydrate is absorbed and transported to and used by muscle as a fuel. Some research have indicated, that a small intake of carbohydrates, or even rinsing the mouth with a carbohydrate containing drink, could give a mental enhancement that improves performance.

In an event lasting longer than 40-60 minutes, ingestion of high GI carbohydrates can enhance performance. Drinking/eating about 60g of a combined fuel source of glucose:fructose or maltodextrine:fructose:sucrose, per hour is recommended.

When an event lasts longer than 2 hours, an amount of up to 90g/h may be preferred. When such high rates of carbohydrates is ingested, it should consist of a mix of multiple transportable carbohydrates, such as glucose : fructose or maltodextrine : fructose.

Keeping hydrated during exercise is as important as eating the right amount and source of carbohydrates. Major disturbances of cell volume have profound effect on cellular metabolism. Cell swelling will favour anabolic actions, such as protein synthesis and glycogen synthesis. Drinking too little fluid will encourage these reactions to proceed in the opposite direction.

There is no substantive evidence that protein taken during an event would improve performance or endurance. There are a number of studies that indicates that a small amount of protein taken during exercise may help decrease the muscle soreness that accompany a long bout of exercise.

3. Recovery time, immediately after an event

This is the ideal window of opportunity during which the body can recover at its best. It is important to eat enough high GI carbohydrates and a small amount of low fat proteins.

The immediate ingestion of high GI carbohydrates is associated with higher muscle glycogen concentrations. The high GI foods could be replaced with carbohydrate supplements made up of glucose or maltodextrins solutions, which allow the fastest possible rate of absorption and delivery to the muscle.
In this short-lasting phase of recovery, the muscle uptake of glucose can proceed independently of the presence of insulin and is more active when muscle glycogen at the end of the exercise is low. The aim of the food intake at this time would be to obtain the fastest rate of glucose delivery to the muscle.

4. Fuelling between exercise

The fuel that the body requires between training events or competitive events would come from the carbohydrates (pasta, bread, rice, rice, etc.), the proteins (milk, eggs, chicken, etc.) and your fat (canola/olive oil, avocado pear, nuts, etc.) consumed throughout the day.

It is estimated that on average a well fed athlete would have up to 2000 calories (8 400kJ) of stores carbohydrates in the form of glycogen and glucose. In addition we have 80 000 calories (336 000kJ) worth of energy in the form of fat! Therefore, running out of fat stores is not a worry. Just continue using moderate amounts of heart healthy fats. Looking at these facts, one could see that it is very important to make sure that your glycogen stores are filled up before an event; thus carbo-loading is very important before an event lasting longer than 60 minutes.

The amount of carbohydrates needed depends on the intensity and duration of the training or event. See the table below.

Intensity and duration Daily carbohydrates needed
General sport up to 60 minutes per day 5 – 6 g carbohydrate per kg body mass
Moderate training 60 – 120 minutes of intense or
lengthy medium-intensity training
6 – 8 g carbohydrates per kg body mass
Endurance training >120 minutes intense training 8 – 10 g carbohydrates per kg body mass
Extreme intense training 5 – 6+ hours (e.g. cycle tour) 10+g carbohydrates per kg body mass

Food with a lower glycaemia index (low GI) is the preferred source of carbohydrates between exercises. Low GI carbohydrates take longer to digest and have a slower raise of blood glucose; this slower, sustained source of energy need less insulin. Physiologically spoken, the lower GI carbohydrates put less strain on the body than higher GI carbohydrates.

Protein in the form of chicken, meat, fish, eggs or milk products are high quality proteins, help with protein synthesis during the recovery period. Our protein need could increase to 1.2-1.7g/kg body weight with endurance and resistance-trained athletes. This protein intake is easily reached with a normal balanced diet. If you are worried that you don’t use enough proteins, ask your dietitian to calculate your daily intake. It is not necessary to use a protein shake if you eat a healthy balanced diet.

Studies focussing on endurance and resistance training have shown eating as little as 10g of protein after an event would achieve a worthwhile effect of muscle growth, repairs and adaptation following the exercise stimulus. A protein intake higher than 20-25g is not recommended.

Whey protein provides a rapidly absorbed high-quality protein source that is often used in supplements. A small serving of whey protein is needed which makes it practical to use after exercise. Dairy products, such as milk or yoghurt, would also increase your whey intake as a recovery feed.

Practical Nutritional Recommendations for the Athlete, Ronald J. Maughana _ Louise M. Burkeb
aLoughborough University, Loughborough, UK; bSports Nutrition, Australian Institute of Sport, Canberra, ACT, Australia

IAAF Booklet, based on the IAAF International Consensus Conference held in Monaco April 2007, updated June 2011

Sports Nutrition Mallorca Conference 2011, booklet

Nestlé Nutrition Institute, Does a Carb-Protein Combination in Sports Drinks Increase Endurance?