Cape Town - There's good advice on healthy food for children. There's also inaccuracy and confusion - and it is impractical.
That, in a nutshell, is what the Association for Dietetics in South Africa (ADSA) thinks of the latest Real Meal Revolution offering.
In a detailed review, ADSA has a hard look at Raising Superheroes – the sequel to Professor Tim Noakes Real Meal Revolution - which was launched this week. (The book, which is about low-carbohydrate nutrition for children, is co-authored by chef Jonno Proudfoot and paediatric dietician Bridget Surtees.)
This is not the first time ADSA and Noakes have crossed paths: the professor has yet to answer a complaint lodged by ADSA at the Health Professionals Council of South Africa, which concerns a tweet in which Noakes advised a mother to “wean” her baby on to a low carbohydrate, high fat diet.
The low-carb, high-fat Banting diet is highly popular, and has hardline fans and critics - and there has been much trading of “my science is better than yours” arguments between Noakes and the medical establishment.
The heart of the ADSA review (and the heart of the criticism of Noakes, it seems) can be found in this paragraph: “Expert opinion and personal experience can be valuable when backed up by a solid evidence base and tested in rigorous research. In the case of this book, however, Prof Noakes often expresses his own views and opinions in a colloquial way and makes statements that have not been tested.”
And should the views of one man and his followers inform social policy, be the platform for a revolution? The book thinks so. The closing statement reads: “In summary, if the parents of newborn and young South Africans were all to follow the advice in this book we would revolutionise the long-term health of all South Africans. And that continues to be the goal of our eating revolution.”
But ADSA says this broad public health aim does not “take into consideration the public health problems and issues of South Africa, and specifically those related to infant and young child nutrition. Culture, availability of foods and income are factors which should be taken into consideration when formulating broad guidelines intended for a population.
“Cost of food, in particular is considered a major barrier to following dietary advice. The advice and recipes in the book are clearly not targeted at the average South African, but rather the higher income market.... There appears to be a constant conflict between these approaches (individual VS population) in the book, which raises many unanswered questions from a public health nutrition perspective.”
And if you are in that higher income target market, and want to know how the book applies to you?
These are the issues that ADSA think are important:
* ADSA says the book advocates a healthy, balanced diet for infants and children. Fresh and real foods are promoted and the Raising Superheroes 'golden rules' echo principles stated in dietary guidelines - for example “steering clear from added sugar and highly processed starchy foods”. The book showcases recipes that include fresh ingredients and the healthier version to some old time classics.
* The book, however, offers confusing advice about breastfeeding and uses outdated terms (“weaning”, for example.
* When it comes to diet during pregnancy, the book is irresponsible. ADSA quotes the book as saying: "We don't necessarily advise that pregnant or breastfeeding women should be following a fully ketogenic Banting diet. In other words, we're not recommending that you exclude carbohydrates from your daily intake to such a degree that your body's energy source switches completely from glucose to ketone bodies. (The scientific evidence on a fully ketogenic diet during pregnancy is insufficient to make definitive calls, though we suspect it would be perfectly fine.)"
ADSA says that in fact ketogenic diets during pregnancy have been linked to amniotic fluid insufficiency, bone mineral loss and calcium excretion, putting both mother and baby at risk of complications and/or deficiencies.
* ADSA says it is inappropriate to introduce a culture of 'dieting' in childhood. “Fostering a healthy relationship with food during childhood is important, and balance, variety and moderation are important components that contribute to this relationship. In addition, many families in South Africa would struggle to sustain the recommendations made in this book, from a practical and cost point of view.”
The book, says ADSA, gives ideas for parents to incorporate fresh ingredients, an array of vegetables and fruit, incorporate various protein rich foods; and to cut down on sugar (with some clever party food ideas).
“Drawbacks of this book include conflicting messages about the inclusion of certain foods, eg whole grains and legumes or 'unrefined carbohydrates' are stated as being acceptable, but rarely used in recipes; the use of 'fresh' and 'real' food are often referred to while numerous recipes include high salt 'processed' and 'cured' meat such as bacon and ham.”
So... this is not a simple issue, and parents hoping for a quick take on whether this is the book for them are going to have to step back and think about it.
*The ADSA review was compiled by Lisanne du Plessis, with inputs from Catherine Day, Maryke Gallagher, Catherine Pereira and Sasha Watkins (registered dietitians and ADSA spokespeople).
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