This transcript was extracted from the ‘Thyroid cancer – eating well‘ video.

Good afternoon everybody. My name’s Fiona Hegarty. I’m one of the dietitians based in Antrim Hospital. Similar to Aileen was saying we have, if anybody is attending Laurel House and wants to speak to a dietitian, we have a dietitian, Leah, that covers the unit. So by all means, just ask on the unit. Today I’m going to go through the healthy eating guidelines, which is known as the EatWell plate and go kind of cover very briefly some eating problems that you may or may not encounter and ways that we can try and work through them.

This talk is about healthy eating, and if you have been told or advised by a healthcare professional to follow a specific diet, it would be important that you would seek advice before you would deviate of any plan that’s been recommended.

Why is a healthy diet important? A healthy diet will give us all the nutrients that we need to provide us with all the energy, vitamins and minerals that we need for our day and daily processes to get a good balance of food of all the different food groups that we’re going to go through, allows us to feel as if our energy levels are good and to be able to utilise it as best we can.

So we’ll feel stronger, energy levels are good, helps our immune system and gives us an overall sense of well-being. This is the Eat Well guide that you may or may not have seen before. This is the model of healthy eating that we use here in Northern Ireland. And what it does is if we were to set out all the foods that we eat every day, this is what it should look like.

So we’re going to go through the individual food groups and as we’re kind of thinking about it, we’re going to talk a bit about portion sizes, that’s kind of the key to healthy eating. Regardless of the service users that I’m talking to, the portion sizes are really key to the overall food groups. Can I give you those Bernie?

Thank you. Sorry. So we’ll start with fruit and vegetables. So fruit and vegetables should make up about a third of the foods that we eat every day. It’s recommended that we should have at least five portions of fruit and vegetables a day. Some countries recommend a lot more so we’re getting off quite easy. The reason that we come up with five portions every day is to get the recommended amount of vitamins and minerals that we need from this food group.

We talk about trying to eat a rainbow, it’s trying to eat lots of different colours of fruits and vegetables. It doesn’t matter whether they’re tinned, fresh or frozen, they all have equal benefit. There is a natural sugar in fruit so if you have type two diabetes, it would be mindful that you would spread fruit out over the day.

But apart from that, there’s no limits on any of the there’s nothing that we wouldn’t be recommending. They’re really low in calories and they’re very high in fibre and fibre is really key to having a healthy diet. And it’s trying to incorporate them in lots of our dishes that we have to eat, adding extra vegetables into dishes, trying to have a side salad, soups, it’s not very, not very soup weather so we’ll go on to salads maybe, which is great to be able to say. So it’s trying to think how can you include additional fruit and vegetables. And if it’s something that you don’t like, is it could you start to have at least 1 or 2 portions in the day?

If you’re not keen on one or other, we don’t have to have a combination of fruit and vegetables that it’s fine to get it all from vegetables or all from fruit but they’re an excellent food and really important for the release of energy on a daily basis. The second most important food group for us is carbohydrates, and especially starchy carbohydrates.

This is where we get all our energy from. So our brains only work on carbohydrates. So it’s really important that we have regular carbohydrate in each meal, spread out over the day. We’re trying to go for high fibre varieties. The majority of us don’t eat enough fibre every day and of all the new evidence that’s coming out with regards to food, it’s to get enough fibre in and have really good gut health is the key for overall well-being.

So we’re trying to go for the high fibre varieties, so the likes of wholegrain granary breads, brown pasta or whole wheat pasta, brown rice, high fibre breakfast cereals and these foods should make up about a third of the food we eat every day. If we’re thinking on what a portion, so ladies it’s probably around 6 to 8 portions a day, men depending how active you are, it would be higher, so it could be 8 to 10 portions a day. A portion would be 30g of breakfast cereal, slice of bread, a few serving spoons of cooked pasta or rice. But as a rule a portion is about the size of the fist, of your fist would be would count as one portion.

Our protein foods are really important for our muscle mass and muscle repair. Good sources of protein are our meats, poultry, eggs, beans, peas, lentil. The plant based sources are a really good source of fibre so really, would be really good to try and include some beans and peas and lentil plant-based foods into our diet. We’re aiming for two portions of protein in the day and again, a portion size of protein is about the size of the palm of your hand.

So men you tend have bigger hands so your portions of meat would be would be bigger. But as a rule we can do it by about we’re looking at the palm of our hand. Fish is a really good source of protein, it’s very low calories, it’s very low in fat and we’re aiming to include at least two portions of fish in our diet on a weekly basis, and aiming for one of those to be an oily fish, which has been shown to be very protective over our heart.

And that would be the likes of salmon, sardines, mackerel, pilchards, those types of those types of fish. Red meat it’s recommended that we shouldn’t have any more than two portions of red meat in the week. And again, red meat the reason behind that is red meat is higher in saturated fat, which is not good for our health. So if you do eat a lot of red meat, I would try to reduce the overall amount of red meat that you take and especially the processed meats like sausages, bacon, cooked ham.

Poultry’s very low in fat without the skin, so the likes of turkey or chicken are really good sources of protein, low in calories and overall low in fat.

So our dairy foods, so we need our dairy foods for our teeth and bones. Up until the age of 35 we can make our teeth and bones stronger, once we get past that age unfortunately, that we have to eat enough calcium every day, otherwise our body will take it from our teeth and bones. So it’s really important and it’s three portions of dairy foods is recommended on a daily basis.

And that would be milk in cereal, a glass of milk, a pot of yogurt, an ounce of cheese which is about the size of your thumbs, not very big, would class as a portion of our dairy foods. Again, trying to go for lower fat varieties. So kind of a low fat milk, diet or low fat yogurts where possible. But it is really important to protect our bones and teeth, especially in later life, that we take enough calcium in because the body will leach it out of our bones if we don’t eat enough. If you’re not keen on dairy foods, if you use milk or dairy alternatives, try to make sure that they’re fortified in calcium. So if we’re having a soya milk, it will say on the packet that it is fortified with calcium.

Oils and spreads, I was going to say my talks just getting cheerier. We need a very small amount of fat every day, the reason that we actually need fat is for there are certain vitamins, A, D, E and K that are fat soluble and we can only get them from fat. The volume of fat that we actually need every day is just less than ten grams, it’s about the size of your thumbnail.

So if we’re thinking on the little pat of butter that you might get in a cafe or a restaurant, it’s about one of those every day is the actual volume of fat that we need. We should be getting all our energy from our carbohydrate and our protein sources is much healthier for us.

To have too much fat in our diet every day can affect things like our cholesterol, our heart health. So if you are, we’ll say able to see your teeth marks maybe in the butter, it could be something that we need to possibly cut down or cheese yeh, yeh, trying to grate an ounce of cheese, you would eat an ounce of cheese before you would even realise you’ve it eaten.

So the overall, we tend to get too much energy from fats in food so it’s trying to choose low fat foods, trying not to add too much oil in cooking. The healthiest types of oils are ones that are based on monounsaturated or polyunsaturated fats. So that would be the likes of our olive oil, rapeseed oil or polyunsaturated fats would be our kind of sunflower oils, the likes of our Flora.

But it is trying to overall, regardless of your personal choice of which one you’d like to use, it’s trying to eat less of it. And like that, there’s a lot of fat in the foods that we eat so especially the treat foods. So the goodies the biscuits, the buns, the pastries and again the processed meats tend to be higher so the likes of our sausages, especially something like sausage rolls, would be particularly high in fat.

So we don’t need treat foods unfortunately. But we do like the majority of us do, like a treat. So it’s trying to get the balance right over the day. If we have the right amount of our fruit and vegetables, our starchy carbohydrates, trying to go for the high fibre varieties, including our dairy and our protein foods, that there’s no reason if the portion size of everything is right over the day that we can’t have a treat.

There is recommendations, it’s kind of very small it’s probably equivalent to about it’d be like a two finger Kit Kat or two biscuits, kind of a small, a kind of a centimetre slice of cake. Everything’s in share sizes now that we don’t like to share. So but it would be the likes of a multipack of crisps, or it’s probably about 4, 3/4 squares of chocolate, the amount that you know would be classed as having a healthy so if we are heavy on the treats that it’s something maybe, could we maybe take out one of the sets of treats, put in a yogurt or some fruit or something instead. From a sugar point of view, we don’t need sugar. If we were to cut out refined sugar completely from our diet, it has no impact.

It’s just empty calories. So if you do add sugar into drinks or drink sugary drinks, that again, that could be something that could be an easy change to kind of improve the health quality of the diet.

Salt is important in a healthy, balanced diet, and especially from a blood pressure point of view. A lot of the salt, over 80% of the salt that we need every day is actually in the foods already. So it’s in the breakfast cereal, it’s in the bread, it’s in the jars or packets that we may or may not use.

So it’s trying as a rule not to add salt at the table. There might be something that you absolutely love, a bit of salt, I was talking to gentleman yesterday and he just loves that bit of salt on a boiled egg. That’s fine, but it’s trying not to have it all of the time and trying to flavour foods with things, different seasonings, pepper’s absolutely fine. All salt’s the same so it doesn’t matter whether it’s rock salt, pink salt, whatever. If it says salt, then we’re trying to cut it down. Again our processed foods have lots of salt in them. So that goes back to the bacon, the ham, the sausages. So overall, those should be foods that should be taken occasionally and not making up a daily part of our diets.

Fluid is really, really important. So we’re aiming to drink at least kind of one and a half, ideally two litres of fluid every day. Water is the best fluid to have, but like our diluting juice is fine, teas and coffees if they’re not particularly strong are all fine counting towards our fluid, but it’s overall we’re aiming to get that 6 to 8 cups of fluid every day.

Feeling thirsty and feeling hungry have the same sensation within the body. So it’s being mindful of, am I actually hungry or am I actually thirsty? And sometimes it can be worthwhile in between meals to have a drink to see actually, I was just thirsty. But again, it’s really important from an energy level point of view that we stay well hydrated and especially from a constipation point of view that our bodies have to have water for all our processes to work as we would want.

Being a dietitian, I’m a bit obsessed with food labels. Food shopping can take a few hours. I don’t recommend it, gets a bit boring after a while, but we look at food labels and now our traffic light signalling on the food labels is a really easy way of seeing, making a decision about the food that we’re going to pick.

So if we were for an example to pick up a pizza, the traffic light on the front of a pizza’s going to be lots of reds. That’s a food that should be an occasional food. It’s not a food that we have to cut out, but it’s a it’s an occasional food. So it’s not something we should be having to eat every day.

If the majority of the label is amber, that’s ok to have most of the time. And if the label is mostly green, then that’s a great food to include on a regular basis every day. So it’s a very quick way without getting into, you know, is that high in fat or not, that we can make a really easy judgment looking at the label, the traffic light label.

Alcohol, the most up to date recommendations for alcohol is that we would have no more than 14 units of alcohol every week, and spread them out over the week. The best kind of diet that we can follow is a mediterranean style diet. Lots of fresh fruits and vegetables, trying to not have processed food. And again, in that style that it tends to spread the alcohol out over the week.

So it’s kind of 1 or 2 glasses on a few evenings and a few evenings without, rather than the Northern Irish tradition of kind of having it all on the one night. What’s a unit of alcohol? Our units are actually a little bit bigger here than in the rest of the UK. It would be just over, a spirit measure of spirit here is just over a unit, a pint of beer is two units, cider’s doesn’t matter, they’re all the same two units in a pint, the little bottle of wine that you might get in a restaurant in a bar is just it’s just over two units. So again it’s been mindful of the units that we have and the recommendations is that we would spread it out and definitely if you do have a take an alcoholic drink to have a few alcohol free days in the week.

Aiming to keep a healthy weight. The reason we want to keep a healthy weight is for our health gains, and you need to decide, I don’t think I have ever had a normal BMI but I am healthy for my weight. So it’s really important that we’re not focusing on the weight on the scales, but actually the health gains that we’re getting from improving our weight should we carry a little bit of extra weight. The weight that really affects our health is the weight that we carry around our tummies. So our waist measurement is really vitally important when we’re trying to get health gains from losing weight, should we need to. Our waist measurements should be less than 37inches for a man and less than 32inches for a lady.

Unfortunately, our waist is not where we’d like it to be, as in the smallest part, it’s actually just below your belly button. So if we’re measuring our waist, it’s a centimetre below your belly button is the actual is where our waist measurement is counted from.

Again, as a trying to follow a healthy or to improve our weight, it would be following the Eat Well guide. Regular meals, balance of food and being mindful of our portion sizes without looking at calories or starting to count, or to weigh out things that actually, if we are following the basic principles of the Eat Well guide with the right portion sizes that our weight should follow suit.

Going to talk about a little just to kind of touch on some of the eating problems that you may or may encounter, may have, or may encounter in the future, because the guidelines will change and there is written information available on all of these. Or if you do encounter any of the eating problems, that would be a really good time to kind of ask to speak to the dietitian just for a little bit more in-depth information.

The first one is poor appetite. So if we’re struggling with eating, everything that I’ve just said doesn’t count. So we don’t follow the healthy eating guidelines. If we have a poor appetite, we really need to prioritise the calories, the energy and the protein, especially that we’re getting in. So it would be a case of if that you weren’t eating enough and coming on to the next one if you need to build up, if you’re losing weight and you don’t want to, then we need to increase the calories.

So that would be everything would be full fat, full fat, no diet varieties, trying to get in and maximise the small and often approach over the day. So little and often, a good approach to a poor appetite is that we would be aiming for three small meals, and it might be that you find the meals quite overpowering, that once a meal is put in front of you that you just can’t face it.

It could be to eat off a smaller plate, even to take meals on a side plate, but to try and make sure that we’re still getting the three meals over the day with at least two snacks. And if you like milk, milk is invaluable in trying to help us so that would be including a pint of milk every day. So that would be the three, two, one to try and manage the poor appetite. Trying to make sure that everything that you are able to manage is nourishing so that we wouldn’t be filling up on water, that actually something like a milkshake or a milky coffee, or just trying to make sure there’s some nutrition value in what you are able to take in. And making the most of days that you feel better, so absolutely maximising if today is a good day, you know, to to eat as much as you can and that will kind of balance out.

And as I say, the building up so it might be that if you have noticed that you are losing weight or that you’re trying to gain weight, the principles of the healthy diet and the breakdown of the portions that we have continues but actually it be important that we’re getting in enough calories. So it would be whole milk, full fat yogurts, those kind of things. We can add cream into porridge or make porridge with milk rather than water. But like that, that that is something that your health care professional team can help you with. If you’re feeling sick with nausea or having kind of episodes of vomiting, dry foods can be tolerated better.

If we have episodes that we are feeling very sick, our body is is going into kind of almost a starvation and what we need to do is to try and switch that off. So kind of dry, bland carbohydrates can really help. So, the likes of even something like a Rich Tea biscuit, dry crackers, you just want to try and turn off that cycle of nausea.

The longer that we go without eating, the harder it is to break that cycle. If we haven’t eaten in a long time, our body can make something called ketones. Those ketones make us sick and it’s just a vicious cycle. So something like that, a very dry plain carbohydrate can make a difference. Sometimes cold foods are tolerated better than very hot foods.

And for a lot of the advice it would be to avoid things that are very high in fat, very greasy and very strong or very spicy can help if we’re feeling sick. Just as Aileen said with regards to diet, from a fatigue point of view, by the time we could have a meal prepared, done all the cooking and sat down that we’re just too tired to actually eat it.

So it’s trying to really focus, can somebody help with cooking? It’s good, a good way of having a little break. But actually that the meal that you’re not too tired by the time the meal is prepared or ready to actually have it to eat. Batch cooking or bulk cooking can be handy that things are readily available and just need to be heated up.

Or again, it might be a case that something like a ready meal or convenience foods can can really help, but being just exactly as echoing what Aileen was saying, the likes have kind of planning ahead nearly having planning the meals so that we know what we’re going to be able to get and that we’ll not be too tired by the time we’re ready.

Some treatment can cause taste changes. So again, the bland foods can really help with taste changes. Trying to season or marinate foods that we’re trying to kind of stimulate that taste back again. It could be changing that you could have been a tea drinker forever and now actually that we’re not liking tea, it’s trying to experiment with different drinks and different fluids.

And sometimes foods that are very sharp or very tart can help with taste changes. Something as simple as having some boiled sweets, something like the lemon sherbets kind of old fashioned sweets can really help. You’re trying to really stimulate, stimulate the taste with something really citrusy that you mightn’t have normally liked, actually can improve things.

A sore mouth. So keeping our mouths, having good oral hygiene, keep making sure our mouths are very clean and cleaned regularly and again would be the same with the taste changes, but from a sore mouth having soft foods, moist foods, putting gravy, sauces on things can help, but trying to avoid things that are very sharp or something like a dry granola, something very dry can exacerbate our sore mouths. Foods that are very salty or very spicy again, can hurt a mouth and again try and foods that are very, very hot again can so trying to avoid those foods if you, if you have. So overall what we’re trying to do is we want a healthy balanced diet, include all our different food groups. We want to make sure that we’re prioritising protein, which is for our muscle mass, muscle repair. We want to maintain the strength that we have.

Getting a good variety again by following the Eat Well plate, that we are having a really good wide range of foods, trying to keep a healthy weight for the health gains and keeping active. Again activity, along with our healthy diet helps to maintain our muscle mass and our strength, which is what we’re really, really focusing on. The energy, obviously, we need enough energy every day. The protein, as I’ve said, and if you want any further advice on anything or you feel that things are changing over time, then just ask for a dietetic referral.

That is me done. Thank you for listening. That’s my email address or you can get it off Bernie if anybody wants any additional information. There’s written information on everything I’ve talked about or like that if you just want to talk things over that I can get that organised for you. Thank you.