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29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

Carbohydrates
Basic client information:
•
•
•
•

Name: Miranda
Gender: female
Age: 21
Occupation: student, who has recently moved away from home to study at university(1)

Diet:

•
•
•
•
•
•

Is relying on chocolate, sweet snacks and caffeinated drinks
She is socialising by consuming more alcohol than she is used to
Breakfast: sugary cereal with fruit juice
Mid morning: chocolate and crisps
Afternoon: chocolate and crisps along with coke or coffee
Evening: sandwich (white bread with jam) and cocktails at a bar(1)

Any obstacles related to her diet:
• Doesn't know how to cook(1)
Physical symptoms:
• Feeling fatigue
• Constipated
• Headaches
• Sleep problems
• Dizziness
• She used to be a high achieving student but is now having problems concentrating in class and forgets what she has learnt
...

Medical assessment:
• Her doctor cannot find anything wrong with her(1)
...
05
...

I would explain and educate Miranda in the different types of carbohydrates, relating it to her current diet and how this effects her blood glucose and
her overall health
...

Carbohydrate is an organic compound made of carbon, hydrogen and oxygen(1)
...
Glucose is the most important, when glucose it broken down, it will be broken
down into carbon dioxide and water, this forms energy that is needed for all metabolic functions
...
ATP is used to build up or break down
molecules
...
The bloodstream carries the energy around to all the cells in our body needing it, the excess glucose is stored as fat
...
The crash is a feeling of lack of energy, as the sugar leaves our bloodstreams as fast as it enters it
...
Therefore I have found it important to measure Mirandas weight, height and BMI and with the tanita machine have a
look at her muscles mass, fat percentage, visceral fat etc
...
Too much or too little of any of these can
have a negative effect on our health
...
Which makes carbohydrates the only nutrient that directly effects our blood glucose level
...
Glucose enters the body cell by help of the hormone insulin produced by the
pancreas
...
05
...
There are different kinds of carbohydrates; simple and complex
...
Simple
carbohydrates are made up off monosaccharides (1 unit) or disaccharides (2 units)
...
There are different kinds of simple carbohydrates: 1)Glucose, 2)Fructose, 3)Sucrose,
which is known as sugar, is made from 1 glucose and 1 fructose, 4) Lactose, a sugar found in milk and milk products, referred to as milk sugar, is made
up of glucose and galactose
...
Fructose has
a slower metabolic pathway, as it will need to go to the liver first to be processed
...
Sucrose is a bit different, the glucose component is immediately
released into the bloodstream and used, whereas the fructose component needs to go to the liver first(1)
...
Simple sugars are
naturally found in milk products, fruit and vegetables but can also be added to foods using white sugar, brown sugar, honey, molasses and maple syrup
etc
...
The wall of the small intestine (duodenum, jejenum and
ileum), is made out of small structural layers like the rest of the GI tract, but apart from this it has some special structural features; circular folds, villi
and microvilli which facilitates the process of digestion and absorption
...
Chyme from the stomach enters the small intestine with partially digested carbohydrates, proteins and lipids
...
The enzyme pancreatic amylase will break
down the remaining starches, as it acts upon glycogen and starches, but not cellulose
...
On each villus, on the surface, is covered by even smaller villi, called microvilli
...
Many molecules are being broken down at the brush-border which
include some of the earlier ones mentioned in relation to simple carbohydrates; The enzyme sucrase breaks the molecule sucrose into 1 glucose and 1
fructose, the enzyme lactase digest lactose into glucose and galactose
...
The small intestine can absorb 120 grams of monosaccharides
per hour
...
Via facilitated diffusion or active transport,
monosaccharides will enter the capillaries of the villi, the big blood supply surrounding the villus is the reason that glucose can easily go from the
small intestine into the bloodstream and effect our blood glucose level quickly(3)
Due to Miranda's diet consisting mainly of simple carbohydrates which in general makes the blood sugar peak, she consumes this with caffeinated

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

beverages which makes it peak even higher and alcoholic drinks which is the reason for her blood sugar to constantly be fluctuating
...
When too much
glucose is present in the body, the pancreas releases the hormone insulin to lower it
...
When this happens, her body
will crave 'sugar' for her to gain back her energy and Miranda will consume more simple carbohydrates, sugary foods and caffeinated beverages(1)
...
Sucrose and lactose has less effect on blood glucose levels as they need to be processed in the liver first(1)
...

I would like to explain the function of the organ pancreas as insulin is produced here as well as glucagon, which is two hormones important in
regulating the blood glucose level
...
99% of its volume, consists
of gland cells which are called pancreatic acini and their attached ducts
...
This fluid travels along the ducts to the lumen of the digestive tract
...
Every single one of these islets contains four types of cells, these cells secretes four different types of hormones
...
Alpha cells
...

2
...
They make up 70% of the pancreatic islets, secrete the hormone insulin
3
...
They make up 7% of the pancreatic islets, secrete the somatostatin insulin
4
...
They make up the remaining of the pancreatic islets cells, secrete the pancreatic polypeptide(1)
The hormones has a complex function which is yet not fully understood(3)
...
Miranda's body is not designed to cope with a regular diet containing a loft of sweet and sugary foods with no nutritional
value, making her blood glucose level drop too low, resulting in symptoms of low blood glucose(1)
...


Insulin(3)

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

Insulin can lower blood glucose level in several ways:
Ø Accelerate facilitated diffusion of glucose into cells, to increase glycogenesis which is converting glucose into glycogen
Ø Increase uptake of amino acids by cells and increase protein synthesis
Ø Speed the synthesis process of fatty acids
Ø Slowing conversion of glycogen to glucose
Ø Slowing formation of glucose from lactic acid and amino acids
All of these processes will lower Miranda's blood glucose level
...
These stimulate the secretion of
insulin as they act to elevate our blood glucose level(3)
...
They come from the nerves parasympathetic fibers
innervating the pancreatic islet
...

• And a hormone released by enteroendocrine cells of the small intestine when glucose is present in the GI tract, called glucose-dependent
insulinotropic peptide(GIP)
...

If our blood glucose level falls below normal it will inhibits the release of insulin and stimulates the release of glucagon(3)
...
Secretion of glucagon is stimulated by:
• Increased activity of the symphatic division of ANS (Autonomic nervous system), which happens during exercising
• When a meal containing mainly protein, amino acids in the blood will rise if blood glucose level is low
...

Complex carbohydrates:
Compared to simple carbohydrate, these are made up of two or more monosaccharide units, they are a chain of glucose molecules put together, referred
to as starches or fibrous carbohydrates(1)
...

If Miranda's blood glucose level would fall below normal and she would eat complex carbohydrates they would immediately be broken down into their
single monosaccharide units, released into the bloodstream for the cells to use the energy immediately
...
05
...
Glucogen storage is a short
term supply, it will empty after 1 day if not filled up again by food consumption(1)
...
Therefore complex carbohydrate must be part of a daily, balanced diet as it brings a lot of value to our overall health
...

Dietary sources of complex carbohydrates would be: nuts, seeds, bread (wholegrain), wholewheat pasta, brown rice, oatmeal and legumes, vegetables
such as; celery, broccoli, potatoes
...

To sum up:
Miranda will eat the simple carbohydrates as her body is in need of energy, due to her fluctuating blood sugar
...
To get back her energy she will eat more simple carbohydrates like her midmorning snack consisting of
chocolate and crisps, she will feel this as a craving as the body is asking for some energy
...
She is also spiking her blood sugar by having
caffeine from chocolate, coke and coffee
...
As mentioned earlier, simple carbohydrates is usually food lacking nutritional value and
are most often high in calories; cakes, biscuits, sweets, chocolate, flavoured and fizzy drinks and heavily processed food as present in Mirandas diet
...
These don't spike the blood sugar as fibers and proteins work to control blood
sugar spiking(1)
...
The symptoms related to her blood glucose level would be feeling fatigue(5),
headaches(6), sleep problems(7), dizziness(8), problems concentrating(9)
...

There are two problems that would need to be addressed in the case of helping Miranda, after my opinion, which would be stabilising her blood
glucose level and dealing with her constipation
...
The importance and reason for addressing both these issues is because of the brain-gut
connection, evidence show that the gut has its own nervous system called enteric nervous system(ENS)(13)
...
CNS can also intervene and change the microbiota composition of the mucosa, which can be restored by the use of

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

probiotics and possibly by diet(14)
...
Stress releases certain hormones called epinephrine and cortisol, this happens as
the hypothalamus will send signals to the autonomic nervous system(ANS) and the pituitary gland
...
These hormones release energy to our body, making us ready to
escape a dangerous situation
...
To prevent glucose from being stored so it can be used immediately, cortisol will inhibits insulin production(16)
...
For most people, if they don't use all of that extra energy, the body is able
to reabsorb it, even if we are stressed again and again
...
Studies has shown if a
person can manage their stress level, they can also control their blood sugar level, sometimes nearly as much as with medication
...

Chronic stress, defined as experiencing 'stressors' over a prolonged period of time, can result in a long-term drain on the body
...
When a person is
stressed, they also tend to eat much more or much less than usual the wrong kinds of food, some might increase use of alcohol(16,17)
...
, and
perhaps her stress level would be my explanation to what is causing her problems which can be eased with changing and balancing her diet as well as
encourage her to be physical active or incorporate some exercising in her daily routine
...
05
...
Bread based on wholemeal flour, there are different
sources, wholegrains such as brown rice, oats, pasta and legumes
...

Eat regular meals; breakfast, lunch and dinner everyday and if needed in between a small snack
...
If drinking coke, I would advise to avoid any diet coke or in general in products with
artificial sweeteners(19), especially with aspartame (20, 21, 22) and the one replacing aspartame called splenda(23) and just drink normal coke
with sugar
...

Make a balanced diet plan which besides complex carbohydrates includes: proteins,fibre and healthy fats
Drink lots of water
...
2 litres, I would suggest her to drink more than that, around 2 litres a
day, which would be around 10 glasses of water
...
75 percent of our stool is water(24)
...
Eventhough there is a lot of dicussion around bottle water, they do not contain chlorine or
flouride(25,26, 27, 28)
...
The guidelines daily amount, GDA, for sugar is 90g, equal to 18 teaspoons for women and 120g, equal 24 teaspoons for
men, this also accounts for hidden sugars in many foods including natural-occurring foods such as fruit, milk and dairy(2)
...
Through my health trainer education
and working as a health trainer, we were taught a method to present for our clients when making them achieve a more healthy well-balanced diet and
eat a variety of foods during the day, the eatwell plate, which shows that a quarter of a plate should be high protein food; meat, fish, eggs, dairy etc
...
The rest of the plate (half) should be made up of fresh vegetables(2)
...
I would not use it for more than that as I have never found it very useful, and the way client were
responding to eat was not always positive
...
As starches are sugar, consuming too many carbohydrates can lead to weight gain, as excessive or unused glucose will be
stored as fat
...
05
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As an example: Both chocolate and apples both contain simple carbohydrates, but chocolate also contains fat and added sugar where an apple
contains fibre, vitamins and minerals
...
Similarly, steamed rice is better than fried rice(29)
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Many starchy foods actually release glucose quicker than sugary foods
...

There are some considerations when following GI(32)
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Pure glucose is considered to score 100 in he index
...
Natural food, this includes most fruit and vegetables, is actually lower at the glycemic index than
processed food, they will therefore effect our blood sugar less
...

Candy such as fruit roll ups are 100 percent sugar and 100 percent corn starch, and processed food containing high fructose corn syrup will both peak the glucose level(33)
...
, a snickers bar is lower at the GI compared to an apple or
orange as it contains fat and protein from the peanuts, milk and chocolate, but whereas the snicker also contains a lot of added sugar, additives, salt, fat and high in calories the fruit
contains additional nutritional things such as enzymes, minerals, vitamins, fibre in some cases protein, which is beneficial for our health(1)
...

The Glycemic Index has existed for more than 20 years, but only few GI values have so far been determined
...
The testing method requires human subjects, and is
both time consuming and relatively expensive, also food manufacturers continue to introduce thousands of new foods each year(32,34)
...
Reported values are generally averages of several tests, but individual
measurements can vary a significant amount
...
This amount of variation adds a great deal of uncertainty to GI calculations(32,34)
...

These changes has also been spotted with subtle alterations of the preparation method so simple as boiling pasta for 15 minutes instead of 10(32,34)
...
There are also individually differences to a person glycemic response, the

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

rate at which people digest carbohydrates varies, also it has shown that it can vary from one time of day to another
...

Another example: Apples have a GI of 38, a medium-size apple, weighing 138 grams, contains 16 grams of carbohydrates and provides a Glycemic
Load of 6
...
If Miranda would base her intake of food on Glycemic Load alone, she would believe that
the peanuts were a better dietary choice than the apple
...
That is 571 (643 minus 72) extra calories, which needs to be taking into account
...
, dry-roasted peanuts without salt contains 164 calories, and oil-roasted peanuts with salt 168
calories
...
The higher calorie, fat and saturated fat
content of oil-roasted peanuts, which could lead to an increased risk for obesity, high cholesterol and heart disease, makes dry-roasted peanuts a better
choice, even though they have slightly less protein and fibre(37)
...
Each group should be present in
Miranda's diet, as regards to her fluctuating blood sugar and constipation
...
, potatoes with skin
• Nuts and seeds
...
It helps Insoluble fibre bulks up stools and makes waste
to keep stools soft, making them easier to pass, which may move through the digestive tract more quickly,
help prevent or treat constipation
...


These fibres are all important for digestive health
...
Providing correct food for our gut bacteria can also help increase the number of healthy bacteria in the gut
...
In my

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

opinion it would be good to start with foods providing insoluble fibre
...
If she uses laxatives, I would suggest her to avoid these as they can make the colon lazy(41)
...
Which I will explain further on
...
, avoid shopping on empty stomach as this can lead to her buying more food than necessary and more of
the wrong foods(42)
...
I would go through
this with her
...

• I would suggest her that we together make 3 personal short term smart goals for each week and 3 long-term goals(43,44)
...

• If she would benefit from certain supplements such as probiotics, vitamins or minerals, I would contact her G to discuss this
...
I would support her in looking for nearby places to go exercising
...

• As she can' t cook I would show her how easily it is to heat, boil and prepare certain things in the oven or on the stew
...

If she eats outside or have takeaways I would suggest healthier places to go to or what meals are healthier to eat than other from the menus
...


29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

BREAKFAST
Breakfast:
• Starchy carbohydrates at breakfast fx
...
Low fat diary is not better than whole fat
...

Preferable organic source(48,49,50,51,52)
...

As Miranda can't cook, these dishes(53) can easily be adjusted to her not having to cook much herself, I have chosen them anyway as they are simple and healthy and it would be
easy to teach her few cooking skills to make these herself
...
Put the porridge oats into a
saucepan with the milk and water
...
Reduce the heat

1
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Lightly toast the cut
sides of each bagel
...


1
...
Heat and simmer
gently for 10 minutes, or until the pears are
2
...


29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

and simmer for 3-4 minutes, stirring
...
Top with
sliced banana and sandwich the bagel tops
in place
...
Serve and top with the yoghurt,
apple and raspberries
...
While the pears are cooking, peel the
oranges with a sharp, serrated knife to remove
all the peel and pith, then cut into segments
...

3
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Share the
pear mixture between 4 bowls and top each
portion with 1 tbsp 0% fat Greek yoghurt
...


Tips

1
...

2
...


1
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Choose pears that aren't too ripe or too hard
...

2
...

2
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Mash the banana and 3
...

the chopped apricots on top
...
Try topping with ready-prepared
mango and fresh pineapple
...
With time she could try to sprinkle the
banana with lemon juice or a pinch of
nutmeg for extra flavour
...
e
...
5g saturates
6g fibre
137mg sodium equivalent to 0
...
e
...
5g protein
46g carbohydrate of which 18g sugars
2g fat of which 1g saturates
5g fibre
270mg sodium equivalent to 0
...
e
...
5g carbohydrate of which 48g sugars
1g fat of which 0
...
5g fibre
149mg sodium equivalent to 0
...
05
...

**I would recommend all diary products to be organic, preferable, and full fat version(48,49,50,51,52)
...

• Add lentils, beans, pasta shapes (wholegrain), peas, noddles (wholegrain) or basmati rice (wholegrain) to soups
...
, that only
needs heating, but she needs to know how to read labels as many of these has added things in them and can be very high in sugar and especially salt
...
Pasta releases glucose into the blood at a slower rate than bread and potatoes
...

• Try pasta or rice salads (wholegrain if possible), can be bought prepared and ready to eat
...

Add proteins
• Slices of lean roast beef, chicken, turkey or fish like salmon to sandwiches or salads
...
Also cheese is a good choice, could be cottage cheese, feta etc
...

• There are also other sources of protein from; tofu, soya (in small amounts(55)), pulses, seeds and nuts
...


1st idea

2nd idea

3rd idea

Egg & watercress bagels

Fishy toast toppers

Pasta salad on lettuce

Serves how many*

4 adults

4 adults

4 adults

Preparation time

10 minutes

15 minutes

10 minutes

Cooking time

12 minutes

0 minutes

12 minutes

Ingredients

4 eggs
40g soft cheese**
2 tsp fresh chives chopped (spring

80g smoked mackerel skinned and
flaked****
4 tbsp Greek-style natural yoghurt**

200g dried pasta shapes or spaghetti
3 tbsp natural yoghurt**
2 tbsp reduced fat mayonnaise

Lunch
Name of dish

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

onions will also work well)
4 wholemeal bagels***
4 handfuls watercress
1 pinch ground black pepper

How to prepare

3 spring onions finely chopped
1 tomato deseeded and chopped
¼ cucumber finely chopped
1 tsp lemon zest only, finely grated
1 pinch ground black pepper
4 slices wholemeal bread***
¼ cucumber sliced, to serve
1 handful watercress to serve

2 tomatoes chopped
¼ cucumber chopped
1 tbsp sultanas
2 handfuls lettuce leaves
75g hard cheese cut into small cubes**,
can be bought like this
3 spring onions sliced

1
...


1
...

Add the prawns (chopped if large),
yoghurt, spring onions, tomato,
cucumber and lemon zest
...


1
...

Drain well
...
While the eggs are cooling, mix the
soft cheese with the chives or spring
onions
...
Split the bagels in half and lightly
toast the cut sides, then spread with the
soft cheese mixture
...
Season with black
pepper, then sandwich the bagel tops in
place
...

Tips

1
...


2
...
Serve with cucumber
slices and watercress
...
If using peppered smoked mackerel,
you won't need to use any extra pepper
in the recipe
...
Mix together the yoghurt and
mayonnaise in a salad bowl
...

3
...


1
...


29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

2
...


2
...


2
...


3
...
Another time, try using smoked trout 3
...

fibre
...

Nutritional information Per adult portion (i
...
¼ recipe)
per portion
1431kJ / 342kcal
18g protein
35g carbohydrate of which 5
...
e
...
5g fat of which 1g saturates
3g fibre
642mg sodium equivalent to 1
...
e
...
Due to my recommended changes, this will also effect the total calorie intake, which will be
recalculated, some of the dishes holds less than 600 calories which suggested, Miranda can have it with something additional
...


•

*** Regarding the bread, when buying bread she needs to be aware of the amount of sugar and salt, here it is good to know how to use the ingredient list
labelling system
...
Instead of being feed algea and water plans as they need to produce the omega fatty acids which are so important
for our health, they are been feed soya and corn
...
This can be hard to avoid and also these fish are less expensive than the others, preferable non-farmed fish, if not

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

possible, than better farmed fish than canned
...

Add beans or lentils to salads, stews, casseroles, oven dishes etc
...

Protein: lean meat, poultry, oily fish, white fish, eggs or peas, beans, lentils, seeds or nuts
...


1st idea

2nd idea

3rd idea

Turkey & pepper stir-fry

Salmon with spring onion mash

Tasty tuna & sweetcorn pasta

Serves how many*

4 adults

4 adults

4 adults

Preparation time

15 minutes

20 minutes

10 minutes

Cooking time

30 minutes

25 minutes

20 minutes

Ingredients

200g wholegrain brown rice
1 tbsp unsalted butter**
300g skinless turkey breast sliced
into strips
2 garlic cloves crushed
2 red peppers deseeded and sliced
2 peppers, any colour deseeded and
sliced
6 spring onions sliced
2 tbsp reduced salt soy sauce

1kg potato peeled and cut into chunks –
these can be bought already prepared in
chunks
6 spring onions finely sliced – these can
be bought already sliced
1 tsp vegetable oil**
4 salmon fillets – these can be bought
already prepared***
4 tbsp full fat milk****
2 tbsp fresh parsley chopped
250g broccoli broken into florets
1 pinch ground black pepper

300g wholemeal pasta shapes
1 tsp olive oil**
1 medium red onion chopped – can be
bought like this
1 garlic clove crushed or finely chopped
400g chopped tomatoes*****
1 tsp tomato puree******
150g sweetcorn drained
2 tsp dried mixed herbs
2 cans tuna in water drained and
flaked*******

Dinner
Name of dish

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

4 tbsp orange juice
1 tsp ground ginger (optional)
How to prepare

1
...


1
...

This description would need to be altered
for Miranda as the potatoes are already
prepared when bought
...
When the rice has been cooking
for 20 minutes, heat the butter in a
wok or large frying pan and stir-fry
the turkey over a medium-high heat 2
...

salmon
...
Add the garlic, peppers and
surface
...

spring onions and fry for another 2- Cook over a high heat for 2-3 minutes,
3 minutes
...
Turn the
salmon over, reduce the heat and cook
4
...
This section
juice and ground ginger (if using) to here also needs to be changed a bit as the
the turkey and cook for a further 2-3 salmon is already prepared
...

5
...


3
...
Let the salmon rest
for a few minutes while making the
mash
...
Drain the potatoes and spring onions
and mash thoroughly
...
Reheat on the hob for 1

1
...
While the pasta is cooking, heat the olive
oil (butter instead) in a large non-stick
frying pan
...

3
...
Just before serving, add the tuna
and stir through gently
...
When the pasta is cooked, drain well and
serve with the tuna and sweetcorn sauce
...
05
...

5
...
Serve with the broccoli
...
For a vegetarian stir-fry,
substitute the turkey with tofu or
lentils
...
Use haddock, coley or cod fillets
instead of salmon, or try using trout
fillets
...
Try using chopped chives or dill
2
...

mixed dried herbs
...
This recipe can be served cold as a salad,
making it perfect for packed lunches
...
Fresh herbs add a delicious flavour, she
can add a few torn-up basil leaves or some
chopped fresh parsley
...
Use the turkey stir-fry as a filling
for wholemeal pittas or tortilla
wraps
...
e
...
1g salt

Per portion (i
...
¼ recipe)
1904kJ / 445kcal
33g protein
46g carbohydrate of which 4g sugars
16g fat of which 3g saturates
7g fibre
110mg sodium equivalent to 0
...
e
...
6g fat of which 0
...
5g salt

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

•

* This is calculated for 4 adults, as Miranda is only 1 person, I would have to reduce the quantities for her recipes, with some of them she could make the
full amount and freeze extra portions for another day(53)
...


•

** Change to unsalted butter instead(?)

•

*** Avoid buying salmon that is farmed, preferable Wild Alaskan Salmon fillets(56,57,58,59,60,61)
...


•

***** Avoid canned whenever possible, better to chop them herself if she can
...
Lower it to only few canned products a week(62,63)

•

******* Avoid canned, better to chose tuna steaks, which are easy to prepare in the oven
...


Snacks:

•
•
•
•
•
•

Fruit – mainly fresh or dried, again avoid canned, she could have this with a small plain yoghurt (preferable organic yoghurt, Yeo valley yoghurt could be a choice
...

Small portion of cereal with full fat milk (cereal low in sugar and salt and preferable organic milk(48,49,50,51,52))
...
The high amount of cacao has some good health benefits, as it is high in antioxidants,
and usually the high amount of cacao gives it a bitter taste making it difficult to overeat(64)
...
The ingredients list(2)
On the ingredients list of a product, all ingredients most be listed in order of the greatest weight
...
, a canned tomato soup as seen below in the picture, the ingredient with the
highest content is 'tomatoes' the next one would be 'sugar', then 'onions', and one of the ingredients with lowest weight would be 'natural flavouring', 'herbs', 'spices' and so on
...


29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

(65
...
The nutritional information(2)
This is usually a table which is displaying the amount of each nutrient
in a package of food, some products will provide more information
than others
...
The
nutritional information is given per serving and per 100g
...
The 100g allows one to compare with other
products/brands, it can help identify whether the food or drink
contains a lot or a little fat, sugar, saturates, fibre and salt by referring
these to food labelling guide (see picture of nutrition facts(2,Figure
2(65))
...
05
...
Guideline Daily Amount (GDA) labelling(67)
...
, a person with diabetic who
wishes to count carbohydrates or someone wanting to loose weight
...
They can
not be found on all food packges yet, but many
...
Also, it presents what proportion (in %) of
ones GDA there is in a serving
...
To keep it simple, they have
based the system on GDA's for women, though this causes other problems with the system(2)
...
The GDA system does not distinguish between the recommendations of maximum, minimum and average amounts
...
The GDA reference for saturated fat is being given in grams based on 10% of energy
...
Consumers eating less than this might mistakenly be encouraged to increase their intake of saturated fat(67)
...
Adult GDAs are sometimes used on childtargeted products
...
This is going to affect the proportion
of GDAs in a portion
...
There are many examples
of such products; KP Snacks Space Raiders, Kellogg’s Frosties, Kellogg’s Rice Krispies, Kellogg’s Ricicles, Kellogg’s Coco Pops, Nestlé Shreddies ‘School Fuel’, Nestlé Cheerios
and Honey Nut Cheerios, and Weetabix Chocolate Weetos(67)
...
A product to use as an example is; Quaker Oats’ Sugar Puffs
...
This adds to big confusion among consumers on how to
interpret these values and this practice is not recommended by The Global Food and Grocery Experts, IGD(67)
...

Cereal manufacturers often use 30g portions for their nutrition information labels, but sometimes they also use 35g, or 45g
...
As an example, on Kellogg’s Corn Flakes packs a portion size is 30g, but their one-pack
portion is 17g
...

Is has been argued that the consumer needs to find matching information on different products to assess them and compare to make the best choice, the problem is that manufactures
has not made this easy
...
Kellogg’s introduced a GDA for iron on the front-of-pack signalling for Corn
Flakes
...
Secondly manufactures has been adding values where no agreed value has been recommend or set y
the IGD, fx
...
Thirdly, some GDA value might not be displayed on all products, on the argument that there is insufficient
space on the product to show all of them
...
The standard GDA signals is lacking

29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist
colour coding for quick consumer appraisal and interpretation as seen in figure 3 below
...
The most suitable method, which has been determined by a research from FSA into consumer preferences and which was also confirmed
by an independent survey from the consumer organisation Which?, is to use a traffic-light signalling system
...
As mentioned the preferred labelling of GDA
within the industry is without the use of colour coding
...
The consumer organisation Which? Also found out in a survey
that traffic-light labels without the percentage information was performing better than numerical labels with added traffic-light colours(67)
...


29
...
2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

4
...
, the colours make it clear visually if a food is healthy or
unhealthy
...

Miranda should aim at choosing products with most green and amber lights and fewer red lights
...
The same goes for fruit and milk products which is important for our health but are high in natural
sugars such as glucose, fructose, lactose and sucrose and will display an amber or red light for sugar , with some products it is therefore necessary to check the nutritional label
instead(2)
...


Overall educating Miranda in reading food labels, to interpret and understand them and compare products in the best way would help her make a better judgement when she goes
grocery shopping or needs a fast sandwich or snack from a local convenience store
...
05
...
I would like to give her some ideas to save money on shopping
...

2
...


First, introduce the habit of always writing a shopping list
...
There are some apps to download to her
mobile if she can, to use for making a shopping list for specific meal plans/recipes or just a pen and paper
...
Which is why I want to show her some simple things and suggest her to cook with other students
...


For Miranda it is about making clever and healthier choices
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29
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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

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2016
by Annemette Jepsen, MCSP
Chartered Physiotherapist and nutritionist

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