Plates of healthiness
View(s):As the season approaches with its share of rich food, Consultant Clinical Nutritionist Dr. Ranil Jayawardena gives a timely reminder of the importance of eating right
Showing MediScene a clear and colourful set of instructions with regard to food, Consultant Clinical Nutritionist Dr. Ranil Jayawardena who is also a Senior Lecturer at the Faculty of Medicine, University of Colombo, presents ‘My Rice Plate’.
This evidence-based approach not only on what to eat and what quantities we should eat, he hopes will help ward off obesity-associated non-communicable diseases (NCDs), while keeping us trim.
The results of this concept, ‘My Rice Plate’ have been published in high quality international nutrition journals.
Dr. Jayawardena says: “Dietary patterns in Sri Lanka are rapidly changing with urbanization. A study shows a considerable proportion of adults failing to follow recommended dietary guidelines. Nearly 70% exceeded the recommendations for starch (carbohydrate) intake, while the daily intake of fruit (0.43 servings/day) and vegetable portions (1.73 servings/day) dropped well below national recommendations, with only 3.5% of adults consuming the recommended five portions of fruits and vegetables per day.”
Carbs seem to have become the bane of the people and he explains how a heaped up plate of rice was fine for those who toiled the land but not now for those who are seated (sedentary) most of the time. Another worrisome matter is that Sri Lankans do not seem to be eating enough protein.
“Sri Lankans obtain nearly 72% of their calorie requirement through carbohydrates (mainly refined), while only 10% of calories are derived from proteins. In a typical Sri Lankan rice plate, there is about 400g of rice and very little vegetables and protein. Thus, cutting down the amount of rice from each meal will help reduce excess calories from the main meals and lead to body weight reduction eventually. With an increase in vegetables and protein-rich foods to achieve daily targets, there will be other health benefits and maintenance of lean mass,” he explains.
‘My Rice Plate’ which is culturally specific has been designed according to the ‘Plate Model’ recommended by local and international nutrition guidelines, MediScene learns.
Before uncovering ‘My Rice Plate’, Dr. Jayawardena focuses on the simple definition of obesity which is the “deposition of excess body fat”. According to the World Health Organization (WHO), people with body mass indexes (BMIs) of 25.0 kg/m2 to 29.9 kg/m2 are considered as overweight and BMIs of 30.0 kg/m2 and above are labelled as obese. However, since Asians tend to have higher amounts of body fat at lower BMIs and a higher risk for obesity associated diseases such as diabetes and cardiovascular diseases, these cutoffs may be insufficient in identifying South Asians individuals with a high risk of obesity-related morbidity and mortality.
Losing weight is all about ‘Calories In vs. Calories Out’, points out Dr. Jayawardena, explaining that to lose weight, you need to consume a few less calories each day than your body burns. In the energy deficit method, you have to measure your calorie intake and consume appropriate amount. However, measuring calories in Sri Lankan foods is not possible practically because there is no complete composition database for Sri Lankan mixed dishes. Secondly, there is a considerable variation in the recipes of the local curries.
Dr. Ranil Jayawardena
This is where ‘My Rice Plate’ comes in handy and ongoing clinical trials have revealed that there is considerable reduction in body weight and waist circumference and an improvement in plasma blood glucose levels in obese adults (BMI>25kg/m-2).
‘My Rice Plate’ is divided into five segments:
One-quarter (1/4) — for rice, noodles, pasta or macaroni.
One-quarter (1/4) — for protein-containing foods such as meat, fish, eggs, and soya products (textured vegetable protein).
Half (1/2) — for non-starchy vegetables. This segment is divided into three equal areas: One-third (1/3) for green leafy salads (mallum) and the other two-thirds (2/3) for two vegetables, including one green.
The colours — yellow for rice; red for protein-containing food; dark green for mallum/green salad; light green for green vegetables and orange for another non-starchy vegetable.
Two calorie boundaries are marked over the plate: Inner calorie boundary (~300 kcal) which has a diameter of 18 cm is for females and the outer one (~350 kcal) which has a diameter of 20 cm is for males.
These calorie values have been printed on their respective lines at three places. In each segment the area between two calorie boundaries is filled with strips of that specific color. Each calorie boundary represents the recommended quantity of a meal according to the gender
‘My Rice Plate’ addresses 3 common issues — controlling the portion size; nutrition balance; and eating awareness.
According to Dr. Jayawardena: “Controlling the starch portion and replacing it with non-starchy vegetables is very important, while the inclusion of vegetables is the best way to lower the calorie density of the main meals. It is also crucial to consume high quality protein-containing foods such as fish, lean meat, egg and soya as part of healthy meal plan.”
This plate is not recommended for:
Children below 5 years of age.
Very active people such as farmers.
Sportsmen and women.
Pregnant and lactating mothers.
Patients who need special dietary advice.
Under-weight adults (BMI<18.5kg/m2)
Rice or equivalents
Everyday Options
Red basmathi, red kekulu or red nadu
Red rice noodles
Wholemeal pasta
Wholemeal spaghetti
Wholemeal atta macaroni
Occasional options
White basmathi, white kekulu, white samba or white nadu
Fried rice
Milk rice
Regular noodles
Regular pasta
Regular spaghetti
Tips for a healthy meal
Do not add salt.
Do not add any oil including olive oil when preparing noodles, pasta, spaghetti etc.
Do not add dressing/cream/mayonnaise to pasta etc.
Minimize using oil when preparing fried rice.
Fried rice should have vegetables.
Do not add thick coconut milk when preparing milk rice. Instead use diluted coconut milk or non-fat liquid milk.
Meat or equivalents
Everyday options
Fish
Chicken
Lean beef
Lean pork
Lean mutton
Egg white
Occasional options
Sprats
Dried fish
Pork
Beef
Mutton
Cuttlefish
Prawn
Crab
Whole egg
For vegetarians
Soya meat/TVP
Tofu
Paneer
Tips for a healthy meal
Do not fry fish, but prepare with spices (mirisata or ambulthiyal).
Use water, diluted coconut milk or non-fat liquid milk for curries.
Do not serve yourself any gravy if prepared with thick coconut milk.
Don’t batter-fry any food.
Green vegetable curry
Everyday options
Bitter-gourd
Snake-gourd
Ridge-gourd
Winged bean
Radish
Knol khol
Kohila leaves
Green beans
Long beans
Okra (bandakka)
Cabbage
Leeks
Yellow/red vegetable curry
Everyday options
Carrot
Beetroot
Pumpkin
Batana
Brinjal
Raw mango
Ambarella
Baby jak
Banana flower
Kohila
Lotus root
Purple cabbage
Mushroom curry
Tips for a healthy meal
Potato, sweet potato, manioc, jackfruit, breadfruit or dhal and other pulses should not be considered as vegetables.
Use diluted coconut milk or non-fat liquid milk for curries.
Use less spices and chillie.
Do not consider coconut sambol as a vegetable.
Green leaves (mallum)/salads
Everyday options
Mallum
Gotukola
Mukunuwenna
Kathurumurunga
Sarana
Kankun
Thampala
Onion leaves
Winged bean
Salads
Salad leaves
Iceberg lettuce
Romaine lettuce
Gherkin
Cucumber
Tomato
Snake-gourd
Onion
Gotukola
Mixed salad
Tips for a healthy meal
Use less coconut for mallum. The best way is to use the ‘leftover coconut pulp’.
Do not add oil/dressings/mayonnaise to salads.
Snacks allowed in-between meals:
A medium-size fruit (80-100g)
Fresh fruit juice (200 ml)
Non-fat liquid milk (200 ml)
A cup of yoghurt (80-90g)
A handful of nuts (20g)
Herbal gruel (200 ml)
Some tips when using ‘My Rice Plate’
Reduce chillie and spices in the curries so that you can eat more vegetables.
Serve yourself the vegetables before the rice.
Start eating the vegetables first and then the rice.
Drink water before and after the meal.
Avoid high-calorie desserts such as ice cream and wattalappan.
A few more tips for better general health
Drink plenty of water
Cut down your sugar intake
Cut down your oil intake
Avoid alcohol
Exercise at least 30 minutes per day
Avoid maladaptive eating patterns – eating while watching TV, drinking fizzy drinks while eating and self-rewarding with food.
| No safe level for alcohol Don’t drink. Alcohol in any quantity is not good for you. Poddak hondai, is not valid anymore, cautions Dr. Ranil Jayawardena, reiterating that “the safest level of drinking is ‘none’”.He speaks with evidence in hand and cites two important studies – ‘Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016’ and ‘No level of alcohol consumption improves health’ published in the Lancet on September 22. Sri Lanka was part of these studies.The Lancet states: “Alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10% of global deaths among populations aged 15–49 years, and poses dire ramifications for future population health in the absence of policy action today.” “The widely held view of the health benefits of alcohol needs revising, particularly as improved methods and analyses continue to show how much alcohol use contributes to global death and disability. Our results show that the safest level of drinking is none. This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks per day. “Alcohol use contributes to health loss from many causes and exacts its toll across the lifespan, particularly among men. Policies that focus on reducing population-level consumption will be most effective in reducing the health loss from alcohol use.”
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