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Childhood, adolescence, pregnancy, menopause, 75+: how your diet should change with each stage of life

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In today’s episode, Clare Collins, a Professor in Nutrition and Dietetics at the University of Newcastle, explains how our diets might need to change depending on what stage of life we’re in.

The Conversation’s Phoebe Roth started by asking: what should kids be eating and how much should parents worry about children eating vegetables?

The full interview can be downloaded from the original article.

An edited transcript is below.

Edited transcript

Clare Collins: Parents worry so much about what children eat. But the rule of thumb is if they’re growing well, then you don’t need to worry. They are eating enough food.

And the way you know if they’re growing well is: if you take their baby book or you have a growth chart on your wall and you plot their height and weight regularly, you’ll be able to see if they’re following one of the lines on the growth chart. And that’s the best indicator.

The other thing that’s worth remembering is that a well child won’t starve themselves. But for children, their appetite is more variable than an adult. With us, we go, “Well, 12 o’clock, better eat lunch,” or “Oh, I’m awake, better have breakfast now because I’m going to be busy at work later.” But for children, they’re much more responsive to their internal cues.

And the younger the child, the more variable their appetite. So a typical thing is, a two or three year old might eat a massive breakfast and tomorrow they don’t eat any. At daycare, they might eat a huge lunch or none at all. And then the same thing happens at dinner. So if your child’s in daycare, you might want to look in the book or ask the staff, did they eat afternoon tea and lunch today? And that’ll give you a little bit of a guide as to whether you should be encouraging them to eat a little bit more dinner or just go, well, they had just had a massive afternoon tea, so they’re not really going to be hungry.

The other thing with children around the evening meal is that they often run out of steam by the end of the day. So having the evening meal as early as is practical. And for a young child, that may mean they’re having their dinner at five o’clock. And then what they eat at the family meal time is an optional extra. Because if you make them wait till 6 or 7pm, they’re over it and dinner becomes a nightmare.

The other thing that we know about kids, in terms of should we worry about them not eating vegetables, is we’ve actually done some research on this. And we found for kids around the age of three, the biggest predictor of their vegetable intake was not what mum had eaten in pregnancy. It was actually what the parents were eating now. So if you really want your children to eat heaps of veggies, it’s monkey-see-monkey-do, then that means we’ve got to look at how much we love our broccoli, mum and dad. And then that will make a big difference.

The other factor that comes into vegetable intake is genetics. And about 25% of people are what are called “super tasters”. That means they have got extra taste buds. And I wrote an article about this on The Conversation, actually. And so they taste things like the brassicas family – so Brussels sprouts, cauliflower – they taste it as more bitter than people who were either, not super tasters or, you know, have less taste buds. But more good news: even if you’re a super taster, if you don’t give up and you have repeated exposure, you even overcome that. So there’s no excuse for not liking your cauliflower.

Phoebe Roth: That’s really interesting. I had no idea about a lot of that. So you started to touch on my next question, but I wonder if there are any other tips you’ve got. I was going to ask, what does the evidence say works for developing healthy eating habits during childhood or for kids if you’re worried perhaps they’re not eating as well as they should be.

Clare Collins: The key thing for developing healthy eating habits in childhood is not giving up and trying not to stress. So really accepting there is variability. Studies have been done on toddler intake and shown that over 24 hours they pretty much eat about the same total energy intake. But if you look meal to meal, hugely variable, like I mentioned.

The other key time when I think parents, you know, the food wars can start around 18 months and then people go, you know, “the terrible twos, they just never eat anything!” Well, if you want to avoid the food wars, then around 18 months, just step back a little bit and observe how much food is your child usually eating, because up until 18 months, babies have tripled their birth weight. So, you know, born around, say you’re around three kilos, well around six months you’ll be six kilos and around 18 months you’ll be nine kilos. Now, if in the next 18 months you tripled your birth weight again, what would that be? Nine, 18, 36 kilos. Around that. So around 18 months, depending on a child’s activity, they can actually go through a period of time where their energy needs are relatively less and you are going “No, last month they’d eat a whole punnet of blueberries!” and then you may start trying to force feed them. That’s where the beginnings of the food wars can start. So, trusting, like I said, that a well child will not starve themselves.

It can be different if the child has medical requirements and need for a therapeutic diet. That’s a whole separate kettle of fish and you’d be needing to talk to your GP, maybe be referred to a dietitian for specific problems or if there’s actual feeding problems, a speech pathologist.

So for the average child, it is about exposure, letting them feed themselves, not force feeding them and rewarding the behaviour that you want to see. So picture this: dinner time at the table. One child chasing those veggies around the plate with a fork and the other child eating up the foods that they’re really hungry for. If you focus on the child doing the “right thing” – you know, “I love the way, Jodi, you’re eating that broccoli and carrots,” rather than, “hey, Sammy, you’re going to sit there til every pea has disappeared off your plate” – well, then you’re reinforcing that vegetables are disgusting. So if you focus on the behaviours you want to see, then the other children start to recognise that, “oh, I only get attention if I’m doing the ‘right thing’. ” So reward the behaviour you want to see.

Most of the dinner is consumed in 20 minutes. So don’t make the meals drawn out. And for kids with a smaller appetite, having healthy snacks will make up for what’s not eaten within 20 minutes.

Phoebe Roth: Okay, great. And today we’re discussing, obviously, the Australian Dietary Guidelines and sort of adapting diet at each stage of life. And so I wanted to know at which of life’s different stages might our dietary needs change? We’ve now talked about kids, but what about, say, for pregnant women, women going through menopause and any others?

Clare Collins: Okay. For boys and girls, their dietary needs stay about the same until adolescence. And then that’s the first time the next alarm bells ring. Once girls start menstruating then their iron requirements are much, much greater. Boys, if they’re super active and they have a big increase in lean body mass – so it’s kind of like, you know, if you go from a little car to a big car, you need a lot more fuel – so for boys, all of a sudden they’re eating a lot more food. And meeting those nutritional requirements of adolescence is important because adolescence is also the time when teenagers typically experiment with different types of diets, you know, so they might be on a vegetarian diet or a vegan diet. So just keeping an eye on that. The key nutrients are iron – and you can get that from vegetarian foods and great articles on The Conversation about that, by the way.

And there’s also articles on The Conversation about adolescents and another typical issue that arises at adolescence, where parents are going “I wonder if this is a dietary problem” is diet and acne. And I’ve actually written on that for The Conversation.

And your nutrient needs for women change again during pregnancy and breastfeeding. The growing baby is a pretty good sponge. So it’s really the mum’s nutritional status that’s most at risk and the baby will be doing its best to grow with whatever fuel’s available. But to optimise the baby’s growth and development, you do want to have a nutritious dietary pattern. But you don’t need as much extra food and nutrients as you think. Basically, it’s equivalent to an extra tub of yoghurt and a salad sandwich to meet your extra requirements. But some diet-related problems do kick off in pregnancy like heartburn or developing constipation. And, you know, pregnant women and this happened to me as well, during pregnancy, go, hey, how come this is happening? Well, during pregnancy, there are hormonal changes to essentially slow down your transit time in your gut to give your body the best chance of getting any nutrients out of the food so to support the pregnancy.

And so eating healthily in pregnancy is really important, but you may need a boost in your dietary fibre intake. And one of the articles I’ve written for The Conversation is on how to manage constipation. And there’s a whole hierarchy of nutrition things you can do. And beyond that, then you really do need to mention it to your obstetrician or your GP in case you need some other type of like medicinal help. And then it’s got to make sure it’s something that’s safe for pregnancy. And you do need to talk to them about that.

Phoebe Roth: Sure. Are there any other life stages where you might need to think about changing your diet? What if, say, you develop a particular health condition?

Clare Collins: If you develop a particular health condition, then absolutely. The most common diet-related health conditions in Australia is type 2 diabetes. And some people are now being diagnosed with pre-diabetes, which is like an alarm bell and gives you a chance to change your dietary patterns and your lifestyle behaviours like physical activity so that you don’t go on to develop type 2 diabetes. And then the other one is heart disease. Both of those have dietary components.

So for type 2 diabetes, you’re likely to moderate the type and amount of carbohydrate. And for heart disease, there’s a whole range of bioactive foods that you can boost your intake of – whole grains, vegetables and fruit, reducing your saturated fat intake. And, you know, you can find articles about all of those things on The Conversation.

But if you read those and you go, oh, wow, it’s way more complex than I thought or I really would like some personalised advice, then ask your GP to refer you to an Accredited Practising Dietitian and get a personalised plan.

Phoebe Roth: Yeah, absolutely. And the other one is menopause. I know you’re writing an article for us coming up on menopause and whether there are specific things you need to keep in mind regarding your diet.

Clare Collins: Menopause is really unfair because one of my colleagues, Lauren Williams, who’s co-authoring the article and she’s from Griffith University up there on the Gold Coast, is her whole PhD research was on this topic and she studied the Australian Longitudinal Study of Women’s Health and followed the women as they transitioned through menopause. And the average weight gain is about two and a half kilos.

But even that is not the most unfair aspect of menopause. What she discovered is that there’s no discount, if you like, on gaining weight, if you lived a healthy lifestyle already, that all women are prone to weight gain during menopause. And it’s a combination of the hormonal changes amplified by life changes. And some of those life changes are that for most women, the physical work actually reduces at that time. You know, the house might be less people living in your house and you don’t have to do as much housework.

For many women, you have more disposable income. So you actually can go out a little bit more, spend more money on eating out. And the other thing is it’s a life stage where alcohol intake increases in women. You know, the perfect storm. You know, you had this lovely, healthy lifestyle and then you gained weight.

But what she also found, which is the important message, is that during that menopausal transition, women who changed something, they went, “Right. I’m going to beat this weight gain.” And they decided to eat more vegetables or develop new, healthier recipes or walk a lot more. They did not gain that average two point, 2.5-ish kilos.

As much as I really think that sucks that we gain weight during menopause, I’m really pleased to know that it’s not inevitable, but it’s kind of like, you know, it’s like having to do a spring clean on your life stage patterns, on your dietary patterns and on your physical activity. And you can get through menopause in a healthy weight and with a healthy lifestyle and be healthier. But we have to be on guard. So unfair.

Phoebe Roth: So in the healthy eating side of things, would that just be sort of following the Australian Dietary Guidelines?

Clare Collins: Well, yes, but we need to make a little note of caution about the Dietary Guidelines. And that is not many people eat like the Australian Dietary Guidelines. In fact, the Australian Institute of Health and Welfare modelled what would happen if people did eat five serves of vegetables and two serves of fruit and had their whole grains and used reduced fat dairy and, you know, chose the leanest forms of protein.

They model that if everyone in Australia tomorrow started eating like the recommendations found in the Australian Dietary Guidelines, that heart disease rates would drop by 62% and that diabetes rates would drop by – type 2 diabetes rates, I should say – would drop by around 40%. That’s not going to happen. People aren’t going to do that. And we know that only 3 out of 100 Australians eat five serves of vegetables a day.

So, yes, definitely eat more like the Australian Guide to Healthy Eating and the Australian Dietary Guidelines, but a good place you can start is the Healthy Eating Quiz. This is a short quiz that takes less than 10 minutes to do. It’s free and it’s online. It rates your dietary patterns compared to recommendations in the Australian Dietary Guidelines. And that now links to a really fun website – we think it’s fun anyway because we invented it – called No Money, No Time. It’s got recipe recommendations to match with your Healthy Eating Quiz report.

We’ve set up some fun filters on there. So if you’ve only got a basic kitchen and you’ve got a microwave and just one pot, you can filter it for recipes matching your kitchen equipment. And we also added this other filter that allows you to say what your healthy lifestyle goals are. And we’ve catered for all ages on that. Some people told us their goal was to have glowing skin. And some people said, I want to do better in my sport. And some people have said I want to manage my weight. So you can further tailor the recipes for that. So No Money, No Time and the Healthy Eating Quiz. And that’s our way of trying to help Australians eat a little bit more healthy and feel better and have their health improve as well.

Phoebe Roth: I am already keen to jump on that straight after this and give it a try. Great. So the Dietary Guidelines, would you say they’re a really good resource and reference point, but possibly not a one size fits all approach?

Clare Collins: Absolutely. And there are some resources on the government websites called Eat for Health, and there are some resources on that. And they are designed for the predominantly healthy Australian population while recognising that overweight and obesity are relatively common and that people are commonly seeking extra advice for things like type 2 diabetes and heart disease. There’s certainly a good first place to stop. But as I mentioned, you may need extra specialised help if you have some of those common chronic diseases. And a good place to start to find out is with a health check up with your general practitioner who can do a heart health check and check your blood pressure. And you know, if you don’t have scales at home, they can do a check on your weight. But more important than that is checking on your blood to see what your cholesterol level is and whether your blood sugar levels are high, indicating you’re at a higher risk for type 2 diabetes.

Phoebe Roth: So what do people need to consider to ensure they’re following the right diet for their individual circumstances or for their stage of life?

Clare Collins: I think the key thing, when it comes to diet-related health or nutrition-related health is knowing what your risk factors are for these chronic conditions. And really to know those, you do need to check in with a health professional, with your general practitioner. You might be a lucky person who has the genes that mean you have wonderful blood sugar levels and you have wonderful cholesterol levels and your blood pressure’s great. Then that would essentially mean that you’re doing the right things for your genes and for your body. But a check-up with your GP is usually a chance to see, you know, what does need to be tweaked in my diet? One of the things about high blood pressure is that it’s really common, but there’s absolutely no signs or symptoms. So until you get it checked by your GP, you wouldn’t even know.

Phoebe Roth: What about for older people? What sort of things do they need to consider about diet?

Clare Collins: Once you start approaching 75 and above, then it’s interesting that your nutrition requirements and your dietary requirements start to shift a little bit. Once you get older, the focus moves to trying not to lose your muscle tissue. There’s a word for that malnutrition of older age and it’s called sarcopenia. And it’s really important. And so as you age to protect your body from sarcopenia, your protein requirements actually start to go up.

And people have this image of, “Oh, you know older people. They just need a cup of tea and a piece of toast.” Well, they actually don’t. They might need their coffee made on milk or they might need a nutritional supplement if their appetite’s really poor. And this is another time where you may need specialised nutrition advice. If there’s any underlying medical conditions or if the older people in your family are in a nursing home, you may need to talk to the nursing home staff about whether they’re meeting their nutritional requirements or not.

As you age physical activity and because your muscle mass decreases, your total energy intake reduces. And it’s a little bit like going from the big car down to the smaller car. You still need the same amounts of vitamins and minerals and things we call phytonutrients. You know, they’re not a vitamin or they’re not a mineral, but they help your body run better. You still need the same amount of them, but you need them in less energy. So there’s like less room for error. So the tea and toast isn’t adequate, you know, for grandma or granddad, for the older person. They’re having nutritious and nutrient dense foods.

So, you know, vegetable soup, so to put all the vegetables in, in the right texture that looks appealing is really important. The other thing as you get older is that your taste buds change. You can have less. Some of your taste buds start to decline. And so flavouring food more and to the way, you know, Nanna or Grandpa like it rather than the way you like it is really important. So it can be a life stage where for people, if they think, “Gee, food just doesn’t taste as good anymore, then trying out what herbs, spices and flavourings they like and using those to replace salt.

Because as you age you’re more prone to high blood pressure and you’re also more prone to developing diabetes. So nutrition remains important right through your life. And it’s a really important part of our social lives.

So I think, you know, if I had one final message, it’s: no matter what you do or how busy you are, still finding that time to cook, prepare and eat with other people is a really important way of preserving your own family’s food culture and looking after the nutrition-related health and the social well-being of everyone in your family.

Phoebe Roth: And the last question I have, I wonder if – it goes into all ages, for anyone that’s trying to eat healthy and follow a healthy diet – where do superfoods fit in? I know that there may not be one answer to fit all, but I think that that’s kind of a question people grapple with it when the next fad is right in front of them. And you know, what do they do? Should they eat this? Should they go out and buy it?

Clare Collins: Fad diets are just so ongoing and regular that we often write articles for The Conversation about them. But you know, my thing about superfoods is that there are super foods, there’s heaps of them and they’re actually all in the supermarket.

And when you walk in the supermarket – this is one way supermarket design does try and help us eat healthy – you walk smack bang into the super food section and they’re right there. They don’t have packages. They don’t have labels. But it’s that wide variety of vegetables and fruit. And I think if there was one important thing to remember, when you go to the supermarket every week when you went to the supermarket or you enter a market, look at those vegetable and fruits and which one has not been in your trolley, you know, in the last couple of weeks? And invite them in. Some of the research that we’ve done shows that the variety of vegetables and fruit, but particularly the variety of vegetables, predicts your long term health care costs.

And we’ve shown that in a research study over 15 years on the Australian Longitudinal study on Women’s Health. And lots of the research we’ve been doing is showing that the variety of those foods that belong to the Australian Guide to Healthy Eating in the Australian Dietary Guidelines, that it’s actually those nutrient-rich foods that predict your nutrient intake and then decide whether you’re on a path for health or you’re not on a path for health. You’re on a path for poor health.

So going for variety in your whole grains, your vegetables, your fruits, your sources of protein, which includes meat, poultry, fish and then all the wonderful vegetarian sources and whole grains. Collectively, those things make up a healthy diet pattern. They make up you when you eat them. And then that determines whether you’re going to be healthy or less healthy.

Phoebe Roth: Is there anything else you want to talk about that we didn’t touch on?

Clare Collins: The only thing is I hope people don’t feel alone when it comes to nutrition. Go and have a look at No Money, No Time. Not only have we loaded that website up with lots of recipes, we’ve also loaded up with lots of information, hacks and myths. We’ve linked a lot of The Conversation articles to it. And then the other place to go for good information is go to The Conversation and type in nutrition in the search bar. And you’ll see lots of the articles that myself, my team and lots of other academics from other universities around Australia have written on food and nutrition.

Phoebe Roth: Thank you so much, Clare, for joining us on Trust Me, I’m An Expert today. It’s been great talking to you again.

Clare Collins: Thank you. It’s my absolute pleasure.The Conversation

Phoebe Roth, Deputy Editor, Health+Medicine, The Conversation; Sophia Morris, Editorial Intern, The Conversation, and Sunanda Creagh, Head of Digital Storytelling, The Conversation