Healthy eating on a plate: eating for health made simple. Module 5: Nutrients at Risk

Transcription

1 Healthy eating on a plate: eating for health made simple Module 5: Nutrients at Risk

2 Healthy eating on a plate: eating for health made simple Module 5 Nutrients at Risk, June 2013 P a g e i

3 Healthy eating on a plate: eating for health made simple Contents Module 5: Nutrients at Risk... 1 Learning Outcomes... 1 Key Messages... 1 Checklist for session... 1 Session outline: Nutrients at Risk... 2 Presenter notes for Module 5: Nutrients at Risk... 3 Calcium... 3 Iron... 5 Vitamin D... 6 Group discussion... 8 Some things to consider when presenting this module... 8 Website resources... 9 Appendix A Resources 10 Activity Sheet Vitamins and minerals for health Activity Sheet - Answers Vitamins and minerals for health Appendix B Script and flashcards..13 Module 5 Nutrients at Risk, June 2013 P a g e ii

4 Healthy eating on a plate: eating for health made simple Module 5: Nutrients at Risk In Australia, people in the community may be instructed by their doctor to take supplements from time to time. It is important that supplements are only taken under supervision and that people know how to maintain nutrient levels through diet and other means once supplements are no longer necessary. This module looks at simple strategies to address iron, calcium and vitamin D deficiencies. Learning Outcomes: By the end of the session participants will be able to: Identify which foods are the best sources of iron and calcium Implement simple strategies to address key nutrient deficiencies Understand that adequate exposure to sunlight and not diet is the best way to gain sufficient vitamin D Key Messages: Eat three serves of reduced-fat dairy (or alternatives) each day Eat fruit or vegetables with each meal to enhance iron absorption Sun exposure and not food is the best way to maintain vitamin D levels Checklist for session: Script and flashcard set for Module 5: Key nutrients Activity Sheet Vitamins and minerals for health Activity Sheet - Answers Vitamins and minerals for health Pens Module 5 Nutrients at Risk, June 2013 P a g e 1

5 Healthy eating on a plate: eating for health made simple Session outline: Nutrients at Risk Time Activity Resources required 2 mins Introduction and overview of the session Understanding why our bodies need calcium, iron and Vitamin D Health consequences of inadequate intake of these nutrients Best sources of these important nutrients 5 mins Calcium Discussion Points: Flashcard: Calcium Why is iron important? and osteoporosis Health consequences of not getting enough calcium Prevention of osteoporosis People at risk Food sources of calcium 5 mins Iron Discussion Points: Flashcards: Iron and anaemia and Why is iron important? Food sources of Health consequences of not getting enough iron iron People at risk Types of iron (haem and non-haem) Food sources of iron Help your body to absorb more of the iron in food 5 mins Vitamin D Discussion Points: Flashcards: Vitamin D and Why is vitamin D important? osteoporosis Health consequences of not getting enough vitamin D Vitamin D People at risk Sources of vitamin D Maintaining vitamin D levels 3 mins Recap of main points 10 mins In-class activity Participants will complete the activity sheet Vitamins and minerals in food Discuss answers as a group. Group discussion Discuss what participants have learnt, confidence and intention to change Activity sheet - Vitamins and minerals for health Answer sheet - Vitamins and minerals for health Module 5 Nutrients at Risk, June 2013 P a g e 2

6 Healthy eating on a plate: eating for health made simple Presenter notes for Module 5: Nutrients at Risk Give an overview of what participants can expect to learn during the session Many vitamins and minerals have been studied and we know if we don t get enough of them the result can be ill health. This is referred to as a vitamin or mineral deficiency. Today we are going to focus on three of the most common deficiencies in Australia and discuss: Why we need calcium, iron and vitamin D The health consequences of not getting enough of these important vitamins and minerals The best sources of these vitamins and minerals Calcium Display Calcium and Osteoporosis flashcard Why is calcium important? Calcium is needed to carry out many important roles in the body including maintaining the normal functions of the muscular and nervous systems. It is such an important mineral that the body needs to keep a constant level of calcium in the blood stream at all times. Health consequences of not getting enough calcium Our bones act as a storage deposit for calcium. If the calcium level drops in the blood, the body will withdraw some calcium from the bones to make up the shortfall. Over time, if more calcium is withdrawn from the bones than deposited then the bones become weak and osteoporosis may develop. As well as eating enough calcium, getting regular exercise is also important for bone health and strength. Osteoporosis means bones with holes. The condition itself will not cause pain or illness; however as bones lose calcium, they lose strength and are easily broken (fractured). The most common breaks occur in the spine, upper arm, wrist, ribs, forearm, pelvis and hip. Bones can break even with a minor fall or knock. A person may show no signs of osteoporosis until a fall occurs which results in a fracture or break. Prevention of osteoporosis Your bones are the strongest they will be (called peak bone density) by the age of 30, however most of the bone strengthening occurs during early adolescent when the growth rate is highest. So the best way to prevent osteoporosis is to start young. This is why it is particularly important for children to get enough calcium and to be physically active every day. After the age of 30, you can slow down the rate at which calcium is lost from the bones by making sure you eat enough calcium every day and get regular exercise. You may also like to consider other things that may be harming your bone health such as: Smoking studies show that smokers have an increased risk of bone fractures Too much salt when excess salt is processed through the kidneys it takes some calcium with it Excessive amounts of caffeine (strong tea, coffee, caffeinated soft drinks). Drinking too much caffeine can have a diuretic effect and flush calcium out of the body. o this includes products that contain guarana, which is a form of caffeine Excessive soft drinks - studies have found that teenagers who drink soft drinks (including diet drinks) have softer bones than those teenagers who don t drink soft drinks Excessive alcohol consumption interferes with calcium absorption Module 5 Nutrients at Risk, June 2013 P a g e 3

7 Healthy eating on a plate: eating for health made simple People most at risk of developing osteoporosis According to the latest Nutrition Survey very few people in Australia are getting enough calcium through the food they eat. Osteoporosis affects women more than men. In Australia 1 in 2 women (half) and 1 in 3 men (a third) over the age of 60 will have a fracture due to osteoporosis. Post-menopausal women Both men and women lose calcium from their skeleton with age, however losses are generally greater in women, especially around menopause when changes in hormone levels speed up the loss of calcium from the bones. In Australia, the average age for a women to go through menopause is 51 years of age. Woman may go through menopause earlier or have menopause induced due to medical conditions or surgery. Lack of sunlight Vitamin D is produced when our skin is exposed to the sun and works with calcium to strengthen bones and increase calcium stores. For this reason, people who do not get adequate exposure to the sun may also be at risk of developing osteoporosis (more information in the Vitamin D section). Food sources of calcium There are only a few foods that contain large amounts of calcium with smaller amounts found in a variety of other everyday foods. Dairy foods are the best source of calcium. It is readily available and the calcium in milk is easily absorbed by the body. For those people who do not drink milk, make sure alternative products (e.g. soy milk) are fortified with calcium (100mg per 100 mls). Eating 2½ serves of dairy foods Average amount of calcium (mg) in standard serve sizes Food Serve size Calcium (mg)* Milk 250 ml glass mg Yoghurt 200 g tub mg Sardines (with the bones) 100g 400 mg Cheese 40 g (2 slices) 300 mg Salmon (with the bones) 100g 200 mg Soya beans 100 g 200 mg Almonds 30 g 80 mg Bread (2 slices) 70 g 55 mg Orange 150 g 45 mg Broccoli (cooked) 75 g 30 mg *Adults need approximately mg calcium per day Adapted from FoodWorks 7 (Xyris 2012) (cheese, milk, yoghurt) or alternatives fortified with calcium every day, along with a good variety of breads, cereals, fruit, vegetables, nuts and seeds should be enough to get a good intake of calcium for most people. Older adults should aim for 3½ - 4 serves of dairy foods or alternatives per day, especially women, to compensate for a greater loss of calcium from the bones around menopause. NOTE: If anyone in the group is concerned about their calcium intake, they should seek advice from a doctor or registered dietitian. Module 5 Nutrients at Risk, June 2013 P a g e 4

8 Healthy eating on a plate: eating for health made simple Iron Display Iron and anaemia flashcard Why is iron important? Iron plays a role in the proper functioning of the immune system and the production of enzymes that help cells to function efficiently. However, the most important function of iron is to form haemoglobin in red blood cells and myoglobin in muscles. Oxygen attaches to the haemoglobin and is then transported throughout the body to be used for energy in daily life. The oxygen stored in myoglobin is released during strenuous exercise. Even though some iron is stored in the body, we lose iron every day through sweat, shedding cells in the intestine and menstruation, so iron stores need to be replaced daily with iron from food. Health consequences of not getting enough iron Over time, if iron stores drop, and aren t replaced, this means that not enough oxygen is able to be delivered to the body, which can lead to iron depletion, iron deficiency and in extreme cases - anaemia. The symptoms of anaemia include: excessive tiredness or fatigue low immunity (you may get sick more often and take longer to recover) feeling the cold more an inability to concentrate Anaemia develops when there is not enough haemoglobin or red blood cells to carry oxygen around the body. This means the heart has to pump harder to get oxygen to the cells resulting in feelings of exhaustion. A person who eats a mixed diet that includes meat will absorb about 18% of the iron they eat. A vegetarian/vegan will absorb only 10%. Vegetarian: does not eat meat, but may eat fish and other animal products e.g. milk, cheese, yoghurt People most at risk of developing iron deficiency or anaemia Women who are menstruating are most at risk of iron deficiency, especially if monthly blood losses are heavy Vegan: does not eat any animal products Pregnant women. The risk increases with each pregnancy due to the greater demand for iron during pregnancy and breastfeeding and the blood losses that can occur when giving birth Vegetarians need to pay special attention to their iron intake. They will need almost twice the amount of iron as those people who include meat in their diets to get the same benefit (see haem and non-haem sources of iron below) Young children under the age of 2 babies are born with enough iron stores to last six months, after this they must eat iron rich food to maintain sufficient levels. Note: Vegetarians also need to ensure they are getting enough B12 in their diet. B12 is important in the formation of red blood cells, nerve cells and DNA material Deficiency can result in a type of anaemia call pernicious anaemia Only animal products contain B12 that can be absorbed by the body (meat, milk, eggs, cheese, yoghurt). Vegans need to eat foods fortified with B12 (e.g. soy milk) or take a supplement Other food sources (seaweed, tempeh, miso, spirulina) also contain B12 but it is not in a form the body can use. Module 5 Nutrients at Risk, June 2013 P a g e 5

9 Healthy eating on a plate: eating for health made simple Display Food sources of iron flashcard Food sources of iron There are two types of iron present in food: Haem iron Found in red meat, chicken and seafood. This type of iron is easily absorbed by the body. The redder the meat the more iron it contains ( chicken and fish do not have as much iron as red meat) Non- haem iron Found in legumes, wholegrains, fortified breakfast cereals and bread, dark green leafy vegetables (broccoli), nuts, seeds, eggs, dried fruit, dried beans and peas. This type of iron is not so easily absorbed by the body Iron supplements should only be taken under the supervision of a doctor. Help your body to absorb more of the iron in food Non- haem iron is absorbed better if one or both of the following is included at the same meal: Haem iron (from red meat, chicken or seafood) A food containing vitamin C - most fruit and vegetables contain some level of vitamin C and is another great reason to include fruit and vegetables at each meal also Cut back on tea and coffee at meal times as the tannins found in these drinks interfere with the absorption of iron. Display Vitamin D and osteoporosis flashcard Vitamin D Why is vitamin D important? Liver is a good source of iron; but it contains high levels of vitamin A, which can be toxic. Pregnant women should avoid eating liver for this reason. Vitamin D combines with calcium to build strong bones as well as being essential for general good health. Health consequences of low levels of vitamin D If a person does not have adequate vitamin D levels, they may be at risk of developing osteoporosis later in life. Vitamin D deficiency can also lead to bone pain, muscle weakness and rickets in children. Module 5 Nutrients at Risk, June 2013 P a g e 6

10 Healthy eating on a plate: eating for health made simple People most at risk of low vitamin D levels Dark skinned people (especially if veiled) o dark skin is not as good at making vitamin D as fair skin Older people and people who are housebound o this group of people is not as likely to be outdoors and the ability to produce vitamin D gets less with age Little or no sun exposure o if people work indoors or need to cover up for religious or cultural reasons their exposure to sunlight may not be enough to produce adequate amounts of vitamin D Rickets affects babies and young children who do not get enough vitamin D. Symptoms include soft, painful bones, fractures and bone deformities. Breastfed babies whose mothers have low vitamin D stores o breast milk is the best first food for babies, however babies are not born with vitamin D stores and so they rely on the small amounts found in breast milk. If the mother is low in vitamin D, then the baby is also unlikely to get enough vitamin D Display Vitamin D flashcard Sources of vitamin D The average person will not be able to get enough vitamin D from food alone, so it is important to get adequate exposure to sunlight and take supplements to restore levels, if they are low. Foods that contain small amounts of vitamin D include: Oily fish, dairy products, fortified products (e.g. some margarines) and eggs Mushrooms that have been exposed to UV light are also a good source of Vitamin D, however this only applies to mushrooms specifically labelled as Vitamin D mushrooms. Maintenance of vitamin D levels To maintain vitamin D levels for a person living in South Australia during summer expose face, arms and hands (or the equivalent skin area) before 11am and after 3pm on most days of the week for 5-7 minutes. During summer the Australian sun can be very harsh. Common sense is needed to balance the risk of skin cancer with the health benefits of getting enough vitamin D During winter (May to August) two to three hours a week of sun exposure is needed to maintain vitamin D levels. Expose arms (or legs) face and hands to the sun for 20 minutes on most days of the week. Recaps the main points from the session: Eat three serves of dairy foods (or alternatives) and get regular exercise each day to prevent osteoporosis (4 serves for women 50+ years and men 70+ years) Eat fruit or vegetables with each meal to enhance iron absorption Sun exposure and not food is the best way to maintain vitamin D levels If participants are concerned about their intake of any of these nutrients they should consult their GP or a registered dietitian Never take supplements without consulting your GP Get your vitamin D levels checked by a GP. A blood test will show if supplements are needed. Once vitamin D levels are restored, supplements can be stopped, however adequate measures to maintain vitamin D levels should be in place before stopping Module 5 Nutrients at Risk, June 2013 P a g e 7

11 Healthy eating on a plate: eating for health made simple Distribute Vitamins and minerals for health activity sheet to participants Give participants enough time to fill in the activity sheet and then go through the answers. Clarify any points and collect the sheets. Make a note of how many participants complete the activity sheet correctly. Group discussion Group discussion and evaluation What will you take away from today s session? How confident are you that you can choose foods that will enable you to increase or maintain your level of these important nutrients? What changes, if any, do you plan to make as a result of today s session? Make notes of comments throughout the session and questions asked when filling out the activity sheet. An overall evaluation will be conducted at the end of the sessions. Some things to consider when presenting this module Taking a wide range of supplements can be concerning for many people. Emphasise the need to consult a GP and have the use of supplements monitored Muslim women may choose not to bare their arms in public. Finding a private place to expose their skin to sunlight may be difficult Refugees may have become accustomed to not eating meat due to scarcity or cost. This could lead to B12 deficiency. Non-vegetarians should be encouraged to eat meat (particularly red meat) 3-4 times per week Vegetarians (no meat in the diet) and vegans (no animal products in the diet) should eat food fortified with B12 or take supplements Breastfed babies of vegetarian/vegan mothers are at particular risk of B12 deficiency. If the mother s B12 stores are low, the baby is unlikely to have any stores. Module 5 Nutrients at Risk, June 2013 P a g e 8

12 Healthy eating on a plate: eating for health made simple Website resources Assisting Torture and Trauma Survivors (ASeTTS) an organisation set up in Western Australia in 2001 to improve the access to nutrition information available to new arrivals. Good Food for New Arrivals is a website which includes resources and background information on the health needs of new arrivals. Calcium Osteoporosis Australia Calcium. Preventing osteoporosis is a major health concern in Australia. This website provides easy to read information about the importance of calcium in preventing osteoporosis. The Better Health Channel, Calcium, This website is funded by the State Government of Victoria and provides easy to understand factsheets on a wide range of health issues. This fact sheet summarises the causes and treatment of calcium deficiency in adults. Iron The Better Health Channel, Iron deficiency adults This website is funded by the State Government of Victoria and provides easy to understand factsheets on a wide range of health issues. This fact sheet summarises the causes and treatment of iron deficiency anaemia in adults. Vitamin D Bureau of Meteorology (BOM) the national weather, climate and water agency. This website provides information on UV ratings and sun protection. Cancer Council Australia, Vitamin D is very important for bone health, and the best source is exposure to the sun, however in Australia sun exposure needs to be carefully balance against the risk of skin cancer. This webpage give practical advice on how to stay safe in the sun and still get enough vitamin D. Vegetarian eating The Better Health Channel, Vegetarian eating. Adopting a vegetarian eating style is more than simply leaving meat off the plate. This webpage explains some of the things vegetarians and vegans must take into account to eat a healthy diet. eatforhealth.gov.au, Simple Vegetarian Recipes, This webpage gives some simple tips on how to ensure vegetarian/vegan eating includes all the minerals and vitamins needed for good health. Module 5 Nutrients at Risk, June 2013 P a g e 9

13 Healthy eating on a plate: eating for health made simple Appendix A Resources Module 5: Nutrients at Risk Module 5 Nutrients at Risk, June 2013 P a g e 10

14 Activity sheet: Vitamins and minerals for health Circle the best source of vitamin D: Circle the best foods for calcium: Circle the correct answer. During winter in South Australia how many minutes of sunlight do you need on your face, hands and arms (or legs) most days of the week? Circle the foods you should eat every day to help your body absorb more iron. 10 minutes 15 minutes 20 minutes 60 minutes

15 ANSWERS - Activity sheet: Vitamins and minerals for health Circle the best source of vitamin D: Circle the best foods for calcium: Answer: You won t get enough vitamin D from food alone. Expose your face, hands and arms (or legs) most days of the week to the sun (see the chart for times in winter and summer). If you are worried about your vitamin D levels see your doctor. Circle the correct answer. During winter in South Australia how many minutes of sunlight do you need on your face, hands and arms (or legs) most days of the week? Answer: All these foods provide some calcium. The best sources are cheese, milk, yoghurt and sardines (as long as you eat the bones). Eat three serves of dairy each day (or alternatives like soy milk, fortified with calcium) and a good variety of other foods to get enough calcium. Older adults should aim for 3½ - 4 serves of dairy foods or alternatives per day, especially women, to compensate for a greater loss of calcium from the bones around menopause. Circle the foods you should eat every day to help your body absorb more iron. 10 minutes 15 minutes 20 minutes 60 minutes Answer: Expose face, hands and arms (or legs) for 20 minutes most days of the week in winter time. In summer time the sun can be very strong. Stay out of the sun between 11am and 3pm and reduce the time to 5-7 minutes. Answer: The vitamin C in fruits and vegetables help to absorb the iron in haem and non-haem foods. Include fruit or vegetables at every meal.

16 Appendix B Script & flashcards Module 5: Nutrients at Risk Module 5 Nutrients at Risk, June 2013 P a g e 13

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18 Script for Module5: Nutrients at Risk Module 5 Food gives our bodies more than just energy. It also provides our bodies with vitamins and minerals. Many vitamins and minerals have been studied and we know if we don t get enough of them the result can be ill health. This is referred to as a vitamin or mineral deficiency. Some deficiencies are more common than others and today we will be talking about: Vitamin D and the minerals calcium and iron What happens if we don t enough of these important vitamins and minerals Which foods are the best sources of iron and calcium Some everyday tips to increase and maintain your levels of these vitamins and minerals We are focussing on these three nutrients today because: One in two women (half) and one in three men (a third) aged over 60 years - living in Australia - will have a bone fracture due to osteoporosis o Getting enough calcium and vitamin D is one key way to reduce the risk of developing osteoporosis In Australia it is estimated that one in three women of childbearing age are iron deficient by the age of years. o Women are a group who need to take extra care to ensure they are getting enough iron otherwise they can become iron deficient and eventually anaemic, which can mean they get sick more often and take longer to recover. Page 1

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20 Script for Module5: Nutrients at Risk Let s start with calcium. Why is calcium important? Every time you move a muscle or your heart beats, calcium is being used. It is also needed to build strong teeth and bones. It is such an important mineral that the body needs to keep a constant level of calcium in the blood stream at all times. What happens if we don t get enough calcium? Our bones act as a storage bank for calcium. If the calcium level drops in the blood, the body takes some calcium from the bones to keep the level constant in the blood. Over time, if more calcium is taken from the bones than deposited - then the bones become weak and osteoporosis may develop. As well as eating enough calcium, getting regular exercise is also important for bone health and strength. Prevention of osteoporosis Your bones are the strongest they will be (called peak bone density) by the age of 30 however most of your bone strength develops when you are a teenager. So the best way to prevent osteoporosis and make sure you have enough calcium in the bank for your later years is to start young. This is why it is particularly important for children to get enough calcium and to get out and be active every day. After the age of 30, calcium starts to be lost from the bones, but you can slow it down by: Eating foods that contain calcium every day Getting out and being active on most days of the week. and make sure that you address other things that can harm your bones and make them weak: stop smoking studies show that people who smoke have a higher risk of having a bone fracture too much salt as excess salt is processed through the kidneys it takes some calcium with it don t have excessive amounts of caffeine (strong tea, coffee or soft drinks containing caffeine or guarana). Drinking too much caffeine can have a diuretic effect and flush calcium out of the body. Studies have also found that teenagers who drink soft drinks have softer bones than those teenagers who don t drink soft drinks (including diet drinks) if you choose to drink alcohol, drink in moderation (no more than two standard drinks a day) alcohol interferes with calcium absorption Page 2

21 Page 3 Calcium and Osteoporosis

22 Script for Module5: Nutrients at Risk Some people are more at risk of developing osteoporosis than others: It is estimated that more than 60% of Australian women do not get enough calcium Post-menopausal women - over the life span women will lose more calcium from their bones than men. This is because when the female hormone oestrogen drops around menopause the calcium losses speed up for about 5-10 years Lack of sunlight - Vitamin D is produced when our skin is exposed to the sun. It works with calcium to strengthen bones and increase the amount of calcium stored in the bones. So people who do not get enough sunlight on their bare skin may also be at risk of developing osteoporosis (this will be discussed more in the vitamin D section). Where do you get calcium from? There are only a few foods that contain large amounts of calcium, and smaller amounts are found in a variety of other everyday foods such as green leafy vegetables, nuts and fish with edible bones, such as sardines and salmon (the bones contain the calcium so if you re not eating the bones, you re not getting the calcium) Dairy foods (milk, yoghurt and cheese) are the best source of calcium. The calcium from these foods is easily absorbed by the body If people drink an alternative like soy milk make sure calcium has been added (fortified). Look for a milk that has 100 mg of calcium per 100 grams this information is on the Nutrition Information Panel on the label Adults need 2 ½ - 3 serves of dairy foods (or alternatives like calcium fortified soy milk) a day. This will provide the majority of the calcium needed. If a good variety of other foods such as, breads, cereals, fruits and vegetables are included as well this will make up the rest of the recommended daily intake of calcium. The best way to get calcium is through food, however some people need to take supplements. Take them at night as your body will absorb them better and don t take them at the same time as any iron supplements as the iron may prevent some of the calcium being absorbed. Older adults should aim for 3½ - 4 serves of dairy foods or alternatives per day, especially women, to compensate for a greater loss of calcium from the bones around menopause. NOTE: if anyone in the group is concerned about their calcium intake, they should seek advice from a doctor or registered dietitian Page 3

23 Page 4 Calcium and Osteoporosis

24 Script for Module5: Nutrients at Risk Why is iron important? Iron helps to keep our immune system working properly which helps to fight illness. However, the most important function of iron is to make healthy red blood cells. When blood cells are healthy they take oxygen around the body so without enough iron - you can start to feel very tired. We do store some iron in our body but we also lose some every day through sweat, shedding cells in the stomach and during menstruation, so iron stores need to be replaced daily with iron from food a similar story to calcium. Health consequences of not getting enough iron Over time, if iron stores drop too low, and aren t replaced, your muscles won t get enough oxygen, which can lead to iron depletion, iron deficiency and in extreme cases - anaemia. The symptoms of anaemia include: excessive tiredness or fatigue low immunity (you may get sick more often and take longer to recover) feeling the cold more an inability to concentrate People most at risk of developing iron deficiency or anaemia Iron deficiency is the most common nutritional deficiency in the world and effects mostly women. In Australia it is estimated 8% of the population are iron deficient Women who are menstruating are most at risk of iron deficiency, especially if monthly blood losses are heavy A high number of pregnancies also increases the risk of iron deficiency because you need more iron during pregnancy to support the growth of the baby and blood losses can be quite high during delivery Young children under the age of 2 babies are born with enough iron stores to last six months, after this they must eat iron rich food to maintain sufficient levels. Vegetarians need to pay special attention to their iron intake we ll discuss this in the next section. Page 4

25 Page 5 Iron and anaemia

26 Food sources of iron Food sources of iron There are two types of iron in food: Animal sources (haem iron) Found in red meat, chicken and seafood. This type of iron is easily absorbed by the body Non-animal sources (non-haem iron) Found in legumes, wholegrains, fortified breakfast cereals and bread, dark green leafy vegetables (broccoli), nuts, seeds, eggs, dried fruit, dried beans and peas. This type of iron is not so easily absorbed and this means people who don t eat meat need to be careful to include enough non-animal sources of iron in their diet. How can you help your body to absorb more of the iron in food? Non-haem iron is absorbed better if some haem iron is eaten at the same meal or a food containing vitamin C is eaten at the same meal. Haem iron (red meat, chicken or seafood) the redder the meat, the more iron it contains (so chicken and fish don t contain as much iron as red meat) A food containing vitamin C - Vitamin C is found in a wide variety of fruits and vegetables and is another great reason to include fruit and vegetables at each meal also Note: Vegetarians also need to ensure they are getting enough B12 in their diet. B12 is important in the formation of red blood cells, nerve cells and DNA material Deficiency can result in a type of anaemia call pernicious anaemia Only animal products contain B12 that can be absorbed by the body (meat, milk, eggs, cheese, yoghurt). Vegans need to eat foods fortified with B12 (e.g. soy milk) or take a supplement Other food sources (seaweed, tempeh, miso, spirulina) also contain B12 but it is not in a form the body can use. Cut back on tea and coffee at meal times as the tannins found in these drinks stop your body from absorbing iron. NOTE: if anyone in the group is concerned about their iron intake, they should seek advice from a doctor or registered dietitian. Iron supplements should only be taken under a doctor s supervision. Page 5

27 Page 6 Food sources of iron

28 Script for Module5: Nutrients at Risk Why is vitamin D important? Vitamin D combines with calcium to build strong bones as well as being essential for general good health. What happens if you have low levels of vitamin D? If a person does not have adequate vitamin D levels, they may be at risk of developing osteoporosis later in life. Vitamin D deficiency can also lead to bone pain, muscle weakness and rickets (soft bones that do not from properly) in children. People most at risk of low vitamin D levels: Dark skinned people (especially if veiled) o dark skin is not as good at making vitamin D as fair skin Older people and people who are housebound o this group of people is not as likely to be outdoors and the ability to produce vitamin D gets less with age Little or no sun exposure o if people work indoors or need to cover up for religious or cultural reasons their exposure to sunlight may not be enough to produce adequate amounts of vitamin D Breastfed babies whose mothers have low vitamin D stores o breast milk is the best first food for babies, however babies are not born with vitamin D stores and so they rely on the small amounts found in breast milk. If the mother is low in vitamin D, then the baby is also unlikely to get enough vitamin D. Page 6

29 Page 7 Vitamin D and Osteoporosis

30 Vitamin D Sources of vitamin D The average person will not be able to get enough vitamin D from food alone, so it is important to get adequate exposure to sunlight and take supplements to restore levels, if they are low. Foods that contain small amounts of vitamin D include: Oily fish, dairy products, fortified products (e.g. some margarines) and eggs Maintenance of vitamin D levels To maintain vitamin D levels for a person living in South Australia during summer you should expose your face, arms and hands (or the equivalent skin area) before 11am and after 3pm on most days of the week for 5-7 minutes. During summer the sun can be very harsh. Common sense is needed to balance the risk of skin cancer with the health benefits of getting enough vitamin D During winter (May to August) two to three hours a week of sun exposure is needed to maintain vitamin D levels. Expose arms (or legs) face and hands to the sun for 20 minutes on most days of the week Recaps the main points from the session: Eat three serves of mostly reduced-fat dairy (or alternatives) every day and get regular exercise each day to prevent osteoporosis Eat fruit or vegetables with each meal to help your body to absorb iron Sun exposure and not food is the best way to maintain vitamin D levels If you are concerned about levels of iron, calcium or vitamin D you should consult your GP or a registered dietitian Never take supplements without consulting your GP and get your levels checked regularly so you know when you can stop taking supplements Page 7

31 Vitamin D + + Vitamin D Page 8

32 Script for Module5: Nutrients at Risk Distribute the Vitamins and minerals for health activity sheet Explain activity to participants There are four questions looking at iron, bone health and vitamin D. Participants need to circle the correct answer. Give participants about 3 minutes to complete the activity and then discuss the answers as a group (as per answer sheet) Group discussion What will you take away from today s session? How confident are you that you can choose foods that will enable you to increase or maintain your levels of these important nutrients? What changes, if any, do you plan to make as a result of today s session? Page 8

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