It is definitely NOT for any public use whatever, nor intended in any way to be taken as advice for any medical or health condition.
"Variety is the spice of life" goes the old saying, and this gives us a lead into a very useful nutrition tip. Here is a quick method to check if your patient's diet is likely to be adequate or deficient. Instead of worrying about tedious calculations of how much your patient is eating of various foods, simply focus on how many different kinds of foods they are consuming.
The idea behind this is simple. A number of studies have shown that there is a good correlation between the variety in a patient's diet and the likelihood that they will meet the requirements for intake of essential nutrients, particularly vitamins and minerals (the micronutrients). This is not surprising when you consider that nature has wisely spread her bounty around. Although there are some particularly wonderful foods when it comes to nutrient density (eggs, breast milk if you are of the proper age!) most foods specialise. They are rich in several nutrients, but lacking in others. So to cover your needs for a broad range of micronutrients you need to dip your palate into a range of foods.
For example, dairy products are excellent sources of protein, calcium and riboflavin (now that milk no longer gets delivered on the front porch in glass bottles to bake in the sun!), but you will not find your daily dose of vitamin C or thiamin in dairy. For those nutrients you need to get stuck into your fruits (or some fresh vegetables) and grains (preferably wholemeal) respectively.
The consequence of this is that, broadly speaking, the greater the variety in your diet, the more likelihood (for any given level of energy intake) that you will get enough micronutrients. Most of us have quite a lot of variety in our food- we might regularly eat 15 or more different foods. The patients we are interested in, however, have severely restricted their choices. This is often due to problems of poverty, illness or loss of interest in eating.
For example, the elderly widower living at home who eats little more than bread, cheese, jam and tea with sugar. Or the anorectic teenager who is trying to live on lettuce, celery and tomato. What the resaerch studies have shown is that regular consumption of less than 10 different foods, particularly 5 or less, is associated with a high likelihood of nutritional deficiencies.
So this month's nutrition tip is simple: just ask the patient to tell you what they eat in a typical day - or indeed what they ate yesterday if you want to pin them down more. Then count the number of different foods. If it is less than 10, particularly closer to 5, be alert. It is time to take a closer nutritional look at this person.
Some readers will recognise in this something similar to the concept of the five food groups. Indeed this is the principle behind them. The problem is that nobody has ever taken the food group concept that little step further and translated it into a practical method for the GP. In fact the five food groups are no longer considered the best approach by nutritionists in Australia (a new concept is about to be introduced), but they can help refine our quick variety check.
Obviously some foods are better than others when it comes to nutrient value. I would be more concerned if my elderly patient's 5 foods were chips, beer, cake, tea and sugar than if they were peas, wholemeal bread, yoghurt, meat and potatoes! So once we have counted the number of foods we can also look to see if they include the desired contribution from the various healthy food groups: meat/fish (and meat substitutes), fruit/vegetables; grains (especially wholegrain), dairy products; oil/butter/margarine. In the next article in this series we will look at how to add this next level of sophistication.
