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Dial-a-dietitan

Food nutrition information is only a phone call away

Dietitians Lise Timmerman and Coralee Hill.
Registered dietitians Lise Timmerman (left) and Coralee Hill say callers are intersted in a wide variety of food and nutrition topics.
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BY BOB ARMSTRONG
Winnipeg Regional Health Authority
Wave, September / October 2016

You've just been diagnosed with diabetes and people are saying you can't eat white rice anymore.

Everything you read about nutrition stresses the importance of fruits and vegetables, but you can't seem to get your kids to eat them.

Your infant is the right age for introducing solid food, but you're unsure how to do it.

In the words of a recently rebooted movie: Who you gonna call?

In Manitoba, the answer is Dial-a-Dietitian, a free service available to everyone in the province.

Registered dietitians Coralee Hill and Lise Timmerman have staffed the Dial-a-Dietitian phone lines at the Provincial Health Contact Centre since 2010. Registered dietitians are regulated health-care professionals who are trained to translate evidence-based food and nutrition recommendations into practical everyday solutions to support health as well as disease prevention and treatment. Call centres and telephone support have been accepted as a cost-effective way to address service gaps and promote health - especially for those living in remote areas or who may be home-bound.

Last year, Dial-a-Dietitian helped more than 1,500 Manitobans, and it appears that the vast majority of people who call in are pleased with the service. An informal evaluation conducted by Dial-a-Dietitian found that 93 per cent of callers said they felt able to make a health-related behaviour change after speaking to one of their dietitians.

The dietitians say callers are interested in a wide range of food and nutrition topics. Some of the more frequently asked questions concern child feeding and diabetes, but enquiries about digestive issues, food safety, cardiovascular issues, weight management, and requests for referral to nutrition services and programs are also fairly common.

"Any time the phone rings, we never know what kind of question we'll have," says Timmerman.

Sometimes the questions and answers are fairly straightforward.

"The caller might say, ‘I took some meat out of my fridge last night and left it on the counter and now I want to know if it's still safe to eat,'" says Hill. The dietitians explain that food safety guidelines say that the maximum amount of time meat should be left at room temperature is two hours, which is why you shouldn't thaw meat on the counter. In such a case, they would advise throwing the meat out.

Sometimes, though, questions can't be fully resolved over the telephone. In these cases, talking to the dietitians will provide a starting point toward reaching a solution. That's something that comes up especially in calls from people with suspected food allergies or intolerances. "We can't diagnose," says Hill.

What they can do is suggest a caller keep a food journal in which they record what they've eaten and what happens, whether it's a matter of digestive upset or rashes or other symptoms. Then, when they see their doctor they'll have information to help lead to a diagnosis or further investigation. Once a caller has seen their doctor - and perhaps an allergy specialist - they can call back for personalized nutrition advice.

The dietitians recognize that eating and making food choices is personal and can be challenging for some. Social, emotional, cultural or economic factors play at least as big a role as the bio-chemical facts of nutrients and the body's needs. In cases like these, the conversations may involve more discussion around food and nutrition beliefs, family dynamics, or poverty and connecting callers with other community nutrition services.

"Often the callers ask one thing, but there are other issues behind it," says Timmerman.

Callers who are asking about weight loss, for example, may call the service with the expectation that a dietitian will offer them a weight-loss diet, notes Hill.

"They may have tried many diets in the past and they haven't worked," she says. "Often, we start the conversation about where they've been and where they want to go to with weight management. We try to steer them to a non-dieting, overall healthier eating approach that may include improving menu planning, grocery shopping or cooking skills, changing their mindset around food and eating, and being physically active." Such calls can be lengthy and can be quite emotional for callers, the dietitians note.

Callers may be focused on a particular aspect of food or a nutrient. They may have heard about the importance of getting enough of a particular nutrient - Omega 3 fatty acids, for example - or they may have heard they should cut back on added sugar or carbohydrates.

Hill and Timmerman try to shift the conversation from "good" or "bad" nutrients and ingredients and instead try to focus on all aspects of food. Talking about food - instead of nutrients and ingredients - helps create a more healthy, enjoyable and positive relationship with what we eat.

"You're not eating fish because of the Omega 3s, you're eating fish because it's delicious with dill," says Timmerman.

"Or because you caught it with your family," adds Hill.

The dietitians understand that there may be economic concerns when callers are trying to eat better or feed their families.

We've all heard that fruits and vegetables are important and that most of us aren't consuming as many portions of them as Eating Well with Canada's Food Guide advises. For some, the price of fresh fruit and vegetables places them out of reach, so Hill and Timmerman will point out that frozen and canned fruit and vegetables can be a more affordable choice. They may also refer callers to services such as the North End Grocery Shuttle, a free weekly bus service to help residents of that neighbourhood who have limited access to full-service grocery stores.

In other cases, nutrition issues may be related to a lack of food and cooking skills. The dietitians will offer simplistic meal ideas. They may also provide callers with contact information to community services and programs, including cooking classes in order to give them the skills to make tasty, nutritious and affordable meals.

They also refer people to dietitians who offer counselling in communities, clinics or privately around the province. It's not uncommon for people diagnosed with heart disease or diabetes to be advised by their doctor to see a dietitian, but don't know how to find one. For them, Dial-a-Dietitian is a starting point. The College of Dietitians of Manitoba website (manitobadietitians.ca) and Dietitians of Canada (dietitians.ca) can also assist the public with accessing dietitian services.

Dial-a-Dietitian was not designed to replace either the one-on-one consultation or the community nutrition services offered in classes. Rather it is intended to offer reliable answers and ideas right when callers need them. For example, a caller who's been advised to see a dietitian about their diabetes may have an appointment set up a few weeks down the road, but they may have questions right now. Likewise, a new parent may go to an infant feeding class where a public health dietitian discusses how to introduce solid foods to their children. But Dial-a-Dietitian is available right at the moment when the parent is dealing with uncertainty about feeding their child.

That's been the case for Rebekah Hiebert, a new mom with 13-month-old twins. She went to an infant feeding class when the girls were four months old and heard about how to introduce solid foods. But a little later when she began to introduce solid foods, she needed someone to talk to.

Told by her doctor to reduce the twins' milk consumption so they would eat, she was overwhelmed with worry about how the girls would react to a dramatic reduction in milk.

"I was crying. I was so scared that my kids wouldn't sleep through the night."

Hiebert found talking to the dietitians boosted her confidence as well as providing information she could use.
"They were very validating," she says. "They were very understanding."

She also called the service when one of the twins had a mild problem with reflux - spitting up - and was given useful advice to ensure that their food stayed down (keep them upright a little longer after feeding). On another occasion, she called with a question about allergies.

Being able to speak over the phone to a dietitian saves time for everybody, she notes. The alternative might have been to take both girls to see her pediatrician, and with two infants she says she needs to bring somebody else with her to a doctor's appointment in order to give her a chance to concentrate on what the doctor says.

Lorraine McDonnell's questions are different, but she too has found the service beneficial. A 75-year-old woman living in McCreary, in western Manitoba, McDonnell has called with questions about the sodium content in canned soups, health concerns regarding artificial sweeteners, mercury in fish, carbohydrates and other topics.

"I wanted to know about diet drinks and artificial sweeteners," she says, in reference to one question she asked because she was concerned about stories in the media concerning the negative effects of drinking artificially sweetened drinks. After discussing her concerns and what she heard, she decided that because she only drank about six ounces of diet soda, the small amount posed no safety concerns.

"They try very hard to solve the problem," says McDonnell, noting that sometimes she'll ask a question and the dietitians will look it up and get back to her with the specific answer.

"The bottom line," says Hill, "is that we try to provide each caller with personalized advice and information to help them make the best decisions for themselves or their families."

Bob Armstrong is a Winnipeg writer.

Wave: September / October 2016

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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