While meal tracking can help you achieve health goals, it is also important to track correctly and to know when to stop. PHOTO ISTOCKPHOTO
SINGAPORE – A woman in her 60s stopped eating egg yolks and oats because she thought these triggered her episodes of irritable bowel syndrome. This chronic condition affects the large intestine and can cause cramping, pain, gas, bloating and issues with bowel movements.
Through keeping a food diary and working with a dietitian, she found that it was actually food containing lactose – milk-related products – that triggered her episodes.
Ms Rachel Tay, senior dietitian at Gleneagles Hospital, says that with this new knowledge, she could help the patient reintroduce the previously shunned foods into her diet.
Logging the foods she ate thus allowed the patient to eat more flexibly and have a more balanced diet.
Ms Tay says a meal diary can help people gain insights into their eating habits. “It is particularly beneficial for individuals managing specific health conditions like diabetes, irritable bowel syndrome and food intolerances,” she adds, as well as for weight management.
Should you track every bite you eat? Dietitians and doctors The Straits Times spoke with say they suggest meal tracking to patients wanting to achieve health goals.
They also say it is important to track correctly and to know when to stop.
Ms Lee Dao Xin, senior dietitian at Changi General Hospital’s department of dietetics, says that scrutinising every mouthful of food could lead to disordered eating behaviours.
“You should consider stepping back if the thought of opening the journal to log your food intake fills you with negative emotions such as dread, anxiety or guilt,” says Ms Lee.
She adds: “A patient in his 20s whom I worked with shared that keeping a food diary induced feelings of anxiety and stress. I assured him that he was right to stop journaling.”
Help with chronic conditions like diabetes
Ms Tan Yan Lin, dietitian with SingHealth Polyclinics, says a meal diary should include what you eat, when you ate it and how much of it you ate.
Meal diaries will look different, depending on your reason for tracking your food, she adds.
Some may want to record their emotions around meals, to identify whether stressors lead to unhealthy eating patterns. A person with irritable bowel syndrome may record whether he experienced any symptoms after a meal.
Dr Lim Su Lin, chief dietitian at National University Hospital, has led the development of meal tracking apps that can help people lose weight and improve their health. ST PHOTO: DESMOND WEE
Dr Lim Su Lin, chief dietitian at National University Hospital (NUH), says keeping a meal diary increases mindfulness about what, when and how much the tracker eats.
“Individuals can make informed decisions about portion control, food choices and meal timing. For dietitians, the diary provides a clearer picture of a patient’s dietary habits, enabling tailored advice and interventions,” adds Dr Lim, who is also head of therapeutics at NUH’s Office of Allied Health & Pharmacy.
Diabetics can benefit from recording their blood glucose levels after a meal.
Ms Eunice Goh Ern Hui, principal clinical dietitian at Singapore General Hospital’s department of dietetics, says the hospital has a programme for people with type 1 diabetes called Dafne (Dose Adjustment For Normal Eating).
Participants log their food, especially carbohydrate intake, and blood glucose level plus insulin intake during the programme. The data gathered helps them match their carbohydrate intake and insulin doses more effectively.
Dr Tan Yu Quan, associate consultant at SingHealth Polyclinics – Bedok, says recording the timing of meals is also important.
One of her patients with diabetes worked the night shift. He tended to eat less healthily on such shifts as he had easier access to fast food than to healthier options. This led to poor control of his blood glucose levels.
Understanding his eating patterns helped her time his medications appropriately. While higher doses are usually taken in the morning, the patient was advised to take higher doses before he started his shift at night, and to take lower doses at the end.
The dose typically taken at noon was to be taken during the middle of his shift. This helped with his blood sugar control.
Healthier eating and long-term payoffs
Dr Lim of NUH has led the development of three apps with meal diary functions, meant to help users better manage their health and chronic conditions.
Apart from counting calories and analysing nutrients in each logged meal, the nBuddy, nBuddy Diabetes and nBuddy Keto apps recommend healthier food and drink options to users. The apps are available on the App Store and Play Store, and some features require in-app purchases.
Dr Lim’s research, published in 2022 in the science journal JMIR Diabetes, found that of 171 patients with type 2 diabetes and pre-diabetes, those who most used the nBuddy Diabetes app – which allows users to record blood glucose levels as well – showed the most improvement in blood glucose control. They also lost more weight than others.
The most recent version, nBuddy Keto, released in 2022, helps users achieve significant weight loss through a healthy keto diet. Unlike traditional keto diets, this regimen keeps fat consumption to less than 50 per cent daily.
Adherence to the app recommendations is important. Dr Lim says: “There’s no use if you just keep a food diary, but don’t do anything with it.”
Tracking her food intake on the nBuddy Keto app helped Dr Sankari Ramanathan eat healthier. She no longer uses the app. ST PHOTO: DESMOND WEE
Dr Sankari Ramanathan, director at the National University Health System’s Research Office, tried the nBuddy Keto app from August 2023 to February 2024.
She lost 25kg, going from a body mass index (BMI) of 35 to 27. BMI indicates weight categories that may lead to an increased risk of health problems. A BMI of 18.5 to 22.9 is considered healthy.
Dr Ramanathan, 49, did not have hypertension or high cholesterol levels before trying nBuddy Keto, but her blood pressure levels and cholesterol levels improved further after using the app. She feels more energetic now, and has gone from seldom exercising to doing cardio and weights five times a week.
She also eats more vegetables now and, while she will not avoid dessert or birthday cake, she will eat smaller portions. “Logging your food, looking at what you are putting into your body, is helpful,” she says.
How to track your meals accurately
Ms Tan says simply taking a photo of your meals can help a dietitian understand your nutritional intake better than having no record at all.
“But if you have a specific health goal in mind, you have to be more consistent and specific,” she adds. This means including portion sizes and ingredients accurately.
If unsure, Dr Tan suggests to patients that they follow the Health Promotion Board’s (HPB) My Healthy Plate model, and keep half the plate for vegetables, a quarter for protein and a quarter for carbohydrates.
Dr Ramanathan has tried meal diary apps not developed in Singapore and notes that these do not include common local dishes. As a result, she would often not log the meals she ate.
One way around this is to use local apps such as nBuddy or HPB’s Healthy 365, experts say.
Dr Lim suggests: “If you cannot find the exact food option, choose the most related item.”
When to stop tracking meals
All the experts The Straits Times spoke to say that meal tracking can lead to obsession over eating and anxiety.
Ms Tan had a patient in her 20s who took a food scale everywhere with her, and became stressed over eating out. She advised the patient to stop tracking her food, since this behaviour was also disrupting the patient’s menstrual cycle.
“When you’re overly focused on tracking calories, it can discourage you from your own body cues of hunger and fullness. You may miss out on eating intuitively,” says Ms Tan.
Dr Lim has also had to intervene when a patient with a history of eating disorders became fixated on her meal diary. “We adjusted the approach by moving from meticulous logging to focusing on intuitive eating. This shift helped the patient regain a balanced perspective that improved her condition.”
Ms Goh says you can stop keeping a meal diary when the health goal has been achieved. You may consider logging your meals periodically to check that you are on the right track.
Dr Tan says even diabetic patients need not log every bite every day. “If diabetics are consistent with their dietary habits and their sugar control is good, they don’t have to track their diets. It’s only when the sugar levels go out of control that a meal diary can help.”
Dr Ramanathan, who used the nBuddy Keto app to lose weight, has stopped tracking her food for months. Her new healthier eating habits are ingrained and she no longer has to refer to the app for information or insights.
However, she keeps the app on her smartphone, just in case. “It’s comforting to know that it is there if I need it,” she says.
