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A natural approach to reducing cholesterol

A natural approach to reducing cholesterol

A natural approach to reducing cholesterol

Cardiovascular disease (CVD) is an umbrella term for a group of conditions that comprise all heart and circulatory diseases which includes coronary heart diseases (CHD), angina, heart attack, congenital heart disease, hypertension, stroke and vascular dementia.  This collection of conditions contributes to the most common cause of death. The risk of developing CVD is closely linked to lifestyle and dietary habits and the foods you choose to eat can have a big impact both on blood fats and body weight.

A poor diet is characterised by foods which are high in sugar and unhealthy fats.   The impact of this type of diet on your health is amplified by the amount of food you eat, which dictates your body weight (a risk factor for CVD).  High cholesterol is a risk factor for CVD and according to statistics from the charity organisation Heart UK, more than half of all adults have raised cholesterol levels. Adopting a healthy lifestyle through diet and exercise can help to lower your cholesterol and as such reduce your risk of disease.

What is cholesterol?

Cholesterol is a waxy substance found in your blood and in your cells. Your liver makes most of the cholesterol in your body and the rest comes from foods you eat. Cholesterol itself isn’t bad and your body needs it to make hormones, vitamin D, digestive fluids and for your organs to function properly.

There are two forms of cholesterol:

Low-density lipoprotein (LDL) is the unhealthy kind of cholesterol often referred to as ‘bad’.  LDL cholesterol can build up in your arteries and form fatty, waxy deposits called plaques.

High-density lipoprotein (HDL) is the healthy kind of cholesterol often referred to as ‘good’. It transports excess cholesterol out of your arteries to your liver, which removes it from your body.

What happens if you have high cholesterol?

High cholesterol itself doesn’t usually cause any symptoms, but it does increase your risk of serious health conditions.  Over time, high levels of LDL cholesterol, especially when oxidised, can damage your arteries, contribute to heart disease, and increase your risk of stroke. Oxidised LDL cholesterol is more likely to stick to the walls of your arteries to form plaques that clog blood vessels.  Smaller LDL particles are more likely to become oxidised by way of excess free radicles, which can build up as a result of smoking, poorly controlled diabetes, excess sugar, excess trans fats and stress.  Oxidised LDL cholesterol can increase inflammation, which over time has the potential to damage tissues and organs in the body.

What can increase your risk of having raised cholesterol?

Many factors can increase your chances of having heart problems or a stroke if you have high cholesterol.

  • An unhealthy diet– especially if rich in saturated fat and sugar, whilst lacking in vegetables
  • Smoking- one particular chemical found in cigarettes called acrolein stops HDL from functioning properly, which can lead to narrowing of the arteries (atherosclerosis)
  • Diagnosed with diabetesor high blood pressure (hypertension)
  • A family history of heart disease

Exercise also plays an important role

Being overweight and not exercising affects the fats circulating within the bloodstream.  Carrying excess weight can increase levels of LDL cholesterol, whilst being inactive can depress protective HDL cholesterol. Maintaining a healthy weight and exercising can help to reverse these effects on cholesterol.

Where does diet fit into the equation?

Certain foods have been shown to reduce cholesterol and can be used alongside medication or as a natural approach to tackling raised cholesterol.  Certain foods work in different ways to lower cholesterol through the effect of soluble fibre (removes LDL cholesterol from the body), unsaturated fats (rebalances cholesterol levels) and plant sterols, which block the body from absorbing cholesterol.

There’s a misconception that foods naturally high in dietary cholesterol such as eggs and shellfish are harmful, but the effect of these foods has little impact.  Cholesterol production is tightly regulated and most of what circulates in the body is made ‘in-house’.  It’s the overconsumption of foods high in sat fats and sugar, and not dietary cholesterol that prompts the body to create excess.

Foods that help to lower and maintain healthy cholesterol levels

Certain foods have been shown to have a beneficial role in lowering and maintaining healthy levels of cholesterol including:

  • Oats
  • Barley
  • Beans, pulses and lentils
  • Nuts
  • Foods fortified with plant sterols
  • Oily fish
  • Soy foods

Ideas for food swaps that can help you to reduce your cholesterol levels

These food swaps encompass the foods that have been shown to help lower and maintain healthy levels of cholesterol.

Breakfast cereal for oats

UK dietary guidelines suggest that we aim to eat 30g of fibre per day but findings from the National Diet and Nutrition Survey have shown that most people only manage to achieve two thirds of this target and that only 9% of men and 4% of women meet the guidance (1).

As far as cholesterol is concerned, it’s soluble fibre that has the greatest impact.  These fibres dissolve in the gut to form a thick paste that binds with cholesterol and cholesterol like substances preventing them from being absorbed.  Oats contain a type of fibre known as oat beta glucan. To get the greatest benefit, research has suggested aiming to eat 3g of oat beta glucan per day (2-4 portions of oat-based foods) and shown that this may help to reduce LDL cholesterol by up to 10% over 4 weeks (2).

Swap you usual cereal for something oat based.  Oats can be used to make porridge or soaked oats, and granola is a tasty option to top yoghurt.  You can also add oats to breakfast smoothies.

Cow’s milk for soy alternative

The protein found in soy-based foods such as tofu, edamame beans and soy milk have been shown to help reduce levels of LDL cholesterol and form a key part of the Portfolio diet. Research has suggested that a 25g daily intake of soy protein can help to lower LDL cholesterol by up to six percent (3).

Food Average serving size Soy protein per serving
Soya milk alternative 250ml 7.5g
Soya yoghurt alternative 125g 5g
Edamame beans 80g 9.3g
Soya nuts (roasted) 30g 15g
Soya mince 100g 16.4g
Tofu 75g 12g
Soya dessert 125g 3.8g

Switching cow’s milk with a soy alternative is a useful way to increase your intake of soy protein.  This alternative can be used in the same way as milk but look for a brand that’s fortified with calcium.

Chocolate bar for dried fruit and nut bar

Processed foods such as chocolate bars are not just high in saturated fat but also added sugars, which can increase levels of LDL cholesterol if eaten in excess.  Dried fruit and nut bars contain less saturated and more monounsaturated fats, which are found in nuts.  Monounsaturated fats help to lower LDL cholesterol and increase HDL cholesterol. Various studies have shown how nuts including almonds, peanuts and walnuts in your diet (50g per day) can slightly lower LDL cholesterol by up to five percent (4).

Dried fruits also have heart healthy properties as they contain resveratrol, which is a polyphenol antioxidant thought to be associated with good heart health.  Sultanas and raisins are particularly high in resveratrol.

Cream for low fat yoghurt

Cream is another food that is high in saturated fat, which can increase your levels of LDL cholesterol.  Saturated fat is not all bad and it does also help to lower triglycerides and nudge up levels of HDL cholesterol when eat in moderation.

Switching to low fat yoghurt over cream is a simple food swap that can be used in the same way when cooking.  You can flavour yoghurt with spices such as cinnamon, vanilla or lemon juice, which makes a nice accompaniment to fruit or fruit-based puddings.

The topic of saturated fat and its role in heart disease is one that continues to cause debate. Regardless of opinion, limiting your saturated fat intake, especially from processed foods will help to maintain a healthy body weight and balance out cholesterol levels.

Butter for low fat spread fortified with plant sterols such as Benacol

The market for functional foods has grown in recent years and at the forefront are plant sterols, which have been shown to help reduce LDL cholesterol.  Plant sterols are extracted from plant gums and help to lower LDL cholesterol by inhibiting it from being absorbed in the body.  Foods with added plant sterols include spreads, milk, orange juice and yoghurt, which can all easily be incorporated into the diet.

Research has shown that consuming 2g of plant sterols per day can lower LDL cholesterol by around ten percent (5).  Try swapping butter for a lower fat spread fortified with plant sterols.

Red meat for oily fish

Red meat, especially fatty varieties, are rich in saturated fat, which can raise levels of LDL cholesterol.  There are many benefits associated with limiting your intake of red meat, which include reducing the risk of colorectal cancer.  Opting for alternative source of protein can be beneficial and oily fish such as salmon, mackerel and trout not only help to regulate cholesterol levels but contain omega 3 fatty acids that have been shown to reduce the risk of heart disease.

Omega 3 fatty acids increase HDL cholesterol and reduce LDL cholesterol as well as reducing triglycerides in the bloodstream.  Swapping red meat for oily fish can reduce your overall intake of saturated fat and offer the benefits associated with omega 3 fatty acids.

White rice for barley

Like oats, barley contains beta glucans that have been shown to help reduce LDL cholesterol.  Beta glucan binds to bile acids in the gut which increases their excretion from the body. This reduced level of bile acids stimulates its production in the liver. In order for the liver to synthesise bile acids it requires LDL cholesterol, which is drawn from circulation in the body. The net effect is a reduction in circulating LDL cholesterol.

Barley can be used in place of rice and works really well in risottos.

Raised cholesterol is a risk factor for heart disease but is easily reversed by the adoption of healthy diet and lifestyle habits, which also influence many other areas of health. If you have high cholesterol and want to approach it from a diet perspective, then including the foods above can help you to achieve the greatest impact.

If you liked this blog and want to learn more about diet and cholesterol then try reading these:

How easy is it to get your ten-a-day?

Turmeric chicken with Asian slaw recipe

Mexican prawn and black bean salad recipe

Super green stir-fry with smoked tofu recipe 

Avocado and white bean smash recipe 

Nutty couscous and veggie salad recipe 

Oat Bircher muesli recipe 

Edamame bean salad recipe

 

References

  1. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  2. https://www.ncbi.nlm.nih.gov/pubmed/21631511
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409663/
  4. https://www.ncbi.nlm.nih.gov/pubmed/16140880
  5. https://www.ncbi.nlm.nih.gov/pubmed/24468148
An in-depth look at the current state of mens health in the UK

An in-depth look at the current state of mens health in the UK

An in-depth look at the current state of men’s health in the UK

Regardless of what sex you are it’s been shown time and again that diet and lifestyle choices have a significant impact on your health and reduce the risk of disease.  Men and women share similar risk factors for ill health and weight is a concern for everyone, but some conditions are more sex-specific to men.  Targeting men’s health often requires a different approach to women and given the slight disparity in attitudes between the sexes, it’s important that awareness continues to grow to help break taboo’s and create an environment that men feel comfortable enough in to seek help when needed and make behaviour changes that can significantly improve their health.

Apologies as this is quite a hefty blog, but for my own curiosity I just wanted to put everything about men’s health into one place to provide insight and the latest research findings to give a good overview of the health landscape according to men.

This includes:

  1. What a typical male diet looks like in the UK?
  2. How overweight men are in the UK?
  3. What lifestyle choices men are making in the UK?
  4. The most common causes of premature death amongst men in the UK
  5. Heart disease amongst men in the UK
  6. Mental health amongst men in the UK
  7. Men’s attitudes towards health and how they access health services

1.What a typical male diet looks like in the UK?  

The National Diet and Nutrition Survey in the UK has shown that both men and women share similar dietary characteristics (1). Both groups eat enough protein and meet the guidelines for total fat but consume too much sugar and saturated fat.  Both sexes also fail to eat enough fibre and very few meet the recommended 5-a-day guidance or eat enough oily fish.  Fewer men than women have micronutrient insufficiencies, but low levels of vitamin D are shared between the sexes, especially during the winter months.

Dietary findings for men (1)

  • The average energy intake is 2091 calories.
  • The average intake of protein is 87.4g, which is 1.5 times the RNI of 55g per day. Protein requirements differ depending on health status and exercise, but the average is around 0.75g per kg of body weight.  Most of the protein in the diet comes from meat and meat dishes (37%).  Twenty three percent comes from cereals and cereal products, whilst 13% comes from milk and milk products.
  • The average intake of total fat is 76.6g per day, which equates to 32.6% of energy intake. This falls within the guidance of no more than 35% of energy intake.  Most of the fat in the diet comes from meat and meat products (24%).  A similar amount (21%) comes from cereals and cereal products including biscuits, cakes and puddings.  Milk and milk products account for 12% of total fat intake.
  • The average intake of saturated fat is 27.5g per day, which equates to 11.6% of energy intake.This exceeds the guidance of no more than 10% of energy intake.  The main source of saturated fat in the diet is from meat and meat products (24%). Twenty one percent comes from cereal and cereal products that includes biscuits, cakes and puddings.  The same percentage comes from milk and milk products, the majority of which comes from cheese.  Nine percent comes from fat spreads with 6% attributed to butter.
  • Sat fat (21% cereals and cereal products – 5% biscuits,4% cakes, 1% puddings), 21% (milk and milk products – 9% cheese), 3% (eggs and egg dishes), 9% (fat and fat spreads – 6% butter), 24% (meat and meat products), 3% (fish and fish dishes), 6% (veg and potatoes – 3% chips), 1% (savoury snacks), 2% (nuts and seeds), 5% (sugar and confectionary – 4% chocolate)
  • The average intake of ‘free’ sugars is 64.3g (12.8 tsp) per day. This is more than twice the guidance of no more than 30g (6 tsp) per day.  The main source of ‘free’ sugars in the diet is from sugar and confectionary (25%), most of which is from table sugar and sweet spreads.  Twenty four percent of ‘free’ sugars comes from cereals and cereal products that includes breakfast cereals, biscuits, cakes and puddings.  Non-alcoholic drinks are also a big contributor with 6% coming from fruit juice and 14% from soft drinks.
  • The average intake of fibre is 20.7g per day. This is just a third of the guidance of 30g per day and only 13% of men manage to achieve this.  The main source of fibre in the diet is from cereals and cereal products (38%), which includes pizza, pasta, rice and bread (more men choose white bread over wholemeal). Thirty eight percent of fibre in the diet comes from vegetables and potatoes, with 7% coming from chips. Twelve percent of fibre in the diet comes from meat products, which are breaded or include pastry or potatoes.
  • The average intake of fruit and vegetables is 4.2 portions, which is below the recommended 5-a-day. Only 29% of men manage to eat 5-a-day.

The micronutrients (vitamins and minerals)

Nutrient Average intake % RNI % below LRNI Key food sources
Vitamin A 921mcg 132% 16% 28% vegetables, 15% milk and milk products, 16% meat and meat products, 11% cereals and cereal products
Vitamin B1 (riboflavin) 1.76mg 136% 6% 27% milk and milk products, 20% cereals and cereal products, 17% meat and meat products
Folate 267mcg 134% 3% 27% cereal and cereal products, 26% vegetables, 10% meat and meat products.
Vitamin D (food sources) 2.9mcg 29% 30% meat and meat products, 19% egg and egg dishes, 17% fish and fish dishes, 15% cereals and cereal products
Iron 11.6mg 134% 2% 38% cereals and cereal products, 21% meat and meat products, 15% vegetables
Calcium 897mg 107% 11% 31% cereals and cereal products, 15% meat and meat products, 9% milk and milk products
Magnesium 302mg 101% 14% 31% meat and meat products, 27% cereals and cereal products, 16% vegetables, 12% egg and egg dishes
Potassium 3145mg 90% 11% 24% vegetables, 18% meat and meat products, 15% cereals and cereal products, 10% milk and milk products
Iodine 172mcg 123% 9% 34% milk and milk products, 12% cereals and cereal products, 10% fish and fish products, 10% meat and meat products
Selenium 55mcg 74% 25% 32% meat and meat dishes, 27% cereal and cereal products, 15% fish and fish dishes, 9% egg and egg dishes
Zinc 9.7mg 102% 7% 34% meat and meat dishes, 25% cereals and cereal products, 14% milk and milk products, 11% vegetables

 

2.How overweight are men in the UK?

The majority of the male population in the UK are either overweight or obese (2,3,4,5).  Obesity is both a disease and risk factor for many other diseases.  Being overweight or obese increases the risk of having high cholesterol, high blood pressure and type 2 diabetes, which are all risk factors for cardiovascular disease (CVD).  Obesity also increases the risk of joint problems, lower back problems, deep vein thrombosis, colon cancer and erectile dysfunction.  Losing and maintaining a healthy weight can have a significant impact on health and reduce the risk of disease.

The prevalence of overweight and obesity vary throughout the UK but in general, rates are higher amongst men.

England (2)

  • Over 60% of men are overweight or obese.
  • Men (65.7%) are more likely to be overweight or obese than women (57.1%).

Wales (3)

  • Twenty three percent of adults are obese and 36% overweight.
  • Sixty five percent of men are obese or overweight compared to 53% women.

Scotland (4)

  • Sixty five percent of adults are overweight and 29% of these are obese.
  • Sixty seven percent of men were overweight or obese compared to 63% of women.

Northern Ireland (5)

  • Sixty percent of adults are overweight or obese (34% overweight and 26% obese).
  • Males (65%) were more likely to be overweight or obese compared to females (57%).

3.What lifestyle choices men are making in the UK?

Diet is important but in terms of health it co-exists with the lifestyle choices we make which include physical activity, smoking and drinking.  A sedentary lifestyle can increase the risk of being overweight, which is a risk factor for disease.  Exercise plays a key part in maintaining a healthy weight and also helps to maintain muscle mass, flexibility and bone strength as well as being good for mental health.

Smoking has been proven to cause cancer and respiratory conditions, whilst excessive drinking is known to be a risk factor for certain cancers and liver disease.

Physical activity in men

The government guidelines suggest that we do at least 150 minutes per week of moderate physical activity in bouts of at least 10 minutes, which equates to 30 minutes on at least 5 days.  Alternatively, it’s suggested that 75 minutes of vigorous activity spread over the week will have the same health benefits.  Moderate physical activity is defined as raising your heart beat whilst still being able to carry on a conversation such as brisk walking or cycling.  Vigorous activity is defined as increasing your heart to beat rapidly, making it much more difficult to carry on a conversation such as running, swimming or football (6).

In the UK, men:

71% met the guidelines

10% some activity1

3% low activity2

16% inactive3

  1. Some activity: 60-149 minutes MPA pw or 30-74 minutes VPA pw or an equivalent combination of these.
  2. Low activity: 30-59 minutes MPA pw or 15-29 minutes VPA pw or an equivalent combination of these
  3. Inactive: Less than 30 minutes MPA pw or less than 15 minutes VPA pw or an equivalent combination of these

Smoking amongst men in the UK

According to findings from the Office of National Statistics (7):

  • In the UK, 17% of men smoke compared to 13.3% of women.
  • The highest proportion of smokers are aged between 25 and 34 years (19.7%).
  • 1 in 4 people in routine and manual occupations smoke compared to just 1 in 10 people in managerial and professional occupations.
  • 5% of people in the UK currently use and e-cigarette (vape) – 2.8 million people
  • 5% of men report vaping compared to 4.6% of women and the highest proportion of vapers are aged between 35 and 49 years.
  • In the UK, 60.8% of people aged 16 years and over who currently smoke said they wanted to quit and 59.5% of those who have ever smoked said they had quit.
  • The main reason for vaping is to help stop smoking (48.8%).
  • Only 0.4% of people who have never smoked reported that they currently vape.

Drinking in the UK

Guidance around drinking is no more than 14 units per week for both men and women (8).

125ml glass of wine = 1.4 units

25ml shot of spirit (37.5% ABV) = 1 unit

½ pint of lager (4%) = 1 units

According to the ONS (9):

  • Men are more likely to drink than women – 9% of men compared to 52.4% of women.
  • Men are also less likely to abstain from drinking as 17% of men and 22% of women said they had not drunk in the last year.
  • 53% of men said their alcohol consumption was no more than 14 units per week compared with 62% of women.
  • 10% of men said their alcohol consumption was more than 14 units per week but less than 21 units per week compared to 7% of women.
  • 12% of men said their average alcohol consumption was more than 21 units but less that 35 units per week compared to 6% of women
  • 4% of men said their average alcohol consumption was more than 35 units but less that 50 units per week compared with 2% of women.
  • 5% of men said their average alcohol consumption was more than 50 units per week compared to 2% of women.

4.The most common causes of premature death amongst men in the UK

  • More men than women die each year – 1156.5 compared with 863.8 deaths per 100K people (10)
  • In the UK one in five men (19%) dies before the age of 65 years (10)

Leading causes of death in 2015 – taken from findings published in 2017 (11)

Leading causes of death by age group for males in England, 2015 taken from findings published in 2017 (11)

 

5.Heart disease amongst men in the UK (12)

  • Heart and circulatory disease cause more than a quarter (26 per cent) of all deaths in the UK; that’s nearly 160,000 deaths each year – an average of 435 people each day or one death every three minutes.
  • There are around 7 million people living with heart and circulatory disease in the UK: 3.5 million men and 3.5 million women.
  • Coronary heart disease (CHD) is the most common type of cardiovascular disease.
  • Coronary heart disease is the most common cause of heart attack. In the UK there are 188,000 hospital visits each year due to heart attacks: that’s one every three minutes.
  • An estimated 915,000 people alive in the UK today (640,000 men and 275,000 women) have survived a heart attack.
  • Over half a million people in the UK are living with heart failure.
  • There are more than 30,000 out-of-hospital cardiac arrests in the UK each year. The overall survival rate in the UK is less than 1 in 10.

6.Mental health amongst men in the UK (13)

  • Over 40% of adults think they have had a diagnosable mental health condition at some point in their life (35.2% of men and 51.2% of women).
  • A fifth of men (19.5%) and a third of women (33.7%) have had diagnoses confirmed by professionals.
  • In 2014, 19.7% of people in the UK aged 16 and older showed symptoms of anxiety or depression – a 1.5% increase from 2013. This percentage was higher among females (22.5%) than males (16.8%).

As far as men are concerned:

  • Just over three out of four suicides (76%) are by men and suicide is the biggest cause of death for men under 35 (14).
  • 12.5% of men in the UK are suffering from one of the common mental health disorders (15).
  • Men are three times more likely than women to become alcohol dependent (8.7% of men are alcohol dependent compared to 3.3% of women (15).
  • Men are more likely to use (and die from) illegal drugs (15).
  • Men are less likely to access psychological therapies than women. Only 36% of referrals to IAPT (Increasing Access to Psychological Therapies) are men (16).
  • Over three quarters of people who kill themselves are men (17)
  • Men report significantly lower life satisfaction than women in the Government’s national well-being survey – with those aged 45 to 59 reporting the lowest levels of life satisfaction (17).
  • 73% of adults who ‘go missing’ are men (18).
  • 87% of rough sleepers are men (19).
  • Men are nearly three times more likely than women to become alcohol dependent (20).
  • Men are three times as likely to report frequent drug use than women (4.2% and 1.4% respectively) and more than two thirds of drug-related deaths occur in men.
  • Men make up 95% of the prison population 72% of male prisoners suffer from two or more mental disorders.
  • Men are nearly 50% more likely than women to be detained and treated compulsorily as psychiatric inpatients (21)
  • Men have measurably lower access to the social support of friends, relatives and community (21)
  • Men commit 86% of violent crime (21)
  • Boys are around three times more likely to receive a permanent or fixed period exclusion than girls (22).
  • Boys are performing less well than girls at all levels of education. In 2013 only 55.6% of boys achieved 5 or more grade A*-C gcses including English and mathematics, compared to 65.7% of girls (23)

The Men’s Health Forum suggests that these statistics indicate that male emotional and psychological distress may sometimes emerge in ways that do not fit comfortably within conventional approaches to diagnosis. They also show that men may be more likely to lack some of the known precursors of good mental health, such as a positive engagement with education or the emotional support of friends and family.

A picture begins to emerge of a potentially sizeable group of men who cope less well than they might:

  • These men may fail to recognise or act on warning signs and may be unable or unwilling to seek help from support services.
  • At the further end of the spectrum they may rely on unwise, unsustainable self-management strategies that are damaging not only to themselves but also to those around them.
  • Such a picture would broadly parallel what is already known about men’s poorer physical health.

7.Men’s attitudes towards health and how they access health services

Health literacy is the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment.  There is evidence that men have lower levels of health literacy than women.

  • One study found that men were than twice as likely as women to have inadequate health literacy (24).
  • An analysis of people with coronary heart disease in south London found that those with low health literacy were more likely to be male, from a non-white ethnic group, live in a more deprived area, have spent fewer years in education, and were less likely to be employed (25).
  • A large study of British adults (970 males and 1246 females) found that women were more likely than men to recall seven out of nine cancer warning signs (26).
  • According to a National Pharmacy Association study, more men than women admit that their understanding of medicines is poor (23.1% against 15.6% women) (27).
  • Men are twice as likely as women to take a new prescription medicine without first reading the patient information leaflet or seeking professional advice (10.9% of men against 5.1% women) (27).
  • Men’s purchase of prescription-only drugs without medical advice, usually via the Internet, is of increasing concern because of the risks of toxicity and missed diagnoses (27).
  • The percentage of men purchasing prescription-only medications without a prescription via the Internet increases to 67% when considering medications for erectile dysfunction specifically (28).

Men and women display different attitudes towards health and illness.  We have a cultural script about masculinity that tells men they need to be tough, brave, strong and self-reliant. It’s exemplified in phrases like “be a man” and “man up”. Men learn from an early age if they don’t act in this tough, masculine way they lose their status and respect as men.

One study carried out in 2016 found men who buy into the traditional cultural script about masculinity and believe they must be brave and self-reliant in order to be respected, had more barriers to seeking care compared to those who did not endorse these beliefs.  Men validating these beliefs about masculinity and enacting them in their own lives were less likely to seek preventative care and are more likely to delay care when they experienced injury or illness (29).

This all has a huge influence on the attitude’s men have towards their health.

  • Health is often socially constructed as a feminine concern and men therefore have to behave as if they are unconcerned about their health if they wish to publicly sustain a ‘real’ male identity (30).
  • Many men appear to legitimise health service usage, only when a perceived threshold of ill health has been exceeded. There is also a tendency amongst men to play down symptoms or to view potentially serious symptoms as simply signs of growing old (30).
  • Fear surrounding the potential loss of masculinity may result in a façade of control and stoicism, instead of honesty about reporting symptoms and accepting interventions, or openness about feelings and insecurities associated with particular illnesses (30).
  • Risk-taking behaviour is associated with masculinity and is, therefore, more common in males than females (30).
  • A King’s Fund study that looked at four behaviours – smoking, drinking, diet and exercise – found that men were more likely to participate in a combination of three or four risky behaviours (31).

Men’s health is unique to their gender and as such the approach to tackling the issues men face needs to take account of their risk of disease and their attitudes towards their wellness.

 

References

  1. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  2. Https://www.gov.uk/government/statistics/health-survey-for-england-2016-findings-and-trend-tables
  3. Https://gov.wales/statistics-and-research/national-survey/?Tab=current&lang=en
  4. Https://www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey
  5. Https://www.health-ni.gov.uk/publications/health-survey-northern-ireland-first-results
  6. Https://www.gov.uk/government/publications/uk-physical-activity-guidelines
  7. Https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017
  8. https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/
  9. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2017/previous/v1
  10. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2015
  11. https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed
  12. https://www.bhf.org.uk/for-professionals/press-centre/facts-and-figures
  13. https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf
  14. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registration
  15. https://digital.nhs.uk/catalogue/PUB17712/alc-eng-2015-rep.pdf
  16. https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/improving-access-to-psychological-therapies-data-set/improving-access-to-psychological-therapies-data-set-reports
  17. http://webarchive.nationalarchives.gov.uk/20160107060820/http:/www.ons.gov.uk/ons/dcp171778_351100.pdf
  18. https://www.york.ac.uk/inst/spru/pubs/pdf/MissingPersons.pdf
  19. https://www.crisis.org.uk/ending-homelessness/rough-sleeping/
  20. https://digital.nhs.uk/catalogue/PUB14184/alc-eng-2014-rep.pdf
  21. https://digital.nhs.uk/catalogue/PUB12994/drug-misu-eng-2013-rep.pdf
  22. http://webarchive.nationalarchives.gov.uk/20160106231734/http://www.ons.gov.uk/ons/rel/crime-stats/crime-statistics/focus-on-violent-crime-and-sexual-offences–2012-13/rpt-chapter-1—overview-of-violent-crime-and-sexual-offences.html#tab-Profile-of-Offenders-Involved-in-Violent-Crimes
  23. http://webarchive.nationalarchives.gov.uk/20130320141729/http://www.education.gov.uk/researchandstatistics/statistics/a00195931/
  24. https://jech.bmj.com/content/61/12/1086
  25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549254/
  26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790705/
  27. https://www.npa.co.uk
  28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069491/
  29. https://www.ncbi.nlm.nih.gov/pubmed/25293967
  30. https://www.bmj.com/content/343/bmj.d7397
  31. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/clustering-of-unhealthy-behaviours-over-time-aug-2012.pdf

 

Heart health diet advice, controversy and confusion

Heart health diet advice, controversy and confusion

Heart health – diet advice, controversy and confusion 

The interest and reporting on health has been revolutionary in driving the key messages about the importance of diet and exercise, but have the scales started to tip in the wrong direction?

The basics of good heart health have remained relatively unchanged in that eating a balanced diet and keeping active are key drivers in reducing the risk of disease. The problem is that the definition of what constitutes a ‘balanced diet’ continues to get redefined as we have become obsessed with the ‘micro’ issues and controversies surrounding this topic.  The consequence of this is that key health messages, which are based on science, have become blurred and cause confusion amongst people on what they should be eating.

The basics

We all know what a healthy diet should look like.  To keep healthy, our diet should include plenty of vegetables, lean proteins, oily fish, high-fibre foods such as beans, pulses and lentils and ‘brown’ carbohydrates over ‘white’.  Foods and drinks that are in high in sugar and saturated fat such as puddings, desserts, confectionary, soft drinks, convenience foods, pies and pastries are perfectly fine in moderation but when eaten to excess, especially in place of healthy alternatives are not good for health.

Simple right? If you follow these principles and control the amount of food you eat then there’s no doubt that you’ll be able to retain a healthy body weight, glean enough micronutrients (vitamins and minerals) and protect yourself against diet-related diseases. Yet many adults still fail to achieve this.

What does the current adult UK diet look like?

The National Diet and Nutrition Survey (NDNS) is a rolling program that assesses the dietary intake of the UK population. This latest version of the survey is a combination of years 7 and 8 (2014/15 – 2015/16) and provides insight into the foods people eat, nutrients gleaned and adherence to public health guidance around nutrition (1).

In summary, the average adult eats too much sugar and saturated fat, not enough fruit and vegetables, too little fibre and hardly any oily fish.  Total fat intake is within the recommended guidelines and we all eat get more than enough protein in our diet.  Vitamin and mineral intakes vary with a significant percentage of some groups not getting enough from their diet.

In more detail…

  • The average fruit and vegetable intake amongst adults is 298g (similar for both men and women), which equates to less than four servings per day.  Only 31% of adults manage to achieve five-a-day, which is higher in women than men (32% versus 29%).
  • The average intake of oily fish is just 8g per day or 64g per week, which is lower than the recommended single weekly serving of 140g.
  • The average intake of ‘free sugars’ amongst adults is over 11 teaspoons per day, which is almost twice the recommended amount.
  • Adults barely manage to get more than 2/3 of their recommended intake of fibre and only 9% meet the guidance of 30g per day (only 4% of women meet this).

 

Percentage of adults with micronutrient intakes below the LRNI

Micronutrient Adults Men Women
Vitamin A 13% 16% 10%
Riboflavin (B2) 10% 6% 14%
Folate 5% 3% 6%
Iron 15% 2% 27%
Calcium 9% 2% 11%
Magnesium 13% 14% 11%
Potassium 17% 11% 23%
Iodine 12% 9% 15%
Selenium 36% 25% 47%
Zinc 8% 7% 8%

 

So, why has healthy eating got so complicated and what is influencing our inability to meet these basic principles?

For the purposes of this blog we’ll set aside the myriad reasons why people make certain foods choices.  This is hugely complex and influenced by emotion, knowledge, peer pressure, access to healthy food, cooking skills, food budget and many other factors.

Let’s focus on the things that have caused confusion around what it means to eat a balanced diet, which can impact on the food choices made by people who are motivated to make changes to their diet to maintain good health and reduce the risk of heart disease.

1.Weight loss

Much of the diet advice we’re exposed to in the media revolves around maintaining a healthy body weight, which is one of the biggest influences over your risk of disease.  Heart disease is the leading cause of premature death and is directly linked to being overweight; the conditions associated with being overweight also act as risk factors for heart disease.  The basic biology of ‘eating less and moving more’ will promote a healthy weight.  The idea that ‘not all calories are created equally’ is very sound but overplayed as within the context of basic healthy eating principles it’s really just common sense.  You know when you’re trying to eat healthily that you should be making up your daily energy (calorie) needs from foods that fit in with the basic principles of healthy eating and not compromising this by figuring out how you can tally a couple of Mars Bars into the equation by skipping meals or eating less nutritious food.

The diet industry and influence of celebrities and social media has seduced people with myriad ways to approach weight loss, which has contributed to the confusion around food choice.  Making long-term small changes to your current diet whilst watching your portion size is probably the best approach but doesn’t appeal to everyone.  Putting very extreme diets aside, there’s no right or wrong way to losing weight and some prefer to embark on a diet plan that lays out exactly what and when to eat.  Diets can be a useful way to ‘kick-start’ your weight loss goals and in some cases can provide much quicker results, but you still need to take on board that adopting long-term habit changes is the only thing that’s going to help you to keep the weight off once the diet has ended.

Attitude towards dieting is important and getting yourself in the right head space is key.  Many people refer to diets in the context of a set period of time and view the end of their diet as being the point that they can start eating ‘normally’ again. However, if your definition of ‘normal’ is reverting back to the way you ate before, then what’s the point if you’re just going to end up putting the weight back on again (classic ‘yo-yo’ dieting).

The best diet is only ever going to be the one you can stick with and forming new healthy eating habits is key to long-term success.  Diets come in many guises and this is where basic healthy eating messages can get blurred.  High protein, low carb, fasting, ketogenic and paleo are just a few examples of how people can develop false ideas around healthy eating.  These diets often label foods as being somehow ‘good’ or ‘bad’, which only adds to the confusion and in some cases can lead to guilt and a feeling of failure if they fail to lose weight or stick to the program.

There’s nothing wrong with dieting, just do your research and work out what approach fits in with your lifestyle.  Once you’ve lost the weight then try reverting back to the basic principles of healthy eating to keep the weight off, which will reduce your risk of heart disease.

2.Food controversy

There have been many books highlighted the impact of certain nutrients on health and questioned current dietary guidelines, which in relation to heart health have revolved around sugar, saturated fat and cholesterol.  I love reading these books as they provide a really interesting insight into the latest science and underline some of the wider controversies that may have shaped the way we are told to eat.  The concepts are very convincing in most cases, but the problem is that without a full understanding of the science of nutrition and research methods, it’s difficult to form an objective opinion and we have all been at a dinner party or sat in the pub with someone reciting the insights this type of literature offers.

The problem I have is that the typical person insinuated by the text is often in the extreme, which is overlooked by the reader. Let’s use carbohydrates as an example. The idea that a high-carbohydrate diet causes weight gain, diabetes and inflammation is rightly true but what defines a high-carbohydrate diet in this instance.  Whenever this is reported in the media or through books, no one actually defines this or shows you what a typical day’s food looks like for this high-carb eating person.  Take a diet of excess calories made up of sugary cereals and muffins for breakfast, washed down with a coffee laden with sugar then a huge white baguette filled with something high in sat fat for lunch and an extra-large pizza for dinner, all of which are accompanied by sugary snacks and soft drinks.  This is clearly not a healthy way to eat and if you eat this way then there’s a very good chance that you’re unhealthy in many other ways such as lacking in exercise. For the reader this is instantly translated as carbs are bad, but you can’t compare this diet with one that contains the right number of calories, forgoes snacking and includes porridge oats for breakfast, quinoa and chicken salad for lunch and then a tofu stir-fry with brown rice for dinner.  Someone following this type of diet may also make healthier lifestyle choices such as exercising regularly. I’m not going to argue the toss over carbohydrates and it’s clear that overdosing on them, especially sugar is no good for your health, but it needs to be put in perspective to be fully understood.

Saturated fat is another good example

It’s taken a while for the nation to adapt to the message that fat isn’t all that bad and research has broadened our understanding of the role this nutrient plays in the diet and its impact on heart disease.  Current advice is that we choose ‘healthy’ fats from foods such as extra virgin olive oil, oily fish, nuts and seeds, which are rich in fatty acids called monounsaturated and polyunsaturated. These fats have been shown to lower the risk of heart disease by ways such as reducing inflammation and levels of ‘bad’ cholesterol.

Saturated fat in the diet has always been sold as being bad for heart health and to be honest if you’re eating a diet that’s high in any type of fat (putting keto diets to one side) then you’re at greater risk of becoming overweight, which is a risk factor for heart disease.  The average adult still eats too much saturated fat but the impact of this on heart health has come under scrutiny.

A landmark scientific review published in the British Medical Journal found no association between saturated fat consumption and all-cause mortality, coronary heart disease, stroke or type 2 diabetes (2).  This study sparked the saturated fat debate and has further studies have contributed to a growing body of evidence that has changed the dialogue on saturated fats.

The impact this study had on the topic of saturated fat in the diet and the relevance of current dietary guidance led to the publication of a report carried out by the Scientific Advisory Committee on Nutrition (SACN). The Saturated Fats and Health report was published in May (2018) after an extensive review of data from high quality cohort studies and clinical trials (3).  Their findings strongly support the current dietary guidance of limiting saturated fat intake to no more than 10% of the total energy from the diet.  This is translated in dietary guidelines as no more than 30g per day for men and 20g per day for women.

SACN found that there were significant limitations in the available data, which may have helped to be fuel the debate on saturated fat. They also said that lowering saturated fat in the diet was needed to improve events related to heart disease.

But is this insight really of any true benefit to people when they’re choosing what to eat? 

If you’re a healthy weight and enjoy full fat Greek yoghurt, butter, cheese or other natural sources of sat fat in moderation as part of your balanced diet then this is unlikely to have any impact on the health of your heart.  However, the problem with talking about diet in terms of nutrients is that foods don’t just contain a single one.  Convenience foods, pies, pizza, pastries, sweet puddings, ice cream, cakes and chocolate contain a lot of saturated fat and are also high in calories, sugar and salt, which we know is not great for heart health. Redefining saturated fat is not straight forward and runs the risk of people thinking these foods are in some way healthy and confuses the issue of food choice, particularly that related to heart health.

3.Superfoods

Nutrition is often defined by individual foods and nutrients but it’s the overall quality of your diet that counts.   The term ‘superfood’ has been banned by the European Food Safety Authority (EFSA), who are the body that regulates food labelling. The regulations put upon the food and supplement industry have helped to provide transparency for consumers as well as providing more information about the nutritional and ingredient content of products.

These regulations do not apply to media coverage and as a result we’re still bombarded with new research findings, foods and nutrients portrayed as being superiorly better for our health, preventing myriad of diseases.  The irony is that many of these foods often come full circle and contribute to the ‘kill or cure’ approach to reporting in the media.

There’s nothing wrong with reading about current research, which is often fascinating, but you need to keep perspective. Blueberries, grapes, red wine and pomegranates may contain compounds that could help to prevent heart disease but including them in your diet doesn’t mean you won’t get heart disease, especially if your overall diet is poor and you make unhealthy lifestyle choices such as not exercising or smoking.

The basic principles of healthy eating have been proven to help reduce the risk of heart disease and diets such as the Mediterranean have been shown to be the ‘gold standard’.  Reading about the next best diet or superfood is hugely interesting but there’s no quick-fix solution to eating and living well, yet many people view these as some sort of panacea.  The controversy is interesting but the outcome in terms of what we are advised to eat doesn’t really stray far from basic healthy eating principles.  The real challenge is finding a way to change your habits and making the right diet and lifestyle choices that will see you through to long-term good health and this includes reducing the risk of heart disease.

 

References

  1. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  2. https://www.bmj.com/content/351/bmj.h3978
  3. https://www.gov.uk/government/consultations/saturated-fats-and-health-draft-sacn-report
More fuss over fat but is focusing on individual foods and nutrients the real issue?

More fuss over fat but is focusing on individual foods and nutrients the real issue?

More fuss over fat!

The world of nutrition is fickle taking little for a food to go from friend to foe and  recent headlines have done just that as coconut oil puts fat back in the firing line.  During a recent presentation given by Dr Karin Michels of Harvard University she described coconut oil as “pure poison” continuing to say that it was “one of the worst foods you can eat” (1).  These comments were made in reference to the fact that the type of fat found in coconut oil, mostly saturated fat, raises levels of LDL (bad) cholesterol, which is a risk factor for heart disease.

Dr. Michels received a fair amount of media attention from her comments but set in the right context of her presentation these were part of a wider opinion of the health food industry, questioning the marketing and attitudes towards so called ‘superfoods’.  During her presentation, Dr. Michels deemed them “unnecessary” and pointed out that we can get the same nutritional benefits from everyday foods such as carrots.

I agree.  We can all get sucked in by the hype and this recent story in the press does give rise to important issues surrounding the marketing of foods and how they’re perceived by consumers.  However, the fact that coconut oil became the focus of the headline illustrates how our current approach to health and nutrition has become more focused on individual foods and nutrients rather than overall diet quality.

What is a balanced diet?

A balanced diet includes plenty of vegetables alongside lean proteins, high-fibre starchy foods (brown rice, oats, wholemeal bread and pasta, wholegrains) and healthy fats (olive oil, oily fish, nuts, seeds). Within the context of this diet there’s plenty of room for the odd sweet treat and if you want to add in a few ‘on-trend’ foods then that’s cool too but you should focus on getting the basics right first

Is fat that bad?

It was over 50 years ago that fat became a key focus of public health, mostly in relation to its impact on heart health.  Heart health is the leading cause of premature death and in the decades that followed, nutrition advice was defined by the message that we should all be following a low-fat diet.  In response to this we all turned to choosing margarine, sunflower oil and ‘low fat’ foods to keep our health in check.  Fast forward to the present day and sugar has become a greater health concern. Findings from the UK National Diet and Nutrition Survey (2) have revealed that the average intake of fat amongst adults is within the recommended guidelines but that our intake of sugar is twice the recommended amount. It also became quickly apparent that many of the popular ‘low-fat’ foods people were choosing to eat were in fact high in sugar.

It’s taken a while for the nation to adapt to the message that fat isn’t all that bad and research has broadened our understanding of the role this nutrient plays in the diet and its impact on disease.  Studies have shown that certain fats such as monounsaturated (MUFA’s) and polyunsaturated (PUFA’s) are better for our health, especially with respect to heart disease (3)(4).  Foods rich in these fats include extra virgin olive oil, oily fish, nuts and seeds, which are key components of the Mediterranean diet, considered by many to be the ‘gold standard’ (5).

Fat is just one component of the diet and any type should be eaten in moderation as they’re the most calorific component of the diet. Putting ketogenic diets (high fat, low carb) to one side, a diet high in fat has the potential to cause overweight, which in itself a risk factor for many diet related diseases.

Saturated fat

The average adult still eats too much saturated fat but the impact of this on heart health has come under scrutiny.  A landmark scientific review published in the British Medical Journal found no association between saturated fat consumption and all-cause mortality, coronary heart disease, stroke or type 2 diabetes (6).  This study sparked the saturated fat debate and further studies have contributed to a growing body of evidence that has changed the dialogue on saturated fats.

The impact this study had on the topic of saturated fat in the diet and the relevance of current dietary guidance led to the publication of a report carried out by the Scientific Advisory Committee on Nutrition (SACN). The Saturated Fats and Health report was published in May (2018) after an extensive review of data from high quality cohort studies and clinical trials (7). Their findings strongly support the current dietary guidance of limiting saturated fat intake to no more than 10% of the total energy from the diet.  This is translated in dietary guidelines as no more than 30g per day for men and 20g per day for women.

SACN found that there were significant limitations in the available data, which may have helped to be fuel the debate on saturated fat. They also said that lowering saturated fat in the diet was needed to improve serum lipid profiles and events related to cardiovascular disease and coronary heart disease.

Fat intake in the UK

The latest NDNS survey (2) showed that the average daily total fat intake in adults is 33.2% of total energy, which is below the guidance of 35%.  It was also shown that the average daily intake of saturated fat in adults is 11.9% of total energy, which is above the 10% guidance. The Scientific Advisory Committee on Nutrition also agreed that we should be choosing foods rich in ‘healthier fats’ such as nuts, seeds, olive oil and avocados over those containing high amounts of saturated fat.  Given total fat intake in the UK is within the guidance it was suggested that the focus should still be on reducing saturated fat to achieve a better balance of fats in the diet.

So, what does all of this actually look like in practice?

I get that this issue needed to be resolved in order to support the current recommendations about saturated fat intake, but in practice it’s not that complicated.  I’m a fan of whole foods and I choose to eat full fat Greek yoghurt over low fat, spread butter on my toast, and enjoy the odd bit of cheese, but they make up a small part of my diet.  According to the NDNS, they make up 27% of the nation’s diet (2).

I choose not to eat other foods that are high in saturated fat on a regular basis.  These foods include pies, pizza, pastries, sweet puddings, ice cream, cakes and chocolate, which are also high in calories, salt and refined carbohydrates such as sugar.  It doesn’t take a rocket scientist to get that none of these foods are ever going to be considered as healthy, but eating them in moderation, within the context of a balanced diet is fine.  The problem with redefining saturated fat is that it can easily cause confusion and if taken out of context may only contribute to unhealthy food choices that increase the risk of weight gain and disease.

What about coconut oil?

Coconut oil is sourced from the meat of mature coconuts and is mostly made up of saturated fatty acids.  Whilst saturated fat is considered to be something we should be cutting down on in the diet, those found in coconut oil are different in structure and called medium chain fatty acids (MCFA’s) as opposed to the long chain variety found in food like cheese and fatty cuts of meat. It’s these MUFA’s and in particular, lauric acid, which are thought to be at the root of the many health benefits associated with coconut oil.

Medium Chain Fatty Acids are more easily digested and directed to the liver (bypassing the gut), where they’re converted into energy rather than being stored as fat. Research has suggested that coconut oil can increase levels of HDL (bad) cholesterol as well as possessing anti-inflammatory, antibacterial and antifungal properties. Coconut oil is also commonly touted as supporting weight loss, but the evidence isn’t strong enough to back this claim.

The popularity of coconut oil

It’s easy to get seduced by food and health trends given the attention and interest they generate in the media and especially when accompanied by a flurry of health benefits.  The research questioning saturated fat and heart health has helped to position coconut oil as a healthy food.  Coconut oil has also made its way into the mainstream like other foods trends that came before it such as quinoa and green juices.  The popularity of coconut oil has been helped by its promotion amongst healthy eating chefs, social media and the ‘clean eating’ revolution.  Evidence of its popularity is reflected in sales, which have grown four-fold since 2014 with predicted sales this year thought to hit £24 million.

Whilst popular, the science surrounding coconut oil doesn’t tally with its associated health benefits, and the effect of coconut oil on heart health is still not clear, which has contributed its controversy.

What oil should you be using on a daily basis?

Whilst polyunsaturated fats such as sunflower oil have always been considered to be the best choice of cooking oil, some have questioned the impact they have on our omega 6 intake, which in excess can impact on inflammation.  Extra virgin olive oil is popular and even more so since becoming more widely available and cheaper to buy.  Speciality oils such as those from nuts and seeds have also become more widely available but not as popular given the fact that many people are unsure how to use them.

In my opinion, extra virgin olive oil is still the best choice.  Time and again, large studies have highlighted the close relationship between the Mediterranean diet and cardiovascular disease (5).  Extra virgin olive oil, which is a major component of this diet, has been shown to be very relevant in lowering the incidence of heart disease and stroke. The majority of fatty acids found in extra virgin olive oil are monounsaturated that have been proven to increase HDL (good) cholesterol and lower LDL (bad) cholesterol.  Compounds found in extra virgin olive oil such as a polyphenol called oleocanthal have been shown to help reduce inflammation (8), which is thought to be a risk factor for many diseases including heart disease.

Given the evidence to support the health benefits of extra virgin olive oil, it only goes to prove the power of marketing that someone would choose any other oil over this one, especially one that is wrapped in controversy.

There are many other oils on the market that offer unique flavours that can be incorporated into cooking such as nut and seed varieties (these work well in dressings and drizzling). Despite the fuss over coconut oil, likening it to poison is a bit harsh and only adds to the ‘kill or cure’ culture surrounding foods in relation to diet and health. Used in moderation, coconut oil can add a unique flavour to dishes that works particularly well with Asian and Indian cuisines.

And what about Superfoods?

Most of us have ‘wised up’ to the notion of ‘superfoods’ and understand that this is nothing more than a marketing ploy, but the word has still become commonplace and seen as a descriptor for foods that may be particularly nutritious.  The idea that one food is more nutritious than another or focusing on a single food or nutrient to protect your health is never a good idea as it’s the overall diet that counts.  Marketing foods as such is of course misleading and food labelling and health claims legislation has helped to create some degree of transparency.

It’s the overall quality of your diet that counts

The National Diet and Nutrition Survey (2) has shown that many people are not eating the right foods to meet their dietary needs.  Only a third of people in the UK manage to eat 5-a-day and very few eat oily fish on a weekly basis.  The average adult is also eating twice the recommended amount of added sugar, too much saturated fat and less than 10% are meeting the guidance for fibre.

Nutrition research tends to look at the effects of individual components of the diet, but it’s worth keeping in mind that people eat food and not nutrients.  Don’t assume that a single food or nutrient is going to be a panacea or antidote to an unhealthy lifestyle, ‘superfood’ or not.  These false expectations are completely redundant as it’s the overall quality of your diet that is going to have the most significant impact on your health.

And the debate on fat?

As far as the debate on fat is concerned, the consensus still seems to be that we should be eating less saturated fat in our diet, whilst focusing on foods that contain PUFA’s and MUFA’s.  Regardless of this, the debate on fat is just one of many in the world of nutrition that all raise important issues.  The downside is that they have the potential to cause further confusion amongst people as to what foods they should be eating, particularly as the science is often not clearly understood or the outcomes are taken out of context or misrepresented in the media.  The wider issue is still how to get people to make better choices to improve the quality of their overall diet and part of this is making food the focus and not nutrients.

 

References 

  1. https://www.telegraph.co.uk/health-fitness/nutrition/diet/now-coconut-oil-poison-fat-should-using-cooking/
  2. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198773/
  4. https://www.ncbi.nlm.nih.gov/pubmed/20351774
  5. https://www.ncbi.nlm.nih.gov/pubmed/20810976
  6. https://www.bmj.com/content/351/bmj.h3978
  7. https://www.gov.uk/government/consultations/saturated-fats-and-health-draft-sacn-report
  8. https://www.ncbi.nlm.nih.gov/pubmed/21443487

 

 

 

 

 

 

 

 

 

Colour code your health by eating the rainbow!

Colour code your health by eating the rainbow!

Colour code your health by eating a rainbow of foods (download as PDF Colour code your health with rainbow foods)

It feels as though we are continually being told to eat more fruits and vegetables to maintain good health and keep diseases at bay, with current research suggesting that eating five-a-day is not enough to reap the health benefits they have to offer.  So, what exactly is it about these nutritious colourful allies that makes them so great? 

The protective effect of antioxidant micronutrients such as the ACE vitamins and selenium have been understood for some time now.  These antioxidants are essential to help reduce free radicals in the body (unstable molecules produced from digestion and exposure to pollution, sunlight and cigarette smoke) and they have have been attributed to lowering the risk of many diseases including cardiovascular disease, cancer and dementia.  However, research has now moved forward to discover the beneficial effects of compounds known as phytonutrients that are responsible for colouring fruits and vegetables, and how they too can have a powerful effect on our health and reduce the risk of disease.

 


“The protective effect of antioxidant micronutrients such as the ACE vitamins and selenium have been understood for some time now”


 

Phytochemicals originally evolved to help plants protect themselves from diseases and insects and research is beginning to demonstrate that in the same way they can also help to protect us from disease.  There are thousands of phytochemicals found in fruits and vegetables and as the research is new we’re only just starting to unveil their identity and extremely complex action within the body.

Although the science is complex, the message is simple; eat a wide variety of different coloured foods.  As nutrients in foods work in synergy and different phytonutrients can be more freely absorbed depending on their make up within the structure of the food, it’s also a good idea to not only mix colours and types of fruits and vegetables but also cooking methods combining raw with cooked (such as adding roasted sweet potato or tomatoes to salad).

 


“Although the science is complex, the message is simple; eat a wide variety of different coloured foods”


 

By dividing different fruits and vegetables by their hue you can see how mother nature has allowed us to colour code our health by eating a rainbow of foods.

 

Red and pink 

 

 

Foods:  watermelon, pomegranate, red peppers, tomatoes, strawberries, pink grapefruit, cranberries, red grapes, raspberries, rhubarb, red chillies

Benefit: Most red fruits and vegetables contain lycopene, which is a member of the carotenoid family which are converted into vitamin A within the body.  This vitamin along with vitamins C and E help to protect the body from free radical damage.  Studies show that Lycopene* may reduce the risk of prostate cancer as well as helping to promote good colon health.  Red berries contain ellagic acid (helps to support the immune system) and anthocyanins, which research suggests reduces inflammation and help preserve memory whilst helping to slow down the degenerative processes of ageing.  These are also considered to be protective against certain cancers and cardiovascular disease as well as showing antiviral and antibacterial properties.

*Lycopene is more freely available in processed or cooked tomatoes.  Try roasting cherry tomatoes with balsamic and a little olive oil, which helps with the absorption of lycopene.

 

Yellow and orange

 

 

Foods: Yellow peppers, orange peppers, cantaloupe melon, carrots, sweetcorn, butternut squash, mangoes, grapefruit, peaches, pineapples, oranges

Benefit: The key antioxidant found in orange and yellow fruits and vegetables are carotenoids (also found in green leafy vegetables). These are converted to vitamin A in the body, which is essential for healthy skin and eyes.  Beta-carotene has been linked to a reduced risk of heart disease and certain cancers as well as playing a role in the immune system, reducing cognitive decline and possibly dementia risk.  You will also find a group of compounds in this hue known as bioflavonoids which studies suggest reduce inflammation in the body and may also work to slow down the development of cancer, heart disease and neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Combining your orange foods with healthy fats found in avocados or oils will help with the absorption of carotenoids.  Try drizzling olive oil over roasted butternut squash.

 

Green

 

Foods: Peas, kale, broccoli, kiwi fruit, avocado, mint, gooseberries, grapes, asparagus, artichokes, pak choi, honeydew melon, green peppers, Brussles sprouts, cabbage, green beans

Benefit: Lutein (found also in yellow fruits and vegetables) and zeaxanthin found in green vegetables are major pigments in the eyes and important for the maintenance of healthy vision.  Studies have shown that people who eat higher amounts of these compounds in their diet have a lower risk of developing age-related macular degeneration (AMD) which is a major cause of blindness as we age. Zeaxanthin may also help to reduce the risk of breast and lung cancers, and play a role in the prevention of heart disease and stroke. Leutiolin is another antioxidant found in green peppers and celery which has been found to lower inflammation in the brain and central nervous system. Green foods also contain quercetin which also has an anti-inflammatory effect within the body.

 

Purple and blue

 

Foods: black grapes, beetroot, cherries, blackberries, blueberries, red onions, aubergines, purple potatoes, purple cabbage, plums

Benefit: Anthocyanins are present in this colourful group of fruits and vegetables.  These compounds are thought to reduce inflammation, which may help with preservation of memory and reduced risk of certain cancers. Blueberries have been the focus of research into the effects of anthocyanins and reduced mental decline (including Alzheimer’s).  Purple grapes are especially high in a type of polyphenol known as resveratrol, which has been shown to protect against heart disease and promote a healthy circulatory system by reducing the levels of bad blood fats and blocking the formation of blood clots (which can cause heart attack and stroke).  Blackberries contain ellagic acid and catechins, which may help to protect against cancer.

 

White

 

Foods: Mushrooms, garlic, onions, cauliflower, endive, parsnips, turnip, taro, celeriac

Benefit: Although not strictly a colour of the rainbow, white vegetables also contain a variety of phytonutrients that can have a protective effect on your health.  Onions and garlic contain quercetin and allicin, which are known to kill harmful bacteria and protect capillaries (smallest of the body’s blood vessels).  You will find powerful polyphenols in mushrooms which can help to reduce the risk of heart disease.  Glucosinolates and thiocyanates found in cauliflower may also help reduce the risk of heart disease and cancer as well as help with digestive disorders.

 

Just adding a few more colours to your meals each day can make a big difference to the nutritional quality of your diet.  Here are my top five tips to adding a little extra colour to your diet:

  • Try to include at least two different colour vegetables with each meal, this could be a salad with tomatoes and cucumber, roasted squash and beetroot or peas with baby onions
  • Smoothies and juices are a great way to combine lots of different coloured fruits and vegetables such as beetroot, carrot and apple
  • Homemade soups are an easy way to combine colours as are stews and casseroles
  • Snack on a variety of chopped veggies (perhaps with a dip such as hummus) such as courgette, red peppers and carrot
  • Throw a handful of mixed berries over porridge, breakfast cereal or yoghurt;  you could even combine them with sweet apples to make a antioxidant-rich fruit compote

 (download as PDF Colour code your health with rainbow foods)

Cooking seared tuna with Fighting Fifty

Cooking seared tuna with Fighting Fifty

So, I have previously posted the delicious recipe for sesame seared tuna with Asian green salad but had the chance to cook the dish with Tracey McAlpine from Fighting Fifty.  Always love cooking with Tracey as we have such as laugh.

What you need to know about tuna

Tuna belongs to the oily group of fish along with salmon, trout, mackerel, sardines and herring.  These fish are a rich source of omega 3, which research has shown can have a positive effect on many areas of health.  Tuna, along with other oily fish is beneficial for heart health and although it is not entirely clear exactly how omega 3 fatty acids benefit the heart, the results show they do.  It is also thought that the heart health benefits may be a combination of omega 3 fatty acids and some other component of oily fish.

Omega 3 fatty acids can help to reduce inflammation in the body which is thought to be at the root of many diseases including that of the heart.  These fats also help to increase the amount of good (HDL) cholesterol and reduce overall triglycerides in the body as well as thin the blood, which also benefits the health of your heart.

Omega 3 has also been associated with good skin and helps to maintain healthy skin cell membranes that keep it supple and moisturised.  The anti-inflammatory effect of these fats may also help with skin conditions such as psoriasis.

It is recommended that we try and eat about two servings of oily fish each week in order to glean adequate omega 3.  These fatty acids are referred to as essential as they must be obtained from the diet.  However, you should try and limit your intake to no more than four servings each week given the fact that oily fish have a high level of heavy metals, which may build up over time.

Tuna is also rich in vitamin A, which is important for healthy skin, immune system and normal vision.  Iron is also an important mineral in the diet and food surveys show that up to 23% of women in the UK have inadequate intakes, which can result in tiredness and fatigue.  Tuna contains a useful 10% of the RDA for iron.  Another key mineral is magnesium that plays a key role in hundreds of chemical reactions in the body and is involved in muscle relaxation and the conversion of food into energy (tuna contains 17% of the RDA per serving).

Tuna are also a rich source of many B vitamins, in particular B12 (over 200% of the RDA).  B vitamins are essential for the health of your skin and required for energy metabolism.  Low intakes of B vitamins can result in tiredness and fatigue.

Try this recipe for yourself!

 

 

 

 

 

Shakshuka

Shakshuka

A heart healthy breakfast

Heart disease is the leading cause of premature death in the UK.  Diet and lifestyle factors have a huge influence on the likelihood of developing heart disease and most of us are well aware of what these are, however, it is the the willingness to change behaviour that poses one the biggest barriers to improving health.  Living a sedentary lifestyle and smoking are risk factors for the condition as is being overweight, which comes with its own set of risk factors such as diabetes, high blood pressure and cholesterol, all of which are directly associated to the food choices we make.

Eating a well-balanced diet that includes a variety of foods will ensure that you get all the nutrients your body needs to maintain good heart health as well as limit those that can increase your risk of heart disease.  A diet rich in plant-based foods, healthy fats (found in foods such as extra virgin olive oil and oily fish) and small amounts of meat, as illustrated by the Mediterranean diet,  is the ultimate heart-healthy way of eating and research has highlighted the benefit of certain foods included in this particular diet such as extra virgin olive oil and antioxidant-rich fruits and vegetables.

The best way to start your day is by eating a nutritious breakfast. Not only does it set you up for the day ahead, but research shows that eating breakfast can help with weight loss as you are more likely to eat less across the day.  Opting for high protein foods is also good for weight loss and studies have shown that eggs can lead to greater satiety (feeling of fullness) than grain-based breakfasts, making you less likely to reach for snacks mid-morning.   If you do not eat eggs then try another protein-rich breakfast such as smoked salmon, scrambled tofu or yoghurt with seeds and nuts.  Choosing sensible portion sizes is also important for weight loss and eating from a small plate is a good tactic (You can find useful examples of average portion sizes of individual foods by visiting sites such as NHS choices or Weight Watchers).

Eggs still get a bad wrap when it comes to heart health as they are naturally high in cholesterol, however we now know that naturally occurring cholesterol in foods has little significant impact on harmful levels in the body.  The British Heart Foundation states that there is no limit on the amount of eggs you can safely include in your diet (although people with very high cholesterol or familial hypercholesterolaemia need to be more cautious).

This delicious shakshuka recipe may not be something to cook on a daily basis, but it makes a great healthy brunch dish for the weekend.  Red peppers, garlic, extra virgin olive oil and tomatoes are rich in vitamins, minerals and phytonutrients (found in plants) that act as antioxidants in the body and help to protect it against disease.  Try serving with slices of toasted sourdough bread or on its own if you are trying to cut down on carbohydrate foods.  This dish is also really versatile.  I have added in a few handfuls of green peas but it can also be modified into something heartier for supper by adding cannellini beans or a serving of brown rice or quinoa.

 

Shakshuka

Serves 3-4

300 calories per serving (without bread)

Ingredients

2 tbsp extra virgin olive oil

2 onions, finely chopped

2 cloves garlic, finely chopped

300g cherry tomatoes, halved

½ lemon, zested

1 tbsp smoked paprika

2 tsp ground cumin

Small pinch of saffron

500ml stock (chicken or vegetable)

3 sweet red peppers, de-seeded and sliced

1 red chilli, chopped

2 x 400g cans chopped tomatoes

2 handfuls of frozen peas

1 tsp sea salt

Ground black pepper

6 large eggs

Small handful flat leaf parsley

Small handful chopped coriander

 

Method

  1. Heat the oil in a large ovenproof pan set on the hob over a medium heat.
  2. Add the onion and garlic then fry for 5-8 minutes until soft.
  3. Add the cherry tomatoes and cook for a further 5 minutes.
  4. Add the lemon zest, paprika, cumin and saffron then cook for a further minute.
  5. Add the stock, peppers, chilli and chopped tomatoes. Cook for 20 minutes or until the peppers are tender. Add the peas after 15 minutes of cooking. You may need to add a little more water if the dish dries out too much. The consistency should be thick but not dry.
  6. Season with salt and pepper.
  7. Make a well in the sauce using a spoon and crack in one egg. Repeat for the other five eggs.
  8. Place the pan in the oven and cook for about five minutes until the egg whites are cooked and the yolk is still runny. Cook a little longer of you do not like runny yolks.
  9. Remove the pan from the oven and garnish with the herbs.
  10. Serve the shakshuka with freshly toasted sourdough or other bread of choice.