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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