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How to cater for vegan guests at Christmas

How to cater for vegan guests at Christmas

Planning Christmas lunch can be a huge operation and even more so if it’s your first time at the helm.  So, what do you do when one of your guests tells you they’re vegan?

If you break down the Christmas lunch table then most dishes are actually plant-based and those that are not can easily be adapted without too much effort.

What do you serve in place of roast turkey?

There are many options that can be cooked alongside the turkey for your vegan guests.  

Vegan roasts made from ingredients such as nuts, seeds, beans, pulses and lentils are a good option and you can find many recipes online.  Look for recipes full of flavour which make the most of dried spices and dried fruits. Stuffed butternut squash is also a really nice option and you can make festive fillings using grains and dried cranberries.

Cooking a vegan roast is always going to be full of the key elements of taste including both flavour and texture.  Another option is a meat-free alternative which are normally made using tofu.  

What about the roast potatoes?

The only consideration here is the type of fat that you choose to cook them in.  Animal fats are often used to roast potatoes at Christmas so be sure to switch to olive or rapeseed oil.  Coconut oil can be used and offers an interesting flavour.  You can also roast with garlic and rosemary for something delicious. 

The key to nice and crispy roast spuds is picking a floury variety and giving them a good shake before you put them in the oven.

What about the vegetables?

All veggies are plant-based so there’s no issue here.  Some vegetable options do contain dairy such as parmesan roasted parsnips or cauliflower cheese.  You can adapt these dishes by using nutritional yeast and fortified plant-based drinks made from soy, nuts and seeds.

What about the gravy, savoury and sweet sauces?

No Christmas lunch is complete without a good gravy.  You can make a good vegan alternative using dried porcini mushrooms which give it a strong ‘umami’ flavour.  

Savoury and sweet sauces that use butter, milk or cream can be made using alternatives made from plant oils, fortified plant drinks, soy, nuts and coconut.

What about the Christmas pudding?

Christmas pudding is not vegan as it contains ingredients such as suet, eggs and honey.  You could make your own vegan alternative but buying one in is much easier.

What about the booze?

This is one thing that non-vegans may not even have ever thought about but not all booze is vegan friendly.  

Some drinks may use isinglass (substance obtained from fish bladders), gelatine, eggs white, seashells and other animal products during the filtering process prior to bottling.  Honey may also be used to sweeten certain drinks so worth keeping an eye out for.

You can check out which brand of alcoholic drink is vegan by using the website Barnivore.

Adapting your Christmas lunch to accommodate vegan guests is really not that difficult once you know where to make the changes.  Many of these changes can be used to feed everyone and will likely go unnoticed by your other guests.  

Of course the other option is start veganuary early and go completely plant-based this Christmas!

 

Is Veganuary really worth the effort?

Is Veganuary really worth the effort?

Veganuary is very cleverly positioned at the start of the New Year which is a time when many people are highly motivated to eat a little better and exercise more. 

Veganism is the pinnacle of plant-based eating and often viewed as being superiorly healthy, but is Veganuary really going to make a difference to your health or is it just a flash in the pan?

What are the health benefits of veganism

Meat-free diets have been shown to benefit key areas of health and reduce the risk of diet related diseases. 

Studies have shown that people who follow a meat-free diet have a lower risk of obesity (1), heart disease (2), high blood pressure (3), type 2 diabetes (4) and digestive disorders such as constipation (5) – although lifestyle plays a key role here and this doesn’t mean following a vegan diet will prevent you from developing these conditions.

How does a typical vegan diet differ to that of omnivores?

It has been shown that vegans are more likely to exceed the daily recommended fruit and vegetable intake.  Eating more of these foods means gleaning a greater quantity of micronutrients and antioxidants such as the carotenoids found in orange and dark green vegetables (6).

Veganuary can educate about plant-based eating

Adopting veganism for January is a great way for people to learn more about plant-based eating.  One of the key lessons is learning how to adapt simple everyday dishes such as curries, chilli and spaghetti Bolognese by switching meat for foods such as tofu, beans, pulses or vegan Quorn. 

Given the vast range of alternative foods now on the market it has become easier than ever to go completely plant based and Veganuary is a good opportunity to showcase this.

Should we limit our meat intake?

Many people eat meat on a daily basis and in some cases at every mealtime.  I’m not a vegan but my personal opinion about meat is that we should eat less and choose the very best quality affordable rather than filling our shopping trolley full of cheap over farmed animal products.

Focus on environment as well as nutrition

There are many different foods you can eat in place of meat that supply similar nutrients including protein, iron and zinc.  For me, the focus regarding meat should be placed on the environmental issues over nutrition. 

Findings from a study carried out by Oxford University suggested that if the world went vegan it could save 8 million human lives by 2050, reduce greenhouse gas emissions by two thirds and lead to healthcare-related savings and avoided climate damages of $1.5 trillion (7).

Despite these impressive stats there are still other issues that vegans need to be conscious of that can impact on the environment.

Eating with the seasons is important to cut back on food miles.  The supermarket fruit and veg aisles tend to be suspended in a constant summer season but in order to have access to these foods they must be flown in from around the world.  The demand for these foods has also had a huge impact on the landscape of certain countries which are now dominated by the poly tunnels required to grow them.

Eating with the seasons is a challenge and does require some skills in the kitchen, especially in the winter months when it’s mostly root vegetables on the menu.

Cattle farming uses vast quantities of water but this doesn’t mean that plant-foods are necessarily any better.  Certain plant foods such as nuts and soy still use huge amounts of water.

Crops such as maize, soy and grains can also have a damaging effect on the biodiversity of land and quality of soil by way of pesticide and fertilisers.

You can’t cut out foreign food imports completely as this would have a huge impact on the farmers in countries that rely on selling their goods to the UK.  Simply being more conscious about your foods choices to achieve a balance is the best approach.

What do I think about Veganuary?

You don’t need to go vegan to be healthy but eating less meat is undoubtably a good thing. While going vegan for one month may not have an immediate impact on your health or global environmental issues it does help enlighten people to the plant-based way of eating. 

If engaging in the Veganuary campaign led to some people adopting this way of eating permanently or others simply committing to Meat Free Monday, then long term the impact on health and environment would be significant. 

In short, I’m a fan.  Veganuary is a brilliant campaign that raises awareness of the many current issues surrounding the way we eat while also educating people on how include more plants in their diet. 

 

References 

  1. https://www.ncbi.nlm.nih.gov/pubmed/20622542/
  2. https://www.ncbi.nlm.nih.gov/pubmed/26138004
  3. https://www.ncbi.nlm.nih.gov/pubmed/24636393
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466938/
  5. https://www.ncbi.nlm.nih.gov/pubmed/21983060
  6. https://www.ncbi.nlm.nih.gov/pubmed/26707634
  7. https://www.pnas.org/content/113/15/4146

How can your diet help you to sleep well during the winter months?

How can your diet help you to sleep well during the winter months?

Sleep patterns may easily be thrown off course during the winter as the increased darkness impacts on our circadian rhythms.  The result is that it may make it more difficult to wake up and leave us feeling sluggish or lacking in energy.  These effects may also impact on the food choices we make and vice versa our diet may impact on sleep.

How can the winter months impact on sleep?

Darker evenings and mornings can impact on sleep in several ways.  Some of these may be associated with the fact that our basic diet and lifestyle behaviours could become challenged during the winter.

How can mood impact on sleep?

How we feel can affect our food choices and pattern of eating.  In some cases, skipping meals may affect overall nutrient intake, some of which are linked to poor sleep such as magnesium.  Erratic eating patterns can also encourage snacking on foods high in sugar that may also affect sleep.

Low mood can also lead to overeating and weight gain, which may impact on mental health. Any form of anxiety linked to our lifestyle can play on the mind and affect our ability to sleep well.

How does diet play a role?

Comfort eating and alcohol consumption may increase during the winter as we get cosy indoors.  This is even more so during the festive season which can also play havoc with our sleep patterns.  The tendency to choose richer foods may also trigger indigestion in some people which will negatively impact on sleep quality.

So, what can you do to help achieve a good night’s sleep in the Winter months?

Stick to your regular sleep/wake pattern

Establishing a set routine is bedrock to sleeping well. Going to bed at the same time every night and waking up at the same time every morning is key to keep your circadian rhythms in sync.

It’s often tempting to hit the hay earlier than normal and stay in bed longer, but this is not going to help with how energised you feel during the day.

Avoid the stodge

It’s tempting to seek out stodgy foods during the winter months but this may impact on your sleep quality.  Overly rich foods can cause indigestion, especially if you’re not used to eating them.

Heartburn is a symptom of indigestion and something many people experience during the festive season, especially when partnered with more alcohol than usual.

If you’re going to eat more stodgy food then try to eat smaller portions and team them with plenty of veggies on the plate to try and balance out your meal.

Invest in a vitamin D3 supplement

We all rely on sunlight to provide us with adequate amounts of vitamin D but during the winter months it has been shown that many of us are lacking in this nutrient (1).  This essential vitamin helps to maintain healthy bones and supports immunity but inadequate levels are associated with fatigue, muscle weakness and low mood.

Research published in the journal Nutrients has suggested that vitamin D deficiency is associated with a higher risk of sleep disorders (2).

Food sources of vitamin D are limited to fortified foods, oily fish, liver, mushrooms and eggs but will not provide you with everything your body needs.

During the Winter months you should take a supplement containing 10mcg of vitamin D3.

Try and stick to making healthy food choices

The colder months can have an impact on our eating habits and food choices.

The longer evenings can also lead to snacking late at night which will do little for your ability to sleep as eating and digestion can prevent the body from shifting into sleep mode.

Foods rich in carbohydrates are craved more in the winter which may be linked to their connection with serotonin (the feel good hormone) and could be the body’s way of attempting to improve mood.  Always choose wholegrain varieties of carbohydrates as these have less impact on blood sugar levels.

Simple carbohydrates such as sugar are digested much more quickly and may impact on sleep quality (3) as well as doing little for your waistline if eaten in excess.  Obesity has been linked to poor sleep by way of its impact on hormones associated with satiety (4).

Eat a nourishing diet that will provide your body with the essential nutrients required for good health, some of which may be connected to sleep such as magnesium.  It is widely understood that magnesium deficiency can cause insomnia.  Research published in the journal Public Health Nutrition has also shown how adequate levels of magnesium are positively associated with sleep duration (5).

Don’t eat too close to bedtime and keep evening meals light including lean proteins (poultry, fish, tofu) and wholegrain carbohydrates (brown rice, wholemeal pasta, quinoa) as this combination can help with the uptake of tryptophan into the brain which assists with the production of melatonin (the hormone that regulates the sleep cycle).

Try and avoid the classic ‘pick-me-ups’

If you’re feeling sluggish during the day then it can be tempting to reach for a food or drink containing caffeine or sugar to help boost your energy levels. Both caffeine and sugar have been shown to disrupt sleep.  The effect is usually short-lived and often followed by a craving for more of the same creating a vicious cycle of highs and lows.

The first morning coffee is like nectar and a perfect way to get you ready for the day ahead.  After this it may be worth avoiding, especially if you have trouble sleeping. Try alternatives such as herbal teas including ingredients such as ginger and lemon which have an invigorating and refreshing effect without the caffeine hit.

It’s worth remembering that tea, chocolate, energy drinks and even decaf coffee all contain a source of caffeine.

Pay attention to the health of your gut

Early research has suggested that the microbes in our gut (microbiome) may be linked to sleep.  It is thought that while a lack of sleep may negatively impact on our microbiome the diversity of microbes in our gut may also lead to disrupted sleep (6).

The connection is not fully understood but it may be worth taking a probiotic supplement to promote a good diversity of bacteria in your gut.

Try to also include plenty of prebiotic foods in your diet which help gut bacteria to flourish.  Prebiotic foods include onions, garlic, beans, pulses and lentils as well as cooked and cooled potatoes, pasta and rice.

The winter months can pose challenges to many areas of your health.  If you are struggling with your sleep then consider the approaches above while also paying attention to the basic sleep hygiene practices addressed in my new book which focus on behaviour, environment and diet (BED).

References

  1. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213953/
  3. https://www.ncbi.nlm.nih.gov/pubmed/26156950
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535424/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675071/
  6. https://www.ncbi.nlm.nih.gov/pubmed/31589627
Nathan Khider Sleep Podcast 2019

Nathan Khider Sleep Podcast 2019

This is a new podcast hosted by my lovey mate Nathan Khider.

Nathan’s YouTube channel is fantastic and involves him interviewing guests that have many interesting stories to tell to hope to inspire and educate his listeners.

My new book, ‘The Art of Sleeping’ is due out today (14th Nov 2019). I talk with Nathan about the reasons why I chose to write this book which revolve around my own persona interest in sleep and my experiences of sleep deprivation and insomnia.

While some of you may sleep well, the reality is that we are a nation of non-sleepers.  Some people believe they can survive on hardly any sleep, but I disagree.  From personal experience of insomnia, I know first-hand how the effects can negatively impact on every aspect of your life.  I’m also guilty of telling people how tired I am rather than taking the action required to tackle the issue head on.

We all need to take sleep seriously as the long-term consequences of not sleeping well are scarier than you think.  For these reasons I decided to write my new book ‘The Art of Sleeping’.  I share my experiences with Nathan and discuss the positive steps we can all take to improve our sleep which in turn will help us to achieve optimal health and wellbeing.

 

Join Cancer Research UK in giving up sugar for February

Join Cancer Research UK in giving up sugar for February

Addicted to sugar? Learn more about how you can ditch the sweet stuff!

Sugar is the villain in the world of nutrition and most significantly those added to foods, which are referred to as being ‘free’.  We all eat too much of it and it’s supposedly more addictive than class A drugs.  So, what’s the deal with sugar and how can we start to cut it out of our diet?

This month we’ve been challenged by Cancer Research UK to ditch the white stuff in the name of charity but why is it so bad for our health, how much are we eating and how can we reduce it?

What are free sugars?

Free sugars are considered to be the ‘bad guys’ and have been defined by Public Health England as all added sugars in any form which include (1):

  • All sugars naturally present in fruit and vegetable juices, purées and pastes
  • All sugars in drinks
  • All sweeteners including table sugar, honey, barley malt, maple syrup, coconut nectar, palm sugar, agave nectar, date sugar and brown rice syrup

Other sugars found naturally in foods such as whole fruits, cereals and dairy foods (not flavoured milks) are not as damaging to health.  Blood glucose levels are less affected by the sugars in these foods as their fibre, fat and protein content slows down its release into the bloodstream.  Foods containing these sugars are also much more nutritious and contain many other nutrients which are beneficial to health.

How much free sugar should we be eating?

Sugar is high on the health agenda with both the World Health Organisation (WHO) and the Scientific Advisory Committee on Nutrition (SACN) urging us to reduce free sugars to just 5% of our daily calorie intake.  Guidance from Public Health England is to limit free sugar intake to no more than 30g (6 tsp) per day.

How much free sugar are we eating in the UK?

Findings from the UK National Diet and Nutrition Survey (2018) have shown that most of us consume too much free sugar (2).  The greatest contributors come from the sweeteners we add to food and drinks, soft drinks and then the usual suspects of confectionary and other sweet treats.

Sugar and heart disease

The relationship between sugar and heart disease has been widely researched and a recent study published in JAMA Internal Medicine found that a high-sugar diet was associated with a greater risk of dying from the condition.  Researchers not only found a strong association between sugar intake and heart disease but that the higher your intake of sugar the greater your risk of disease (3).

It’s not fully clear how sugar and heart disease are related but several indirect pathways have been implicated. The liver converts excess sugar into fat and when overloaded this may increase the likelihood of fatty liver disease, which contributes to diabetes risk (a key factor in the aetiology of heart disease).  Other risk factors for heart disease such as high blood pressure and inflammation have also been associated with diets high in sugar (3)

Sugar and cancer?

Sugar is often talked about with respect to cancer but according to Cancer Research UK, there’s no direct link between the two.  Saying that, the two may be indirectly associated with one another, which has more to do with the impact of obesity.  An unhealthy diet, which may include an excess of sugar in the diet has the potential to cause weight gain and evidence from research has shown that being overweight or obese can increase the risk of many different types of cancer including breast, bowel, oesophageal and pancreatic (4).

Beyond smoking, obesity is one of the greatest preventable risk factors in the development of cancer.  It’s been predicted that by 2035 almost three quarters of the UK population will be overweight or obese, which may cause a further 670,000 new cases of cancer over the next 20 years.

Exactly how being overweight or obese causes cells to become cancerous is not yet fully understood but is thought to be triggered by chemical signals released from excess body fat. We need some fat for the body to function properly, but excess may be harmful as it releases hormones and growth-promoting signals in the body, which encourage inflammation and influence how often our cells divide. These changes in cell division are thought to be one of the most likely reasons why carrying excess fat increases the risk of cancer (5).

How to start cutting free sugars out of your diet

Food surveys have shown we all eat too much of the white stuff and yet most of us find it impossible to cut it out of our diet.  Ditching free sugars for good is probably an unrealistic goal for the majority of people, but this current campaign led by Cancer Research UK offers an opportunity to kick-start new eating habits and explore ways to reduce them from your diet.

Top tips to tackling sugar in your diet

Try and make simple changes to your diet that involve cutting down on the amount of free sugars you consume.  The tips below can help you to reduce the amount of free sugars in your diet and beat the cravings that act as a key barrier to change.

Understand sugar on the label

Many of the foods typically high in free sugars are obvious to spot, but a significant amount of those we consume are hidden in salad dressings, condiments, breakfast cereals, soups, cook-in-sauces and ready meals.

The front of pack labelling highlights the amount of sugar in a food product so opt for green or amber traffic lights. This labelling can be misleading as it represents all the sugars so also refer to the ingredient list.  To identify free sugars, look for anything that ends in ‘ose’ (sucrose, glucose, fructose) as well as any healthier sounding alternatives, such as raw sugar, barley malt, maple syrup, coconut nectar, palm sugar, agave nectar, date sugar and brown rice syrup.  These are all classed as free sugars.

Switch to sweet snacks lower in free-sugars

To reduce the amount of free sugar you add to food you can opt for dried fruits or homemade compotes.  If you’re looking for something sweet to snack on, then try fresh or dried fruits alone or topped onto plain yoghurt.  You can also control the amount of sugar you add to homemade fruit breads, which can be topped with nut butters.

Include plenty of protein in your diet

Protein helps to keep you feeling full and can lessen the desire to snack between meals.  Structure your meals by teaming proteins with healthy fats (olive oil, avocado, nuts and seeds), fibre (wholegrains) and plenty of vegetables.  If you need to snack between meals then something protein-based such as boiled eggs, pulse-based dips (hummus) or lean meat proteins are a great option.

Get a little spicy!

Sweet spices such as ground ginger, allspice, nutmeg and cinnamon can make a great substitute for sugar.  These spices can be added to hot beverages and smoothies or sprinkled over porridge and yoghurt in place of sweeteners such as sugar or honey.

Ditch sugary drinks

Soft drinks are one of the biggest contributors to sugar in the diet and even so-called health drinks can be loaded with sugar in one of its many forms.  Try flavouring sparkling water with fruits, vegetables and herbs such as lemons, limes, strawberries, mint, cucumber, rosemary, fresh ginger and basil. Herbal teas are also lovely when brewed, chilled and sweetened with a little honey.

Keep occupied

Research shows that the desire for something sweet after you have eaten is more likely to stem from habits formed during childhood as opposed to anything more biological (6). Evenings are the downfall of most people when it comes to snacking, so the first step is to keep sweet treats out of the house.  The next step is to find ways to occupy your time such as going out for a walk, doing something around the house or having a nice bath with a good book rather than flopping in front of the TV with a family pack of minstrels.  There’s some truth in the saying, “Idle hands make for the devil’s work”.

Gum

Research findings are mixed but have shown that chewing gum may help overcome sweet cravings in some people (7). Make sure you opt for sugar-free varieties!

Learn to chill

We’re more likely to seek out sweet treats and comfort foods when under stress.  Try to adopt other ways to manage your stress rather than relying on food. Magnesium helps to relax the body and can be found in foods such as nuts, seeds and even a little high-cocoa dark chocolate, which is also rich in the compounds phenylethylamine that acts as mild mood booster.

Try chromium

This mineral has been shown to help manage blood glucose (sugar) as part of something called the glucose tolerance factor (GTF).  This factor increases the effectiveness of insulin, which is a hormone that helps to control blood sugar levels by transporting glucose into cells.  Chromium also helps the body to process the carbohydrates, fats and proteins in the foods we eat.  Whilst not conclusive, research has suggested that chromium supplements may help with cravings (8) and anecdotally, some people find these a useful way to reduce sugar cravings by taking with meals.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/29587886
  2. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  3. https://www.ncbi.nlm.nih.gov/pubmed/24493081
  4. https://scienceblog.cancerresearchuk.org/2017/05/15/sugar-and-cancer-what-you-need-to-know/
  5. https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2531152/
  7. https://www.ncbi.nlm.nih.gov/pubmed/17118491
  8. https://www.ncbi.nlm.nih.gov/pubmed/16184071
Can you cure a hangover?

Can you cure a hangover?

Can you cure a hangover?

So, it’s that time of year again when all good intentions go to pot as we succumb to the excitement of the festive season and even the most ardent ambassadors of sobriety get swept up in the moment.  This time of year is synonymous with overindulgence and to be honest, why not enjoy yourself.  However, the fun times can come at a cost as we are left nursing the effects of a hangover the following day. For those with a more engaging social diary the whirlwind of events can start to take their toll as the festive season unfolds and heavy drinking over a long period can cause problems further down the line.

Research shows that we tend to drink more during the festive season and according to a survey commissioned by Cancer Research UK, young adults consume an average of 63 units in the run up to Christmas, which is the equivalent of 30 glasses of wine or 22 pints of beer.  As well as causing hangovers, this excess of booze can also affect our waistlines as these units contribute an extra 4000 calories (1).

What is a hangover?

The effects of drinking too much include headaches, dehydration, nausea and stomach ache as well as that non-descript feeling of anxiety experienced by some people and the lack of good quality sleep.  Alcohol is broken down in the liver and produces a compound called acetaldehyde, which is responsible for the unwanted side-effects of alcohol consumption. These effects become worse as you drink more, which leads to greater the build-up of acetaldehyde.

Whats the cure?

Everyone has their own take on the ultimate hangover cure but according to a large systematic review published by the British Medical Journal, researchers concluded that there was no convincing evidence for any conventional or complimentary interventions to prevent or treat them (2).  However, getting the basics right such as keeping hydrated, eating before drinking and choosing or avoiding certain foods and drinks may go some way to ease your pain.

Never drink on an empty stomach

Drinking on an empty stomach can be a recipe for disaster as this allows alcohol to be absorbed into the bloodstream more quickly.  According to the survey carried out by Cancer Research UK, a third of Brits aged 25-34-year olds said they skipped a meal to account for the extra calories (1).   The approach of avoiding food is seriously misguided as it not only increases the effect of alcohol but makes you more likely to nibble on bar snacks, buffets or visit the kebab house on the way home by stimulating the appetite.

Try to eat something before you go out even if it’s a sandwich on the way to the pub and choose something substantial with a good source of protein and healthy fats such as tuna sandwich, which will have more impact than a light salad.

Avoid dark coloured drinks

Dark coloured drinks such as brown spirits and red wine are rich in compounds called congeners.  These are impurities produced during the fermentation process, which add to the taste, aroma and appearance of dark coloured drinks.  The higher the concentration of congeners the more intense the hangover is likely to be the following day.

Hydrate!!!!

Few of us appreciate the impact of dehydration on the body, which can leave you feeling lightheaded, tired, confused and irritable. The body can survive for some time without food but not without water, which is why the effects of dehydration are felt more quickly.  Dehydration is a key driver for hangovers, especially as alcohol inhibits the production of anti-diuretic hormone, which is used by the body to re-absorb water.  Falling ill from drinking and vomiting only adds to the impact of dehydration.

To keep hydrated throughout the evening, alternate your alcoholic drinks with water and increase the length of your drinks with soda water or low-calorie mixers.  Drink plenty of fluids before bed and the following day and adding in electrolyte sachets can help to rebalance your system and replace nutrients commonly depleted by alcohol such as magnesium, potassium, calcium and B vitamins.

Avoid the greasy fry-up

The greasy fry-up is ubiquitous with hangovers but can actually leave you feeling much worse.   Fatty foods such as fried eggs, fried bread, sausages and bacon can put a strain on your digestive system as they take longer to break down and may encourage indigestion as well as leaving you feeling sluggish during the day.

Try something lighter such as boiled, poached or scrambled eggs on toast.  Eggs are nutritional powerhouses and contain a good source of the amino acid cysteine, which helps the liver to breakdown acetaldehyde.  Low blood sugar also contributes to the hungover feeling so team your breakfast with a glass of fresh fruit juice as a natural source of sugar as well as vitamin  C.

Think twice before reaching for the coffee

Coffee is a great pick-me-up but caffeine can leave you feeling jittery and upset sensitive tummies. Not everyone is as sensitive to the effects of caffeine so it’s a matter of personal choice.  Herbal teas are a good way to hydrate and ingredients such as ginger can help with nausea as well as providing an invigorating zingy flavour.  Ginger can be enjoyed as a tea by adding 1-2 tsp of ginger powder, ½ a lemon and 2 tsp of honey to a teapot, topping with hot water and leaving to brew for five minutes before serving.  The addition of a little honey can provide a gentle way to rebalance blood sugar levels.

Avoid energy drinks

Don’t be tempted by energy drinks as they are often high in sugar.  Some brands contain as much as 45g or 9 tsp of sugar per 500ml can, which will cause a serious sugar rush followed by a major crash, especially if drunk on an empty stomach.  These drinks, even if sugar- free are also loaded with high amounts of caffeine and other stimulants that can leave you feeling jittery and increase bowel spasms, especially in sensitive hungover guts.

Artichoke supplements may help

This supplement stimulates bile production and can help to relieve bloating and other symptoms of indigestion associated with alcohol consumption.  If you know you have a hectic month of over-indulgence ahead of you then try taking this supplement daily.

Foods that may help to promote good liver function

Certain foods may encourage greater bile flow through the liver, which helps to remove toxins more efficiently.   These include bitter and dark green vegetables (rocket, cabbage, kale and cabbage) and  globe artichokes.  Beetroot has also been traditionally associated with liver health by way of a plant compound called betaine.  All vegetables are hugely beneficial to health so the message here is just to eat more of them in general!!

I hate to be the bearer of bad news, but the reality is that there is no miracle cure when it comes to hangovers and how rough you feel is largely dependent on how much you have drunk.  Whilst there are plenty of useful tips such as those above to help you feel a little less shabby the following day, it’s important to always drink sensibly.

 

References 

  1. Cancer Research UK Dryathlon 
  2. https://www.bmj.com/content/331/7531/1515

 

A dietary approach to prostate health

A dietary approach to prostate health

A dietary approach to prostate health

The awareness of men’s health has become more visible in recent years with the help and awareness driven by organisations such as the Movember Foundation, which have made the topic more accessible with their brilliant approach that resonates perfectly with men of all ages.

Prostate health

There are numerous health issues related to men, which encompass both mental and physical health and include conditions such as infertility, impotence, depression, overweight and those related to the prostate. Despite the raised awareness, many men still find it difficult or embarrassing to seek help and this is heavily influenced by social stigma, which is a key consideration in the promotion of men’s heath as it creates a barrier to men seeking help and advice.

Prostate health is unique to men and is typically correlated with age given that conditions associated with it mostly affect male baby boomers (aged 54-74 years) and Gen X (aged 39-53 years).  Diet and lifestyle have a key role to play in prostate and many other areas of health and establishing good habits from an earlier age will pave the way to better health in the long-term.

What is the prostate?

The prostate is a small gland about the size of a walnut, which surrounds the tube (urethra) responsible for carrying urine out of the body and also secretes fluid that nourishes and protects sperm.

Common prostate health complaints include benign prostatic hyperplasia (BPH) or enlarged prostate.  The prostate gland naturally continues to grow with age but can cause troublesome symptoms in men with BPH, which make it difficult to urinate and empty the bladder.  Other prostate heath conditions include prostatitis (inflammation of the prostate, which can occur from the age of 30) and prostate cancer, which incurs more than 40,000 newly diagnosed cases every year in the UK making it the most common form of cancer amongst men.

Symptoms of both BPH and prostate cancer are similar given they are both related to an enlarged prostate and include:

  • Frequent urination
  • Weak or interrupted urine flow or the need to strain to empty the bladder
  • The urge to urinate frequently at night
  • Blood in the urine
  • Blood in the seminal fluid

Prostate cancer

Prostate cancer is a big health issue amongst men but is slow to develop meaning symptoms may not occur for many years until the prostate is large enough to affect urination.  An enlarged prostate does not mean you have cancer, but the symptoms shouldn’t be ignored.  The causes of prostate cancer are largely unknown, but the risk is increased beyond the age of fifty and for reasons as yet unclear the disease appears to be more common in men of African-Caribbean or African descent.  There also seems to be a slight increased risk in men with a family history of prostate cancer.

A reliable method of screening for prostate cancer is yet unavailable and early detection relies on vigilance about symptoms and regular check-ups with your GP.  A blood test called prostatic-specific antigen (PSA) test is available but is not specific to prostate cancer and PSA levels can be raised as a result of other non-cancerous conditions.  If you have raised PSA levels, then you may be offered an MRI scan to help further diagnose the risk of cancer.

Men’s attitudes to health

Research has shown how men are less likely to engage and react to healthcare information or recall the warning signs of cancer when compared to women (1,2). The cultural script of men has imprinted a definition of masculinity characterised by a need to be tough, brave, strong and self-reliant, which can influence their attitudes towards seeking help and overall self-care. Phrases such as ‘man up’ are now common place in our lingo used by men and women alike and are a good example of how this characterisation of men continues to be enforced.

Boys from an early age are often led to believe that if they don’t exhibit these characteristics of the ‘traditional’ male then they will in some way lose their status and respect as men, which contributes to many of the issues surrounding men’s health.  Kids story books and animated movies are riddled with such characterisations of princes and superheroes relied upon to save the day, which is often (rightly) fiercely protested against by women seeking equality but is less considered as to the impact on young men and the contribution to social stigma putting pressure on men to behave in a certain way.

The importance of diet on health

Research convincingly shows that people who eat a healthy diet are more likely to live longer and have a reduced risk of disease, but the link between diet, food and specific health conditions is often less clear.  It’s the overall diet that has the greatest impact on health but in the case of prostate health there are some studies to suggest that certain foods and nutrients may be particularly beneficial.  Most of these benefits can be achieved by eating a healthy balanced diet but introducing certain foods may be worth paying some consideration to.

How can diet help with prostate health?

I don’t want to sound boring, but you have to get the basics right first.  The modern dialogue around nutrition is overly focused on individual nutrients and foods, whilst the nature of the current wellness landscape gives more credence to the latest fads and diet trends over the basic principles of healthy eating.  Focusing on eating a balanced diet can help insure micronutrient intake and also help you to maintaining a healthy body weight, which is one of the best things you can do to reduce your risk of ill health.  This is particularly relevant to prostate cancer as findings from the World Cancer Research Fund (WCRF) have shown a strong association between being overweight or obese and the risk of developing the disease (3).

Start with the basics

Start by eating three meals daily and cutting out snacks unless you really need to include them.  Pile the veggies high, limit your intake of red meat, switch to ‘brown’ carbs and wholegrains, choose healthy fats (olive oil, avocados, nuts, seeds), cut back on sugar, watch your salt intake and serve small portions of food to help manage your weight.

Eat more salmon

Oily fish such as salmon are the richest source of omega 3 fatty acids, which we need to obtain from the diet.  Intake of oily fish in the UK is low with very few people including this food in their diet.  Omega 3 fatty acids have been shown to help reduce inflammation in the body, which may help to relieve the symptoms of BPH.  Salmon fillets can be marinated to make them more interesting or added to dishes such as fish pie, curry and salads.

Get more fibre in your diet

High-fibre foods include fruits (fresh and dried), vegetables, wholegrains, nuts, seeds, beans, pulses and lentils. According to the National Diet and Nutrition Survey only 13% of men meet the recommended dietary guidance of 30g per day and this is most likely due to choosing refined carbohydrates, not eating enough vegetables and ignoring foods such as beans and pulses (4).  Dietary fibre can help to reduce the risk of constipation, which can put pressure on the bladder and worsen symptoms of BPH.  Eating more fruits and vegetables is probably the easiest and most effective change you can make to your diet to significantly improve your health.  Many foods in this group contain a good source of vitamin C, which is also thought to help relieve the symptoms associated with BPH (5). Most of us get more than enough vitamin C in our diet but foods such as berries, peppers, citrus fruits, broccoli and cauliflower are good sources.

Cut down on fizzy drinks, alcohol, caffeine and artificial sweeteners

You should try and avoid drinking anything up to two hours before bedtime to lessen the need to use the bathroom during the night. Fizzy drinks, alcohol, caffeine and artificial sweeteners can all irritate the bladder and worsen the symptoms of BPH so you should try limiting your intake of these types of drinks.

Eat foods rich in beta-sitosterol

Foods rich in a plant substance called beta-sitosterol have been shown to reduce the symptoms of BPH including urinary flow and volume and may help to lessen the effects of inflammation and prostate growth. Foods rich in beta-sitosterol include seeds, extra virgin olive oil, avocado, nuts, raw cacao and fresh coriander.

Include soy foods as part of your diet

There’s a little research to suggest that phytoestrogens (plant compounds that mimic the effect of the hormone oestrogen) found in soy called isoflavones may help to relive the symptoms of BPH.  Soy isoflavones can be found in foods such as tofu, soya milk, soya yoghurt, miso, tamari, edamame beans and tempeh.  These foods have also been shown to help reduce cholesterol, making them a healthy addition to the diet and are a great alternative to animal protein for those looking to go meat-free. Swapping dairy products for soy is the simplest way to start including it in your diet.

Soy is one of the most controversial foods and you may have heard of the research linking it to the growth of ‘man boobs’.  Firstly, the effect of plant oestrogens on hormonal balance is weak and secondly, the research involved the consumption of unrealistically huge amounts of soy milk every day.

Eat plenty of foods rich in zinc

This mineral is very important for men, who have a higher daily requirement than women.  Zinc is essential for male reproductive health, which includes proper prostate function.  Research has suggested that men suffering with BPH and prostate cancer may have lower levels of zinc, but this is not considered a risk factor for either condition.  You can get plenty of zinc in your diet by eating foods such as shellfish, meat, pulses, beans, wholegrains, nuts, seeds and eggs.

Red fruits and vegetables

Red fruits and vegetables are rich in the antioxidant phytonutrient lycopene.  Tomatoes are the richest source, especially when cooked or processed but other foods include red peppers, pink grapefruit and watermelon.  Lycopene has long been associated with reducing the risk of prostate cancer but updated findings from the WCRF have downgraded the evidence to support this link from ‘strong’ to ‘no conclusion possible’ in light of the current available research (3).  Lycopene may still be beneficial for prostate health and these new findings don’t mean that it’s suddenly redundant, but only that the new research has made it more difficult to establish a link to prostate cancer.

A healthy balanced diet is important for all areas of health, which includes that of the prostate.  Focusing on food and managing your weight are significant ways to help promote good prostate health and the sooner you adopt healthy eating habits the better.  All men over fifty should be vigilant about recognising the signs of prostate cancer and seek regular check-ups with their GP as a habitual part of their lifestyle.

For more advice on prostate cancer visit the NHS website here.

For more information on mens health and diet try reading these blogs

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

The blokes guide to going vegan 

Cooking for prostate health

How easy is it to get your 10-a-day?

Quorn, cauliflower and sultana curry recipe 

Super green stir-fry with smoked tofu recipe 

 

References 

  1. https://jech.bmj.com/content/61/12/1086
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790705/
  3. https://www.wcrf.org/dietandcancer/prostate-cancer
  4. https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
  5. https://www.ncbi.nlm.nih.gov/pubmed/19716283
Chocolate can be good for you

Chocolate can be good for you

Chocolate can be good for you

This week is Chocolate Week!!!!

The History of chocolate 

The history of chocolate dates back over 3000 years to the Olmec civilization.  Cocoa powder is made from cocoa beans that are harvested from a tree called Theobroma Cacao, meaning ‘food of the Gods’.  Aztecs are thought to have enjoyed cacao beans by making a ‘drink’ called Chicolati, which was believed to increase wisdom, boost energy and act as an aphrodisiac. This brew was seasoned with vanilla, chilli, honey or fruit and whipped into a froth using little sticks.  I love their choice of flavours, which have now become commonplace amongst chocolate bars and puddings.

Since its discovery by Europeans and the vast time through to modern day, millions of people have helped to drive the popularity of this ultimate sweet treat.  The reputation of chocolate has evolved over time from a luxury food synonymous with wealth, to an easily affordable comfort food whilst the association with romantic gesture (food of love) and mood has remained since first discovered.

Global retail sales of chocolate are staggering with estimates of over £75 billion per year and in the UK alone, we spend over £3 billion annually.

Types of chocolate

Chocolate comes in many forms nowadays and is defined by the percentage of cocoa it contains.  Milk chocolate contains a low percentage of cocoa (23% cocoa solids) and is high in sugar and saturated fat.  Darker varieties have a greater percentage of cocoa (anything from 70-90% cocoa solids) and slightly less sugar and saturated fat (although still high).  Cocoa powder contains hardly any sugar, low amounts of saturated fat and is rich in minerals and other compounds that may benefit health.

Nutritional content of cocoa

Cocoa in its raw form is a good source of minerals including iron (helps to maintain healthy red blood cell production), magnesium (helps to maintain healthy bones, promotes muscle relaxation and converts food into energy), phosphorus (healthy bones and converts food into energy), potassium (helps maintain fluid balance and helps the heart to work properly),  zinc (helps to make new cells and enzymes in the body and wound healing) and copper (helps to produce red and white blood cells and with iron usage in the body).

Nutritional breakdown of unsweetened cocoa powder per 2 heaped tsp

Calories         44

Fat                  1.9g

Sat fat             1.8g

Carb                 1.6g

Sugar              0g

Fibre               2.3g

Protein           2.6g

Also contains….

Iron                 1.57mg (11% RDA)

Magnesium    73mg   (19% RDA)

Phosphorus    92mg (13% RDA)

Potassium       210mg (10.5% RDA)

Zinc                 0.97mg (9.7% RDA)

Copper           0.55mg (55% RDA)

Other compounds found in cocoa

Cocoa is richer in antioxidants that almost any other food on the planet.  These antioxidant compounds are called flavanol polyphenols and have been shown to help reduce the risk of disease. Cocoa also contains a compound called theobromine, which acts as a stimulant similar to caffeine but without the jittery side-effects. You will also find phenethylamine (PEA) in cocoa, which is a compound that stimulates the central nervous system to amplify the action of brain chemicals including the ‘feel’ good hormones serotonin and dopamine.  Phenethylamine is also thought to mimic the brain chemistry of someone in love, which is why it’s often thought of as an aphrodisiac.

What are the potential health benefits of cocoa?

In moderation there’s nothing wrong with eating chocolate within the context of a healthy diet, but too much of anything can have its downsides and our reliance on high sugar snacks has been instrumental in the rise of diet related diseases including obesity.

Whilst overindulging on chocolate snack bars and puddings is clearly not great for your health, research has shown that there may be health benefits associated with cocoa, which is the raw ingredient.

Just to be clear, there are no benefits associated with tucking into a few packets of Minstrels and any positive impact on health is linked to cocoa in its raw form of cocoa powder or raw cacao.  The closest chocolate comes to having any health benefits is the dark variety with a high percentage of cocoa solids (70% and above), but this still needs to be eaten in moderation given its high sugar and sat fat content.

Heart disease

The polyphenols in cocoa are thought to dilate the arteries, which improves elasticity and may reduce the risk of heart attack. The effect of these antioxidants is also thought to be similar to aspirin in that they help to thin the blood and prevent unwanted clots with research showing that the effect after drinking a cup of cocoa lasting more than 6 hours (1).  Findings from a large analysis of seven studies carried out by researchers at Cambridge University found that both men and women with the highest intake of cocao were 37% less likely to suffer with coronary heart disease and 29% less likely to experience a stroke compared to those with the lowest intakes (2).

Cholesterol

Studies have shown that cocoa may have a positive impact on cholesterol, raised levels of which are considered to be a risk factor for heart disease.  Findings from a clinical trial published in the Journal of Nutrition showed that the polyphenols found in cocoa powder contributed to a reduction in LDL (bad) cholesterol, elevation in HDL (good) cholesterol and suppressed the oxidation of LDL cholesterol, which is thought to be particularly damaging to tissues such as those lining the arteries of the heart (3).   The effect on oxidation may be explained by the antioxidant effect of polyphenols as they help to protect the body from free radical damage (4).

Blood pressure

Research around blood pressure stems from islanders of Kuna that don’t appear to develop high blood pressure as they get older, which is in part attributed to the high amounts of cocoa they consume on a daily basis. It was noticed that once they left the island and consumed less cocoa they lost the protective effect on blood pressure.  The link between cocoa and blood pressure is that the flavanols it contains increase the availability of nitric oxide in the blood, which dilates blood vessels and lowers blood pressure.  Researchers from Adelaide University found that drinking cocoa (rich in flavanols) significantly lowered blood pressure when compared to a flavanol-free placebo drink (5).  Similar findings have also been shown in several other studies although the effect is not that strong (6, 7).

Brain health

Studies have shown that drinking cocoa at least 5 days of the week boosts the flow of blood to the parts of the brain that help with cognition and may improve performance and alertness (8).  The antioxidants in cocoa also help to neutralise the low-grade inflammation associated with ‘foggy’ thoughts. Studies of older people that are mentally impaired have found that those who regularly drank cocoa had greater improvements in memory and verbal reasoning than those who did not (9). It’s for this reason that cocoa has been of interest to researchers investigating dementia.

Chocolate as a functional food?

Advances in innovation have seen a rise in chocolate products with added health benefits.  Companies such as Ombar produce a dark chocolate bar fortified with probiotic cultures.

How to add more cocoa into your diet

Whilst many people enjoy eating chocolate and may understand the potential benefit of choosing dark over milk varieties, less people know how to use cocoa powder beyond a drink.

If you’re not familiar with using cocoa powder, then try these ideas below for a little inspiration:

  • Add 1 tbsp to your protein shake.
  • Add 1 tbsp to porridge.
  • Make homemade energy balls by blending cocoa or raw cacao powder, dates and chopped hazelnuts to a food processor.
  • Combine 1 tbsp with hot milk of choice for a warming evening drink rich in magnesium that helps to promote muscle relaxation and has been shown by research to induce sleep. Try adding cinnamon, ground cardamom or chilli for extra flavour.
  • Add cocoa or raw cacao powder to chilli con carne for richness and intense flavour.

The reality of chocolate and health

The truth still remains that chocolate, even dark chocolate, is never going to be considered a healthy food as it contains high amounts of sugar and saturated fat, which if eaten in excess will counteract any potential health benefits of cocoa.  However, you can reap the health benefits of cocoa by incorporating it into your diet in ways that allow you to control the amount of sugar and saturated fat.  It’s also worth pointing out that the true benefit of nutrition lies in the overall diet and not single foods so whilst the health potential of cocoa is interesting, you still need to focus on eating a well balanced and varied diet.

Try this recipe from my book The Detox Kitchen Bible.  These brownies are still a sweet treat but contain much less sugar than usual recipes and harness the benefits of cocoa.

Beetroot Brownies

Makes 9

Ingredients

150g raw beetroot, peeled and cut into small cubes

50g hazelnuts

100g gluten and wheat-free flour

1 tsp baking powder

60g raw cacao powder

120g runny honey

½ tsp salt

3 eggs

75ml rapeseed oil

Method

  1. Preheat your oven to 200°C. Line the bottom and sides of a 20cm square cake tin with greaseproof paper.
  2. Put the beetroot in a microwave-safe bowl with 50ml water, cover with clingfilm and cook on a high heat for 7 minutes until soft. If you don’t have a microwave, wrap the beetroot in foil and bake in the heated oven for about 40 minutes until soft.
  3. Put the hazelnuts in a blender and blitz until they are roughly chopped. Transfer them to a large mixing bowl. Sift in the flour, baking powder and cacao powder.
  4. Now blitz the cooked beetroot in the blender for 1–2 minutes until smooth. Add to the dry ingredients in the bowl but do not mix just yet.
  5. Using the blender for the third time, put the honey, salt and eggs in it and blitz for 3 minutes. Pour into the bowl and mix with the rest of the ingredients using a wooden spoon. Be gentle, as you want to keep air in the mixture whilst combining it thoroughly.
  6. Pour the mixture into the prepared cake tin and bake in the heated oven for about 30 minutes or until a skewer inserted into the centre comes out clean. Allow to cool completely before cutting into squares.

You can find more delicious recipes from Lilly and the gang at the Detox Kitchen website.

If you liked this blog and want to learn more about chocolate then have a read of these:

Raw cacao and avocado mousse recipe 

Raw cacao and cashew nut milk

 

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/10871557
  2. https://www.ncbi.nlm.nih.gov/pubmed/21875885
  3. https://www.ncbi.nlm.nih.gov/pubmed/17513403
  4. https://www.ncbi.nlm.nih.gov/pubmed/11684527
  5. https://www.ncbi.nlm.nih.gov/pubmed/19910929
  6. https://www.ncbi.nlm.nih.gov/pubmed/17609490
  7. https://www.ncbi.nlm.nih.gov/pubmed/22301923
  8. https://www.ncbi.nlm.nih.gov/pubmed/16794461
  9. https://www.ncbi.nlm.nih.gov/pubmed/25733639

 

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