The facts and figures around heart health and cholesterol are stark. Coronary heart disease (CHD) remains one of the major killers in the UK and Ireland, with 64,000 UK adults and 4,140 Irish adults dying of CHD every year.
The incidence of CHD saw an impressive decrease in the past decade thanks to better medical intervention and reduction in smoking. However, that has plateaued and incidences are beginning to rise again due to increasing rates of obesity and type 2 diabetes, compounded by the fact that we are living longer.
What can we do about it? Actually, a lot. Around 93 per cent of deaths from CHD have been attributed to risk factors that can be modified – dietary habits and lifestyle. High cholesterol levels are one of the major risk factors to CHD.
This October, HEART UK’s National Cholesterol Month, sees the launch of the updated Ultimate Cholesterol Lowering Plan (UCLP©). It’s a science-based approach to encouraging diet change to include foods proven to improve heart health – and particularly lower cholesterol levels.
Originally developed in 2011 by HEART UK with the science and nutrition team at Alpro, the step-by-step plan is based on both heart health science and behavioural strategies. It can be tailored to meet any individuals’ motivation level and preferences – users are encouraged to build the plan that suits them best, so that change is realistic and easy to maintain. They’re encouraged to incorporate more changes only as and when they feel ready to do so.
It’s made up of three steps:
1. Improving motivation and tackling barriers to change.
2. Establishing a heart healthy foundation diet.
3. Incorporating four UCLP©-specific foods to the foundation diet, proven to impact on cholesterol levels:
– Soya foods
– Oats and barley
– Foods and drinks fortified with plant stanols or sterols
– A daily handful of any unsalted, unsweetened nuts
A new scientific review for healthcare professionals shows how the latest evidence supports the UCLP© guidelines, including the benefits to heart health of:
– Reducing saturated fat and partly replacing it with heart healthy unsaturated fats: for example, replacing high saturated fat meat with plant proteins such as beans, lentils, nuts and soya; or switching from full cream dairy products to lower fat versions or plant-based drinks and yoghurt alternatives.
– Increasing oil rich fish
– Encouraging higher fruit, vegetable and wholegrain intake
The review should give confidence to the healthcare professionals that advising their patients to follow the UCLP© will have positive outcomes; equally the patients will know it’s trusted by experts. On Wednesday 30 November a special UCLP© NutriWebinar will explore the science in detail and help health professionals understand how to apply the plan. It’s free and CPD-accredited; we hope you’ll join us for it. Sign up for the UCLP© NutriWebinar
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When it comes to food choices, what should we be advising those suffering from type 2 diabetes to help them manage weight and glucose?
Do we focus on a low carb diet?
Cutting out fat?
Or just the simple principle of sticking to Eatwell guidelines?
Media headlines continue to offer 101 different – conflicting – solutions. So what’s the truth? How can we piece together this apparent mess to best support those with diabetes?
Next week, in the second in our series of diabetes NutriWebinars, expert Dr Duane Mellor, RD, Senior Teaching Fellow at Aston Medical School, Aston University will be exploring these topics.
Looking at how advice has shifted over the past few decades, he’ll be talking through the latest evidence and explaining what health professionals can do to actually help people living with type 2 diabetes.
The webinar will also cover evidence from the last couple of years that shows that type 2 diabetes is not necessarily always a condition for life: through weight loss and maintenance, we can actually help people go into remission.
Fundamentally, it’s about putting the person with the condition at the centre – rather than trying to force them into eating habits that don’t suit their lifestyle, culture or preferences. Instead of concentrating on specific nutrients at specific times of the day – ‘you must have starchy carbs at breakfast’ – it’s working out what works for them, at the same time as creating an overall balanced diet.
Inviting questions and ideas from participants, the NutriWebinar is set to be an interesting, informative and empowering evening. (Plus, it’s free and counts as CPD.) We hope you’ll join us and encourage colleagues to join in too: register now
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At long last, the Scientific Advisory Committee on Nutrition (SACN) report on saturated fats and health was published this month. The conclusion? Nothing new: saturated fat leads to heart disease and we should limit it to 10% of our calorie intake. So will it finally put an end to the irresponsible advice that abounds suggesting saturated fat isn’t so bad for you?
It’s taken over a year from the draft report to final version because of the number of comments, criticisms and questions as to why certain studies were or weren’t included as part of the overall evidence into sat fats.
The SACN committee has investigated and answered each one, including only the highest quality evidence available. The studies that came to the wrong conclusions about saturated fat were shown to be flawed.
They’re open about certain limitations to the evidence: for example, whether replacing saturated fat intake with carbohydrate can be beneficial. None of the studies look specifically at ‘good’ carbs (for example wholegrain cereals), just at carbs overall. Further research still needs to be done into this.
But the overall conclusion was inescapable: to reduce cardiovascular disease we should lower our intake of saturated fat.
So will high profile influencers like Dr Michael Mosley or Joe Wicks take note and stop promoting ingredients like coconut oil, which is shown to have higher saturated fat than butter and lard?
Sadly, we think it’s unlikely. For one reason or another they seem to have too much invested in it.
But if you’re reading this and feel as strongly as we do about the need to stop the irresponsible advice, join us in canvassing the influencers to open their eyes to the dangers of what they’re suggesting – rather than just thinking about their commercial interests or looking for the next great headline. #saynotosatfat
Go to the British Nutrition Foundation website for a summary of the SACN report findings
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‘The levy is working.’ That’s the conclusion from a recent survey of drinks sales, a year on since the Soft Drinks Industry Levy (SDIL) – or sugar tax – was introduced.
The study concentrated on products that sell in large enough volume to have a public health effect. In a ‘historic change’, sales of Coke Zero Sugar increased by 50 per cent and Pepsi, sugar-free Max by 17 per cent. Full sugar Classic Coke and Blue Pepsi sales both fell.
The shift is attributed to the sugar free drinks being cheaper than their full sugar equivalent, as a result of the SDIL. Giving consumers the economic incentive to buy drinks that are healthier has worked. As the authors of the study say, ‘Discounts have had the effect that economists expected and health specialists hoped for.’
New sugar free versions of popular drinks are being increasingly sold in major retailers, with the hope that they’ll also become more prominent in smaller, independent shops. The positive trend is moving in the right direction – and it’s happening relatively quickly.
More needs to be done from a retail environment point of view, especially alerting customers to the discounts. Non-lead brands do still have work to do on reducing their sugar levels – although affecting a far smaller number of individuals, they still impact on health. And of course, the drinks industry is just one part of the wider obesity story.
We wondered what the effect of the sugar tax would be when it was introduced. So it’s fantastic to hear the dramatic change that’s already happened – and we’ll be monitoring the year ahead with interest.
The study was carried out by Jack Winkler, Emeritus Professor of Nutrition Policy, London Metropolitan University and Tam Fry, chair National Obesity Forum. Go to BeverageDaily.com to read the full results
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According to headlines, iodine deficiency is the latest threat to our health in the UK. What’s more, the media says, poor iodine status is due to the rise of veganism and our increasing love for plant-based drinks as milk alternatives.
The headlines focused on the fact that dairy milk is our main source of dietary iodine, whilst plant-based drinks (with a few exceptions) do not contain iodine.
But is lack of iodine an issue? Could an increased consumption of plant-based drinks put people at risk of iodine deficiency?
It’s a complicated issue, but let’s look at the facts…
Is iodine important in the diet?
Yes. Iodine is essential. The body needs iodine to make thyroid hormones, which is fundamental for foetal and young children’s growth and brain development. Severe iodine deficiency in pregnant women can cause irreversible brain damage in their offspring. Population studies have also demonstrated a lower IQ score of around 13 points in severe iodine-deficient populations compared to iodine replete populations. The World Health Organisation (WHO) has stated that low iodine status is the single most preventable cause of brain damage in the world.
Adequate iodine status is especially critical for women of child-bearing age, during pregnancy and whilst breast feeding, to ensure optimal brain development in the foetus and young infant. Continued optimum intake in childhood and adolescence is fundamental as the brain continues to develop. It is important to note that folate, iron and long-chain omega-3 fats are also critical to brain development.
Severe iodine deficiency is rare in developed countries like the UK. However, there are significant numbers of women, especially of child-bearing age who are mild to moderately iodine deficient. A number of recent meta-analysis (including findings from UK population groups) indicate a high probability of compromised cognitive development in children whose mothers had mild to moderate iodine status during pregnancy. How significant these lower IQ scores are to cognitive ability in adulthood has yet to be established.
Measuring iodine status of a population
Median urinary iodine concentrations (UIC) are the best way to assess the iodine status of a population or large group. This is because the iodine content of foods is too variable to rely on dietary intakes as a measure of iodine status.
How the WHO classifies iodine deficiency.
|For a healthy population 6 years and older
||For pregnant and breast feeding women
|Median UIC is below 100mg/L AND
If 20% or more of that population has a median UIC of less than 50mcg/L.
|Median UIC below 150mcg/L
Does the UK have an iodine deficiency problem?
According to the latest National Diet and Nutrition Survey (NDNS) using WHO criteria, from an overall population perspective we’re actually not doing badly, with all age groups and sexes showing adequate iodine status.
However, severe to moderate deficiency (UIC <50mcg/L) still afflicts a significant number of our population:
• Approximately 1 in 10 children aged 4-18 years
• 14% of adults 19-64 years
Unfortunately, the NDNS does not currently perform UIC measures in pregnant women or the under 3s, the most susceptible population groups to low iodine status.
Women of child-bearing age (16-49 years) are classified as iodine replete, with a median UIC of 102mcg/L.
However, almost 70% of them would be classified as mildly to moderately iodine deficient if they were to become pregnant – i.e. UIC levels below 150mcg/L – when taking account for the increased demands of the foetus and young infant.
As a result, many are calling for the government to review the UK’s iodine initiatives, especially for women who are planning/are pregnant, or are breast feeding.
How does what we eat impact on our iodine levels?
The ocean is nature’s source of iodine, thus fish, seaweed and algae are rich sources. Additionally, coastal soil regions will acquire some iodine from coastal waters.
Therefore, higher intakes of seafood are paramount for adequate iodine status and studies have found seafood intakes to be positively correlated with iodine status.
In the UK, fish intakes are exceptionally poor. Few meet the government’s recommendation of two 140g servings per week. Average total fish weekly intakes in the UK:
• The majority of 4-18 year olds consume no more than 56g.
• The majority of adult women (19-64 years) consume 84g fish.
• The majority of adult men (19-64 years) consumer nearly 100g fish.
Iodine and dairy milk
In the UK, farming practices were changed in the 1930s to eradicate the high incidence of iodine deficiency. Animal feeds were fortified with iodine and the use of sterilizers containing iodine were introduced. This resulted in a significant increase in iodine levels of dairy milk and a consequent eradication of severe iodine deficiency.
Winter milk is significantly higher in iodine compared to summer milk, as dairy cattle are more likely to reared indoors with fortified feed in the winter months.
Thus the key source of iodine in the UK is indeed dairy milk – contributing to 34-40% iodine intakes in adults and 40-51% iodine intakes in 4-18 year olds.
Could plant-based drinks place the nation at risk of Iodine deficiency?
It is true that the majority of plant-based drinks do not contain iodine. However:
1. Incidence of mild to moderate iodine deficiency in pregnant women has actually been high in the UK since the 1990s, when milk intake was at its highest.
2. Despite the recent popularity of plant-based drinks, dairy milk intakes have seen little reduction. And plant-based drinks consumers also continue to drink dairy.
Since 2010, milk intakes have reduced by just 74mls per person per day (a 6.5% decrease), while plant-based drinks – although on a sharp incline – equate to just 45ml per person per day.
Therefore, plant-based drinks – whether they are or not fortified with iodine – are not the cause of the iodine deficiency that has been present for many decades.
• Cognition is affected by multiple environmental, psychological as well as dietary components e.g. pollutants, home environment, education level, various nutrients including vitamin D, iron, folate and iodine.
• Iodine is not highlighted in advice provided to expectant mothers, nor is it on the government agenda.
• No studies have indicated vegan populations, who exclude all dairy, to have lower IQ levels compared to omnivores.
There are also effective initiatives that have helped to eradicate severe iodine deficiency
• The WHO Iodized Salt programme has been adopted in many countries and proven to be successful.
• Iodine supplements have shown to be effective when given to women in the first or second trimester of pregnancy.
1. Many factors are at play when considering brain development of the foetus and young infant:
– Adequate intake of a number of nutrients, including iodine but also iron and folate
– Optimal environmental and psychological settings.
‘Fixing’ one aspect or one nutrient is not the answer to helping optimise cognition in the UK.
Saying this, iodine is one of the essential nutrients for brain development. That has been overlooked and needs to be addressed by the government, on a similar level to iron, folate and vitamin D – especially for expectant women and breast-feeding mothers. Monitoring iodine status needs to be instigated by the government for these groups and young children.
2. The increase in plant-based drinks’ popularity is not the cause of the sub-optimal iodine status in the UK, which has been prevalent in pregnant women for decades – way before plant-based drinks became mainstream.
Rather, the poor dietary patterns of the UK population need to be addressed, especially with regard to our less than optimal fish intake – the richest source of iodine.
Whenever we see the media headlines expounding the ‘benefits’ or ‘dangers’ of individual nutrients or foods, we worry. After 20 plus years in public health nutrition and communications, we believe there is a responsibility and an urgent need for all involved in this field to move away from doing this. In the majority of cases it’s not helpful and is more often scaremongering.
a. We need communications to focus on a balanced food intake. Focusing on a single nutrients in the media is dangerous and ignores all the bigger questions that need addressing: especially obesity and its many associated diseases and “how to” best help the nation enjoy a healthy balanced food intake for optimum health.
b. We need food and health communications that are not only healthy but also sustainable for our planet. Current scientific evidence repeatedly highlights the impact that our food choices have on the environment because of their significant contribution to greenhouse gas emissions, deforestation, biodiversity loss, and destruction of the ecosystem, use of fresh water and polluting of soil.
Beef and dairy cattle farming have been highlighted as the major dietary contributors, whereas plant-based drinks have been shown to be significantly more sustainable.
Leading experts have concurred that a balanced diet that is based predominantly on plant foods – including plant-based drinks – with lower intakes of meat and dairy, without having to exclude them altogether, is both sustainable and nutritious. Read our Sustainable Diets blog for more information.
It is incumbent upon all food and health influencers to incorporate these messages into all relevant food and health communications. Unfortunately, this is not yet being considered widely.
1. Chambers L. Are plant-based milk alternatives putting people at risk of low iodine intake? Nutr Bulletin 2018;43:46-52
2. PHE. Results of the National Diet and Nutrition Survey (NDNS) rolling programme for 2014 to 2015 and 2015 to 2016. 2018 [cited 5/11/2018]
3. WHO-UNICEF. Assessment of iodine deficiency disorders and monitoring their elimination. Third Edition. 2008 [cited 9/25/2018]
4. Bath S, Rayman M. A review of the iodine status of UK pregnant women and its implications for the offspring. Environ Geochem Health 2015;37(4):619-29.
5. Levie D, Korevaar TIM, Bath SC et al. Association of maternal iodine status with child IQ: a meta-analysis of individual-participant data. J Clin Endocrinol Metab. 2019 Mar 28. [Epub ahead of print]
6. Dineva M, Rayman MP, Levie D et al. Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts. Eur J Nutr. 2019 Feb 8. [Epub ahead of print]
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