Ultra-processed foods linked to cancer: Nutrilicious News Digest

Ultra-processed foods linked to cancer: Nutrilicious News Digest

Popular in the news this week is the story linking eating ‘ultra-processed’ foods and cancer, as reported by the Independent (‘Processed food, sugary cereals and sliced bread may contribute to cancer risk, study claims‘) the BBC the Daily Mail and The Guardian.

These headlines are based on a study published in the British Medical Journal this month. In the study, foods were classified based on the NOVA system, which relates to the nature, extent and purpose of food processing. Those falling under the category of ‘ultra-processed’ include:

  • Mass-produced bread and buns
  • Sweet or savoury packaged snacks including crisps, chocolate bars and sweets
  • Sodas and sweetened drinks
  • Meatballs, poultry and fish nuggets
  • Instant noodles and soups
  • Frozen or shelf-life ready meals
  • Foods made mostly or entirely from sugar, oils and fats

Study details and findings
A cohort of 105,000 people were followed for an average of five years. A 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant 12% increase in the risk of overall cancer and 11% in the risk of breast cancer.

Alongside the original study, the British Medical Journal have also published an editorial further explaining the findings.

Behind the headlines: the Nutrilicious dietetic view

Limitations of the study
While this story has been heavily publicised, there are several limitations of the study which mean we cannot draw firm conclusions:

  • Those who ate a lot of ultra-processed foods had other behaviours that have been linked to cancer which could skew the results. They include being more likely to smoke, being less active, consuming more calories overall and more likely to be taking the oral contraceptive. The researchers stated that their impact ‘cannot be entirely excluded’.
  • Cause and effect cannot be established for an observational study: we cannot say that ‘ultra-processed foods have caused the increase in cancer’. It is an association found.
  • The term ‘ultra-processed’ is still somewhat vague, so it’s difficult to establish which specific foods might be responsible for the increased cancer risk, and why.
  • The participants were mainly women who had decided to take part in a health and diet study themselves, so were likely to be interested in their health. This means the sample may not be highly representative of the general public.

That said, we can give credit to the large sample size used in the study giving more reliability to the findings.

Response from Cancer UK
Helping to put this study into context, Professor Linda Bauld from Cancer Research UK responded: “It’s already known that eating a lot of these foods can lead to weight gain, and being overweight or obese can also increase your risk of cancer, so it’s hard to disentangle the effects of diet and weight.”

She also said the study was a ‘warning signal to us to have a healthy diet’ but individuals should not worry about eating a bit of processed food ‘here and there’ as long as they were getting plenty of fruit, vegetables and fibre.

So, can we reduce the risk of cancer?
It’s estimated that one in two people will develop cancer at some point in their lives. Whilst some risk factors for cancer are non-preventable (such as genetics), there are still lots of things we can do to help reduce our risk:

  • Eating a healthy, balanced diet
  • Limiting red meat and avoiding processed meats
  • Maintaining a healthy weight
  • Abstaining from smoking
  • Keeping alcohol intakes below government guidelines
  • Protecting your skin from sun damage
  • Knowing your body (e.g. checking for lumps)

For more details on all of the above, go to the National Health Service. The World Cancer Research Fund also carry out a continuous review of the scientific evidence into the subject of diet, lifestyle and cancer risk. Read their cancer prevention recommendations.

Takeaway message
This study does not allow us to draw firm conclusions about ultra-processed foods and cancer. However, we should certainly be reminded of the importance of diet and lifestyle in cancer prevention.

After smoking, excess weight is one of the biggest causes of cancer and it has also been estimated that about one third of cancers could be prevented by changing our diet and lifestyle. This includes being a healthy weight, following a healthy diet and engaging in physical activity.

What changes could you make to help reduce your risk?

Reference: Macmillan Cancer and Cancer Research UK

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Going vegan can prevent diabetes: Nutrilicious News Digest

Going vegan can prevent diabetes: Nutrilicious News Digest

Plant-based diets made the headlines again this week, with coverage of a study suggesting a vegan diet can prevent type 2 diabetes. It was reported by the Daily Mail (‘Going vegan can prevent overweight adults from falling victim to diabetes’) and Medical News Today.

In the study, 75 participants were put into two groups. One group was asked to follow a low-fat, plant-based vegan diet with no calorie restriction. The other was asked to make no dietary changes for a period of 16 weeks. Participants prepared all their own meals and for both groups, alcoholic drinks were restricted to one per day for women and two per day for men.

All the participants had a Body Mass Index (BMI) between 28kg/m2 and 40kg/m2 (putting them into the ‘overweight’ or ‘obese’ categories), with no history of diabetes.

At the end of the study, the plant-based group reported:

  • Marked improvements in beta-cell functioning – these are the cells which produce the hormone insulin, which is important for controlling blood sugar levels (a key factor in diabetes where blood sugar levels are elevated or harder to control).
  • A significant increase in how well the body responded to insulin – when the body is less sensitive to the hormone insulin, it increases the chances of developing type 2 diabetes.
  • A decrease in BMI and body fat levels – this is important because excess body weight is strongly associated with increased risk of type 2 diabetes.

It was reported that neither group made any changes to their physical activity regimen, nor did they change the use of their medications.

Read more details of the original study


Behind the headlines: the Nutrilicious dietetic view

Whilst this is yet another study showing positive effects arising from a plant-based diet, we must be aware of its limitations:

  • Efforts were made to help ensure adherence to the diet (such as dietitian telephone calls to the participants and food diaries completed at the start and end) but this still relies on the honesty and accuracy of the participant.
  • As noted by the researchers, the participants used in the study were ‘generally health-conscious individuals’ who were willing to make significant dietary changes. Thus, we cannot be sure findings would be representative of the general population if they were to eat a vegan diet.
  • The study is too short and too small to show conclusively that a vegan diet prevents type 2 diabetes.
  • The meals were prepared by the participants and thus any changes or fluctuations were not controlled or recorded.

On the other hand, a strength of the study is that it was a randomised controlled trial, which is the gold standard in research for measuring the effectiveness of an intervention.

The link between plant-based diet and reduced risk of diabetes
The researchers recognised that the major factor accounting for the reduced risk of type 2 diabetes in the plant-based group was the weight lost (including visceral fat lost).

The link between the two is well established. Research shows that for every kilogram of weight loss, there is a 16% reduction in risk or type 2 diabetes.*

The generally higher fibre and lower fat content of plant-based diets (which also includes vegetarian diets) would be expected to be helpful in reducing the energy density, and thus total calorie content of the diet. This could help with reducing obesity.

*Hammam et al (2006) Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes.

Takeaway points
In the UK, 11.9 million people are at risk of developing type 2 diabetes: prevention is clearly of great importance. The disease can have both short-term and long-term complications.

Further research will be needed to determine whether a vegan diet could prevent type 2 diabetes, and whether the positive improvements noted in this study require a strict vegan diet or whether the positive effects could be achieved with smaller changes.

Evidence shows the best ways to reduce risk of type 2 diabetes include:

  • maintaining a healthy weight;
  • eating healthily; and
  • keeping physically active,

Adopting principles from a plant-based diet can certainly help with the first two points. The range of benefits of adopting a more plant-based diet are discussed further in last week’s blog.

For more information on reducing risk see Diabetes UK alongside their useful information about veganism and diabetes.

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Vegetarian and vegan diets more popular than ever: Nutrilicious News Digest

Vegetarian and vegan diets more popular than ever: Nutrilicious News Digest

The rise in popularity of vegetarian and vegan diets is in the news, including stories in the Daily Mail INews. This comes following a release by Kantar Worldpanel of supermarket sales figures and analysis of consumer behaviour. It revealed:

  • Over January 2018, one in ten shoppers purchased a meat-free ready meal. This has increased by 15% compared with the same time last year.
  • During January 2018, 29% of evening meals were now free of meat and fish.
  • Britons consumed 3.9 billion meat free evening meals in the 12 months to October 2015. This rose to 4.3 billion in the 12 months to October 2017.
  • As a nation, we consumed 87 million more entirely vegan-friendly meals in 2017 than in 2015.

Announcements of product sales and ranges underscore these figures. In just two examples, it was also reported in the news this week that sales of Quorn (a meat substitute product) have increased globally by 16%. Last month also saw Tesco bring out their own vegan range, Wicked Kitchen, highlighting the increasing demand for more plant-based options.

Behind the headlines: the Nutrilicious dietetic view

There are many reasons why we could be seeing an increase in the popularity of meat free meals.

The trend of ‘Veganuary’ (where individuals adopt a vegan diet for the month of January) is likely to have contributed to the findings which related to the month of January 2018.

Richard Allen, a spokesman for Kantar Worldpanel, emphasised increasing access to meat-free foods: “The surge in vegetarian evening meals over the past year is down to the wider availability of products which make eating meat-free more attractive and practical.”

He continued: “Our ideas about what’s healthy are also changing – we’re more focussed on foods that are natural and less processed and eating a varied diet.”

What are the benefits of a plant-based diet?

The evidence for plant-based diets is growing and can offer many benefits. Indeed, the updated ‘Eatwell Guide’ saw that plant sources of protein were listed ahead of animal food sources of protein. The protein group now has the title ‘Beans, pulses, fish, eggs, meat and other proteins’, highlighting the increased role plant-based diets can play.

Benefits of adopting a more plant-based diet include:


  • Research has shown that vegetarian and vegan populations tend to have lower blood pressure, cholesterol levels and rates of cardiovascular disease compared to their omnivorous counterparts. This could be due to less saturated fat in the diet and more polyunsaturated fats, in addition to other cardio-protective components in the diet such as soya and nuts.
  • Plant-based diets tend to have a more balanced macronutrient profile. For example, the higher fibre content of plant-based diets is often accompanied by lower fat intakes. This can help reduce the energy density of the diet and thus help reduce the total energy (calorie) intake. This could help prevent people being overweight/obese, and therefore any related negative effects and co-morbidities (e.g. type 2 diabetes, increased cancer risk etc).


  • Animal foods are resource intensive (energy, land and water) and thus tend to have higher greenhouse gas emissions compared to plant foods per unit weight.
  • Modelling work has shown that reducing the amount of animal foods in the diet will make a critical contribution to climate change mitigation.


  • Recent research has suggested that the British government could reduce its healthcare and societal costs by £5.21 billion if just 10 per cent of the UK population emphasised plant-based foods in their diet.

References: Clarkson V, Plant Food Sources of Protein for Optimum Health, Muscle Status and Sustainability – The Evidence and Practice and Schepers J & Annemans L., The potential health and economic impact of plant-based food patterns in Belgium and the United Kingdom. Nutrition 15th December 2017 (in press)

Does this mean meat is off the menu?

Gaining the benefits of a plant-based diet does not have to mean a diet no with meat at all. A ‘flexitarian‘ diet is predominantly plant-based without completely eliminating meat and can be extremely beneficial for health and reducing carbon footprints.

Indeed, meat, poultry and fish are nutritious foods and can provide a range of nutrients beneficial for health. We are advised by the NHS to have two portions of fish per week, one of which is oily. They also advise how meat can fit into the diet.

Takeaway points

We welcome findings that plant-based meals are being explored and becoming more popular. We encourage everyone to enjoy a varied diet featuring a wide variety of plant-based whole foods.

Overall, plant-based eating isn’t new. It’s not radical. And it’s definitely not about cutting things out. A plant-based diet shouldn’t be defined by what it excludes, but by what it includes. The core message is ‘put plants first’. Instead of planning meals around meat, bring veggies, fruits, whole grains, pulses, legumes, nuts and seeds from the side of the plate to front and centre.

It doesn’t have to be wholesale change: many benefits can be achieved by simply reducing intake of meat rather than following a strict vegetarian or vegan diet. We recommend making small steps to include more plant-based foods and meals in your diet, to benefit your health and the planet.

If you do decide to go further, the NHS gives advice on ensuring a vegetarian or vegan diet is balanced. The British Dietetic Association are part of an important alliance with the Vegan Society to share the message that all well-planned vegan diets can support healthy living in people of all ages.

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Is soya milk the healthiest alternative to cow’s milk?: Nutrilicious News Digest

Is soya milk the healthiest alternative to cow’s milk?: Nutrilicious News Digest

Each week we investigate the nutrition and diet topics making the headlines. This week, the Daily Mail discussed the health profiles of non-dairy milk alternatives.

The article was based on a study in the Journal of Food Science and Technology titled ‘How well do plant-based alternatives fare nutritionally compared to cow’s milk’?

The four most consumed non-dairy milk drinks were studied: almond, soy, rice and coconut milk (all unsweetened varieties). Nutritional values were obtained from the food packaging and the USDA database.

The review discussed the pros and cons of each milks, with the aim to help make consumers be able to make a more informed decision. Their main findings were as follows:

Coconut milk Almond milk Rice milk Soya milk

Low calories

No proteins
Rich in saturated fats
Balanced diet
Low calories

Almond allergy
Comparable caloriesCons
Rich in sugar
Unbalanced diet
Rich in protein
Balanced dietCons
Soy allergy

The headlines point to soya is the best alternative to cow’s milk, with researchers concluding that, ‘among alternative milks only soy milk contains comparable amounts of nutrients’.

More detailed findings and rationale for each of the points above are all discussed in the original study, alongside nutritional values for each of the milks.

Behind the headlines: the Nutrilicious dietetic view

The study is especially relevant because of the increasing popularity of non-dairy alternatives to milk and the increasing recognition of the health benefits of plant-based diets, and plant foods being more environmentally sustainable. Indeed, the latest ‘Eatwell Guide’ from Public Health England updated the name of one of the food groups from ‘Milk and Dairy Foods‘ to ‘Dairy and Alternatives’, highlighting the growing role of such foods in our diets. Plant food sources of protein were listed ahead of animal food sources of protein for the first time: the protein food group is now called ‘beans, pulses, fish, eggs, meat and other proteins’.
See our blog on the new Eatwell Guide

There are many reasons why people are choosing such products, including health, environment, allergies and intolerances, and veganism.

Our assessment of the study

  • A good amount of data was analysed. For a non-dairy milk to be included within this study, at least four examples had to be available for each type of milk.
  • The study uses American data. We cannot be sure findings will be the same for the UK and Irish products, although they are likely to bear many similarities. Opinions were also gathered regarding taste of the different milks and the UK population may react differently.
  • Due to missing data, the research did not cover all the vitamins as intended.

One of the main conclusions from the study was that soya milk contained more protein than other alternatives. We did our own analysis of the four unsweetened* milks, alongside two other unsweetened milks available for reference. Here are our findings:

Cow’s milk (Semi skimmed) Coconut milk Almond milk Rice milk Soya milk Oat Milk Cashew milk
Per 100ml (mean values)    
Energy, kcal 47 36 13 47 29 40 26
Fat g 1.8 1.5 1.1 1.0 1.5 1.0 1.0
Sat fat g 1.1 1.4 0.1 0.2 0.3 0.1 0.2
Sugars g 4.8 3.3 0.1 6.2 0.5 3.7 1.7


Protein g 3.6 0.2 0.5 0.1 2.7 0.7 0.5
Calcium mg 123 120 120 120 120 120 120
Vitamin D2 ug 0.00 0.75 0.89 0.89 0.75 0.75 0.75
B12 ug 0.91 0.38 0.38 0.38 0.38 0.38 0.38

Values from Forestfield Dietplan 7, National Dairy Council – the nutritional composition of dairy and plant-based drinks nutritional information: a range of current products on the market. *There are also sweetened versions of these products on the market.

Is soya milk the best non-dairy alternative?

  1. Protein The most notable similarity between cow’s milk and soya milk compared to the other non-dairy milks is the higher protein levels, as highlighted in the original study. While this has grabbed the headlines as being highly beneficial, for the majority of the UK population protein intakes are in fact in excess of requirements. The UK National Diet and Nutrition Survey shows that only 7–8% of protein for those aged 11–65+ comes from cow’s milk. Calling one milk ‘healthier’ than the other based on this alone is generally not useful or appropriate. Single food measures of protein content or indeed quality do not reflect the scale of impact across the total diet and not enough attention is given to this key consideration.
  2. Calcium Cow’s milk is known to be a great provider of the UK’s calcium intake, providing from 26% in 4–10 year olds to 18% in 11–18 year olds and in 19% in adults aged 19–64. We can see that all of the non-dairy alternatives to cow’s milk closely match this. They are also fortified with vitamin D, which aids in calcium absorption and is beneficial for bone health. Cow’s milk in the UK does not have vitamin D.
  3. Saturated fat One benefit of all the non-dairy milks is that they are generally lower in saturated fat than cow’s milk, providing 0.1–0.6%. Coconut milk is the exception, with levels higher at 0.9–1.9%. One 200ml glass of coconut milk provides 2.8g saturated fat on average, whereas the other non-diary milks average at 0.4g saturated fat. The coconut milk ranks ‘medium’ for saturated fat under the drinks traffic light labelling system, the others are ‘low’.
  4. Cholesterol Looking more specifically into soya and the advantages it can have for health, one point not discussed in this study is that soya can also help reduce cholesterol levels. This forms part of the Ultimate Cholesterol Lowering Plan from HEART UK.
  5. Iodine This essential trace element is an important component of the thyroid hormones. A recent study from the University of Surrey investigated 14 non-diary milks in the UK and found that iodine levels were only 2% that of in cow’s milk. Women of childbearing age and pregnant women are most at risk of deficiency. Information on alternative sources of iodine are discussed on a British Dietetic Association (BDA) iodine factsheet.
  6. Is soya ok? Soya products such as soya milk alternatives often hit the news, with suggestions they can be bad for our health. However, many of these claims are untrue, as discussed on the BDA Fact Sheet for Soya. Soya forms part of a healthy balanced diet. The British Heart Foundation also discusses the role of soya milk as a replacement for cow’s milk. A very recent review of plant food sources of protein for optimum health by Dietitian Vanessa Clarkson can be found on this plant protein fact sheet


A healthy alternative for adults
For those looking to replace cow’s milk in the diet with a plant-based milk, fortified soya milk bears the most nutritional similarities to cow’s milk. However, the other plant-based drinks analysed also provide many of the nutrients. Its crucial to consider them in the context of the whole diet and we feel confident that these products can contribute to a healthy balanced more plant-based diet for adults.

Which non-dairy milk is considered the ‘best’ will depend on individual needs, with personal taste playing an important role. Faced with so much choice, here are some points to consider when buying a non-dairy alternative to milk:

  • Choose non-dairy milks that have been fortified with calcium and vitamin D for bone health. Organic varieties and homemade milks may not contain high enough levels – read the label.
  • For vegans in particular, choose a milk that has been fortified with vitamin B12 – often found to be low in the vegan diet. Other groups at risk of low vitamin B12 including vegetarians, the elderly and individuals with gastrointestinal disorders.
  • Choose unsweetened varieties where possible to minimise intake of free sugars.
  • Soya milk is higher in protein than other non-dairy alternatives, although lower protein milks should not pose an issue for the general adult population.
  • Soya milk can help as part of a cholesterol-lowering diet.
  • Coconut milks will be higher in saturated fats, which can raise ‘bad’ LDL cholesterol levels.
  • Swapping cow’s milk for non-dairy alternatives could result in a lower iodine intake unless the milk has been fortified with iodine. Some may be fortified – read the label if there is a concern.
  • As with any food or drink product, don’t just treat it in isolation: it’s the total dietary intake that’s important. Whether having dairy milk or a substitute, we need to make sure that our overall food intake is healthy and nutritionally balanced.

Non-dairy milks for children
Parents of children wishing or needing to avoid cow’s milk should seek dietetic advice to ensure their diet is balanced at every age. See the British Dietetic Association factsheet for more information


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Gluten free foods are less healthy: Nutrilicious News Digest

Gluten free foods are less healthy: Nutrilicious News Digest

This week we explore the headline ‘Gluten free foods are more expensive and less healthy’. The story was picked up in The Independent and The Sun, amongst others.

It is based on a study published in the Journal of Human Nutrition and Dietetics, which compared the nutritional information and cost of gluten free foods available in the UK (679 products) and comparable regular foods (1045 products).

Findings from the study include:

  • More gluten free foods were classified as containing high and medium fat, saturated fat, sugar and salt (HFSS) compared to the regular foods, using the traffic light labelling system.
  • More gluten free bread and flour products contained high fat and sugar.
  • Fewer gluten free crackers contained high fat and sugar.
  • Gluten free products were more likely to be lower in fibre and protein than regular foods.
  • Gluten free foods had higher salt content than regular products.
  • Gluten free products were 159% more expensive than the regular ones (working out as £1.14/100g vs £0.44/100g).

Behind the headlines: the Nutrilicious dietetic view

We should note there were some limitations to the study:

  • It’s a comparison of products and did not look at actual overall dietary nutrient intake of people who eat gluten free food. So we don’t know the context of these findings: one person may have an overall more healthy diet than someone else.
  • Composition of foods is based on food labels and not the chemical analysis (the gold standard method).

Nevertheless, it analysed a significant number of products and is very relevant and important to consider. Although the traffic light labelling system is only one way to look at whether a food is healthy, it is still a useful guide. Gluten free foods were typically higher in HFSS.

Let’s look at just one of the nutritional differences found: fibre. Overall it was found that gluten free foods are often lower in fibre. The latest report from the Scientific Advisory Committee on Nutrition (SACN) on Carbohydrates and Health recommended that adults aim for 30g fibre per day. The current average falls below this at 18g per day. In the analysis, regular wholegrain pasta averaged at 8.0g fibre per 100g (a large single portion), whereas the gluten free comparison averaged at just 3.2g.

A number of foods included within the study are processed; the gluten free varieties will often have ingredients added to replace the gluten, which can cause problems in terms of nutrition.

Following a gluten free diet

A gluten free diet is necessary for medically diagnosed conditions, for example coeliac disease.

Following a Department of Health consultation, some UK National Health Service Trusts have compromised and/or withdrawn gluten free prescriptions. There is a concern that not all individuals with coeliac disease will be willing to spend the extra money on gluten free foods and suffer health problems as a result. Coeliac UK are currently campaigning to try and protect gluten free prescriptions. See details here

Sarah Sleet from Coeliac UK responded to the study: “It’s really important that the quality of gluten free foods is as good as that available for all consumers. We’re not surprised to see the research shows the high cost of gluten free food, which will make it difficult for patients with coeliac disease, particularly the most vulnerable, to stick to the gluten free diet should the Department of Health remove gluten free food on prescription.”

The trend

In recent years, following a gluten free diet has become a wider trend, with many celebrities following it. This study of a significant number of products highlights that following such a diet without a medical need for it may not have any nutritional advantages over a regular diet. Not to mention it costs a whole lot more.

Takeaway points

  • Many whole foods are naturally gluten free e.g. quinoa, brown rice, pulses. Opting for these, rather than the foods trying to mimic/replace gluten, could be of benefit to those following a gluten free diet.
  • In reality, many will continue to choose ready-prepared options and rely on such foods such as shop-bought bread. So people who medically require a gluten free diet need access healthier foods at a lower cost, especially in light of prescription cuts.
  • If you’re someone who chooses gluten free because you think it’s healthier, check the nutritional values of products carefully.
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