Currently 2.3 million people in the UK are living with heart disease, at an annual cost of £953m to the NHS. We’re involved in an on-going battle to try to reduce it.
For those in the health industry, the link between high cholesterol and heart disease is well known. Meta-analyses, genetic studies and randomised controlled trials totalling more than 2 million participants, 20 million person-years of follow up and 150,000 cardiovascular events demonstrate a close correlation between cardiovascular disease (CVD) and high levels of low-density lipoprotein cholesterol (LDL-C).
What’s less known is the impact plant stanol esters can have on lowering cholesterol.
Changing behaviours of those at risk of heart disease
GPs and practice nurses are key influencers when it comes to persuading people to change their lifestyle to improve their health. So it’s vital to make sure these healthcare professionals (HCPs) have the facts – and materials – they need to support this.
In a survey we undertook this year of HCPs on behalf of Benecol, we found that persuading patients to improve their diet change is a key priority when it comes to reducing cholesterol – along with cutting smoking and increasing physical exercise.
We discovered that while the HCPs are well aware of the importance of cutting saturated fat and sugar, and want to communicate about healthier eating to patients, they are less likely to know the impact plant stanol esters can have on lowering cholesterol.
Plant stanols and sterols can reduce cholesterol by up to 10% in two to three weeks.
Over 70 clinical studies have demonstrated that plant stanols effectively lower cholesterol.
How do they work?
Consumption of foods with added plant stanols or sterols (1.5 – 2.4g/day) should take place at meal times. Mixing with food and digestive juices results in the displacement of dietary and biliary cholesterol in the fat absorption pathways in the gut.
Cholesterol absorption is reduced by about 50% and studies have shown a dose-dependent reduction in circulating LDL-C of 7 – 10% on average.
Cholesterol begins to lower immediately. With continued use full reduction is achieved within 2 – 3 weeks and is sustained over the longer term. What’s more, if used alongside statin therapy, plant stanols lower LDL-C by an additional 10% – an effect greater than doubling the statin dose, which, at best, only provides a 6% additional LDL-C reduction.
Plant stanols provide an easy diet-based solution to all hypercholesterolaemic patients, including those with mildly elevated serum cholesterol level. They would also be especially recommended for those averse to taking statins, anxious to keep statin doses low, or at higher risk from potential statin-related side effects.
They are recommended by a number of prevention and treatment guidelines as part of a cholesterol-lowering diet, including the European Society of Cardiology, the Atherosclerosis Society, UK JBS3 guidelines and the World Health Organisation.
Our holistic communications approach to help reduce cholesterol
As a result of our research, we created a holistic communications approach in association with HEART UK – the Cholesterol Charity and leading heart health dietary specialists – to support practice nurses and GPs, and their patients.
- We created information sheets for the healthcare professionals with full information about dietary changes patients can make to lower LDL-C levels. Included in this was the latest evidence not only on plant stanols but on all dietary recommendations for lowering LDL-C.
- Alongside this were fact sheets for patients, clearly explaining the problem of high cholesterol and the lifestyle changes that would have a significant impact on their health.
We highlighted the key motivators for patients – the fact that a small change would bring quick results.
Companies are accused of only being interested in their profits – and of course, they are ultimately accountable to stakeholders, so money is always going to come into it.
But what we found with Benecol’s approach is that they are genuinely determined to help combat the huge problem of heart disease that exists. Reaching out to health professionals they wanted to understand issues fully and how best to communicate lifestyle change – not just dietary, which would help promote the message of plant stanols, but also more widely, include all dietary matters as well as smoking and exercise.
The materials tell the whole story, educating the professionals and patients and then leaving it in their hands how to act.
Health professionals responsible for communicating heart health cholesterol lowering advice can order these packs by calling the Benecol Helpline 0800 018 4010 and asking for your health professional Benecol Toolkit ‘Small Change, Big Results’ pack.
A new World Wildlife Research Fund (WWF) report, Eating for 2 Degrees – New and Updated Livewell Plates, calls on the UK Government and Climate Change Committee to set goals for reducing emissions from the food sector. Following-up from the original 2011 WWF Livewell report, it aims to ‘provide diets that are good for both people and the planet.’
There are new plates developed specifically for adolescents (10–17 years old), adults (18–64), the elderly (65–85) and vegans. They illustrate the absolute minimal dietary changes needed by 2030 to keep below a two-degree rise in global temperature, as per the 2015 Paris Climate Change Agreement. The new Livewell Plates are described as,”representative diets that meet national nutritional requirements while reducing the environmental footprint of the food system that produces them.”
The Plates were based on modelling from Public Health England’s Eatwell Guide and current dietary intakes as baselines. They aim to create a diet with the fewest possible changes to current recommendations while meeting the restrictions imposed. In general, they contain more plant foods, particularly those that are nutrient dense such as vegetables, wholegrain cereals products, nuts, legumes and vegetable oils.
This report builds on thinking on healthy sustainable diets that we are increasingly seeing from consumer and public health organisations and think tanks. And the WWF believe it’s time that the UK Government implements healthy eating advice that also integrates sustainability.
The authors hope to develop additional Plates in future, including one for infants and primary school children, as well as country-specific Plates.
What are the Livewell Principles?
People are advised to follow the following Livewell Principles:
- Eat more plants – enjoy vegetables and whole grains
- Eat a variety of foods – have a colourful plate
- Waste less food – one third of food produced for human consumption is lost or wasted
- Moderate your meat consumption, both red and white – enjoy other sources of protein such as peas, beans and nuts
- Buy food that meets a credible certified standard – consider MSC, free-range and fair trade
- Eat fewer foods high in fat, salt and sugar – keep foods such as cakes, sweets and chocolate as well as cured meat, fries and crisps to an occasional treat. Choose water, avoid sugary drinks and remember that juices only account for one of your 5-a-day however much you drink.
Changes we think should be implemented in light of the report
- Food businesses including manufacturers and caterers should be looking at ways of including more plant foods in general into their products and menus, and using credible certified standards where these are available.
- Food service in particular can look at ways of promoting their expanding range of plant-based options. A new scheme from Veganuary, The Humane League UK and Vegan Chef Day gives a good example of raising awareness.
- Retailers should be looking at ways of shifting their promotional budgets away from high fat, salt, sugar foods and towards the core foods in the Eatwell Guide and Livewell Plates.
- We are already seeing a shift in reported consumption of animal products by consumers. A recent report from Mintel suggesting 28% of Brits have reduced or limited their meat consumption in the last six months. Consumers can further support their efforts towards more sustainable diets by thinking more holistically – eating more plants, wasting less, and so on.
Mindfulness is often used to promote well being and help reduce stress and anxiety and considerable benefits have been shown from a large body of research in positive psychology. In essence mindfulness practice teaches us to pay full attention in the present moment, non judgementally to our physical and emotional experiences. 1
Several studies have looked at the potential benefits of applying these techniques to eating. Researchers point out that of the multiple daily decisions we make about food, most are unconscious often resulting in overeating and other unhealthy eating patterns. Mindful eating aims to raise our awareness of the internal and external environments before, during and after eating and the reasons behind some of our decisions we make with the aim of improving diet. As shown in Figure 1 mindful eating may explore the “why, what, when and where” of our food consumption as well as the “how”( including speed of eating) and “how much” (portion size).
Figure 1 The Mindful Eating Cycle
Mindful eating aims to promote awareness not only of the nutritional content of our food but other qualities such as the appearance, smell, taste and texture. It may focus attention on the environmental triggers to overeating, the thoughts and feelings that arise when we eat, how we deal with guilt or anxiety around food and the role of unhelpful distractions like TV or social media in causing overeating.
Several studies show that speed of eating is associated with higher energy intakes and greater risk of obesity. 2-3 In addition eating as a genuine response to hunger and satiety signals (intuitive eating) is strongly associated with a lower body mass index 4. Mindfully slowing eating and allowing a delay for satiety to register, may therefore be an effective strategy to help prevent or manage obesity.
Mindless consumption of large portion sizes of food and drink are also strongly linked with higher energy consumption and risk of obesity. 5 Some studies show those who score highest on measures of mindful eating, in particular those who pay attention to their emotions and feelings around eating, eat smaller portions of energy dense foods. 6 Even brief teaching of mindful eating techniques have been shown to reduce overeating on unhealthy snacks (such as chocolate chip cookies in one study) when we are particularly hungry. 7
In a recent review of 61 studies, researchers consistently found the larger the amount of food we serve ourselves the more is eaten . 8 Mindfully reducing triggers to overeating such as large portions and tableware sizes, repackaging or purchasing single portion package sizes and placing unhealthy foods or leftovers out of sight may be effective behaviour tools to moderate the types or quantities of food consumed.
Mindful eating strategies can help promote evidence based behaviour change commonly advised for improving health as recommended in public health interventions.
For example some of the effective eating behaviour strategies to help weight loss which may be promoted by mindful eating techniques are shown in shown in Table 1.
Table 1 Some evidence based eating behaviour strategies advised to help weight loss which can be promoted by mindful eating techniques
Adapted in part from NDR- UK 9402 Changing For Good 11
In addition to a role in weight management, mindful eating has been shown to help people improve diet in a wide range of conditions including eating disorders, metabolic syndrome and diabetes. 9-10 Regular practice may also increase awareness of the positive and nurturing opportunities of food preparation and consumption.
To be successful mindful eating needs to learnt and developed by regular and confident practice. For instance studies show that people who make permanent changes to eating patterns are more likely to lose weight and keep it off.
At present there are few large, randomised studies on mindful eating and further research would be useful. However, mindfulness techniques which can be taught may be a useful and effective addition to the toolbox for improving informed, conscious choices around eating which could include any food behaviour change strategy or related communication programme.
1. Ludwig DS and Kabat-Zinn J (2008) Mindfulness in medicine. JAMA. 300 : 1350-2
http://www.ncbi.nlm.nih.gov/pubmed/18799450 (Accessed November 2015).
2. Leong SL ,Madden C, Gray A et al ( 2011) Faster self reported speed of eating is related to higher body mass index in a nationwide survey of middle –aged women. J Am Diet Assoc 111: 1192-7
http://www.ncbi.nlm.nih.gov/pubmed/21802566 (Accessed November 2015).
3. Otsuka R, Tamakoshi, K Yatsuya H et al (2006) Eating fast leads to obesity: findings based on self-administered questionnaires among middle-aged Japanese men and women.
http://www.ncbi.nlm.nih.gov/pubmed/16710080 (Accessed November 2015).
4. Madden CE, Leong SL, Gray A et al ( 2012) Eating in response to hunger and satiety signals is reacted to BMI in a nationwide sample of 1601 mid – age New Zealand women. Public Health Nutr 15 : 2272-9 http://www.ncbi.nlm.nih.gov/pubmed/22443858 (Accessed November 2015)
5. Wansink B (2011) B Mindless Eating : why we eat more than we think. Hay House UK. http://mindlesseating.org/ (Accessed November 2015).
6. Beshara M, Hutchinson AD and Wilson C ( 2013) Does mindfulness matter? Everyday mindfulness, mindful eating and self-reported serving size of energy dense foods among a sample of South Australian adults. Appetite 67: 25-9
http://www.ncbi.nlm.nih.gov/pubmed/23548262 (Accessed November 2015).
7. Marchiori D and Papies EF ( 2014) A brief mindfulness intervention reduces unhealthy eating when hungry, but not the portion size effect. Appetite 75: 40-5
http://www.ncbi.nlm.nih.gov/pubmed/24361312 (Accessed November 2015).
8. Hollands GJ, Shermilt, I Marteau TM et al (2015) Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Library September 2015.
(Accessed November 2015).
9. Kristeller JL, Wolever RQ (2011) Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eating Disorders 19:49-61.
10. Miller CK, Kristeller JL, Headings A et al.(2012) Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. J Acad Nutr Diet. 112:1835-1842.
11. Changing for good NDR- UK Ref 9402
http://www.ndr-uk.org/vmchk/Weight-management/Changing-for-Good.html (Accessed November 2015).