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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Fry ups in pregnancy, coconut oil and sleep: Nutrilicious News Digest

Fry ups in pregnancy, coconut oil and sleep: Nutrilicious News Digest

Each week we analyse some of the hot headlines in health and nutrition news. This week we look at the role of choline in pregnancy, the health aspects of coconut oil and whether sleep can help us cut down on sugar.



The effect of choline during pregnancy has been in the news this week, reported by the IndependentThe Times, the Daily Mail and the Mirror.

This is based on a small study of 26 women entering their third trimester of pregnancy, who were randomised to consume either 480mg or 930mg choline supplement in addition to a controlled diet.

Babies were tested at 4,7,10 and 13 months of age and it was found that reaction time was significantly faster in babies of mothers who consumed 930mg choline supplement daily.

Behind the headlines: the Nutrilicious dietetic view
We don’t hear of choline, which is a vitamin-like nutrient needed for the normal function of all cells, especially those in the liver and the central nervous system, including the brain.

Although choline is an essential nutrient, this study is a long way off proving that pregnant women need to focus on choline supplements to improve their children’s cognition, much less that fry ups result in intelligent babies:

  • This was only a small study. It looked at a nutrient that does not register in UK dietary reference values as no incidence of choline deficiency has been reported.
  • The women were given supplements rather than food in order to boost their levels – the headlines suggesting fry ups could be beneficial are misleading and could put mother and baby’s long-term health at risk.
  • The reaction time results are of limited value for assessing the impact on cognitive development in the babies beyond 12 months.

Eating a healthy balanced diet, maintaining a healthy weight gain, keeping active and avoidance of alcohol and smoking during pregnancy will help ensure the best outcomes for the mother and the baby. Specific supplements of vitamin D and folic acid are also recommended by UK government. For tips on a healthy diet see the NHS



This week Dr Michael Mosley has been promoting the use of coconut oil as a health product, as picked up by the BBC, The Times and the Daily Mail. The suggestion is that despite high levels of saturated fat, coconut oil might still be good for you.

This report comes from the ‘Trust Me I’m a Doctor’ team, a new BBC series featuring Dr Mosley. 94 volunteers were involved, aged between 50 and 75 years, with no history of diabetes or heart disease. They were split into three research groups and for four weeks added to their diet as follows:

  • Group 1: 50g of extra virgin coconut oil (about 4 tbsp) consumed daily
  • Group 2: 50g of extra virgin olive oil (about 4 tbsp) consumed daily
  • Group 3: 50g of unsalted butter (about 3 tbsp) consumed daily

Baseline measurements were taken for blood lipids, including LDL (‘bad’) and HDL (‘good’) cholesterol. The findings, averaged out, were as follows:

  • Group 1 (coconut oil) – no rise in LDL levels; 15% rise in HDL levels
  • Group 2 (olive oil) – small reduction in LDL (although deemed as non-significant); 5% rise in HDL
  • Group 3 (butter) – 10% rise in LDL levels; 5% rise in HDL levels.

The participants’ weight and body fat remained unchanged.

Behind the headlines: the Nutrilicious dietetic view
This is a disappointing well-publicised study that will only serve to fuel consumers’ confusion about how they can reduce the incidence of UK’s number 1 killer, heart disease.

On the surface, the findings paint the picture that coconut oil could be good for the heart, through raising levels of HDL cholesterol.

However, conducted over only a short period of time, overall diet quality of the participants was not assessed – including overall saturated fat, free sugars and refined carbohydrate intakes from other food sources. Based on this, it is unclear what brought about the changes in lipid profiles and no conclusions can safely be made on the benefits or harmful effects of coconut oil.

Contradicting studies
While this study fuels the growing trend for coconut oil, it cannot compare to the extensive scientific literature reviews of good-quality studies by leading heart health and academic experts. These have shown consistently that saturated fats have an overall negative effect of increasing LDL cholesterol.

We discuss the different types of saturated fats found in coconut oil amongst other key points in our blog, Is Coconut Oil Really Good for You?

What are the current recommendations for use of coconut oil?
Here are what some of the major health organisations have to say about coconut oil:

  • Heart UK – published a statement on coconut oil that for people wanting to lower their cholesterol, coconut oil should be avoided.
  • British Heart Foundation – state there is not enough good-quality research to provide us with a definitive answer as to whether the types of saturated fats in coconut oil are any better for us than other saturated fats.
  • UK Department of Health – Advises to consume only small amounts of coconut oil

We need to promote good quality science, which is the basis for international and national guidelines with regard to saturated fat. These included reductions in saturated fat (a maximum of 20g and 30g daily for women and men, respectively), inclusion of unsaturated fats, replacement of refined carbohydrates with whole grains, minimising intakes of free sugars and increasing our fruit and vegetable intakes.

Two level tablespoons of coconut oil provides 19g of saturated fat and is therefore not considered a healthy choice for regular consumption. As part of a balanced diet, coconut oil is fine to have in small quantities.

We look forward to seeing the latest extensive review of research undertaken by the Scientific Advisory Committee on Nutrition, due to be published by March this year.



The Telegraph (Sleep yourself slim: how an extra 90 mins in bed can stop sugar cravings), The Times, the Sun and the Daily Mail (How 20 minutes’ extra sleep could help you say no to cake) have reported on the impact sleep could have on sugar intake.

A study involved 42 participants with poor sleeping habits (deemed as having typically between five and seven hours sleep per night), who were encouraged to follow a personalised sleep extension protocol. The body mass index (BMI) of each participant was between 18.5kg/ m2 to less than 30kg/m2. They each kept food diaries.

The four-week randomised control trial involved:

  • Group 1 (intervention group): 21 participants received a behavioural consultation session targeting ‘sleep hygiene’ – this involved avoiding screens late at night, keeping work out of the bedroom and reducing caffeine.
  • Group 2 (control group): 21 participants maintained habitual short sleep patterns

Over the four weeks, the intervention group extended their time in bed by 55 minutes on average and their sleep duration by 21 minutes compared with the control group.

On average, there was a reported 10g reduction in intake of free sugars compared to the control group. BMI did not change in the four-week period.

Free sugars are all the different types of sugar we have in our diet, excluding the sugars found naturally in intact fruit and vegetables, milk and milk products. 10g of free sugars is equivalent to 2.5 tsp of sugar, 1.5 tsp of honey, 90ml of cola or 110ml of fruit juice.

Behind the headlines: the Nutrilicious dietetic view
Once again, this study was only of a small number of people and for a short period of time. It was not designed in a way to accurately assess dietary intake, so we cannot be confident that improved sleep patterns will cause a reduction in sugar intake. Food diaries rely on the honesty of the patient and are not necessarily accurate.

Is there a link between sleep and body weight?
Some of the news outlets gave the impression that extra sleep will cause weight loss, but this was not found.

However, the NHS does recognise that sleeping less may contribute to weight gain, highlighting previous studies showing that people who sleep less than seven hours per day are 30% more likely to be obese than those who sleep for nine hours or more.

Sleep is important for mental and physical health and evidence for its role in weight loss/obesity is growing. The NHS recommends seven to nine hours a night. Find out more about ways to get a good night’s sleep.

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The Mediterranean diet, stroke and fruit juice: Nutrilicious news digest

The Mediterranean diet, stroke and fruit juice: Nutrilicious news digest

Each week we analyse some of the hot headlines in health and nutrition news. In our last round up for the year, we look at a ‘Mediterranean diet pill’, herbal remedies for stroke, and fruit juice in asthma.


This week the Daily Mail, the Metro and the Express are reporting on the use of a Mediterranean diet pill to help prevent heart disease.

Scientists have issued a patency for a pill that is thought to replicate the Mediterranean diet. This is based on findings from Cambridge University that lycopene (the chemical that gives tomatoes and other fruits their red colouring) absorption is significantly increased by combining it with milk protein. Scientists believe that combining the two into a pill (a ‘Mediterranean diet pill’, as the headlines say) could have effects such as reducing furring of the arteries, helping to keep the heart healthy.

The pill is available over the counter and is called ‘Ateronon Heart.’

Behind the headlines: the Nutrilicious dietetic view

Although this pill is being referred to as a ‘Mediterranean diet pill’ and that lycopene may have potential benefits for the heart, there are many elements of the Mediterranean diet that have not been considered. The whole diet plays a key role in contributing to the health benefits attributed to it such as heart health. To highlight, traditionally, people in the Mediterranean have:

  • Lots of fruit and vegetables
  • Wholegrain breads and cereals, nuts, pulses (peas, beans and lentils) seeds and fish
  • Less saturated fat from dairy and red meat sources
  • Moderate alcohol consumption
  • Higher levels of sunshine and more oily fish which results in good levels of vitamin D

As can be seen, it is not just as simple as amount of lycopene that may be contained within this diet (from tomatoes and other fruits and vegetables). There are so many factors that would mean the pill is not the necessarily going to give the same effects as having a Mediterranean diet. The reference to the product as a ‘Mediterranean diet pill’ as described by the headlines is thus somewhat misleading.

At this stage, no conclusions can be drawn with regard to any benefits the diet pill may have for heart disease. It is certainly not to be used as a substitute for a healthy diet. The Mediterranean diet, by use of real food, would indeed be encouraged for heart health. Exercise can also help reduce the risk of heart disease by helping with weight control, lowering cholesterol and blood pressure.

For more info: NHS and Heart UK’s Mediterranean Diet factsheet



The BBC and the Daily Mail have reported on the possibility of a herbal remedy for stroke recovery.

The trial involved 330 patients in China who had suffered an ischaemic stroke. The trial began within one week of the patients having the stroke. It was found that use of herbal supplement ‘ginkgo biloba’ alongside aspirin was linked with better cognitive skill scores on tests. Tests were taken at the start of the trial and then 12, 30, 90 and 180 days later, to assess any cognitive impairment.

More rapid improvements were also found with speech and muscle strength when ginkgo biloba was taken.

Behind the headlines: the Nutrilicious dietetic view

Firstly, let us understand more about what ginkgo actually is. Ginkgo biloba is a herbal supplement available without prescription that is sold in health food shops and some pharmacies in the UK (£4.99 for 30 tablets). It comes from the leaves of one of the oldest living tree species (the maidenhair tree).

Looking at an example packaging of ginkgo biloba from a high street retailer, the following is written as a description of the product: ‘Ginkgo helps the maintenance of good cognitive function and also contributes to normal blood circulation. Normal blood circulation is associated with brain performance and reactivity, and helps to maintain memory with age and preserve cognitive function.’ Although this sounds very beneficial, this has not been scientifically proven.

While the findings from this study are positive for use of ginkgo biloba, there are limitations of the research that must be noted. The study was relatively small and much larger, longer term studies are needed before any sound conclusions can be drawn. Furthermore, the study is subject to researcher bias, a point which has been recognised by Dr David Reynolds of Alzheimer’s Research UK who gave the following statement in response to the study: “The researchers were able to tell which participants received the ginkgo biloba extract and which didn’t – a set up that can strongly influence results.”

We therefore need much more comprehensive research into the field and cannot actively promote the use of ginkgo in stroke recovery from this research alone.

For more info: British Dietetic Association) and the original study



Also this week the Daily Mail, the Independent and the Express have picked up on a study linking fruit juice drinking in children with asthma.

This is based on a study of 1,068 mother and child pairs which found that children aged between 7 and 9 years were 79% more likely to have asthma if they regularly drank fruit juice (unsweetened 100% juice). It was also reported that the women who drank soda and sugary drinks whilst they were pregnant were 70% more likely to have their child to develop asthma by mid-childhood.

The original study discusses the different levels of fruit juice and sugary drink consumption from which the conclusions have been drawn.

Behind the headlines: the Nutrilicious dietetic view

Firstly, with regard to the fruit juice drinking being associated with childhood asthma, as with many dietary studies, we cannot prove that it is the fruit juice drinking causing the effects seen. There are many factors which could influence the results. For example, it could be that the fruit juice drinkers have an unhealthier diet and lifestyle, which could skew the results.

Also the study relied on the women to recall and provide information on fruit juice consumption for their children, for which the accuracy could be questioned.

Fruit juice can contribute to a ‘five a day’ portion and contains a good source of vitamins and minerals such as vitamin C. However, portion size is important and should be limited to a 150ml glass (a small glass). It can only ever count as a maximum of one portion of your five a day.

Fruit juice is a source of ‘free sugars’, which should be limited in our diet for health reasons such as leading to obesity and tooth decay. The Scientific Advisory Committee on Nutrition (SACN) currently advise that free sugar intake in the UK should account for no more than 5% of our daily energy intake. Advice for the different age groups is as follows:

  • Children 4-6 years – no more than 19g free sugars per day (5 teaspoons)
  • Children 7-10 years – no more than 24g free sugars per day (6 teaspoons)
  • Children 11 years + and adults – no more than 30g free sugars per day (7 teaspoons)

We should be reminded in view of this study that there is a recognised link between a child being overweight or obese and developing asthma. Eating and drinking too much sugar (for which fruit juice is a concentrated source of) can contribute excess calorie intake. This contributes to being overweight and obese, which can in turn contribute to causing asthma. However, the study does not prove a direct link between fruit juice and asthma development.

As discussed above, this study also found that higher intakes of sugary drinks in mothers during pregnancy increased asthma prevalence in their children. Again, no causal relationship can be assumed here and the same limitations of the study apply to this finding.

However, it is important to eat a healthy diet during pregnancy for the health of both the mother and the baby. Having too many sugary drinks during pregnancy would contribute to excess calorie intake. This in turn increases the chances of putting on too much weight, which can cause complications such as gestational diabetes. The NHS provides advice on appropriate weight gain during pregnancy.

To conclude, this research does not prove that fruit juice drinking by children or that drinking of sugary drinks by expectant mothers causes childhood asthma. Sugary drinks and fruit juices are sources of free sugars and therefore excess calories and for this reason should be limited. However, fruit juice can help contribute to ‘five a day’ but it is important to control portion size to no more than 150ml per day for adults.

For more info: Asthma UK and SACN

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Alcohol, breastfeeding, alternative diets for cancer: Nutrilicious news digest

Alcohol, breastfeeding, alternative diets for cancer: Nutrilicious news digest

Each week we analyse some of the hot headlines in health and nutrition news. This week we look at wine glass size increase, NHS breastfeeding incentives and a man who claims a raw vegan diet cured his cancer.



This week the BBC, the Daily Mail, the Guardian, The Daily Telegraph and The Sun reported on the increasing size of wine glasses being served up.

New research from Cambridge University found that wine glasses are as much as seven times larger than they were 300 years ago.  Measurements were taken of 411 glasses from 1700 until modern day.

Looking at sources including eBay, museums and department stores, it was found that wine glass capacity has increased from an average of 66ml in the 1700s to 417ml in the 2000s, and the average wine glass size in 2016-2017 was 449ml.  

Behind the headlines: the Nutrilicious dietetic view
While these headlines may lead us to assume that an increase in wine glass size directly correlates to an increase in wine consumption, this has not been proven by the research. Nor can we assume that reducing wine glass size would lead to a decrease in alcohol consumption – although it has been found previously that large tableware increases food consumption, so the same may be true for glass sizes with drink.

Not only are glass sizes increasing as this research has shown, but the average strength of wine has also increased. This points towards a greater consumption of alcohol than in the past.

The adverse effects of drinking too much alcohol is well documented. It can increase the risk of least seven types of cancer, including bowel cancer and breast cancer, and is also linked with pancreatitis, liver disease, heart disease and diabetes.

Calories can sometimes be forgotten with alcohol but in fact it contains nearly as many calories per gram as fat does (7kcal per gram for alcohol and 9kcal per gram for fat). A 175ml glass of wine contains around 160 calories. For more information on alcohol and calories see Drinkaware’s handy Unit & Calorie Calculator.

With Christmas looming, it can be easy to overdo the alcohol consumption. The government recommends both men and women stick to no more than 14 units per week. To find out what constitutes a unit see Drinkaware. For wine, a 125ml glass of wine would be one unit, so it is a worry to think that a 449ml glass would contain over three units.

The take home message is to not exceed government guidelines for alcohol consumption and to be aware of glass size as this may well have a role in the amount of alcohol consumed.

For more info: British Medical Journal



The Guardian, the Evening Standard, the BBC, The Daily Telegraph and the Daily Mail have reported on how shopping vouchers could potentially be used to help increases rates of breastfeeding in the UK.  

This is based on a trial of 10,000 women in deprived areas which found that giving shopping vouchers to mothers resulted in a significant rise in breastfeeding rates.

The vouchers were worth £120 and were provided if the babies received breastmilk (including expressed) at two days, 10 days and six weeks old. If babies were still being breastfed at six months, a further £80 of vouchers were given to the mothers.

A 6% increase in rates of breastfeeding was found which the researchers concluded was a modest but statistically significant increase.

Behind the headlines: the Nutrilicious dietetic view
One limitation of this study is that we cannot be sure that the reported rates of breastfeeding are accurate. It relies on the honesty of the mother and potentially an economically struggling mother may report that she is breastfeeding when in reality she is not in order to obtain the vouchers. The data is therefore unreliable as no clinical test was used to confirm whether a mother was breastfeeding. We cannot say that by employing such a scheme on a larger scale in the UK would actually increase breastfeeding rates.

However, it is good that methods are being tested and investigated to help try and encourage breastfeeding, as it offers many benefits for both mother and baby. It is perfectly designed for the newborn baby, helps protect the baby from infections and diseases, provides health benefits for the mother, is free of cost and is ready whenever the baby needs it. It can also help with bonding.

In the UK breastfeeding rates are particularly low. The NHS advises exclusive breastfeeding for six months. The most recent UK Infant Feeding Survey highlighted that:

  • 81% women initiated breastfeeding (69% exclusively)
  • 69% breastfeeding at one week (46% exclusively)
  • 55% breastfeeding at six weeks (23% exclusively)
  • 35% breastfeeding at six months (1% exclusively)

So there is clearly huge room for improvement in this country.

Breastfeeding is not necessarily easy. The NHS acknowledges this and has provided advice on common breastfeeding problems. Identifying barriers to breastfeeding and providing plenty of support to mothers remains of key importance to help increase rates in the UK.



Also in the news this week is story about a man who claims to have cured his stage 4 cancer by following a vegan diet. This was picked up by the Metro (Man claims he ‘cured’ stage 4 cancer by switching to vegan diet), the Daily Mail (Father of two CURED cancer by going vegan), the Mirror (Brave cancer sufferer shares incredible story) and The Sun (Did vegan diet cure cancer?).

Rob Mooberry was diagnosed with stage 4 colorectal cancer in 2012 and believes his tumour shrank by 80% by following a raw vegan diet.

From the information we are given, it is understood Rob had undergone surgery, radiotherapy and chemotherapy (following which his cancer reduced to stage 3a). He took a break before his next course of treatment as he felt he could not undergo it and changed his diet to a raw vegan diet in November 2012. His following scan in early 2013 showed that the cancer had reduced by 80%. Rob’s cancer has now been in remission for five years and he has not received any further medical treatment.

Behind the headlines: the Nutrilicious dietetic view
The question on many people’s minds will be whether or not the raw vegan diet was responsible for ‘curing’ the cancer. We certainly cannot prove that the diet what was responsible for the reduction in tumour size. There is no scientific evidence to suggest this could be the case and Rob had previously undergone medical treatment. Also, this report is purely based on anecdotal evidence and does not necessarily mean the same could be applied to the next person with the same results.

Cancer Research UK provide advice on alternative diets and their role in cancer. They do not recommend using alternative therapies in place of medical treatment due to the lack of scientific evidence of their effectiveness. They also point out that unproven methods of alternative cancer treatment could make someone very ill. Supporting this further is Macmillan Cancer Support, who state on their website that ‘no alternative therapies have ever been proven to cure cancer or even to slow its growth’.

Following a raw vegan diet needs careful attention to ensure it is balanced. This diet was recently discussed by the British Dietetic Association as it has been considered one of the ‘top 5 worst celeb diets to avoid in 2018’.

To sum up, there is no evidence to suggest that a raw vegan diet can cure cancer and it is important to remember alternative therapies should not replace normal medical treatment. Alternative diets can cause various health problems and advice from specialists should always be sought before embarking on such dietary changes.

For more info: Cancer Research UK and Macmillan Cancer Support.

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Top Nutrition Headlines 11 December – A Nutrilicious Digest

Top Nutrition Headlines 11 December – A Nutrilicious Digest

Each week we analyse some of the hot headlines in health and nutrition news. This week we look at type 2 diabetes reversal through weight loss, the rise in childhood obesity and raw flour health risks.



This week we have the BBC (‘I beat type 2 diabetes with 200-calorie drinks’), The Guardian (Radical diet can reverse type 2 diabetes new study shows), The Daily Mail (Three month diet reverse Type 2 diabetes), The Sun (Millions of diabetics could be cured by losing weight and eating healthier) and The Express (Type 2 diabetes symptoms diet reverse) reporting that it may be possible to reverse type 2 diabetes by following a ‘crash diet.’

The findings come from a study called DiRECT (Diabetes Remission Clinical Trial), where it was found that by following an intensive low-calorie diet for three to five months people could put their diabetes into remission. Nearly half of the study participants were in remission after one year. There was a close link found between amount of weight lost and remission of type 2 diabetes.

Here are the results for the percentages of people who were in remission after one year based on the amount of weight lost:

  • 86% of people who had lost over 15kg (2.4 stone) in remission
  • 57% of people who lost 10-15kg (1.6-2.4 stone) in remission
  • 34% of people who lost 5-10kg (0.8-16 stone) in remission

There was also a control group who did not follow the low calorie diet, but were given the best diabetes care available and only 4% went into remission.

Behind the headlines: the Nutrilicious dietetic view
Firstly, it should be recognised what is meant by ‘putting diabetes into remission’. In this study being in ‘remission’ was defined as having a HbA1c level below 6.5% (48mmol/mol) after 12 months, with at least two months without diabetes medication. HbA1c is a measure of blood glucose levels over the past two to three months and can be used to diagnose diabetes. It should be noted that being in ‘remission’ does not necessarily mean the diabetes has gone completely and hence people still need regular check-ups.

This research backs up previous studies investigating the potential of reversing type 2 diabetes. This DiRECT study recruited many more participants (298 recruited vs 11 and 30 in the two previous studies), making it much more reliable, and testing was carried out over a much longer period.

Points to note

  • While this is a very promising piece of research and extremely exciting for people with type 2 diabetes, it should be noted that the study is not over yet. It is unclear at this stage how long the remission will last for; whether it will reduce the risk of long term diabetes related complications; and whether this type of treatment could be feasible within the NHS.
  • The people involved in the study had been diagnosed with type 2 diabetes for up to six years and so the findings may not apply to those have had the condition longer. Participants also were not included if they were taking insulin.
  • The diet involved was intensive. Participants followed a daily diet of around 800kcal diet (made up of four soups or shakes fortified with vitamins and minerals) for between 8 and 20 weeks, followed by a long-term programme of weight loss maintenance. Certainly not an easy fix!
  • The headlines alert us to the positive findings of the study but one person in fact developed severe abdominal pain, related to gallstones. This was thought to be possibly caused by the intervention. Further studies are required to ensure the diet is safe for widespread use.
  • The weight management programme was delivered with medical supervision and dietitians were involved to help support long term weight management. While it may seem possible to put type 2 diabetes into remission, this type of diet should certainly not be undertaken alone and anyone attempting to do this should ask for help from a GP and dietitian.

The Deputy Head of Care at Diabetes UK provided this useful statement: “If you’re thinking about trying a low-calorie diet, it’s really important you speak to your GP and get referred to a dietitian. This is to make sure you get tailored advice and support.

“It’s also important to bear in mind that if you’re treating your Type 2 diabetes with certain medications, such as insulin or sulphonylurea, a low-calorie diet can make hypos more likely. So you’ll need support to make changes to your medications and check your blood sugar levels more often.”

For more information, go to Diabetes UK and the Newcastle University study



We are being alerted by the BBC (‘Stark’ increase in overweight youngsters), The Times (A fifth of children are obese by 14) and the Daily Mail (Now one in three British teenagers is already overweight) of the increasing prevalence of obesity in children.

Data from the Millennium Cohort (a group of more than 10,000 children born between 2000-2001 who have been followed for years) revealed that 25% were overweight or obese at age 7, increasing to 35% by age 11. Little change was found between age 11 and 14 years.

There were notable differences found between different nations and there were links found between the mother’s education level, whether the child was breastfed and whether the parents owned their own home. Full results are discussed by the Institute of Education.

Behind the headlines: the Nutrilicious dietetic view
The headlines alert us to the growing problem of obesity in children and action clearly needs to be taken. The following risks are associated with it:

  • Higher chance of premature death and disability in adulthood
  • More likely to stay obese in adulthood and develop noncommicable diseases such as diabetes and cardiovascular disease at a younger age
  • Muscoskeletal disorders in adulthood (e.g. osteoarthritis)
  • Certain cancers in adulthood (endometrial, breast and colon)

Source: World Health Organisation

It is unclear from this research why there is such an increase in rates of obesity between ages 7 and 11, which then levels off. Children may start to make more of their own choices past 11 years and this is thought to potentially have a role.

In view of these recent findings, we should be reminded of the action that is planned to help combat obesity in the UK. These are discussed in full on the UK Government’s website. Key examples from this plan include:

  • The Sugar Tax – The government plan to introduce a soft drinks levy to be enforced from April 2018. Producers and importers have been given two years to lower the sugar appropriately in their drinks to allow them to not face the levy. Our blog Draft Soft Drinks Levy – Objectives, Thresholds, Exemptions & Impact? discusses this further. This is a very encouraging and hopeful move considering that the latest National Diet and Nutrition Survey highlighted that soft drinks are a major contributor to sugar in children’s diets.
  • Taking out 20% of sugar in products – firms have been called to cut sugar by 5% by the end of this year and by 20% by 2020. We discussed on last week’s blog the action that Kellogg’s have been taking on their top selling cereal products to cut the sugar.

There are also new rules due to be implemented on food advertising. Last month the BBC reported on how young children are being bombarded with adverts for high fat, high sugar foods, which is more than likely to be having a negative influence on food choices. The news rules are discussed in our blog New rules on food advertising to help tackle childhood obesity.

It is interesting to note that Amsterdam is the only European country that has successfully managed to reduce obesity rates in the last five years with a range of programmes, mainly through schools. Clearly, many measures will need to be employed to help combat childhood obesity in the UK. Let us hope that the actions due to be undertaken in UK will help improve the current rather desperate situation. Monitoring of the effectiveness of such actions will be of key importance in the future.

For more information, go to NHS and UCL



Also in the news this week is the warning over eating raw cookie dough. This was reported by The BBC, The Telegraph, The Evening Standard, The Sun and The Daily Mail.

The UK Foods Standards Agency have now provided guidance that we should not eat raw flour, including cookie dough. This is due to outbreaks in the US of food poisoning caused by E.Coli.

Behind the headlines: the Nutrilicious dietetic view

E.Coli is a type of bacteria that can cause diarrhoea, blood in faeces, stomach cramps, fever and vomiting. Before this guidance on raw flour, it was understood that E.Coli could be caught from infected foods such as raw leafy vegetables, undercooked meat or raw milk products.

We now must ensure we are aware of the potential risk associated with raw flour, including cookie dough and cake mixture for example. We may think we shouldn’t have a taster of these due to the raw egg. However, in October 2017, the Foods Standards Agency published advice that runny eggs are safe to eat for all, so long as they are stamped with the British Lion Code of Practice.

So now the reasoning behind avoiding having a taster of dough is down to the raw flour contained within it. It is also advised to wash hands thoroughly before and after using flour and to ensure worktops are wiped afterwards. Rest assured that cooking the flour will kill the bacteria that causes the infection.

It is important to be aware of this new advice from the Foods Standards Agency to reduce any complications caused E.Coli. Certain groups of people should take particular note of this new guidance, such as those with a weakened immune system and pregnant women, where food poisoning can cause harm to the unborn baby. When giving food safety advice to such groups, this latest advice on flour should be included.

For more information, go to NHS

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Top nutrition headlines 27 Nov – A Nutrilicious digest

Top nutrition headlines 27 Nov – A Nutrilicious digest

Each week we analyse some of the hot headlines in health and nutrition news. This week: Breast cancer in larger women; vitamin D and arthritis; and health benefits of coffee.


HEADLINE 1: Breast cancer tumours ‘larger’ in overweight women

The BBC, Daily Mail and The Telegraph picked up on a Swedish study which found that cancerous breast lumps are less likely to be detected in overweight or obese women before the tumour becomes large. The suggestion is that they should therefore be offered more regular screening.

Behind the headlines: the Nutrilicious dietetic view

It is unclear for definite why cancerous lumps are less likely to be detected in women with high BMI. It could be because the tumours are growing at a faster rate or it could be that because their breasts are larger, the tumours were harder to find.

Current guidelines for screening in the UK are that all women aged between 50 and 70 are invited for screening every three years. Cancer Research UK have spoken out regarding this study, stating that it does not provide enough evidence to support a change in the guidelines.

In terms of breast cancer prevention, the role of Body Mass Index (BMI) has been recognised by Cancer Research UK, whereby being overweight (BMI 25-29.9kg/m2) or obese (BMI 30kg/m2 and above) is a known risk factor. Although screening guidelines are to remain the same, this study further reiterates the importance of maintaining a healthy weight.
Calculate your BMI


HEADLINE 2: Vitamin D may help prevent rheumatoid arthritis, suggests study

The Guardian reported on a laboratory study that investigated the role of vitamin D in rheumatoid arthritis (RA), following previous research showing it might have anti-inflammatory effects.

It was found that in non-diseased tissue, the immune cells responded well to active vitamin D. In contrast, the tissue from inflamed joints in people with RA was much less effective in responsiveness to vitamin D.

The researchers suggested that vitamin D supplementation may therefore be able to help prevent the onset of RA. They also said that while it is vitamin D is unlikely to be a successful treatment for established RA patients, if there was a route to make the diseased cells respond to vitamin D, then potentially this could help with treatment options. Another suggestion is that vitamin D supplementation may help with the prevention of inflammatory conditions such as RA. .

Behind the headlines: the Nutrilicious dietetic view

This was a small laboratory study that only involved 15 participants and much more research is needed to investigate why the RA cells were insensitive to vitamin D. Although useful in understanding vitamin D in RA, we cannot draw conclusions regarding the use of vitamin D supplements to either prevent or potentially help treat people with RA. The suggestions are pure speculation; there would be a lot more research needed to investigate both of these points

Regardless of the potential effects on inflammation, the UK’s Scientific Advisory Committee on Nutrition advise that all adults and children over the age of one should be taking a daily 10mcg vitamin D supplement during the autumn and winter months (October to March). With our main source of vitamin D through exposure to sunlight, it can be hard to get adequate supplies in these months. Although we can obtain vitamin D from foods such as oily fish, eggs, red meat and liver, sources are limited so supplements are a better way of being sure.

For more information, go to
BDA Food Facts, Vitamin D
Arthritis UK, Diet and Arthritis


HEADLINE 3: Three cups of coffee a day ‘may have health benefits’

News outlets once again jumped on a ‘healthy coffee’ study, with the BBC, ABC News, Daily Mail and The Guardian picking up on a study which looked into previous research into coffee and health. The researchers looked into more than 200 studies, most of which were observational by design.

Those who drank three cups of coffee per day appeared to reduce their risk of heart disease and of death from heart disease. The most notable benefits were the effects on liver disease and liver cancer, with coffee drinking reducing the risk.

Behind the headlines: The Nutrilicious dietetic view

In last week’s Nutrition News Digest we also reported on a study that found benefits of coffee drinking and reducing the risk of liver cancer.

Although this week’s study backs up recent research, similarly to last week it cannot prove that it is actually the coffee drinking causing the effects seen. There are many factors, including the lifestyle of coffee drinkers, which may contribute to the effects. Moreover, most of the studies included within the analysis were of low quality – as recognised by the researchers.

The headlines focus on the positive aspects of coffee drinking. Although most of the effects were found to be positive in this research, some of the studies also showed a harmful health outcome (e.g. for fracture risk in women).

There is a useful summary of the current evidence into coffee and health in an editorial in the British Medical Journal, Coffee gets a clean bill of health, which discusses the questions many people may be asking in response to these recent headlines, including:
1. whether coffee should be recommended to prevent disease; and
2. whether people should start drinking coffee for health reasons.

Both questions are answered as ‘no’. There is simply not enough sound evidence to make these conclusions.

Nevertheless, the advice remains the same in that a caffeine intake of up to 400mg per day (3-4 cups of coffee) is perfectly safe and that coffee is absolutely fine to include in moderation. Pregnant women should limit their intake to less than 200mg per day (2 cups of instant coffee).

For more information, go to:
NHS, pregnancy and caffeine
EFSA, Scientific opinion on the safety of caffeine

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