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

Top Nutrition Headlines 13th Nov – A Nutrilicious Digest

HEADLINE: ‘Emotional toll of diabetes ‘needs more recognition’

Same story also reported by

Nutrilicious Dietetic Comments – Take Home Messages

This news article highlighted that many people with diabetes are suffering from related emotional issues. A survey from Diabetes UK (involving 8,500 people with diabetes) found that three out of five said their condition made them feel down. Only three in ten felt they had control of their condition. Dietitians, alongside other healthcare professionals have an important role to play in educating people with diabetes. When people are diagnosed with diabetes, thoughts around food choices are often present and can persist. As shown in the news article, one survey participant stated ‘I am constantly thinking about food.” Dietitians Nutritionists and all involved in food and health communications have a role in helping those with Diabetes to feel like that they can take control of their food choices and it not become a big burden on their daily life. For both type 1 and type 2 diabetes, education programmes are offered which can help people manage their condition better. Whilst improvements are in need in terms of access to specialist healthcare professionals and other areas, we should be reminded of the Diabetes UK Checklist for the 15 healthcare essentials that people with diabetes should receive (see below).

Where to find useful information on the topic
Diabetes UK,
Diabetes UK, Emotional Wellbeing

HEADLINE: Tofu IS linked to prostate cancer, study reveals – but experts stress men shouldn’t cut it out of their diets just yet


Nutrilicious Dietetic Comments – Take Home Messages

The study behind this headline involved 27,004 men and they found an association between dietary intake of isoflavones and an elevated risk of advanced prostate cancer. A food frequency questionnaire was used to establish dietary intake of isoflavones from soya sources. It should be noted that this is an association found, not a cause and effect relationship and in terms of the totality of the evidence to date we cannot draw the conclusion that tofu causes prostate cancer. To the contrary the American Institute of Cancer Research in their latest review of soya and cancer mentions that in some cases, research indicates that soya isoflavones may in fact lower the risk of prostate cancer. Some studies suggest that lifelong soya consumption and exposure to isoflavones – especially before and during puberty – may protect against the development of prostate cancer. Prostate Cancer UK have spoken about this new research and stated that ‘much more research is needed to measure the actual intake of isoflavones in people with varied eating habits.’ It is very difficult to draw solid conclusions from trials trying to isolate the impact of a single food type when we eat such a varied diet. The take home message is that we do not need to be cutting tofu out from our diet based on this study; much more research is needed. Tofu is a nutritious food and can indeed form part of a healthy diet; it is low in saturated fat (1g per 100g) and offers a good source of protein (12g per 100g).

Where to find useful information on the topic

Prostate UK, Diet, physical activity and your risk of prostate cancer
BDA Food Facts, soya

HEADLINE: Drinking coffee may help prevent liver cancer, study suggests


Same story also reported by
Daily Mail, ‘Drinking three cups of coffee each day could save your life: Beverage slashes the risk of fatal liver diseases by 70%, reveals review’

The Sun, Drinking three to five cups of coffee a day reduces risk of liver cancer, experts say

The Express, ‘Drinking coffee can cut the risk of cancer’

Nutrilicious Dietetic Comments – Take Home Messages

This headline was based on the analysis of 26 studies (involving more than 2.25 million participants), which concluded that people who drink more coffee, including decaffeinated (to a lesser extent), were less likely to get liver cancer. Compared with non-coffee drinkers, those who drank one cup a day had a 20% lower risk of developing the most common form of liver cancer. Those who consumed two cups a day had a 35% reduced risk and for those who drank five cups, the risk was halved. However, the researchers judged the quality of the evidence they found using the GRADE criteria and deemed it be ‘very low’. One reason for this is the lack of randomised controlled trials (considered to be the gold standard within research). In this study, it is hard to be certain whether it was the coffee causing the outcome or other non-controlled for factors. E.g. do the coffee drinkers tend to have a healthier lifestyle in other ways which may confound the results? Nevertheless, this is an interesting study and moderate consumption of coffee is not a problem and can help towards our daily hydration needs. The EFSA advise that intakes up to 400mg of caffeine are safe for healthy adults in the general population. The exception lies with pregnant women who are advised to limit this to 200mg per day, the equivalent of two mugs of instant coffee.

NHS, pregnancy and caffeine
EFSA, Scientific opinion on the safety of caffeine

Top Nutrition Headlines 6th Nov – A Nutrilicious Digest

Each week we analyse some of the hot headlines in health and nutrition news

HEADLINE 1: Could sugary diets fuel Alzheimer’s disease? Scientists discover link between high levels of glucose in the brain and memory loss symptoms

The story linking sugar to Alzheimer’s disease was reported in The Daily Mail, The SunThe Express and Hello Magazine

Behind the headlines: the Nutrilicious dietetic view
This news was headline-grabbing indeed, with all the stories suggesting that diets high in sugar could be linked to Alzheimer’s disease.

The story is based on a study finding that there were significant abnormalities in glucose breakdown in patients with Alzheimer’s – resulting in high levels of brain glucose.

However, the actual reasons for these abnormalities remain unclear and cannot be drawn from this study. The study is still at an early stage and more research is needed to investigate whether genetic or perhaps environmental factors are the cause of such abnormalities. The headlines may lead people to think that high sugar diets cause Alzheimer’s. However, the study did not directly test this and no causal relationship can be assumed at all.

Nevertheless, as part of a healthy diet, sugar should be limited. SACN advise that less than 5% of daily energy should come from free sugars (which amounts to 30g per day for an average person over 11 years).

Where to find useful information on the topic

BDA Food Facts, Sugar
Alzheimer’s Society, Risk factors and Prevention

HEADLINE 2: Arthritis: Following THIS diet could help stave off the crippling condition
SWITCHING to a superfoods diet can help fight rheumatoid arthritis, research has found

The story in the Daily Express was also reported by:
NDTV: Scientists reveal the diet and superfoods that can beat arthritis
Daily Mail: Diet to beat arthritis
The Sun: Blueberries, ginger and olive oil offer pain relief to thousands of rheumatoid arthritis sufferers
Times Now: Rheumatoid arthritis: Indian scientists list foods that may help ease the condition

Behind the headlines: the Nutrilicious dietetic view
This headline is based on a list of ‘superfoods’ that has been produced following a review of journals publishing on the subject. The list of foods includes blueberries, olive oil, green tea, pomegranates, dried plums, ginger and more. Those who carried out the research also recommend avoiding meat and including probiotics.

Many studies seem to hit the headlines regarding so called ‘superfoods’ (a term for which there is no official definition). However, no single food can outweigh the impact of the rest of one’s diet and hence a whole diet approach is recommended.

What we know is that no single food can cure arthritis. Rather than following a list of ‘superfoods’ as this headline suggests, having a healthy balanced diet, Mediterranean style, with a variety of fruit and vegetables, whole grains, beans, fish and healthy fats would be advised.

The links given below discuss in more detail key aspects of a healthy diet for arthritis, the role of vegetarian diets and the potential role of supplements for the condition:

Arthritis UK, Diet and Arthritis
BDA Food Facts, Diet and Rheumatoid Arthritis

HEADLINE 3: Cheers! Red wine cuts diabetes risk in women: Moderate drinking found to reduce chance of the disease by 27%

The story in The Daily Mail was also reported by:
The Express: Type 2 diabetes symptoms: Drinking RED WINE could help LOWER risk of condition
Health Spectator: Drinking tea and red wine reduces type 2 diabetes risk

Behind the headlines: the Nutrilicious dietetic view
This study looked into the eating habits of women aged between 40 and 65 years old. Through a food questionnaire it concluded that a diet rich in antioxidants (foods including red wine, dark chocolate, tea, fruits, nuts and vegetables) will reduce the risk of type 2 diabetes by 27%.

From this type of research, it cannot be proven that a diet rich in antioxidants, or as the headlines specifically say drinking red wine, reduces diabetes risk; it is an association found and more studies are needed. Food questionnaires, as used in this study, have questionable accuracy and the study can only be applied to middle aged women. Whilst many of the foods listed in this study such as fruit and vegetables play an important part in the diet, alcohol can have detrimental effects to our health and should be limited (no more than 14 units per week).

Looking at the bigger picture, it is interesting to note that the WCRF recommend for reducing cancer risk as much as possible, we should not be drinking alcohol at all. For type 2 diabetes prevention, the most important lifestyle factors are to maintain a healthy weight, eat a balanced diet and be active.

For more information, go to:
NHS, Drinking and Alcohol 
WCRF Alcohol and Cancer Risk
Diabetes UK, Preventing Type 2 Diabetes


New study – a Nutrilicious review AJCN cow’s milk or non-cow’s milk beverages & children’s height

New study – a Nutrilicious review AJCN cow’s milk or non-cow’s milk beverages & children’s height

The study
A recent publication in the American Journal of clinical nutrition presents the results of a study on the dietary intake of cow’s milk and non-cow’s milk beverages in children aged 24-72 months. The authors conclude that non-cow’s milk consumption is associated with lower childhood height.

Our review
There are multiple issues with the methodology used in this study that cast doubt on the value of its results and conclusions.
• The paper compares 4,632 cow’s milk drinkers with 643 non-cow’s milk drinkers. However, within these two groups there are 397 children consuming both cow and non-cow’s milk, meaning that only 4.8% (246) children in the study consume only non-cow’s milk.
o Additionally, data from the children consuming both cow’s and non-cow’s beverages are included in both groups and therefore the data are counted twice in the analysis.
• Non-cow’s milk is defined as any other type of milk not based on cow’s milk and included both plant and animal beverages e.g. goat’s milk, alongside soya and nut beverages which all have very different nutritional values. Additionally, many plant-based beverages are now fortified with vitamins and minerals. The authors therefore are completely unware of the nutritional values of the non-cow’s milk beverages and for the plant-based varieties, whether or not they were fortified nor can they make any connection between the groups for the quality and quantity of protein.
• The authors did not take other dietary factors into account. They propose that one of the key reasons why cow’s milk is important for height is achieving adequate protein intakes. Yet, without a full dietary analysis, they cannot be aware which children met their protein requirements and which did not. There are also many other protein sources in young children’s diets.
• The authors only adjusted data for maternal height but not for paternal height. The height of both parents should have been taken into account.
• The only dietary intake collected was how many 250ml cups of cow’s milk or non-cow’s milk was consumed per day. This was undertaken by questionnaire, which may be subject to measurement error or recall bias.
• It is not known when the children started consuming the non-cow’s milk drinks, or why they were consuming non-cow’s milk, both of which could have a significant effect on the results observed.
• The authors also recognise a potential height measurement error given the young age of the children.
• Finally, it is a cross-sectional study, not designed to look for causal effect, and thus the simplistic conclusion that height is effected by milk type cannot be drawn.

Our key take outs
Overall, the study is misleading and no conclusions can be drawn except that it is important for parents to be educated on children’s nutrition. Parents of children wishing or needing to avoid cow’s milk should seek dietetic advice to ensure that suitable alternatives are used and the nutritional quality of their overall diet is balanced. There is no reason why a healthy child following a balanced diet should not include calcium and vitamin fortified plant-based beverages. Additionally, soya beverages are similar to cow’s milk for protein quality and quantity.

About Nutrilicious
At Nutrilicious we help to change the way people eat for better health and planet. We do this by helping organisations and health influencers including the media with nutrition and health advice and support. We love good science and credible creative news and headlines. We get a little upset however when they mislead or cause confusion.

Our nutrition professionals are either Registered Dietitians or Registered Nutritionists with at least a bachelor’s degree in dietetic or nutrition science and extensive experience in public health nutrition. They are bound by the Association for Nutrition and the British Dietetic Association respectively to continue professional development and follow standards of ethics, conduct and performance. This means you can be assured that our advice will always be up to date with the latest recommended guidance and practice.

Draft Soft Drinks Levy – Objectives, Thresholds, Exemptions & Impact?

Draft Soft Drinks Levy – Objectives, Thresholds, Exemptions & Impact?

How much is the UK public willing to pay for sweetened soft drinks?
The draft Finance Bill 2017 was published on Monday, 5th December. Not normally associated with health and nutrition news, this year, the introduction of the soft drinks levy has definitely hit the newspaper headlines. Still awaiting the finer details, the draft does provide further insight and confirms the details announced during the 2016 budget announcement. Out for comment, it will be interesting to see how industry reacts with many of the big players already making huge reformulation changes to ensure the few of their products are taxable.

So what is in the draft Finance bill?
All soft drinks which contain 5g or more of added sugars per 100ml will be in scope of the tax. This will also include alcoholic drinks of ABV up to 1.2%.

The exemptions:
• Smallest manufacturers and importers of the smallest producers abroad.
• Soft drinks containing less than 5g added sugars per 100ml or no added sugars drinks.
• Drinks classified as ‘Foods for Special Groups’ which includes baby foods and formulae.
• Sugar containing milk-based drinks with a minimum of 75ml of milk per 100ml.
• The new trend of plant-based milk alternatives is also exempt as long as they are a source of calcium.
• Alcohol substitute drinks.

Transition period until April 2018 – providing reformulation time for all industry.

The two sugar thresholds still remain:
Products with 5-8g added sugars will be taxed at a lower level than those providing 8g or more of added sugar per 100ml.

The exact tax level has yet to be defined, but according to the Guardian Monday 5 December headlines, the levy would increase the cost of a 1L bottle of soft drink containing 5g sugar per 100ml by 18p and those containing 8g and more of sugar per 100ml by 24p.

Policy objective is to reduce childhood obesity through the reduction of total calories by removing additionally calories consumed via added sugars within soft drinks. It hopes to raise in excess of £500 million in the first year which they have promised to invest in physical activity for children.

The government wants to encourage industry to reduce sugar levels by:
• Reformulation
• Reduction in portion size
• Import of lower sugars / reformulated drinks

Economic impact (Estimated by the Office for Budget Responsibility). Based on estimates made in 2016:
The levy will add a quarter of a percentage point to CPI growth in 2018 and 2019.

Health impact.
It is believed that the health of the nation will be significantly improved especially with a reduction of obesity related diseases e.g. diabetes type 2.
The main reason for the sugar focus is that it is seen as additional excess calories.

Impact on industry.
The government believes that 300 UK producers will need to register for the levy and the impact on their business should be negligible. However, the Coca Cola representative’s view at the All Party Parliamentary Group on Adult & Childhood Obesity Meeting on the 5th December, had a different opinion stating that the average cost per reformulation was in the range of £½million and that smaller manufacturers would not be able to absorb this cost.

Operational impact (HMRC costs): there will be a one-off capital costs to develop the system for tax collection and on-going resources costs for HMRC to implement this change and monitor compliance.

An additional comment made by at the All Party Parliamentary Group on Adult & Childhood Obesity Meeting on the 5th December, was that the government had yet to demonstrate clearly if this sugar tax will have a significant impact on obesity.

Demonising carbs and low sat fat advice isn’t getting us anywhere

Demonising carbs and low sat fat advice isn’t getting us anywhere

The latest headlines have been fueled by the ill-advised national obesity forum publication ‘Eat fat, cut the carbs and avoid Snacking to reverse obesity and type 2 diabetes” (23rd May) and the findings from survey of its 80,000 diabetic patients undertaking a 10-week low carb programme (31st May).

It is always important to challenge current thinking and explore new research. It is however, highly irresponsible to debate current thinking using studies that have already been discredited for methodological flaws. Add to which, in our opinion, it’s also unhelpful and damaging to design and direct a debate around controversial research findings for the consumer arena. Unless of course, we expect consumers to be totally adept at interpreting research findings into context of public health and able to fully understand and critique statistics and methodologies. This is unlikely when we consider that not all expert health professionals are able to correctly interpret research data into context nor have the skills to grasp appropriate selection criteria, dietary methodologies and limitations of study findings.

Low saturated fat debate – based on the same bad science
It was very disappointing to see the NOF cite the same studies that have been discredited in the past for methodological flaws and study selection bias. Their conclusions that lowering saturated fat intakes has no correlation to cholesterol levels or CVD outcome does not only go against the totality of scientific evidence but demonstrates their experts lack of knowledge in the critiquing of published data. Obvious factors such as the presence of trans fats from polyunsaturated margarines, the overall macronutrient profile of diets and which macronutrient replaced saturated fat reductions in the intervention groups were completely ignored in the studies cited by the NOF. These are very basic and undisputed factors that impact on CVD and serum cholesterol outcomes. An excellent explanation has been published by Dr Nita Forouhi from the University of Cambridge and covered by Prof. Bruce Griffin from University of Surrey during the Alpro Foundation symposium in March this year.

The totality of evidence points to:
• We should be talking about foods and diet and not individual nutrients.
o I.e. saturated fat sources from dairy do not adversely affect serum cholesterol levels compared to saturated fat from processed meat. Therefore, advice to consumers should be to eat less processed meats and not to eat less saturated fats.
• Lowering saturated fat intakes is important for reducing serum cholesterol levels, however, it isn’t enough. Which macronutrient replaces the saturated fat energy is important with polyunsaturated fats proving most effective whilst refined carbohydrates will show no benefit and in some cases negative effect.
• Whole diet approach should be encouraged where higher soluble fibre wholegrains, beans and peas, fruit and veg, oil rich fish and lean proteins are encouraged. It is the nutritional profile of the whole diet that will impact on CVD outcomes.
• Meta-analysis are not full proof and their conclusions should never be taken at face value. It is important to have a full understanding of the selection criteria used and potential contraindications that have been missed.

Low carbohydrate diets and type 2 diabetes
This has been fuelled by the patient led forum at where it encourages its subscribers (over 120,000 patients with diabetes) to embark on a low carb 10-week programme. This has been championed by Dr Unwin, a GP from Southampton, who was frustrated at the lack of weight loss and poor glycaemic control of his type 2 DM patients following traditional dietary advice. He embarked on prescribing the low carb diet and has found that his patients are sticking to the dietary regimen, losing weight and significantly improving their HbA1c readings with significant financial savings to his practice. He has published two papers, one with 19 subjects and the other based on a case study. The low carb diet recommends anything from 0-130g of carbohydrates a day – normally no more than 100g – and a higher vegetable intake with lower fruit intake. To put it into context, 100g carbohydrate equates to 5 thick slices bread, 4½ medium bananas, 4 small servings (30g) of cornflakes OR 1¾ medium jacket potatoes. Carbohydrate calories are replaced, in the main, by unsaturated fats but also from proteins. Studies published on the success of this regimen are often small in number and over a short period of approx. 3 months. However, they are promising and seem to support the high protein satiety theory and better compliance to dietary restrictions. Ultimately, individuals on these regimens do consume significantly fewer calories. Although this dietary regimen can be successful for some patients, so have other regimens been proven to be as successful including higher wholegrain and low fat diets.

The primary goal for type 2 diabetes is weight loss to help optimise glucose control, therefore, dietary regimens should be matched to the individual patient’s needs. Different approaches will work for different individuals.


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