Brexit: Politics and our plates

Brexit: Politics and our plates

Happy New Year from the team here at Nutrilicious!

We thought that with the new year comes a great opportunity to take stock and consider what’s lined up for food, nutrition and public health in 2019.


Brexit: Politics and our plates

By far and away, the biggest thing in our diaries for 2019 will be Brexit and what will inevitably mark a fundamental change to the British food system as we’ve come to know it. Come 29 March,  the deal will be done (or not!) and what that will look like is anybody’s guess right now.

The UK does not feed itself. We rely heavily on other countries for our food supply, with only 49 per cent of the food consumed in the UK produced here and 30 per cent coming from the EU; the equivalent to 10,000 shipping containers each day. For some commodities such as fruits and vegetables, our dependence on imports is much higher, in this case, we import 90 per cent of the fruits and vegetables we consume.

And so, because our food system is complexly intertwined with the EU, once we leave, it will significantly change our trading relationships, both with the EU, as well as those countries out of the EU that have trading agreements with it.

Consequently, people’s diets will be most likely be affected, with a working paper from the Oxford Martin School on the Future of Food warning that food prices are likely to increase, particularly for fruit and vegetables. According to this modelling, a Hard Brexit (trading on World Trade Organisation terms which imposes tariffs on imports) could lead to 5,600 additional deaths per year, associated with reduced consumption of fruits, vegetables, and nuts. This will not only affect individuals but the wider costs to society are pegged at increased healthcare expenditure at around 600 million GBP. On a positive note, there may be small benefits on obesity rates and reduced red meat consumption (see Figure 1)!

Figure 1. Changes in mortality in the UK by risk factor and cause of deaths under a Hard Brexit

The current deal on the table, due to be voted on in mid-January aims to provide a continuous tariff-free and quota-free access to EU markets, but even if voted through, the road ahead is likely to be tumultuous. Initially, the EU Withdrawal Act writes EU law over into UK law ­– triggering some necessary changes in relation to country of origin labelling and address information. Further changes to our food and nutrition labelling and food regulations may be unavoidable if international trade deals require them.

We should all be watching closely to how Brexit translates to the food on our table, dietary choices and ultimately public health.

For further information on how Brexit may affect the food system, we recommend reading the FRC’s Brexit briefing papers: https://foodresearch.org.uk/food-brexit-briefings/

 

EAT-Lancet Commission report

We’re expecting that the EAT-Lancet Commission report on Food, Planet, Health, due to launch on 17 January, is going to make waves. Never has the connection between food, planetary and human health been more apparent, with the need to address issues and impacts ever more pressing.

Housed at the Stockholm Resilience Centre, the EAT-Lancet Commission partnership brings together leading global researchers into five working groups, investigating:

  1. What is a healthy diet?
  2. What is a sustainable food system?
  3. What are the trends shaping diets today?
  4. Can we achieve healthy diets from sustainable food systems? How?
  5. What are the solutions and policies we can apply?

The report will include the latest research on each of these workstreams and will be publishing targets that deliver for both people and the planet.

For further information and to sign-up for updates, go to the Food, Planet, Health website: https://foodplanethealth.org

If you want to understand more about sustainable diets and how these new targets apply to your business, or would like a scientific review completed on another hot topic, please get in touch on 020 8455 2126.

 

Coming down the line from government

It looks like the team at Public Health England have been busy. While the rest of us were enjoying our mince pies, they have been working hard behind the sciences and they have kicked off the new year with the launch of new Change4Life messaging, raising awareness of the fact that on average, children are consuming their childhood sugar requirements by 10-years old.

But what else is on the agenda for the year ahead? With the updated Childhood Obesity Strategy published mid-2018 came promises of consultations on bans on pricing and positional promotions in retailers and a 9pm watershed for advertising of unhealthy food and drinks. Though we did see consultations conducted on the ban of sale of energy drinks to children and mandating calorie labelling in the out-of-home sector, some of the other consultations have not materialised yet, but they will be coming this year.

North of the border, the Scottish government also just completed their consultation on restricting junk food promotions, so it will be interesting to see what emerges there.

In 2018, SACN also consulted on their draft review of saturated fats, which recommended a continuation of previous COMA recommendations of 10% total calories. The final report is due at some point 2019 and is on the agenda for discussion at the next SACN meeting in March.

With saturated fat such a hot topic and matter of debate, keep your eyes peeled for this one, as it will provide some much-needed clarity and authoritative recommendations.

In addition, according to SACN meeting notes, the following items should also be expected in 2019:

  • Whole Systems Obesity Programme: a joint initiative of PHE, the Local Government Association and the Association of Directors of Public Health are due to publish their guide and tools in the spring
  • Product ranges targeted at babies and young children: scope and ambition for this programme is due mid-2019, following initial scoping and consultation that has already been conducted with industry and other stakeholders
  • School Food Standards: technical update to commence in 2019
  • National Diet and Nutrition Survey Year 1-9 Report: due imminently

So, that’s a brief flavour of some of the key things coming up on 2019. As ever, there’s lots of things to keep us busy!

Here at Nutrilicious we can help with your nutrition and health strategy, nutritional assessments of product portfolios, insights – views from the outside world of nutrition influencers and what they think of your offering – overall helping to put you on the front foot of your competition and upcoming government reformulation targets or standards. Or, perhaps you have key messages that you’d like to share with stakeholders through engaging new media such as interactive webinars and podcasts. To discuss your policy and communication requirements, you can reach us on 020 8455 2126.

Best wishes for a healthy and happy 2019.

 

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All disease begins in the gut

All disease begins in the gut

As Hippocrates, the father of modern medicine, said more than 2,000 years ago, ‘All disease begins in the gut’. And modern science is proving it as true today as it was then.

In this blog we outline the importance of gut microbiota and the use of diet to affect them to try to improve health and welfare.

For a detailed exploration of the topic, register for our free, CPD-accredited NutriWebinar. Led by experts Professor Glenn Gibson and Laura Tilt, it will give you both incredible insight into the science and practical tips on how to help balance gut microbiota for real health benefits.

The importance of the gut microbiome

We have more than 1,000 species of bacteria in our gut. And there’s been an increasing realisation among scientists that these can have a profound effect on our health – from Irritable Bowel Syndrome to infections, asthma and inflammatory disease right through to bone health and cognitive function.

This understanding has led researchers to investigate what we can do to affect the microbiota, to be applied to this wide range of health problems. A steady stream of scientific publications over the last 15 years address the topic, alongside research into probiotics and, more recently, prebiotics – which selectively fertilise the ‘good’ bacteria.

Our gut microbiome status changes throughout our lives. We acquire our gut bacteria mostly at birth. Moving through the milk years, there are differences in acquiring bacteria between breast-fed and infant formulae fed babies: human milk.

There is change again at the weaning stage, after which the gut microbiota remains fairly stable. As we get older there is then a decrease in the largely in beneficial bacteria like the bifidobacteria.

The gut microbiota can be susceptible to various challenges: stress, infection, antibiotics and poor diet all amongst the factor coming into play on a daily basis.


How does diet affect our gut microbiome and our health?

Carbohydrates, proteins, amino acids and lipids are all metabolised by microbiomes in different ways, with different outcomes for our health.

Carbohydrate metabolism – especially that of fibre – leads to organic acids, short chain fatty acids, that have shown to be beneficial in the gut. For example:

  • Acetate is metabolised by the muscle, kidney, heart and brain
  • Propionate, cleared by the liver, is an appetite regulator also said to be involved in cholesterol synthesis
  • Butyrate is a fuel and regulates cell growth

Fibre itself can stimulate the growth of good bacteria. It’s been estimated that per 100g fibre fermented, 30g of bacteria is produced.

Metabolism of excess protein, on the other hand, leads to less positive end products:

  • Ammonia induces quick cell turnover
  • Phenols/indoles may act as co-carcinogens
  • Amines are linked to migraine, cancer, schizophrenia

Balancing our gut microbiota

  1. Increased fibre intake

To help ensure balanced gut microbiota, our diet needs to include enough fibre. As discussed in our recent blog, government recommendations advise 30g per day for adults, representing a 60% increase in intake for most. Laura Tilt provides excellent advice on how this can be achieved in the NutriWebinar.

  1. Probiotic and prebiotics

Much work has been done into probiotic supplements: live ‘good’ bacteria that bring health benefits, especially lactobacilli and bifido bacteria.

More recently, scientists have found that prebiotics could have an even more profound effect on our health. They work by selectively proliferating beneficial bacteria, which in turn inhibit pathogens. They may also have a more general effect, including dampening inflammatory issues.

Prebiotics are found naturally in human breast milk and in fructans and inulins in vegetables including asparagus, onion, banana and leeks. They can also be taken as supplements, especially in GOS forms.

Takeaway message

As our understanding of the link between gut microbiota and our health has grown, researchers have increasingly looked to see where we can have the most impact.

We’re in a position where health and nutrition professionals can advise clients on what they can do to improve their gut health and therefore overall wellbeing. We look forward to our research widening and deepening further to improve our understanding in this vital area.

Get involved in the discussion on social media: @Nutrilicious @NutriWebinar #lifelonglearning #feedingthegut

 

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Increasing fibre intakes is key to improving the nation’s health

Increasing fibre intakes is key to improving the nation’s health

The most recent government guidelines on fibre intake recommend 30g per day for adults. Levels are currently at just 20g per day for adult men and 17.1g per day for women – that’s an average 68% increase in intake needed to meet recommendations.

And it’s not just adults: there’s a significant disparity between recommended and actual fibre intake across all age groups.

So why is fibre so important? And what can we do to help people meet the recommended intake levels?

Here’s a quick overview. To explore the topic in more detail, join our upcoming Fibre NutriWebinar, on Wednesday 7 November.

The benefits of fibre 

Dietary fibre has long been recognised for its health benefits. But it’s only in recent years that our understanding and appreciation of it has significantly progressed.

Fibre’s health effects mainly result from two key factors – its physical properties (eg stool bulking, viscosity, binding ability) and its effect on the gut microbiota and luminal environment.

Amongst its many beneficial properties, clinical trials have proven that fibre:

  • Decreases blood pressure
  • Increases satiation
  • Decreases glucose absorption
  • Increases bacterial a faecal mass (commonly associated with health benefits including reduced risk of colon cancer)
  • Exerts benefits through gut microbiota

Where are we getting our fibre from?

The main sources of fibre in the UK are cereals, vegetable and potatoes, contributing to 70% of total intake.

Interestingly, white bread and potato products prepared with fat (eg chips and crisps) are significant contributors. This is despite the fact that they have comparatively low fibre content, showing that consumption is high.

One of our challenges is to educate the public on healthier fibre sources – fruit, vegetables, whole grains and pulses, rather than broad recommendations on increasing cereals.

Understanding and helping consumers

We know that despite the convincing body of evidence for the role of dietary fibre in many chronic conditions, translating and achieving fibre recommendations in practice can be challenging.

Understanding the key barriers faced by the public and putting forward strategies to overcome these is key to facilitating better health for all.

Find out more about the FREE Fibre NutriWebinar with Dr Megan Rossi, RD and register now.

It’s one of our ongoing NutriWebinar series examining key nutrition topics with experts in the field.

 

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Updated childhood obesity plan: But how does it measure up?

Updated childhood obesity plan: But how does it measure up?

The government recently announced new measures to halve rates of childhood obesity by 2030 and significantly reduce the health inequalities that persist – closing the gap in obesity rates between children from the most and least deprived areas.

This proposal builds upon the first chapter of the Childhood Obesity Plan, which was widely criticised at the time as lacking the breadth and depth of initiatives needed to effectively tackle such a widespread and entrenched issue.

Steve Brine, Public Health Minister has stated: “One in three children are now overweight or obese by the time they leave primary school. Overconsumption, combined with reduced activity, is having a catastrophic effect on our children’s health. As both a parent and minister, I am committed to driving today’s pledge of halving obesity over the next 12 years with bold new action.”

“Our updated plan will put parents in charge, providing more information and support. Our aim is to help families make healthier choices, which will in turn provide a better chance at a longer, healthier life for our children.”

Obesity – A systems issue

The financial burden of obesity is too great to ignore: it’s estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2017/18, which, to put into context is more than was spent on the police, fire service and judicial system combined. The wider costs to society of these conditions are around £27 billion a year, if not higher.

Ever since the Foresight report was published over a decade ago, it has been recognised that obesity is a systems issue and one that therefore requires reform at many points, to deliver change. This idea and the fact that no plan to date has sought to address childhood obesity in a multi-sector way, was reiterated in the recent inquiry by the parliamentary Health and Social Care Committee into childhood obesity. Childhood Obesity: Time for Action argued for a change in narrative, making clear that obesity is everyone’s business and “an effective childhood obesity plan demands a holistic, joined-up, ‘whole systems’ approach with clear and effective leadership”.

How does the Childhood Obesity Strategy measure up?

This update to the Childhood Obesity Strategy is a welcome step forward. It contains a raft of proposed measures that seek to tackle the issue using a co-ordinated range of policy levers. What is also good to see is that this new plan takes a firm but fair approach in how it will deliver change: using voluntary measures in the first instance but being clear that a harder tact with the likes of regulatory and fiscal measures will be considered where progress is deemed insufficient, or where a level playing field is required.

Here at Nutrilicious, we’ve taken a closer look at what’s in store and benchmarked the new childhood obesity plan against the World Cancer Research Fund’s NOURISHING framework, as well as the recommendations from the Health and Social Care Committee’s report mentioned earlier.

The NOURISHING framework

The NOURISHING Framework sets out that policies are needed within three core areas to improve diets: the food environment, food system and behaviour change communication.

N – Nutrition label standards and regulations on the use of claims and implied claims on food
O – Offer healthy food and set standards in public institutions and other specific settings
U – Use economic tools to address food affordability and purchase incentives
R – Restrict food advertising and other forms of commercial promotion
I – Improve nutritional quality of the whole food supply
S – Set incentives and rules to create a healthy retail and food service environment
H – Harness food supply chain and actions across sectors to ensure coherence with health
I – Inform people about food and nutrition through public awareness
N – Nutrition advice and counselling in health care settings
G – Give nutrition education and skills

Bearing in mind that some policies and actions targeting childhood obesity were in place prior to this strategy update, overlaying the new measures show how broad their impact alone intends to be:

New measures N O U R I S H I N G Nutrilicious notes
Improved food labelling to display ‘world-leading, simple nutritional information’ as well as information on origin and welfare standards following Brexit X
Strengthen School Food Standards to reduce sugar consumption X X We would like to see these universally applied and close the loophole that exists for some academies
Strengthen Government Buying Standards for Food and Catering Services* X X
Ban price promotions such as buy one get one free, multibuys or unlimited refills of unhealthy foods and drinks in the retail and out of home sector* X It is good to see a mandatory approach applied here, as this is what is undoubtedly needed when policies will impact businesses’ bottom line.
Ban the sale of energy drinks to children* X
Ban promotion of unhealthy food and drink by location e.g. positioning – checkouts, end of aisles and store entrances, in retail and out of home sector* X
Introduce a 9pm watershed on unhealthy food and drink advertising and similar protection online* X We would like to see similar controls applied to sports advertising
Review governance arrangements for advertising rules (currently overseen by the Committee of Advertising Practice and Advertising Standards Authority) X
Potentially bring ‘sugary milk drinks’ into the soft drinks levy if insufficient action on sugar reduction takes place X X
Introduce mandatory calorie labelling for out of home sector in England* X X
Sugar reduction plan for products aimed exclusively at babies and young children due in 2019* X
Calorie reduction plan due mid-2019* X
Develop trailblazer programme with local authority partners to highlight what can be done within existing powers X We would like to see greater powers for local authorities and health services
Develop plan to use Healthy Start vouchers to provide additional support to children from lower income families* X
Ofsted will review school curriculum to understand how it can better support healthy behaviours, including food choices X X We would like to see improved early years education for parents to support a healthy first 1000 days and compulsory home economics with healthy cooking skills at the core in both primary and secondary schools

*Proposal for further consultation

Is it enough?

While we applaud this latest round of the childhood obesity plan, we would also draw attention to the fact that there is still some way to go.

By mapping the proposed policy options against the NOURISHING framework, we can see that in this latest iteration of the plan much more focus has been given to shaping an environment that enables and supports healthier choices, which is great to see.

However, what is noticeably absent is the ‘I’ in terms of improving food and health literacy of the population. In a ‘post truth’ world where consumers are increasingly sceptical of messages coming from the scientific community, and when social media influencers are capturing the hearts and minds of the masses with questionable dietary advice, never has it been more important to provide clear, simple and authoritative information and advice. As such, we’d like to the see the government step-up their efforts on social marketing and educational campaigns.

What is more, a number of recommendations made in the Health and Social Care Committee are notably absent, including:

  • Establishing a Cabinet-level committee to review the implementation of the plan, ensuring it gets the high-level traction it requires
  • Proposing further measures around early years and the first 1,000 days of life, including targets to improve rates of breastfeeding
  • Banning the advertising and promotion of follow-on formula milk
  • Providing local authorities with further powers to limit unhealthy food and drink advertising near schools (the only powers available to local authorities extend to the positioning of the billboards themselves, not the content of the advertising)
  • Introducing services for children living with obesity

Finally, while this plan is overtly focussed on limiting unhealthy foods and drinks and making processed, packaged foods a little better through reformulation (lower in salt etc), we would also like to see equal attention given to measures that work improve the quantity and quality of foods that we do want people to eat more of. Changing the dietary landscape will require strong efforts to provide families with the tools and knowledge to instil these healthier behaviours in a sustainable way.

The full plan for action can be viewed here:

https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action

 

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Latest advice on infant feeding: has anything changed?

Latest advice on infant feeding: has anything changed?

The final ‘Feeding in the First Year of Life’ report published by the Scientific Advisory Committee on Nutrition (SACN) supports current government recommendations including breast is best, introduction of allergenic foods from six months and the importance of variety and textures.

Covering infant feeding from birth to 12 months, it provides its recommendations to government based on the best available evidence for the short- and long-term health outcomes for infants and mothers.

The one note of significant difference to existing advice is the recommendation that vitamin A supplements for infants should be discontinued. This will cause some inconvenience as most infant vitamin drops, which were developed on government advice, include vitamin A.

What is the SACN recommending to government?

  • More strategies and support to help mums breast feed exclusively for the first six months of the infant’s life and to continue breast feeding alongside weaning for the first year.
  • Where breast feeding is not possible, infant formulae based on either cows’ or the more recent goats’ milk are the only suitable alternative options. Soya-based formulae should only be introduced under medical advice.
  • Only breast milk, formula or water as a drink should be offered between six and 12 months.
  • Solids should be introduced from around six months of age, ‘having achieved developmental readiness’. The SACN found no evidence for the critical window of opportunity (four-six months) for increased acceptance of solids.
  • Reducing risk of ‘fussy eaters’. Based on the evidence available, it is recommended that perseverance with repeated exposure of a variety of textures and flavours should be encouraged.
  • Introduction of textures is critical for the development of munching and chewing. Textures should be introduced incrementally depending on the infant’s individual development rate.
  • Baby-led weaning: due to too few studies, the SACN could not make any recommendations. However, it did make the point that the limited evidence to date is promising for earlier self-feeding and less food fussiness.
  • All allergenic foods should be introduced from six months in small quantities and one at a time. This is of course for infants not at high risk of or diagnosed with an allergy. It is particularly important for peanuts and hen’s eggs, where the evidence is strong that delayed introduction increases the risk of allergy later in life. Additionally, nuts such as peanuts should not be given whole until the age of five years to prevent choking risk.
  • Vitamin D intakes remain a concern for infants who are being breast fed or on less than 500ml formula daily. The SACN acknowledges the poor update of vitamin drops for babies but continues to emphasise the importance of encouraging breast feeding mums to use vitamin D supplements from birth.
  • Iron continues to be an issue beyond six months of age and greater emphasis should be placed on the introduction of iron rich foods, rather than supplements, from the start of weaning.
  • Vitamin A supplementation should no longer be encouraged as risk of deficiency is low and advises the government to review its current baby vitamin drop recommendations.
  • Energy intakes remain too high and infant weights exceed standard weight charts. There is a need to better monitor overweight and obesity in infants.
  • Salt and sugars intakes remain high in infants, with commercial baby foods, especially fruit purees, being the main contributors.
  • Throughout the report, the SACN make no distinction in their advice between commercial or home-made complementary foods – could this be a sign that reality and practicality has been taken into consideration?

The Public Health England (PHE) sugar reduction programme for complementary foods will be far more controversial than the new SACN recommendations.

We have heard this week that PHE have just finished their scoping work for their sugar reduction programme of complementary foods for infants and are preparing for discussions with industry, NGOs and other interested parties.

Setting sugar reduction targets for this category will be challenging, to say the least.

  1. The complementary foods’ regulation, which PHE cannot over-ride, permits significantly high levels of sugars: up to 20g total sugars per 100g for ‘fruit only’ products and up to 25g per 100g for desserts and puddings.
  2. There are huge discrepancies between PHE’s classification of ‘free sugars’ and regulatory and labelling classifications of ‘added sugars’. Sugars naturally present in fruit and vegetable purees are classified as ‘free sugars’ by PHE but not as ‘added sugars’ by foods or labelling regulations.
  3. Some will argue that pureed formats of fruit and vegetable are essential as first foods, especially by those from the ever-exploding pouch market, and as such should be excluded from the ‘free sugars’ classification. However, there should be a strong opposition from health experts and very active pressure groups:
    • There is a growing consensus that fruit and sweet tastes should no longer be recommended as first foods in order to reduce the infants’ continued preference for sweetness.
    • Additionally, with the SACN’s affirmation that complementary feeding should start around six months, purees are no longer essential. At that age the infant is ready, and should be encouraged, to develop their munching and chewing skills which means the need for textures. Pureed food on the other hand only rely on an infant’s innate skills of sucking and swallowing.

Interesting times…let’s wait and see.

Complementary foods regulation update – will this rock the boat?

The updated version of the 2006 regulation on processed cereal-based foods and baby foods for infants and young children has yet to be published. The revised regulation was rejected last year for numerous reasons, including pesticide and sugar upper limits being too high.

The next version should be with us this year and it will be interesting to see how it aligns with the SACN’s and PHE’s recommendations – especially with regard to sugars and when solid foods should be introduced. Currently, the regulation (and the failed 2017 revision) permitted solid food introduction from four months.

Welcoming the findings

Only recently, the BBC reported the potential benefits of feeding solids as early as three months, which is likely to have caused confusion for parents.

So we’re pleased that this new SACN report helps to give support for the current advice in the UK: babies should ideally be exclusively breastfed for six months, and solid foods should be introduced after this. Or, as Dr Alison Tedstone, Chief Nutritionist at Public Health England (PHE) put it: “SACN’s robust advice puts to bed any arguments about a beneficial effect of early introduction of solid foods.”

We do however notice the very precise wording of ‘around six months’.

There is some concern amongst dietetic paediatric experts that setting a specific time for solid food introduction is unrealistic, may place some infants at risk and is an added pressure for mums on top of guilt faced by those who do not wish to or cannot breast feed.

The important factor is that solid foods should only be introduced when an infant is developmentally ready: when they can sit with minimal support and hold their head steady; can co-ordinate eyes, hands and mouth; and are able to reach out to pick up food and bring it to their mouth. Some infants may be ready before six months; a few may not be ready yet at that stage.

It’s important government advice should ensure mums understand that there is flexibility ‘around’ the six months.

Further advice on early feeding and breastfeeding
In the UK we have some of the lowest breastfeeding rates in the world, so it is important to provide help and support to mothers wishing to breastfeed. The NHS gives information about where to get help.

See also:

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New review concludes omega-3 fats have no benefits for heart health… or does it?

New review concludes omega-3 fats have no benefits for heart health… or does it?

An extensive detailed analysis of the current scientific evidence into omega-3 seems to have thrown a spanner in the works for heart health dietary advice.

Conducted by Cochrane, the review concludes that there is no correlation between cardiovascular health and intakes of the long chain omega-3 fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) over a one- to six-year period.

Long chain omega-3 fats have long been associated with reductions in blood triglycerides, blood pressure and thrombosis; producing anti-inflammatory and anti-arrhythmia effects as well as improving endothelial function and insulin sensitivity.

This most recent publication will raise many eyebrows within the heart health professional arena and likely to be taken up by media editors who seem to enjoy questioning the trustworthiness of public health guidelines. These recommend a diet including omega-3, especially found in oil-rich fish such as salmon, tuna and mackerel.

So, do we need to change dietary guidelines on the importance of omega-3 and oil-rich fish?

Before we jump the gun, it’s important to put things into context:

1. The shortcomings of the review

a. The studies investigated in this review predominantly used omega-3 supplements. Thus the outcomes cannot be related to oil-rich fish consumption which is the main dietary source of EPA and DHA.

b. The studies were also of one to six years’ duration, which is a relatively short period to assess disease and mortality risk. And conclusions cannot be reached for a lifetime consumption of foods rich in EPA or DHA.

c. Many of the studies may not have used adequate number pf subjects in the studies to elicit a result. This is especially the case for studies conducted in healthy individuals (and therefore low risk of heart disease), which would require very high numbers to demonstrate a difference in the omega-3 and non-omega-3 study groups.

d. Any studies conducted over the last two decades of people at risk of cardiovascular disease (CVD) will be in individuals already medicated with statins and other cardio-protective drugs, which may mask the effect, if any, of additional omega-3.

2. Omega-3 benefits go beyond heart health

Long chain omega-3 fats are critical for eye and brain development of the foetus and young children. Therefore, food sources should be included in a healthy balanced diet of children and adults planning for a family.

3. Oil-rich fish is not just omega-3. It offers so many health benefits.

a. Unlike omega-3 supplements, oil-rich fish is a rich source of not only the long chain omega-3 fats but also of selenium, zinc, vitamin D and iodine; woefully lacking in the UK diet.

b. Oil-rich fish has a healthier fat profile when compared to red meat and other animal proteins. Replacing saturated fat with unsaturated fat in the diet has been proven to have a positive effect on blood lipids and cardiovascular health (as confirmed by Cochrane’s 2015 review and the SACN’s & the WHO’s draft 2018 reports). See our saturated fat blog

Indeed, the authors themselves remind us of the other nutritional benefits of oil-rich fish and that this review does not negate public health advice that consuming oil-rich fish is beneficial to health.

The Nutrilicious view

Taking vitamin and mineral supplements as a substitute for eating a healthy balanced diet has never been encouraged by health professionals. However, dietitians recognise that when demands for specific nutrients are high, or when an individual’s nutritional intake is at proven risk of being compromised, supplements can play an important role. For example, pregnancy and folic acid; under-5 year olds and vitamins C and D; or sufferers of osteoporosis and calcium and vitamin D.

Therefore, these findings do not come as any surprise: omega-3 supplements are not a solution to better heart health. There are numerous dietary and lifestyle factors that impact on heart health. It should always be about food rather than the benefits of single nutrients.

As Linda Main, Dietitian and dietary advisor for cholesterol charity HEART UK, explains: “We continue to advise the lifelong consumption of a heart healthy diet centred around eating whole foods rather than the emphasis being on nutrients.

“Eating patterns such as the Mediterranean, DASH or the UCLP© diets result in the consumption of a nutritionally appropriate diet. This is characterised by eating plenty of vegetables, fruits, wholegrains, vegetable proteins such as nuts and soya, seeds, vegetable oils and spreads. In those who consume animal proteins, the inclusion of low fat dairy, lean and largely unprocessed meat and white and oily fish and seafood are recommended.

“Omega-3 supplements are not currently advised by HEART UK and would not be our first choice, except when prescribed by a recognised qualified health professional or when needed to safeguard the intake of the essentially fatty acid – alpha-linolenic acid.”

As oil-rich fish is an excellent low saturated fat protein source, and the main dietary source of long-chain omega-3 fats as well as other crucial nutrients, it should continue to be part of dietary guidelines.

Additionally, for those wishing to follow a more plant-based diet, it’s reassuring that the report finds consumption of the shorter chain omega-3 fats found in plant foods (like rapeseed and soya oil) has cardio-protective qualities. This supports findings from population studies that vegetarians and vegans have a lower incidence of cardiovascular events and mortality compared to non-vegetarians.

Current UK heart health dietary advice remains unchanged:

  • Lower the amount of food eaten which is high in saturated fat and replace it with foods high in unsaturated fats (which Cochrane’s 2015 review supports, SACN 2017 Saturated fat draft guidance).
  • Increase our intake of fibre (especially from beans, pulses, oats and barley), nuts.
  • Consume at least five servings of fruit and vegetables daily.
  • Reduce intakes of red meat and avoid/limit processed meat.
  • Consume two portions of fish weekly – one of which should be oil rich.
  • Increase intakes of leaner and plant-sources of protein.
  • Use sterol or stanol fortified products (if blood cholesterol is raised after other dietary changes have been made).

It’s interesting to note that, unlike the US, the UK does not (and has never) recommended taking dietary supplements of omega-3 fish oil.

For up to date expert advice on heart health visit: heartuk.org.uk

Further references

Saturated fat and heart health reports

Supplements for specific groups
NHS UK: Vitamins for children; Vitamins, supplements and nutrition in pregnancy

 Vegetarian and vegan diets and health outcomes

  • Rizzo N, Jaceldo-Siegl K, Sabate J et al. Nutrient profiles of vegetarian and non-vegetarian dietary patterns. J Acad Nutr Diet.. 2013;113(12):1610-9.
  • Sobiecki J, Appleby P, Bradbury K et al. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res.. 2016;36(5):464-77.
  • Springmann M, Godfray H, Rayner M et al. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci U S A.. 2016;113(15):4146-51.
  • Clarys P, Deliens T, Huybrechts I et al. Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients.. 2014;6(3):1318-32.

Cochrane is an established body of researchers, health professionals and patients across the globe renowned for their high quality scientific reviews of nutrition and health evidence.

 

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