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

by Tanya HAFFNER | Feb 9, 2018 | Hot Topics in nutrition, Media in context, Surveys and insights

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

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

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

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

Coconut milk	Almond milk	Rice milk	Soya milk
Pros Low calories Taste Cons No proteins Rich in saturated fats	Pros Balanced diet Low calories Taste Cons Almond allergy	Pros Comparable caloriesCons Rich in sugar Unbalanced diet	Pros Rich in protein Balanced dietCons Taste Soy allergy

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

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

Behind the headlines: the Nutrilicious dietetic view

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

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

Our assessment of the study

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

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

	Cow’s milk (Semi skimmed)	Coconut milk	Almond milk	Rice milk	Soya milk	Oat Milk	Cashew milk
	Per 100ml (mean values)
Energy, kcal	47	36	13	47	29	40	26
Fat g	1.8	1.5	1.1	1.0	1.5	1.0	1.0
Sat fat g	1.1	1.4	0.1	0.2	0.3	0.1	0.2
Sugars g	4.8	3.3	0.1	6.2	0.5	3.7	1.7
Protein g	3.6	0.2	0.5	0.1	2.7	0.7	0.5
Calcium mg	123	120	120	120	120	120	120
Vitamin D2 ug	0.00	0.75	0.89	0.89	0.75	0.75	0.75
B12 ug	0.91	0.38	0.38	0.38	0.38	0.38	0.38

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

Is soya milk the best non-dairy alternative?

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

Conclusions

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

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

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

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

Gluten free foods are less healthy: Nutrilicious News Digest

by Tanya HAFFNER | Feb 1, 2018 | Hot Topics in nutrition, Thoughts, Media in context

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.

Energy drinks and unhealthy food advertising: Nutrilicious News Digest

by Tanya HAFFNER | Jan 24, 2018 | Thoughts, Media in context, The Nation’s Health

Each week we analyse some of the hot headlines in health and nutrition news. This week we look at the health effects of energy drinks; and a new report from Cancer Research UK on unhealthy food advertising for children.

HEADLINE 1: MORE THAN HALF OF YOUNG PEOPLE SUFFER SIDE EFFECTS FROM ENERGY DRINKS

This week the adverse effects of energy drinks have been reported by the Daily Mail, the Independent and The Sun.

The headlines are based on a study published in the Canadian Medical Association Journal. It carried out an online survey of 2,055 children and young adults aged 12-24, who were asked about their consumption of energy drinks and coffee, and any adverse outcomes they experienced.

55.4% of those who had ever consumed energy drinks (no more than 2 drinks per day) had experienced at least one adverse effect. The most common were fast heartbeat (24.7%), difficulty sleeping (24.1%) and headache (18.3%). Few reported nausea/vomiting/diarrhoea (5.1%), chest pain (3.6%) or seizures (0.2%). 3.1% of the respondents had sought medical advice.

The side effects were consistent with the potential effects of caffeine but were significantly more prevalent than with those who’d reported effects from coffee.

Behind the headlines: the Nutrilicious dietetic view
There are significant limitations to the study, making it impossible to draw any clear conclusions or new insights into the impact of energy drinks on health:

The quantifies of caffeine consumed were unknown
Medical history was not recorded.
The authors admit that there were many other compounding factors to the side effects, such as alcohol and drug consumption.
They also acknowledge difficulty with under- and over- reporting.

What the study does highlight, however, is the popularity of energy drinks among young people.

So what is considered ‘safe’ when it comes to energy drink consumption?

How energy drinks could affect your health

The impact of caffeine

Caffeine is phytochemical stimulant of the central nervous system. It is naturally found in coffee, cocoa beans and tea leaves.

The effects of caffeine vary greatly between habitual drinkers and non-caffeine consumers, who may consume a one off-caffeine drink.

Habitual healthy caffeine drinkers consuming moderate amounts would not experience negative side effects from caffeine. Sugar-free variants will count towards hydration, improved sports performance and alertness.

As with all foods and drinks, moderation is key. Safety limits on daily intakes have been set by the UK based on European Food Safety Authority (EFSA) guidelines:

For healthy adults (aged 16+, excluding pregnant and breastfeeding women): No more than 400mg caffeine per day (3-4 cups of coffee or 2-4 cans of energy drinks, depending on the size of the can). No more than 200mg caffeine (2 cups of coffee or 1-2 energy drinks) as a single dose. Some adults may be sensitive to caffeine. For them, single doses of 100mg may result in difficulty sleeping and reduce sleep duration, particularly when consumed close to bedtime.
For pregnant and breast-feeding women: No more than 200mg per day (1-2 cups of coffee, 1-2 energy drinks). Doses greater than this have been associated with increased risk of miscarriage and lower birth weights
For under 16s: Up to 3mg/kg body weight daily intakes of caffeine do not raise safety concerns. For a 14-year-old teenager weighing 51kg, this would equate to around 153mg of caffeine (1-2 cans energy drink).

Taurine and other energy drinks constituents: EFSA’s 2015 scientific review found no evidence for safety concerns with regard to the interaction between caffeine and other energy drink constituents such as glucuronolactone and taurine.
Increasing free sugars in the diet – the bigger concern

The more popular energy drinks are loaded with free sugars. Even if drunk in moderation in terms of caffeine content, the free sugars content will impact negatively on health.

A typical 250ml serving provides 27.5g sugars (7 teaspoons). That’s 92% of the recommended daily intake for children aged 11 upwards and exceeds daily recommendations for 7-10 year olds by 3.5g.

These drinks are nutrient poor and energy rich, providing excess energy that our young do not need in our current environment of increasing obesity and micronutrient deficiencies.

Of major concern is the larger 500ml serving size of some energy drinks. These can exceed not only the daily caffeine recommendations for teenagers and young children (160mg per 500ml) but also the free sugars recommendation. One brand provides 80g free sugars per 500ml can. That’s three times the daily recommendation of free sugars for 7-10 year olds and 2.5 times for older children and adults.

Take home message
Sugar-free energy drinks containing caffeine can be drunk in moderation. They contribute to hydration, improve alertness and do not have any negative health implications. Habitual moderate caffeine consumption is perfectly safe. Large sizes loaded with sugar do not play a part in a balanced diet.

For more advice on healthy drink choices, go to the NHS website

HEADLINE 2: CANCER RESEARCH UK ARGUES LINK BETWEEN TV ADS AND CHILDHOOD OBESITY

This week, Cancer Research UK called for a ban on advertisements for high fat, salt or sugar (HFSS) foods during talent shows and live sports. This was picked up by the Daily Mail and the Express, as well as BBC’s Newsnight.

It follows their online survey involving 3,348 young people aged 11–19 years, a representative sample of the UK population. Comparisons were made between high commercial TV viewing (three hours per day or more) versus moderate (0.5-3 hours per day).

12 HFSS foods were investigated (confectionery, desserts, flavoured yogurts, cakes/biscuits, milk drinks, takeaways, sugary drinks, sweetened cereals, energy drinks, fried potato products & crisps).

See full details of the report and the methodology used

Key findings include:

There was a significant increase in junk food consumption with the higher viewing of advertisements – 520 more junk food items were consumed per year for each child by those in the high vs moderate TV viewing group.
Those in the high TV viewing group were more likely to have a greater overall HFSS food consumption across 10 out of the 12 HFSS foods investigated.
Key times of exposure to junk food advertisements were in the evenings and weekends, i.e. not classified as ‘children’s viewing time’.

This is of relevance because currently advertising HFSS foods is banned during programmes aimed at children (introduced in 2008 – a decade old!), but the ban does not apply to later mainstream programmes such as live sport and talent shows. The TV regulator, Ofcom, have previously highlighted that 7-8pm is when children currently watch the most TV.

Junk foods ads were equally effective on TV and on demand streaming.

As a result, Cancer Research UK is calling for restrictions up until 9pm on TV and tighter controls for online streaming.

Behind the headlines: the Nutrilicious dietetic view
This is a detailed survey from Cancer Research UK, involving a large number of participants and provides evidence (although not causal) that HFSS marketing could be driving unhealthy eating and drinking.

The lead researcher Dr Jyotsna Vohrarom Cancer Research has stated: ‘This is the strongest evidence yet that junk food adverts could increase how much teens choose to eat.’

It has been shown that high consumption of individual foods including takeaways, sugary drinks and confectionary items are linked to increased BMI in children and young adults.

While this report does not directly show that HFSS marketing causes childhood obesity, Cancer Research UK have announced that alongside other reports, they will release a report later this year investigating the link between marketing and weight.

The problem of childhood obesity
Childhood obesity is a huge public health issue in the UK, with nearly a third of children aged 2 to 15 years classed as overweight or obese. An obese child is five times more likely to become an obese adult. In the short term this can cause physiological and psychological harm and long term, negative health effects and the risk of cancer increases. See more details on our blog Behind the Headlines 11th December.

Take home messages
This year, much action is being taken to help combat the obesity crisis, including the sugar tax, calls for sugar reduction in foods, campaigns on children’s snacking and more – as discussed on the Government’s website.

This new report highlights that HFSS marketing poses a risk for consumption of unhealthy foods, which through excess calories could contribute to obesity.

It also shows that HFSS advertisements were viewed during family shows in evenings and weekends, which should be exempt based on the new Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) regulations (see our blog New rules on food advertising to help tackle childhood obesity.

We hope this important report will put pressure on Ofcom and the Government to enforce tighter regulations for HFSS marketing, furthering the fight against childhood obesity.

Policy recommendations as a result of the research are discussed in the full report.

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

by Tanya HAFFNER | Jan 15, 2018 | Hot Topics in nutrition, Thoughts, Media in context, The Nation’s Health

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.

HEADLINE 1: EATING FRY UPS DURING PREGNANCY CAN BOOST BABIES’ INTELLIGENCE

The effect of choline during pregnancy has been in the news this week, reported by the Independent, The 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

HEADLINE 2: IS COCONUT OIL A SUPERFOOD?

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.

HEADLINE 3: A GOOD NIGHT’S SLEEP HELPS YOU CUT SUGAR

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.

Children’s snacks; processed meat and breast cancer: Nutrilicious News Digest

by Tanya HAFFNER | Jan 9, 2018 | Thoughts, Media in context, The Nation’s Health, Impactful health initiatives

Each week we analyse some of the hot headlines in health and nutrition news. This week we look at a new ‘Change4Life’ campaign on children’s snacks and the link between processed meats and breast cancer.

HEADLINE 1: LIMIT CHILDREN’S SNACKS TO 100 CALORIES

Popular in the news this week is the new campaign being launched to encourage healthier snacking in children. This has been reported widely, including the BBC, Sky News, The Telegraph, ITV News, the Sun and The Guardian.

Figures have shown that half the sugar consumed by children in England aged 4–10 comes from unhealthy snacks such as biscuits, cakes and sweets, as well and fizzy and juice drinks.

Public Health England (PHE) have launched a new ‘Change4Life’ campaign promoting children’s snacks which are no more than 100 calories. They also advise cutting number of snacks down to twice per day.

The campaign will run for eight weeks and offers money-off vouchers if parents sign up for lower-sugar snacks. Selected supermarkets including Tesco are supporting the campaign.

The Change4Life ‘Food Scanner’ app has also been updated and improved, showing parents the amount of sugar, salt and saturated fat in their food.

Behind the headlines: the Nutrilicious dietetic view
According to the latest National Diet & Nutrition Survey (NDNS), 4–10 year olds consume on average 53.5g free sugars daily – equivalent to 13 teaspoons. Unhealthy snacks and sweet drinks contribute to at least half this daily intake – equivalent to around 7 teaspoons per day.

We discussed the need for free sugars to be limited for children in a previous blog. Improvements must be made in this area and we sincerely hope this campaign can make a difference.

The scale of the problem
According to the new analysis by PHE, every year each 4–10 year old consumes on average 400 biscuits; more than 120 cakes, buns and pastries; around 100 portions of sweets; nearly 70 of both chocolate bars and ice creams; plus over 150 juice drink pouches and cans of fizzy drink.

As these products are predominantly energy dense with few nutrients on offer, looking at the total calorie contribution per year makes the latest findings even more alarming:

PHE classified unhealthy snacks/drinks	Energy contribution to children’s diet per year
Biscuits	26,682 kcal
Buns, cakes, pastries	26,682 kcal
Sugar confectionery	5,366 kcal
Chocolate confectionery	10,673 kcal
Ice-cream	10,673 kcal
Sweetened soft drinks including sweetened fruit juices	10,673 kcal
Total annual energy intake from unhealthy snacks and drinks	90,749 kcal
Daily calorie equivalent	249 kcal
Weekly calorie equivalent	1,740 kcal

The campaign to change habits
A simple ‘rule of thumb’ advice is being promoted by the campaign to help make it easier for busy families to reduce the intake: ‘look for 100 calorie snacks, two a day max’.

While 50kcal saving per day may not seem a lot, over a year that’s a saving of over 18,000 kcals.

It should be noted that the advice does not focus on fruit and vegetables. A variety of these should be encouraged, aiming for a minimum of five portions per day.

Examples of snacks that fall at or below 100 calories include:

One Soreen malt mini lunchbox loaf (30g) – 95 calories
One small pot of fruit fromage frais (42-85g) – 45-75 calories
Snack pack of raisins (14g) – 38 calories
One banana – 81 calories
One apple – 51 calories
One Hartley’s no added sugar jelly pot (115g) – 7 calories
One packet skinny popcorn (17g) – 57 calories
One packet Tesco’s lentil curls (20g) – 91 calories

(Source: Values obtained from Dietplan 7 and online supermarkets 2018)

The packaged snacks should also ideally show as greens and ambers on the ‘traffic light’ labelling system (indicating they are not too high in sugar, fat, saturated fat or salt). More information on food labelling is supplied by Change4Life.

It is also useful to check on the label that the portion consumed is what the label portion actually relates to. For example, a large pack of crisps may display the calories for 1/8 of the packet but it can be easy for a child to have more than this portion.

What’s missing from the advice
Although it is positive that action is being taken to promote healthier snacking, the campaign only focuses on the role of calories and may not necessarily teach parents about what makes up a healthy snack.

For example, a handful of nuts would contain more than 100 calories, yet nuts are a nutrient dense food and have many benefits to our health. Snacks can contain less than 100 calories but not contain any valuable nutrients, as in the case of many cereal bars. So, it is questionable how well this campaign will educate parents about healthy eating.

Nevertheless, if improvements can be made to the current eating habits in children it will be beneficial.

HEADLINE 2: EATING BACON, SAUSAGES AND OTHER PROCESSED MEATS INCREASES BREAST CANCER RISK IN OLDER WOMEN

Also in the news this week is the suggestion that eating processed meats will increase the chances of getting breast cancer. This was picked up by the Sun, the Daily Mail, the Evening Standard and the Independent.

The study involved 262,195 women aged 40–69, followed over a period of seven years. For this cohort, a 21% increased breast cancer risk was associated with women consuming more than 9g processed meat per day.

However, when the study was combined with another 10 cohort studies and a meta-analysis performed, the risk was significantly lower.

The meta-analysis found processed meat consumption to be associated with 9% increased risk of breast cancer in post-menopausal women only. No association was found in pre and peri-menopausal women, nor was an association found with red meat consumption.

Behind the headlines: the Nutrilicious dietetic view
The study looked at a variety of processed meats, but clearly the UK headlines are pulling at the Brits’ heart strings by focusing on bacon and sausages.

Firstly, what counts as processed meat? Processed meats are defined as meat which has been preserved through salting, curing, fermentation, smoking or other processes. Examples include sausages, bacon, ham, salami, chorizo, corned beef, hot dogs and pepperoni.

9g processed meat equates to:

1 and a bit sausages
2½ rashes of back bacon or medium slices ham
13 thin 5cm diameter slices of salami
Almost 3 Peperamis

This study adds further supports to one of the key messages for cancer prevention to avoid processed meat and reduce overall intakes of red meat (no more than 500g per week) whilst focusing on a more plant-based diet.

In order to truly help women reduce their risk of breast cancer, messages like this, focusing on one food type, are not helpful. Study findings should be placed in context of overall dietary and lifestyle advice proven to lower risk as well as regular breast screening checks. This study only found correlation in post-menopausal women and only reported on processed and red meat findings.

With 50,000 new cases of breast cancer every year in the UK, 20,000 of which could be prevented through dietary and lifestyle modifications, there are far more pertinent actions women can take. The World Cancer Research Fund (WCRF) highlights the following as major risk factors for breast cancer:

Gaining weight in adulthood
Drinking alcohol
Being physically inactive
Not breastfeeding when you have a baby
Being overweight or obese (for post-menopausal breast cancer)

Although this study further supports the evidence that processed meat isn’t great for women’s health (or, indeed men’s health), we need to stop scare-mongering and instead provide helpful advice to women concerned about the UK’s number one cancer. Scientific findings need to be put into context and then interpreted into practical and helpful advice for consumers.

As well as the lifestyle recommendations by WCRF, it is also important to continue encouraging women to regularly check their breasts for lumps and seek medical assistance if they have any concern as well as attend any breast cancer screening invitation from their health service.

For more tips and advice see World Cancer Research Fund UK and Cancer Research UK

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

by Tanya HAFFNER | Dec 22, 2017 | Hot Topics in nutrition, Thoughts, Media in context, The Nation’s Health

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.

HEADLINE 1: MEDITERRANEAN DIET IN A PILL COULD HELP BEAT HEART DISEASE

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

HEADLINE 2: HERBAL REMEDY FOR STROKE RECOVERY?

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

HEADLINE 3: CHILDREN WHO DRINK FRUIT JUICE HAVE A HIGHER RISK OF DEVELOPING ASTHMA

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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