How to eat more fibre

Eat More Fibre

eat more fibre

Denis Burkitt, an eminent physician and researcher from the 1970’s, who made many observations about the role of dietary fibre in health, is reported to have said ‘If you pass small stools, you have to have large hospitals’. It’s a flippant phrase, but he may have been right in many ways.

How to eat more fibre

Fibre is a key component of a healthy diet. Here in the UK, we are encouraged to consume 30g fibre per day – but the average adult intake is just 19g (NDNS, 2018). We could be doing a bit better.

Why is fibre important?

Alongside the basic role of fibre in regulating our gut health, studies have consistently shown that a high fibre intake is associated with a reduced risk of several other chronic (long-term) conditions, including:

  • Cardiovascular diseases, including heart disease or stroke
  • Certain types of cancer (including colorectal)
  • Type 2 diabetes
  • Obesity
(Veronese et al., 2018) (Reynolds et al., 2019)

There are lots of theories about how and why these benefits might occur; a higher intake of fibre may help reduce total body inflammation, benefit the gut microbiota, help us feel fuller for longer and balance blood sugar and lipid levels (Reynolds et al., 2019). But you don’t need to take specific fibre supplements to get these potential benefits as common foods that contain lots of fibre – such as fruits, vegetables and wholegrains – also happen to be great sources of vitamins, minerals and other beneficial plant chemicals. It’s a bit of a win-win.

6 ways to boost the fibre in your diet

1. Integrate more beans and pulses into your meals. Alongside legume-centric recipes (like hummus, bean stews, baked beans or dahl), try adding them into other dishes. Blend cannellini beans into vegetable soups, roast chickpeas to sprinkle onto salads or throw some lentils into mince to bulk it out.

2. Eat plenty of whole fruit or vegetables. Buy a vegetable scrubbing brush and give everything a good wash first, and you’ll often get away without having to peel them (so long as the skins are actually edible, obviously). I suggest gradually working towards having 3 portions of fresh fruit and up to 6 portions of vegetables a day.

3. Increase a specific type of fibre in your diet, called resistant starch (which is thought to be particularly beneficial for the gut microbiota) by cooking, then completely cooling pasta and potatoes before eating them. The process of cooling to fridge temperature creates chemical changes in the structure of the carbohydrates, which make them resistant to digestion – even if you heat them up again. So cold potato or pasta salads have more resistant starch in them than if you simply ate the same salad hot.

4. Add seeds or nuts to a range of dishes. Porridge, salads, soups, baking, bread – they can all take a sprinkle of seeds or a handful of chopped nuts. Even crunchy nut butters count. Have a go at making some chia puddings for a fibre-rich but still light and delicious breakfast or dessert.

5. Choose to eat whole, minimally processed grains wherever possible. The minimal processing part (i.e., when the grain looks pretty similar to how it did whilst growing, rather than being processed into a packaged food or flour) is probably quite important to maximise potential nutritional benefits. Look out for quinoa, brown rice, whole rolled oats, millet, amaranth and pearl barley.

If you have time, it’s worth soaking your whole grains for a while before cooking. I usually aim for 12-24 hours, covering the grains liberally in filtered water, then drained before cooking in fresh water. This helps to make them more digestible, and cuts significantly down on cooking time. But it’s not something to worry too much about if you’re pushed for time.

6. When buying grain-based products, like pasta or bread, try to buy the brown or wholegrain options rather than the plan white ones. Things like brown spelt or rice pasta, 100% wholegrain rye bread (such as the ones from Biona) or wholegrain crackers. A useful trick to help guide you is to look for foods with >6g fibre per 100g on the label.

Are there any downsides to increasing the fibre in my diet?

As with everything in nutrition, too much of a good thing can be problematic for some people.

If you suffer from gastrointestinal disease, such as Crohn’s disease, ulcerative colitis, other conditions of the bowel or IBS, you may have been advised to be cautious about the amount or type of fibre you consume. In which case, please do continue to follow the advice you have been given. Even for otherwise healthy people, a rapid change in fibre intake can lead to a change in bowel habits (either diarrhoea or constipation). Always make shifts gradually, and ensure you’re drinking plenty of water too.

If you have low iron or other mineral levels, then increasing the amount of fibre you consume has the potential to make the problem worse. This is because a high fibre diet can slightly inhibit the absorption of certain essential minerals from food. Soaking legumes and pulses before cooking them can help, as can ensuring that you are getting plenty of the important dietary minerals overall, and avoiding drinking tea or milky drinks around mealtimes (as these can also inhibit mineral absorption). As always, a bit of common sense and attention to your own body’s cues goes a long way.

References 

NDNS: National Diet and Nutrition Survey: Results from years 7 and 8 (combined), 2018. Office for National Statistics. gov.uk/government/statistics/

Reynolds, A., Mann, J., Cummings, J., Winter, N., Mete, E. and Te Morenga, L. (2019). Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet, 393(10170), pp.434-445.

Veronese, N., Solmi, M., Caruso, M., Giannelli, G., Osella, A., Evangelou, E., Maggi, S., Fontana, L., Stubbs, B. and Tzoulaki, I. (2018). Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. The American Journal of Clinical Nutrition, 107(3), pp.436-444.

Baron, R. (2013). Eat more fibre. BMJ, 347(f7401).


What is Positive Nutrition?

Positive Nutrition:
What is it? How would it benefit me?

In recent years, I have wholeheartedly embraced the idea of Positive Nutrition. For those who read Nourish & Glow: The 10-day plan, you will probably be familiar with the idea already, as it forms the basis of the entire book (it is far, far more than just a meal plan).

 

In a nutshell, Positive Nutrition is an approach to eating that focuses on getting the ‘good’ stuff into our bodies, rather than worrying too much about excluding or cutting out the so-called ‘treats’. It is a shift in thinking from deprivation to abundance that can be incredibly liberating, particularly if we have been caught up in a cycle of on-off dieting culture for a long time.

 

Fundamentally, our bodies need a wide range of essential nutrients every day to function optimally. Yet our whole conversation around food for the past few decades has often been about minimisation – somehow ‘less’ has become synonymous with ‘better’. But eating less food (usually with the aim of consuming less calories), inevitably also means less nutrients. So by restricting our diets, we are also reducing our body’s ability to digest and absorb the essential nourishment we need to function.

So whilst yes, of course, we do need to be conscious of maintaining a sensible energy balance overall, that doesn’t necessarily mean less food. It is instead about choosing enough of the right sorts of food to meet our body’s requirements for nutrition. Those foods – like colourful fruits and vegetables, wholegrains, nuts and seeds, proteins and healthy fats – should therefore be our priority in terms of our financial budget and cooking time, as well as our appetite and ‘energy budget’. If we do happen to have the odd slice of chocolate cake or glass of wine as well, then that is absolutely fine. But it doesn’t take away from the fact that we still need to eat our greens.

I believe therefore that a healthy diet first focuses on the positives – adding a deliciously wide variety of whole foods into our diets, creating nourishing balanced meals, and ensuring we are hydrating ourselves properly. When we practice eating like this, we can rapidly start to feel and see a difference, without having to feel the stress and scarcity associated with highly restricted dieting again.

The Positive Nutrition Pyramid printables

For more information on how Positive Nutrition works day-to-day, including a full explanation of my tool the Positive Nutrition Pyramid, do take a look at my book Nourish & Glow: The 10-day Plan.

You can download a free PDF of the pyramid here to use alongside the book.

Nourish & Glow:
The 10-day plan

most comprehensive
In my most comprehensive book to date, the 10-day plan is the result of over a decade of work as a nutritional therapist. This is a liberating, energising plan that celebrates Positive Nutrition. It will equip you with the building blocks needed to develop and implement a lifetime of balanced eating that is unique to you. Available in digital & audio format.

BUY HERE (UK)

Thinking About: Fish

Thinking About: Fish

Fish is such a nutritious, versatile and delicious ingredient. I love how simple it is to make into a super healthy and quick meal – just a few minutes baked in the oven or under the grill, a squeeze of lemon and some steamed vegetables on the side. Perfect.

Even better is that as well as being one of the best sources of omega-3 fatty acids we find in nature, seafood can also provide us with a source of great quality protein, vitamin D, iodine, potassium, iron, zinc, selenium and a few B vitamins. Smaller fish, like sardines, whitebait or anchovies can also give us a useful source of non-dairy calcium.

So what are the healthiest types of fish to eat?

All fish can be healthy in moderation, but sadly, our seas are not as clean as they once were. I would therefore be careful not to eat the larger predator fish too often, as the contamination of pollutants and heavy metals (such as PCBs, pesticides, plastic micro-particles and mercury) in fish increases as you move up the food chain. These include swordfish, shark, marlin and even tuna. Farmed fish also tends to be slightly higher in pollutants than wild fish. Interestingly, one study even found that the level of pollutants in salmon steak was highest at the head end and central section, but lowest at the tail, and avoiding eating the skin resulted in around a further 10% reduction (1).

I would also try not to rely too much on smoked, tinned or cured fish, as it is generally best to stick to unprocessed foods as much as possible, plus they can also be very high in salt.

But wild smaller fish, particularly the oily ones, such as unsmoked mackerel or sardines could be enjoyed twice a week, plus maybe another portion of white fish, for a thyroid-healthy boost of iodine. There are separate guidelines for pregnancy (see the link below for more information);

nhs.uk/chq

What flavours work best with fish?

I think the classic flavour combinations have stood the test of time because they work so well. Lemon, fennel, fresh green herbs, olives, tomatoes, pesto, chilli, olive oil, black pepper – they are all easily available and can transform a simple piece of fish into a tasty dish in no time. But some more unusual flavours I have been experimenting with include saffron (delicious made into a sauce), sumac, preserved lemon and smoked paprika. I suppose it is just a case of giving it a go, and finding new combinations that you enjoy.

Top tips for cooking fish

  1. Try to buy the freshest fish you can get your hands on, and if at all possible, cook it the same day. I was always advised to try to avoid buying fish on a Monday too – as often it is caught the Friday previously, so is already 3 days old!
  2. If fresh fish is hard to get hold of though, then white fish tends to freeze a bit better than oily fish.
  3. If you are oven-baking, try to make a parcel out of baking paper to cook your fish in. This keeps lots of the moisture, flavour and juice around the fillet, and really helps to stop it from drying out.
  4. Always use a timer! I find it so easy to get distracted in the kitchen, and then all of a sudden it’s overdone. So a timer, set a couple of minutes less than the recipe states, means that I can quickly check how things are coming along. You are aiming at the point just as the flesh starts to turn opaque, and then you can take it out of the oven.
  5. Don’t forget that your fish will continue to cook a bit, even after you have taken it out of the oven.
  6. Overcooked fish can be quite tasteless, dry and rubbery. Not an enjoyable eating experience! One sign that this might be happening is that you may see lots of white, foamy liquid coming out of the fish. This is harmless albumin, and even perfectly cooked fillets will have a bit, but if there is a lot then it suggests that the temperature is too high and would benefit from being turned down a little.
  7. If you need to substitute an oily fish in a recipe (such as salmon or mackerel) for a lean fish (generally the white fish – things like haddock and cod), you might want to add something to help baste the fish as it cooks, like a few slices of fresh tomato, some lemon juice or a drizzle of olive oil to prevent it from drying out.

Fish dishes here on the site

. . . . . . .

References 

(1) Bayen, S., Barlow, P., Lee, H.K. and Obbard, J.P. (2005) ‘Effect of cooking on the loss of persistent organic pollutants from salmon’, Journal of Toxicology and Environmental Health, Part A, 68(4), pp. 253–265.


Should I Be Taking Supplements?

should I take supplements

should I take supplements

This is a question that I am asked almost daily. The idea certainly seems appealing, that by taking these little pills, you can almost ‘insure’ yourself against perhaps a less-than-perfect lifestyle. On the opposite side of the argument, we are told that we don’t need to supplement as long as we eat a well-balanced diet. So what’s going on?

Firstly, it is really important to emphasise that every individual is unique, and therefore the decision whether or not you need a supplement is not something that you can work out from a blog post. The most I can do here is to give you some information to help you decide (alongside your healthcare professional if needed), where you stand on this matter.


Nutritional depletion

Unfortunately, in today’s frantic world where meals are often grabbed on-the-go, it can be pretty challenging to make sure that you are getting enough of all of your nutrients over the course of a day or week. There are lots of reasons for this,

  • You really need to be eating a very well balanced and thoughtfully considered diet to have a good chance of including all the micronutrients you require. This is by no means impossible, but it does mean a diet jam-packed full of high nutrient density foods: things like fresh fruit & vegetables, nuts, seeds, good fats, legumes, oily fish, organic eggs and other high-quality proteins. There really isn’t much space in terms of energy consumption left for less nutrient dense foods (sugar, processed foods, alcohol) (1). See my article on Positive Nutrition for more on this.
  • We no longer eat food fresh from the ground. As hunter-gatherers, or even as farmers, we would be eating food very soon after it was picked. It is thought that the longer fresh food is stored, the more depleted of certain phytonutrients and vitamins it may become. Food picked weeks ago and transported halfway across the world may still look fresh, but may also have a different nutrient profile to something picked and eaten the same day.
  • Food production and animal and plant breeding methods make commercially grown food vastly different to the diet we evolved to eat – which was predominantly wild food. Although I do not sign up to the Paleo ideal as such, the principle that we haven’t ‘caught up’ yet to the environment that we now live in is likely true. Wild plants for example have a tougher life – they are not cosseted with herbicides to fight off competition, pesticides to fight off predators or fertilisers to make growing easy. In essence, they have to work harder to exist, and therefore may akso have a higher phytonutrient profile (natural compounds that protect a plant as it grows). Animals which would originally have eaten a grass-based diet, including many other meadow plants, are now kept in barns and given grains (which potentially changes their fat profile) (3). Even fish haven’t escaped intensive farming practices (causing some farmed ‘oily’ fish to have minimal beneficial omega-3 content) (4). The animals and plants we now eat can therefore have fewer. or at least different, nutrients than were available to our ancestors.
  • Cooking (especially boiling), can leach vitamins and phytonutrients out, depleting their nutritional profile.
  • Intensive food processing can severely deplete nutrients, yet still create foods dense in energy. This energy: nutrition ratio is an important point to make. We want to optimise out body’s access to a wide range of essential nutrients, while at the same time maintaining a healthy energy balance. Therefore, overly relying on heavily processed foods to form the bulk of our diets runs the risk of us inadvertently developing nutrient deficiencies, yet still having a diet high (perhaps even too high) in simple energy. The bottom line? Minimally processed whole foods are a great way of optimising this balance (of course, allowing for the odd treat from time-to-time).

Given all of this, it seems like it might be quite difficult to get enough of the right nutrition into our bodies, so perhaps you’re thinking a multivitamin would be a good idea?

There is a but, however  . . .


More is not always more

Unfortunately, it is not so simple as just adding a couple of multivitamins into your diet and job done. I know the message you’re getting here is a bit confusing then, which reflects the confusion in the media too. For example, one day vitamin D is a panacea for all ill-health, the next it causes some worrying disease. The problem is that nutrition research is very difficult to do reliably, and researchers often look at nutrient supplements individually as if they were drugs. It is hard to measure the effect of nutrients working together as a ‘team’. For example, spinach is a brilliantly health food, but if all you ate was spinach, you would get poorly and die. You need to eat a balanced amount of all the nutrients to maintain optimum health.

A word of warning. Research has also shown that in certain circumstances, nutritional supplements can, in fact, be dangerous. Of course, preventing or treating a serious deficiency is very important, but if someone has a less severe deficiency (a “subclinical” deficiency), there is really not much known about how this should be treated, Taking supplements, particularly at high doses, can cause immediate side effects (such as tummy upsets) (5), but more worrying are the long-term effects. These can range from kidney stones (6) to worsening pre-existing medical problems (5), even potentially increasing the risk of cancer (8), infections (9) or death (10), amongst many more reported effects. So, without wanting to cause alarm, the message is that there needs to be a degree of caution when taking supplements, particularly single supplements at high doses. More is definitely not always better, especially if you are already getting plenty in your diet. Other factors to consider before taking a supplement include;

  • Although we have a pretty good idea about how much of each nutrient we need to prevent a serious deficiency, we do not know enough yet about what ‘optimal’ levels of nutrients are, so therefore how can we know what optimal supplement doses are? Even the recommended nutrient intake values published by the government are often based on educated best guesses.
  • Everybody needs and metabolises different amounts of each nutrient. Therefore a one-size-fits-all multivitamin is unlikely to be optimum for anyone.
  • We are not sure of the ideal ratios of nutrients to take together. For example, taking zinc can make you copper deficient, so should you take them together, and at what doses? There needs to be more research to make this information available.
  • We are now starting to understand the very important role that genetic variation has on how we absorb, use and excrete individual nutrients (11). Whereas current recommendations target the majority of the population to prevent nutritional deficiencies, using a more personalized approach based on an individual’s genome (their unique DNA code) would allow much more targeted recommendations. This is still a pretty novel concept, but we may find that it becomes increasingly more mainstream in the future.


Regulation

When you go to the doctor and get a prescription, you know that the pill you take is what it says it is. This is because medicines are a heavily regulated product, and undergo years of testing before they are released to patients. Unfortunately, supplements do not have the same level of controls applied to them, so it is very difficult to know exactly what you are buying. These are some of the possibilities when you buy supplements over-the-counter;

  • The form that the nutrient is prepared in may mean that it is absorbed poorly by the body.
  • The dose on the label may not match the dose in the pill
  • The raw materials (such as fish oil supplements, or herbs) may not be tested or processed to remove contaminants (such as mercury, PCBs, or lead)
  • The pill may contain other ingredients than those listed on the packaging
  • The manufacturing process may have poor quality control processes, leading to unreliable quality between batches.
  • Be cautious about too-good-to-be-true marketing claims! They most probably are…

So, whilst I do not endorse or condemn any supplement manufacturers, I would urge you to be cautious if you chose to buy and take supplements. As with the food you eat, try to get supplements from a reputable firm that is happy to tell you about its quality control procedures. Guidance from a healthcare practitioner can be useful to help you navigate which product may be best for you.

 


Special circumstances

Sometimes, you will be diagnosed with a specific nutrient deficiency, or be at risk of one, such as anaemia. In this instance, it would be important both to try to understand the root cause of the deficiency (in partnership with a health professional), as well as working towards improving it through careful nutritional changes and/or supplements.

Likewise, if you are trying to have a baby, or are pregnant, it is recommended that you should be regularly taking at least a folate and vitamin D supplement. Take a look at this page for further information;

nhs.uk/conditions/pregnancy-and-baby/

 

The bottom line?

  1. Consider seeking assessment from a qualified nutrition or healthcare professional before taking a supplement, to work out whether you really need one. It is almost always better to be targeted, and only take what your body requires. Be wary of single nutrient, high dose supplements, particularly if you are taking them for a prolonged time.
  2. Getting a widely varied, great quality diet should be your primary focus. This is the best way to get all the nutrients your body needs, in forms that it can recognise and use, alongside lots of beneficial phytonutrients too. Sometimes it’s thought that it could be these phytonutrients which give more health benefit than the vitamins themselves! It is also very difficult to ‘overdose’ yourself with nutrients from food.
  3. You could try using a food diary app that calculates your nutrient consumption as well as your total calories, to give you an idea of where you might want to make some tweaks.
  4. Eating your food as fresh, minimally processed and lightly cooked as possible to boost nutrient content without adding any extra calories.
  5. Consider growing your own to make sure that you can cut down the time to consumption as much as possible – this can be a great money saver on organic veggies too.
  6. If you are considering becoming, or already are pregnant, do make sure that you check out the information on antenatal supplements.
  7. When choosing supplements, go for the highest quality you can find. Ask for advice if you are unsure about which brands to trust.

The most important thing to take away is that choosing to take, or not take, supplements is very much an individual, personal choice. I hope that after reading this article you feel armed with a little bit more information to take away, to help you make your own decisions, in collaboration with a healthcare or nutritional practitioner if you want some more support.

References

(1) NDL/FNIC food composition database home page (2011) Available at: http://ndb.nal.usda.gov (Accessed: 2 December 2015).

(2) Davis, D.R. (2009) ‘Declining fruit and vegetable nutrient composition: What is the evidence?’, HortScience, 44(1), pp. 15–19.

(3) Średnicka-Tober, D., Barański, M., Seal, C., Sanderson, R., Benbrook, C. and Steinshamn, H. (2016) ‘Composition differences between organic and conventional meat: A systematic literature review and meta-analysis’, British Journal of Nutrition, 115(06), pp. 994–1011.

(4) Weaver, K.L., Ivester, P., Chilton, J.A., Wilson, M.D., Pandey, P. and Chilton, F.H. (2008) ‘The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish’, Journal of the American Dietetic Association, 108(7), pp. 1178–1185.

(5) Pazirandeh, S., Burns, D. and Lo, C. (2014) Overview of water-soluble vitamins, UpToDate. Available at: http://www.uptodate.com.oala-proxy.surrey.ac.uk/contents/overview-of-water-soluble-vitamins?source=machineLearning&search=vitamin+c&selectedTitle=5%7E150&sectionRank=1&anchor=H54#H54 (Accessed: 14 October 2015).

(6) Nasr, S.H., Kashtanova, Y., Levchuk, V. and Markowitz, G.S. (2006) ‘Secondary oxalosis due to excess vitamin C intake’, Kidney International, 70(10), pp. 1672–1672.

(8) Lippman, S.M., Klein, E.A., Goodman, P.J., Lucia, M.S., Thompson, I.M. and Ford, L.G. (2009) ‘Effect of Selenium and vitamin E on risk of prostate cancer and other cancers’, JAMA, 301(1), p. 39.

(9) Graat, J.M., Schouten, E.G. and Kok, F.J. (2002) ‘Effect of Daily Vitamin E and Multivitamin-Mineral Supplementation on Acute Respiratory Tract Infections in Elderly Persons’, JAMA, 288(6), p. 715.

(10) Miller, E.R., Pastor-Barriuso, R., Dalal, D., Riemersma, R., Appel, L. and Guallar, E. (2005) ‘Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality’, Annals of Internal Medicine, 142(1), p. 37. doi: 10.7326/0003-4819-142-1-200501040-00110.

 (11) Stover, P. (2006) ‘xInfluence of human genetic variation on nutritional requirements’, Am J Clin Nutr, 83(2), pp. 4365–4425.


Thinking About: Fats

thinking about: fats

thinking about: fats

You may have read in the media or heard on the news that a report published by the National Obesity Forum in association with Public Health Collaboration has been published. It states, rather topically, that low-fat foods have had ‘disastrous health consequences’ and the public health guidelines on consuming a low-fat, high carbohydrate diet should be reversed.

This opinion piece has since been heavily criticized by other experts, who say that the report has misquoted evidence and merely cherry-picked information that supported their argument. Without far deeper analysis, no conclusions can be rightfully drawn from the report.


So who has got it right?

Firstly, it is very difficult indeed to carry out good, quality nutritional research. That is because everyone is unique: our genetics, our environmental determinators, our physical activity levels, job, family, work, finances, social norms and much, much more, have a huge impact on both the nutrition choices we make and the impact these choices have on us, in both the short and long term. The act of drawing general conclusions from large population studies and then attempting to apply results to an individual is always going to be tricky, as only a small minority of us will ever hover around the perfect statistical average! Neither side is necessarily therefore 100% ‘right’ or ‘wrong’ – it would depend on the specific person involved.

 

 

Having said that, there now appears to be confusion around fats. Are they healthy? And if so, which ones and how much?

There are various types of fat. Some are less healthy and some more healthy. But first, we need to understand what they are and the common sorts of foods that they are found in. Here is a handy ‘traffic-light guide’:

trans fat > avoid
Processed fats, margarine, pastry, cakes, biscuits, commercial salad dressings, sunflower, soybean, rapeseed & corn oil heated to high temperatures

saturated fat > eat cautiously
Animal fats (such as those found in meat), cheese, milk, butter, cocoa butter, palm oil, coconut oil, ghee

polyunsaturated fat > eat regularly 
Essential fatty acids Omega-3 & Omega 6, oily fish, chia seeds, linseeds, walnuts, hemp oil

monounsaturated fat > eat regularly 
Avocado & avocado oil, nuts, seeds, olive oil

Everyone should avoid trans-fats as far as possible: they are associated (even in small amounts) with an increase in all causes of death, particularly cardiovascular disease (1).

Although we now think that saturated fat is less harmful than it was previously thought to be, it is still not really a ‘health’ food. This is because it can increase blood cholesterol and other lipids if eaten in excess, or in those who are susceptible. Recent studies have, however, shown that its association with heart disease, diabetes and stroke risk may not be as clear-cut as we used to think (1).

It is really important to point out though, that we know now that replacing the calories saved by switching from a high saturated fat diet to a low-fat diet with processed or refined carbohydrates, is less healthy than just sticking with the higher saturated fat diet in the first place. i.e., sugar and refined carbohydrates are probably worse for you than if you just stuck with the higher-fat diet in the first place (2).

But, switching from a high saturated-fat diet to one that is more abundant in polyunsaturated fats (especially the omega-3 fats), monounsaturated fats (such as olive oil, nuts and seeds) and unprocessed carbohydrates (such as those found naturally in vegetables and whole fruits) is healthier altogether (2).

Certain fats are very healthy, indeed are essential for our good health and are known as the Essential Fatty Acids. We have to get them from our food as we cannot make them in our bodies. There are two types;

Omega-6 fats You really don’t need to worry about getting enough omega-6 fatty acids in your diet. Almost everyone probably consumes too many of them, as they are found abundantly in plant oils, processed foods, baked goods, salad dressings, snack and fried foods. It is theratio of omega-6 to omega-3 that is most important – and you want to aim to get that ratio as close to around 1:2 omega-3:omega-6 as possible (so make sure you avoid taking any extra in supplements) (3). The UK average is currently a ratio of 1:15!

Omega-3 fats These are essential for good health, and most people eating a Western diet do not get anywhere near enough. They are found in oily fish, fish oil and algal oil supplements (which is thought to be the best way of consuming them, as the plant-based sources need to undergo a complicated transformation process in the body, which many people have limited capacity to do). Plant sources include, however, walnuts, chia seeds and linseeds. Good oily fish sources include fresh or frozen mackerel, wild salmon and sardines.

So what can we say in conclusion?

  • Not all fat is good and not all fat is bad …
  • … but do avoid trans fats
  • Enjoy saturated fats cautiously – but it’s worth paying attention to the quality of what you are consuming. The way an animal is raised will change the health profile of its fats (so go for free-range, organic as much as possible).
  • Try not to replace calories from fats with calories from sugar and refined carbohydrates. Don’t forget that vegetables and whole fruits are fantastic sources of unrefined carbohydrates without a grain in sight.
  • Enjoy healthy sources polyunsaturated fats and monounsaturated fats regularly – such as nuts, seeds, avocados, oily fish and olive oil. They are full of fat-soluble vitamins and in the case of omega-3 fatty acids, are essential for good health.
  • Consider working alongside a nutrition professional if you have any concerns about your blood cholesterol, lipids, blood pressure, cardiovascular disease risk or other health worries, as they will be able to tailor individualized advice to your specific circumstances.

references

(1) de Souza, R.J., Mente, A., Maroleanu, A., Cozma, A.I., Ha, V. and Kishibe, T. (2015) ‘Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies’, BMJ, , p. h3978.

(2) Hu, F.B. (2010) ‘Are refined carbohydrates worse than saturated fat?112’,American Journal of Clinical Nutrition, 91(6).

(3) Simopoulos, A.P. (2016) ‘An increase in the Omega-6/Omega-3 fatty acid ratio increases the risk for obesity’, Nutrients, 8(3).

 


Detox: Fact or Fad?

detox: fact or fad?

‘Detox’ is certainly an appealing concept. For some, it allures to the purification and redemption of an unhealthy lifestyle; a ‘quick-fix’ to undo the late nights and hangovers. For others, the suggestion of weight-loss, clearer skin, shiny hair, all seem good reward for cleansing ourselves.

But beyond being an undoubtedly lucrative marketing term, what are these so-called ‘toxins’? Is it actually possible to ‘detox’ at all? Or is it all just an elaborate myth?

You’re probably getting quite fed-up by the bombardment of articles suggesting you ‘detox’: all those pieces that instruct you to drink only green juice for three days; give up all manner of supposedly ‘toxic’ foods; perform elaborate bath-time rituals to ‘draw the toxins out’; or more worrying, encourage the unlicensed use of laxatives or diuretics.1 Nowadays, there are even commercially processed foods and drinks widely available that label themselves as ‘detox’, suggesting an elixir effect at their heart. The now ubiquitous use of the term ‘detox’ (and the fads surrounding it) become all the more elaborate every year.

What is a ‘toxin’?

In medicine, the word ‘toxin’ is usually used to describe either drugs or alcohol, and ‘detox’ is the medicalised process to help someone wean off these substances.1

In more widespread use, the term is now also used to describe the thousands of different substances that get into our bodies, such as pollutants, pesticides, synthetic chemicals, processed foods, heavy metals and more.1 We can be exposed to these from the foods and drinks we consume, but also from the cosmetics or cleaning products we use, and the air we breathe. Some we can control, others we cannot.

Where do toxins come from?

Global industrialisation and intensive farming has hugely increased the number of chemicals we are exposed to. Unfortunately, the majority of these have not yet been tested for any potential risks or hazards in humans.1 It is therefore hard to know whether they are harmful, or harmless. We also remain uncertain of the potential additive effects there may be from the sheer number of different substances we are exposed to. The bottom line is that there remains a huge amount of uncertainty.

What we do know is that some chemicals accumulate in the body2, and that high doses of certain pollutants or chemicals may be damaging to health.1 For example, links have been made to certain ‘toxin’ exposures and certain types of chronic diseases – such as cardiovascular disease, Type II diabetes, and obesity.7 The British Heart Foundation is currently funding extensive research into the risks of air pollution and poor heart health: bhf.org.uk/

Some examples of ‘toxins’ we may be exposed to

PCBs (polychlorinated biphenyls), which have been banned or restricted in both the USA & the EU since the 1970;’s are still detectable in almost all human blood, fat and breast milk samples.3

A 2012 study from the European Food Standards Agency reported that almost all food products contain detectable levels of POPs (persistent organic pollutants), particularly fish, meat, and dairy products.4

Phthalates are found in all sorts of products, from cosmetics, to food packaging and even the coating on nutritional supplements.5 Concerns have been raised that they may disrupt normal hormonal function in humans.6

BPA (bisphenol A) is found in plastic packaging, water bottles and food tins. It has been linked to numerous health issues, from cardiovascular disease to reproductive changes. It is still being used, because although links have been made, there has been no absolute proof of harm.1

However, there is no evidence that average, everyday minimal exposure to these ‘toxins’ should be cause for alarm. Personally, I tend to fall on the more sceptical side and avoid what I can. However, I know many others who prefer to take a more relaxed approach until such a time as they are provided with hard evidence. With sceptical consideration or not, the good news is that our body is incredibly good at ‘detoxifying’ a lot of these chemicals by itself: no crazy diets required!

Detoxification is something our body does for us

There are lots of complex pathways that happen 24/7 inside us to process the onslaught of chemical substances. In fact, as well as dealing with external ‘toxins’, we are constantly using the same pathways to process normal by-products from our own metabolism, too (8). Detoxification is something that our bodies are very good at, whether we are on a ‘detox’ or not. There is no ‘magic’ bullet supplement, powder, drink or diet that can do this job for us. Don’t believe the spurious claims on packaging that states otherwise.

How does it work? The science bit  . . .

Most detoxification and biotransformation (a fancy word for turning one substance into another: in this case, a ‘toxin’ into something safer) happens in our liver, although minor roles are also played by the kidneys, the lining of the gut, our gut microbiota, the lungs and skin.8 It’s basically a team effort. 8

‘Detox’ within the body is a beautifully orchestrated set of chemical reactions, which get hold of a toxic substance, mix it up a bit, add some tag-on substances to make it safer, and then try to excrete it out of the body. This process can be split into two key phases:

  1. Phase I detox8,7
    This involves at least 57 different pathways, known as the ‘cytochrome P450’ system. Through all sorts of different reactions, various enzymes involved in this pathway manipulate and transform toxins into different forms, known as ‘intermediary metabolites’.
  2. Phase II detox8,7
    These ‘intermediary’ metabolite’s then go into phase II detox – known as the ‘conjugation’ pathway. Here, various extra compounds are attached (such as glucuronides, sulphates, glutathione or various amino acids). These usually help to make the substance more water-soluble, so it can be excreted into the bile (which then ends up in the stools) or urine. For this last stage, the elimination part, it is generally considered important to have a healthy gut function (do check out my 3 part feature on Gut Health for more info).

Does everything go through this process?

No. A few ‘toxins’, such as POPs and heavy metals (including mercury, cadmium, aluminium and lead) may potentially accumulate in fat tissue or bones, rather than being eliminated from the body. I therefore encourage my clients to minimise exposure to these where possible.9

How to support your body for true detoxification

You are probably now familiar with the idea that ‘detox’ is definitely not a diet, a supplement or a beauty ritual. Nor is it something that you can do one week a year and throw caution to the wind for the other 51 weeks. Your body is ‘detoxing’ all day, every day, so I think it is far better to look at ways we might be able to support these processes.

What does this all mean in real life?

I am against any sort of extreme diet, ‘detox’ or otherwise, especially ones which have no absolute proof of benefit – which is, at the moment, the case for specific detox diets.1

Also, I don’t think that any concept that encourages us to associate food with sin, contamination, ‘toxicity’ or guilt is helpful. We have to eat, after all, and I worry that ‘detox’ diets, particularly the more extreme ones, not only run the risk of being dangerous, but also potentially set the stage for an increasingly anxiety-provoking relationship with food. Bad news all round.

But, rather than just throwing the idea of ‘detox’ completely, we can take a pragmatic approach instead (at least whilst we are waiting for the research to give us more specific answers). I believe that the best course of action is to always follow a sensible, mixed, varied, and whole-foods diet – which also happens to be an otherwise healthy lifestyle and nutrition plan. Win-win! (and handily my book Nourish & Glow: The 10-Day Plan covers all of this).

.

I hope that this article helps you to better understand what the concept of detox actually means, where the word came from, and how the health industry jumped on it in the first place. I also hope that the information helps you to make better, more consistent choices throughout the year, rather than just a week.

References & Bibliography:

1. Klein, A.V. and Kiat, H. (2014) ‘Detox diets for toxin elimination and weight management: A critical review of the evidence’, Journal of Human Nutrition and Dietetics, 28(6), pp. 675–686. doi: 10.1111/jhn.12286.

2. Genuis, S.J. (2010) ‘Elimination of persistent toxicants from the human body’, Human & Experimental Toxicology, 30(1), pp. 3–18. doi: 10.1177/0960327110368417.

3. Solomon, G.M. and Weiss, P.M. (2002) ‘Chemical contaminants in breast milk: Time trends and regional variability’, Environmental Health Perspectives, 110(6), pp. a339–a347. doi: 10.1289/ehp.021100339.

4. EFSA (2012) ‘Update of the monitoring of levels of dioxins and PCBs in food and feed’, EFSA Journal, 10(7), p. 2832. doi: 10.2903/j.efsa.2012.2832.

5. Schettler, T. (2006) ‘Human exposure to phthalates via consumer products’, International Journal of Andrology, 29(1), pp. 134–139. doi: 10.1111/j.1365-2605.2005.00567.x.

6. Swan, S.H. (2008) ‘Environmental phthalate exposure in relation to reproductive outcomes and other health endpoints in humans’, Environmental Research, 108(2), pp. 177–184. doi: 10.1016/j.envres.2008.08.007.

7. Hodges, R.E. and Minich, D.M. (2015) ‘Modulation of metabolic detoxification pathways using foods and food-derived components: A scientific review with clinical application’, Journal of Nutrition and Metabolism, 2015, pp. 1–23. doi: 10.1155/2015/760689.

8. Cline, J. (2015) ‘Nutritional aspects of detoxification in clinical practice’, Alternative therapies in health and medicine., 21(3), pp. 54–62.

9. Qin, Y.Y., Leung, C.K.M., Leung, A.O.W., Wu, S.C., Zheng, J.S. and Wong, M.H. (2009) ‘Persistent organic pollutants and heavy metals in adipose tissues of patients with uterine leiomyomas and the association of these pollutants with seafood diet, BMI, and age’, Environmental Science and Pollution Research, 17(1), pp. 229–240. doi: 10.1007/s11356-009-0251-0.


Thinking About: Dairy

thinking about
dairy

Updated Feb 2020

I have learned over the past few years that there is a big difference between the information I can share one-to-one with my nutritional therapy clients and that which I can share with a broader audience through my writing.

When I write, I don’t know anything about the people who are reading my words. Over time, I have therefore become increasingly conscious of trying to make this information as broadly applicable, safe and balanced as possible. It cannot say exactly what you should or should not do, as every ‘you’ is different.

When, however, I am working with a client, I do know about them; their history, nutritional requirements, likes, dislikes and lifestyle. I can therefore make much more specific recommendations and can also follow up over time to see if my suggestions are working.

The question of whether or not to consume dairy is a great example of this difference and one that really has no ‘right’ or ‘wrong’ answer.

Personally, for example, I am lactose intolerant and really struggle to consume much dairy at all. But Willow, my daughter, is fine with dairy, so she enjoys it regularly.

If you suffer from a dairy allergy or intolerance (as many of my clients seem to), are choosing to eat more plant-based, or simply feel better without it, for example, then I would suggest it is OK to continue avoiding dairy. Do make sure, however, that you are getting the equivalent nutrients from other sources.

However, if you love the taste of dairy products, and feel fine with them in your diet, then it is also OK to continue enjoying them regularly.  Dairy products are still recommended by most nutritional guidelines around the world, and where possible, it’s a good idea to keep our diets as varied as we can (Lamarche et al., 2016).

Either way, learning to listen to your body and notice how different foods make you feel (if they make you feel anything) is often a good place to start. But so is being informed about the choices you are making.

I hope this article and some of the further reading it recommends may help a bit with the latter.

Please note: This article refers specifically to dairy consumption in adults. The guidelines for babies and children are significantly different and are not covered here.

What are some of the differences between dairy milks?

Full-fat vs. Low-fat

The total fat content of dairy products varies a lot. While opinions about the potential risks of saturated fat have changed over the past few years, it is still generally considered better to have less saturated and trans fats and more unsaturated fats (such as those found in olive oil, oily fish, nuts & seeds etc.).

Unless you are drinking a lot of milk, the overall difference in grams of saturated fat consumed between a skimmed (0.1-0.3% fat), semi-skimmed milk (around 1.7% fat) and whole milk (around 3.25% fat) is often not that significant, especially when compared to what you’d get from a single portion of cheese (which can be up to 40% fat) or butter, for example. So a moderate intake of milk is not something I’d worry about regarding saturated fat content. I do recommend sensible moderation when it comes to butter, cheese and cream, however.

A review of randomised studies of high vs. low fat dairy concluded that for most healthy people, it would be reasonable to include both low and whole fat dairy food as part of a healthy diet (Benatar, Sidhu and Stewart, 2013).

When dairy products, particularly yoghurts, have been processed to make them lower fat, it’s sensible to be aware of what that fat has been replaced with. Often it is sugar, sweeteners or other additives. Instead of these, I’d suggest unsweetened natural yoghurt and adding fresh or frozen fruit to it.

Organic

Organic milk may contain slightly more omega-3 fat (although less of the essential minerals iodine and selenium) than non-organic milk (Średnicka-Tober et al., 2016). The absolute difference in omega-3 fats is not huge though and could be made up for by eating some oily fish, for example.

We don’t yet know what long-term effects – if any – potential residual chemicals (such as antibiotics, pesticides etc.) and hormones found in milk may have on us.

In the UK, there are different animal welfare regulations between organic and non-organic milk production.

Raw milk

Pasteurisation of milk helps to ensure it is safe to drink by reducing the number of potentially harmful microbes (such as E.Coli bacteria) contained within it. It can also prolong shelf life and minimise food waste by reducing numbers of spoiling bacteria.

Some people, however, advocate for raw milk, as they feel that pasteurisation reduces the potential nutritional benefits. There is not enough high-quality research yet to say definitively what these benefits, or risks might be (MacDonald et al., 2011).

It is advised that pregnant women, infants, small children, elderly people and those with a compromised immune system do not consume raw milk, or products (such as yoghurt / cheese) made from it, due to the potential risk of infection.

For more information on the safety of raw milk: food.gov.uk/safety-hygiene/raw-drinking-milk

A1 vs. A2

A major source of the protein found in milk is called beta-casein, of which there are two subtypes – named A1 and A2. It is now possible to buy milk that has only the less common A2 protein (most supermarket milk also has A1).

Some studies have found that, in people with milk intolerance, A2 milk may give them fewer gastrointestinal symptoms (such as bloating or pain), compared to regular milk. This suggests that there may be some people who, instead of being intolerant to the lactose sugar, are intolerant to the A1 milk protein casein instead (Jiaqin et al., 2016, Pal et al., 2015, Allison and Clarke, 2005).  

These studies have been small and many have been funded by the A2 industry, so as ever, larger independent studies are needed (Truswell, 2005).

What are some of the potential
benefits of dairy?

Essential nutrients

Milk contains many essential nutrients, from calcium to vitamin D (particularly if it’s fortified), phosphorus, potassium, iodine, B vitamins and more. It is a good source of protein and a low-sugar drink that is cheap and readily available.

Iodine is a particularly important nutrient to highlight. Milk and dairy products are the main source of iodine for most people in the UK and a lack of iodine in our diet over a long period of time can potentially lead to thyroid issues. Iodine deficiency before and during pregnancy is of particular concern, as it may affect infant brain development.

Most milk-alternative drinks are not yet fortified with iodine (check the label), so this is a key nutrient to be mindful of if you reduce or remove dairy milk from your diet.

Take a look at this fact sheet for more information on iodine.

If you are interested in your daily intake of calcium, this calculator from the International Osteoporosis Foundation is a fun and informative questionnaire to have a play around with.

Cardiovascular disease risk

There have been various studies suggesting a link between dairy consumption and reduced risk of cardiovascular disease (heart disease and/or stroke) (Alexander et al., 2016). Although when it comes to milk specifically, the evidence points toward a more neutral association (Lamarche et al., 2016).

More research is needed to confirm these results and to look at how different types of dairy products may (or may not) affect risk, or if there are certain groups of people who may be affected more than others, for example.

Taste and food diversity

An area of nutrition that can sometimes be overlooked if we dive too deeply into the evidence, is the importance of preference and taste.

Do you like milk and dairy products? It’s a good question to ask. I personally don’t get along with it well, so don’t include much cow’s milk dairy in my own diet. But my family drinks milk and enjoys yoghurt and members of my team feel better for including dairy in their diet. It’s very much a personal decision.

Restricting foods or food groups (without a specific reason to do so), can sometimes lead to stress and anxiety around food. I therefore urge flexibility wherever possible, rather than rigid, black-and-white food ‘rules’.

What are some of the potential issues with dairy?

Many people in the UK are reducing their intake of milk, or avoiding it altogether, due to concerns over animal welfare and sustainability. While these are, of course, valid reasons to shift our dietary patterns, this article will look at the more nutritional aspects of milk instead.

Lactose intolerance

Intolerance to milk-containing foods is common and increases with age. This is thought to be because as we get older, our need to digest milk declines (which we would originally have only consumed from our mother’s breast).

The majority of the world’s population starts to decrease their ability to digest milk by the age of 3-5 years. This trend then continues as we get even older; in one study, around half of adults over 50 were lactose intolerant and around a quarter were under the age of 50, although this does vary between ethnic groups and Northern Europeans seem to have one of the highest lactose tolerances (Rao et al., 1994, Montgomery, Grand and Buller, 2015).

Milk intolerance is caused by low levels of the enzyme ‘lactase’ which breaks down the milk sugar known as ‘lactose’. This is usually due to a genetic trait, which means that we don’t produce enough of the lactase enzyme anymore (Montgomery, Grand and Buller, 2015).

This matters because lactose sugar needs to be broken down into two smaller sugars, glucose and galactose, before it can be absorbed as energy.

If this breakdown doesn’t happen, then the lactose travels onwards from the small bowel into the large bowel. In those who don’t have good lactase enzyme activity, around 75% of the unabsorbed lactose sugar will pass into the large bowel (Montgomery, Grand and Buller, 2015).

When unabsorbed lactose reaches the colon it is fermented by the gut bacteria, producing gas. This can distend and stretch the bowel walls, leading to discomfort and bloating, two of the classical signs of lactose intolerance. The higher sugar load of the large bowel also draws water into the gut, which can sometimes lead to loose stools or diarrhoea (Montgomery, Grand and Buller, 2015).

The symptoms of lactose intolerance may include the following (noticed after eating at least two servings of dairy / day)*

  • Long-term problems with diarrhoea
  • Abdominal pain or discomfort
  • Bloating
  • Flatulence

*Note: These symptoms are very non-specific, so if you are suffering from any of the above, or are worried you might have lactose intolerance, do see your GP to just check there is nothing else that might be going on. This is especially important in children.

Lactose intolerance & yoghurt / cheese

Processing milk into yoghurt or cheese may reduce the amount of lactose sugar it contains. For example, when making yoghurt, some of the lactose is fermented to produce lactic acid, which gives yoghurt its characteristic tangy taste.

Therefore, some people who can’t tolerate milk particularly well due to lactose intolerance may find that they are able to eat small portions of yoghurt or cheese. This will always vary from person-to-person.

Inflammation

The degree to which dairy products can result in inflammation is variable depending on lots of individual factors, perhaps the most important being in those people who have an allergy to milk.

If we eat foods that our immune system reacts to (called a ‘hypersensitivity’ reaction), this can lead to a pro-inflammatory state (Bordoni et al., 2015). It is sensible in those instances to avoid consuming dairy products. If in doubt, ask for professional advice on this.

However, according to the findings of a review on the topic, dairy – particularly fermented dairy products (like yoghurt & cheese) – could also have some anti-inflammatory effects. This may be, in part, due to the bacteria they contain, perhaps interacting with our own gut microbiota (which we know plays a key role in modulating and communicating with the immune system) (Bordoni et al., 2015).

Fractures

The idea that high milk consumption directly reduces the risk of broken bones, particularly as we age, has been questioned in recent years.

A British Medical Journal study reported that high milk consumption does not necessarily protect against fractures and for women in particular, might even increase risk (Byberg et al., 2014). Further studies have had more neutral effects, however, while others have suggested a slight reduction in the risk of having a hip fracture in women who drank more milk (Lamarche et al., 2016).

Again, more research is needed (especially amongst different ethnic groups, who may have higher or lower rates of lactose intolerance).

In the meantime, however, the Royal Osteoporosis Society has some useful articles on Looking After Your Bones (and specifically on Nutrition for Bones). theros.org.uk/.

If you’re interested in the links between dairy and bone health in children, take a look at this NHS article on ways to ‘boost your child’s bone health’ if you’d like more information: https://www.nhs.uk/live-well/healthy-body/bone-health-in-children/

Acne?

I personally found that my acne vastly improved without dairy.

I have often queried if this happened due specifically to the reduction in dairy, or because I replaced that dairy with lots more fresh fruits and vegetables, or perhaps a combination of the two. But I was interested to read this article recently, which gives an interesting take on a potential mechanism underlying the link between dairy and acne: examine.com/

As always, it is each to their own and it’s important to be in tune with our own bodies. The link between diet and acne is still a contentious one.

It’s worth mentioning, however, that I am careful to ensure I am replacing the nutrients of any foods I remove (from whole food sources where possible), as well as looking more broadly at my lifestyle. Stress and poor sleep, for example, are other big acne triggers for me.

 

The bottom line?

Dairy products can be enjoyed by many of us as part of a balanced diet (particularly by those of Northern European descent, where there tends to be less incidence of lactose intolerance in adulthood). They contain a wide range of essential nutrients and can bring diversity and taste benefits to our diet.

However, for some people, reducing or removing dairy products from the diet may be beneficial for a variety of reasons as touched on above. If you think that you might be dairy intolerant, or have other concerns related to subjects discussed in this article, please consult with your healthcare provider, as the symptoms are rather non-specific and it is important to ensure that you are not missing another diagnosis.

If you do choose to reduce the amount of dairy you are consuming, it is important to make sure that you have plenty of other sources of the essential nutrients that it provides – particularly calcium, iodine and B-vitamins. Take a look at my article on 9 nutrients in a plant-based diet for further information on alternative sources.

There are now plenty of great tasting dairy alternatives available. However, these have variable levels of nutrients (and tend to be lower in protein), so always read the labels. Look out for options that contain added calcium and iodine and try to minimise sweeteners, sugars, emulsifiers or other artificial additives. It is more important to consider what we do eat in our diets, than what we don’t eat.

Disclaimer:

Nothing written here is a substitute for personal medical or nutritional advice. Please be mindful of your own needs, and seek appropriate professional support as necessary. This article is for information only.

References & Bibliography:

Alexander, D., Bylsma, L., Vargas, A., Cohen, S., Doucette, A., Mohamed, M., Irvin, S., Miller, P., Watson, H. and Fryzek, J. (2016). Dairy consumption and CVD: a systematic review and meta-analysis. British Journal of Nutrition, 115(4), pp.737-750.

Benatar, J., Sidhu, K. and Stewart, R. (2013). Effects of High and Low Fat Dairy Food on Cardio-Metabolic Risk Factors: A Meta-Analysis of Randomized Studies. PLoS ONE, 8(10), p.e76480.

Bordoni, A., Danesi, F., Dardevet, D., Dupont, D., Fernandez, A., Gille, D. and et al. (2015). Dairy products and inflammation: A review of the clinical evidence. Critical Reviews in Food Science and Nutrition, 57(12), pp.2497-2525.

Brown, G., Warren, A., Bello, H. and Rao, D. (1994). Prevalence of lactose maldigestion. Digestive Diseases and Sciences, 39(7), pp.1519-1524.

Byberg, L., Melhus, H., Warensjo Lemming, E., Basu, S., Langenskiold, S., Wolk, A. and Michaelsson, K. (2014). Milk intake and risk of mortality and fractures in women and men: Cohort studies. BMJ, 349(oct27 1), pp.g6015-g6015.

Clarke, A. and Allison, A. (2005). Further research for consideration in ‘the A2 milk case’. European Journal of Clinical Nutrition, 60(7), pp.921-924.

Clarke, A., Ni, J., Yellend, G., Lu, X., Leiming, X. and Jianqin, S. (2016). Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ mi. Nutrition Journal.

Grover, S., Friedman, L., Buller, H., Grand, R. and Montgomery, R. (2015). Lactose intolerance: Clinical manifestations, diagnosis, and management. [online] Available at: UpToDate [Accessed 4 Apr. 2016].

Ho, S., Kukuljan, S., Woodford, K. and Pal, S. (2015). Milk intolerance, beta-casein and Lactose. Nutrients, 7(9), pp.7285-7297.

Lamarche, B., Givens, D., Soedamah-Muthu, S., Krauss, R., Jakobsen, M., Bischoff-Ferrari, H., Pan, A. and Després, J. (2016). Does Milk Consumption Contribute to Cardiometabolic Health and Overall Diet Quality?. Canadian Journal of Cardiology, 32(8), pp.1026-1032.

Liu, J., Li, W., Fang, Z., Han, Z., Zuo, P., Wang, L. and Cui, X. (2004). D-Galactose-caused life shortening in Drosophila melanogaster and Musca domestica is associated with oxidative stress. Biogerontology, 5(5), pp.317-326.

Liu, J., Packer, L., Long, J., Hu, Y., Li, X., Zhang, Q., Zuo, P. and Cui, X. (2006). Chronic systemic D-galactose exposure induces memory loss, neurodegeneration, and oxidative damage in mice: Protective effects of R-α-lipoic acid. Journal of Neuroscience Research, 83(8), pp.1584-1590.

MacDonald, L., Brett, J., Kelton, D., Majowicz, S., Snedeker, K. and Sargeant, J. (2011). A Systematic Review and Meta-Analysis of the Effects of Pasteurization on Milk Vitamins, and Evidence for Raw Milk Consumption and Other Health-Related Outcomes. Journal of Food Protection, 74(11), pp.1814-1832.

NHS (2018). Dairy and alternatives in your diet. [online] nhs.uk. Available at: https://www.nhs.uk/live-well/eat-well/milk-and-dairy-nutrition/ [Accessed 22 Feb. 2020].

Pal, S., Kukuljan, S., Woodford, K. and Ho, S. (2014). Comparative effects of A1 versus A2 beta-casein on gastrointestinal measures: A blinded randomised cross-over pilot study. European Journal of Clinical Nutrition, 68(9), pp.994-1000.

Steinshamn, H., Benbrook, C., Sanderson, R., Seal, C., Barański, M. and Średnicka-Tober, D. (2016). Higher PUFA and n-3 PUFA, conjugated linoleic acid, α-tocopherol and iron, but lower iodine and selenium concentrations in organic milk: A systematic literature review and meta- and redundancy analyses. British Journal of Nutrition, 115(06), pp.1043-1060.

Truswell, A. (2005). The A2 milk case: A critical review. European Journal of Clinical Nutrition, 59(5), pp.623-631.

Xiao, M., Chen, Y., Marshall, C., Gao, J., Huang, H. and Hao, L. (2014). The influence of gender, age and treatment time on brain oxidative stress and memory impairment induced by d-galactose in mice. Neuroscience Letters, 571, pp.45-49.

 


Thinking About: Oily Fish

thinking about:
oily fish

We have all seen the headlines that oily fish is apparently yet another ‘superfood’ and therefore something we should be including more of in our diets. But does the evidence support these claims? And if so, what types of oily fish should we be on the lookout for?

Examples of oily fish

Anchovies, Sardines, Pilchards, Herring, Mackerel, Trout, Salmon, Tuna (fresh tuna only)

  What actually is an oily fish?

Oily fish differ from white fish, aside from being darker and stronger in flavour, due to their higher ‘good’ fat content. One such family of ‘good’ fats, the omega-3 fats, are thought to be very important in maintaining our health and preventing ill-health. Oily fish is one of the key sources of omega-3 fats in our diets.

What actually is an oily fish?

Oily fish differ from white fish, aside from being darker and stronger in flavour, due to their higher ‘good’ fat content. One such family of ‘good’ fats, the omega-3 fats, are thought to be very important in maintaining our health and preventing ill-health. Oily fish is one of the key sources of omega-3 fats in our diets.

Examples of oily fish:

Anchovies, Sardines, Pilchards, Herring, Mackerel, Trout, Salmon, Tuna (fresh tuna only)

Can’t we get omega-3 from plant oils, like rapeseed?

Yes, and no. ‘Omega-3’  fatare actually a collection of different fats, which we get from various sources. But it is the long-chain omega-3 fats, known as ‘DHA’ & ‘EPA’ that have been associated with the majority of health benefits in clinical studies. These are mainly found in oily fish, fish oil supplements or some phytoplankton supplement.

Plant sources of omega-3, from walnuts or rapeseed oil for example, provide us with more of the short-chain omega-3 fatty acids. Unfortunately, our bodies are rather inefficient at converting these into the more biologically active long-chain DHA & EPA forms. So, at present, it’s generally considered best not to rely on plant sources as your only source of omega-3 fats. Vegans take note.

The potential benefits of oily fish & omega-3 oils

One of the key benefits of consuming oily fish is therefore thought to come from their high concentration of these omega-3 fatty acids – although they also contain a number of other beneficial nutrients too: protein, vitamin D, iodine, potassium, iron, zinc, selenium, B vitamins and even calcium in the smallest fish (where you eat the bones, such as anchovies & sardines).

Omega-3 fats have been linked to all sorts of potential health benefits. It is important to point out that many of these research findings have not been proven in large-scale population studies, and so may therefore not be applicable to everyone. However, they do give us some enticing hints to possible future uses.

Here are a few examples of current research areas:

  • They may potentially help to reduce blood triglycerides (Musa-Veloso et al., 2010), and blood pressure (Cabo, Alonso and Mata, 2012).
  • They may reduce the risk of stroke (Chowdhury et al., 2012)
  • EPA (one of the long-chain fish oils) could sometimes be beneficial to people diagnosed with major depression (Sarris et al., 2016).
  • They may help to promote optimal growth of the brain and eyes in developing infants when consumed during pregnancy, and may also reduce the risk of pre-term delivery for some babies (Jordan, 2010).
  • They could reduce the risk of autoimmune diabetes in adults (Lofvenborg et al., 2014), although there is no clear evidence that they reduce risk of the more common Type 2 diabetes.
  • They could reduce your risk of developing ‘wet’ macular degeneration (a major cause of adult blindness). (Rahu et al., 2008)

If you do choose to take omega-3 oil supplements, please do make sure it is a high quality form, and that you have discussed it with a healthcare professional

Baked Trout on a Bed of Vegetables

As with all things nutrition related, there is almost always a balance of positives and negatives to consider:

The potential downsides of oily fish 

Unfortunately, most fish and shellfish now contain some levels of pollutants or heavy metals such as PCBs or mercury. The larger oily fish, such as fresh tuna, can contain higher concentrations of these than the smaller fish (Chahid et al., 2014). This may be a concern if you eat a lot of fish, or eat mainly the largest types of fish – such as shark or marlin. Also, farmed fish may contain more pollutants, and less omega-3 fats, than wild or marine fish, although there are some examples of good practice in farmed fish production now (Rodriguez-Hernandez et al., 2017).

I would consider it sensible to therefore try to balance the benefits of eating oily fish (getting the omega-3 fats and other important nutrients) with the risks of eating too much (exposing yourself to an excess of pollutants or heavy metals).

In general, it is advised that this balance falls at around 1-2 portions of oily fish a week, ideally enjoying more of the smaller varieties (mackerel & sardines) than the larger ones (especially tuna): a portion is in the region of 140g, or 1 medium sized fillet (NHS Choices, 2017). You can also enjoy another 1-2 portions of white fish or seafood (i.e., not oily fish) on top of this per week.

A word on fish in pregnancy

Eating fish in pregnancy is good both for you, and for your baby (if you can stomach it!), and is therefore to be encouraged.

However, you can be a bit more vulnerable to the effects of pollutants during this important time, so the dietary advice is slightly different. This advice is also true for those who are considering pregnancy, or are trying to conceive, too.

  • Avoid shark, swordfish and marline altogether, and minimise your intake of fresh tuna. The largest types of fish such as these can contain high levels of mercury which can damage a baby’s developing nervous system.
  • Avoid all raw shellfish, such as oysters.
  • Eat no more than 1-2 portions of oily fish per week – so that means no more than 280g/week. Ideally, try to stick to smaller types; unsmoked mackerel (look in the freezer aisle), sardines in olive oil, and organic or wild salmon or trout.
  • Eat up to 1-2 portions of ‘other’ fish (such as white fish) or seafood products a week on top of this, such as canned tuna. NHS guidelines say no more than 4 cans of tuna a week, but I would suggest 2 cans per week is still a reasonable amount, particularly if you are having your oily fish as well. Eat a variety of fish wherever possible.
  • Be very careful if you are taking fish oil supplements during pregnancy. Some of these, such as cod liver oil, can contain high levels of vitamin A – which can be harmful to your unborn baby. Speak to your midwife or doctor for more information.

I would also generally advise that you follow the same advice for children.

For more information on fish in pregnancy:

A reassuring word in this complex area: It is considered better for you to eat a couple of portions of fish each week than to avoid it altogether due to anxiety regarding mercury or pollutants. The majority of the UK population does not consume enough oily fish to meet suggested dietary guidelines. In other words, be conscious of potential pollutants, but don’t let them put you off eating fish altogether.

Any advice about choosing sustainable oily fish?

Sometimes, it can seem like the more you know about nutrition, the more complicated it can be to decide what to eat. And then adding in environmental mindfulness to that equation can seem rather daunting. But there are lots of resources available to help you make these decisions, and once you’ve done it a couple of times it does get much simpler – I promise.

Intensive fishing and unsustainable farming practices are threatening our fish populations. Check out the Marine Conservation Society’s easy to use website to help guide the most sustainable seafood choices:

goodfishguide.org

In general, I look out for either organic or wild fish whenever I can get hold of them.

A few of my preferred fish suppliers:

  • lochduart.com – responsible, eco-friendly farmed salmon from Scotland.
  • fish4ever.co.uk/welcome-to-fish-4-ever – ethical canned fish
  • reelfish.co.uk – ethical canned tuna (I tend to just stick to the ones in spring water)
  • newlynfreshfish.co.uk – mail order fresh fish from the traditional fishing port of Newlyn in Cornwall, packed in a leak-proof box with plenty of ice so it reaches you in great condition. You can phone or email them to arrange delivery of seasonal, wild fish to your preferences – or simply order one of their ready-made selection boxes.

Disclaimer: Please discuss this topic with your doctor or nutrition professional (visit my FAQ page for info) if you are interested in finding more information, or considering taking supplements. There are certain instances where increasing your intake of omega-3 fats is not advisable. As with all articles on ameliafreer.com, this is no substitution for individual medical or nutritional advice.

Cabo, J., Alonso, R. and Mata, P. (2012) ‘Omega-3 fatty acids and blood pressure’, British Journal of Nutrition, 107(S2), pp. S195–S200. doi: 10.1017/s0007114512001584.

Chahid, A., Hilali, M., Benlhachimi, A. and Bouzid, T. (2014) ‘Contents of cadmium, mercury and lead in fish from the Atlantic sea (Morocco) determined by atomic absorption spectrometry’, Food Chemistry, 147, pp. 357–360. doi: 10.1016/j.foodchem.2013.10.008.

Chowdhury, R., Stevens, S., Gorman, D., Pan, A., Warnakula, S. and Chowdhury, S. (2012) ‘Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: Systematic review and meta-analysis’, BMJ, 345(oct30 3), pp. e6698–e6698. doi: 10.1136/bmj.e6698.

Jordan, R.G. (2010) ‘Prenatal Omega-3 fatty acids: Review and recommendations’, Journal of Midwifery & Women’s Health, 55(6), pp. 520–528. doi: 10.1016/j.jmwh.2010.02.018.

Löfvenborg, J.E., Andersson, T., Carlsson, P.-O., Dorkhan, M., Groop, L., Martinell, M., Tuomi, T., Wolk, A. and Carlsson, S. (2014) ‘Fatty fish consumption and risk of latent autoimmune diabetes in adults’, Nutrition & Diabetes, 4(10), p. e139. doi: 10.1038/nutd.2014.36.

Musa-Veloso, K., Binns, M.A., Kocenas, A.C., Poon, T., Elliot, J.A., Rice, H., Oppedal-Olsen, H., Lloyd, H. and Lemke, S. (2010) ‘Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides’, Nutrition Reviews, 68(3), pp. 155 167. doi: 10.1111/j.1753-4887.2010.00272.x.

NHS Choices (2017) Fish and shellfish. Available at: http://www.nhs.uk/Livewell/ (Accessed: 3 February 2017).

Rahu, M., Chakravarthy, U., Young, I., Vioque, J., de Jong, P.T. and Bentham, G. (2008) ‘Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoic acid intakes, and associations with neovascular age-related macular degeneration’, The American Journal of Clinical Nutrition, 88(2), pp. 398–406.

Rodríguez-Hernández, Á., Camacho, M., Henríquez-Hernández, L.A., Boada, L.D., Valerón, P.F. and Zaccaroni, A. (2017) ‘Comparative study of the intake of toxic persistent and semi persistent pollutants through the consumption of fish and seafood from two modes of production (wild-caught and farmed)’, Science of The Total Environment, 575, pp. 919–931. doi: 10.1016/j.scitotenv.2016.09.142.

Sarris, J., Murphy, J., Mischoulon, D., Papakostas, G.I., Fava, M. and Berk, M. (2016) ‘Adjunctive Nutraceuticals for depression: A systematic review and Meta-Analyses’, American Journal of Psychiatry, , p. appi.ajp.2016.1. doi: 10.1176/appi.ajp.2016.15091228.