Welcome Nutrition in a nutshell  -  how to eat healthy and live longer   Catherine Collins RD FBDA Principal dietitian, St...
<ul><li>Dietary change is a common New Year resolution </li></ul><ul><li>“ We have a population in constant state of high ...
What is a dietitian? ‘ Dietitians translate the science of nutrition into practical information about food. They work with...
What is a dietitian? Dietitians:  a profession “uniting food, culture and science to improve human health and quality of l...
<ul><li>Anyone can be a nutritionist… </li></ul><ul><li>or ‘Leading Clinical Nutritionists’… </li></ul><ul><li>or ‘Nutriti...
Life expectancy 80% of life is disease free 78 years men 82 years women
Longer old age or   longer ill health? <ul><li>Life expectancy has increased for both men and women </li></ul><ul><li>Age ...
Nutrition and health Where’s the evidence? Population studies Organ health Individuals Cell function Environment Diet Life...
The ‘Mediterranean diet’ Where did the  idea  of the ‘Mediterranean Diet’  originate?  Great Britain – or Greece?
<ul><li>James Lind (1716-1794) </li></ul><ul><li>Surgeon on HMS Salisbury </li></ul><ul><li>First nutrition experiment at ...
<ul><li>Sir Jack Drummond (1891-1952) </li></ul><ul><li>Pioneer of vitamin research in the 1930-40’s </li></ul><ul><li>Adv...
Public health nutrition  (1940-1955) typical  weekly  ration,1942 <ul><li>540 g of meat  (fish, sausages and offal were of...
<ul><li>‘ Dig for Victory’  increased intake of vegetables and fruit </li></ul><ul><li>Fortification of food offset ration...
The ‘Mediterranean Diet’ <ul><li>Dr Ancel Keys (1904-2004) </li></ul><ul><li>US Nutritional physiologist, seconded to the ...
The ‘Mediterranean’ diet blueprint: Cretan diet of the 1950’s <ul><li>simple food components; regular meals </li></ul><ul>...
Dietary fat: the messages <ul><li>Saturated fat raises ‘bad’ cholesterol and increases risk of heart disease and stroke </...
Cell communication helps organise the body response <ul><li>Cells ‘talk’ to each other by using lots of different methods,...
Membrane response <ul><li>Saturated fats make cell membranes more reactive, sending out ‘loud’ messages to other cells, ma...
Vegetable oils Olive oil is rich in anti-oxidant polyphenols Rapeseed oil is a good source of omega-3 fat Although all are...
Eat  more  fruit and veg <ul><li>5-a-day is the minimum to provide: </li></ul><ul><ul><li>Vitamins and minerals </li></ul>...
How to do it…   <ul><li>Have a glass of fruit juice with breakfast </li></ul><ul><li>Make one of your between-meal snacks ...
Food is more important than focussing on nutrients… lycopene carotenoids polyphenols Vitamin C folic acid Phytoene Phytofl...
Should I choose organic? <ul><li>More ‘biologically active’ phytochemicals per 100g: </li></ul><ul><ul><li>Plant protectio...
Best cooked - or raw? <ul><li>Cooking destroys some heat-sensitive vitamins e.g. vitamins B and C </li></ul><ul><li>Cookin...
Superfoods… are just foods with good PR <ul><li>All fruits and vegetables provide both nutrients and non-nutritive benefic...
Blood levels of dietary antioxidants over a 6 hour period Pomegranate juice: Ellagitannins, anthocyanins Tea:  theaflavones...
<ul><li>Pomegranate juice boosts blood levels of antioxidants ellagitannins and anthocyanins  </li></ul><ul><li>BUT how ma...
Nutritional blueprint for a healthy diet:  the food matrix Fruits, vegetables: vitamins, minerals, phytochemicals, fibre, ...
Mediterranean diet helps weight control: kcal per 100g food African diet: 107 kcal Healthy diet: 125 kcal British diet: 16...
How reliable is the evidence? <ul><li>Is it a large study?  Small studies often end up with errors that affect the results...
The EPIC study: E uropean  P rospective  I nvestigation of  C ancer a ‘big’ study with little left to ‘chance’ <ul><li>Ini...
<ul><li>More dairy foods and calcium reduce bowel cancer </li></ul><ul><li>High fibre or a high fish intake reduces the ri...
Fruits and vegetables <ul><li>High fibre intake reduces bowel cancer risk </li></ul><ul><li>High intakes of fruit and vege...
It’s never too late to change!   <ul><li>15,792 men and women aged 45 to 64, taking part in an American heart disease risk...
We should all join Club-Med! <ul><li>12 research studies addressing ‘Mediterranean Diet’ </li></ul><ul><li>1,574,299 subje...
Are supplements of use? <ul><li>Folic acid 400mg daily before and for the first three months of pregnancy help prevent spi...
<ul><li>No effective UVB sunlight of the right wavelength in the UK from November to March  </li></ul><ul><li>60% of poten...
“ One hundred years after the first vitamin was named, what is known about them has not translated into beneficial, standa...
The expert view… “ Food , not specific nutrients, is the fundamental unit to health in human nutrition” Professor Linda Ta...
To summarise… <ul><li>Eat more fruit and veg -  why not try a new one occasionally? </li></ul><ul><li>Have at least 1 meat...
<ul><li>“ Food is part of a balanced diet” </li></ul>Enjoy!
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Nutrition in a nutshell

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Nutrition in a nutshell was presented by Catherine Collins at St George's Healthcare NHS Trust as part of a selection of presentations offered to foundation trust members. If your interested in becoming a FT member please email members@stgeorges.nhs.uk

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  • Nutrition in a nutshell

    1. 1. Welcome Nutrition in a nutshell - how to eat healthy and live longer Catherine Collins RD FBDA Principal dietitian, St George’s Hospital
    2. 2. <ul><li>Dietary change is a common New Year resolution </li></ul><ul><li>“ We have a population in constant state of high alert for foods that will kill them or cure them </li></ul><ul><ul><li>Good foods will not only make us healthy, but also righteous </li></ul></ul><ul><ul><li>Bad foods make us sinful – and will kill us” Tim Byers </li></ul></ul><ul><li>Short-term extreme dietary habits often started – and quickly suspended – at this time of year </li></ul>
    3. 3. What is a dietitian? ‘ Dietitians translate the science of nutrition into practical information about food. They work with people to promote nutritional well-being, prevent food-related problems and treat disease.’ NHS Careers web page
    4. 4. What is a dietitian? Dietitians: a profession “uniting food, culture and science to improve human health and quality of life” Dr Johanna Dwyer; US NIH Dietitian is a ‘legally protected’ term. It is illegal to use the title unless you are a dietitian.
    5. 5. <ul><li>Anyone can be a nutritionist… </li></ul><ul><li>or ‘Leading Clinical Nutritionists’… </li></ul><ul><li>or ‘Nutritional Therapists’… </li></ul><ul><li>… the term is not ‘protected’ by law </li></ul>How many of you are nutritionists?
    6. 6. Life expectancy 80% of life is disease free 78 years men 82 years women
    7. 7. Longer old age or longer ill health? <ul><li>Life expectancy has increased for both men and women </li></ul><ul><li>Age at which we develop a ‘serious illness’ that will affect our life is static </li></ul><ul><li>We have one additional year of ill health before we die, based on current UK statistics </li></ul><ul><li>So far, healthy diet and lifestyle appears to optimise health and longevity. The evidence for vitamin supplements is not only in its infancy, but at the moment appears not proven. </li></ul>
    8. 8. Nutrition and health Where’s the evidence? Population studies Organ health Individuals Cell function Environment Diet Lifestyle and activity
    9. 9. The ‘Mediterranean diet’ Where did the idea of the ‘Mediterranean Diet’ originate? Great Britain – or Greece?
    10. 10. <ul><li>James Lind (1716-1794) </li></ul><ul><li>Surgeon on HMS Salisbury </li></ul><ul><li>First nutrition experiment at sea in 1747 </li></ul><ul><li>identified oranges and lemons to have &quot;most sudden and good effects&quot; in treating scurvy, a condition responsible for the death of two thirds of sailors on traditional ocean sailing routes </li></ul><ul><li>Trading links with British Caribbean lead to limes becoming a standard fruit carried on board. British sailors became known as ‘Limeys’ </li></ul><ul><li>Lime juice cordial was developed to provide an alternative to the storage of limes in alcohol </li></ul><ul><li>The Merchant Shipping Amendment Act of 1867 made it law to carry lemons or limes on seafaring vessels </li></ul>British nutrition research… The first randomised controlled trial
    11. 11. <ul><li>Sir Jack Drummond (1891-1952) </li></ul><ul><li>Pioneer of vitamin research in the 1930-40’s </li></ul><ul><li>Advised the Ministry of Food on suitable food rations, and the use of vitamin supplements in WWII </li></ul><ul><li>Frederick, Lord Woolton (1883-1964) </li></ul><ul><li>Appointed Minister of Food in 1940 </li></ul><ul><li>Became infamous for his PR campaigns </li></ul><ul><li>- particularly the ‘Woolton steak and kidney pie’ (a vegetable pie containing no steak, and no kidney, because these meats were rationed) </li></ul>British nutrition research…
    12. 12. Public health nutrition (1940-1955) typical weekly ration,1942 <ul><li>540 g of meat (fish, sausages and offal were off ration) </li></ul><ul><li>4 oz (113g) of bacon/ham </li></ul><ul><li>3 pints of milk </li></ul><ul><li>1 oz (28 g) cheese </li></ul><ul><li>2 oz (57 g) butter </li></ul><ul><li>2 oz (57 g) fat or lard </li></ul><ul><li>2 oz (57 g) loose tea </li></ul><ul><li>1-4 eggs </li></ul><ul><li>2oz jam + 3oz sweets + 3oz sugar </li></ul><ul><li>+ &quot;points&quot; for tinned/ dried food </li></ul>Note: less saturated fat and sugar than pre-war diet
    13. 13. <ul><li>‘ Dig for Victory’ increased intake of vegetables and fruit </li></ul><ul><li>Fortification of food offset rationing: </li></ul><ul><ul><li>Calcium added to the ‘National’ bread (continues today) </li></ul></ul><ul><ul><li>Vitamins A and D added to margarine (continues today) </li></ul></ul><ul><li>Promotion of vitamin supplements: </li></ul><ul><ul><li>‘ welfare vitamins’ </li></ul></ul><ul><ul><li>Cod liver oil </li></ul></ul><ul><ul><li>Orange juice </li></ul></ul>Rationing
    14. 14. The ‘Mediterranean Diet’ <ul><li>Dr Ancel Keys (1904-2004) </li></ul><ul><li>US Nutritional physiologist, seconded to the UK Ministry of Food during WWII </li></ul><ul><li>Noted a higher mortality in US peers compared to UK when he returned to the US </li></ul><ul><li>Hypothesis that rationing improved health of society – particularly with respect to saturated fat and cardiovascular disease </li></ul><ul><li>Developed the Seven Countries Collaborative Study launched 1958 </li></ul><ul><li>Monitored 13,000 men aged 40–59 years on diet, health and lifestyle with repeated health assessments after 5 and 10 years </li></ul>
    15. 15. The ‘Mediterranean’ diet blueprint: Cretan diet of the 1950’s <ul><li>simple food components; regular meals </li></ul><ul><li>based on wholegrain carbohydrates </li></ul><ul><li>at least 5 portions of fruit and vegetables daily </li></ul><ul><li>predominant fat - mono-unsaturated fat in olive oil </li></ul><ul><li>regular omega-3 fat intake from oily fish </li></ul><ul><li>modest amounts of lean meat </li></ul><ul><li>less full fat dairy foods </li></ul>Confirmed similar finding to that of British Diet during rationing!
    16. 16. Dietary fat: the messages <ul><li>Saturated fat raises ‘bad’ cholesterol and increases risk of heart disease and stroke </li></ul><ul><li>Saturated fat - when made into cell membranes - boosts inflammation and promotes short term and long term cell damage </li></ul><ul><li>It is the proportion of saturates, rather than the amount, that is of concern </li></ul><ul><li>Cut fat from meat before cooking, and use vegetable oil if necessary </li></ul><ul><li>Choose potato-topped rather than pastry pies </li></ul><ul><li>Choose scones and bread rather than pastries and cakes </li></ul><ul><li>Swap butter for unsaturated spreads, preferable mono-unsaturated ‘olive’ type spreads. If you must have butter, go for lower fat spreadable versions </li></ul>LESS THAN a third of total fat to come from saturates
    17. 17. Cell communication helps organise the body response <ul><li>Cells ‘talk’ to each other by using lots of different methods, including sending signals from their outer layer, the cell membrane </li></ul><ul><li>When a cell becomes inflamed the membrane fat releases chemicals to ‘warn’ other cells </li></ul><ul><li>These cells ‘tell’ other cells and the inflammation message continues </li></ul><ul><li>The type of fat in the diet, and so in our cell membranes, influence this response- and is noticeable in conditions like arthritis </li></ul>
    18. 18. Membrane response <ul><li>Saturated fats make cell membranes more reactive, sending out ‘loud’ messages to other cells, making pain and inflammation worse. </li></ul><ul><li>Polyunsaturates from corn and sunflower oil (omega-6 polyunsaturates) do exactly the same </li></ul><ul><li>Omega-3 polyunsaturates (e.g. rapeseed oil, fish oils) send out weaker signals, lessening inflammation response </li></ul><ul><li>Mono-unsaturates (e.g. rapeseed oil and olive oil) send out very weak signals </li></ul><ul><li>Having more mono-unsaturates and omega-3, and less omega-6 and saturated fats in the diet, is the optimal choice </li></ul>
    19. 19. Vegetable oils Olive oil is rich in anti-oxidant polyphenols Rapeseed oil is a good source of omega-3 fat Although all are low in saturates, sunflower oil has a high polyunsaturate content so is not the healthiest choice Olive oil Sunflower oil Rapeseed oil 27 55 6 92 825 11 58 Polyunsaturates 74 19 Monounsaturates 14 11 Saturates 98 92 Total fat content 882 825 kcals per 100ml
    20. 20. Eat more fruit and veg <ul><li>5-a-day is the minimum to provide: </li></ul><ul><ul><li>Vitamins and minerals </li></ul></ul><ul><ul><li>Soluble ‘gel’ type fibres for healthy bowel bacteria, and a lower cholesterol </li></ul></ul><ul><ul><li>Plant chemicals - ‘phytochemicals’ – often more powerful than vitamins: lycopene, lutein, quercetin, polyphenols, anthocyanins </li></ul></ul><ul><ul><li>Different colours provide different phytochemicals </li></ul></ul><ul><li>A ‘portion’ is a ‘handful’: </li></ul><ul><ul><li>1 tablespoon cooked vegetables </li></ul></ul><ul><ul><li>1 orange/ 2 satsumas </li></ul></ul><ul><ul><li>150ml fruit juice/ fruit smoothie (equal to 1 small carton) </li></ul></ul><ul><li>Choose fresh, frozen, canned, dried </li></ul>
    21. 21. How to do it… <ul><li>Have a glass of fruit juice with breakfast </li></ul><ul><li>Make one of your between-meal snacks a piece of fruit </li></ul><ul><li>Have a tomato or side salad with lunchtime meal </li></ul><ul><li>Have two veggies (potatoes DON’T count) with your evening meal </li></ul><ul><li>Canned or frozen fruits and vegetables are just as good </li></ul>
    22. 22. Food is more important than focussing on nutrients… lycopene carotenoids polyphenols Vitamin C folic acid Phytoene Phytofluene Lutein + zeaxanthin Quercetin Kaempferol Naringenin Dietary anti-oxidants help limit cell damage 9-oxo-octadecadienoic acid A tomato has much more functionality than the sum of its vitamin content
    23. 23. Should I choose organic? <ul><li>More ‘biologically active’ phytochemicals per 100g: </li></ul><ul><ul><li>Plant protection from pests e.g. glucosinolates, allicin </li></ul></ul><ul><ul><li>Protection from UV light damage e.g. lutein, lycopene </li></ul></ul><ul><ul><li>Greater measured anti-oxidant potential in test tube analysis </li></ul></ul><ul><li>BUT - People eat portions , not weight units </li></ul><ul><ul><li>We eat a ‘unit’ such as an apple or one tomato – not ‘100g of apple’ </li></ul></ul><ul><ul><li>Non-organic foods tend to be bigger, so unit-for-unit both contain similar phytochemical levels per serving </li></ul></ul>
    24. 24. Best cooked - or raw? <ul><li>Cooking destroys some heat-sensitive vitamins e.g. vitamins B and C </li></ul><ul><li>Cooking increases your choice of vegetables (e.g. potato, aubergine, turnip) </li></ul><ul><li>Cooking softens the plant cell walls, releasing cell contents more readily such as beta-carotene </li></ul><ul><li>Anti-oxidant lycopene in tomatoes is made more soluble by cooking, so is absorbed by the body in greater amounts – especially when in the presence of oil or fat in the diet </li></ul><ul><li>Eat both raw and cooked vegetables – both are good in different ways </li></ul>
    25. 25. Superfoods… are just foods with good PR <ul><li>All fruits and vegetables provide both nutrients and non-nutritive beneficial agents (‘phytochemicals’) </li></ul><ul><li>Superfoods are those with research to prove their phytochemical usefulness </li></ul><ul><li>A higher level of anti-oxidant potential from phytochemicals in a food does not necessarily mean greater health benefit </li></ul><ul><li>If the anti-oxidants are cleared quickly from the blood their usefulness is limited </li></ul><ul><li>Using the example of pomegranate juice vs. tea… </li></ul>
    26. 26. Blood levels of dietary antioxidants over a 6 hour period Pomegranate juice: Ellagitannins, anthocyanins Tea: theaflavones, catechins, phenolic acids Regular tea consumption sustains anti-oxidant activity over the day
    27. 27. <ul><li>Pomegranate juice boosts blood levels of antioxidants ellagitannins and anthocyanins </li></ul><ul><li>BUT how many glasses of pomegranate juice did you drink today? The answer is often ‘none’ </li></ul><ul><li>Tea also contains antioxidants – particularly EGCG, other catechins, thearubigins and theaflavins </li></ul><ul><li>The British drink more tea than pomegranate juice </li></ul><ul><li>… so the overall anti-oxidant benefit is similar from both. </li></ul>Superfoods? It’s just clever marketing
    28. 28. Nutritional blueprint for a healthy diet: the food matrix Fruits, vegetables: vitamins, minerals, phytochemicals, fibre, very low in calories ‘ Lean’ protein foods: Iron, B12, mono- and omega-3 fats Wholegrain carbs: main energy source for brain; blood sugar control; B group vitamins, fibre Low fat dairy foods: calcium-rich, variable fat content, probiotic Fats and oils: Mono-unsaturates and fish oils reduce inflammation; fat-soluble vitamins; better blood sugar control; helps absorb important nutrients
    29. 29. Mediterranean diet helps weight control: kcal per 100g food African diet: 107 kcal Healthy diet: 125 kcal British diet: 160 kcal Fast food outlet: 262 kcal The more fruit and veg you eat, the lower your overall calorie intake per day
    30. 30. How reliable is the evidence? <ul><li>Is it a large study? Small studies often end up with errors that affect the results. Tossing a coin three times doesn’t give you the correct answer as to whether 100 coins would land head down if you dropped them – getting this result is chance </li></ul><ul><li>Is it reported in a major health journal? Or is it a small survey or personal anecdote to promote a product such as a vitamin supplement? </li></ul><ul><li>Does it generally conform with what we already know, perhaps adding a different angle? If it doesn’t, then its likely to be a faulty study </li></ul>
    31. 31. The EPIC study: E uropean P rospective I nvestigation of C ancer a ‘big’ study with little left to ‘chance’ <ul><li>Initial data collected from 1992 – 2000 </li></ul><ul><li>512,000 healthy people in 10 European countries </li></ul><ul><li>Includes 90,000 British men + women </li></ul><ul><li>Repeated surveys every 3 years </li></ul><ul><li>Followed for 10 years so far…. </li></ul>
    32. 32. <ul><li>More dairy foods and calcium reduce bowel cancer </li></ul><ul><li>High fibre or a high fish intake reduces the risk from meat intake </li></ul><ul><li>Cancer risk factors </li></ul><ul><li>High intakes of processed meats and red meat </li></ul><ul><li>High fat diets </li></ul><ul><li>High alcohol intake </li></ul><ul><li>Being overweight or obese </li></ul>EPIC findings so far….  
    33. 33. Fruits and vegetables <ul><li>High fibre intake reduces bowel cancer risk </li></ul><ul><li>High intakes of fruit and vegetables lowers all cancer risk </li></ul><ul><li>The study does not discriminate organic from non-organic produce </li></ul><ul><li>(Lowers risk of heart attack and stroke) </li></ul>
    34. 34. It’s never too late to change! <ul><li>15,792 men and women aged 45 to 64, taking part in an American heart disease risk (ARIC) study </li></ul><ul><li>970 (8.4%) newly adopted a healthy lifestyle: </li></ul><ul><ul><li>at least 5 portions of fruits and veg daily </li></ul></ul><ul><ul><li>at least 2½ hours per week of exercise </li></ul></ul><ul><ul><li>maintain BMI between 18.5 – 30 </li></ul></ul><ul><ul><li>stopped smoking </li></ul></ul>40% reduction All cause mortality 35% reduction Cardiac events
    35. 35. We should all join Club-Med! <ul><li>12 research studies addressing ‘Mediterranean Diet’ </li></ul><ul><li>1,574,299 subjects followed for 3-18 years </li></ul><ul><li>9% reduction in overall death rates </li></ul><ul><li>9% less in death from cardiovascular disease </li></ul><ul><li>6% less in risk of cancer, or dying from cancer </li></ul><ul><li>13% reduction in risk of Parkinson’s disease and Alzheimer’s disease </li></ul>Sofi et al: British Medical Journal 11 th September 2008
    36. 36. Are supplements of use? <ul><li>Folic acid 400mg daily before and for the first three months of pregnancy help prevent spina bifida and similar defects </li></ul><ul><li>Vitamin D for everyone – especially if you avoid the sun, and for ALL children under 2 and ALL pregnant women. Adult dose is 10-25  g of Vitamin D daily. Take with food. </li></ul><ul><li>One-a-day broad spectrum multivitamins and minerals providing 50-100% RDA provides useful ‘health insurance’ if concerned about dietary quality </li></ul>
    37. 37. <ul><li>No effective UVB sunlight of the right wavelength in the UK from November to March </li></ul><ul><li>60% of potent UVB sunlight to make Vitamin D occurs between the hours of 11am – 3pm </li></ul><ul><li>The amount of Vitamin D made in 25 peak time minutes in the South would take 1-2 hours in the North! </li></ul><ul><li>Cloud cover reduces the suns effectiveness by half </li></ul><ul><li>New guidelines suggest 10-15 minutes of peak sunlight exposure a couple of times a week is safe. </li></ul><ul><li>Darker skinned people need 5-10 minutes longer due to natural skin protection </li></ul>Vitamin D from sunlight…
    38. 38. “ One hundred years after the first vitamin was named, what is known about them has not translated into beneficial, standardised recommendations for public health” Prof Irwin Rosenberg USDA Human Nutrition Research on Aging Are vitamins really a natural extension of a healthy diet?
    39. 39. The expert view… “ Food , not specific nutrients, is the fundamental unit to health in human nutrition” Professor Linda Tapsell Smart Foods Centre, University of Woolongong, Australia “ We are confusing ourselves and the public by talking so much about nutrients when we should be talking about foods …” “ consumers get the idea that diet and health can be understood in terms of specific nutrients” “ It’s not the best approach and may be wrong” Professor David Jacobs, University of Minnesota
    40. 40. To summarise… <ul><li>Eat more fruit and veg - why not try a new one occasionally? </li></ul><ul><li>Have at least 1 meat free meal each week </li></ul><ul><li>Eat regularly, and aim for three meals a day </li></ul><ul><li>Choose wholegrain or wholemeal more often than white for bread, pasta and rice </li></ul><ul><li>Enjoy a little of what you fancy – be it alcohol or chocolate! </li></ul><ul><li>Reduce your saturated fats, choosing monounsaturated fat in preference </li></ul><ul><li>Exercise and lifestyle also influences health </li></ul>Does this mean me?
    41. 41. <ul><li>“ Food is part of a balanced diet” </li></ul>Enjoy!

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