The rise of sugar is a fascinating piece of our social history – from its discovery in India to an expensive luxury added in small quantities to some foods and drinks and now to the astronomical amounts we consume today. Its story includes establishing it as a crop in the New World, the development of slavery to fulfil the market in Europe, blockades in the Napoleonic War preventing its transatlantic shipment and the development of rival sugar beet manufacture in Europe. Is the latest part of the story that it is making us ill?

It’s uncommon to find someone who doesn’t like sugar. Although people vary in how much sweetness they enjoy, most of us gain pleasure from sweet foods and drinks. Sugar is quickly absorbed and the sweetness triggers the “reward centre” in our brain, making us feel good. Many of us turn to sweet things when we feel a bit low and in need of comfort or perking up; and sweet snacks such as chocolates or biscuits are often shared amongst friends or given as gifts.

But recently sugar has been getting some bad press. You have probably seen the headline accusation that sugar is “the new tobacco”, suggesting that sugar, like smoking, is the cause of widespread disease. Certainly, a large part of the population is now designated “obese”, which is worrying as a large amount of body fat increases the chance of major diseases such as diabetes, heart disease and stroke.

Others have countered by saying that it’s not specifically sugar that has led to the current levels of obesity and diabetes, but people eating too many calories from all types of food and drink.

So does our sugar consumption matter? The simple and straight answer is “yes”.

In fact, the subject has become so important that a consortium of Britain’s leading doctors and scientists have formed a group – Action on Sugar – to publicise the problem and what’s to be done about it.

Although defenders of sugar are right that there is no decisive evidence yet that sugar alone leads to obesity and disease, there can be no doubt it is a major contributing factor. The attractive taste of sweet food and drinks makes it easy to consume too many calories. And it is possible, as some doctors think, that fructose – which makes up half of the main type of sugar we eat – is not handled well by our bodies and is turned into fat that is linked with diseases*.

These days sugar seems to be in everything. The amount of sugar sold each year is truly stunning. It’s not just the sugar we buy for home use and the sugar you’d expect to find in desserts and confectionary. Processed food often sells more on taste than on nutritional quality, and added sweetness can make all sorts of food seem more appetising. This means sugar can be found in a huge variety of savoury foods, from ham to curries, soups to ready meals, pizzas to tins of beans. And there’s the large quantities of sugar that go into soft drinks, particularly fizzy drinks and so-called “sports drinks”, where one can may contain the equivalent of many teaspoons of sugar. Many people see these drinks as a major health hazard, and several states in the USA are taking steps to limit their sales.

Our bodies do not need sugar – however much we want it! It fulfils no nutritional need, and cutting back on added sugar makes a lot of sense. (Most nutritionists agree that there is no need to worry about the sugar naturally occurring in whole fruit and vegetables.) Reducing the sugar in your diet is a great help to achieving and maintaining a healthy body weight, and the health advantages of doing so are immense.

For all our sakes let’s wish Action on Sugar every success.

 

*We explain how your body processes fructose in our book, How to Live to 110: Your comprehensive guide to a healthy life

 

So many enjoyable things seem to be bad for us. But here’s some welcome good news – if you like nuts!

Some of the strongest evidence yet of the health benefits of eating nuts has come from two large US research studies*. These followed 76,000 women and 42,000 men over periods of 30 years and 24 years respectively. The participants were all health professionals, and periodically they were asked to fill in questionnaires about their lifestyle and what they were eating. These studies have produced a lot of good evidence about the health risks and benefits of different foods and aspects of lifestyle.

Recently, researchers have focused on what these studies show about eating nuts**. They found that the more times a person ate nuts each week, the less likely he or she was, on average, to have died during the study period or to have suffered cancer, heart disease or lung disease. Those who said they ate nuts every day did best, but even eating nuts once a week seemed to be associated with health benefits.

Unfortunately, the studies did not record what types of nuts people ate, nor how these were prepared – salted, spiced, roasted or whatever. It is likely, though, that most of the participants, as health professionals, would have been aware of the risks of eating too many salted products.

Interestingly, the frequent nut eaters tended not to be overweight. This does not automatically mean that eating nuts helps you keep slim: for example, the people who ate nuts might have led healthier lifestyles. The researchers therefore carefully took into account all the other factors that might have contributed to the health results they found with nuts, using statistical techniques to tease out what was associated with nut eating. It does indeed seem that eating nuts is associated with lower risk of the major diseases.

This is consistent with a range of earlier, smaller-scale studies, and with the widely supported Mediterranean Diet, which encourages eating 30g of nuts a day and has been shown to be effective at reducing the risk of those diseases.
Nuts contain vitamins, minerals and vegetable nutrients, unsaturated fat (oil) and proteins, and they contribute to dietary fibre.

If you are thinking of adding nuts to your diet, try to avoid added salt and be cautious about the calories in nuts. Because of the oil they contain, some types of nuts have quite a lot of calories for their size, and if you start eating nuts daily, you may need to cut back on the other calories you eat.

*The studies are the Nurses Health Study and the Health Professionals Follow Up Study.
** Link to nuts study: http://dx.doi.org/10.1056/NEJMoa1307352

 

Great news for over-60s who like gardening! And for DIY enthusiasts and people who enjoy similar activities around the home and garage.

A recent study* from Stockholm, Sweden, showed that men over 60 who did these activities daily were nearly a third less likely to suffer from diseases such as coronary heart disease, stroke and diabetes than men who were less active. Indeed, these men gained almost as much benefit as those who were more vigorously active.

The study followed 4,000 men aged over 60 for twelve years, and obtained their results by repeatedly questioning the participants about 12 different activities and through laboratory tests.

These findings are valuable because many people as they get older find that they can’t fully achieve the recommended levels of physical activity – or are disinclined to do so. The research shows how everyone can derive significant benefit from the activities they can do and enjoy doing.

Activities like gardening and DIY entail standing, using upper and lower limb muscles and walking, and this increases metabolic rate, maintains muscle power, preserves bones and affects body metabolism. Though everyday activities may not involve more than moderate levels of exercise, these effects have been shown to be of clear benefit.

This doesn’t mean that greater levels of physical activity are unnecessary. Part of the study showed those who were even more active gained an even greater reduction in risk of the diseases.

Our society has become increasingly sedentary both at work and in leisure time. Sitting for long periods is one of the riskiest things anyone can do, and yet many older and retired people – and, indeed, many younger people – spend much of their day sitting. This study helps confirm the advice that we should all reduce sitting to a minimum and find something we like doing instead.

 

*Link to study abstract:  http://bjsm.bmj.com/content/early/2013/10/08/bjsports-2012-092038

 

 

One of the most significant studies in health has just celebrated 65 years since it started, and it’s still going strong.

Over those 65 years, residents of the small town of Framingham in Massachusetts, USA, have been participating in long-term studies looking at heart disease and its causes.

By the mid-1950s, the number of middle-aged men succumbing to coronary heart disease was causing serious concern – not least when several world leaders developed it. The disease had been on the rise since the start of the 20th century and the Framingham Heart Study set out in 1958 to establish what was behind this.

The study initially recruited more than 5,000 men and women, nearly a fifth of the whole population of Framingham. The researchers collected data about each of the participants every two years using interviews, clinical examinations and laboratory tests. The data covered participants’ lifestyle and environment as well as looking at their health and genetic profiles. This helped to show the importance of not smoking, taking enough physical activity, treating high blood pressure, avoiding obesity and the importance of blood fats in preventing coronary heart disease.

By 1971 the study had recruited a second generation of participants and in 1994 it extended its recruitment to reflect the changing population resulting from an influx of South Americans. 2002 saw the recruitment of a third generation. Over time, the study was widened to include other diseases, notably type 2 diabetes and dementia.

There were similar studies going on elsewhere but none was quite so comprehensive or prolonged. The Framingham study resulted in many papers published in leading scientific journals, and the work was widely discussed in scientific societies worldwide, greatly influencing research, debate and health policy.

Indeed, the findings in this and the other studies changed the way doctors looked at illness. Previously, most doctors thought of an illness as being caused by germs. If the germs could be killed or prevented from spreading, the illness would be eliminated. The Framingham discoveries required a rethink. This resulted in the concept of ‘non-communicable disease’ to explain much of modern illness and highlighted the importance of what we as individuals could do to prevent these diseases, as well as transforming the public health agenda.

There are questions over the future of this study, and whether it will continue to bring sufficient returns on the cost now that its primary objectives have been achieved. The US government has cut substantially its share of the funding.

But the fact remains that this study generated a novel way of looking at all disease and increased phenomenally our understanding of coronary heart disease.

About the study:  http://www.framinghamheartstudy.org/about/

 

We’re told the NHS is strapped for cash and it might get worse before it gets better. So, is there anything we can do as individuals? Actually, yes there is. Better still, it may even bring us financial benefits too.

A recent report* from Nuffield Health and the London School of Economics called “12 minutes more…” makes a strong economic case for taking more exercise. It is an approachable document well worth browsing through.

The health benefits of activity have been shown repeatedly: increased physical activity reduces the risk of heart disease and stroke, helps control type 2 diabetes, reduces blood pressure and body fat, improves aspects of mental health and much more. As a result, governments around the world – including our own – have recommended we all do at least 150 minutes of moderately physical activity a week.

Unfortunately, the report concludes that the majority of us don’t achieve this level. But it goes a stage further by looking at what this means economically for individuals and for the country.

First, there’s the personal burden when someone contracts one of the long-term diseases that physical activity might have helped prevent. Quite apart from the unpleasantness of the disease itself, there is the potential for loss of earnings and the impact this has on one’s own life and the lives of family members.

Secondly, there’s the less obvious but even greater burden illness puts on society as a whole through the loss of economic activity and the demands placed on the NHS and other organisations. The sums involved are quite staggering. If everyone did the recommended amount of exercise, the report authors calculate this would save the NHS £257 million per year. Mental health savings – taking account of savings for the NHS, earnings and welfare – would be over £6.3 billion.

On an individual level, the report estimates that the average household income of those that do moderate sports is more than £6,500 a year higher than inactive households. These people are also more likely to be employed.

This report contains a lot of detail establishing how all these figures were calculated. But even if only a proportion of these staggering amounts could be saved it shows that we can all do our bit by increasing our activity levels.

Many economists believe that if something doesn’t hit our own pocket directly we tend to ignore it – and that certainly seems true for physical activity. It’s only when a report like this spells it out to us that we can see clearly the enormous cost inactivity is having.

And the solution is hardly a drastic one. The report’s title “12 minutes more…” comes from its bottom line finding: that all it would take to improve our health and personal finances, and to relieve the financial pressure on the NHS, is an increase in the amount of activity we do on average of just 12 minutes a day.

 

 

*Link to the report: http://www.nuffieldhealth.com/sites/default/files/inline/Nuffield%20Health_%20LSE_Low-Fitness_Report.pdf

 

People are vegetarians for a variety of reasons. Some simply dislike the taste of meat products, while for others it is ethical or cultural aspects that are important. Whatever the reason, it seems a major benefit that many vegetarians enjoy is better health.

A recent large-scale investigation supports this. The Adventist Health Study in North America looked at dietary information for 73,000 men and women who were followed for 5 years. These were grouped into categories according to their diet: nonvegetarian, semi-vegetarians (i.e. people who eat meat or fish but at most once a week), vegetarians who eat fish, vegetarians who eat eggs and dairy products, and vegans.

Around 2,500 of these people died during the study period, and the researchers were able to compare the number of people in each diet group who died. Overall – after correcting for other factors that might have had an influence – the results suggested that vegetarians were about 12% less likely to die of any cause during the period than the meat eaters. The group that came out best were the vegetarians who also ate fish, and the vegans also did well. The benefits seemed to be greater for men than women.

In particular, the vegetarians were less likely to die from cardiovascular, kidney and endocrine diseases. Interestingly, the researchers didn’t find a difference in the number of deaths from cancer.

Studies like these cannot prove definitively that vegetarianism was the cause of people living longer: there is always the possibility of some hidden factor not taken into account. But this was a large study carefully carried out, and it does seem to support the health benefits of a vegetable-based diet. At the very least it should help vegetarians strengthen their resolve to continue, and give the rest of us reason to think about what we eat.

There is other evidence that cutting back on meat-eating is a good idea (see, for example, Meat and Diabetes). But it is worth remembering that changing other aspects of your diet – such as cutting back on salt and sugar, eating plenty of vegetables and fruit, and looking after your body weight – may have as great an impact on your health.

Link to the study: http://archinte.jamanetwork.com/article.aspx?articleid=1691919

 

There’s compelling evidence that keeping active has very great health benefits, helping to prevent many of today’s common diseases. But how much do you need to do? And does it matter what activity you choose?

A recent study* has provided some interesting evidence. Over a 6-year period, researchers compared 16,000 walkers with 33,000 runners to see what difference physical activity made to their risk of high blood pressure, diabetes and level of blood cholesterol – factors linked with heart disease.

They grouped the walkers and runners according to the average amount of activity they did. To do this, they used a measure (“metabolic equivalent”) that took account of the weight of each person and the calories they burnt. This allowed the amount of activity done by the walkers and the runners to be compared directly. The highest-activity group was doing the equivalent of an hour or so of brisk jogging every day (or a couple of hours of brisk walking), while the lowest-activity group was averaging around an hour of gentle walking a day in total (or the equivalent in jogging). There were two categories in between these, and all four levels were compared with people who did little activity at all.

The results showed that, broadly, the more activity people did, the greater the benefits in terms of high blood pressure, diabetes and blood cholesterol levels.

What was particularly interesting, though, was that the results for walking and running were very similar. A given amount of activity – whether running or a longer period of walking which expended the same energy – seemed to result in similar health benefits.

This study offers encouragement to those unable (or unwilling!) to get into higher levels of exercise. And it backs up all the previous research showing that even some physical activity is certainly more beneficial than none.

 

*Link to the study abstract: http://atvb.ahajournals.org/content/early/2013/04/04/ATVBAHA.112.300878.

 

 

Sometimes new research really makes you sit up and think – even when it’s too soon to know whether it will turn out to be certain enough for us to change our habits.

Researchers* have recently shown how one of the proteins in red meat – carnitine – is broken down by bacteria normally present in the gut to produce a chemical that’s converted into something that has been shown in animals to damage arteries in the heart, brain and elsewhere in the body.

That chemical is TMAO (which, if you are interested, is short for trimethylamine-N-oxide), and it causes the damage through atherosclerosis**, the process that causes a build-up of material in artery walls and eventually leads to blockages that cause heart attacks. For many years, this process was blamed on saturated fat; but perhaps it’s the red meat that does the harm.

The experiments showed that TMAO was present in the blood of meat eaters but not in that of vegans. Its level rose after a hearty meal of steak.

If their observations are repeated and prove to be correct, this could explain why some meats, for example chicken, are less hazardous than others. It could even lead eventually to recommendations to change our eating habits. Another possibility might be that a course of antibiotics could eliminate some of the gut bacteria responsible for production of TMAO, making eating red meat less hazardous for those who like it.

For now, it is too soon for this interesting research to form the basis of recommendations. More work involving greater numbers of people needs to be done. But it suggests a need for a search for other sources of carnitine in our diet, and it raises an interesting observation: perhaps, even in this era of antibiotics, bacteria may still be a cause of major human diseases.

 

*Link to the study abstract: http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3145.html

Link to a story in the New York Times: http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?pagewanted=all&_r=0

**More on atherosclerosis and heart disease: http://www.how-to-live-to-110.com/Chaps/A01_avoid_heart_disease.html

 

Prof Brian Kirby, Co-author of How to Live to 110: Your comprehensive guide to a healthy life www.how-to-live-to-110

 

Today, Sunday 7 April, is World Health Day, and this year’s theme – chosen by the World Health Organisation – is raised blood pressure. The WHO has issued a brief on this subject, which is readable and well worth a look*.

More than a billion people worldwide have raised blood pressure (or “hypertension”). Over the past 25 years, numbers have been steadily increasing all around the world in wealthy and developing countries alike.

In Britain up to one in five men have it – and most don’t know, as there are no symptoms until a complication arises, which is why it is often referred to as the “silent killer”. Many of the complications are serious, often causing long-term disability and, eventually, death. Arteries bear the brunt of raised blood pressure and, over time, the heart, brain, limbs and kidneys can become damaged, and this can lead to heart attacks, stroke and kidney failure, as well as other diseases.

While raised blood pressure runs in some families, no single gene for it has been discovered. Indeed, genetic make-up is unlikely to explain the extraordinary numbers of people with this condition or its increase in so many different countries.

Researchers have instead made a compelling case that these increases are related to the amount of salt we consume, a reduction in physical activity, the increased drinking of alcohol and the stress arising from industrialisation. In addition, smoking is known to make it worse. Arteries become stiffer with ageing – which contributes to raised blood pressure – and so countries with older populations and those where diabetes is becoming more prevalent are seeing an increasing problem. Within individual countries, communities with social deprivation face the greatest problem.

The World Health Organisation has calculated that raised blood pressure accounts for 20 per cent of health expenditure on diseases of the heart and blood vessels. It has a high impact on a country’s health system, and for individuals and their families the cost of being unable to work due to the aftermath of untreated high blood pressure can be devastating.

The WHO is planning recommendations for action by its member states. Any strategy needs to be affordable, sustainable and effective. In many countries, including our own, it will mean promoting life-style changes. The two measures that can make the greatest contribution are increasing physical activity levels and reducing salt consumption. The long-standing WHO recommendation on salt is that we should each consume less than 5 g per day. In many countries, salt intake is 9 to 12 g per day, and even in the UK most of us consume well above the target level.

Achieving the recommendation will require considerable cooperation from the manufactured food industry. Many companies are already working to reduce the salt content in their products, but this would be accelerated if we as consumers put pressure on them by cutting down or avoiding salt-rich foods. It’s worth, in particular, checking the salt in your bread, processed meat, snacks and condiments.

There’s more we can do as individuals. Physical activity helps reduce the risk of getting high blood pressure, as well as helping to control it if you already have the condition. If you haven’t had your blood pressure measured recently, it’s worth getting it checked by your GP, pharmacist or other health professional. This is simple, quick and painless. If it turns out you have raised blood pressure, catching it early means it can be controlled before it does your body any great harm. For a few people, it may even be a sign of a specific cause for their high blood pressure, such as kidney disease, that needs treating.

In the UK we have the means to do something both as individuals and as a country; let’s follow the WHO’s lead.

Happy World Health Day.

* A global brief on hypertension: silent killer, global public health crisis: http://www.who.int/campaigns/world-health-day/2013/en/index.html

 

Prof Brian Kirby, co-author of “How to Live to 110: your comprehensive guide to a healthy life” (which includes a chapter that explains high blood pressure and what you can do to avoid it or keep it under control).

www.how-to-live-to-110.com

 

Do you remember the days, back in the 20th century, when the advice was not to eat eggs because they were rich in cholesterol?

Back then, the relationship between cholesterol and heart disease was first emerging. The theory in those days was that the more cholesterol there was in your diet, the higher the cholesterol level would rise in your blood; and the higher that went, the more likely you were to have a heart attack.

This idea seems to have stuck. Even though our understanding of heart disease has moved on, you still sometimes see recommendations that suggest keeping the amount of cholesterol you consume to less than, say, 300 mg per day. (A large egg contains about 210 mg, a significant proportion of that target.)

These days, we know far more about how the body handles the cholesterol we eat, and fats in general. In particular, we know that the cholesterol we eat has only a small effect on the cholesterol level in the blood. High cholesterol levels are due to other causes.

Indeed, a recent study* has again confirmed that eating an egg a day does not lead to heart disease or stroke. This study analysed the results of 17 earlier studies on heart disease or stroke, which together involved more than 7 million people. The results showed that people who ate one egg a day were no more likely to die of heart disease or stroke than those who didn’t. (Those with an underlying disorder of fat metabolism are an exception, and it has been suggested that the result might not apply to people with diabetes.)

With Easter coming soon, and eggs in people’s minds, this is timely reassurance.  Eggs are a readily available, inexpensive, low-calorie food. They contain vitamins, minerals, proteins and unsaturated fats; and there is even some evidence that eating eggs increases levels of beneficial HDL-cholesterol in those on low carbohydrate diets.

We can all enjoy an egg for Easter.

 

*Link to the study: http://dx.doi.org/10.1136/bmj.e8539

 

© 2012 How to Live to 110 Suffusion theme by Sayontan Sinha