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

 

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 have long been health warnings over eating too much red meat. Initially the concern was over its fat content, and more recently there has been interest in whether the way red meat is broken down in the body might be behind an increase in the risk of heart disease and, to a lesser extent, stroke. Eating red meat has also been shown to have links with bowel cancer.

Now it may be the turn of type 2 diabetes, a rapidly increasing disease that not only brings its own problems but also contributes to the risk of heart disease.

Researchers* have used health data collected in nearly 150,000 American men and women who were followed up over more than 7 years. Among these, there were 7,450 new cases of type 2 diabetes.

In addition to the already known factors that might have explained these new cases, the researchers looked changes in the amount of red meat the participants ate. Those who increased their consumption by an average of half a serving of red meat a day for a four year period were more likely to get diabetes during the subsequent four years than those who didn’t. And those who cut their red meat consumption over the first four years were then less likely to go on to develop diabetes.

This wasn’t the whole story as there were changes in body weight – which is known to be a factor in diabetes – to take account of. But there was enough evidence to suggest red meat played a part in these people developing the condition.

However, a word of caution is needed. A study of this sort that looks retrospectively through data that wasn’t specifically collected for the purpose is not enough to establish cause and effect, or to say how such an effect arises.

For researchers, it raises interesting questions about red meat and how it might have led to this finding. For the rest of us, it is a useful reminder that we should be conscious of what we eat and of maintaining an appropriate body weight, and that those of us who consume a lot of red meat might consider the already current advice to replace some of it with fish, chicken, pulses or vegetables.

*Link to the study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1697785

 

 

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

 

Almost everyone likes sugar. Many people like it a lot – a fact that hasn’t escaped food manufacturers.

No longer is sugar simply something to be added at table or used in cakes, biscuits and jams. It has become ubiquitous: you now find it in all sorts of unexpected places – sauces and salad dressings, cured meats, breakfast cereals, curries and ready meals. And, of course, large quantities are added to many fizzy drinks.

There is currently a debate about how much sugar people consume in the industrialised nations. The sugar industry would like us to think it is modest; but – based on the amount of raw and refined sugar produced per year, supported by surveys of populations – it seems that over the past 45 years there has been at least a threefold increase in sugar consumption. In recent years, the increase has been even faster at about 4 to 5 percent per year.

Bangladesh appears to be the country with the lowest sugar consumption at 8 kg per person per year and Israel the highest with an astonishing 66 kg per person per year. Given that this is an average figure, some Israelis must be consuming considerably more – virtually the equivalent of their entire body weight in sugar!

With rising levels of obesity in industrialised and emerging nations alike, and an alarming increase in type 2 diabetes around the world, the question arises of whether these alarming health trends have anything to do with our bodies becoming swamped by sugar.

Recent studies have been examining this. In one*, data from 175 countries showed that levels of diabetes increased with increased availability of sugar, even after taking into account body weight and physical activity levels. The researchers therefore concluded that there was a probable relationship between diabetes levels and sugar consumption, but stressed that their methodology could not prove it. (Reaching secure conclusions about cause and effect requires vast long-term studies.)

In an unrelated study**, the American Heart Association has estimated that sugar-sweetened drinks are responsible worldwide for around 180,000 deaths per year: 133,000 from diabetes, 44,000 from heart disease and 6,000 from cancer. The researchers expressed concern; but again commentators have cautioned about drawing premature conclusions about cause and effect.

Evidence is certainly mounting that sugar consumption at today’s levels may be a major contributor to poor health. Indeed, some communities in the United States are already considering ways of reducing sales of sugary drinks through taxation or banning large portion sizes. Perhaps we should be doing the same on this side of the Atlantic.

Certainly, though, we could each do with a hard look at the stunning amount of sugar we may be consuming. Cutting down will do us no harm, and may prove to be great for our health.

 

*Link to the diabetes and sugar study: http://dx.doi.org/10.1371/journal.pone.0057873

**Multimedia resources, including taped interviews with an AHA expert offering perspective on the science, are available on the right column of this link http://newsroom.heart.org/news/180-000-deaths-worldwide-may-be-associated-with-sugary-soft-drinks?preview=b39f71c47418e98ba6ebd2660b859f96

 

 

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

 

 

“Non-communicable diseases” are those – such as heart disease, diabetes, cancer and lung disease – which arise from lifestyle and environmental factors rather than from germs and infections. Before the 20th Century, most deaths were due to infectious diseases. Now, nearly two-thirds of deaths worldwide are due to non-communicable diseases.

Tackling this presents an enormous challenge globally. A United Nations meeting in New York in 2011 identified the four major factors that we all need to address: poor diet, physical inactivity, tobacco use and alcohol intake.

But persuading adults to change their lifestyle is far from the whole picture. There is growing evidence that we also need to focus attention on children – and even on babies before they are born!

Some of these diseases have their roots in childhood. Coronary artery disease is one that has been extensively investigated. Many of the risk factors can be shown to have their onset in childhood, when dietary and other habits begin to form under the influence of family members and childhood friends. Parents need better information on the importance of encouraging physical activity and a good diet in their children.

A recent article in The Lancet* goes further and suggests that disease in later life can be affected by what happens to us before we are born. For example, if the mother is poorly nourished or has diabetes, this is associated with her unborn child being at greater risk of developing non-communicable diseases when it reaches adulthood.

There is also some evidence that if a pregnant mother or infant is exposed to certain pollutants in the atmosphere or in food, this too may have an impact on the child in the long term, potentially affecting its immune responses and its neurological and reproductive functions when adult. How this happens probably relates to changes in the way the baby’s DNA is processed during its development, when substantial changes can be passed from cell to cell as they divide and grow. These changes can last and have a knock-on effect in adult life.

These findings add to the urgent need for worldwide action to curb environmental pollution from harmful chemicals.

 

 

*Link to article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61609-2/fulltext?rss=yes

 

We can get the vitamins we need from a healthy diet containing fruit and vegetables, yet an industry has grown up based on the tempting idea that using supplements to boost our intake will make us even healthier. But will it?

In Britain we spend roughly £400 million pounds a year on supplements, most bought by the middle-aged and elderly. We don’t know how many people use them here but it’s likely to be much the same as in the United States, where one in three people regularly take a vitamin supplement.

But does taking supplements bring any benefits? Over the past few decades there has been a lot of research to find out, comparing the health of those taking supplements with those who didn’t. Unfortunately, many of these studies have not been able to provide a clear answer. They had too few participants or did not go on for long enough, or inconsistencies allowed conflicting interpretations.

There have been some large-scale studies, though. For example, the Cancer Prevention Study in the early 1980s recruited 1 million people and the Women’s Health Initiative another 160,000. Neither showed any substantial benefits from supplements in reducing cardiovascular disease such as heart attacks or stroke. Another study – the Nurses Health Study involving 89,000 nurses over 5 years – indicated that supplements gave some protection from colon cancer. But, worryingly, a study in Sweden of 35,000 women found a 19% increase in breast cancer.

When researchers examined 68 studies involving 230,000 subjects together in a meta-analysis, they found no overall benefit from taking supplements, even though some of the individual studies had suggested there might be.

These somewhat mixed findings have made coherent advice difficult. An absolutely rigorous study has been needed, with enough participants unfailingly taking either the supplement under investigation or an inactive placebo for enough years.

Such a study has now been carried out. The Physicians’ Health Study II involved 14,600 male physicians with a mean age of 64 years, 70 per cent of whom continued for more than 10 years in a randomised controlled double blind trial. Two papers have been published so far*. The first showed no reduction in heart attacks or stroke, the other a modest but statistically significant reduction in cancer (from 18 per thousand person-years down to 17). More papers are likely to follow, covering eye disease and cognitive decline.

So at last there is clear evidence from a rigorously controlled trial that taking vitamin supplements can result in a significant (but modest) reduction in cancer in men. There’s no reason to suppose the findings wouldn’t also apply to women. But there’s an equally clear indication of no benefit in heart disease or stroke. So what advice should be given?

Some people may feel that the modest reduction in cancer warrants the trouble and expense of taking a vitamin supplement. On the other hand, it might be better simply to eat the recommended levels of fruit and vegetables – as people have done for millennia.

 

*Links to the papers:

Gaziano JM et al. Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II randomized controlled trial. JAMA 2012 Oct 17; [e-pub ahead of print]. (http://dx.doi.org/10.1001/jama.2012.14641)

Sesso HD et al. Multivitamins in the prevention of cardiovascular disease in men: The Physicians’ Health Study II randomized controlled trial. JAMA 2012 Nov 7; 308:1751. (http://dx.doi.org/10.1001/jama.2012.14805)

 

Many years ago it was pointed out that we get more information about the clothes we wear than about the food we eat. At long last, this week sees the announcement of a major step forward in labelling our food.

Choosing what to eat – and what our food contains – has become increasingly important to consumers. There’s now wide awareness of the need for care in the amount of fats and oils, sugar, other calories and salt in our diet. Many people are keen to stay trim and to avoid the diseases associated with too much or the wrong things in our diet.

Much of the information consumers need is already available on packages – if you look carefully enough – but the busy shopper really needs a quick way to see exactly what they are buying. Food companies have increasingly been providing this, but with wide differences in how it’s done.

After years of debate and disagreement over the best methodology, there has finally been a major step forward by the food industry in accepting a common scheme. Anna Soubry, the Health Minister, has just announced a voluntary scheme which is due to be adopted by summer 2013*. In this scheme, food packaging will display a “traffic light” colour coding style that combines guideline daily amounts and the words “High”, “Medium” or “Low” for each of the major food components contained in the product.

Jane Landon, Deputy Chief Executive of the National Heart Forum, has described the announcement as “real progress towards a universal system of clear, consistent nutritional labelling to help UK consumers know what is in the food they are buying. She warned, though, that there are still potential problems in agreeing the detail of the proposed system. Critically, the criteria on which the colour coding is based must be scientifically robust and meaningful. “Any watering down of the ‘traffic light’ criteria developed by the Food Standards Agency would signal a lack of commitment by food companies.”

Some providers are concerned that the new labelling will reduce sales of some of their products. But good nutrition shouldn’t depend on consumers eliminating just specific products from their diet and that of their family. It is more about considering all the components together, and that needs easily accessed information.

Ultimately, better information can only be good for us all. It should also stimulate the food industry to look at how they can compete to produce the healthier foods many consumers will be seeking out.

Timely, responsible adoption of this measure by the food industry and its use by consumers will be a significant step in the right direction in helping people to eat a healthy diet and producers to provide it.

 

*Link to the Government announcement:

http://mediacentre.dh.gov.uk/2012/10/24/hybrid-system-for-food-labelling-given-green-light/

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