Your Diet & Your Health | A Review of A Talk Given by Dr Aseem Malhotra

How dietary changes rapidly reduce cardiovascular risk but the bad behavior of Big Food is damaging your health”


This was the title of a talk  I attended on Thurs 1st May given by Dr Aseem Malhotra in association with The College of Medicine.

It will not surprise people who know me that this is a subject I’m interest in. Our wellbeing is intricately linked with how and what we eat.

I try very hard to avoid any of the usual soapboxing about obesity or diet or evangelical healthiness that is all too prevalent. I don’t think it helps anyone and the thing it often achieves is the polarity of both opinion and self-worth. Fundamentally, we know a healthy diet is necessary.

The aim here is to share what was presented on the evening. I’m quite sure there are aspects I’ve missed but the messages are there.


headlinesBackground of Dr Aseem:

  • Cardiologist
  • Science Director at Action on Sugar
  • Involvement in preventative health care through improved diet came by seeing at first hand the downstream physiological impact of Cardiovascular Disease (CVD) in patients. He was driven to improve upstream prevention to reduce cardiovascular disease

Key Points:

  • 60% of the UK population is obese
  • A third of children in the UK are obese
  • If we took no action at the current rate of rising obesity 90% of the population would beobese by 2050 with £6Bn per year spent on directly treating it
  • Obesity has overtaken all under-nutritional NCDs (non-communicable disease)
  • We live in an Obesogenic Environment with processed and sugar dense foods everywhere
  • The NHS system is a Toxic Hospital Food Environment which legitimises junk food by making it available on hospital trolleys and in entrance foyers
  • 50% of the 1.4m NHS employees are obese
  • An entrenched healthcare system & staff attitudes perpetuates a “revolving door of healthcare” within the NHS

1:500 Ratio

The Money Spent on Health Promotion -v- Food Marketing

For every £1 spent by the World Health Organisation on health promotion the Food Industry spends £500 on marketing/advertising.

exerciseExercise

  • Exercise alone is not the answer to better health
  • Exercise activity has increased yet obesity has also increased
  • It’s time to dis-associate exercise & diet in terms of health benefits
  • “You can’t out run a bad diet”

dietChanges in Diet

Even after decades of negative eating habits and the subsequent build-up of arterial plaque, improvements in CVD can be seen as follows:

  • Stop smoking – benefits seen within 6 months
  • Increasing fatty fish intake – will reduce CVD by 20% – benefits seen within 6 months – 1 year
  • Increasing Omega 3 & Vitamin E – will reduce CVD risk – benefits seen within 6-8 months
  • All dietary changes will see a benefits within 1-3 years
  • Salt reduction from 8.6g/day to 5.6g/day – would reduce CVD related deaths by 14,000 per year
  • Reducing intake of transfats – would reduce deaths by 4,000 per year

 

med-dietThe Mediterranean Diet

This has positive affects on CVD mortality with experiments resulting in a 30% decrease in mortality rates over 4.8 years.

The key elements are:

  • Extra Virgin Olive Oil (EVOO) – 4 tablespoons a day
  • 30+g nuts per day (15g walnuts/7.5g hazelnuts/7.5g almonds)
  • Extra portions of fruit per day
  • 10% increase in wholegrains
  • 2% reduction of salt

 

Diet Changing Strategies

strategyUpstream: Population-wide strategies through legislation

  • This comes down to government initiatives along the line of sugar tax or, as in the US NYC legislating to remove transfats from food
  • A cited use of sugar tax could be to supplement the purchase of fresh food
  • Some believe legislation is an infringement of personal choice, but those who argue for legislation cite that so is wearing seat belts or speed limit restrictions. These legislations are in place knowing the dangers they avert

Downstream: Targeted at individual awareness & responsibility

  • This has been the approach to date; nudging by government health departments as well as voluntary agreements with the food industry
  • In as much as many choices rest with the individual, issues arise about representation of dietary data, helpful labeling of processed & packages foods, etc.

 

action-on-sugar

Action on Sugar

World Health Organisation guidelines state that 10% of energy should come from intrinsic sugars.

WHO guidelines are:

  • 9 teaspoons of sugar/day for men
  • 6 teaspoons of sugar/day for women
  • 3 teaspoons of sugar/day for children

Examples of Sugar levels:

  • A single Mars bar has 9 teaspoons of sugar (3 times daily allowance for a child)
  • A daily can of Coke (150 cals) creates an eleven-fold increase in the development of diabetes; more than if you were to ingest 150 calories from intrinsic sugar within regular food
  • In the US, 50% of processed food contains hidden sugars

Added sugars promote Metabolic Syndrome leading to CVD and diabetes.

The prevalence of Metabolic Syndrome is significant:

  • 72m people are known to be clinically obese
  • 168m people have a normal range BMI*, of this 40% (67.2m) have Metabolic Syndrome

The key preventative target group is this 40% with normal range BMI.  Yet 67.2m people either have no idea of their condition or how they are contributing to it.

* Note: I’m referencing BMI as it was the measure in the talk. I don’t fully agree with BMI and  its definitions of normal or overweight as it does not take into consideration skeletal or muscular mass. But it is the standard marker and it will be used by your nurse, GP, hospital and insurance company. Get clever about it once you’re in the ballpark of your weight goal.

 

satietySatiety

Articificial Sweetners

  • Do not satiate you as easily as sugars
  • You eat more as a result

Juices/Smoothies

  • Shop-bought are laden with additional sugars
  • Home-made juices/smoothies also contain concentrated levels of sugar

Eating Fruit -v- Drinking Juices/Smoothies

  • Cited experiment where two people are given 6 oranges each
  • One juices the oranges. Drinks the juice and can continue to eat more
  • The other can eat no more than 4 oranges before becoming full

take-awayWhat I Took Away From The Evening

  • There is a burgeoning frustration among those who care about diet/nutrition that the healthcare system neither actively supports nor embodies a healthy approach to eating – several people cited stories of a junk food culture within the NHS and what this represents to those using it (ranging from overweight professionals to prominence of vending machines & fast food outlets on site)
  • There is no extensive nutritional training within Medical School
  • GPs have a mediocre level of nutritional knowledge – they might even be as susceptible to advertising & marketing as the rest of us
  • Lobbying and marketing appear to be the strongest contenders in the education of the populus – ‘he who shouts loudest’
  • Disputed facts continue to muddy the waters of what the man in the street should believe. Does this only fuel his complacency and promote a “fix me when I’m broken” culture?
  • Food labels need to be clearer. Many in the room believed that sugars are mis-represented on food labels with added sugars not being listed in addition to intrinsic sugars
  • This also led to the point that all calories are not equal so it’s important to break down your food types (eg. fat = 9 cals/gram, sugar 4 cals/gram)
  • Nutritionists mistrust The Healthy Eating Plate stating that it allows for cokes & juices which contribute to increased sugar intake
  • If your diet contains ready-made meals with a plastic wrapper for re-heating or microwaving, consider it salt & sugar heavy – Go Fresh!
  • Look at your supermarket. Note the levels of fresh produce they provide compared to processed foods. Be honest about what you’re purchasing and begin to eradicate processed foods
  • The speed of noticeable improvement in someone’s health and risk reduction of CVD with a few food changes is rapid, even following many years of a bad diet

I Think You’ve Heard A Lot of This Before

It’s clear that at this point the individual is the one who has to decide to make dietary changes. State level guidance comes too late and with little regard to walking the talk within its own system let alone outside.

At the risk of adding to the current over use of a catchphrase: When it comes to your diet, your supermarket shop and your daily choices: Be Mindful!

And before those I know pick me up on the smoothie references. I’ll continue with my veg/fruit smoothies but it won’t be by the gallon and they’re usually pretty chewy!

We don’t need to demonise food. We do need to understand food.


Quotes from the evening:

“Food choices are often automatic and made without full conscious awareness”

– Theresa Marteau, Behavioural & Health Research Unit

“You can’t out run a bad diet”

– Dr Aseem Malhotra