FOCUS ON HEALTHY EATING This piece looks at issues surrounding dietary related poor health, the science behind why some foods are good for you and others not and what the CIEH is doing to give environmental health practitioners (EHPs) the opportunity to play an active role in educating and promoting a healthier lifestyle. Following the successful launch of the CIEH ‘Eat Clever’ food and lifestyles toolkit (see below), a national healthy eating conference will be held later in the year. POOR DIET POOR HEALTH Health professionals and scientists have recognised for many years that poor diet is inextricably linked to poor health. Diet is a risk factor in incidence of cancer, coronary heart disease and diabetes. Recent studies suggest poor diet is related to 30 per cent of life- years lost in early death. Furthermore, the wealth of new research material highlights the fact that the lower the socioeconomic group, where people live in the UK and their ethnic background the more likely they are to develop a diet-related disease. A lack of access to healthy foods, made more difficult by poor transport and poor cooking/storage equipment in housing; inadequate shopping facilities and lack of money to buy expensive fruit and vegetables has become known as food poverty. Specific areas where food poverty exists have been termed as food deserts, but there has been much scientific debate about the true nature and extent of such deserts. In 1998 Lang and Caraher (Food Poverty and Shopping Deserts: What are the Implications for Health Promotion and Practice?) state: “It is recognised that the emergence of food deserts in areas of social and economic deprivation is a contributory factor to the widening gap in health inequalities”. A study carried out by Southampton University’s department of geography showed that diet in a deprived part of Leeds dramatically improved following the opening of a nearby superstore. For those unable to access and cook healthy foods the alternative diet, high in fat, salt and sugar has been dubbed the modern malnutrition and costs the NHS an estimated £2 billion each year in treating diet-related ill health. Furthermore, there is a general lack of cooking skills in the UK. A Mori poll for the National Food Alliance in 1993 found that more children could programme a video recorder than boil an egg or bake a potato. EFFECTS OF DIET ON HEALTH Statistics below taken from the National Heart Forum: Nutrition and Food Poverty – A Toolkit for Those in Developing or Implementing a Local Nutrition and Food Poverty Strategy. Reducing overall mortality • Among men who had had a heart attack, those who were advised to eat oily fish had a 29% reduction in two-year all-cause mortality compared with those who did not receive this advice. • Obese patients who lose just 10kg of weight have a 20%-25% decrease in overall mortality. Reducing sudden cardiac death • Among previously healthy people, eating 2 portions of fish a week reduces the risk of sudden cardiac death by up to 50% in men and 30% in women. • Linolenic acid (e.g. from soya and rapeseed oils) reduces fatal heart attacks in women by 45%, but does not reduce non-fatal heart attacks. Reducing the risk of coronary heart disease and stroke • Fruit and vegetables have a strong protective effect against stroke and a weaker protective effect against coronary heart disease. • Eating another portion of fruit or vegetables a day decreases the risk of coronary heart disease by 4% and stroke by 6%. • Among obese people, the cardiovascular benefits that can be achieved from 5%-10% weight loss are: – symptoms of angina reduced by 91% – 33% increase in exercise tolerance – a fall of 30%-50% in fasting plasma glucose – a fall of 10mmHg systolic and diastolic blood pressure – a fall of 15% in LDL cholesterol; a fall of 30% in triglycerides; an increase of 8% in HDL cholesterol. • Advice to reduce dietary sodium intake may enable people with well-treated hypertension to stop taking their medicines and remain normotensive. • Reducing dietary sodium intake further lowers both systolic and diastolic blood pressure in those already on the ‘DASH’ diet – a diet rich in fruit and vegetables, and with low-fat dairy products and a reduced overall fat intake. • Following a low-fat diet on average lowers blood cholesterol by 5.3% after six months. • Healthy diets can reduce the risk of a second heart attack. For example, the Lyon diet (low fat, olive oil, lots of fruit and vegetables and starchy foods) was associated with a reduction in the risk of deaths from heart attacks by 35% as well as deaths from all causes by 44%. • 0.8mg of folic acid a day leads to a 16% reduction in coronary heart disease, a 25% reduction in deep venous thrombosis, and a 24% reduction in stroke. • Increased wholegrain consumption is associated with a decrease in the risk of coronary heart disease of up to 25%. Reducing the risk of diabetes • In people with impaired glucose tolerance, dietary intervention led to a 31% reduction in the incidence of diabetes. Diet plus exercise led to a reduction of 42%. • In people with impaired glucose tolerance, lifestyle intervention to increase physical activity and reduce weight led to a reduction in diabetes of 58% and was significantly more effective than metformin (a drug used to treat people with diabetes). Reducing the risk of cancer • Childhood fruit consumption may have a long-term protective effect on cancer risk in adults. • Higher levels of energy intake in childhood increase the risk of mortality from non-smoking related cancer in adult life: an increased energy intake of 240Kcal per day is associated with a 20% increased risk of mortality. • Around 40% of endometrial cancer, 25% of kidney cancer and 10% of breast and colon cancers would be avoided by maintaining a healthy weight with a BMI of under 25. • In people aged under 75 years, changing to a diet that is high in fruit and vegetables is associated with a decreased risk of cancer at many sites, particularly colorectal, stomach and breast cancer, in the following 10 years. • Increased dietary fibre is associated with a decreased risk of colorectal and pancreatic cancer. • The risk of developing colorectal cancer among high consumers of red and processed meats – i.e. those eating an average of 140g cooked weight or more a day – may be almost double that of average consumers who eat 90g a day. (140g per day is equivalent to about 12-14 portions a week.) • High intakes of red or processed meat may also increase the risk of breast, lung, prostate and pancreatic cancer. To read the toolkit in full please visit: www.heartforum.org.uk/pdfs/Nut_TkitAll.pdf. EAT CLEVER: A CIEH TOOLKIT In an effort to address a lack of nutritional and cooking knowledge an ‘Eat Clever’ food and lifestyles toolkit has been launched by the CIEH in Wales. Accredited by the Open College Network (OCN), the toolkit consists of a five week course enabling participants to get a certificate in basic nutrition, food hygiene and cookery skills. Addressing a number of key poor health issues, the CIEH ‘Eat Clever’ toolkit is aimed at young mothers, elderly people or students whose actions can have a significant impact on their own health and of their families. Director of CIEH Wales, Julie Barratt, said: “While a lot of the focus has been on the school kitchen, if the message is not backed up by a healthy, balanced diet at home we will not win the battle against dietary-related health problems. “Parents provide two-thirds of a child’s dietary requirements. Good health and nutrition must begin in the home, with skills and knowledge handed down to children.” The ‘Eat Clever’ campaign aims to produce a series of small scale, local training projects, tackling common myths around healthy eating and giving young mothers the practical skills needed both when purchasing food and when preparing it in the home. The courses, accredited by the OCN, will enable successful participants to obtain a Basic Nutrition, Hygiene and Food Skills Certificate. On the final day of each course participants get the opportunity to put all they have learnt together by preparing a meal for themselves. Typically run for a morning a week over five weeks, the course provides participants with basic cookery skills; advice on the nutritional elements, such as: protein, fats, sugar and salt levels and carbohydrate and advice on food hygiene, focusing primarily on the fours Cs: cooking, cleaning, chilling and cross contamination. The initiative aims to address many of the misconceptions and negative beliefs about nutrition, not least that healthy food is expensive and time consuming to prepare. The project is based on the award winning Operation Christmas turkey initiative piloted by Anglesey Local Health Alliance aimed at groups of 6-8 mothers which culminated in a communally cooked Christmas meal. Julie Barratt added: “This is an excellent initiative. It can be used flexibly and targeted at those who are in For further information please contact Julie Barratt at: firstname.lastname@example.org. THE IMPORTANCE OF WATER Drinking water is currently low on the public health agenda and its importance is often overlooked when providing nutritional advice. But a growing number of informed people are convinced that encouraging a recommended daily intake can bring real health benefits. According to the Water for Health Alliance - a collaborative alliance aimed at moving the importance of water up the health agenda, of which the CIEH is a member - insufficient water intake can have serious effects on health. Speaking on behalf of the CIEH policy officer Ian Gray said: "Water is a fundamental nutrient. It is the prime nutrient and it's a very good substitute for fizzy, sugary drinks and diuretics such as tea or coffee." Several studies, Water for Health state, have reported a decreased risk of colon, breast and urinary tract cancer with increased water consumption. The reason given for this protective effect may be that poor hydration interferes with carcinogen removal. The alliance also state that as well as the many health benefits, water plays a vital role in regulating blood pressure as it enables the blood to get rid of excess salt. The kidneys play a key role in controlling blood pressure via their ability to regulate hormones, which influence the tension in blood vessels and in controlling the amount of salt and water in the body. If the kidneys cannot function properly, because of dehydration, this can lead to high blood pressure. Long term high blood pressure can lead to cardiovascular disease, including heart attacks and strokes. Whilst Water for Health recognise that further research is needed, a broad variety of studies suggest that insufficient water intake can have an effect on: blood pressure, cancer, concentration, diabetes, gallstones, heartburn, kidneys, mental performance, obesity, physical performance, respiratory disease as well as many others. For further information on the work of the Water for Health Alliance, or to read the research in full, please visit: http://www.water.org.uk/home/resources-and- links/water-for-health. CASE STUDIES USA – MyPyramid Plan The United States Department of Agriculture recently released the MyPyramid food guidance system. The system aims to provide options to help Americans make healthy food choices about the food they eat, whilst promoting an active lifestyle. Using the website, individuals can enter their age, gender and level of physical activity and the plan will give details of the types of food that should be eaten, and in what proportions, as well as providing nutritional information on the range of foods required. Based on the Dietary Guidelines for Americans 2005, the plan gives science- based advice on a diet that: • Emphasises fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; • Includes lean meats, poultry, fish, beans, eggs, and nuts; and • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. For more information on the MyPyramid plan please visit: www.mypyramid.gov. Megabite In October 2001 Housing Justice, a Christian homeless charity, established a food token scheme, providing the opportunity for members of the public to help the homeless without giving cash. The Megabite scheme was set up to help people who do not have access to a good diet by offering a way for members of the public to become involved without having to give cash handouts. Megabite co-ordinator Tara Guha said: “Most homeless people want to eat more healthily but lack the opportunity to do so.” Designed to prevent people feeling uncomfortable when donating money to people on the streets, the scheme allows members of the public to purchase food squares to give to the vulnerable, avoiding fears of cash being spent on addiction. The "meal square" vouchers are fraud-resistant, credit card-sized tokens worth £1, which people can buy from their local MegaBite project. The vouchers are then exchanged at agreed food outlets, and the outlets are reimbursed. Tokens can be exchanged for food at a variety of small cafes and some takeaways, where fresh fruit and vegetables are offered, rather than just burger bars. Four schemes are now being run in Exeter, Exmouth, Southampton and Cardiff. MegaBite was based on existing models of successful food token schemes, particularly that of Palace Gate Project in Exeter (now known as Exeter Community Initiatives). In 1997 the BBC programme Food and Drink ran a feature on Palace Gate's food token scheme, which led to a deluge of inquiries from people wanting to know more. Churches National Housing Coalition (CNHC) was brought on board, and commissioned research that indicated that a number of similar schemes were operating around the country, though not always so successfully. CNHC hosted the first ever national food token conference in 1998. The overwhelming desire of delegates present was for a co-ordinating body providing support and unifying operating procedures for food token schemes. This led to MegaBite being born. For further information on the scheme please visit: http://www.justhousing.org.uk/megabite/megabite.htm or contact Alison Gelder at: email@example.com. Nuneaton and Bedworth BC Food hygiene specialists at Nuneaton and Bedworth BC have launched a pioneering website offering information on food safety and healthy eating to coincide with National Food Safety Week, with the help of furry mascot Spud. More than 60 representatives of local food businesses attended the launch at Bedworth’s civic hall, including CIEH policy officer Jenny Morris, who gave a presentation on new EU food hygiene regulations, scores on doors and the Food Standards Agency’s Safer food, better business campaign. The attendees were given an introduction to the website, which was developed by the council’s environmental health services food safety team. The site is aimed at owners and staff in food businesses, schools, colleges and the public. As well as giving advice on food safety, it provides information on low fat foods and fruit and vegetables, and explains food labelling. It will also regularly feature free competitions. The site has more than 500 pages. In September, it will be expanded to include SpudZone, offering an interactive games area for children to increase their awareness of food hygiene. Spud has also been the star attraction at two local one-day exhibitions on barbecue safety. Geoffrey Ashford, cabinet member for environmental health services, told the launch that, according to Food Standards Agency statistics, more than 5 million people suffer from food poisoning every year. He said: ‘We are now in barbecue season so Food Safety Week is the perfect time for everyone to learn more about food safety. If anyone needs information or advice all they need to do is log on to the new website.’ The new initiative complements the council’s existing health and safety matters website, which won a Hela innovation award. This has taken half a million hits since its launch on September 2001. For details of the new website, see www.nbbcfood.info. DAILY GUIDELINES The Government, along with many health organisations have issued nutrient- based recommendations for dietary intake. The average man requires 2500 calories a day and the average woman 2000 calories, dependent upon the level of physical activity. Daily amounts are broken down as follows: Nutrient Men Women Fat 95g 70g Saturates 30g 20g Fibre 20g 16g Sugar 70g 50g Salt 6g 6g FIVE A DAY GUIDANCE Increasing consumption of fruit and vegetables can significantly reduce the risk of many life-threatening diseases, such as heart disease, stroke, and cancer by up to 20%. To eat at least five portions of a variety of fruit and vegetables each day is consistent with dietary recommendations from Government through the Department of Health 5 A Day programme and around the world, including the World Health Organisation (WHO). Examples of Fruit Portions Sizes Fruit Portion Equivalent to 80g Apple, dried rings 4 rings Apple, fresh 1 medium apple Apple, puree 2 heaped table spoons Apricot, canned 6 halves Apricot, dried 3 whole Apricot, fresh 3 apricots Apricot, ready to eat 3 whole Avocado Half an avocado Banana chips 1 handful Banana, fresh 1 medium banana Blackberries 1 handful (9-10 berries) Blackcurrants 4 heaped tablespoons Blueberries 2 handfuls (4 heaped tablespoons) Cherries, canned 11 cherries (3 heaped tablespoons) Cherries, dried 1 heaped tablespoon Cherries, fresh 14 cherries Clementines 2 clementines Currant, dried 1 heaped tablespoon Damsons 5-6 damsons Dates, fresh 3 dates Fig, dried 2 figs Fig, fresh 2 figs Fruit juice 1 x x150ml Fruit salad, canned 3 heaped tablespoons Fruit salad, fresh 3 heaped tablespoons Fruit smoothie 1 x 150ml Gooseberries 1 handful Grapefruit segments, canned 3 heaped spoonfuls Grapefruit, fresh Half a grapefruit Grapes 1 handful Kiwi fruit 2 kiwi fruit Kumquat 6-8 kumquats Lychee, canned 6 lychees Lychee, fresh 6 lychees Mandarin, canned 1 medium mandarin Mandarin, fresh 1 medium Mango 2 slices (2 inch slice) Melon 1 slice (2 inch slice) Mixed fruit, dried 1 heaped tablespoon Nectarine 1 nectarine Orange 1 orange Passion fruit 5-6 fruit Paw Paw (papaya) slice 1 slice Peach, canned 2 halves or 7 slices Peach, dried 2 halves Peach, fresh 1 medium peach Peach, ready to eat 2 halves Pear, canned 2 halves or 7 slices Pear, dried 2 halves Pear, fresh 1 medium pear Pear, ready to eat 2 halves Pineapple, canned 2 rings or 12 chunks Pineapple, crushed 3 tablespoons Pineapple, dried 1 heaped tablespoon Pineapple, fresh 1 large slice Plum 2 medium plums Prune, canned 6 prunes Prune, dried 3 prunes Prune, ready to eat 3 prunes Raisins 1 tablespoon Raspberries, canned 20 raspberries Raspberries, fresh 2 handfuls Rhubarb, canned chunks 5 chunks Rhubarb, cooked 2 heaped tablespoons Satsuma 2 small satsumas Sharon, fruit 1 sharon fruit Strawberry, canned 9 strawberries Strawberry, fresh 7 strawberries Sultanas 1 heaped tablespoon Tangerine 2 small tangerines Examples of Vegetable Portion Sizes Vegetable Portion equivalent to 80g Ackee, canned 3 heaped tablespoons Artichoke 2 globe hearts Asparagus, canned 7 spears Asparagus, fresh 5 spears Aubergine 1/3 aubergine Beans, black eye, cooked 3 heaped tablespoons Beans, broad, cooked 3 heaped tablespoons Beans, butter, cooked 3 heaped tablespoons Beans, cannelloni 3 heaped tablespoons Beans, French, cooked 4 heaped tablespoons Beans, kidney, cooked 3 heaped tablespoons Beans, runner, cooked 4 heaped tablespoons Beansprouts, fresh 2 handfuls Beetroot, bottled 3 baby whole or 7 slices Broccoli 2 spears Brussel sprout 8 sprouts Cabbage 1/6 small cabbage or 2 handfuls sliced Cabbage, shredded 3 heaped tablespoons Carrots, canned 3 heaped tablespoons Carrot, fresh, slices 3 heaped tablespoons Carrot, shredded 1/3 cereal bowl Cauliflower 8 florets Celery 3 sticks Chick peas 3 heaped tablespoons Chinese leaves 1/5 ‘head Chinese leaves Courgettes Half a courgette Cucumber 2 inch piece Curly Kale, cooked 4 heaped tablespoons Karela Half a karela Leeks 1 leek, white portion only Lentils 3 tablespoons Lettuce, mixed leaves 1 cereal bowl Mangetout 1 handful Mixed vegetables, frozen 3 tablespoons Mushrooms, button 14 buttons/3 handfuls/3-4 heaped tablespoons Mushrooms, dried 2 tablespoons or handful porcini Okra 16 medium Onion, dried 1 heaped tablespoon Onion, fresh 1 medium onion Parsnips 1 large Peas, canned 3 heaped tablespoons Peas, fresh 3 heaped table spoons Peas, frozen 3 heaped tablespoons Pepper, canned Half a pepper Pepper, fresh Half a pepper Pigeon peas, canned 3 heaped tablespoons Radish 10 radishes Spinach, cooked 2 heaped tablespoons Spinach, fresh 1 cereal bowl Spring greens, cooked 4 heaped tablespoons Spring onion 8 onions Sugarsnap peas 1 handful Swede, diced and cooked 3 tablespoons Sweetcorn, baby 6 baby corn Sweetcorn, canned 3 heaped tablespoons Sweetcorn, on the cob 1 cob Tomato puree 1 heaped tablespoon Tomato, canned plum 2 whole Tomato, fresh 1 medium or 7 cherry Tomato, sundried 4 pieces From the Department of Health (DoH) 5 A Day message. For further information please visit: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/FiveA Day/FiveADayGeneralInformation/fs/en. SEASONAL EATING By eating fruit and vegetables according to growing season consumers can reduce the cost of buying fresh produce. As well as being cheaper, fruit and vegetables purchased within the correct season will generally be fresher. Issues affecting environmental protection can also be addressed. Seasonally purchased goods produced within the UK avoid additional greenhouse gases associated with their transportation. Produce available can be seen from the table below: Month Produce January British root vegetables: Harvested in the month are cabbages, celeriac, leeks, mushrooms, parsnips, shallots and sprouts. Onions are available all year. Apples, beetroot, carrots, potatoes and pears kept in cold storage. February Root vegetables as above as well as early: carrots, chard, cauliflower, spinach and turnips. March New crops planted the previous year come to season including: broccoli, carrots, cauliflower, spring greens, parsley, radishes, rhubarb and leeks. Potatoes, carrots, apples and pears are available from cold store. April Mid April to mid June is when stored produce begins to end but is also too early for the new season’s goods. Lettuce and watercress starts to become available as well as continuing broccoli, spring greens, radishes and rhubarb. Potatoes and carrots still in cold store. May First new potatoes and asparagus. Potatoes and carrots still in store. June New potatoes, asparagus, broccoli, green beans, broad beans, carrots, cauliflower, Chinese leaves all come in as the month progresses. Lettuce continues. Soft fruits also come in, including: blackcurrants, cherries, gooseberries, strawberries, tomatoes and herbs. July Broad beans, French beans, broccoli, cabbage, cauliflower, carrots, courgette, cucumber, fennel, lettuce, new potatoes, tomatoes, watercress peaking. Also available are: blackcurrants, loganberries, redcurrants, strawberries and tayberries August Vegetables and soft fruits continue. Tree fruits come in at the end of the month. As well as aubergines, broccoli, chard, main crop carrots, gooseberries, herbs, leeks, lettuce, new potatoes, peas, peppers, sweetcorn. Onions are also harvested to be stored through winter and the first apples and plums are picked. September Summer vegetables joined by earliest winter crops. Continuation of fruits. This includes: Aubergines, beans, beetroot, broccoli, Brussels sprouts, cabbage, red cabbage, courgette, cucumber, kale, leeks, lettuce, marrows, onions, red onions, peppers, sweetcorn, spinach, Swedes, along with apples, blackberries, damsons, pears, plums and figs. Main crop potatoes also begin. October Main crops continue. This includes: Artichoke, broccoli, Brussels sprouts, beetroots, carrots, cauliflower, leeks, marrows, mushrooms, onions, sweetcorn, and watercress. Courgettes finish by end of the month as does lettuce. November Vegetable crops are disappearing as the frost arrives. Brussels sprouts, cabbage, cauliflower, carrots, leeks, parsnips, and potatoes continue along with pears and quinces. December Winter vegetables and stored produce. Useful links: Diet rich in Red Meat Is Linked with Bowel Cancer: www.timesonline.co.uk.