Health professionals and scientists have recognised for many years

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					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: j.barratt@cieh.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: a.gleder@housingjustice.org.uk.

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.

				
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Description: Health professionals and scientists have recognised for many years