Nutrition science - an update and myth busting

1. Nutrition science - an update and myth busting British Nutrition Foundation 50th Anniversary Scottish Conference March 2017 Dr Stacey Lockyer RNutr (s.lockyer@nutrition.org.uk) Nutrition Scientist, British Nutrition Foundation, London, UK

2. BSc (hons) Biology with Psychology MSc Nutrition and Food Science Research assistant • PhD - Olive leaf polyphenols & cardiovascular risk Research Fellow – National Clinical Guidelines Centre, Royal College of Physicians

3. NutritionScientist, BNF • Journal - Nutrition Bulletin • Website - Information standard (NHS) • New content • Project work for member companies • Media duty • EU project – BACCHUS (www.bacchus-fp7.eu) • CVD Task Force • E-seminars • Conference presentations

4. Nutrition science update

5. SACN Carbohydrates and Health report (2015) New dietary recommendations: Fibre intake should increase to 30 g/day in adults (previous rec. 23/24 g) • For children, the recommended intakes are: • 15g/day (age 2-5); • 20g/day (age 5-11); • 25g/day (age 11- 16); • 30g/day (age 16-18). Free sugars intake should decrease to <5% energy from 2 years+ The consumption of sugars-sweetened drinks should be minimised

6. The UK’s healthy eating model ↑ 38% ↑ 40% • Updated March 2016 • More emphasis on plant-based diet • Sustainability messages

7. https://www.nutrition.org.uk/healthyliving/healthyeating/eatwellvideo.htmlhttps://www.nutrition.org.uk/healthyliving/healthyeating/eatwellvideo.html

8. Methodology behind the Eatwell Guide https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/575623/eatwell_guide_report.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/575624/eatwell_guide_annex_1.pdf • An External Reference Group was established to provide advice for methodologies for refreshing the Eatwell Plate. • Linear programming carried out to establish the segment sizes - diet with least amount of change from current UK diet. • Qualitative research was undertaken to establish the best way to communicate the updated messages to consumers (design, images, messaging). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/575625/eatwell_guide_annex_2.pdf

9. Impact of the Eatwell Guide • - Starchy carbohydrates+69% • - Fruit and vegetables +54% • - Foods high in fat and sugar −53% • Increased consumption of n-3 fatty • acids and most micronutrients apart • from zinc, calcium and riboflavin • - £5.99/adult/day vs. current diet: £6.02 http://bmjopen.bmj.com/content/bmjopen/6/12/e013182.full.pdf Research spotlight • Life expectancy would increase by 5.4 • months for men and 4.0 months for • women • 440,000 fewer new cases of diabetes in men and 340,000 fewer cases in women • Fewer new cases of CVD, colon cancer, stroke • Reducing the consumption of red and processed meat and increasing intake of fibre and fruit and vegetables has greatest impact on health gains http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0167859&type=printable https://www.nutrition.org.uk/nutritionscience/researchspotlight/research-spotlight-january-2017.html

10. Nutrition myths1. Carbohydrates are fattening

11. Carbohydrate confusion Sugars Complex carbohydrates Free sugars ‘Not free’ sugars Starch Fibre We should: -base meals on starchy carbohydrates -increase our fibre intake by choosing wholegrain/high fibre versions of starchy carbohydrates e.g. brown rice, wholewheat pasta, wholemeal bread, potatoes with skin, plus include other foods such as nuts, seeds and pulses in our diet -reduce our intake of free sugars

12. Perception of starchy carbohydrates • 2014 Food and You Survey – FSA • 475 interviews carried out in Scotland • Only 26% rated consuming starchy foods as being very important for a healthy lifestyle • 68% did not place starchy foods in correct section of the Eatwell Plate • Our survey revealed a negative view of starchy carbohydrates among UK practice nurses http://onlinelibrary.wiley.com/doi/10.1111/nbu.12212/epdf

13. Carbohydrates and body weight • SACN report: carbohydrates (wholegrain or higher fibre versions where possible) should form about 50% of daily energy intake • Carbohydrate ~4 kcal/gram (fibre ~2kcal/gram) vs. fat ~9 kcal/gram • Some evidence that fibre can  satiety • Hypothesis that diets high in total carbohydrate cause weight gain is not supported by RCTs

14. https://youtu.be/a8Iy6SYmQFI https://www.nutrition.org.uk/healthyliving/basics/fibre.html

15. Consumer page – healthy living

16. Nutrition science https://www.youtube.com/watch?v=5NHdcsuX6Dg http://onlinelibrary.wiley.com/doi/10.1111/nbu.12244/full

17. Health effects of resistant starch • Quoted by media outlets worldwide: • Time • Medicalresearch • Healthline • Nutraingredients ~3000 downloads in first month

18. Nutrition myths 2. Saturated fat is nothing to worry about any more

19. http://onlinelibrary.wiley.com/doi/10.1111/nbu.12219/full

20. Controversy over saturated fat Recent meta-analyses of cohort (observational) studies - no significant association between saturated fat intake and CVD in large populations. This has led to debate about the current recommendation to limit saturated fat intake. Issues and complexities: • Studies examined often compare diet at a distant time point with CVD events/deaths when diet will have changed over time. • Some older studies don’t represent current diets. • Individual fatty acids have different effects on the body. • We don’t eat individual fatty acids we eat foods. • Reducing saturated fat in the diet without due attention to what replaces it could have a negative impact on cardiovascular risk.

21. 2015 Cochrane review of all dietary studies that involved a reduction in saturated fats 15 randomised controlled trials (≥2 years duration) 59,000 subjects 17% reduction in cardiovascular events observed in studies where saturated fat was reduced 27% reduction in cardiovascular events observed in studies where saturated fat was replaced with polyunsaturated fats Fewer published studies looking at replacement with monounsaturated fat but more recent evidence suggest benefits Hooper et al. (2015) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011737/pdf National and international dietary guidance to reduce saturated fat in the diet and replace with small amounts of unsaturated fatty acids remains

22. UK saturated fat intake:National Diet and Nutrition Survey rolling programme years 5-6 Dietary recommendation: No more than 11% food energy https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf

23. Nutrition myths3. Coconut oil is good for you

25. McCance and Widdowson fatty acids supplement

26. >26,000 downloads since March 136 http://onlinelibrary.wiley.com/doi/10.1111/nbu.12188/epdf

27. Summary • Consistent evidence that coconut oil raises blood cholesterol • No evidence that coconut oil can promote weight loss • No evidence that coconut oil can alleviate symptoms of Alzheimer’s or improve immunity.

28. UK saturated fat guidelines Based on a 2,000 kcal diet (women) and 2,500 kcal diet (men): No more than 20 g saturated fat/day (women) No more than 30 g saturated fat/day (men) 2 tablespoons (~ 30 g) of coconut oil will exceed recommended daily maximum intake for women and approaches the maximum value for men

29. Nutrition myths 4. Artificial sweeteners promote weight gain

31. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002195http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002195 https://www.nutrition.org.uk/nutritioninthenews/headlines/diet-drinks-make-you-fat.html • Opinion piece, not a systematic review • Based on observational studies – cannot demonstrate cause and effect • RCTs - low calorie drinks calorie intakes and body weight vs. sugars-sweetened drinks • EatwellGuide says ‘Swap sugary soft drinks for diet, sugar-free or no added sugar varieties to reduce your sugar intake in a simple step’ • EFSA assess the safety of all additives including sweeteners • Overall, plain water is the best choice of drink but low calorie artificially sweetened drinks are a good option for those who like the taste of sugar sweetened drinks

32. Nutrition myths 5. We are consuming too much of everything

33. Energy balance Two thirds of adults (aged 16 and over) in Scotland are overweight or obese A third of children aged 12-15 in Scotland are overweight or obese Source: Scottish Health Survey 2015 http://www.gov.scot/Publications/2016/09/2764/downloads#res505810

34. Micronutrient status • Possible causes of micronutrient deficiencies in teenagers • Breakfast skipping/eating on the go • More control over food choice • Girls aged 11-18 years consume least milk - concerns over bodyweight/media influence? Miller, R., Spiro, A. and Stanner, S. (2016), Micronutrient status and intake in the UK – where might we be in 10 years' time?. Nutr Bull, 41: 14–41 http://onlinelibrary.wiley.com/doi/10.1111/nbu.12187/pdf

36. A healthy, balanced diet should align with the Eatwell Guide

37. Thank you! For further information go to: www.nutrition.org.uk