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Cut sugar intake by half, eat seven or nine portions of fruit and vegetables a day rather than five, avoid protein, shun low-fat foods – these are just some of the often conflicting dietary tips we have received this year as experts seek to reiterate that what we eat has a direct effect on our health.But with a growing list of things that we should supposedly avoid at mealtimes, it might be easier to ask: What SHOULD we be consuming?
For those looking to the Government for help, there is currently little resolution. A generation of Britons has grown up looking to the NHS eatwell plate – with its five segments representing different food groups – as a guide to what a healthy diet should look like.
What to eat in 2014: How the NHS eatwell plate should look taking into account the latest scientific findings on food and diets
But almost two decades after the plate was created, experts – including those like Dr Mike Rayner who first came up with the idea – say it is time to start again. The recommendations are based on outdated nutritional data, and worse, are encouraging poor habits, they say.
So with the help of leading dietary experts, we have now given the plate a complete overhaul, based on the latest scientific evidence. What is on it – and what is not – may surprise you.
The main problem with the current plate, created in 1995, is the inclusion of foods now known to be detrimental to health if consumed regularly.
Dr Rayner says: ‘On it is a can of cola, which might suggest we’re encouraging people to drink sugary soda, just like we’re encouraging them to eat fruit and vegetables which are also depicted.’
Katharine Jenner, a registered nutritionist and lecturer at Bart’s Health NHS Trust in London, agrees.
‘With all we know about the detrimental effects of added sugar in our diet, it is ludicrous that we should still be showing a custard tart on the plate as an essential part of our diet. If anything, foods like this should come with a big warning sign.
‘Likewise, when a growing body of evidence is linking salty and fatty processed foods with heart problems – the biggest causes of death in the UK – if the plate is to have any place in educating the nation, it should adopt bold, clear advice about what we should be eating only occasionally rather than suggest it is part of a healthy balanced diet.’
The original plate was based on evidence of how diet could reduce the risk from cardiovascular disease.
Scientists looked at what the average Briton was eating and then calculated how much this would need to change to lower the risk of stroke and heart attack – the nation’s biggest killer.
And there has been some success: according to the National Diet and Nutrition Survey, over the past 20 years our intake of saturated fat, added sugar and salt is down.
The survey, based on self-reporting, also shows the average adult now eats about four portions of fruit and veg a day too – up by about half a portion in a decade and just short of the five-a-day target set by the World Health Organisation (WHO) in 2003.
MAGIC OF SEVEN A DAY - HOW TO GET YOUR DAILY PORTIONS
This section of the plate is larger than before, reflecting evidence that the more fruit and veg you eat, the lower your risk of dying from heart disease. A large recent study of Britons showed that those who ate more than seven portions a day also had a 40 per cent reduced risk of premature death. This study is not unique.
‘The advice for five-a-day is from the World Health Organisation, but its original 2003 report actually says the intake should be 400g to 500g a day – in other words five to six-and-a-half portions a day,’ says Lucy Jones.
‘A recent review of evidence in Finland has led the authorities there to increase their recommendations from five portions a day to six, and many countries encourage even more than this.’
There has been confusion recently about whether increasing vegetable and fruit intake would push sugar consumption above what is recommended by the WHO.
Yet Jones explains: ‘Their guidance concerns only added sugars – the white stuff stirred into drinks or found in cakes and buns, and syrups, honey and the like. It most definitely was not suggesting there should be a limit to naturally occurring sugars consumed while eating, say, a portion of swede, which was bizarrely flagged up as a high-sugar food in newspaper reports.’
Experts believe evidence suggests that a seven-a-day diet boosts cardiovascular health benefits without pushing calorie intake too high. And it won’t stop there. You’ll gain another portion when you eat beans or lentils that are in the ‘meat and beans’ segment, often hitting eight a day.
It’s hard to say exactly what the ratio of fruit to veg should be as the studies haven’t found an answer. But our experts say the emphasis is on variety. ‘Eat as many colours as you can,’ says Jones. ‘Colours represent varying nutrients. And always include leafy greens. Tinned and frozen vegetables are included alongside fresh.’
Although there have been concerns about the high-sugar, low-fibre balance in fruit juice, Government health tsar Professor Susan Jebb said she does think orange juice can be one of our five-a-day – as long as people have no more than 150ml a day, or half a glass.
‘The advice for five-a-day is from the World Health Organisation, but its original 2003 report actually says the intake should be 400g to 500g a day – in other words five to six-and-a-half portions a day,’ says Lucy Jones.
‘A recent review of evidence in Finland has led the authorities there to increase their recommendations from five portions a day to six, and many countries encourage even more than this.’
There has been confusion recently about whether increasing vegetable and fruit intake would push sugar consumption above what is recommended by the WHO.
Yet Jones explains: ‘Their guidance concerns only added sugars – the white stuff stirred into drinks or found in cakes and buns, and syrups, honey and the like. It most definitely was not suggesting there should be a limit to naturally occurring sugars consumed while eating, say, a portion of swede, which was bizarrely flagged up as a high-sugar food in newspaper reports.’
Experts believe evidence suggests that a seven-a-day diet boosts cardiovascular health benefits without pushing calorie intake too high. And it won’t stop there. You’ll gain another portion when you eat beans or lentils that are in the ‘meat and beans’ segment, often hitting eight a day.
It’s hard to say exactly what the ratio of fruit to veg should be as the studies haven’t found an answer. But our experts say the emphasis is on variety. ‘Eat as many colours as you can,’ says Jones. ‘Colours represent varying nutrients. And always include leafy greens. Tinned and frozen vegetables are included alongside fresh.’
Although there have been concerns about the high-sugar, low-fibre balance in fruit juice, Government health tsar Professor Susan Jebb said she does think orange juice can be one of our five-a-day – as long as people have no more than 150ml a day, or half a glass.
BEEFING UP THE BODY - WITHOUT TOO MUCH MEAT
‘We’re eating about 50 per cent too much protein – 75g a day compared to the 50g recommendations, according to the National Diet and Nutrition Survey,’ says Jones.
‘People are eating too much meat.
‘Protein provides the nutrients that help the body to repair itself.
White meat, fish and eggs also provide many of the vitamins and minerals we need.
But eating too much animal protein is associated with a raised risk of heart disease and bowel cancer.
There are also associations with gout.’
On our new plate, this meat and beans segment is slightly smaller than before.
‘This is because, believe it or not, you’ll now be getting some extra protein from eating wholemeal carbohydrate and some from those extra two portions of fruit and veg,’ says Katharine Jenner.
Mike Rayner agrees that a change is needed in the type of protein we consume.
‘We’ve altered the imagery on this section to emphasise plant-based protein such as beans, tofu and nuts.
'Chicken, eggs, nuts and fish are still on the plate and can eaten daily, but be aware of portion sizes.’
Jenner adds: ‘This whole segment is only about ten per cent of your entire diet – a really small amount.
'A portion of meat should be no larger than the size of a pack of cards, yet a fish fillet or steak bought from the supermarket is usually around twice this size.
‘Note that red meat features very little because research has shown that eating even a small portion every day is associated with an increased risk of bowel cancer, probably due to the type of iron it contains.’
Oily fish provides the best source of omega-3 fatty acids for brain health and vitamin D.
However, processed meats such as sausages and bacon are shown on the ‘beware – occasional treat only’ list due to their high salt content, and links to bowel cancer and heart disease.
‘People are eating too much meat.
‘Protein provides the nutrients that help the body to repair itself.
White meat, fish and eggs also provide many of the vitamins and minerals we need.
But eating too much animal protein is associated with a raised risk of heart disease and bowel cancer.
There are also associations with gout.’
On our new plate, this meat and beans segment is slightly smaller than before.
‘This is because, believe it or not, you’ll now be getting some extra protein from eating wholemeal carbohydrate and some from those extra two portions of fruit and veg,’ says Katharine Jenner.
Mike Rayner agrees that a change is needed in the type of protein we consume.
‘We’ve altered the imagery on this section to emphasise plant-based protein such as beans, tofu and nuts.
'Chicken, eggs, nuts and fish are still on the plate and can eaten daily, but be aware of portion sizes.’
Jenner adds: ‘This whole segment is only about ten per cent of your entire diet – a really small amount.
'A portion of meat should be no larger than the size of a pack of cards, yet a fish fillet or steak bought from the supermarket is usually around twice this size.
‘Note that red meat features very little because research has shown that eating even a small portion every day is associated with an increased risk of bowel cancer, probably due to the type of iron it contains.’
Oily fish provides the best source of omega-3 fatty acids for brain health and vitamin D.
However, processed meats such as sausages and bacon are shown on the ‘beware – occasional treat only’ list due to their high salt content, and links to bowel cancer and heart disease.
FATS: THIS OIL'S SLICK
This is a new section to make it clear that some fats may be a better choice than others. Olive oil is frequently used in the
Mediterranean diet so it is thought that the monounsaturated fatty acids (MUFAs) it is rich in may be more closely linked to good heart health than saturated fats such as butter and lard.
Sunflower oil also contains MUFAs. Other vegetable oils contain polyunsaturated fatty acids or PUFA. Some studies show that swapping saturated fats such as butter and lard with these types of oil may benefit health, but more research is needed.
Jones explains: ‘Butter can still be eaten, as can vegetable oil spreads such as sunflower.
'But you should never choose it over olive oil, rapeseed oil or an olive spread if you are eating two tablespoons of vegetable oils a day, which is the amount found to be beneficial.
'Eating butter on top of that might mean your weight starts to increase.’
Mediterranean diet so it is thought that the monounsaturated fatty acids (MUFAs) it is rich in may be more closely linked to good heart health than saturated fats such as butter and lard.
Sunflower oil also contains MUFAs. Other vegetable oils contain polyunsaturated fatty acids or PUFA. Some studies show that swapping saturated fats such as butter and lard with these types of oil may benefit health, but more research is needed.
Jones explains: ‘Butter can still be eaten, as can vegetable oil spreads such as sunflower.
'But you should never choose it over olive oil, rapeseed oil or an olive spread if you are eating two tablespoons of vegetable oils a day, which is the amount found to be beneficial.
'Eating butter on top of that might mean your weight starts to increase.’
DAIRY: LAP UP MILK
All types of dairy are included to reflect the most recent knowledge about saturated fat intake. ‘Older research linked saturated fats to heart disease but this is now being questioned,’ explains Jones.
‘Many sources of saturated fat are also of little nutritional benefit, such as cakes and pastries, and eating too much of these foods is where the problem lies.
'Milk, on the other hand, is a good source of calcium, protein, vitamins and other minerals. Infants, younger children and the elderly can benefit from the calories provided by whole milk. But the difference between semi-skimmed and whole milk is about 100 calories a pint, so if you are overweight then you might want to choose a low-fat variety.’
Our plate suggests between 13 and 15 per cent of your diet should be low-fat milk and small portions of cheese. The plate highlights soya milk too, which contains plant protein without the fat content of milk. Again, avoid sweetened versions.
‘Many sources of saturated fat are also of little nutritional benefit, such as cakes and pastries, and eating too much of these foods is where the problem lies.
'Milk, on the other hand, is a good source of calcium, protein, vitamins and other minerals. Infants, younger children and the elderly can benefit from the calories provided by whole milk. But the difference between semi-skimmed and whole milk is about 100 calories a pint, so if you are overweight then you might want to choose a low-fat variety.’
Our plate suggests between 13 and 15 per cent of your diet should be low-fat milk and small portions of cheese. The plate highlights soya milk too, which contains plant protein without the fat content of milk. Again, avoid sweetened versions.
BREADS AND WHOLEGRAINS: FAST WAY TO BOOST YOUR FIBRE INTAKE
Bread is the way for starchy carbs
The main change is the quality of the starches eaten.
Figures show Britons are getting just under the recommended 50 per cent of their energy from carbohydrate. However, we are also consuming on average just 14g of fibre, 10g less than the current recommendation.
‘We’re not choosing the right carbohydrates,’ says Jenner. ‘More of our starchy foods need to have the word ‘‘whole’’ in them – wholegrain, wholemeal – because they contain this fibre.’
A diet high in fibre containing 90 grams of wholegrain (three servings) a day has been shown to reduce the risk of bowel cancer by 20 per cent, according to a study in the British Medical Journal.
As well as this, the hugely respected EPIC study into diet and cancer has followed more than 500,000 people and found that a diet high in fibre reduces the risk of bowel cancer. In the UK, 16,000 people a year die of bowel cancer.
Gone is a picture of cornflakes on the original plate, replaced by a box of porridge oats.
Food survey data shows the average adult eats two slices of white bread a day but only 18g of wholemeal bread, which means many people are not eating it every day.
The aim is to consume 24g of fibre a day (which contains 18g of non-starchy polysaccharides). Increasing fruit and vegetable intake to seven a day will boost fibre levels, as will eating more pulses. ‘A slice of wholemeal bread provides 2.7g of fibre [normal brown bread is a mixture of white and wholemeal and usually contains about 1.5g] while wholewheat pasta can provide up to 7g of fibre per portion, so they’re both good sources,’ Jones says.
‘We thought long and hard about this and believe white bread, rice or pasta should still be on the plate. They’re not the ideal choice in terms of fibre, but they offer small amounts of B vitamins and calcium, so can be a minimal part of a healthy diet. The chances are, if you’re eating lots of white bread, you probably aren’t eating much wholegrain, and this needs to change.’
Our experts were adamant that potatoes should stay because their skin contains fibre.
Jones adds: ‘Favour boiled or baked potato over mashed, which it is low in fibre. This means you feel less full and therefore eat bigger portions and consume more calories.’
And the amount of salt we each eat a day has dropped by a fifth, and was reported last week to be 8.1g on average. Yet this remains higher than the 6g (one teaspoon) target, despite the evidence that even this modest reduction has prevented thousands of heart attacks and strokes.
Sugar intake is also far too high. Although the public has managed to reduce the amount of table sugar we add to food and hot drinks, we’re now buying more sweet treats than ever before.
This problem caused the WHO to announce in March that our intake of this type of sugar needs to halve to protect heart and dental health.
Over this same period, large and impressive studies have begun to show a relationship between high fruit and veg intake and lower heart-attack risk, indicating that we may need to eat even more.
As with the old eatwell plate, our proposed new version does not dictate exact portion sizes because men, women and children need different amounts of calories.
What is important is the proportions, whatever our age or activity level.
Astonishingly, some public health officials have recently argued that telling people to increase their fruit-and-veg intake from five to seven a day will deter many from even trying.
But is this true? Does healthy-eating advice make people give up trying in despair? Dietician Lucy Jones is optimistic.
‘Dietary guidelines are not there to punish,’ she says. ‘Obviously, no one is perfect and everything can be eaten in moderation.
But we want to provide an honest, helpful blueprint to what should be eaten as an antidote to the endless edicts about food to avoid.
‘It’s also important that people realise many foods that are eaten regularly perhaps should not be. What you do with this advice is, of course, up to you.’
TREAT THESE TREATS WITH CAUTION
Our experts were adamant that portraying cola and cake alongside foods we need, such as fruit and veg, would simply confuse people and suggest they are part of an ideal diet. ‘We want to make what is implicit in the eatwell plate explicit,’ says Jones.
‘So we’ve added a new line that shows which foods should be occasional treats, perhaps eaten once a fortnight rather than every day.’
Biscuits that are high in sugar and fat, sausages that are high in salt and fat, and fizzy drinks that are just sugary are included in this line to make it clear these are not part of the plate.
‘Just two sausages can provide half of the UK’s recommended daily salt intake of 6g a day, and some manufacturers don’t seem to have done a huge amount to reduce this,’ says Jones.
‘WHO recommends we eat no more than five grams a day and this is something we want to take into account in this plate rather than the UK’s higher limit of 6g. The link between high salt intake and heart disease is strong.’
New official guidelines from WHO suggest we should get only ten per cent of our energy from added sugars – 200 calories for a woman and 250 for a man.
Data shows that many adults are aware of this and so have reduced the sugar that is obvious in their diet by cutting back on table sugar and sweet spreads to just 11g a day. Many are still eating too many sugary snacks, but it’s also the hidden sugars added by manufacturers to savoury dishes, sauces and low-fat snacks that are helping to push consumers through the limit.
The eatwell plate represents not a single meal or a day’s food but just the general diet. For all of these reasons the experts don’t think there is space to regularly consume biscuits, crisps, cakes, pastries and pasties, or drink cola, so these have been moved on to the occasional treat list.
This should help to reduce our saturated fat, salt and sugar intake. The fall in calories from this segment should allow for an increase in calories from the extra fruit and veg we consume.
Jenner concludes: ‘The current eatwell plate has cake on it, so people will look at all the other foods they need to eat and then the junk food pictures and think, “Have I had my daily cake?”
‘This is ridiculous. People will not stop eating cakes and biscuits, even if they aren’t on the plate, but having them there just seems to encourage it.’
‘So we’ve added a new line that shows which foods should be occasional treats, perhaps eaten once a fortnight rather than every day.’
Biscuits that are high in sugar and fat, sausages that are high in salt and fat, and fizzy drinks that are just sugary are included in this line to make it clear these are not part of the plate.
Not for everyday use: That we shouldn't eat sugary treats like soda, cookies and chocolate every day has been clear for years, however now salty processed meats have been added to this list
‘Just two sausages can provide half of the UK’s recommended daily salt intake of 6g a day, and some manufacturers don’t seem to have done a huge amount to reduce this,’ says Jones.
‘WHO recommends we eat no more than five grams a day and this is something we want to take into account in this plate rather than the UK’s higher limit of 6g. The link between high salt intake and heart disease is strong.’
New official guidelines from WHO suggest we should get only ten per cent of our energy from added sugars – 200 calories for a woman and 250 for a man.
Data shows that many adults are aware of this and so have reduced the sugar that is obvious in their diet by cutting back on table sugar and sweet spreads to just 11g a day. Many are still eating too many sugary snacks, but it’s also the hidden sugars added by manufacturers to savoury dishes, sauces and low-fat snacks that are helping to push consumers through the limit.
The eatwell plate represents not a single meal or a day’s food but just the general diet. For all of these reasons the experts don’t think there is space to regularly consume biscuits, crisps, cakes, pastries and pasties, or drink cola, so these have been moved on to the occasional treat list.
This should help to reduce our saturated fat, salt and sugar intake. The fall in calories from this segment should allow for an increase in calories from the extra fruit and veg we consume.
Jenner concludes: ‘The current eatwell plate has cake on it, so people will look at all the other foods they need to eat and then the junk food pictures and think, “Have I had my daily cake?”
‘This is ridiculous. People will not stop eating cakes and biscuits, even if they aren’t on the plate, but having them there just seems to encourage it.’
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