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Recent research suggests that we really are what we eat.

Many of us know that a healthy diet reduces our risk in later life of problems such as heart disease, stroke, diabetes and cancer. However, it seems that food also influences our mental health and behaviour, including mood, concentration, impulsivity and even how we react to stress. This is not really surprising when you consider that food supplies the energy for our brain to function, along with the raw materials needed to make the brain cells and the chemicals that allow communication between them. Amazingly the brain accounts for only 2 percent of body weight but it uses about 20 per cent of the calories we need each day. The main fuel used is carbohydrate which comes mainly from eating enough starchy foods in the diet.

Recent studies show that eating breakfast helps improve mood, concentration and our ability to deal with stress. A recent study on over 800 nurses carried out in Wales showed that those who ate breakfast (which for most was breakfast cereal) had lower stress levels, fewer problems thinking and concentrating and surprisingly fewer injuries and accidents at work⁽¹⁾. In contrast, snacking on crisps, chocolate and biscuits was associated with higher stress and more injuries outside of work. Further research is needed to find out why this might be but it illustrates the potential importance of diet on behaviour.

Some interesting research has also been done recently on young offenders. This has shown that they often choose poor diets low in fruit and vegetables and fish, both in prison and on the outside, despite the availability of healthy alternatives⁽²⁾. This in turn is believed to have an effect on behavior.

Two major scientific studies inside prisons have looked at the effect of supplementing prisoners' diets with key vitamins, minerals and essential omega 3 fatty acids (normally found in oily fish) to replace those which may be missing from a poor diet^(3-4). Prisoners taking the nutritional supplements showed large reductions in violent, aggressive and antisocial behaviour, compared with those taking placebo or dummy pills. The first study at Aylesbury Young Offenders' Institute involving 231 volunteers showed that inmates receiving supplements committed a third fewer offences. The positive effects of an enhanced diet on antisocial behaviour have also been recently reported in the USA and Netherlands.

This suggests the potential of improved diet, as a complement to other approaches, to influence both the environment within prison and possibly reduce re-offending rates. Further work on this area is being led by scientists at Oxford University involving 1000 inmates at three UK prisons (Hindley in Wigan, Lancaster Farms in Lancaster, and Polmont in Falkirk) to see if better nutrition can improve behaviour. The findings will be reported in 2012. Watch this space for more information.

The results could have wide implications for the way we think about how our diet affects mental health and behaviour and the way we feed young people in a range of settings other than prison.

For easy value-for-money recipes using these foods which supply these valuable nutrients please see FOOD INSIDE OUT, RECIPES section.

References:
1.Chaplin K , Smith AP (2011) Breakfast and snacks: associations with cognitive failures, minor injuries, accidents and stress.Nutrients. 3:515-28.
2. Eves A & Gesch CB (2003) Food provision and the nutritional implications of food choices made by young adult males in a young offender’s institution. Journal of Human Nutrition and Dietetics 16:167-179.
3. Gesch, C.B., Hammond, S.M., Hampson, S.E., Eves, A., Crowder, M.J. (2002) Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. British Journal of Psychiatry 181 22-8.
4. Zaalberg AP, et al (2010) Effects of nutritional supplements on aggression, rule breaking and psychopathology among young adult prisoners. Aggressive Behavior 36: 117-126.

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Eating a Mediterranean style diet helps you stay healthier - no matter where you live!

Mediterranean countries have long been popular with British holidaymakers. Each year around 13 million of us visit Spain and 12 million visit France. Others such as Italy, Portugal and Greece are always in the top ten summer holiday destinations.

Travel surveys suggest one of the main features we like about these countries (aside from the weather of course) is the traditional local food. When we conjure up memories of the typical Mediterranean dinner table many of us see colourful fruit and vegetables, olive oil, wholegrain cereals along with fish and small amounts of lean meat and low fat dairy foods - all washed down with a glass or two of red wine.

However for many people a return home signals the end to this way of eating. This is a shame because not only is this diet delicious, it’s also good for us.

This has received further confirmation in the last few months as several studies have hit the headlines reporting on diet and health links in thousands of people around Europe and confirming a range of benefits which can be derived from the Mediterranean style diet.

One such study led by the University of Athens, looked at the diets of 75,000 older adults living in nine European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, United Kingdom). The study showed that no matter which country was home, the closer you followed the Mediterranean style diet, the longer you lived. Those surveyed were each given a score from 0-9 based on how closely their diet matched the typical Mediterranean diet with the higher the score the closer the match. The researchers found that a high dietary score was linked to a lower overall death rate mainly from reductions in both cardiovascular disease and cancer. Many other intervention studies from countries as far apart as India and France have shown the diet offers a powerful protective effect against heart attacks. The evidence is now so strong that just last month the National Institute for Health and Clinical Excellence (NICE) recommended that people who have suffered a heart attack in the preceding 3 months should be specifically advised to eat a Mediterranean diet. The advice for this group included clear guidance to consume between two and four servings of oily fish per week (see Eating fish may cut risk of heart problems below). For those affected who cannot eat oily fish for whatever reason, fish oil capsules should be available on prescription from their GP.

Another recent study looking at adults living in Greece found that those who eat a traditional Mediterranean diet are 60 per cent less likely to be obese. Researchers reported that greater adherence to the Mediterranean diet was associated with a 51 per cent lower risk of being obese and a 59 per cent lower risk of having central obesity, where weight gain is most concentrated around the waist conferring greater health risks.

A rather more surprising study was also published this month in the journal Thorax. The results showed that, for several thousand adults living in the US, eating a Mediterranean style diet reduces the chances of them developing a severe lung condition, chronic obstructive pulmonary disease (COPD) by half. COPD includes both emphysema and chronic bronchitis and is the most common respiratory problem in industrialised countries. In the UK it is the 4^th commonest cause of death in middle-aged men (after heart disease, stroke and lung cancer) and a major cause of chronic sickness.

The research found that those who ate a predominantly Western diet rich in fatty and sugary processed foods were much more likely to develop COPD, whereas eating a diet rich in fruit and vegetables cut the risk significantly. This was true even when other factors such as smoking and age were controlled for and showed that the closer the diet adhered to a Mediterranean diet the lower the risk of developing COPD over a 12-year period.

Other recent studies have also shown the Mediterranean-style healthy diet is important in protecting against other respiratory diseases such as asthma for both adults and children. In one study researchers measured the diet, respiratory symptoms, and allergic reactions of 700 children aged 7-18 living in areas in the Greek islands. Parents completed questionnaires on their children's diet and symptoms. The diets were assessed for a set of 12 foods including fruits, vegetables, whole-grains, legumes, nuts and olive oil. 80% of children ate fresh fruit and over 60% ate fresh vegetables at least twice a day, a strong contrast with the UK where the average intake is only about 2 and a half portions of fruit and vegetables combined per day.

The effects of the Mediterranean diet seem to reach beyond the body and into the brain. Several recent studies suggest that a mediterranean-style healthy diet significantly reduces the risk of developing forms of dementia such as Alzheimer's disease. American researchers looked at the diet of over 2,000 adults during a four year period. The more closely people kept to a Mediterranean diet, the less likely they were to develop Alzheimer's, those with the highest match to the diet had a 40% lower risk than those with the lowest match.

So whatever your health concerns, if you want to follow a Mediterranean style diet without leaving your front door, try the following tips. You too can experience that "Mediterranean feeling" without increasing your carbon footprint.

• Choose spreading and cooking fats for daily use wisely. Where possible use vegetable oils, such as rapeseed or olive oil, and soft spreads made from them, but use them sparingly.
• Cut down on saturated fat from fatty meats and meat products such as such as sausages, pies and streaky bacon. Trim the fat from cuts of red meat and the skin from chicken and limit your intake of deep fried fast food. Go very easy on animal fats such as butter and cream.
• Feast on fish. Include fish dishes each week including at least one portion of white fish and one of oil rich fish a week such as salmon, trout, mackerel, herrings, sardines or pilchards. Fresh, smoked, frozen and canned varieties all count.
• Make it wholegrain. When choosing foods from the starchy food group, replace refined cereal foods with wholegrain varieties. Wheat, oats, barley, rye and rice can all be eaten in the wholegrain form. Aim to get at least half your starchy carbohydrates as wholegrains - around two to three servings a day.
• Fill up on fruit and vegetables. Aim to eat a minimum of five portions of a variety of different coloured fruits and vegetables each day. They contain a wide range of protective plant nutrients or phytochemicals. Fresh, frozen, canned all count in the diet. 100% juice or smoothies, dried fruit, beans and pulses count too but only as one portion a day, no matter how much you have.
• Go easy on alcohol. Moderate drinking (around one or two units per day) has been shown to have protective health effects in men and post-menopausal women. In particular, red wine contains beneficial substances that may protect the artery walls. Over this amount, the detrimental effects, for example increased blood pressure or liver cirrhosis, are greater than any positive effects of compounds in red wine.

References:
Chatzi L, Apostolaki G, Bibakis I, Skypala I, Bibaki-Liakou V, Tzanakis T, Kogevinas M, Cullinan P. Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete. Thorax Published Online : 5 April 2007. doi:10.1136/thx.2006.069419.
Panagiotakos, C. Chrysohoou, C. Pitsavos, C. Stefanadis ( 2006) Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study.  Nutrition 22 (5) 449-456 D.
Scarmeas, N., Stern, Y., Mayeux, R., Luchsinger, J. A. (2006). Mediterranean Diet, Alzheimer Disease, and Vascular Mediation. Archives of Neurology 63: 1709-1717.
Trichpoulou A, Orfanos P, Norat T et al ( 2005) Modified Mediterranean diet and survival : EPIC cohort study. British Medical Journal 330: 991.
Varraso R, Fung T T, Hu F B, Willett W, Camargo C A. Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men. Thorax Published Online : 15 May 2007. doi:10.1136/thx.2006.074534.

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Olives have been cultivated in the Mediterranean for over 4000 years but only recently have they begun to feature as a major player in the diet anywhere outside of Southern Europe. Amazingly in the UK sales of olive oil have risen by almost 40% over the past 5 years.

Olive oil is obtained by crushing fresh olives and over 80 varieties of olive are used in the process. The final product can classified in several ways. Extra virgin oil is the juice from the first mechanical or cold pressing of the olives. It is generally considered to be the most flavourful and best quality oil. Virgin is the next best quality. Neither extra virgin nor virgin olive oil contain any refined olive oil. Refined olive oil is sometimes called 100% pure but is a blend of virgin and refined oil, often lacking in flavour and colour.

Olive oil is believed to be a significant factor in the health properties of the so-called Mediterranean diet. This diet seems to protect against both heart disease and stroke, as well as certain forms of cancer and some inflammatory illnesses. However nutritionists are not sure quite how or why this is so.

The fat in olive oil is monounsaturated, a type of good fat. This helps keep blood cholesterol low unlike saturated animal fats which will increase it. However this doesn't fully explain the wide range of health benefits

Recently a team of Spanish researchers showed that these health benefits may be the result of a group of chemicals in olive oil called polyphenols. They have a range of powerful effects in the human body including anti inflammatory, antioxidant and anti clotting properties.

The researchers fed a test group of people olive oil high in phenols or the same oil with the phenols removed. They then looked at the elasticity of their artery linings. Usually a dose of fat would impair artery flexibility but the high phenol group did not show this. Instead the lining of their arteries remained elastic and healthy blood circulation was maintained. This was the first study to show a health benefit of polyphenols in humans which would be expected to lower heart disease and stroke

Polyphenols include oleuropectin, lignans and catechols which are also found in tea, dark chocolate, vegetables and some fruits such as pomegranates. They are particularly plentiful in extra virgin olive oil giving it a pungent flavour and colour. They are found at much lower levels in refined olive oils and seed oils such as rapeseed and sunflower where they are lost as part of the processing.

Extra virgin olive oil, like wine, varies hugely in price but there's no need to spend a fortune. I found several good imported brands and some supermarket own brand extra virgin oils for between £4 and £6 a litre compared to the more familiar, upmarket brands at £7 and £10 a litre.

Olive oil is still high in calories - one tablespoon has 120 calories, the same as a slice of bread and butter. Use it in moderation if you are watching your weight. Lite on the bottle refers usually to a refined oil where the phenols along with colour and flavour have been removed - not to a lower calorie product. The daily amount of olive oil used in the Mediterranean is around 20ml, or 2 tablespoonsfull, a day so try not to exceed that - you can buy a drizzler or spray can to help regulate use. Olive oil based spreads are a good alternative to butter and margarine.

Finally it's worth remembering that there are other aspects of the Mediterranean diet responsible for the multiple health benefits including regular intakes of oily fish, poultry, fruit and vegetables, low fat dairy products, wholegrains nuts and low intakes of full fat red meat and dairy produce.

References:
Ruano, J et al (2005) Phenolic content of virgin olive oil improves ischemic reactive hyperemia in hypercholesterolemic patients, Journal of the American College of Cardiology. 46(10):1864-8.

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What’s the story?

Recent market research has shown that sales of ordinary household salt dropped by 10% last year. Conversely sales of rock and sea salt are escalating as people seek out alternatives. But are they any better for you and why does it matter?

High blood pressure or hypertension is very common in the UK; 1 in 4 adults suffer from it. It usually occurs as we get older and the walls of our blood vessels lose some of their elasticity and become rigid. Several aspects of your diet can cause this to happen more quickly. Untreated hypertension increases the risk of heart attacks and stroke as well as kidney and eye damage. The good news is that changes to your diet, especially the amount of salt eaten, can be a very effective part of both treatment and prevention of high blood pressure.

Find out more at: http://www.salt.gov.uk/salt_and_your_health.shtml.

All forms of salt, including sea salt and rock salt are basically sodium chloride and it’s the sodium that is the problem in relation to blood pressure. Sea salt and rock salt contain a few more minerals than ordinary table salt but not enough to be of any real benefit. It’s good that the message is getting through to consumers that too much salt can raise blood pressure. However it’s a mistaken belief that switching to one will have a beneficial effect on your blood pressure.

We all eat on average 9.5 g salt per day that’s 1 and a half teaspoons. Recommendations for health suggest we keep below 6g per day (1 teaspoon). About a quarter of our daily salt comes from that at table and in cooking so cutting down on these can help. For help with this see: http://www.salt.gov.uk/cooking_without_salt.shtml.

The good news is that it only takes a few weeks to get used to eating less salt. That’s about the same length of time it takes to start seeing a benefit on your blood pressure. Some people like to use a salt substitute, made from potassium chloride, where a dish really needs it. However this doesn’t allow to get used to eating meals with a less salty taste

However, surprisingly, around three-quarters of the salt we eat is hidden in processed foods including sauces, ready meals and takeaways. Reducing your intake of these and choosing lower salt options is vital to reducing overall salt intake.

Check the label for lower salt varieties when you do need to use processed foods.

Salt is often listed as sodium on food labels.
Salt = sodium x 2.5.

1g salt = 0.4g ( 400mg) sodium

Use the following as a guide to what is a lot and what is a little salt (or sodium) per 100g food.

This is A LOT of salt
1.25g salt or more per 100g
0.5g sodium or more per 100g

This is A LITTLE salt
0.25g salt or less per 100g
0.1g sodium or less per 100g

If a food contains between 0.25g and 1.25g salt (or between 0.1g and 0.5g sodium) per 100g, this is a moderate amount.

Try to avoid eating lots of foods that are high in salt (1.25g salt or more per 100g). If you eat lots of these foods, it can be very easy to have more than 6g. This is why it's important to choose foods that are lower in salt, when you can.

For more information on understanding food labels see: http://www.salt.gov.uk/understanding_labels.shtml.

If you have high blood pressure the other dietary changes you might find helpful are:

• Keeping to a moderate intake of alcohol no more than 2-3 units per day for a man and 1-2 units for a woman (lower if advised by your doctor). A unit is half a pint of normal strength beer, a small (125ml) glass of wine or a pub measure of spirits (25ml).

• Losing weight - even as little as 5-10% of your starting weight – if you are overweight. This is especially true if the weight is carried centrally i.e. around your waist.

• Eating a low fat diet, rich in essential minerals and including:

• Fruit and vegetables- Aim to eat at least 5 portions per day. Fresh, frozen, dried and canned all count. If you are using canned vegetables look for lower salt varieties.

• Low fat options of dairy foods such as semi skimmed milk, low fat yoghurts and low fat cheese. Include 2-3 servings per day.

• Wholegrains including breakfast cereals, brown pasta and wholegrain bread . Aim for 2-3 servings per day

• Oily fish. Include at least 1-2 portions per week. Examples include salmon, pilchards, sardines, mackerel, herring and trout. Fresh, frozen or canned are all good but avoid fish canned in brine. (See previous article, below.)

Changing your diet along with keeping active will lead to a significant drop in your blood pressure levels, whether or not you are taking tablets. The effects can often be seen quite quickly- usually within weeks of starting. For some more useful tips see: http://www.eatwell.gov.uk/healthydiet/8tips/.

"Eating fish may cut risk of heart problems" (Reuters, August 2005).

What was the story?

A relatively low level of fish consumption may reduce the risk of having a heart attack and heart-related chest pain by over 30%, according to researchers in Greece. The researchers analysed fish consumption among 848 patients who had experienced either a heart attack or heart-related chest pain and 1078 similar subjects who had not. Further analysis showed that fish consumption was tied to an 11 % reduced risk of these symptoms among smokers and a 24% reduced risk among diabetics.  The results are published in the latest issue of International Journal of Cardiology."

What are the facts behind the headlines?

This isn’t completely new information as nutritionists have known for several years that eating oily fish is good for you. After all, the Inuit and Japanese people who eat a lot of fish rarely get heart attacks!

The omega 3 fats found in oily fish can help lower your blood pressure, reduce blood clotting and help your heart beat in a normal rhythm- all of which help reduce the risk of heart attacks especially in people at high risk.

Recent evidence also suggests oily fish have a role in preventing mental health problems such as depression, dementia including Alzheimer’s and even learning and behaviour in children. For more information see: Food and Behaviour Research.

A variety of tasty fish whether canned frozen fresh or smoked all count including:

• salmon
• trout
• herring
• mackerel
• sardines
• pilchards
• kippers

Fresh or frozen tuna also counts but canned tuna is not very rich in omega 3.

For clear-cut health benefits aim to eat oily fish at least once a week. A serving is about 100g or one small can. Oily fish can be used as filings for sandwiches or jacket potatoes, in stir-fries or with pasta and rice dishes. You could also try fish cakes or fish pie made with oily fish.

Some people are worried about possible environmental pollutants in oily fish but recent studies have shown that the health benefits outweigh the risks . However there are limits to the amount we should eat and some long lived fish such as shark, swordfish and marlin should also be avoided by certain groups in the population including girls and women who might have a baby one day. They also shouldn’t eat more than two portions of oily fish a week. In general, this advice also applies to women who are pregnant or breastfeeding.

Women who aren’t going to get pregnant in the future, boys and men there is no risk in eating up to 4 portions per week. For more information please see: Food Standards Agency - Your guide to oily fish.

Vegetarians can get omega 3 from "omega 3 enriched" eggs or spreads (check the label). Organic milk is also a reasonable source. Oils and seeds such as flaxseeds or linseeds, rapeseed and some nuts such as peanuts pecans, almonds and walnuts as well as green leafy vegetables also contain omega 3 although at much lower levels .

Omega 3 capsules (not the same as cod liver oil) are also available. Aim for around 0.5-1g omega 3 fat per day. Do stick to amount on label and choose especially formulated for children for this age group.