Red meat and cancer

You may have noticed that there’s been a fair bit in the news lately about how eating lots of red and processed meat causes cancer. This latest media frenzy was caused after the International Agency for Research on Cancer (IARC) released a report in October stating that processed meat is a ‘definite’ cause of cancer, and red meat a ‘probable’ cause.

What are red and processed meats?
Red meat refers to all mammalian muscle meat, including, beef, veal, pork, lamb, mutton, horse, and goat. Note that this list includes pork, and minced meat would also come under this classification.
Processed meats include any meat that has been salted, cured, smoked or other processes used to enhance flavour or preserve. For example; bacon, salami, sausages, ham and canned meats.

What did the IARC report investigate?
Actually, this report didn’t investigate anything new, it was an evaluation of existing evidence and research. They evaluated over 800 studies that involved the relationship between intake of red and processed meats and cancer. According to this evidence, they then worked on grouping foods into certain classifications.
(An important thing to note is that the categories in the infogram below represent how confident the IARC are that something causes cancer, not how much cancer it causes).

151026-IARC-Meat-rating-TWITTER

Basically, what this chart is telling us, is that the IARC found sufficient evidence to conclude that high intakes of processed meats definitely cause cancer. The evidence for red meats was not as strong or clear, so is classified as a ‘probable’ cause of cancer.
Most of the evidence was linked to bowel (colorectal) cancer, and stems from a meta-analysis of 10 studies published in 2011. A key finding from this paper was that processed meat was more strongly linked to bowel cancer than red meat. They concluded that:
Every 50g/day of processed meat increases the risk of colorectal cancer by 18%.
Every 100g/day of red meat increases the risk of colorectal cancer by 17%.

However, this doesn’t mean that eating red or processed meats increases your risk of bowel cancer by 17/18%, as this is a measure of relative risk. In other words, someone who eats 50g of processed meat every day has a 1.18 times increased risk of developing bowel cancer when compared to someone who doesn’t eat processed meat. To put this into perspective, compare it with smoking (the most important avoidable cause of cancer in the world). Men who smoke 15-24 cigarettes a day have a 26 times higher risk of developing lung cancer than non-smokers.

So should I still eat red meat?
Red meat is fine in moderation, and is a valuable source nutrients including protein, iron and zinc. But, what exactly is moderation? This is much harder to quantify.
In general, the Department of Health recommends that people who eat more than 90g (cooked weight) of red meat per day should cut down to 70g or less. Try to keep processed meats such as sausages and salami as ‘occasional’ foods rather than things you eat every day. You could also try having alternative sources of protein such as chicken, turkey, fish, lentils and pulses (kidney beans, chickpeas etc.)

In conclusion, having a diet that is high in red meat is not good for you, but the occasional bacon sandwich is still fine. And importantly, the risks are much lower than other things associated with cancer risk, such as smoking.

More info:
IARC Press release
IARC FAQs

Cancer Research, UK: Processed meat and cancer
NHS Choices: Red meat and bowel cancer
Cancer Research, UK: Smoking and lung cancer

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FAQs – session 1

I’m opening up my brain to you guys!
Do you have a burning question about food, diet or nutrition that you’ve always wanted to know the answer to?
No matter how random, get in touch via email, twitter or facebook and I’ll do my best to answer in my new series of FAQs.

Due to my hectic work schedule, I sometimes eat really late at night, is this bad?
Research shows that it’s not the time at which you eat the calories, but the total amount of calories consumed throughout the day that matters.

It’s not like by eating just before you go to bed you’ll immediately store those calories all as fat because…(prepare yourself! Shock…horror…!)…you still burn calories when you sleep! I know, it’s great! If you think about it, it makes total sense. You still need your heart, your lungs and even your brain to work when you’re sleeping, right? All of these processes require energy.

The one downside of eating just before going to bed might be that some people get an upset stomach from going into a horizontal position so soon after eating, but in terms of weight gain, the balance of what you eat through the day is much more important.

Are carbs fattening?
I have lost count of how many times I have been asked this question.

First of all, scientifically speaking, the term ‘carbs’ or ‘carbohydrates’ doesn’t just apply to starches, it applies to all ‘sugars’, so this includes the sugars found in dairy products, fruits, vegetables and chocolate. Fibre is also a type of carbohydrate. However, when people ask me this question, most of them are referring specifically to starchy carbs such as bread, pasta, potatoes and rice.

Starchy carbs are an important source of energy, vitamins, minerals and fibre – (fibre is important in disease prevention and some types have been shown to reduce cholesterol levels, see my post on fibre for more details).Per gram, ‘carbs’ contain the same number of calories as protein, so no, they on their own are not fattening. Carbs have got their bad reputation because people often eat much more than they need, and because we tend to add fats to them. A large number of processed products are also carbohydrate based, and these often have fats added to them to enhance their flavour. Rice, pasta, potatoes, bread or cereals in sensible portions are healthy foods to include in your diet (select brown/wholewheat options to up your fibre intake).

I’ve heard that I shouldn’t eat fruit after a meal, is this true?
The short answer here is…..NO!

People have asked me this stating that they have read that eating fruit straight after a meal interferes with the digestion of food eaten.  Well I’m not quite sure where this comes from, but the truth is fruit may actually HELP with the absorption of some nutrients after a meal. As mentioned in my vitamin C post, fruits containing vitamin C may help absorb iron from foods, especially non-meat sources. Rich in nutrients, fruit is a completely healthy thing to have as a dessert, it’s lower in calories than apple pie and custard, and if it helps curb your sweet tooth, it’s definitely a better option than a handful of biscuits!

Remember though that it’s everything in moderation, fruit (like any other food) contains calories and too much of a good thing can be not such a good thing! See my post on portion sizes for more info.

Do I need to go gluten free to lose weight?
No. Unfortunately, the media has a big impact on what diet is perceived as ‘healthy’. Gluten free does not automatically mean less calories, sometimes it can even mean more…as well as more added sugar…!

Some people have a true intolerance to gluten and have to cut it out from their diet. Given that gluten free produce is (generally) more expensive, harder to get hold of, there is less choice available, I tend to advise people not to go gluten free unless they need to. That said, of course, health is about the bigger picture, so yes, it is possible to lose weight and be healthier by going gluten free, but do you need to do it? Certainly not.

How many eggs should I have in a week?
People are often concerned about the egg and cholesterol debate. Eggs are a great source of nutrients, quick to cook and easy to make a meal from. Egg yolks do contain cholesterol, in fact 1 egg contains around 55% of your daily recommended amount. However, it is not as simple as eating more cholesterol = higher cholesterol levels*. It has been found that saturated fats (fats that are solid at room temperature, mostly from animal sources) have a bigger impact on your total cholesterol level than cholesterol contained in foods.

There is currently no recommendation in place regarding a maximum number of eggs per week, but bear in mind that we should try and eat a variety of foods – so don’t rely on eggs as your sole source of protein.

*For people with familial hypercholesterolemia (a hereditary condition causing high-cholesterol), there is a recommended limit on eggs and other foods that contain cholesterol. For more information, download this comprehensive leaflet from the British Heart Foundation.

Is planning the key to eating healthily?

how_to_magnetic_meal_planner

“Planning is the key to success”

People associate planning with success in many aspects of life, and it is often something that is also associated with food too.

There’s no doubt that planning can help make eating healthily easier when work gets busy or when you get tired, and I strongly believe that some degree of planning is necessary for a healthy lifestyle. However, the extent of planning needed can vary, and you need to find something that works for you. The idea would be that, to whatever extent you choose to plan, it eventually becomes normal and you’re able to incorporate it into your routine without even thinking of it as planning!

Planning is something I talk through with my patients, and below I’ve included some ideas I commonly suggest. These suggestions range from more drastic to small changes that could help make healthy eating easier for you. Try applying some of these to your life, depending on what you have time for.

  • Ensure your cupboards, fridge and freezer are stocked with basics to make a healthy meal. I suggest that people at least have the following, these are food items that have a relatively long shelf life and can be used to make a balanced meal:
    • Starchy carbohydrates: oats, pasta & rice
    • Proteins: eggs, beans, lentils, tinned tuna/salmon, maybe some yoghurt
    • Fruit & vegetables: tinned tomatoes, dried fruit, frozen vegetables of choice, onions, garlic, salad items
    • Spices & herbs
  • Make in bulk. Whenever you’re making a meal, make extra and freeze it.
  • Take the time at a weekend to design a menu plan for the week. You can choose whether to detail every meal, or just write down evening meals if you find this is when you struggle most.
  • Spend an afternoon at the weekend preparing all meals for the following week
  • If you prefer to buy fresh vegetables, but hate the time it takes to prepare them, try chopping in bulk and freezing. This will save you the prep time next time.
  • Have a ‘go-to’ list of meals that are quick to prepare and that can be made from ingredients you usually have in your cupboards. Examples might include:
    • Vegetable omelette with some rice
    • Tuna & sweetcorn pasta salad
    • Rice with kidney beans in tomato sauce

So is planning essential to have a healthy diet?
…I’m not saying that everyone should sit down on a Sunday, plan every meal for the following week and then spend hours preparing it all (although that may work for some)! However, having in enough ingredients to make a healthy meal is a big helping hand when it comes to living a healthy lifestyle, and even that requires a little planning!

Portion Distortion

Did you know….?

  • Dinner plate size has increased an average of 6.5cm over the last 50 years – that increases the area on your plate by up to 70%!
  • Choosing extra thickly sliced bread over medium increases the amount you eat of it by 60%
  • Fast-food chains used to serve just one size of fries, this is now the portion size provided with the kids meals

Given these facts, perhaps it’s not surprising at how quickly the obesity crisis has taken a global hold. It has become the norm to expect larger portions when eating out, and this (together with increased plate size) often leads to eating more at home.

This is portion distortion.
Your norm becomes bigger and bigger until the bigger is the new ‘normal’.

Obviously, everyone is different and will need different amount of foods depending on your weight, how active you are and your current situation.

However, there are some simple rules you can apply when cooking and when eating out that will help you get your portion sizes back in check – and there’s no need for weighing scales or any special equipment!

This reference guide groups food into different types to make it easy to see what a typical portion* should be.

Vegetables

Guiding-Hands-ArtWhen you’re looking at how much of what to put on your plate, the vegetable part of your meal should take up around 1/3 to 1/2 of your plate, and roughly fill your hands like the picture opposite.
Recommended portion size of vegetables is larger than other foods because they are low in calories and provide us with minerals, vitamins and fibre.

Guiding-Hands-Art

Fruits

A portion of fruit would be what you could fit in one hand, or roughly the size of your fist. The exception here is dried fruit, in this case you need to think of it in its hydrated form to get the right portion size. For example, 2-3 apricots would fill your hand, therefore 2-3 dried apricots are a portion.

Starchy Carbohydrates

Guiding-Hands-Art

Starchy carbs include foods like; pasta, rice, bread, potatoes, cereals and cereal products. You should look at having a source of starchy carbs with every meal. Good choices are oats, wholewheat pasta, brown rice and wholegrain bread as these are higher in fibre and release energy more slowly. Depending on how active you are, you could have between 1-2 portions (or 1-2 clenched fists) of starchy carbohydrates with every meal.

ProteinGuiding-Hands-Art

The amount of protein someone needs can vary depending on their weight and what their aims are, but for the general population a portion is around the size of your palm. This would be equal to a small chicken breast, two eggs or a few tablespoons of beans/lentils. Aim to have 2-3 palm-sized portions every day.

Fats & Oils

Guiding-Hands-Art

As it’s the most calorie dense nutrient, a portion of fat or oil is considerably smaller than the other foods. There are some fats that are beneficial for heart health, but when it comes to calories a fat is a fat! More info
When you’re cooking with oils, spreading butter or using oil as a dressing, try to stick to no more than a thumb-print (or teaspoon) size portion.

In addition to the above, you should also try to have 2-3 portions of dairy products per day. A portion is a matchbox size of cheese, a standard yoghurt pot (~125g) or a 200ml glass of milk.

 *Serving or portion?

A serving is a measured amount of food or drink, such as one slice of bread or 100mls of juice. A portion is the amount of food that you put on your plate to eat, you choose whether this is a big or a small portion. Take soft drinks for example, they will often quote a serving size on the label that is less than the amount within the bottle.

Fibre

Dietitians and other healthcare professionals can often be heard talking about how we should eat more fibre. You may understand that it is “good for you” to have fibre in your diet. But have you ever thought about why?

This post explains the different types of fibre, looks at some of its benefits and suggests how you can include more of it in your diet.

Types of fibre

Fibre-rich foodsAn easy way to remember foods that contain fibre is that they all come from plants. Meat, fish and dairy foods do not contain fibre.
Fibre can be split into two different types, soluble and insoluble. Both have different health benefits, so we should try to include both types in our diets.

  • Soluble fibre
    As the name suggests, soluble fibre dissolves in water. In the gut, this helps soften your stools. Consequently, if you suffer from constipation, gradually increasing your intake of soluble fibre can help make it easier to go. Soluble fibre can also help lower cholesterol levels.
    Foods such as oats, pulses, lentils, golden linseeds, potatoes and vegetables are all good sources of soluble fibre.
  • Insoluble fibre
    Insoluble fibre cannot be digested, instead it is used as a ‘food’ source for good bacteria we have in the gut, helping keep our gut healthy. Insoluble fibre also acts as a sponge, helping keep us fuller for longer and move food through our digestive system.
    Good sources of insoluble fibre include; bran, wholegrain and wholemeal foods, skins of fruits and vegetables and nuts and seeds.

To help differentiate between the two different types, think about making porridge (or oatmeal) on the stove, the oats ‘dissolve’ into the liquid. When cooking brown rice, the rice does not dissolve, but rather absorbs the water and goes soft. This is because the oats are high in soluble fibre, whilst brown rice is high in insoluble fibre.

Benefits

As fibre can help you feel full for longer, it can be a useful tool when trying to manage your weight. It can also help control your blood glucose and cholesterol levels. Having a diet high in fibre can also reduce your risk of cardiovascular disease, type 2 diabetes and bowel cancer.

How much?

According to EFSA (European Food Safety Authority) adults should be aiming for around 25g of fibre per day. Most people aren’t eating enough. On average, people manage to eat around 14g of fibre per day.

Increase your fibre intake

If you want to increase your intake of fibre, it is important that you do so gradually. Increasing your intake too rapidly can result in stomach cramps and leave you feeling bloated. You should also make sure you drink plenty of water, aim for 6-8 glasses per day.

You can increase the amount of fibre in your diet by ensuring your diet contains plenty of fruit and vegetables, opting for wholegrains (brown rice/bread/pasta over white), leaving the skin on potatoes and adding beans or lentils to your soups and salads. Ensuring a vegetarian meal once per week is a great way of upping your fibre intake #meatfreemonday!

What does 25g a day look like?

fibre in a dayIBS

People who have digestive problems or IBS (irritable bowel syndrome) may need to adjust the type and amount of fibre they have in their diets depending on their symptoms. This is something that needs to be assessed on an individual basis. You should see your doctor or dietitian for more advice regarding this.

More information

Fibre-rich foods
General information on fibre from patient.co.uk
NHS information on constipation
NHS information on diarrhoea
NHS information on IBS

Hydration, hydration, hydration!

As featured in my April newsletter (sign up here), this is a post all about the importance of keeping hydrated.

Sooo many clients I see tell me “oh, I know I need to drink more” or “I don’t drink enough”. Consequently, I often focus one of their goals around finding a way to get more water into their day.

Of course, drinking enough water is important all year round, but as the weather gets warmer, the amount of water your body loses increases, which means that more needs to be replaced.

waterWhy do we need water?

It is very easy to take the humble tap, hose or water cooler for granted. We typically use water for so much of our daily routine; watering the garden, washing clothes, showering, cooking and drinking. Water plays an important role in many aspects of life, and our body is no exception; we could not live without it.

Most of our body is made up of water; our cells, muscles and blood all contain it. Water plays a part in controlling our body temperature, metabolism, heart rate and blood pressure as well as removing waste products and ensuring the concentration of minerals in the blood stays balanced. When this balance is disrupted, processes in the body cannot function properly.

As well as the critical role water has in our general health, drinking plenty can also help with weight management. This is because occasionally our brain mistakes the signals of thirst for hunger. So next time you feel peckish, think about when you last had a glass of water before reaching for the nibbles!

What happens when we don’t drink enough?

If you lose more fluid that you drink, you will eventually become dehydrated. You lose fluid through breathing, sweating and urinating. However, the amount of fluid that you lose can vary a lot depending on how active you are, your environment and your current state of health.

Signs that you are not drinking enough may include: dark coloured urine, not needing to urinate as often as usual, dry mouth, thirst,  tiredness and lack of ability to concentrate.

How much to drink

This varies depending on how much water you are losing. The hotter it is and more active you are, the more you will need to  drink.

A loose guide is around 1.2-1.5 litres (or 6-8 glasses). However, the best way to tell if you are drinking enough is by the colour of your urine. It should be a light, straw colour.

NB: Try not to wait until you are thirsty to drink as by this point you are already dehydrated!

What to drink

Water is always best to rehydrate you. Milk, diluted squash, fruit juice and soft drinks also count, but watch out for the calories in juices and sugary sodas and the caffeine in teas and coffees (which can have a diuretic effect). Green or herbal teas are a good choice if you prefer something warm.

How to drink more

Sometimes, people are well aware that they should be drinking more, but it is a habit that is difficult to get in to. People find different ways that work for them but here are some suggestions:

  • Drink from a big bottle
    This is a handy way of measuring exactly how much water you are getting through on a daily basis. If you are sat at a desk and have the bottle handy, you are much more likely to take sips throughout the day. It is surprising how far away the water cooler is when you are in the middle of writing that report…!
  • Always carry water with you
    If you are often out and about it is very easy to go hours without drinking. So, it is always a good idea to take a bottle of water with you, especially when on holiday somewhere warm.
  • Have large glasses with meals
    If you really struggle to get into the habit of drinking water through the day, having a large glass of water with every meal is a good start.
  • Develop a schedule
    Start the day with a large glass of water, drink every time your kids do, set a reminder on your phone to leave your desk every hour for a drink…Find something to set a schedule to and stick to it. It will soon become a habit.
  • Mix it up!
    If you get bored with the taste of normal water, try adding a slice of lemon, lime or even mint leaves! Green teas taste great too!

Like my Facebook page for more handy hints and to keep up to date with my nutrition goings on! 

Allergies and Intolerances

allergy

I get so many questions regarding allergies and intolerances, so I decided it was time to write a post about it!

People are often not sure on how to go about getting a proper diagnosis, and there is a lot of self-diagnosing going on. As a dietitian, I recommend as varied a diet as possible, so will always recommend that people seek advice from a qualified professional who uses recognised diagnosis methods to avoid them cutting out foods unnecessarily.

Reactions to foods are common, but most are caused by an intolerance rather than an allergy. Let’s start at the beginning and understand the difference between an allergy and an intolerance.

The difference

A true allergy is defined as “a response of the body’s immune system to a normally harmless substance”. The key word here is IMMUNE system. When someone has a true allergic reaction, this triggers an immune response, or, in other words, the body releases histamine. The release of this histamine will in turn cause a series of reactions which present themselves as symptoms. The presence and nature of these symptoms plays a key part in determining the diagnosis.

An intolerance does not involve the immune system, and therefore does not trigger the release of histamine. An intolerance can be triggered by various things, such as missing crucial enzymes needed to digest foods (as in lactose intolerance), IBS (see my post on irritable bowel syndrome here) or increased sensitivity to naturally occurring substances or food additives.

Symptoms

People who have an intolerance can often consume a small amount of the food and not experience any symptoms, whereas those with allergies can have severe reactions even to small amounts. Allergic reactions can also get progressively worse the more times the person consumes that food.

Allergic reactions are caused by the release of histamine, and generally happen quite soon after the offending food has been consumed. Typical allergic symptoms include; a bumpy, red rash formed around or inside the mouth, tingling or itching around the mouth and throat or swelling of the lips, tongue or throat. In severe cases, people can go into anaphylaxis, which can be life threatening.

Symptoms associated with an intolerance are likely to be less serious than allergic symptoms, take longer to appear* and are often linked to digestive problems. However, this does not mean that they are unimportant. Intolerance symptoms can be debilitating and very uncomfortable for the individual. Typical symptoms include; bloating, abdominal pain and diarrhoea.

*To complicate things a little bit further, there are different types of allergies, IgE and IgG. IgE allergic reactions tend to cause immediate onset of symptoms. However, IgG symptoms can take much longer to develop, sometimes several days. People with allergies often experience a mixture of both types of symptoms. This is why it’s important to get the opinion of a qualified professional so that they can help you determine the nature of your allergy.

Diagnosis

If you think that you, or your child, may have a food allergy or intolerance, the first thing to do is to make an appointment with your GP. When you speak to your GP, they will ask you several questions to help determine the type of reaction you are having. Questions may include what type of symptoms, how long they took to appear, how long they lasted and also whether there is a family history of allergies. Sometimes it helps to begin keeping a food and symptom diary when you suspect an allergy to help you answer these questions!

If your doctor suspects an allergy, there are then a couple of options depending on the symptoms. The best, most accurate diagnosis is likely to come from a combination of your clinical history and the following tests:

Skin-prick test. This is where small amounts of the suspected allergens (foods likely to cause a reaction) are placed into the skin on the forearm. If the skin-prick becomes red, itchy or swollen, this indicates a positive reaction. This test is painless but should be carried out an an allergy centre or doctors clinic, due to it carrying a slight risk of anaphylaxis if your reaction is severe.

Blood test. This involves testing a sample of your blood for presence of certain anti-bodies.

Food elimination. As the name suggests, this is when you cut out the food that you suspect is causing the reaction from your diet. After a period of about 2-6 weeks, the food should then be reintroduced. If the symptoms disappear during the time when you’re not eating the food, and reappear on its reintroduction, then this can be used as a diagnosis. Before starting such a diet, you should seek advice from a dietitian to ensure that you are not losing out on nutrients by eliminating the offending food(s).

Non-evidence based testing. There are some shops that sell kits for allergy testing or outlets that offer testing hair/blood samples for presence of allergens. The principles on which these tests claim to be based are unproven, and research into their effectiveness has found them unreliable.

Unfortunately, tests used for diagnosing food intolerance (with the exception of lactose intolerance) are not always reliable. Some practitioners use IgG blood tests as a result for intolerances, however the evidence is patchy and most allergy specialists consider IgG results unhelpful in isolation.

It is also important to note that none of the allergy tests above are 100% conclusive all of the time. Usually, these tests are used in combination with your clinical history and symptom description. Your GP or doctor will probably have his suspicions upon talking to you, and then the tests will sometimes be used to confirm the diagnosis.

Again, because of the significance of clinical history in diagnosing allergies/intolerances, you can appreciate how important it is to involve a qualified professional.

More information

Allergy UK
NHS Choices
Patient.co.uk
MayoClinic