Towards a new paradigm for public health

Food-Vegetables-01In 1990, physician and health economist Christopher Murray at Harvard University and medical demographer Alan Lopez at the World Health Organisation embarked on the first ever attempt to measure the global burden of disease and developed the now-famous Disability Adjusted Life Year (DALY) metric that made it possible to combine estimates of mortality and morbidity burden around the world. DALY is the sum of years lived with disability [YLD] and years of life lost [YLL].

Since then, there have been estimates in 1999 to 2002 and 2004. But the latest iteration of the project, Global Burden of Disease 2010, has been on a different scale, involving nearly 500 researchers from more than 300 institutions in 50 countries. It is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors.

Twenty years ago, the project assessed the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions over one calendar year. Now, thanks to advances in technology, the availability of data, and the participation of experts around the world, as well as the leadership of a core group of researchers, the scope has increased to 291 diseases and injuries in 21 regions, for 20 age groups, and an estimation of trends from 1990 to 2010. Global Burden of Disease 2010 also includes an assessment of 67 risk factors.

The results, published yesterday in seven articles in The Lancet, are set to shake up health priorities across the world.

In summary, the analysis shows that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

There were 52.8 million deaths in 2010 compared with 46.5 million deaths in 1990. Of these, 12.9 million were from ischaemic heart disease and stroke, or one in four deaths worldwide, compared with one in five in 1990. Cancer claimed 8 million lives in 2010 compared with 5.8 million in 1990; trachea, bronchus and lung cancer accounted for 20% of these. Twice as many people died of diabetes in 2010 – 1.3. million – than in 1990, which is higher than deaths from tuberculosis or malaria (1.2 million each). Deaths from HIV/AIDS increased from 0.30 million in 1990 to 1.5 million in 2010, reaching a peak of 1.7 million in 2006. The fraction of global deaths due to injuries (5.1 million deaths) was marginally higher in 2010 (9.6%) compared with two decades earlier (8.8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1.3 million in 2010) and a rise in deaths from falls.

The contributions of risk factors to regional and global burden of diseases and injuries has shifted substantially between 1990 and 2010, from risk factors that mainly cause communicable diseases in children to risk factors that mainly cause non-communicable diseases in adults.

The proportion of overall disease burden attributable to childhood underweight – the leading risk factor worldwide in 1990 – had more than halved by 2010, making childhood underweight the eighth risk worldwide, behind six behavioural and physiological risks, and household air pollution from solid fuels. Other risks for child mortality, such as non-exclusive and discontinued breastfeeding, micronutrient deficiencies, and unimproved water and sanitation, have also fallen. However, child and maternal undernutrition risks collectively still account for almost 7% of disease burden in 2010, with unimproved water and sanitation accounting for almost 1%.

Of the non-communicable disease risks, high blood pressure, high body-mass index, high fasting plasma glucose, alcohol use, and dietary risks have increased in relative importance. This overall shift has arisen from a combination of the ageing population, substantial achievements in lowering mortality of children aged younger than 5 years, and changes in risk factor exposure.

These broad global patterns mask enormous regional variation in risks to health. In sub-Saharan Africa, risks such as childhood underweight, household air pollution from solid fuels, and suboptimal breastfeeding continue to cause a disproportionate amount of health burden, despite decreasing. The shift to risk factors for non-communicable disease was clear in east Asia, North Africa and Middle East, and Latin America.

For people aged 15 to 49 years, the leading risk factor worldwide was alcohol use, followed by tobacco smoking including second-hand smoke, high blood pressure, high body-mass index, diet low in fruits, drug use, and occupational risk factors for injuries. Risk factor rankings in this age group stayed broadly similar between 1990, and 2010, with the exception of iron deficiency, which dropped from the fourth leading risk factor in 1990, to ninth in 2010.

High blood pressure, tobacco smoking including second-hand smoke, alcohol use, and diet low in fruits were all in the top five risk factors for adults aged 50 to 69 years and adults older than 70 years, in both 1990, and 2010, accounting for a large proportion of disease burden in both age groups. Globally, high blood pressure accounted for more than 20% of all health loss in adults aged 70 years and older in 2010, and around 15% in those aged 50 to 69 years. Tobacco smoking including second-hand smoke accounted for more than 10% of global disease burden in each of these age groups in 2010.

Globally, the sum of years lived with disability and years of life lost (DALY), was influenced most by dietary risk factors and physical inactivity – together these were responsible for 10% of the global disease burden in 2010.

Of the individual dietary risk factors, the largest attributable burden in 2010 was associated with diets low in fruits (4.9 million deaths), followed by diets high in sodium (4.0 million deaths), low in nuts and seeds (2.5 million deaths), low in whole grains (1.7 million), low in vegetables (1.8 million deaths), and low in seafood omega-3 fatty acids (1.4 million deaths). Physical inactivity and low physical activity accounted for 3.2 million deaths.

This impressive analysis of global health issues by Christopher Murray and colleagues provides much reason for hope but also challenges the current medical paradigm and global healthcare system.

It shows clearly that the focus of global health authorities in recent decades on reducing infection and malnutrition has paid off – life expectancy has increased almost everywhere. This focus needs to continue to minimise incidence of diseases like tuberculosis, malaria and HIV/AIDs.

It also reveals, however, that the leading causes of death in the modern developed world are conditions which cannot be controlled by vaccinations, antibiotics, improved sanitation or insecticides. The data provide evidence that the risk factors for non-communicable diseases like heart disease, cancer and diabetes, are predominantly related to poor diet and lifestyle.

The large attributable burden for dietary risk factors such as diets low in fruits, vegetables, whole grains, nuts and seeds, and seafood omega-3 fatty acids might come as a surprise to some. The large burden is caused by both high exposure, e.g., low intake of fruits and vegetables in many regions – and large effect sizes.

Given the crucial role of dietary and lifestyle factors in determining long-term health, the answer to alleviating the suffering created by these chronic non-communicable diseases does not lie in the current medical model, with its preoccupation with drugs and surgery. Our doctors are trained to relieve symptoms not to address the underlying causes of chronic disease. Powerful commercial interests in the food, pharmaceutical and health sectors drown out the voices of those who can see that the solution is really very simple.

Widespread consumption of plant-based diets, rich in vegetables, fruit, whole grains, beans, nuts and seeds, together with not smoking and more physical activity, would transform people’s lives and radically reduce healthcare costs. It is not rocket science.

Dr Murray, I salute you and your colleagues for a first rate piece of work. May the truths you have exposed become part of mainstream understanding as quickly as possible and lead to a sea change in our approach to health and well-being.

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References

Murray et al (2012). Global Burden of Disease 2010. The Lancet, 13 December 2012.

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Nutrition – a game changer in global healthcare

Fierce political debate rages on both sides of the Atlantic about the rising cost of healthcare and what should be done about it.

Spending on health services in the UK has more than doubled in cash terms in the last decade, growing from £53 billion in 2000-01 to £120 billion in 2010-11; this is equivalent to an increase of around 80 per cent in real terms (1).  In England, 22 per cent of total public spending is devoted to healthcare.

In the USA, more than $2.5 trillion is spent annually on medical care.  But as recently as 1950, Americans spent only about $8.4 billion ($70 billion in today’s dollars).  After adjusting for inflation, Americans now spend as much on health care every ten days as they did in the entire year of 1950 (2).  In the USA, medical spending now represents nearly 20 per cent of gross domestic product (GDP).

The cost of health insurance continues to climb for US companies and workers, with annual family premiums growing at a pace triple that of 2010 and outpacing wage increases (3). The chairman and CEO of Starbucks, Howard Schultz, is quoted as saying that his company spends more money on insurance for its employees than it spends on coffee (4).

New legislation, large-scale reorganisation of health services, changes in insurance schemes and budget cuts are all among the radical measures being taken by governments to address this issue.

There is much less press coverage though about the real game changer with respect to reducing healthcare costs – improving nutrition and lifestyle.

Chronic or non-communicable diseases are the top cause of death worldwide, killing more than 36 million people in 2008.  Cardiovascular diseases were responsible for 48 per cent of these deaths, cancers 21 per cent, chronic respiratory diseases 12 per cent, and diabetes 3 per cent (5).

In most middle- and high-income countries non-communicable diseases were responsible for more deaths than all other causes of death combined, with almost all high-income countries reporting more than 70 per cent of total deaths due to non-communicable diseases (6).

In the UK and the USA, non-communicable diseases account for over 80 per cent of all deaths (5).

Common, preventable risk factors underlie most of these non-communicable diseases.  These risk factors are a leading cause of the death and disability burden in nearly all countries, regardless of economic development.

The leading risk factor globally for mortality is raised blood pressure (responsible for 13 per cent of deaths globally), followed by tobacco use (9 per cent), raised blood glucose (6 per cent), physical inactivity (6 per cent), and overweight and obesity (5 per cent) (7).

If we were to stop overeating, stop eating unhealthy foods, stop smoking and stop living sedentary lives, these risk factors would reduce, the prevalence of these diseases would reduce, healthcare costs would reduce and we would enjoy a greater quality of life.

Simple changes to diet and lifestyle really can make a dramatic difference to your health and well-being (8).

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Works Cited

1. National Audit Office. Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland. s.l. : National Audit Office, 2012.

2. Robbins, John and Robbins, Ocean. Beyond the Obamacare debate – why does healthcare cost so much? . s.l. : Fox News, 2012.

3. US Health Insurance Costs Rise. [Online] 27 September 2011. http://www.guardian.co.uk/world/2011/sep/27/us-health-insurance-costs-climb.

4. Businessweek. [Online] 21 November 2004. http://www.businessweek.com/stories/2004-11-21/online-extra-a-full-bodied-talk-with-mr-dot-starbucks.

5. World Health Organisation. Non-communicable diseases country profiles 2011.

6. —. Global status report on noncommunicable diseases 2010. . Geneva : s.n., 2011.

7. —. Global health risks: mortality and burden of disease attributable to selected major risks. . Geneva : s.n., 2009.

8. Willett, W.C. Eat, Drink and Be Healthy. New York : Free Press, 2001. ISBN 0 684 86337 5.

9. Parliamentary Office of Science and Technology. Health Behaviour. Postnote, May 2007, no. 283. 2007.

McDonald’s Map – fast food forward?

macdonalds_us_high_9_25This week photographer Stephen Von Worley set the blogosphere buzzing with his astonishing image of the distribution of the 13,000 McDonald’s fast food outlets across the United States.

Close to highways and population centres, there is apparently no escape from the Big Macs, fries, 710-calorie salads and super-sized vats of coke.

Is anywhere sacred, wondered Von Worley?

“For maximum McSparseness, we look westward, towards the deepest, darkest holes in our map: the barren deserts of central Nevada, the arid hills of southeastern Oregon, the rugged wilderness of Idaho’s Salmon River Mountains, and the conspicuous well of blackness on the high plains of northwestern South Dakota.  There, in a patch of rolling grassland, loosely hemmed in by Bismarck, Dickinson, Pierre, and the greater Rapid City-Spearfish-Sturgis metropolitan area, we find our answer.  Between the tiny Dakotan hamlets of Meadow and Glad Valley lies the McFarthest Spot: 107 miles distant from the nearest McDonald’s, as the crow flies, and 145 miles by car!”

Yesterday, Britain’s Telegraph Newspaper reported that America’s Fast Food Temple is celebrating its 30th anniversary in France by opening its 1,142nd Gallic outlet a few yards from the Louvre Museum.

“This is the last straw,” said one art historian working at the Louvre, who declined to be named. “This is the pinnacle of exhausting consumerism, deficient gastronomy and very unpleasant odours in the context of a museum.”

This echoes the sentiment of many in France who view “McDo” as the Trojan horse of globalisation and the scourge of local produce and long lunches.

Despite this, statistics suggest the battle of Le Big Macs has already been lost. France has become McDonald’s biggest market in the world outside of the US, according to the chain. While business in traditional brasseries and bistros is in freefall, the fast food group opened 30 new outlets last year in France and welcomed 450 million customers – up 11 per cent on the previous year.

British people will either be horrified or reassured to know that despite the comparatively tiny size of our islands, we still find room for an artery-busting 1,250 McDonald’s outlets.

Is it any wonder we have an obesity crisis?

 

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Do high fat diets make us stupid and lazy?

babyeatingburgerinwombRats fed a high-fat diet show a stark reduction in their physical endurance and a decline in their cognitive ability after just nine days, a study by Oxford University researchers has shown.

The research, funded by the British Heart Foundation and published in the FASEB Journal, may have implications not only for those eating lots of high-fat foods, but also athletes looking for the optimal diet for training and patients with metabolic disorders.

‘We found that rats, when switched to a high-fat diet from their standard low-fat feed, showed a surprisingly quick reduction in their physical performance,’ says Dr Andrew Murray, who led the work at Oxford University and has now moved to the University of Cambridge. ‘After just nine days, they were only able to run 50 per cent as far on a treadmill as those that remained on the low-fat feed.’

High-fat diets, such as those that are prevalent in Western countries, are known to be harmful in the long term and can lead to problems such as obesity, diabetes and heart failure. They are also known to be associated with a decline in cognitive ability over long time spans. But little attention has been paid to the effect of high-fat diets in the short term.

Physical endurance – how long we can keep exercising – depends on how much oxygen can be supplied to our muscles and how efficiently our muscles release energy by burning up the fuel we get from the food we eat. In particular, using fat as a fuel is less efficient than using glucose from carbohydrates, but the metabolic changes induced by different diets are complex and it has been controversial whether high-fat feeding for a short time would increase or decrease physical performance.

The Oxford team set out to investigate whether rats fed a high-fat diet for just a few days showed any change in their physical and cognitive abilities.

All 42 rats were initially fed a standard feed with a low fat content of 7.5 per cent. Their physical endurance was measured by how long they could run on a treadmill and their short-term or ‘working’ memory was measured in a maze task. Half of the rats were then switched to a high-fat diet where 55 per cent of the calories came from fat. After four days of getting used to the new diet, the endurance and cognitive performance of the rats on the low- and high-fat diets was compared for another five days.

‘With the standard feed, 7.5 per cent of the calories come from fat. That’s a pretty low-fat diet, much like humans eating nothing but muesli,’ says Dr Murray. ‘The high-fat diet, in which 55 per cent of the calories came from fat, sounds high but it’s actually not extraordinarily high by human standards. A junk food diet would come close to that.

‘Some high-fat, low-carb diets for weight loss can even have fat contents as high as 60 per cent. However, it’s not clear how many direct conclusions can be drawn from our work for these diets, as the high-fat diet we used was not particularly low in carbs,’ he adds.

On the fifth day of the high-fat diet (the first day back on the treadmill), the rats were already running 30 per cent less far than those remaining on the low-fat diet. By the ninth day, the last of the experiment, they were running 50 per cent less far.

The rats on the high-fat diet were also making mistakes sooner in the maze task, suggesting that their cognitive abilities were also being affected by their diet. The number of correct decisions before making a mistake dropped from over six to an average of 5 to 5.5.

The researchers also investigated what metabolic changes the high-fat diet was inducing in the rats. They found increased levels of a specific protein called the ‘uncoupling protein’ in the muscle and heart cells of rats on the high-fat diet. This protein ‘uncouples’ the process of burning food stuffs for energy in the cells, reducing the efficiency of the heart and muscles. This could at least partly explain the reduction in treadmill running seen in the rats.

The rats that were fed a high fat diet and had to run on the treadmill also had a significantly bigger heart after nine days, suggesting the heart had to increase in size to pump more blood around the body and get more oxygen to the muscles.

While this research has been done in rats, the Oxford team and Andrew Murray’s new group in Cambridge are now carrying out similar studies in humans, looking at the effect of a short term high-fat diet on exercise and cognitive ability.

The results will be important not only in informing athletes of the best diets to help their training routine, but also in developing ideal diets for patients with metabolic disorders such as diabetes, insulin resistance or obesity. People with such conditions can have high levels of fat in the blood and show poor exercise tolerance, some cognitive decline, and can even develop dementia over time.

‘These are startling results,’ says Professor Kieran Clarke, head of the research team at Oxford University. ‘It shows that high-fat feeding even over short periods of time can markedly affect gene expression, metabolism and physical performance. By optimising diets appropriately we should be able to increase athletes’ endurance and help patients with metabolic abnormalities improve their ability to exercise and do more.’

‘In little more than a week, a change in diet appears to have made the rats’ hearts much less efficient,’ says Professor Jeremy Pearson, Associate Medical Director of the British Heart Foundation, who funded the research. ‘We look forward to the results of the equivalent studies in human volunteers, which should tell us more about the short-term effects of high-fat foods on our hearts. We already know that to protect our heart health in the long-term, we should cut down on foods high in saturated fat.’

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Journal reference:

Murray et al. Deterioration of physical performance and cognitive function in rats with short-term high-fat feeding. The FASEB Journal, 2009; DOI: 10.1096/fj.09-139691

Processed People – a new documentary

processed_dvdTwo hundred million Americans are overweight and 100 million are obese.  In the UK, approximately 24 million people are overweight and 13.5 million are obese.  

Being severely obese is as hazardous to health as smoking.  In the US, obesity has now overtaken smoking as the no. 1 cause of premature death. 

More than 75 million Americans have high blood pressure and 24 million people are diabetic.  In the UK, 12 million people have high blood pressure and an estimated 3 million people are diabetic.  Heart disease remains the no. 1 cause of death for men and women, followed by stroke and obesity-related cancers. 

In the US, 60 percent of bankruptcies are caused by what has become known as “medical debt”. 

Fast food, fast medicine, fast news and fast lives have turned many of us into sick, uninformed, indebted, “processed” people. 

A new documentary called Processed People features interviews from nine health and environmental experts/advocates.  They discuss how and why we have got into this mess and what we can do to break the “processed people” cycle.

 Trailers for the film are available on YouTube.

If you would like to escape from the “processed people” cycle and live as nature intended, please come and learn how to cook with natural unprocessed foods at Cooking for Health classes, held throughout the year in Somerset, UK.

The need for healthier drinks

boy_drinking_by_jynmeyer_stock_xchng(1)This week, the British Soft Drinks Association published the 2009 UK Soft Drinks Report.  Despite the recession and the wet summer, total soft drink consumption held up, with a 1 per cent increase in market value, although volume declined by 1 per cent.  Bottled waters and smoothies were particularly hit by a decline in volume, whilst carbonated drinks, still and juice drinks increased in volume.  Consumers’ focus on health and wellbeing, and a desire for naturalness benefited the not from concentrate (NFC) fruit juice category with volumes up 10 million litres so that NFC juice now represents over 45% of the chilled juice segment. The overall retail value of fruit juice did, however, decline in 2008 (down 4% to £1900 million).  In total, £13 billion was spent on soft drinks in the UK, representing consumption of 13905 million litres.  This is an average of 4.4 litres per person per week, or the equivalent of 2 cans per person per day.

Consumption of soft drinks is continuing to rise.  Findings from the last UK National Diet and Nutrition Survey showed that consumption of soft drinks in adults in 2000/01 was equivalent to 4-5 cans per week, compared to less than 3 cans per week in 1986/87.  The majority of soft drinks consumed were carbonated.  Statistics from the British Soft Drinks Association show that 60 per cent of the carbonated drinks consumed are low-calorie and no added sugar types.  In 2000/01 young men and women (19-24 years) consumed over three times the quantity of soft drinks as did the oldest men and women (50-64 years).

Evidence from the British Soft Drinks Association suggests that children drink an average of 4.7 litres of soft drink per week, of which only 10% are fruit juice or water. 

According to the last National Diet and Nutrition Survey in the UK, soft drinks (mainly carbonated) were the single largest contributor to non-milk extrinsic sugars (NMES) intake in all age groups, providing a quarter to a third of intake on average.  

It is interesting to note that groups with the lowest mean intakes and biochemical status of almost all nutrients had the highest consumption of soft drinks. 

Although the British Soft Drinks Association denies a link between soft drink consumption and obesity, pointing instead to the value of soft drinks for encouraging adequate hydration, there can be little doubt that these rivers of sugar are doing little to enhance the health of the nation. 

Each 330 ml can of sugary drink or juice typically has 10 to 12 teaspoons of sugar, and 150 or more calories.  Is it pure coincidence that the rising thirst for sugar-water has paralleled the epidemic rise of obesity and type 2 diabetes? There is now strong evidence that sugary drinks have contributed substantially to the rapid growth of “diabesity”.  Women who have one or more servings of a sugary drink per day have nearly double the diabetes risk of women who rarely have sugary drinks. 

Latest research from the Harvard School of Public Health finds disturbing evidence of a link between sugary drink consumption and heart disease. The study, published in the April edition of the American Journal of Clinical Nutrition, followed the health of nearly 90,000 women over two decades. It found that women who drank more than 2 servings of sugary beverage each day had a nearly 40 percent higher risk of heart disease than women who rarely drank sugary beverages. 

Water, of course, is the best beverage option. It delivers everything the body needs – pure H2O – with zero calories. But for some tastes, ordinary water is just too dull and it is unrealistic to expect people to overcome their sugar-water addiction overnight.  Instead, it will require concerted effort at a range of levels to retrain our palates.  We need to educate individual consumers about the benefits of consuming less sugary drinks, provide healthier alternatives in schools and worksites, and encourage creativity and innovation among food scientists and marketers in the beverage industry to develop products that consider health and well-being whilst maintaining profitability. 

For further information about the effects of drinks on our health, please come to a Cooking for Health Course, led by Nutrition Consultant Jane Philpott, MA (Oxon), MSc, PhD.

Alzheimer’s Disease, metabolic disorders and the role of diet

Accumulating evidence for the role of metabolic disorders such as insulin resistance, diabetes, obesity and hypertension in increasing the risk of Alzheimer’s disease and vascular dementia, is reviewed in a new paper published this month in the Archives of Neurology.

alzheimersbrain

In the same journal, compelling evidence is presented that higher pre-diagnosis total cholesterol, low-density lipoprotein cholesterol, and diabetes are associated with faster cognitive decline in patients with incident Alzheimer’s disease.

A cohort of 156 patients with incident Alzheimer’s Disease (mean age 83 years) were followed for up to 10 years.  Changes in a composite score of cognitive ability were monitored from diagnosis onwards.

“These findings indicate that controlling vascular conditions may be one way to delay the course of Alzheimer’s, which would be a major development in the treatment of this devastating disease as currently there are few treatments available to slow its progression,”

said Yaakov Stern, Ph.D., a professor at the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain and director of the Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center at Columbia University Medical Center, and senior author of the paper.

“Preventing heart disease, stroke and diabetes – or making sure these conditions are well managed in patients diagnosed with them – can potentially slow the disease progression of Alzheimer’s,” said Dr. Stern.

Diets high in fruit, vegetables, fibre and unsaturated fats, and low in sugar, salt and saturated fat are known to reduce the risk of a range of chronic conditions, such as diabetes, heart disease and stroke.  This means eating more plant-based foods and less processed and animal-based foods.

wholegrainsandveg

Stabilising blood sugar is crucial.  This may be done by eating a diet with a low glycaemic load, that is, one that includes moderate quantities of complex carbohydrates which release glucose slowly into the bloodstream.  Whole grains, such as whole-wheat bread, brown rice, quinoa, millet and buckwheat are valuable for helping to ensure smooth regulation of blood sugar.  In contrast, highly refined carbohydrates, such as white bread, white rice, white pasta and table sugar, create a roller-coaster of blood sugar highs and lows, which if left unchecked, can ultimately give rise to insulin resistance and eventually to diabetes.  Potatoes release sugar into the bloodstream almost as fast as table sugar and thus should be eaten sparingly, unless you are lean and exercise regularly.  Consuming protein with carbohydrates at every meal has also been found to help regulation of blood sugar.

Increasing the quantity of vegetables and fruit in the diet is also vital.  Blood sugar levels are easier to maintain if vegetables are emphasized more than fruit, as some fruit contains a lot of sugar.  A minimum of 5 portions of fruit and vegetables per day is recommended.  For easy tips for increasing the amount of fruit and vegetables in your diet please click here.

Unsaturated fats found in plant oils, such as olive oil and the oils of nuts and seeds, and in oily fish, are beneficial for preventing heart disease and other vascular health conditions.  For practical suggestions for ways to incorporate more healthy unsaturated fats in your diet please click here.

For information and practical tuition in how to put all these recommendations together to create fabulous food that protects you from diabetes, heart disease and Alzheimer’s Disease, please come to a Cooking for Health course, run by nutrition expert, Dr Jane Philpott.