The Seven Golden Rules for a Healthy Life

If we follow these simple steps, can we really reduce our risk of heart disease?

Cardiovascular disease (CVD) still remains the biggest killer in the UK.  In 2010, around 180,000 people died from CVD and 80,000 of these deaths were from coronary heart disease (CHD).  Although over the past decade, there has been a decline in death rates from heart disease in England, there still remains regional and socioeconomic differences in both incidence and case fatality, along with behaviour inequalities.

In 2010, the American Heart Association (AHA) proposed seven factors to help people understand the most effective ways of avoiding CVD and lowering the risk of developing cancer. 

The findings came from a long term study carried out by researchers from Northwestern University (Chicago), the University of Minnesota, and a number of other US research institutions; their findings were published in the peer-reviewed journal Circulation.  The cohort study followed 13,253 white and African American participants for between 17 and 19 years, to establish if maintaining ideal levels of the seven health factors could reduce heart disease and lower the risk of cancer. 

The Seven Simple Steps

• 1      Not smoking (never smoking or quitting more than 12 months ago
• 2      Maintaining a healthy body weight (that is a healthy Body Max Index (BMI)
• 3      Eating Healthily (diets rich in nutrition, fruits and vegetables)
• 4      Physical Activity (at least 75 minutes per week of vigorous physical activity, or 150 minutes per week of moderate or moderate plus vigorous activity
• 5      Having low cholesterol levels
• 6      Healthy blood sugar rates
• 7      Healthy blood pressure

The Findings

From the study, researchers found that the health benefits were higher among people who met the ideal levels for each of the seven factors.  For example, people who achieved ideal levels for six of more factors had a 51% reduced cancer risk and those who met the ideal levels of four factors had a 33% reduced rate of developing cancer.

While the findings have been welcomed, it is worth noting that smoking appeared responsible for the majority of the associations seen between the seven factors and cancer risk. This once again exemplifies how smoking has a direct correlation with your heart, blood pressure, circulation and individual risk of lung cancer.

What more can be done?

As highlighted above, CVD and CHD continues to be a major health concern in the UK, with health issues being more prevalent among low income earners. Those from lower socioeconomic groups are more likely to have poorer diets, lead sedentary lifestyles, suffer from mental health issues and partake in health risk behaviour, including smoking and alcohol abuse. These factors have a major impact on heart disease.

Type 2 diabetes and obesity are also some of the main contributors leading to CVD.  In England alone, a quarter of adults are obese and the prevalence of diabetes in the UK is around 5% for women and 6% for men.  The financial cost to society can also be detrimental.  The statistics reveal that in 2009, CVD cost the UK economy £19 billion – putting further strain on the health care system.

Although the AHA’s seven steps to improving health helps people to understand where to make the changes in their life (healthy eating, exercising), the problem is how to make these changes?  For most people, breaking old habits and changing behaviour can seem like an impossible task, and for some, change is not always welcomed. How do we engage with people and offer advice on sensitive issues that could potentially save their lives?

The RSPH, having recognised the fundamental importance of behaviour change to improve health, has developed a qualification in Understanding Behaviour Change, Level 2 Award, to provide an understanding of communication styles and practical skills to help individuals implement lifestyle changes. The one day programme will also aim to give learners knowledge and confidence to offer brief advice and engage in brief interventions.  Sometimes, having the right conversation with someone can have far reaching positive affects.   For further information on the qualification please click here or contact Gina Mohajer.

For further information on heart disease visit the British Heart Foundation here

Can mobile apps help people lose 

weight...and keep it off?

Many of us may be well accustomed to using health and fitness mobile apps that have the sole purpose of counting calories and measuring activity levels, to help us lose weight. With the majority of people now using Androids and iPhones, downloading apps to our mobile phones is easy and hugely popular. As a result, tracking what we consume on a daily basis has never been so simple. 

However, how effective are these calorie counting apps? Can technology really aid us in reaching our ideal weight, or is it just a fad, a fashion accessory that will be forgotten with the next diet fix?  Furthermore, as with all successful weight loss, does it come down to our own behaviour and self motivation to bring about healthy changes to our life?

A recent study from the Northwestern University Feinberg School of Medicine, identified as the first of its kind, sought to examine the relationship between technology and the impact it had on weight. The study will be published in the Archives of Internal Medicine. 

The Study and Findings

The Northwestern technology research incorporated behaviour change techniques, including self monitoring, goal setting, feedback and social support.

The research examined a cohort of sixty nine overweight and obese men who were an average age of fifty eight. All participants were offered health education classes on nutrition, exercise and behaviour change; every two weeks during the first six months and once monthly for the remainder of the year. 

Each participant received personalised weekly calorie and activity goals to help them lose weight and all participants were encouraged to attend nutrition and health classes. The participants were divided into two groups. One half recorded their activity and diet on paper, whilst the other half used the Northwestern technology mobile device, to transmit their data to a behaviour coach, who monitored and provided feedback twice a month. 

From the evidence, it was found that those who used the mobile device and attended eighty percent of the nutrition classes lost fifteen pounds and maintained this for one year. The weight loss for those who used the mobile app but who did not attend any classes lost almost nine pounds. The group who attended classes but did not use the mobile app, did not loose any weight. 

The lead investigator of the study and Professor at the University, Bonnie Spring, found the results to be positive and argued that mobile devises could have a significant role to play in making people more health aware; "The app is important because it helps people regulate their behaviour, which is really hard to do....Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment." 

However, Spring also emphasised that weight loss only occurred when people attended health education classes and engaged in regular exercise. The app alone would not be effective.

"The 'widget' is critical but it is not magical by itself," Spring added. "People need all the tools at their disposal." 

Should we all be downloading apps?

Diets usually fail because we end up eliminating certain food groups – and in the long term this is not sustainable. The difference between “diet fads” and calorie counting mobile apps, is that the latter can help set achievable and realistic goals, whilst simultaneously tracking our calorie intake and activity levels. 

It is often the case that we do not realise how many calories certain foods contain, and so, we are ignorant to all the hidden fats/sugars.  Thus, these quick and easy food tracking devices empower us to make sensible and more informed decisions that govern our health and weight. 

A frequent user of a calorie counting mobile app, Koorosh Ashrafi, PhD Research Scientist at BTG International group company, says; “I’ve lost 10 kilos over the past 6 months, and you learn balance is the key.  I’ve lived quite a sedentary lifestyle because of the pressure of work and studying, and I was still consuming the same amount of calories as 10 years ago when I was training as a rugby player.  Although I am a firm believer of everything in moderation, having a device at the tip of your fingertips, really does educate you about food and its content”

Nelly Araujo, Development Administrator at RSPH, and previous user of the mobile app says; “The goal setting was a motivational tool for me, but I found doing the mobile exercise with my partner, is what also drove me to make healthy changes – because we could support and encourage each other”

Bringing about behaviour changes in our life is no easy task.  We have to want to do it and it helps if we have the right tools at our disposal along with a good support network.

Spring believes that one of the big challenges in treating obesity is the need to provide behavioural treatment in a healthcare system where professionals don’t often have the time and training to support people with unhealthy diets or mental problems.

The RSPH is a strong advocator of the benefits of making healthier behavioural changes, but acknowledges that for many this can be challenging. The RSPH Level 2 Awards in Understanding Behaviour Change, is a qualification aimed at helping learners, health trainers and anyone working within the community to engage with individuals to develop strategies to undergo behaviour change and to offer brief advice and interventions to support individuals in improving their health and wellbeing.  Please click here for further information on the qualification, or contact Gina Mohajer.   

Why we should take that extra little time and have a nutritious and whole grain breakfast

Are you one of those people who eats breakfast on the go? Not really thinking about what is going in your mouth so long as it does the job of filling you up?  Or worse yet, do you skip breakfast all together, simply because you do not have the time?

Research has shown that breakfast is the most important meal of the day; increases concentration, helps with weight loss and lowers cholesterol levels.  However, it is what we consume for breakfast that will make the fundamental difference to our health. 

Cardiovascular disease accounts for one-third of deaths worldwide, of which unhealthy diets is a major risk factor.  We are reminded time and time again of the many health benefits of consuming a diet that is rich in fibre, whole grain and cereal.

Numerous studies over the years have supported the argument that these types of foods can reduce the risk of developing certain diseases including, coronary heart disease, colon cancer, diabetes and other chronic conditions.

However, why do so many of us choose to ignore these dietary recommendations? Is it because we are lazy, stuck in rut and don’t know how to make changes? Or is it because we know certain foods are good/bad for us but don’t really understand why?

As John O’Mullane and Carol Muir author of the Fat Factor point out;

“When it comes to diet related problems...you need to be armed with the necessary background information that will allow you to make informed decisions”.

Why is whole grain food good for us and what can we do to make sure we have enough of it in our diet?

Grains consist of three parts, the Bran (the outer layer which contains the fibre, omega-3 fatty acids, vitamins and dietary minerals) the Endosperm (the main part which is mostly starch) and the Germ (the smallest part which contains vitamin E, phosphorus, magnesium, folate and thiamine).

When grains are refined, i.e the bran and germ is removed (to make white flour, white bread, pastries) it leaves behind the energy-dense but nutrient-poor endosperm portion of the grain.  This process strips away more than half of wheat's B vitamins, 90 percent of the vitamin E, and virtually all of the fibre. 

Refined grains and cereals often have a higher GI, which means that it causes a sharp rise in blood sugars and hence causes the pancreas to work even harder.

Phillip Mellen, M.D., lead author and an assistant professor of internal medicine said "Years ago, scientists hypothesized that the higher rates of chronic diseases we have in the West, including heart disease, are due, in part, to a diet full of processed foods.”

The benefits

Whole grains help protect against Heart Disease, Type 2 Diabetes, Cancer and Obesity

“A growing body of research shows that returning to whole grains and other less-processed sources of carbohydrates and cutting back on refined grains improves health in myriad ways” Harvard School of Public Health.  

Numerous studies over the years are pointing to the conclusion that whole grain and better health walk hand in hand.  A major research study from the Wake Forest University of Medicine, analysed seven studies involving 285,000 people between 1966 and 2006.  From the data they found consuming whole grains on a daily basis lowered the risk of cardiovascular disease considerably.

“Eating an average of 2.5 servings of whole grains each day is associated with a 21 percent lower risk of cardiovascular disease compared to consuming only 0.2 servings”, said Mellon.

The main reason for this reduction in heart disease is because whole grain, as opposed to refined foods, decreases blood pressure, lowers cholesterol in the blood stream and steadies insulin levels. 

Type 2 Diabetes

A large study of 160,000 women whose health and dietary habits were followed up over 18 years, found that those who consumed 2 -3 servings of whole grains a day were 30 percent less likely to have developed type 2 diabetes than those who rarely ate whole grains.  As such, researchers estimate that swapping white rice for whole grain could lower diabetes risk by 36 percent. 

Cancer

The data on cancer is a little more ambiguous, however, the properties contained within whole grain such as phytoestrogens (plant estrogens), the essential minerals such as, magnesium, selenium and manganese, are believed to protect against some cancers.  A Norwegian study found that people who ate the highest amount of whole grains reduced their risk of death from cancer by almost 25 percent.  A consistent protective effect has been observed when whole grains are eaten three to four times a week. 

Healthy Bowel Movement and Weight Control

The fibre in whole grains helps prevent constipation by increasing the movement of food through the digestive tract.  As a result, this decreases levels of destructive bacteria and the build up of carcinogenic compounds.  Wheat fibre can bind certain toxins and remove them from the large bowel.

Moreover, high fibre foods including wholegrain breads, cereals and oats, can be an effective way to help loose weight healthily.  Not only are whole grains naturally low in saturated fat they take longer to digest and create a feeling of fullness – discouraging overeating. 

What are whole grain foods and how much should we be eating? 

Examples of whole grain foods include rye bread, brown rice, oatmeal, barley, bulgur wheat, wheat berries and flours such as whole wheat.  Although there are no standard guidelines on how much whole grain we should eat, it is recommended that we consume at least three servings of whole grain a day.  Swapping white bread and white rice for brown, having more whole wheat and whole grain cereals are just some suggestions.  For information and useful tips on how to incorporate whole grain into your diet click here 

Altering our diet is not always easy, but making small changes can have far reaching and positive affects to our health and what better way to start than with breakfast! 

Read more on the benefits of whole grain by click here.  

Whole grains should be eaten as part of a balanced diet. 

Why making just two lifestyle changes can have positive and far reaching affects on health

A recent study, at the Northwestern University Feinberg School of Medicine, found that changing one bad habit can have a positive knock on effect on other behaviours.  A simple step such as watching less television, can simultaneously reduce the amount of time one spends snacking on unhealthy foods – as these two behaviours are closely related.   As such, the notion that you must radically transform your life in order to be healthier is not necessarily true and often hard to maintain.  Making just a couple of small changes, as the study demonstrates, can have a real and long lasting impact on people’s health.

The study was conducted by Bonnie Spring, professor of preventive medicine at Northwestern University Feinberg School of Medicine, in an attempt to find out the most effective way to spur people to change common bad health habits.  204 adult patients with unhealthy habits, were given the following treatments; an increase in vegetables/fruit and physical activity and decrease in fat and sedentary leisure.  Over the course of the three weeks, the patients had to record their daily data into a personal digital assistant in order to establish if they met their goals. 

After the three weeks, patients no longer had to maintain their “healthier” lifestyles, but were still required to send data three days a month for six months.

After the completion of the six months, the study found that the patients kept to their new healthier lifestyle changes rather than reverting back to their old habits.  Around 86% of the participants said that once they had made the initial change, they tried to maintain it.  By incorporating fruits and vegetables in their diet empowered them to believe that they were in fact capable of change. 

The results indicated that the most effective way to improve health required two key behaviour changes, namely cutting the amount of time spent watching TV or on the computer and eating more fruits and vegetables.  It is believed that these two simple changes could have long lasting results.   

Spring said, "Just making two lifestyle changes has a big overall effect and people don't get overwhelmed."

The majority of the population, where obesity is most prevalent, often lead unhealthy and sedentary lifestyles, putting them at high risk for heart disease, diabetes and cancer.  Spring argues that it is often hard for doctors to know where to initiate change in unhealthy habits, without discouraging or offending patients.   Thus this “two way” simple approach enables others to make realistic and manageable changes by giving them confidence to carry it out.

“With this simplified strategy, people are capable of making big lifestyle changes in a short period of time and maintaining them”  


Photo by Sina Bahrami http://5127.co.uk/

New Nutrition Guidelines published 

for Pre-School Children

This week, the School Food Trust has published guidelines on what foods young children should eat.

The guidelines have been introduced as a result of an independent report in 2010, which flagged demand for clearer guidance from childcare providers and parents.

The report highlighted the growing concern, that a fifth of children are either overweight or obese before they start school.  With Type 2 diabetes on the increase and dental health in young children deteriorating, the School Food Trust advocates that healthy eating before the age of five is essential.   

The voluntary guidelines, which are aimed particularly at nurseries, childminders and other providers of service for preschoolers, is an attempt to educate adults on healthy eating habits for young children in order to help reduce childhood obesity.

The guidelines include recommendations on the types of food to offer young children, portion sizes, sample menus as well as advice on tackling fussy eating and involving children in food and cooking activities.   

Children’s Minister Sarah Teather said: “Healthy eating is at the heart of helping every child get the best start in life”. 

As such, the new guidelines illustrate the importance of a varied diet for the under-fives, one which is rich in fruit, vegetables and dietary fibre, and how to avoid too much saturated fat, sugar and salt, which can contribute to weight gain and tooth decay.

The School Food Trust said; “Children start learning about food at a very early age. The messages they receive during this time lay the foundations for the choices they make about food as they move up to school and beyond”.

To download the Voluntary Food and Drink Guidelines For Early Years Setting in England – Practical Guide please click here.  

Cutting out the Fat....

The relationship between fatty foods and developing type 2 diabetes

As levels of obesity continue to rise, posing as a serious threat to public health, conditions of type 2 diabetes has also increased.  Evidence has suggested a strong link between obesity and developing type 2 diabetes, however, scientists have now discovered how a high fat diet can cause type 2 diabetes.  Researchers believe this discovery will not only help explain the relationship between fatty foods and obesity, but it may lead to finding a cure for the disease.   

This week the Daily Mail and BBC Health News reported the findings.

The study published in the peer-reviewed journal Nature Medicine, was carried out by researchers from the University of California and the RIKEN Advanced Science Institute in Japan.  The study sought to investigate whether a high-fat diet might contribute to causing type 2 diabetes, by looking at its effect on the insulin producing cells of the pancreas on mice, and on the response of cells to insulin.  The scientists investigated their findings further on human pancreatic cells in the laboratory.

The Science bit

In type 2 diabetes, the cells in the pancreas that normally produce insulin – called beta cells – gradually stop working over time.  These cells respond to increased levels of sugar in the blood by producing insulin, but this ability is lost in type 2 diabetes.  The cells of the body become less responsive to insulin (insulin resistance) and fail to take up the sugar in the blood stream.  This then causes high levels of sugar circulating around the body, which is detrimental to cells and tissues.   

The Research

Scientists looked at what effect a high-fat diet had on the activity of certain genes and proteins in the cells that are thought to help the beta cells function. Particular focus was placed on a protein called GnT-4a glycosyltransferase.  In healthy pancreatic cells this protein helps in the detection and response to glucose in the blood stream.

The researchers found that when they fed mice a high-fat diet, the genes encoding the GnT-4a protein and one of the glucose sensing proteins (called Slc2a2) became less active in the mice’s pancreatic cells.

The scientists also genetically engineered mice to have a form of GnT-4a that was always active in the beta cells. They then looked at how these mice responded to the high-fat diet.  The theory was that if dietary fat had its effects by stopping these proteins working, then these genetically engineered mice should be less susceptible to the effects of a high-fat diet.

The Findings

It was found that high-fat diets in mice affected the insulin-producing cells, reducing their ability to correctly respond to the presence of glucose.  As such, there were high levels of glucose circulating in the bloodstream and a reduced ability of certain tissues to respond to insulin and take up sugar.   Tests on pancreatic tissue from people with type 2 diabetes suggested that similar changes may be occurring in humans.

However, in mice genetically engineered to have GnT-4a work constantly in the beta cells, the high-fat diet had less of an effect on blood sugar levels and the ability of the cells to respond to insulin, even though the mice became fat.  This enhanced understanding of the effects of fat on pancreatic cells, provides a possible biological explanation as to why high fat diets can lead to type 2 diabetes. Researchers believe this will also aid the development of possible new treatments for type 2 diabetes.

However, human research is a lengthy process and finding a cure for type 2 diabetes may take years.  Thus, the best current advice to prevent type 2 diabetes, is to maintain a healthy weight, do exercise and eat a healthy diet.  For further information on this research please visit NHS Choices

What You Can Do?

At RSPH Training Solutions we take health seriously and we believe that through education and training, people can learn to make better lifestyle choices and positively influence people around them.  The level 2 Award in Understanding Health Improvement provides knowledge and understanding of the benefits of good health and well being, and of the barriers to making a change of lifestyle.  This qualification is specifically designed for people who work with the public in a healthcare environment and those who have an interest in developing public health skills.  For further information on the course please click here or contact Nicolette Boustaoui   or by phone 020 7265 7325. 

Sporting Advice

Today the Department of Health launched new advice on how to maintain fitness levels and stay or get healthy, for people of all ages.  The UK-wide physical activity guidelines by the four nations’ Chief Medical Officers, is intended to help people understand the benefits of physical activity and also promote the simple steps that people can take to incorporate activity into their everyday lives.

Although the guidelines build on previous advice about the positive outcomes of physical activity, they also highlight that being more active can dramatically reduce the risk of serious diseases such as heart disease, stroke and diabetes.

Key New Elements of the Guidelines Include:

How to incorporate physical activity into busy lives.  Adults can get their 150 minutes of activity a week in sessions of ten minutes or more and should aim to be active every day. 30 minutes five times a week is just one way this can be achieved.

·         Greater emphasis on vigorous activity and muscle strengthening through, heavy gardening, group sports, such as volleyball and basketball or swimming. There is good evidence this stimulates bone formation and maintains muscle mass;

·         Advice tailored to every age group including - for the first time - guidance for parents for under-fives;

·         Reducing and minimising periods of sedentary behaviour.

·         The guidance has a renewed focus on being active everyday and spells out the recommended minimum levels of activity for each age group:

The Recommendations:

Under Fives

180 minutes - three hours - each day, once a child is able to walk

Children and young people (5-18 year olds)
60 minutes and up to several hours every day of moderate to vigorous intensity physical activity. Three days a week should include vigorous intensity activities that strengthen muscle and bone. Adults (19-64 years old) and older people (65+) 150mins - two and half hours - each week of moderate to vigorous intensity physical activity (and adults should aim to do some physical activity every day). Muscle strengthening activity should also be included twice a week.

England's Chief Medical Officer Sally Davies said:

"Being active has enormous health and well being benefits. It protects against many of the biggest causes of early death like heart disease, and stroke, and can promote good mental health.
"The latest figures show that almost a quarter of adults are obese and on current trends by 2050 it means 9 in 10 adults will be overweight or obese. We know that more than 60 per cent of adults are not active enough which is why today the UK Chief Medical Officers are launching the first UK-wide guidelines that draw on the latest science to inform weekly levels of physical activity - whatever your age. "But it's not just about health. Cycling and walking more can save on transport costs, reduce congestion and pollution."

Robin Gargrave, Director of Innovation and Development at Central YMCA said:
"In terms of health benefits, we know that the duration, intensity and type of physical activity for a young person is very different to that required for an older adult. Most people know they can improve their health by being more active, but face barriers, which prevent them from doing so.

"This advice addresses these barriers by recognising the limitations of a 'one size fits all' approach to physical activity - it speaks directly to people at different stages of their lives and is flexible in its approach. For providers such as Central YMCA, this advice will enable us to develop and target physical activity interventions more effectively."

To access the guidelines, click here and to view the press release, click here

RSPH – Sport for Health: Bringing Sport into People’s Lives.

Sport for Health is a two part programme specifically for people who work in sport, either in a professional or voluntary role. It is designed to help them increase the level of physical activity amongst people who do not normally take part in sport.  It provides an understanding of how an active lifestyle promotes good health, and a practical approach to understanding the barriers people face and ways to overcome them.

Through the Mayor’s Legacy Fund, applicants can attend the courses at a 75% discount on the normal rate (ie the trainee fee is £50 per day as opposed to the normal £200).   In order to qualify for the discount applicants need to commit to 20 hours of voluntary work in the London area – either in sports or in encouraging others to take part in physical activity.
To find out more about this course, available funding and other programmes offered by RSPH, please click here call Nicolette Boustaoui on 020 7265 7325 or email sportforhealth@rsph.org.uk.