A healthy diet should be enjoyable as well as providing a good balance of nutrients. Dietary advice should provide alternatives so that everyone can achieve a diet which is both healthy and enjoyable. The emphasis is on balance and quantity rather than advising complete avoidance of any particular food.
A healthy diet will include moderate amounts of milk and dairy products, meat, fish or meat/milk alternatives, together with limited amounts of foods containing fat or sugar.
In October 2005 the government issued its eight tips for eating well, which are:
- Base meals on starchy foods.
- Eat lots of fruit and vegetables.
- Eat more fish, including a portion of oily fish each week.
- Cut down on saturated fat and sugar.
- Eat less salt - no more than 6 g a day.
- Be active and maintain a healthy weight.
- Drink plenty of water.
- Don't skip breakfast.
Clinical Editor's Comments (September 2017)
Dr Hayley Willacy recommends the following paper on carbohydrate consumption and mortality in the Lancet recently. The prospective cohort study enrolled over 135,000 people aged 35 to 70 years without cardiovascular disease, from 18 countries in different geographical regions. Higher carbohydrate intake was associated with an increased risk of total mortality, with those eating the most carbohydrates proportionally having a 28 per cent greater risk than those eating the least, although no difference was seen in the risk of cardiovascular disease or cardiovascular disease mortality. Conversely, intake of total fat and each type of fat was associated with a lower risk of total mortality, while a higher saturated fat intake was associated with lower risk of stroke.
The following general advice should be given to patients:
- Eat a variety of different foods; no single food provides all the nutrients required for the body to stay healthy.
- Eat the right amount to be a healthy weight:
- Women tend to need less energy than men and older adults tend to need less energy than adolescents and young adults.
- Regular aerobic exercise is a very important part of weight control.
- Eating breakfast every day can help people control their weight, probably just by decreasing hunger for unhealthy foods later in the day.
- Starch, fibre and wholegrain foods:
- Eat plenty of foods rich in starch and fibre - eg, bread, cereals, rice, pasta and potatoes, which also contain fibre, calcium, iron and B vitamins.
- Wholegrain foods contain more fibre and other nutrients than white or refined starchy foods and include wholemeal and wholegrain bread, pitta and chapati, wholewheat pasta and brown rice, wholegrain breakfast cereals.
- Wholegrain cereal foods are particularly rich in insoluble fibre, which helps to prevent constipation.
- Soluble fibre in fruit, pulses (beans, lentils and chickpeas) and vegetables can help to reduce the amount of cholesterol in the blood.
- Increasing fibre reduces the risk of heart disease, diabetes and colo-rectal cancer.
- Eat plenty of fruit and vegetables:
- There is evidence that a diet rich in fruit and vegetables reduces the risk of developing coronary heart disease and some cancers.
- The UK government recommends eating at least five portions of fruit and vegetables daily but in other countries the recommendation is for 7, 8 or even 10. Try to eat a wide variety of different fruits and vegetables.
- One portion of fruit or vegetables weighs about 80 g . Some examples are:
- An apple, banana, pear, orange or other similar-sized fruit.
- Two plums or similar-sized fruit.
- A grapefruit or avocado.
- A slice of large fruit, such as melon or pineapple.
- Three heaped tablespoons of vegetables (raw, cooked, frozen or tinned).
- Three heaped tablespoons of fruit salad (fresh or tinned in fruit juice) or stewed fruit.
- A heaped tablespoon of dried fruit (such as raisins and apricots).
- A dessert bowl of salad.
- A glass (150 ml) of fruit juice.
- A cupful of grapes, cherries or berries.
- Try to eat at least two portions of fish (fresh, frozen or canned) a week, including a portion of oily fish. Smoked fish can be high in salt.
- Oily fish include salmon, mackerel, trout, herring, fresh tuna, sardines, pilchards, eel.
- Shark, swordfish and marlin: don't have more than one portion a week because of the high levels of mercury.
- Protein-rich foods include meat, fish, eggs and pulses.
- Eggs were thought to increase coronary heart disease risk but research suggests this is not the case.
- Poultry such as chicken and turkey contain less fat than meats such as pork and beef, although red meat is a richer source of iron.
- Smoked and cured meats should be eaten sparingly. Research indicates they may increase the risk of several types of cancer.
- Minerals and vitamins: the diet should contain adequate quantities of all essential vitamins and minerals. A healthy level of most vitamins and minerals will be found in a varied diet rich in fruits and vegetables, protein and dairy products.
- Avoid too many foods that contain a lot of fat:
- Fat contains twice as many calories per gram as carbohydrate or protein so eating a lot of fat will contribute towards obesity.
- Foods high in saturated fat include meat pies, sausages, burgers, meat with visible white fat, hard cheese, butter and lard, pastry, cakes and biscuits, chocolate, cream, soured cream and crème fraîche, coconut oil, coconut cream and palm oil.
- Avoid frequent sugary foods and drinks:
- New recommendations suggest that free sugars (found in soft drinks, yoghurts, cakes and biscuits etc) should not account for more than 5% of total dietary energy.
- Sugar causes tooth decay and sugary foods tend to be high in calories, contributing to obesity.
- Avoid excessive salt:
- It contributes to high blood pressure.
- Adults (and children aged 11 years and over) should have no more than 6 g of salt a day. Younger children should have even less.
- 75% of the salt we eat comes from processed food - eg, some breakfast cereals, ready meals, meat products, soups, sauces, bread and biscuits.
- Other flavourings can be added to food to make it tasty in place of salt: garlic, herbs or spices.
- Ensure adequate fluid intake:
- In climates such as the UK, we should drink approximately 1.2 litres (6 to 8 glasses) of fluid every day to stop us becoming dehydrated. In hotter climates the body needs more than this.
- Excessive amounts of caffeine-containing drinks (eg, tea, coffee and cola) should be avoided because of their diuretic effect.
- Keep alcohol consumption within recommended limits:Alcohol is also high in calories, so cutting down helps to control weight as well as avoiding other alcohol-related problems. Women should not drink more than 14 units of alcohol a week and men not more than 21 units a week. A unit is:
- Between a third and a half pint of standard-strength (3-5%) beer, lager or cider.
- A pub measure of spirit.
- A glass of wine is about 2-3 units and alcopops are about 1.5 units.
- Alcohol intake should be spread throughout the week. Try to have at least two alcohol-free days each week and avoid binge drinking (more than 6 units for women or 8 units for men).
Further reading and references
World Cancer Research Fund; Recommendations for Cancer Prevention.
Your guide to eatwell plate - helping you eat a healthier diet; Public Health England
Dehghan M, Mente A, Zhang X, et al; Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017 Aug 28. pii: S0140-6736(17)32252-3. doi: 10.1016/S0140-6736(17)32252-3.
Maintaining a healthy weight and preventing excess weight gain among adults and children; NICE Guidance (March 2015)
Threapleton DE, Greenwood DC, Evans CE, et al; Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 2013 Dec 19347:f6879. doi: 10.1136/bmj.f6879.
Carbohydrates and Health; Scientific Advisory Committee on Nutrition
Hartley L, Igbinedion E, Holmes J, et al; Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database Syst Rev. 2013 Jun 46:CD009874. doi: 10.1002/14651858.CD009874.pub2.
van Bussel BC, Henry RM, Schalkwijk CG, et al; Fish consumption in healthy adults is associated with decreased circulating biomarkers of endothelial dysfunction and inflammation during a 6-year follow-up. J Nutr. 2011 Sep141(9):1719-25. doi: 10.3945/jn.111.139733. Epub 2011 Jul 13.
Rong Y, Chen L, Zhu T, et al; Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ. 2013 Jan 7346:e8539. doi: 10.1136/bmj.e8539.
De Stefani E, Boffetta P, Ronco AL, et al; Processed meat consumption and risk of cancer: a multisite case-control study in Uruguay. Br J Cancer. 2012 Oct 23107(9):1584-8. doi: 10.1038/bjc.2012.433. Epub 2012 Sep 25.
Jequier E, Constant F; Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010 Feb64(2):115-23. doi: 10.1038/ejcn.2009.111. Epub 2009 Sep 2.
Alcohol Unit Guidelines; Drinkaware