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Seven dietary changes to protect your health – and the planet

Consider a diet that can prolong your life and, at the same time, feed a growing global population without causing further damage to the environment.

That’s just what 37 scientists from 16 countries (the EAT-Lancet Commission) did for two years. Their findings resulted in recommendations for a healthy diet that can feed the world’s population from sustainable food systems and were published on Thursday in the medical journal The Lancet.

They recognize that food production needs to nourish human health and support environmental sustainability; currently, our food systems are threatening both. Strong evidence indicates that livestock farming is one of the biggest drivers of climate change, biodiversity loss, land degradation, water use and chemical pollution.

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The “planetary-health diet,” largely plant-based and low in red meat and sugar, is estimated to feed 10 billion people by 2050 from sustainable food systems. The researchers also believe it will prevent 11 million premature deaths a year caused by an unhealthy diet.

What’s in the diet?

Daily protein comes mostly from plants including beans, lentils, soy and nuts. Whole grains, not refined, are included, and fruits and vegetables fill half of your plate at meals.

The recommended 2,500-calorie diet doesn’t completely eliminate animal foods. It can include, each day, one half-ounce of red meat, one ounce each of fish and poultry and one cup of milk or yogurt. One to five eggs can be eaten a week.

Plant-based oils are substituted for animal fats and added sugars are limited to 31 g a day, in line with the WHO recommendation for sweeteners.

Is it feasible?

The planetary-health diet is a huge shift from the way we eat. But eating this way isn’t completely foreign.

The traditional Mediterranean diet of the early 1960s was largely plant-based and contained only 35 g of red meat and poultry combined each day. Many traditional diets (e.g., West Africa, India, Mexico and parts of Asia) contain lots of plant protein and little meat or dairy.

Some people, though, feel that achieving this global diet isn’t feasible.

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Not today; that’s for sure. Reaching these dietary targets by 2050, the EAT-Lancet Commission points out, will require policies that encourage healthier food choices, agriculture sustainability, stricter rules around governing of land and oceans and reducing food waste.

Transitioning to a sustainable diet at home

In the meantime, there are small steps you can take on an individual level to move toward the planetary-health diet.

Replace meat with pulses. Substitute cooked brown or green lentils for half of the ground meat in meatloaf, meatballs, burgers, shepherd’s pie, stuffed peppers and marinara sauces.

Replace some of the meat in tacos and burritos with black beans or pinto beans. Reduce the amount of meat in chili and add extra kidney beans or chickpeas. Eventually, replace all of the meat with beans or lentils.

Replace cheese in sandwiches with hummus.

Use nuts to replace meat. Add almonds or cashews to a vegetable stir-fry instead of beef or chicken. For lunch, have a nut-butter sandwich instead of ham or turkey.

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Boost plant protein at meals by tossing toasted nuts or pumpkins seeds into greens salads.

Set a target. Determine how many meatless meals you’ll eat each week and then build on that. Vegetarian chili, tofu stir-fry, salad with edamame, bean burgers, chickpea curry and lentil soup are protein- and nutrient-packed lunches and dinners.

Include plant-based breakfasts, too. Try a smoothie made with fruit, greens and soy or pea milk, whole grain toast with almond butter, oatmeal topped with nuts and berries, quinoa or millet porridge or scrambled tofu.

Pack in produce. Eat a mix of fruits and vegetables, at least five servings a day (one serving is one-half cup of cooked or raw vegetables, a half-cup of berries or one medium fruit). One-half of each meal should consist of these foods.

Consider your snacks. Making snacks 100-per-cent plant-based is an easy step to take. Choose fruit and nuts, homemade trail mix, vegetables and hummus, whole grain crackers with nut butter, soy/pea milk smoothies or soy lattes.

Rethink restaurants. You’ll find a variety of plant-based options at restaurants that specialize in ethnic cuisines such as Indian, Middle Eastern, Mexican, Japanese and Chinese.

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Or, pick a plant-based restaurant near you and when travelling.

Reduce food waste. Shop for, store and repurpose foods to minimize waste at home. Avoid buying in bulk; purchase only what you need whenever possible.

Buy “ugly produce,” misshapen fruits and vegetables often thrown away by farmers and grocery stores. Use vegetable scraps to make soup stock.

Store leftovers at the front of the fridge so you don’t forget them; eat within three or four days.

Leslie Beck, a Toronto-based private practice dietitian, is Director of Food and Nutrition at Medcan.

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Intermittent fasting boosts health by strengthening daily rhythms

Various versions of the intermittent fasting diet appear to have weight loss benefits. A new study investigating why they work concludes that circadian rhythms are key.

Intermittent fasting has become popular, but how does it work?

While the modern world appears awash with fad diets, people seem to be giving a fair bit of attention to intermittent fasting.

As its name implies, intermittent fasting involves eating nothing for extended periods of time.

Some studies have found that this type of diet is beneficial, but exactly why it benefits health is not yet clear.

Recently, a group of scientists at the University of California, Irvine investigated the impact of fasting on our circadian clock.

Daily sleep–wake cycles, or circadian rhythms, drive the ebb and flow of human life; they control much more than just our sleepiness levels. Our 24-hour cycles involve metabolic, physiological, and behavioral changes that impact every tissue of the body.

Perhaps the most well-known way to influence the clock is via exposure to bright lights, but this isn’t the only way; food intake also impacts the clock.

We are slowly beginning to understand how eating plays a role in modulating circadian rhythms, but we know even less about how a lack of food might affect rhythms.

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Fasting and circadian rhythms

The authors of the new study were particularly interested in learning about how fasting influenced circadian rhythms in the liver and skeletal muscles. The researchers published their findings in the journal Cell Reports.

Fasting is a natural phenomenon for most animals, because food is not always readily available. In times of hardship, certain metabolic changes occur to allow the body to adapt.

For instance, when glucose is scarce, the liver begins to create ketones from fatty acids, which the body can use as an emergency energy source.

A host of fasting-induced transcription factors drive these metabolic changes. These transcription factors also seem to influence circadian rhythms.

As an example, one study split mice into two groups; the researchers put one on an intermittent fasting regime, and they allowed the second to eat whenever it liked.

Both groups consumed the same amount of fat and calories; however, despite having the same energy intake, mice in the fasting group did not develop obesity or metabolic disorders as the other mice did.

Also, importantly, the authors noted that the animals’ circadian oscillations were more robust in the fasting group.

As the authors of the recent study point out, “[F]asting appears to be a strong metabolic cue to entrain rhythmic gene expression.”

Scientists believe that having more clearly defined cycles might be part of the reason that fasting promotes good health.

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Rhythmic fasting genes

The most recent study also involved mice. While the animals adhered to 24-hour periods of fasting, the scientists measured various physiological functions.

They saw that while fasting, mice used less oxygen and energy. However, as soon as the mice ate, these gene-driven physiological changs were reversed. This mirrors what researchers have previously seen in humans.

Lead study author Prof. Paolo Sassone-Corsi explains what the researchers found, saying, “We discovered [that] fasting influences the circadian clock and fasting-driven cellular responses, which together work to achieve fasting-specific temporal gene regulation.”

They also note that it influenced different tissue types to different degrees. As Prof. Sassone-Corsi says, “Skeletal muscle, for example, appears to be twice as responsive to fasting as the liver.”

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How might this benefit us?

Having assessed the gene changes that occur with fasting, the scientists now need to explain how they might benefit health.

Prof. Sassone-Corsi suggests that “the reorganization of gene regulation by fasting could prime the genome to a more permissive state to anticipate upcoming food intake and thereby drive a new rhythmic cycle of gene expression.”

He adds, “In other words, fasting is able to essentially reprogram a variety of cellular responses. Therefore, optimal fasting in a timed manner would be strategic to positively affect cellular functions and ultimately benefitting health and protecting against aging-associated diseases.”

Over the years, it has grown increasingly clear that disrupting circadian rhythms can increase the risk of obesity and metabolic disorders, such as diabetes. This new work brings us closer to understanding why that might be.

Though understanding the influence of fasting on circadian rhythms and gene expression is still in its infancy, the authors hope that one day, their work will help find the optimum fasting regime for health.

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A bit of meat, a lot of veg – the flexitarian diet to feed 10bn

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Getty Images

A diet has been developed that promises to save lives, feed 10 billion people and all without causing catastrophic damage to the planet.

Scientists have been trying to figure out how we are going to feed billions more people in the decades to come.

Their answer – “the planetary health diet” – does not completely banish meat and dairy.

But it is recommending we get most of our protein from nuts and legumes (such as beans and lentils) instead.

Their diet needs an enormous shift in what we pile on to our plates and for us to turn to foods that we barely eat.

What changes am I going to have to make?

If you eat meat every day then this is the first biggie. For red meat you’re looking at a burger a week or a large steak a month and that’s your lot.

You can still have a couple of portions of fish and the same of chicken a week, but plants are where the rest of your protein will need to come from. The researchers are recommending nuts and a good helping of legumes every day instead.

There’s also a major push on all fruit and veg, which should make up half of every plate of food we eat.

Although there’s a cull on “starchy vegetables” such as the humble potato or cassava which is widely eaten in Africa.

So what is the diet in detail?

If you served it all up this is what you would be allowed each day:

  1. Nuts - 50g a day
  2. Beans, chickpeas, lentils and other legumes – 75g a day
  3. Fish - 28g a day
  4. Eggs - 13g a day (so one and a bit a week)
  5. Meat - 14g a day of red meat and 29g a day of chicken
  6. Carbs - whole grains like bread and rice 232g a day and 50g a day of starchy vegetables
  7. Dairy - 250g – the equivalent of one glass of milk
  8. Vegetables -(300g) and fruit (200g)

The diet has room for 31g of sugar and about 50g worth of oils like olive oil.

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Will it taste awful?

Prof Walter Willet, one of the researchers who is based at Harvard, said no and that after a childhood on a farm eating three portions of red meat a day he was now pretty much in line with the planetary health diet.

“There’s tremendous variety there,” he said. “You can take those foods and put them together in thousands of different ways. We’re not talking about a deprivation diet here, it is healthy eating that is flexible and enjoyable.”

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Molly Katzen

Image caption

These are some plates of food that meet the planetary health diet rules

Is this for real, or just a fantasy?

This plan requires changes to diets in pretty much every corner of the world.

Europe and North America need to cut back massively on red meat, East Asia needs to cut back on fish, Africa on starchy vegetables.

“Humanity has never attempted to change the food system at this scale and this speed,” said Line Gordon, director of the Stockholm Resilience Centre, at Stockholm University.

“Whether it’s a fantasy or not, a fantasy doesn’t have to be bad… it’s time to dream of a good world,” she says.

Taxes on red meat are one of the many options the researchers say may be necessary to persuade us to switch diets.

Who came up with this?

A group of 37 scientists from around the world were brought together as part of the EAT-Lancet commission.

They’re a mix of experts from farming to climate change to nutrition. They took two years to come up with their findings which have been published in the Lancet.

Why do we need a diet for 10 billion people?

The world population reached seven billion in 2011 and it’s now around 7.7 billion. That figure is expected to reach 10 billion around 2050 and will keep on climbing.

Will it save lives?

The researchers say the diet will prevent about 11 million people dying each year.

That number is largely down to cutting diseases related to unhealthy diets such as heart attacks, strokes and some cancers. These are now the biggest killers in developed countries.

How bad is farming for the planet?

The use of land for growing food and forestry accounts for around a quarter of global greenhouse gas emissions. That’s about the same as from electricity and heating, and substantially more than from all the trains, planes and automobiles on the planet.

When you look more closely at the food sector’s environmental impact, you can see that meat and dairy are the major factors. Worldwide, livestock accounts for between 14.5 and 18% of human-induced greenhouse gas emissions.

When it comes to other warming gases, agriculture is one of the leading contributors to both methane and nitrous oxide emissions.

Agriculture is also a significant source of air pollution with ammonia from farms a major cause of fine particulate matter, which the World Health Organization (WHO) says is a threat to health worldwide.

Similarly when it comes to water, agriculture and food productions are one of the biggest threats, consuming 70% of global freshwater sources for irrigation.

So will this diet save the planet?

The researchers’ aim was to feed more people while:

  • minimising greenhouse gas emissions
  • preventing any species going extinct
  • having no expansion of farmland, and
  • preserving water

However, just changing diets is nowhere near enough.

To make the numbers add up, also requires a halving of food waste and an increase in the amount of food produced on current farmland.

Why isn’t meat being banned?

“If we were just minimising greenhouse gases we’d say everyone be vegan,” said Prof Willet.

However, it was unclear whether a vegan diet was the healthiest option, he said.

So what happens now?

The EAT-Lancet Commission is going to take its findings to governments around the world and bodies such as the WHO to see if it can begin to change the way we eat.

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Security and public health: the interface

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Invest in health for global security and growth, Gates urges donors

LONDON (Reuters) – Donating billions of dollars to global funds that fight poverty and disease is one of the best investments governments can make to boost security and economic growth, philanthropists Bill and Melinda Gates said on Thursday.

Ending epidemics of infectious diseases such as malaria, polio, HIV and malaria is proving tough, they said, but dramatic progress made by global aid mechanisms recent decades means the world’s people are now healthier and more productive.

“The data has been really striking,” Melinda Gates told reporters on a teleconference.

She cited figures from the World Health Organization and others showing that since 1990, under-five mortality rates have fallen by more than 50 percent, and deaths due to infectious diseases like HIV, malaria and measles have also halved.

“A child born today is half as likely to die before the age of five, compared to if she was born in 2000,” Melinda Gates said. “The human and economic benefits of this are enormous.”

The multi-billion dollar philanthropic Gates Foundation she co-chairs with her husband Bill, the co-founder of Microsoft, is one of the largest funders of global health program aimed at helping poor people escape disease, poverty and premature death.

The Foundation is seeking to encourage international donor governments such as the United States, Japan, Australia, Germany, Britain and many others to replenish four key global funds in the next 18 months so they can continue their work.

The funds include the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Polio Eradication Initiative (GPEI) and the GAVI vaccines alliance and the Global Financing Facility for child and maternal health.

Bill Gates said he was optimistic that wealthy donor governments remain committed to funding international aid for poor countries, but added: “We never want to take it for granted, because … just one (donor) country dropping back could cost hundreds of thousands of lives.”

He also said he was concerned that “distraction by domestic issues” may mean the still urgent need for global aid funding may not get the attention it deserves.

“People shouldn’t become complacent,” he said. “We still have a little less than six million children who die under the age of five.”

Reporting by Kate Kelland; Editing by Raissa Kasolowsky

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Drinking green tea for its health benefits? Stop using tap water and use bottled water only

Brew green tea in bottled water instead of tap water to reap its health benefits, scientists have said.

The result is a tea with almost double the amount of the antioxidants, according to a study by Cornell University.

However, if you’re drinking green tea for taste, tap water will yield the best cup, ensuring it’s not too bitter.

EGCG (epigallocatechin gallate) is a natural antioxidants found in green tea, shown to be beneficial for the brain and heart in studies.

Celebrities including Jennifer Aniston are fans of the Asian brew, believed to be an aid for weight loss, energy and stress control. 

It's best to brew green tea in bottled water instead of tap water to reap the benefits of ECGC - the antioxidant - scientists at Cornell's Sensory Evaluation Center have said

It’s best to brew green tea in bottled water instead of tap water to reap the benefits of ECGC – the antioxidant – scientists at Cornell’s Sensory Evaluation Center have said

Jennifer Aniston said she drank the tea, popularly seen as an aid for weight loss, every day

Jennifer Aniston said she drank the tea, popularly seen as an aid for weight loss, every day

To conduct the tests, 2.5g of green tea was weighed out into pre-warmed Gaiwan tea brewing vessel with 125ml of water at 80°C (176°F).

The green tea infusion was brewed for three minutes and then strained through a fine mesh strainer.

EGCG in the tea infusions was measured by the researchers, and around 100 tea drinkers were recruited to taste the tea.

After giving details on their normal tea drinking habits, the volunteer evaluated six cups of tea – three black, and three green.

They rated each tea sample on a scale of one to nine for how much they liked its taste and appearance.

They were also taught how to use a specific scale to measure the sweetness, bitterness, sourness and earthiness of the brews. 


An anti-ageing drug may be on the horizon using the plant supplement quercetin – found in red wine, onions and green tea, research suggests.

Scientists have discovered a drug cocktail that clears senescent – or ‘zombie’ – cells from the body.

Senescent cells are alive but non-functioning and have been linked to everything from arthritis to Alzheimer’s. 

They are also thought to cause the deadly lung disease idiopathic pulmonary fibrosis (IPF) by triggering inflammation. 

Researchers gave 14 patients the cancer drug Sprycel (dasatinib) and quercetin, and they became significantly more mobile after just three weeks.

The findings, published The Lancet online journal EBioMedicine, raise hope that senolytic drugs may lead to a new way of targeting age-related disease. 

Results showed levels of ECGC in the green teas were ‘drastically reduced’ in those brewed with boiled tap water. No effect was noticed in the black teas.

The researchers said this is because the levels of calcium, magnesium and iron are higher in tap water.

Professor Robin Dando, one of the authors of the study, said: ‘Bottled water is able to extract the EGCG more efficiently.’

He added this is because calcium and magnesium have been filtered out of the ‘purer’ water, and iron concentration is also ‘brought down a notch’. 

Professor Dando added: ‘With purer water, you get more health benefits out of the tea.’ 

Consumers liked green tea brewed using tap water more than using bottled water, because it produced a sweeter taste.

But there was hardly any difference in black tea brewed in either tap water or bottled water.  

The findings were published in the journal Nutrients.

‘The average consumer for black tea isn’t able to tell the difference,’ said lead author Melanie Franks. 

‘Whether it was tap water or bottled water, the taste differences are too subtle.

‘Since black tea has fewer catechins than green tea due to the oxidation process in manufacturing, the type of water used seems less important to the everyday tea drinker.’

Jennifer Aniston ‘drinks green tea throughout the day,’ according to an interview with The Telegraph

Green tea, which originated in China and is made from Camellia sinensis leaves, is a well-researched area. 

ECGC has been found to stave off or slow the progression of Alzheimer’s disease in a 2015 University of Missouri study, when combined with physical activity. 

But other components found in green tea – caffeine, amino acid L-theanine and other catechins have shown possible health benefits in studies. 

These include lower cholesterol, a lower risk of Parkinson’s and even cancer. They have also been shown to boost metabolism.


Green tea extracts may cause liver damage, the EU food safety watchdog said in April 2018.

The European Food Safety Authority assessed the safety of green tea supplements from dietary sources. 

Taking more than 800mg of green tea catechins each day may pose health concerns, according to the body’s review, but officials were unable to confirm a safe dose.

The watchdog called for further scientific trials into the effect of green tea catechins and for labels to announce the risks.

Retailers, including high street chain Holland Barrett, sell the supplements. But most contain less than 800mg. 

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Oregano essential oil: 10 health benefits and how to use it

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    Chedid, V., Dhalla, S., Clarke, J. O., Roland, B. C., Dunbar, K. B., Koh, J., … Mullin, G. E. (2014, May 1). Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global Advances in Health and Medicine3(3), 16–24. Retrieved from

    Dantas, B. P., Alves, Q. L., de Assis, K. S., Ribeiro, T. P., de Almeida, M. M., de Vasconcelos, A. P., … Silva, D. F. (2015, April–June). Participation of the TRP channel in the cardiovascular effects induced by carvacrol in normotensive rat [Abstract]. Vascular Pharmacology67–69, 48–58. Retrieved from

    de Castro, R. D., de Souza, T. M. P. A., Bezerra, L. M. D., Ferreira, G. L. S., de Brito Costa, E. M. M., Cavalcanti, A. L. (2015, November 24). Antifungal activity and mode of action of thymol and its synergism with nystatin against Candida species involved with infections in the oral cavity: An in vitro study. BMC Complementary and Alternative Medicine15(1), 417. Retrieved from

    Khaki, M. R. A., Pahlavan, Y., Sepehri, G., Sheibani, V., Pahlavan, B. (2013). Antinociceptive effect of aqueous extract of Origanum vulgare L. in male rats: Possible involvement of the GABAergic system. Iranian Journal of Pharmaceutical Research12(2), 407–413. Retrieved from

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Why you shouldn’t follow the health regimes of these ‘peak zen’ people – The Conversation

January is a popular month for newspapers to publish health and fitness articles. One that caught my eye was in The Times and featured health fanatics who have reached “peak zen” (whatever that is). There’s Alex Beer (38), a model, Tim Gray (39), founder of a web marketing company, and Dasha Maximov (30), a freelance business consultant.

Let’s start with Alex Beer’s regime. He likes to drink “slightly pink” raw coconut water the minute he wakes up. Staying hydrated is important, but there’s no reason to choose coconut water over the regular stuff. A recent study found no difference in hydration when using tap water or coconut water.

Between meetings, Beer likes to drink a charcoal shot. Activated charcoal is often marketed as an aid to rid the body of toxins. If you’ve been poisoned, activated charcoal is brilliant, if not, it’s not much use. It doesn’t detox you – that’s what your kidneys are for. The same goes for the digestive enzymes (which Beer also likes to take) – you’ve already got those in your body and they do a pretty good job on their own.

Read more:
Activated charcoal doesn’t detox the body – four reasons you should avoid it

Moving on to Tim Gray. The tablespoon of coconut oil he adds to his coffee will only succeed in making it taste like sun cream. If that’s what you’re after, fill your boots. But coconut oil is a fat, which means it’s got a lot of calories in it. And to make matters worse, it’s high in saturated fats, which even us non-zens tend to eat too much of. Why would you want to have even more?

Read more:
Coconut oil: not quite poisonous, but best treated with caution

Gray says he doesn’t eat “any processed food at all”, which sounds nice if it were possible. Processed foods are those that have undergone changes to make them edible or safe to eat. Milk is pasteurised to get rid of any bugs that could make you sick. That’s processing. And you have to process it again to turn it into cheese or yogurt. If the pork belly that Gray likes to eat for lunch wasn’t processed, it would arrive on his plate as a whole pig, complete with mud and parasites.

Unprocessed pork.
Gareth Weeks/Shutterstock

The snobbery around processed foods is largely unfounded. There’s a difference between processing foods to make them safe and processing foods that makes them unhealthy, such as adding salt to ready meals to make them tastier. Processed foods can be a more affordable way to get your five a day (canned, frozen and dried fruits all count) and they can be a boon for people with arthritis or people who can’t chop veg to prep it for dinner. Frozen peas are not the same as a beefburger and chips.

Not entirely wrong

Not everything that these zen beings have to say should be discounted, however. Dasha Maximov is right about the fact that fish is good for you. And having lots of veg in your diet is also good. But some of Maximov’s claims, such as grains cause inflammation, are potentially harmful. People on gluten-free diets tend to have less fibre, vitamins and minerals. If there isn’t a medical reason to avoid gluten, you risk causing more harm to your health than good.

Read more:
Why gluten-free food is not the healthy option and could increase your risk of diabetes

Gray says that “life is too short not to enjoy the world and the people in it” and I agree with him. But life is also too short to spend it following dodgy nutrition advice that prevents you actually enjoying it, that at best will waste your money and at worst could have long-lasting detrimental effects on your health.

More on evidence-based articles about diets:

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Proper Breathing Brings Better Health

As newborns, we enter the world by inhaling. In leaving, we exhale. (In fact, in many languages the word “exhale” is synonymous with “dying.”) Breathing is so central to life that it is no wonder humankind long ago noted its value not only to survival but to the functioning of the body and mind and began controlling it to improve well-being.

As early as the first millennium B.C., both the Tao religion of China and Hinduism placed importance on a “vital principle” that flows through the body, a kind of energy or internal breath, and viewed respiration as one of its manifestations. The Chinese call this energy qi, and Hindus call it prana (one of the key concepts of yoga).

A little later, in the West, the Greek term pneuma and the Hebrew term rûah referred both to the breath and to the divine presence. In Latin languages, spiritus is at the root of both “spirit” and “respiration.”

Recommendations for how to modulate breathing and influence health and mind appeared centuries ago as well. Pranayama (“breath retention”) yoga was the first doctrine to build a theory around respiratory control, holding that controlled breathing was a way to increase longevity.

In more modern times, German psychiatrist Johannes Heinrich Schultz developed “autogenic training” in the 1920s as a method of relaxation. The approach is based partly on slow and deep breathing and is probably still the best-known breathing technique for relaxation in the West today. The contemporary forms of mindfulness meditation also emphasize breathing-based exercises.

In fact, every relaxation, calming or meditation technique relies on breathing, which may be the lowest common denominator in all the approaches to calming the body and mind. Research into basic physiology and into the effects of applying breath-control methods lends credence to the value of monitoring and regulating our inhalations and exhalations.

Yoga and meditation have inspired many of the breathing exercises used today. The benefits of controlled respiration were first theoretically posited centuries ago by the practitioners of pranayama yoga. Credit: Getty Images

Mind under the Influence

Even a rudimentary understanding of physiology helps to explain why controlled breathing can induce relaxation. Everyone knows that emotions affect the body. When you are happy, for instance, the corners of your mouth turn up automatically, and the edges of your eyes crinkle in a characteristic expression. Similarly, when you are feeling calm and safe, at rest, or engaged in a pleasant social exchange, your breathing slows and deepens. You are under the influence of the parasympathetic nervous system, which produces a relaxing effect. Conversely, when you are feeling frightened, in pain, or tense and uncomfortable, your breathing speeds up and becomes shallower. The sympathetic nervous system, which is responsible for the body’s various reactions to stress, is now activated. Less well known is that the effects also occur in the opposite direction: the state of the body affects emotions. Studies show that when your face smiles, your brain reacts in kind—you experience more pleasant emotions. Breathing, in particular, has a special power over the mind.

This power is evident in patients who have breathing difficulties. When these difficulties are sporadic and acute, they can trigger panic attacks; when they are chronic, they often induce a more muted anxiety. It is estimated that more than 60 percent of people with chronic obstructive pulmonary disease (COPD) have anxiety or depressive disorders. These disorders probably stem in part from concerns about the consequences of the disease (what could be more distressing than struggling to breathe?), but purely mechanical factors may contribute as well: the difficulty these patients experience often leads to faster breathing, which does not necessarily improve the quality of their oxygen supply but can aggravate their physical discomfort and anxiety.

Rapid breathing can contribute to and exacerbates panic attacks through a vicious circle: fear triggers faster breathing, which increases fear. In 2005 Georg Alpers, now at the University of Mannheim in Germany, and his colleagues observed significant and unconscious hyperventilation when people who had a driving phobia took their vehicles on the highway (where they might not be able to pull over if they become agitated).

Whether anxiety derives from breathing problems or other causes, it can be eased by a number of breathing techniques derived from traditional Eastern approaches (see “Six Techniques for Relieving Stress”). For example, “follow your breath,” an exercise that focuses attention on breathing, is one of the first steps in mindfulness meditation, whereas alternate nostril breathing comes from yoga. Combining reassuring thoughts with breathing is an approach incorporated into sophrology, a technique that emphasizes harmony of body and mind and that borrows exercises from many approaches, including yoga and mindfulness.

Overall, research shows that these techniques reduce anxiety, although the anxiety does not disappear completely. Breathing better is a tool, not a panacea. Some methods have been validated by clinical studies; others have not. But all of those I describe in this article apply principles that have been proved effective. They aim to slow, deepen or facilitate breathing, and they use breathing as a focal point or a metronome to distract attention from negative thoughts.

Spotlight on Cardiac Coherence

A close look at one popular technique—cardiac coherence—offers more detail about the ways that breathing exercises promote relaxation. With the help of biofeedback, the approach attempts to coordinate breathing with heart rate, slowing and steadying breathing to slow and stabilize the heartbeat.

The method was developed based on the understanding that slow, deep breathing increases the activity of the vagus nerve, a part of parasympathetic nervous system; the vagus nerve controls and also measures the activity of many internal organs. When the vagus nerve is stimulated, calmness pervades the body: the heart rate slows and becomes regular; blood pressure decreases; muscles relax. When the vagus nerve informs the brain of these changes, it, too, relaxes, increasing feelings of peacefulness. Thus, the technique works through both neurobiological and psychological mechanisms.

Cardiac coherence’s stabilization of the heartbeat can dampen anxiety powerfully. Conversely, patients with overactive heartbeats are sometimes misdiagnosed as victims of panic attacks because their racing heartbeat affects their mind.

A typical cardiac coherence exercise involves inhaling for five seconds, then exhaling for the same amount of time (for a 10-second respiratory cycle). Biofeedback devices make it possible to observe on a screen how this deep, regular breathing slows and stabilizes the beats. (The space between two heartbeats on the display is never exactly the same, but it becomes increasingly more consistent with this technique.) Several studies have confirmed the anxiety-diminishing effect of these devices, although the equipment probably has more influence on the motivation to do the exercises (“It makes it seem serious, real”) than on the physiological mechanisms themselves. Simply applying slow breathing with the same conviction and rigor could well give the same result.

Some versions of cardiac coherence recommend spending more time on exhaling than on inhaling (for example, six and four seconds). Indeed, your heart rate increases slightly when you inhale and decreases when you exhale: drawing out the second phase probably exerts a quieting effect on the heart and, by extension, on the brain. This possibility remains to be confirmed by clinical studies, however.

Other work suggests that the emotional impact of the breathing done in cardiac coherence and various other kinds of exercises stems not only from effects on the periphery—on the parasympathetic nervous system—but also from effects on the central nervous system. Breathing may well act directly on the brain itself.

In 2017, for instance, Mark Krasnow of Stanford University and his colleagues showed in mice that a group of neurons that regulates respiratory rhythms (the pre-Bötzinger complex in the brain stem) controls some of the activity of the locus coeruleus, a region involved in attention, wakefulness and anxiety. Breathing techniques may influence this seat of emotions by modulating the activity of the pre-Bötzinger complex.

Beyond any direct effects produced by slowed breathing, the attention given to inhaling and exhaling may play a role in the brain’s response. In 2016 Anselm Doll and his colleagues, all then at the Technical University of Munich, showed that this attentional focus eases stress and negative emotions, in particular by activating the dorsomedial prefrontal cortex, a regulatory area of the brain, and by reducing activity in the amygdala, which is involved in these emotions.

In addition, paying attention to breathing causes most people to slow it down and to deepen it, which as I have mentioned, is soothing. Cognitive resources are limited, and so when individuals concentrate on breathing, they are not thinking about their worries. Those who practice mindfulness learn to notice when their attention drifts away from breathing and goes back to their concerns, and they train themselves to return periodically to their breathing. This refocusing has a relaxing effect on anyone and helps to combat ruminative thinking in people who have anxiety or depression, especially those who are particularly prone to negative thoughts that run in a loop.

When to Use Breathing Techniques

What is the best time to apply slow-breathing techniques? One is during occasional episodes of stress—for example, before taking an exam, competing in a sporting event or even attending a routine meeting at work. In 2017 Ashwin Kamath of Manipal University in India and his colleagues studied stage fright before a public speaking engagement. The participants, all medical students, spent 15 minutes doing alternate nostril breathing—that is, slowly inhaling through one nostril and exhaling through the other by applying finger pressure to the side of the nose not being used. Compared with members of the control group, participants experienced somewhat less stress when speaking publicly.

These exercises may also help when insomnia strikes. In 2012 Suzanne M. Bertisch of Harvard Medical School and her colleagues reported, based on survey data, that more than 20 percent of American insomniacs do these breathing exercises to sleep better. They may be on to something. In 2015 Cheryl Yang and her team at National Yang-Ming University in Taiwan showed that 20 minutes of slow breathing exercises (six respiration cycles per minute) before going to bed significantly improves sleep. Insomniac participants went to sleep faster, woke up less frequently in the night and went back to sleep faster when they did wake up. On average, it took them only 10 minutes to fall asleep, almost three times faster than normal. The investigators attributed the results both to the calming mediated by the parasympathetic system and to the relaxing effect of focused breathing.

But respiratory techniques do not work only for acute stresses or sleep problems; they can also relieve chronic anxiety. They are particularly effective in people with psychiatric disorders such as phobias, depression and post-traumatic stress disorder. In 2015 Stefania Doria and her colleagues at Fatebenefratelli e Oftalmico Hospital in Milan, Italy, offered 10 training sessions of two hours each, spread out over two weeks, to 69 patients with anxiety or depressive disorders. The training included a varied set of breathing techniques (such as abdominal breathing, acceleration and deceleration of rhythm, and alternate nostril breathing.), combined with some yoga stretches. The researchers observed a significant decrease in symptoms at the end of the protocol. Even better, improvement was maintained two and six months later, with follow-up sessions just once a week and some home practice during this period.

Breathing exercises also help to counter the accumulation of minor physical tension associated with stress. Therapists recommend doing them regularly during the day, during breaks or at moments of transition between two activities: you simply stop to adjust your posture and allow yourself a few minutes of quiet breathing. Therapists often suggest the “365 method”: at least three times a day, breathe at a rhythm of six cycles per minute (five seconds inhaling, five seconds exhaling) for five minutes. And do it every day, 365 days a year. Some studies even suggest that, in addition to providing immediate relief, regular breathing exercises can make people less vulnerable to stress, by permanently modifying brain circuits. In a practice that may seem counterintuitive, however, counselors may encourage some anxious patients to breathe rapidly instead of slowly, as part of an effort to train them to cope with their anxieties (see box “Inhale for Panic!”).

But why confine breathing techniques to negative emotions? It is also worth applying them during pleasurable moments, to take the time to appreciate and remember them. In short, one can pause and breathe for enjoyment as well as to calm down.

Open Questions

Tradition and experience encourage the use of respiratory-control techniques, and scientific studies increasingly suggest that it is a good idea. Nevertheless, further research is still needed, particularly given that some studies lack control groups. One exception stands out: focusing on breathing often is not a good idea for people having a panic attack that stems from anxiety over their physical state (also known as interoceptive anxiety). In this case, focusing on physiology, such as muscle tension or breathing, may actually amplify panic (“Now that I’m paying attention to it, my breathing doesn’t seem regular. Am I choking? What will happen if I suddenly stop breathing?”) For these people, breathing techniques should be tested and practiced under the supervision of a therapist.

Otherwise, considering how often everyone experiences emotional discomfort in their everyday life and its negative consequences on health, we would all do well to regularly pay attention to the way we breathe. Start with brief periods of conscious, quiet breathing several times a day. Breathing is like solar energy for powering relaxation: it’s a way to regulate emotions that is free, always accessible, inexhaustible and easy to use.

In fact, I am mystified that controlled breathing is not recommended and practiced more widely. Perhaps it is perceived as too simple, commonplace and obvious to be a remedy. Faced with the complexity of negotiating the ups and downs of human life, many people may assume that simple solutions cannot be effective.

Or maybe we are intimidated by the sacred aspect of breathing, by its connection to life and, especially, to death. In the 1869 novel The Man Who Laughs, Victor Hugo wrote: “Generations are puffs of breath, that pass away. Man respires, aspires, and expires.” Ultimately, we don’t like to think that we are nothing more than “puffs of breath.”

Six Techniques for Relieving Stress

Here are some commonly used breathing techniques. Five to10 minutes of exercise can relieve sporadic stress and even fend off panic attacks. More regular practice can lower the daily levels of anxiety.

Stand Up Straight

Posture is important for breathing: hold yourself straight, without stiffness, shoulders back, sitting or standing. This body posture facilitates the free play of the respiratory muscles (of the diaphragm and between the ribs). Good posture enables your body to breathe properly on its own.

Follow Your Breath*

Simply observe your respiratory movements: be aware of each inhalation and exhalation. Focus on the sensations you feel as air passes through your nose and throat or on the movements of your chest and belly. When you feel your thoughts drift (which is natural), redirect your attention to your breath.

Abdominal Breathing

Breathe “through your stomach” as much as possible: start by inflating your belly by inhaling, as if to fill it with air, then swell your chest; as you exhale, first “empty” your stomach, then your chest. This type of breathing is easier to observe and test while lying down, with one hand on your stomach.

Rhythmic Breathing

Near the end of each inhalation, pause briefly while mentally counting “1, 2, 3” and holding the air before exhaling. This counting while not breathing can also be done after exhaling or between each inhalation or exhalation. It is often recommended for anxious patients to calm anxiety attacks because it induces a beneficial slowing of the breathing rate.

Alternate Nostrils*

Breathe in and out slowly through one nostril, holding the other one closed using your finger; then reverse and continue by alternating regularly. There are many variations of this exercise—for example, inhaling through one nostril and exhaling through the other. Research suggests that what is most important, aside from slowing the breathing rhythm, is breathing through the nose, which is somewhat more soothing than breathing through your mouth.

Think Reassuring Thoughts While Breathing

With each breath, think soothing thoughts (“I am inhaling calm”). With each exhalation, imagine that you are expelling your fears and worries (“I am exhaling stress”).

*Technique validated by clinical studies.

Inhale for Panic!

Whereas slow breathing soothes, overly rapid breathing can induce feelings of stress and anxiety. This phenomenon is used in behavioral therapy sessions to train anxious patients to confront their emotions directly. By deliberately hyperventilating, patients artificially trigger an unpleasant anxiety, which they get accustomed to feeling and learn to put in perspective. This technique also enables them to see that poor breathing habits amplify their fear.

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Carbohydrates, fibre and a healthy diet

Low-carb does not mean no-carb, nor does it mean low-fibre (Blow to the low-carb diet as WHO report says fibre cuts early deaths, 11 January). Your article appears to confuse low carbohydrate and low grain consumption. Proponents of a low-carb diet typically encourage the replacement of highly processed carbohydrates with fruits, vegetables, nuts and seeds (all sources of carbohydrate), thereby increasing the amount of fibre consumed as well as the intake of vitamins, minerals and phytonutrients.

The study actually concluded that the certainty of evidence for relationships and critical outcomes was graded moderate for dietary fibre and low to moderate for whole grains (The Lancet: “Carbohydrate quality and human health: a series of systematic reviews and meta-analyses”). In addition, it included the caveat that high levels of whole grains could cause depletion of iron and other minerals in individuals who are low in these.

As this was an epidemiological and observational study, association can be suggested but causation cannot be proved; it could have been that the improved outcomes were due to other factors, or a combination of factors.

Further sounding a note of caution in interpreting the findings, Professor Gary Frost of Imperial College London commented that the reliance on self-reported intake of carbohydrate, prone to error and misreporting, was a limitation of the study and that caution should be exercised in interpreting the data as the number of studies is small and the results are heterogeneous.

It can be suggested that humans existed for thousands of years without consuming the “healthy whole grains” that we are urged to eat today, and that the diseases such as type 2 diabetes, heart disease and cancer that plague us today were rare or non-existent. Your headline does not help readers to interpret this research, and undermines the great results that Diabetes UK and others are achieving with their promotion of a low-carbohydrate diet.
Sue Morgan

Your article suggests that diets such as the Atkins diet may be harmful because they do not provide enough dietary fibre. Dietary fibre is certainly vitally important for health, but the article fundamentally misunderstands the distinction between carbohydrates and fibre. Vegetables are stuffed full of fibre – it is primarily cellulose, the main stuff that plants are made of. It is indigestible carbohydrate.

Since diets like the Atkins encourage eating protein and fibrous veg over carbohydrate-rich foods, like bread, pasta and chips, to state that “low-carb” diets are consequently going to be low in fibre is untrue and misleading.
Dr Nick Evans
Institute for Developmental Sciences, Faculty of Medicine, University of Southampton

Re your article on the ketogenic diet (A fat lot of good, G2, 7 January), it took my fully qualified, highly experienced doctor more than a year to convince me to try going keto. I’ve now been on this diet for 15 months.

A ketogenic diet is not low in fibre as your article states – quite the opposite. You can eat 10 portions of vegetables every day and comfortably remain in ketosis. The key is avoiding any veg with a net carb value of more than about 10% (potatoes and parsnips are off the menu).

The article also states that the keto diet is high in saturated fat and red meat. Fatty red meat is a popular choice for keto dieters but it is by no means necessary (a fact that your article itself highlights in its mention of vegan-keto). Indeed, you can quite easily get by on merely fish and fowl alone without eating any red meat at all. You should also eat plenty of healthy fats, namely hemp oil, olive oil, avocados, nuts, seeds and oily fish. They are easily incorporated, reducing reliance on saturated fats like butter and lard.

Dismissing keto as a dangerous diet fad is not representing it fully or accurately. Ketogenic dieters are generally not the bacon-guzzling saturated fat fanatics we are often portrayed as.
Anna McGuirk
St Albans, Hertfordshire

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