A Healthy Diet for a Healthy Life

Unhealthy lifestyles have resulted in the increased incidence of Non-Communicable Diseases (NCD’s) globally, whilst increased life expectancy has aggravated the burden of NCD’s. Unhealthy diet, sedentary life style, tobacco and alcohol use and mental stress, are some of the major preventable aspects amongst the factors that affect human health. Of these, unhealthy diet is the major contributory factor for non-communicable diseases. Thus, a diversified, balanced, healthy diet, throughout the lifespan is essential for good health. Excessive calorie and salt (sodium) intakes are the two major and common issues associated with an unhealthy diet. The former leads to obesity and noncommunicable diseases whilst the latter leads to high blood pressure.

Often, individuals do not pay attention to the importance of beverages when evaluating their diet, though beverages account for 20% of the total calorie intake. Therefore, the choice of beverages merits as much attention as solids in one’s selection of food for regular consumption. As a beverage closest to water, whilst containing very minimal amounts of salt and almost zero calories, Tea presents itself as the most natural and most logical alternative for regular consumption. Research has also revealed that flavonoids in tea could reduce the risk of NCD’s.

Life Expectancy

Average global life expectancy at birth was 71.4 years in 2015 whilst, in 1960 the same rating had been 52.5years. Initially increasing only gradually, in the period 2000 to 2015, global life expectancy has increased by 5 years, primarily due to the availability of improved medical care, resulting in the containment or eradication of most infectious diseases, which were the major causes of mortality in the past.1 For example, out of 15 million small-pox patients in 1967, 2 million died. However, by 1979 the disease was considered eradicated, worldwide, by successful vaccination programmes. Similarly, effective medications have been discovered for other diseases such as malaria, which, in the past, were deadly afflictions.

Burden of Disease in the Elderly

A major negative aspect of increased life expectancy is the corresponding increase in NCD’s, particularly Heart Disease, Stroke, Diabetes, High Blood Pressure and Cancer. According to the World Health Organization (WHO), leading causes of death at present are, Heart Disease with 8.5 million, Stroke at 6.7 million, Diabetes at 1.5 million and Lung Cancer at 1.2 million. Thus, whilst lifeexpectancy has increased, the quality of life of the elderly has declined due to NCD’s.

According to the WHO, whilst the global average life-expectancy in 2015 was 71.4 years, the healthy life-expectancy is only 63.1 years, indicating that most of the elderly global population would be burdened with diseases in the latter part of life, leading to an increase in health related expenditure.1 The annual average health care expenditure in the over 65 group in US was USD 11,089, whilst in the working age group (19 - 65 years), it was USD 3352.2 Where health care is provided by the State, cost of care of the elderly has become a large proportion of national expenditure, whilst in other countries it has become the burden of the individuals themselves , as well as that of the families and support groups.

Life Style and Non-Communicable Diseases

Whilst advancing age results in a natural increase in the risk of most NCD’s, apart from increased life-span, life-style is also a major influential factor. This applies to the young as well, observed as a recent emerging trend. According to the WHO, healthy life-expectancy could improve by 5 - 10 years, merely with the adoption of a preventive, or healthy life-style.

Factors that Affect Health

Genetics, or inherited character, is outside individual control, and a family history for cardiovascular disease or stroke, for instance, increases individual’s risk for such diseases. Ethnicity is yet another contributory factor, with African-Americans, for example, demonstrating a higher level of risk for certain NCD’s than whites living in the US. However, apart from ageing and inheritance, preventable factors, such as sedentary life-style, tobacco and alcohol use and mental stress, are hugely influential on individual health.3

Sedentary Life Style

Humans are spending increasing amounts of time in activities requiring minimum physical activity. Most innovations are designed to minimize human movement and muscular activity at home, work place, schools and public spaces, resulting in a sedentary life for the majority. From an evolutionary perspective humans have the capacity to be mobile throughout the day. The shift from a physically demanding life to a sedentary life is sudden as it has occurred during a tiny fraction of human existence. Further, during the past twenty years, ‘screen time’ such as using computers, watching television, playing video games, all sedentary activities, has increased dramatically.

Scientific research on the impact of decreased physical activity and the correlation on physical work, energy expenditure and health, indicate that a sedentary life-style could lead to heart disease, diabetes, obesity and some types of cancer. Therefore, current public health recommendation is to engage in at least 20 minutes of moderate to vigorous activity per day (150 minutes per week).4

Tobacco and Alcohol use

Scientific research has provided clear evidence on the increased and dose dependent (higher the dose higher the risk) relationship between tobacco use and cancer in the oral cavity, throat and lung. In addition, it has a similar relationship with heart disease too. Therefore, current public health recommendation is to completely avoid tobacco. In 2012, 3.3 million deaths (5.9% of global deaths) were due to alcohol consumption which has a complex relationship with health. Research has clearly shown that heavy drinking could lead to many disease conditions while moderate drinking may have beneficial effects on heart disease.5 Moderate alcohol consumption is defined as up to 1 drink per day for women and up to 2 drinks per day for men. One drink is defined as a drink that contains approximately 14 grams of pure alcohol, which is found in:

• 12 ounces (~350 ml) of regular beer, which is usually about 5% alcohol • 5 ounces (~150 ml) of wine, which is typically about 12% alcohol • 1.5 ounces (~50 ml) of distilled spirits, which is about 40% alcohol 6

However, the issue is that moderate consumption carries the potential for abuse in the long-term.

Mental Stress

All animals, including humans, have a stress response, essential in certain situations such as confrontation with danger, when the hormones released in response prepares the animal, either to face danger or flee from it. Pulse rate increases, breathing becomes faster, muscles tense and the brain uses more oxygen, gearing the animal for survival.

In the short term stress is useful and does not affect health. However, with chronic or prolonged stress, the same chemicals and hormones carry the potential for conditions such as mental disorder

and depression, paving the way for NCD’s such as impaired immunity, increased risk of heart disease, high blood pressure and diabetes.

Common factors which cause prolonged stress are;

• Routine stress related to the pressures of work, family and other daily responsibilities. • Stress brought about by a sudden negative change, such as losing a job, divorce, or illness. • Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or be in danger of being killed.

Seeking guidance from qualified healthcare personnel is important to cope with prolonged stress.7

Diet

According to the WHO, diet plays the most crucial role in the development of NCD’s, with unhealthy diet being a leading global factor affecting general health. Adopting healthy dietary habits early and adhering to such throughout could protect against NCD’s such as heart disease, cancer, stroke and diabetes. Breast feeding, too, fosters healthy growth and improves cognitive development and, in the long-term, contributes to minimizing the risk of obesity and the consequent development of NCD’s.

Rapid urbanization, changing lifestyles and increased production of processed food have changed the dietary patterns globally, with a large proportion of the global population consuming

more food than necessary, leading to obesity and the development of NCD’s. People generally are consuming foods high in energy, fats, free sugars and salt/sodium, at the expense of healthy food such as fruit, vegetables and whole grains, which are high in dietary fibre.

The nature and composition of a balanced, diversified diet will vary, depending on individual needs (age, lifestyle, degree of physical activity) and the individual’s cultural context. However, irrespective of all circumstances, the basic principles of what constitutes a healthy diet will not vary.

According to the WHO guidelines, a healthy diet for adults should contain:

• Fruits, vegetables, legumes (e.g. lentils, beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat, brown rice). • At least 400 g (5 portions) of fruits and vegetables a day. (Potatoes, sweet potatoes, cassava and other starchy roots are not classified as fruits or vegetables.) • Less than 10% of total energy intake from free sugars which is equivalent to 50 g (or around 12 level teaspoons) for a person consuming approximately 2000 calories per day, but ideally less than 5% of total energy intake for additional health benefits. Most free sugars are added to food or drinks by the manufacturer, cook or consumer, and can also be found in sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. • Less than 30% of total energy intake from fats.

Unsaturated fats (e.g. found in fish, avocado, nuts, sunflower, canola and olive oils) are preferable to saturated fats (e.g. found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard). Industrial trans fats (found in processed food, fast food, snack food, fried food, frozen pizza, pies, cookies, margarines and spreads) are not part of a healthy diet. • Less than 5 g of salt (equivalent to approximately 1 teaspoon) per day and use iodized salt.3

Beverages

Beverages are often not considered when individuals think about overall food intake, though regularly consumed beverages have a great influence on our health. Additional calorie intake is one of the main issues related to inappropriate beverage choices. According to 2015 - 2020 Dietary Guidelines for Americans, beverages account for 20% of total calorie intake.6 Therefore, careful attention should be paid to the calorie intake from beverages. Beverages selected for regular consumption should be very close to water in calorie and salt content, whilst hydrating the body. Water has neither calories, nor salt.

Tea

Tea (without milk or sugar) fits this description as it contains almost zero calories and very low amounts of sodium (see chapter 2 for chemical composition of tea). Further, scientific research has revealed that tea contains high amounts of flavonoids which could reduce the risk of noncommunicable diseases. Therefore, tea is an ideal beverage for regular consumption.

• Unhealthy diet is a major contributory factor for the risk of non-communicable diseases. • A diversified balanced healthy diet throughout the lifespan is essential for good health. • Although beverages contribute significantly to the calorie and salt intake, adequate attention is not paid to regularly consumed beverages when healthy diets are planned. • Tea having almost zero calories and very low salt content and high flavonoid content, would be an ideal choice as a beverage for regular consumption that could also reduce the risk of non-communicable diseases.

“I know very well that I am in a minority here. But still, how can you call yourself a true tea-lover if you destroy the flavour of your tea by putting sugar in it? It would be equally reasonable to put pepper or salt. Tea is meant to be bitter, just as beer is meant to be bitter. If you sweeten it, you are no longer tasting the tea, you are merely tasting the sugar; you could make a very similar drink by dissolving sugar in plain hot water.”

George Orwell, “A Nice Cup of Tea,” Evening Standard, 12 January 1946

REFERENCES

1. Global health observatory data, World Health Organization. Available at www.who.int/gho/mortality_burden_disease/life_tables/ en/ Accessed on 8th September 2016 2. The high concentration of US healthcare expenditure, Research in Action, Issue 19, Agency for healthcare research and quality, US

Department of health and human services. Available at archive.ahrq.gov/research/findings/factsheets/costs/expriach/ Accessed on 8th September 2016 3. Healthy diet, Fact Sheet No. 394, World Health Organization. Available at www.who.int/mediacentre/factsheets/fs394/en/

Accessed on 8th September 2016 4. Sedentary behaviour: Emerging evidence for a new health risk. Mayo clinic proceedings, 2010 Dec., 85(12), 1138-1141 5. Alcohol: facts and statistics, U.S. National Institute of alcohol abuse and alcoholism, Available at www.niaaa.nih.gov/alcoholhealth/overview-alcohol-consumption/moderate-binge-drinking Accessed on 8th September 2016 6. 2015 - 2020 Dietary Guidelines for Americans. 8th Edition. December 2015, U.S. Department of Health and Human Services and U.S.

Department of Agriculture. Available at health.gov/dietaryguidelines/2015/guidelines/. Accessed on 8th September 2016 7. Fact Sheet on Stress, U.S. National Institute of Mental Health. Available at www.nimh.nih.gov/health/publications/stress/index. shtml Accessed on 8th September 2016